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At least 91 records · Page 5Linked to original sources
PubMed1999

Early experience in the use of the Advanced Breast Biopsy Instrumentation: a report of one hundred twenty-seven patients.

BACKGROUND: Recently there has been a great interest in developing alternative breast biopsy techniques that yield the appropriate histologic information in the least invasive and most cost-effective manner. The objective of this study was to evaluate the efficacy and results with the Advanced Breast Biopsy Instrumentation (ABBI) method for stereotactic excisional biopsies of nonpalpable mammographically detected breast lesions. METHODS: All patients with nonpalpable mammographic abnormalities who fulfilled the selection criteria for the ABBI procedure were studied. Pathologic diagnosis, the size of the specimen, the length of the procedure, postoperative complications, patient satisfaction, and the cost of the ABBI procedure were analyzed. RESULTS: One hundred twenty-seven of 139 patients (94.2%) underwent the ABBI procedure. Twelve patients (8.61%) required conversion to the needle localization procedure. Mammographically, 64 lesions revealed microcalcifications, 51 showed nodular densities, and 12 demonstrated both findings. Histologically, 21 lesions (16.5%) were malignant, whereas 106 were benign (83.5%). The mean operative time for the procedures was 62.5 minutes. Postoperatively 5 patients had local ecchymosis and 1 had a hematoma. The average cost per patient was found to be $1000, considerably less than for needle localization biopsy. CONCLUSION: With proper patient selection the ABBI procedure has proved to be a valuable tool in the armamentarium of the breast surgeon. Its efficiency, accuracy, and patient acceptance have been well documented in our hands.

Anesthesia, Local↗
PubMedDate not supplied

Hyperamylasemia after hepatectomy in chronic liver disease patients.

BACKGROUND/AIMS: Postoperative hyperamylasemia after hepatectomy occurs frequently, but the mechanism is not clear. METHODOLOGY: We studied the postoperative evaluation of 11 patients with hyperamylasemia after hepatectomy (Hyper-Amy group), compared with 35 patients without hyperamylasemia (Norm-Amy group), in terms of preoperative features, intraoperative findings or procedures, postoperative management and complications, parameters for pancreatitis, and comparisons in serum amylase and lipase levels between patients with chronic liver disease and those with normal livers. RESULTS: In preoperative features, viral infection and chronic liver disease presented much more in the Hyper-Amy group than in the Norm-Amy group, and indocyanine green 15-minute retention rate was higher in the Hyper-Amy group than in the Norm-Amy group. There were no significant differences in the intraoperative findings or procedures, or postoperative management and complications between the two groups. In parameters for pancreatitis, the serum amylase and lipase levels were higher in the Hyper-Amy group than in the Norm-Amy group on days 3, 7 and 14. In comparison, between patients with chronic liver disease and normal livers, the serum amylase levels were higher in patients with chronic liver disease than in patients with normal livers on days 7 and 14. CONCLUSIONS: We should pay attention to the incidence of hyperamylasemia after hepatectomy in patients with chronic liver disease, so we can give rapid treatment for pancreatitis.

Aged↗
PubMed1995

[Laparoscopic sigmoid resection].

Laparoscopic colorectal surgery not only presupposes knowledge in conventional surgery of the large bowel but also requires extensive experience in laparoscopic techniques. Furthermore every individual of the operating team should have suitable experience to guarantee effective co-operation. The presented study reports on 41 laparoscopic resections of sigmoid colon and upper rectum. The operations were carried out on 31 patients with benign and 10 patients with malignant diseases. In 1 case we had to change to an open procedure. Postoperative complications were seen in 10 patients, one of whom died (secondary haemorrhage 2; anastomotic leakage 1, Douglas haematoma 1, inflammation of the drainage tract 6). Preoperative management, intraoperative procedures and postoperative results are described and discussed.

Adult↗
PubMed2005

Remifentanil as a single drug for extracorporeal shock wave lithotripsy: a comparison of infusion doses in terms of analgesic potency and side effects.

UNLABELLED: This randomized, double-blind study was designed to evaluate analgesic effectiveness and side effects of two remifentanil infusion rates in patients undergoing extracorporeal shock wave lithotripsy (ESWL) for renal stones. We included 200 patients who were administered remifentanil either 0.05 microg x kg(-1) x min(-1) (n = 100) or 0.1 microg x kg(-1) x min(-1) (n = 100) plus demand bolus of 10 microg of remifentanil via a patient-controlled analgesia (PCA) device. No other sedating drugs were given. The frequencies of PCA demands and deliveries were recorded. Arterial blood pressure, oxygen saturation, and respiratory rate were recorded throughout the procedure; postoperative nausea and vomiting (PONV), dizziness, itching, agitation, and respiratory depression were measured posttreatment. Visual analog scale (VAS) scores were taken preoperatively, directly postoperatively, and 30 min after finishing the procedure. There were no statistically significant differences in the frequency of PCA demands and delivered boluses or among perioperative VAS scores. The extent of PONV and frequency of dizziness and itching immediately after and dizziness 30 min after the end of treatment were significantly reduced in the smaller dose group. We conclude that a remifentanil regimen of 0.05 microg x kg(-1) x min(-1) plus 10 microg demands is superior to 0.1 microg x kg(-1) x min(-1) plus demands, as there was no difference in the VAS scores recorded between groups and it has a less frequent incidence of side effects in patients receiving ESWL. IMPLICATIONS: Remifentanil is an appropriate analgesic choice for patients undergoing extracorporeal shock wave lithotripsy (ESWL) therapy, as it has both fast onset and offset times. We studied remifentanil as a sole drug for ESWL and have shown that an infusion rate of 0.05 microg x kg-1 x min-1 plus patient-controlled analgesia demands of 10 microg provides adequate analgesia and has significantly less side effects than a dose of 0.1 microg x kg-1 x min-1 plus 10 microg demands.

Adolescent↗
PubMed2000

Postoperative recovery in children after minimum versus full-length sternotomy.

BACKGROUND: Minimal access incisions for pediatric cardiac surgery have been reported to hasten postoperative recovery. This prospective study compared recovery after a minimum versus full-length sternotomy for repair of atrial septal defects in children. METHODS: We studied 35 children undergoing atrial septal defect repair using a full-length sternotomy (n = 18) or ministernotomy (n = 17) according to the surgeon's preference. All children were managed according to an established clinical practice guideline. Intraoperative comparisons included patient demographics, bypass and cross-clamp times, and, as a measure of stress response, epinephrine, norepinephrine, and lactate levels at six time intervals throughout the surgical procedure. Postoperative comparisons included pain scores at 6, 12, and 24 hours, frequency of emesis, analgesic requirements, respiratory rate and gas exchange, and length of intensive care unit and total hospital stay. Nurse and parent assessment scores of overall recovery were constructed using visual analog and Likert scales. RESULTS: No significant differences between mini- versus full-length sternotomy were detected for the measured outcome variables. No adverse outcomes were detected. CONCLUSIONS: In this prospective study, a ministernotomy did not enhance postoperative recovery, and the primary advantage appears to be an improved cosmetic result.

Adolescent↗
PubMedDate not supplied

Lateral column symptomatology following plantar fascial release: a prospective study.

Plantar fasciitis or heel spur syndrome usually resolves with conservative management, but for patients with continued pain, surgical intervention is often pursued. In some cases, plantar fasciitis is relieved, but pain in the lateral column area appears postoperatively. This lateral column pain may be debilitating for the patient and often overlooked by the foot and ankle surgeon. The goal of the study was to identify the maximum amount of plantar fascia that can be surgically released to treat recalcitrant heel pain effectively while preventing the development of lateral column symptoms. All patients undergoing plantar fasciotomy after failing conservative treatment were eligible to participate. Patients rated their pain with an 11-point (0-10) visual analog scale (VAS) and described its location prior to and at monthly intervals after their surgery. Surgeons recorded whether 25, 50, or 66% of the plantar fascia was released during surgery. Open procedures were performed 72% of the time, and endoscopically in 28% of the patients. Key outcome variables included degree of fascial release and foot structure. Patients (n = 47) with lateral column pain after surgery (n = 15 feet) had a mean +/- S.E. of 60.6 +/- 3.0% of their plantar fascia released while those without pain (n = 35 feet) had only 48.7 +/- 1.9% of this fascia released during surgery (ANOVA, p = .019). Age, weight, body mass index, gender, smoking status, comorbidities, general health, surgical procedure, postoperative care, calcaneal inclination angle, and talar declination angle did not differ for these groups (p > .146). For this patient population, regardless of surgical technique (endoscopic or open release), lateral column symptoms were more likely to result when more than 50% of the plantar fascia was released. The report proposes that a maximum of 50% of the plantar fascia be released during surgery.

Adult↗
PubMed2004

[Patients' perioperative worries and experiences].

AIM: The aim of this study was to detect the main causes of patients' preoperative distress and their subjective experiences. METHODS: After institutional ethic committee approval and patients consent an anonymous questionnaire was randomly distributed on the first and second postoperative day. Its content were basic demography, preoperative anxiety level using five point verbal scale, main cause; of anxiety, the worst postoperative experience, postoperative pain intensity (11 point scale) and its treatment incidence of postoperative nausea and vomiting (PONV) and other side effects of the surgery and the anesthesia. Correlations with specific patients' characteristics were searched for to determine the risk groups. RESULTS: Two hundred filled in questionnaires out of the 244 distributed could be used for further evaluation. Sixty-two per cent of patients suffered from preoperative anxiety, more women (p < 0.01) and more frequently after intra-abdominal (intra-thoracic) surgeries (p < 0.05). Forty-three per cent of patients had no subjective problems following surgery, others suffered more frequently from the postoperative pain (18.5 percent), PONV (11.5 percent) and postoperative procedures, e.g. changing of dressing, drains and from the postoperative regime. There was a correlation between PONV and both the intensity of postoperative pain and anamnesis of PONV during previous surgery (p < 0.01).

Anxiety↗
PubMed1994

[Emergency surgery in patients over eighty].

The authors describe a series of 139 over-eighty patients (M = 53, F = 86), who underwent emergency surgery between 1-1-1987 and 30-6-1993. They consider diagnosis, copathology, type of surgical procedures, postoperative complications and final results. In this series they study 73 large bowel obstruction and 48 peritonitis. They notice important copathologies in 78% of patients, in particular cardiovascular diseases. They performed 74 mayor surgical procedures with 48% of postoperative complications and exitus in 24% of cases, due overall to exacerbation of coexisting diseases. The authors underline the direct between mortality rate and number of copathologies, and analyze the basic rules to follow in surgical indications and during the postoperative period.

Age Factors↗
PubMed1996

[Laparoscopic ileostomy and colostomy in Crohn disease patients].

The indications, operative procedure, postoperative complications and advantages of laparoscopic ileostomy and colostomy as compared with "open" enterostomy are described and demonstrated in our own patients with Crohn's disease. Major indications for laparoscopic enterostomy in patients with Crohn's disease are stenosis, fecal incontinence and complex anal fistulas in those with severe Crohn's proctitis. Most Crohn patients tolerate laparoscopic enterostomy and an increasing number demand this minimally invasive technique. The period of convalescence is much shorter and complications in connection with laparotomy are minimized.

Adult↗
PubMed2003

Anterior skull base surgery without prophylactic airway diversion procedures.

OBJECTIVE: Although anterior skull base surgery has become a relatively safe and effective procedure, postoperative complications remain a serious problem. One of the most devastating complications of anterior skull base procedures is tension pneumocephalus (TP). In order to prevent TP, authors have recommended the use of prophylactic airway diversion procedures, such as prolonged endotracheal intubation or prophylactic tracheostomy. However, these procedures may mask neurologic deterioration, delay treatment, and prolong rehabilitation. The purpose of this study was to determine the need for airway diversion procedures in anterior skull base surgery. STUDY DESIGN: Eighty-five patients underwent anterior skull base operations through the subcranial approach without prophylactic airway diversion. Sixty-four patients underwent resection of tumors, 12 patients underwent repair of cerebrospinal fluid leak, 6 patients underwent surgery due to anterior skull base fungal infections, and 3 patients underwent anterior skull base reconstruction procedures. RESULTS: The complication rate of TP was 1.2% (1/85). This complication rate is similar to that previously reported for operations performed with airway diversion procedures. CONCLUSION: Prophylactic airway diversion procedures are unnecessary in routine anterior skull base operations. Airway diversion should be indicated only when factors that might predispose the patient to risk of TP have been identified (ie, chronic cough or obstructive pulmonary diseases).

Adolescent↗
PubMed1988

Assessment of the use of transfusion therapy perioperatively in patients with sickle cell hemoglobinopathies.

During the period of 1978 to 1986, 66 patients (31 men, 35 women) with a mean age of 28.4 years and various sickle cell hemoglobinopathies underwent 82 surgical procedures; 28 were emergencies. Fifty of the 66 patients had HbSS, 13/66 had HbSC, and 3/66 had HbS-thalassemia. All 66 patients received transfusions, although not for all procedures. In 48 patients, transfusion therapy was only administered preoperatively. Simple transfusions (1 to 10 units) were administered in 31 of 48 procedures. Exchange transfusions (1 to 6 units) were performed in nine of 48 procedures. Preoperative hematocrit ranged from 7.0% to 54.2%; of those receiving transfusions the hematocrit ranged from 22.6% to 53.7%. Intraoperative transfusions (1 to 10 units) were performed in 14 of 82 procedures; postoperative transfusions (1 to 6 units) were performed in 13 of 82 procedures. No advantage was noted in preoperative exchange transfusion as measured by a decrease in postoperative complications; a slight increase was seen in atelectasis in this group of patients with preoperative transfusions. An increase was reported in the complication rate of patients with an hematocrit of less than 30%. The type of transfusion (preoperative, intraoperative, or postoperative) administered did not appear to be related to postoperative morbidity rates. The complication rate for simple transfusions was 51.6% and for multiple transfusions, 55.6%. HbSS hemoglobinopathy had the higher complication rate. The hepatitis B surface antigen was demonstrated in four of 66 (6.1%) patients; ten of 66 (15.2%) developed alloantibodies. The benefits of transfusion therapy should be judged according to clinical needs; not all sickle cell patients need exchange or preoperative transfusion.

Adult↗
PubMed2003

Reconstruction after extirpation of sacral malignancies.

Defects after extirpation of either sacral or rectal tumors often present a reconstructive challenge to plastics surgeons. Because of their relative infrequency, management guidelines, in the authors' opinion, have been overlooked. They think that successful, comprehensive treatment lends itself to an integrated team approach. They review their experience with immediate reconstruction after total sacrectomy for sacral malignancies performed between 1996 and 2001. Medical records were reviewed retrospectively for the surgical procedure, postoperative complications, and eventual outcome. A total of 9 patients underwent sacrectomy with a gluteus maximus flap for reconstruction. Six patients had a simultaneous omental flap for complete obliteration of the surgical defect. The authors' experience suggests that this combination of techniques is a reliable approach for reconstruction of these extensive surgical defects.

Aged↗
PubMed1983

Estimation of surgical risk in the elderly: a correlative review.

Age continues to be a risk factor for overall mortality in elective and emergency surgical procedures. Postoperative pneumonias, life-threatening cardiac complications, and malignancy-related complications account for most deaths. Heart disease, dementia, and diabetes confer an additional surgical risk for elderly patients. Careful preoperative assessment, however, can categorize elderly patients into groups that are at no additional risk. Factors other than age should be considered in estimating surgical risk in the elderly.

Abdomen↗
PubMedDate not supplied

Periprocedural hypertension: current concepts in management for the vascular surgeon.

Periprocedural hypertension is a common finding in patients undergoing vascular surgery or endovascular procedures, and this may pose a risk for subsequent cardiovascular morbidity or mortality. Accordingly, the vascular surgeon who wishes to improve outcomes needs to be proficient not only in surgical technique but also in the medical management of the patient's associated conditions, especially hypertension. Vascular procedures need not be cancelled unless the blood pressure (BP) is more than 180 mm Hg systolic or 110 mm Hg diastolic, but attention should also be paid to evidence of end organ damage in making this decision. In most cases preoperative antihypertensive medications should be continued up till the procedure. Postoperative hypertension may require 1 of a number of intravenous medications, which are listed. Oral nifedipine should generally be avoided for fear of inducing an uncontrolled hypotensive response and cardiac ischemia.

Adrenergic alpha-Antagonists↗
PubMed1990

[Completion pneumonectomy--a review of 29 cases].

From 1962 through 1988, a total of 29 consecutive patients had completion pneumonectomy (CP). Indications for initial pulmonary resection were primary lung cancer in 27 patients, metastatic lung tumor in 1, and mediastinal tumor with pulmonary invasion in 1. Indications for CP were lung cancer (including local recurrence, pulmonary metastasis from the first lung cancer, and second primary lung cancer) in 21 patients, complications after initial operations in 7, and pulmonary arterial injury during second operation in 1. Severe adhesion of the residual lung and the hilar structures made operative procedures extremely difficult. Injury of pulmonary arteries occurred in 6 patients. Especially, in cases the left upper lobe had been resected previously, deviation of the lower lobe and hilar adhesion lead to operative difficulty. Post-CP bronchial fistula occurred more frequently in what the bronchi had been dissected at more peripheral level than main bronchus, because of some severe hilar adhesions. Operative mortality was 13.8% (9.5% for second lung cancer, 28.5% for post-operative complication). Five-year survival for patients with lung cancer was 32.9% according to the Kaplan-Meier method. We conclude that the indications for CP are clinically resectable lung cancer and bronchial stenosis with residual pulmonary organic changes following bronhoplastic procedure. Postoperative bronchofistulae should be managed by other operative procedure.

Adenocarcinoma↗
PubMed1986

Percutaneous placement of ventriculoatrial shunts: four-year case experience.

During the past 4 years, we have used percutaneous placement of the atrial catheter in 39 patients who have undergone ventriculoatrial shunting. The age range of our patients has been from 9 to 74 years of age, with routine indications existing. Both subclavian and internal jugular venous access have been utilized, with the latter being our preferred route of access for reasons of safety. Average operative time has been approximately 35 to 40 minutes. Both traditional and split-sheath introducer catheters have been used. Patient follow-up has been up to 4 years. Intraoperative complications have been limited to puncture of the carotid artery on two occasions; neither affected the ultimate performance of the procedure. Postoperative complications have been limited to those peculiar to shunt procedures in general and have required revision in four instances. One patient suffered an infection secondary to shunting. The benefits of this procedure seem to include safety, decreased operative site exposure, and decreased operative time, all factors that may contribute to a lower than normal infection rate and may warrant consideration of this procedure in adolescents and adults for whom ventriculoatrial shunting is indicated.

Adolescent↗
PubMed2003

Video-assisted laparoscopic procedures in peritoneal dialysis.

BACKGROUND: Although laparoscopy is commonly adopted for the diagnosis and management of various medical or surgical problems, its use for patients with peritoneal dialysis has seldom been addressed. This retrospective study analyzes the indications and clinical effects of this procedure. METHODS: A retrospective chart was drawn up and a videotape review performed for 18 laparoscopic procedures involving 198 patients receiving peritoneal dialysis on a long-term basis at our dialysis unit from May 1992 to June 2002. The clinical and demographic parameters in this study included gender, age, underlying renal diseases, duration of peritoneal dialysis before laparoscopy, indications of laparoscopic intervention, laparoscopic findings, time of operation, laparoscopic procedures, postoperative complications, mortality, and catheter results. RESULTS: A total of 18 laparoscopic procedures were performed in 17 uremia patients, with indications including catheter malfunction in five cases, preimplantation evaluation of peritoneal space in three cases, evaluation of the etiology underlying intractable peritonitis in nine cases, and verification of the cause for dialysate leakage in one case. Four (80%) of the five catheter malfunctions were successfully corrected, including one case of catheter migration and three cases of omental wrapping, whereas correction failed in the remaining case because of severe bowel adhesion. New catheter placement after adhesiolysis was successful in all three cases of preimplantation peritoneal evaluation (100%). Of the nine patients whose peritonitis episodes were evaluated, two were found to have secondary peritonitis, two had fungal peritonitis; one had tuberculous peritonitis and four had bacterial peritonitis. In the case of persistent exit-site dialysate leakage, laparoscopy showed a penetrating injury of the abdominal wall, raising a strong suspicion of iatrogenic injury during the tunneling maneuvers in initial catheter placement. Two conversions to laparotomy were performed: one to repair the penetrating injury and the other to save the life of a patient threatened by severe fungal peritonitis with abdominal cocoon formation. The laparoscopic procedures lasted 20 to 150 min (average, 50 min). Despite one instance of postoperative hydrocele, there was no operative mortality. CONCLUSIONS: The analytical results of this study demonstrate that the current video-assisted laparoscopic technique is an effective means for managing several problems related to peritoneal dialysis such as catheter malfunction, preimplantation evaluation, location of the source of the dialysate leak, and assessment of the causes for peritonitis. Thus, this technique should always be considered when the these problems arise.

Adolescent↗
PubMed1997

Malrotation: the postoperative period.

BACKGROUND/PURPOSE: There have been many reports of patients who have persistent gastrointestinal symptoms after undergoing Ladd's procedure. Postoperative return of bowel function in many of these patients seems to be delayed. METHODS: Postoperative return of bowel function after performance of a Ladd's procedure was studied retrospectively in a series of 57 children treated between 1981 and 1994. Excluded were those patients who had a malrotation in combination with an abdominal wall defect, a congenital diaphragmatic hernia, or duodenal atresia. Patients were divided in two groups; one group consisted of patients less than 1 year of age and one group of those 1 year of age and older. RESULTS: Nasogastric tube decompression was necessary for an average of 6.7 days in the first group and 4.3 days in the older children (P = .03). A midgut volvulus delays resumption of bowel function postoperatively. Gastric tube decompression was necessary for 8.6 days (n = 15) compared with only 5.1 days (n = 45) for the group without a volvulus (P = .003, analysis by t test). CONCLUSION: The authors recommend that a central venous line be inserted for feeding purposes when a volvulus is present at operation.

Adolescent↗