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PubMed2001

Procedures nurses use to remove central venous catheters and complications they observe: a pilot study.

BACKGROUND: Removal of internal jugular and subclavian central venous catheters is a common nursing intervention. Venous air embolism is a serious complication of catheter removal. Although some procedures have been recommended to prevent venous air embolism, whether nurses use these procedures and what complications patients experience are unknown. OBJECTIVES: The purposes of this pilot study were (1) to determine what procedures nurses use to remove internal jugular and subclavian central venous catheters, (2) to find out what complications patients are experiencing, (3) to find out if complications experienced are related to the procedures used, and (4) to develop a questionnaire about central venous catheters. METHODS: A descriptive and correlational design was used. The subjects were 29 nurses whose job description included removal of internal jugular and subclavian central venous catheters. Two questionnaires were used: a demographics questionnaire and the questionnaire about central venous catheters. RESULTS: Descriptive statistics were used to analyze the sample, to determine the percentage of nurses sampled who use the recommended procedures, and to describe the frequency of complications observed. The sample size was not sufficient for observed complications to be correlated with procedures. CONCLUSIONS: None of the nurses sampled had venous air embolism diagnosed in their patients. They reported observing dyspnea, pain, bleeding from the insertion site, and arrhythmias. Many of the nurses reported that they did not always use all the recommended procedures; only 9 nurses (31%) reported always using all the recommended procedures.

Catheterization, Central Venous↗
PubMed2002

Detection of oxytocin mRNA in hypertonic saline Fos-activated PVN neurons: comparison of chromogens in dual immunocytochemical and in situ hybridization procedure.

OBJECTIVE: The aim of the present experiments was to elucidate: 1. the stability and usefulness of a 3,3 -diaminobenzidine tetrahydrochloride (DAB) chromogen intensified with nickel and cobalt (DAB-Ni-Co) in the dual immunocytochemical and in situ hybridization procedure using Fos-protein antibody and oxytocin mRNA (OXY mRNA) radiolabeled probe; 2. the susceptibility of the free floating and mounted cryostat sections, freshly prepared or stored for 24 month at -20 degrees C. METHODS: The dual staining procedure was tested on neurons of the hypothalamic paraventricular nucleus (PVN) activated by an intraperitoneal injection of hypertonic saline (HS, 1.5 M, 5 ml, 60 min). Two dual labeling procedures were compared: 1/ Fos-immunostaining with DAB alone and combined with OXY mRNA in situ hybridization and 2/ Fos-immunostaining with DAB-Ni-Co and combined with OXY mRNA in situ hybridization. In both experiments free floating and mounted cryostat sections, freshly prepared or stored for 24 month at -20 degrees C, were tested. RESULTS: HS strongly stimulated both the parvicellular and magnocellular population of PVN neurons followed by an extensive Fos-immunolabeling in many cell nuclei. The first staining sequence with Fos-DAB labeling resulted in a good staining quality on both the fresh and for 24 month stored mounted sections. Although the free floating sections during the in situ procedure showed the same staining properties as the mounted ones, with respect to their increased fragility on the end of the hybridization procedure, they were difficult to mount and stretch on poly-L-lysine coated slides. On the other hand, Fos-immunolabeling with DAB-Ni-Co exhibited improved staining density of the single DAB chromogen in the first staining sequence of the dual staining procedure. However, DAB-Ni-Co mixture showed up as an unstable chromogen complex, which after completing the in situ hybridization process completely disappeared from each type of section. CONCLUSIONS: The results of the present dual immunocytochemical-in situ hybridization staining utilizing Fos-antibody and OXY mRNA oligoprobe indicate that this procedure is applicable on free floating as well as mounted cryostat sections, freshly prepared or stored for 24 month at -20 degrees C. However, the dual procedure is only successful when the immunoproduct in the first sequence is visualized with an unintensified DAB and not with combined DAB-Ni-Co chromogen and when the histological sections in the second sequence are not processed as free floating but are attached to a poly-L-lysine coated microscopic glasses.

3,3'-Diaminobenzidine↗
PubMed2002

Laparoscopic Ladd's procedure for intestinal malrotation: report of three cases.

Ladd's procedure for laparoscopic repair of malrotation has many advantages over conventional surgical techniques, such as earlier feeding and discharge. However, this procedure is still not commonly used in Taiwan. This report describes the results of treatment of intestinal malrotation in three patients using laparoscopic Ladd's procedure. The patients, aged 8 days, 17 days, and 3 years, underwent laparoscopic Ladd's procedure between July 1999 and September 2000. All three patients had symptoms of intermittent vomiting and were shown to have intestinal malrotation by upper gastrointestinal series study. The procedure was performed using three trocars of 5 mm diameter placed at the infraumbilical ring and the right and left lower quadrants. All procedures were completed laparoscopically. The operative times were 4.8, 3.6, and 3.5 hours, respectively. Feeding was started on postoperative Day 2 to 5, and the hospital stay was 6 to 11 days. Our results suggest that laparoscopic Ladd's procedure can be performed safely in pediatric patients. In addition, patients are expected to benefit from the smaller incision, earlier feeding, shorter hospital stay, and fewer complications compared with traditional Ladd's procedure.

Child, Preschool↗
PubMed2002

Surgical procedure logging with use of a hand-held computer.

OBJECTIVE: To evaluate the feasibility of incorporating hand-held computing technology in a surgical residency program, by means of hand-held devices for surgical procedure logging linked through the Internet to a central database. SETTING: Division of General Surgery, University of Toronto. DESIGN: A survey of general surgery residents. METHODS: The 69 residents in the general surgery training program received hand-held computers with preinstalled medical programs and a program designed for surgical procedure logging. Procedural data were uploaded via the Internet to a central database. Survey data were collected regarding previous computer use as well as previous procedure logging methods. MAIN OUTCOME MEASURE: Utilization of the procedure logging system. RESULTS: After a 5-month pilot period, 38% of surgical residents were using the procedure-logging program successfully and on a regular basis. Program use was higher among more junior trainees. Analysis of the database provided valuable information on individual trainees, hospital programs and supervising surgeons, data that would assist in program development. CONCLUSIONS: Hand-held devices can be implemented in a large division of general surgery to provide a reference database and a procedure-logging platform. However, user acceptance is not uniform and continued training and support are necessary to increase acceptance. The procedure database provides important information for optimizing trainees' educational experience.

Attitude to Computers↗
PubMed2003

Stress-like responses to common procedures in individually and group-housed female rats.

The objective of this study was to assess the cardiovascular function and behavior of female Sprague-Dawley rats housed individually or with one or three cage mates under resting conditions and when subjected to common husbandry and experimental procedures and potentially stressful olfactory stimuli. Heart rate (HR) and mean arterial blood pressure (MAP) were assessed continuously by using radiotelemetry and are reported for the following periods: for 1 hour each day prior to any human interaction; for 12 h each day during the dark phase of the 12:12-h light: dark photoperiod; and for 2 h before and 3 h after acute husbandry and experimental procedures. Home-cage behaviors (sleeping, awake but not moving, moving, rearing, and grooming) were scored once each minute for 15 min before and 45 min after the acute procedures. Mean resting HR values in the mornings prior to human contact were significantly (P < 0.05) lower in rats housed four per cage than animals housed alone or with one cage mate, whereas MAP during this period was lowest in rats housed two per cage. Nocturnal HRs were highest in rats housed two per cage, whereas nocturnal MAP did not differ significantly between housing groups. When rats were subjected to acute husbandry and experimental procedures, HRs increased 80 to 180 beats per min (bpm) above a baseline of 300 to 325 bpm and were significantly (P < 0.05) increased for periods of 30 to 90 min after the procedures. MAP showed increases that were proportionately the same as those in HR. Group housing often, but not always, reduced these cardiovascular responses. Procedure-induced arousal behaviors occurred in all housing groups after the acute husbandry and experimental procedures, but the occurrence of these behaviors was less frequent and of shorter duration in group-housed rats than rats housed alone. In light of these results, we conclude that under resting conditions group housed rats were somewhat less stressed than were rats housed alone. Further, we conclude that common procedures induce significant stress-like responses in female rats, and the magnitude and duration of these responses are reduced by group housing.

Animal Husbandry↗
PubMed1992

Directional coronary atherectomy at the Toronto and Mount Sinai Hospitals: report of the initial 120 procedures.

OBJECTIVE: To assess the procedural success and complication rates of the first 120 directional coronary atherectomy cases performed at two Toronto hospitals. DESIGN AND SETTING: Case series in tertiary referral centres. PATIENTS: One hundred and thirteen patients in whom 120 atherectomy procedures were attempted between July 1990 and April 1992. INTERVENTION: Directional coronary atherectomy. MAIN RESULTS: Angiographic success was obtained in 115 of 120 procedures (96%) involving 117 of 123 lesions (95%). Procedural success (angiographic success without death, myocardial infarction or coronary bypass surgery) was obtained in 110 of 120 procedures (92%). Adjunctive balloon angioplasty was required in 20 procedures (17%). There was one death at 36 h in an elderly patient who underwent an emergency procedure while in cardiogenic shock. Periprocedural non-Q wave myocardial infarction occurred in five patients. There were no Q wave myocardial infarctions. Three patients required coronary bypass surgery prior to discharge and vascular complications occurred in five patients. CONCLUSIONS: Directional coronary atherectomy can be performed with procedural success and complication rates comparable to conventional balloon angioplasty. Randomized trials are underway to determine if atherectomy results in a lower restenosis rate.

Adult↗
PubMed2004

[Is the information we give women prior to invasive prenatal procedures adequate?].

BACKGROUND: The aim was to evaluate the psychological impact on women undergoing invasive procedures of prenatal diagnosis. SETTING: Department of Gynecology and Obstetrics, 1st Medical Faculty, Charles University, Prague. MATERIAL AND METHODS: A questionnaire was given to 200 pregnant women and to 160 midwives and students. The acquired data were statistically evaluated using the non-parametric chi 2 test for a 5% confidence interval and the Kruskal-Wallis test (analysis of non-normal distribution of random variables). RESULTS: We found that 85% of pregnant patients were satisfied with the information given by their obstetrician prior to the procedure, 53% of the patients were distressed about the procedure. The largest percentage of patients feared complications of the procedure, while fear of the results of the procedure took second place. CONCLUSION: We found that only some of the patients and midwives had complete information about the actual method of performing these procedures, about the risk, and about the time it takes to obtain results. Most patients receive their information from a doctor-geneticist, which is in agreement with our system. The patient's distress regarding the procedure is not dependent on the level of education. From the acquired data, it follows that greater significance should be placed on the informing patients as well as midwives about all aspects of performing invasive procedure of prenatal diagnosis. According to our study, neither the patient nor the midwife have an adequate perception of the benefits and risk of prenatal diagnostic examinations.

Adult↗
PubMed1987

Results of 232 consecutive percutaneous transluminal coronary angioplasty (PTCA) procedures in single- and double-vessel coronary artery disease.

Over a 3-year period, we performed 232 consecutive percutaneous transluminal coronary angioplasty (PTCA) procedures in 171 patients, 132 (77%) of whom were men and 39 (23%) of whom were women. The patients' ages ranged from 26 to 85 years (average, 56.5 years). All of the patients had symptoms of coronary insufficiency, manifested by stable angina in 106 cases, unstable angina in 44 cases, post myocardial infarction angina in 19 cases, arrhythmia in 1 case, and syncope in 1 case. All PTCA dilatations were done by the same operators, using the same technique. The procedures were categorized as follows: Group 1 included 157 single-vessel PTCA procedures, which had a success rate of 87.3%; these included 52 dilatations of the right coronary artery (success rate, 84%), 94 dilatations of the left anterior descending artery (success rate, 86%), and 11 dilatations of the left circumflex system (success rate, 90%). Group 2 included 29 double-vessel PTCA procedures (58 total procedures), which had an 88% success rate, and group 3 comprised 17 vein-graft PTCAs, with an 86.9% success rate. Complications included coronary artery occlusion in 15 cases (9.0%), myocardial infarction in four cases (2.3%), and cardiac arrhythmia in one case (0.6%). There were no deaths. Fifteen patients (8.8%) underwent coronary artery bypass surgery during the same hospitalization (3.8% of these operations were performed on an emergency basis). Thirty-six patients (15.5%) had a second PTCA procedure owing to restenosis, which occurred either before the patient was discharged from the hospital (eight cases) or 3 to 30 months after the original procedure. We conclude that, when performed by experienced operators with optimal technical resources, PTCA results in an acceptable success rate; therefore, this procedure should be a satisfactory method of myocardial revascularization in well-selected patients with either single- or double-vessel coronary artery disease.

Journal Article↗
PubMed1991

Diagnostic x-ray procedures and risk of leukemia, lymphoma, and multiple myeloma.

Exposure to diagnostic x-rays and the risk of leukemia, non-Hodgkin's lymphoma (NHL), and multiple myeloma were studied within two prepaid health plans. Adult patients with leukemia (n = 565), NHL (n = 318), and multiple myeloma (n = 208) were matched to controls (n = 1390), and over 25,000 x-ray procedures were abstracted from medical records. Dose response was evaluated by assigning each x-ray procedure a score based on estimated bone marrow dose. X-ray exposure was not associated with chronic lymphocytic leukemia, one of the few malignant conditions never linked to radiation (relative risk [RR], 0.66). For all other forms of leukemia combined (n = 358), there was a slight elevation in risk (RR, 1.17) but no evidence of a dose-response relationship when x-ray procedures near the time of diagnosis were excluded. Similarly, patients with NHL were exposed to diagnostic x-ray procedures more often than controls (RR, 1.32), but the RR fell to 0.99 when the exposure to diagnostic x-ray procedures within 2 years of diagnosis was ignored. For multiple myeloma, overall risk was not significantly high (RR, 1.14), but there was consistent evidence of increasing risk with increasing numbers of diagnostic x-ray procedures. These data suggest that persons with leukemia and NHL undergo x-ray procedures frequently just prior to diagnosis for conditions related to the development or natural history of their disease. There was little evidence that diagnostic x-ray procedures were causally associated with leukemia or NHL. The risk for multiple myeloma, however, was increased among those patients who were frequently exposed to x-rays.

Adult↗
PubMed1990

[Evaluation of decontamination procedures used at digestive endoscopy units in Gironde].

Decontamination procedures used for endoscopes were noted in 23 digestive endoscopy units, public and private, in the department of Gironde and compared to recommended procedures. Serial, bacteriological samples were obtained from one esogastroscope and one colonoscope in each unit, after upper endoscopy and colonoscopy diagnostic procedures at the end of the endoscopy session. Six units of 23 used complete decontamination procedures. In the 17 other units, principal errors of decontamination procedures were: inadequate cleaning of internal channel of scopes (12 units) and lack of utilization of glutaraldehyde between each endoscopy (8 units). Bacteriological samples were negative in 11/12 endoscopes after a complete decontamination procedure and in 8/39 after an inadequate procedure (p less than 0.01). Complete procedures are efficacious but not used often enough. Information and changes in endoscopic practices are necessary in digestive endoscopy units.

Bacterial Infections↗
PubMedDate not supplied

Oxygen desaturation is common and clinically underappreciated during elective endoscopic procedures.

This study compared how often oxygen desaturation occurred during conscious sedation for upper and lower procedures, the frequency and extent of desaturation occurring after sedation with diazepam plus meperidine to that occurring after midazolam plus meperidine, and the relationship between age or type of procedure (upper versus lower) with oxygen desaturation to less than 90%. Two-hundred and thirty-six consecutive patients undergoing elective upper or lower endoscopic procedures under conscious sedation had oxygen saturation measured by pulse oximeter before sedation, following sedation but prior to the procedure, and while sedated and undergoing the procedure. Forty-five percent of the subjects desaturated to less than 90% without demonstrating any clinical signs of distress, including 40% of those undergoing upper procedures and 54% of those undergoing lower procedures. Neither the age of the patient, the drugs used, drug doses used, nor the type of procedure accurately predicted which patients would desaturate to less than 90%. Potentially significant oxygen desaturation cannot be reliably predicted by clinical criteria. Pulse oximetry is far more sensitive than standard clinical monitoring practices in detecting oxygen desaturation.

Adult↗
PubMed1989

[New selection criterion for Fontan procedure: pulmonary artery clamping test and pulmonary vascular resistance in increased pulmonary blood flow].

A new selection criterion for Fontan procedure, pulmonary artery clamping test (PACT) was developed and employed in 13 candidates for Fontan procedure. PACT was aimed to evaluate the response of pulmonary vascular bed to increased pulmonary blood flow and calculate the pulmonary vascular resistance in the increased pulmonary blood flow as a selection criterion for Fontan procedure, preoperatively. After a median sternotomy incision, an electromagnetic flow meter was employed for measuring the pulmonary blood flow (Qp) on the pulmonary trunk. By clamping the left pulmonary artery and the right pulmonary artery, right pulmonary vascular resistance and the left pulmonary resistance in the pulmonary blood flow of Qp were calculated respectively. By means of electrical analogue, right and left lungs were simulated as resistors in parallel. And the equivalent pulmonary vascular resistance Rpc was calculated as the predicted pulmonary vascular resistance in the increased pulmonary blood flow of two times Qp. Fontan procedure was performed in 9 cases with a Rpc of less than 3 unit.m2 with a successful result and no death. Postoperative cardiac index ranged from 2.6 to 3.7 L/min.m2 with a mean of 2.8 L/min.m2. Postoperative pulmonary vascular resistance ranged from 1.6 to 3.2 unit.m2. Postoperative cardiac index was correlated with postoperative pulmonary vascular resistance. And postoperative pulmonary vascular resistance was well correlated with equivalent pulmonary vascular resistance but was not correlated with preoperative pulmonary vascular resistance measured by Fick's method at the preoperative catheterization. In Fontan procedure, the pulmonary blood flow frequently increases to a certain degree postoperatively. And pulmonary vascular resistance is not a static resistance, but a dynamic resistance. Hence, in discussing a pulmonary vascular resistance as a selection criterion for Fontan procedure, the pulmonary blood flow in which the pulmonary vascular resistance stand should be taken into account. Equivalent pulmonary vascular resistance Qpc is a theoretical selection criterion for Fontan procedure and well reflects the postoperative pulmonary vascular resistance. Fontan procedure can be successfully performed with a Rpc of less than 3 unit.m2.

Adolescent↗
PubMed1988

Surgical treatment of stress urinary incontinence: a comparison of the Kelly plication, Marshall-Marchetti-Krantz, and Pereyra procedures.

Six hundred eighty patients surgically treated for stress urinary incontinence were observed annually for up to ten years to compare the efficacy and complications of three types of repair procedures. Although Marshall-Marchetti-Krantz procedures yielded the most effective repair in the immediate postoperative period, Kelly plications were equally corrective more than three years after surgery (69 and 66%, respectively). Both were superior to the original Pereyra urethropexies at all times. Repeat operations were more likely to fail than primary repairs. The efficacy of the Pereyra procedure was increased with the use of permanent suture. Marshall-Marchetti-Krantz procedures were not affected by suture selection. Pereyra procedures had more complications, many related to intravesical suture. Success rates of all procedures declined steadily with lengthening periods of observation. We conclude that Kelly plications and Marshall-Marchetti-Krantz procedures have similar long-term efficacy and complication rates. The use of intra-operative cystoscopy and permanent suture with the Pereyra procedure might make it competitive.

Absorption↗
PubMed1988

[Procedures and results of limb salvage surgery of musculoskeletal sarcoma].

During the 8-year period beginning 1979, 116 cases of musculoskeletal sarcoma were treated by limb salvage operation. Of these, the local recurrence rate was 9% and the postoperative metastatic rate was 28%. The limb salvage rate was about 80%. Limb salvage procedures were generally performed using curative surgical procedures without preoperative adjunctive therapy. However, reduction of the surgical margin to achieve local cure was made possible by combined therapy with preoperative adjunctive chemotherapy or radiotherapy. The wide procedures combined with preoperative adjunctive therapy achieved a local curability rate equal to curative procedures. Marginal procedures following preoperative radiotherapy were also undertaken in those cases in which the tumor was located in an area for which curative or wide procedures were not feasible. Also, similar procedures were performed for patients of advanced age, patients with lung metastasis, patients who refused ablative surgery, and for extirpation of lymph node metastases. Accordingly, we were able to determine which procedures best ensure local curability. Also, the most significant prognostic factor was found to be local recurrence caused by inadequate surgical margin. This was especially true in the treatment of high malignant sarcoma. Moreover, from analysis of recurrent cases, the suggested factors contributing to local recurrence were: the invasive character of the tumor, lymph node metastasis, skip metastasis, tumor dissemination due to pathological fracture, previously performed inadequate surgery, venous invasion, and multicentrical occurrence of certain tumors.

Adult↗
PubMed1986

Retropubic cystourethropexy: a review of two operative procedures with long-term follow-up.

The purpose of this report is to present a personal experience, with an up to 16-year follow-up, in the management of stress urinary incontinence using a retropubic cystourethropexy. An attempt is made to prove that, in addition to the standard Kelly anterior colporrhaphy, a transvaginal retropubic cystourethropexy helps to improve long-term results. Also, the results of transvaginal retropubic cystourethropexy (modified Pereyra procedure) and abdominal retropubic cystourethropexy (modified Marshall-Marchetti-Krantz procedure) are reviewed. Two hundred fifty-two patients received a modified Pereyra procedure and 490 patients underwent a modified Marshall-Marchetti-Krantz procedure in a 17-year period. The final corrected results of both of these procedures indicate that the percentage of patients clinically cured are almost identical (93%). Thus, for the treatment of genuine stress urinary incontinence, either the modified Pereyra procedure plus anterior colporrhaphy or the Marshall-Marchetti-Krantz procedure can be used with almost identical results. The route of the procedure performed, either abdominally or vaginally, is often determined by associated findings.

Adult↗
PubMed1985

Indican interference with six commercial procedures for measuring total bilirubin.

We have studied the effect of indican on six commercial procedures for the measurement of total bilirubin in serum. Total bilirubin measured by the Bilirubin A-Gent (Abbott) 2,4-dichlorophenyl diazonium procedure increased by 50 mg/L for each 1 mmol/L of added indican. Similarly, total bilirubin measured by the Bilirubin C-System (Boehringer Mannheim) 2,5-dichlorophenyl diazonium procedure increased by 33 mg/L per mmol/L of indican. Indican also interfered with the Micro Bilirubin Reagent Set (Harleco) Malloy-Evelyn procedure, but to a much lesser extent. The Jendrassik Bilirubin Reagent System (American Monitor) and a modified Jendrassik-Grof procedure (Hoffmann-LaRoche) adapted to the Cobas Bio analyzer were unaffected by the presence of indican. The amount of interference with the 2,5-dichlorophenyl diazonium procedure increased significantly with color development time and was twice the initial amount after 30 min. Concentrations of indican as high as 0.38 mmol/L have been found in sera of patients with renal failure, which would increase total bilirubin values measured by the first two procedures above by 19 and 12 mg/L, respectively. Users of these procedures should therefore be suspicious of unexpectedly high bilirubin values obtained with sera from patients with chronic renal disease.

Autoanalysis↗
PubMed1984

Large-pore hemodialytic procedures in pigs with ischemic hepatic necrosis; a randomized study.

In order to define further the therapeutic role of hemodialytic procedures in acute hepatic failure, 20 pigs with ischemic hepatic necrosis underwent randomized hemodialysis against an electrolyte solution (n = 6), hemofiltration with re-infusion of an electrolyte solution (n = 5), control hemofiltration with re-infusion of autologous ultrafiltrate (n = 4) or no extracorporeal procedure at all (n = 5). Pigs on hemodialytic procedures survived significantly longer (51 +/- 11 hrs) than controls (36 +/- 8 hrs). There were no differences in the duration of survival between hemodialysis and hemofiltration, nor between controls undergoing and those not undergoing an extracorporeal procedure. Electroencephalograms showed more rapid (p less than 0.05) deterioration in control animals than in the treatment group. Putative toxins such as ammonia, glutamine, tyrosine, tryptophan, and methionine all decreased transiently in the treatment group; in the control group a continuous increase in the levels of the putative toxins was observed. Comparison of all pigs surviving 35 hrs or less (n = 6) and animals surviving more than 45 hrs (n = 7) showed that long-term survival was significantly associated with lower plasma ammonia and methionine concentrations and fewer abnormalities on the electroencephalogram 10 hrs after the start of extracorporeal procedures; moreover six of the 7 long-term survivors underwent hemodialysis or hemofiltration procedures. We conclude that hemodialytic procedures prolong survival in pigs with ischemic hepatic necrosis by slowing the development of encephalopathy; this effect of hemodialytic procedures may be mediated by the lowering of plasma ammonia and methionine levels.

Ammonia↗
PubMed1980

A prospective, controlled study to compare the Scheie procedure with Watson's trabeculectomy.

Decisions regarding patient care are made difficult because of lack of adequate knowledge. Surgeons try to decide upon choice of procedure and surgical technique based on the results of their experience and their understanding of published reports. Yet there are virtually no prospective controlled studies comparing different procedures for open-angle glaucoma. The present study compares peripheral iridectomy with a thermal sclerostomy, as described by Scheie, with trabeculectomy, as described by Watson. In 15 patients with primary open-angle glaucoma a Scheie procedure was performed in one eye and a trabeculectomy in the other, the choice of procedure being determined randomly. Surgical technique was standardized. Shallow or flat anterior chambers were more common in patients treated with a Scheie procedure, but in the 15 cases studied no patients required alteration of their postoperative care because of any complication. When reevaluated five years later, central visual acuity was approximately the same in both groups, control of glaucomatous disease was considered to be slightly easier in patients receiving a Scheie procedure, and intraocular pressure was 16 mm Hg in patients treated with the Scheie procedure in contrast to 22 mm Hg in those in whom a trabeculectomy had been performed. The Scheie procedure resulted in a thin cystic conjunctival bleb. In only two cases was a detectable bleb present following trabeculectomy.

Cataract↗