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At least 109 records · Page 6Linked to original sources
PubMed2002

[Penetrating keratoplasty in keratoconus in years 1990 and 1999].

The purpose of this study was to compare grafts performed because of keratoconus in our clinic in years 1990-1999. These years were chosen for analysis because in this time some methods of grafting were changed, particularly: material for transplantation, graft's size, method of trephination and graft suturing, also management after operation. The study included 51 patients (17 females, 34 males) with keratoconus, aged 16 to 46 (mean age 31.3), which have had penetrating keratoplasty done in years 1990-1999. The amount of surgery, sex of patients, preoperative preparation, kind of graft material, technique of operation, methods of graft suturing, postoperative procedure, the time of patients hospitalization, time of suture removing, postoperative visual acuity and complication were compared.

Adolescent↗
PubMed1976

[Possibilities and limits of outpatient surgery (author's transl)].

The aims of modern outpatient surgery include: the comprehensive development of ambulatory therapy especially the repertoire of operations, preclinical standardized diagnostic procedures, postoperative outpatient care and rehabilitation. The main reasons for this development are analyzed. In order to make further progress in the direction indicated the number of surgeons working in outpatient departments will have to be increased. Own experiences in outpatient saphenectomy, excisions of Dupuytren's contracture, haemorrhoidectomy, mastectomy, herniorrhaphy, enucleation of cold nodes in the thyreoid gland (171 operations between 1972 and 1974) encourage further efforts in this direction.

Ambulatory Care↗
PubMed1997

No analgesic effect of ibuprofen or paracetamol vs placebo for hysterectomies.

The aim of the present study was to evaluate the postoperative opioid-sparing effect of a pre-operative nonsteroidal anti-inflammatory drug (NSAID) (ibuprofen) vs paracetamol in a prospective, double-blind, placebo-controlled study. It was also investigated whether the use of ibuprofen or paracetamol would influence the amount of surgical bleeding. Sixty-six women scheduled for elective open hysterectomy were randomized into one of three groups. All patients received premedication (diazepam 10 mg) and test drugs orally 1 h before the start of anaesthesia: Group 1 (n=23) received 800 mg ibuprofen; Group 2 (n=22) received 1000 mg paracetamol; and Group 3 (n=21) received placebo. General anaesthesia was given with thiopentone-fentanyl-atracurium induction, and maintained with nitrous oxide-isoflurane. Postoperatively, the patients were evaluated hourly during the recovery period, and 1 and 4 days after the procedure. Postoperative pain was measured by visual analogue scale (VAS), verbal pain score and the need of standardized opioid rescue medication. Intra-operative bleeding was measured, as well as reduction in blood haemoglobin content 24 h and 4 days after the procedure. No differences were found between the groups in postoperative pain measured by any variable or opioid consumption at any time. The amount of surgical bleeding was equal in the three groups. Ibuprofen or paracetamol given pre-operatively to hysterectomy patients do not have a postoperative analgesic or opioid-sparing effect. Perioperative surgical bleeding is not influenced by these drugs.

Clinical Trial↗
PubMed1978

[Arthrolysis in the treatment of post-traumatic extensor rigidity of the knee (author's transl)].

Extensor rigidity of the knee may be due to a wide variety of causes and is certainly quite often a sequela of an injury. Rigidity is caused by damage to tissue distant or proximal to the knee joint, in the joint itself, or simultaneously at several locations. In many cases considerable improvement can be achieved by arthrolysis. However, this requires detailed knowledge of the involved and expected pathologic changes. Besides detailed clinical and x-ray examination via arthrography it is particularly important to select and prepare the patients properly. Knee arthrolysis can never be based on only one surgical procedure. The authors differentiate between covered and open loosening of the stiffened joint besides intraarticular and extraarticular arthrolysis, and a combined intraarticular and extraarticular procedure. Postoperative followup treatment is at least just as important as the surgical procedure itself. Complications can be largely avoided via subtile technique and sufficient experience. The authors report on 16 followup examinations effected during the past four subsequent to arthrolyses of the knee. On the average there was an improvement in flexibility and stretch-ability by 70 degrees, or a relative flexibility increase by 80%. No serious complications were seen. Arthrolysis of the knee is recommended as a well-tried and highly successful surgical procedure.

Adult↗
PubMed1995

Percutaneous endoscopic sinus surgery for frontal sinusitis or a cyst.

Using percutaneous endoscopic surgery, we achieved good results in patients with frontal sinus cyst. The surgical procedure is described and discussed. The endoscopic system consisted of a needle-shaped rigid fiberscope (direct-vision and angle-vision types [30 degrees, 90 degrees]) 1.7 mm in diameter with a light source. A small incision was made at the eyebrow, the sinus was cleaned, and an opposite hole was made through the existing wound. This procedure permitted less invasive surgery under direct view of the surgical field compared with conventional percutaneous transnasal frontal sinus procedures. Postoperative patency of the sinus was also satisfactory. This percutaneous endoscopic procedure was designed for surgical maneuvers in the frontal sinus through a small, 3- to 5-mm incision. This technique is considered effective for the treatment of inflammatory disorders of the frontal sinus caused by positional abnormalities after trauma or recurrence after conservative transnasal surgery.

Adult↗
PubMed1997

[Postoperative pain after interventions in the area of the mouth-jaw-face].

In order to establish effective postoperative analgesia we studied the incidence and significance of pain following maxillofacial surgery. The trial included 102 patients undergoing one of six different surgical procedures. Postoperative pain was assessed using a visual analogue scale (VAS) and the short form of the McGill Pain Questionnaire (SF-MPQ) up to the third postoperative day. Postoperative pain intensity was significantly correlated to operating time, the frequency of analgesic demand and the type of surgery (orthognathic surgery > TMJ surgery > osteosynthetic surgery > osteotomy of impacted third molars > tumor resection > removal of osteosynthetic materials). Patient's age, sex and ethnic origin did not significantly affect the severity of postoperative pain.

Adolescent↗
PubMed1996

Granisetron reduces vomiting after strabismus surgery and tonsillectomy in children.

PURPOSE: To evaluate the antiemetic efficacy of granisetron, a selective 5-hydroxytryptamine type 3 receptor antagonist, on postoperative vomiting in children undergoing general anaesthesia for strabismus repair and tonsillectomy with or without adenoidectomy. METHODS: In a randomized, placebo-controlled, double-blind study, fifty patients, 4-10 yr of age, were given a single dose of either placebo (saline, n = 25) or granisetron (40 micrograms.kg-1, n = 25) iv over 2-5 min after the induction of anaesthesia and prior to the surgical procedure. Postoperatively, during the first 24 hr after anaesthesia, the frequencies of retching and vomiting were recorded. RESULTS: There were no differences between the two groups with regard to patient characteristics, surgical procedures and anaesthetic or postoperative management. The incidence of retching was 36% and 12% after administration of placebo or granisetron, respectively (P < 0.05); the corresponding frequencies of vomiting were 32% and 8% (P < 0.05). Four children who had received placebo required another rescue antiemetic drug, whereas none who had received granisetron needed this agent. CONCLUSION: Granisetron is effective in the prevention of retching and vomiting after strabismus repair and tonsillectomy in paediatric patients.

Antiemetics↗
PubMed2000

Noncardiac surgery: postoperative arrhythmias.

Postoperative arrhythmias are common and represent a major source of morbidity after both cardiac and noncardiac surgical procedures. Postoperative dysrhythmias are most likely to occur in patients with structural heart disease. The initiating factor for an arrhythmia in a given patient after surgery is usually a transient insult, such as hypoxemia, cardiac ischemia, catecholamine excess, or electrolyte abnormality. Management includes correction of these imbalances and medical therapy directed at the arrhythmia itself. The physiologic impact of arrhythmias depends on arrhythmia duration, ventricular response rate, and underlying cardiac function. Similarly, urgency and type of treatment is determined by the physiologic impact of the arrhythmia, as well as by underlying clinical status. The purpose of this review is to provide current concepts of diagnosis and acute management of arrhythmias after noncardiac surgery. A systematic approach to arrhythmia diagnosis and evaluation of predisposing factors is presented, followed by consideration of specific bradyarrhythmias and tachyarrhythmias in the postoperative setting.

Anti-Arrhythmia Agents↗
PubMed1992

Lacrimal drainage system injury in functional endoscopic sinus surgery. Incidence, analysis, and prevention.

Injury to the lacrimal drainage system with resultant epiphora is a complication of functional endoscopic sinus surgery. A study of 24 patients was conducted to determine the incidence and significance of lacrimal drainage system injuries during functional endoscopic sinus surgery. Intraoperative testing demonstrated seven occult injuries (15%) in 46 endoscopic procedures. Postoperative testing demonstrated diversion of lacrimal drainage into the middle meatus in two patients and spontaneous healing of the injured lacrimal drainage system with restoration of normal drainage in three of the patients available for follow-up testing. In no patient did epiphora develop. It is concluded that the nasolacrimal drainage system is in close proximity to the dissection cavity during functional endoscopic sinus surgery and, hence, is at risk for inadvertent injury. Occult damage to the nasolacrimal drainage system would appear to be a common event during functional endoscopic sinus surgery; however, the complication of postoperative epiphora is rare.

Child↗
PubMed2001

Postoperative management: buttock claudication and limb thrombosis.

As a result of endovascular repair of abdominal aortic aneurysms and the necessary associated adjunctive procedures, postoperative buttock claudication and limb thrombosis are complications that every physician who implants stent-grafts should be able to recognize and treat. Whereas the presenting complaints of these complications can be quite obvious, the treatment of them may be not so simple. Studies have shown that 28% of patients who underwent embolization of one or both hypogastric arteries develop buttock claudication. Yet 78% of these affected patients spontaneously resolve their symptoms. Strategies to both minimize and successfully treat this complication are obviously of the utmost importance. Likewise, limb thrombosis can be easy to recognize, but treatment strategies and methods to limit this complication can be quite complex and remain somewhat controversial. One center was able to reduce their limb thrombosis rate from 17% to 0% through the use of intravascular ultrasound and aggressive adjunctive stenting. The purpose of this article is to first review the data concerning these complications and then to discuss treatment strategies that are designed to minimize and treat the actual complication.

Aortic Aneurysm, Abdominal↗
PubMed1997

Toe amputations and ray resections.

Loss of a part of the lower extremity is an unfortunate complication of diabetes. Indications and general principles of amputation have been established. Distal limb salvage procedures include forefoot amputation alternatives, digital amputations, and ray resections. A variety of risks and complications are associated with these procedures. Postoperative management including prosthetic and accommodative therapy may enhance the successful outcomes of these procedures.

Amputation, Surgical↗
PubMed1988

Comparison of propofol induction with thiopentone or methohexitone in short outpatient general anaesthesia.

The per- and post-operative characteristics of three different i.v. anaesthetic induction agents were studied double-blindly in 75 patients admitted for outpatient gynaecological dilatation and curettage. All the patients were premedicated with midazolam 0.1 mg/kg i.m. Induction started with alfentanil 0.015 mg/kg i.v. 60 s before either: propofol 2.2 mg/kg i.v., or thiopentone 4.0 mg/kg i.v., or methohexitone 2.0 mg/kg i.v. All the patients received 66% nitrous oxide in oxygen. The propofol patients were significantly better relaxed and had a higher incidence of hypotension during the procedure. The methohexitone patients had higher pulse rates and a higher frequency of hiccups during the procedure. Propofol induction resulted in a faster awakening of the patients and a better recovery function compared with methohexitone for the first 15 min and compared with thiopentone for the first 240 min after the procedure. Postoperative side-effects were less frequent in the thiopentone group, and minor abdominal pain was significantly more frequent in the propofol group. There was no significant difference between the groups for any variable after 240 min postoperatively.

Adult↗
PubMedDate not supplied

Spiral CT following the Whipple procedure: distinguishing normal postoperative findings from complications.

Following a Whipple procedure for a patient with pancreatic cancer, postoperative imaging with CT is essential to exclude complications and to identify recurrence. Accurate interpretation of these examinations requires knowledge of the type of surgery performed and the normal appearance of the abdomen on CT following this complex surgery. The purpose of this pictorial essay is to illustrate the normal appearance of the bowel following a Whipple procedure as well as some of the complications.

Diagnosis, Differential↗
PubMed1993

Hematologic effects of total knee arthroplasty. A prospective evaluation.

In a prospective evaluation of 41 patients (57 knees) treated with index cemented total knee arthroplasty, perioperative blood testing was performed on blood counts, fibrinogen, and fibrin degradation products (FDP). The preoperative platelet count averaged 314/nl (range, 160-502/nl), whereas postoperatively, the count nadired at an average of 173/nl (range, 60-305/nl). Fibrinogen levels increased from 304 mg/dl (range, 170-442 mg/dl) to an average high of 647 mg/dl (range, 317-1018 mg/dl). Patients were also classified according to whether they had been treated with unilateral or bilateral procedures. Postoperatively, unilateral patients had an average 32% decrease in the platelet count, compared with the 64% decrease seen in bilateral patients. Analysis of fibrin split products revealed a trend toward greater elevation of these degradation products after bilateral procedures. The hematologic changes represented evidence of activation of the coagulation and fibrinolytic systems. These changes tended to be more pronounced in patients treated with bilateral procedures, and were manifested in postoperative elevation of fibrinogen and fibrin degradation products, with reductions in the platelet count. The degree of relative thrombocytopenia raises concerns about careful evaluation of candidates for bilateral arthroplasty, especially when determining the preoperative platelet count.

Aged↗
PubMed1988

Dihydroergotamine and the thromboprophylactic effect of dextran 70 in emergency hip surgery.

In a prospective randomized controlled trial treatment with a combination of dextran 70 and dihydroergotamine (DHE) was compared with the administration of dextran 70 alone as prophylaxis against postoperative thrombo-embolic complications in emergency hip surgery. Forty-five consecutive patients with a fractured hip entered the study. Twenty-one were randomized to prophylactic treatment with dextran 70 (group 1) and twenty-four patients received dextran 70 and DHE (group 2). Both regimens were initiated pre-operatively and the surgical and postoperative procedures were the same in the two groups. On the first and fourth postoperative day, Tc-plasmin scintigraphy of the lower extremities and pulmonary ventilation/perfusion scintigraphy were performed to detect any deep vein thrombosis (DVT) and/or pulmonary emboli. A total of 19 per cent of group 1 patients developed DVT and so did 25 per cent in group 2; this difference was not statistically significant. Of the detected DVT, 60 per cent were subclinical, and 7 per cent of the patients had minor pulmonary emboli, all of which were symptomless. No therapeutic difference could be demonstrated between the two regimens. A recent report claiming that adding DHE to the prophylactic administration of dextran 70 considerably reduces the incidence of postoperative DVT in emergency hip surgery is questioned.

Aged↗
PubMed2002

Laparoscopic splenectomy.

BACKGROUND: Laparoscopic splenectomy is currently the procedure of choice for elective splenectomy. This study reviews the initial 100 laparoscopic splenectomies completed at the Cleveland Clinic Foundation. METHODS: A retrospective review of elective laparoscopic splenectomy was performed to assess clinical outcomes at the Cleveland Clinic Foundation. Patient demographics, preoperative diagnoses, operative characteristics, morbidity, and mortality were evaluated. RESULTS: Of the 169 elective splenectomies completed over a 4-year period from 1995 to 1999, 100 were attempted laparoscopically. The proportions of all splenectomies attempted laparoscopically by year were 17%, 38%, 75%, and 72%. Nearly 70% of splenectomies were performed for idiopathic thrombocytopenic purpura or malignancy. Overall, the mean blood loss was 181 ml, and the mean operative time was 170 min. Splenomegaly occurred in 31% of the patients and accounted for longer operative times. Three patients required conversion to an open procedure. Postoperative complications were seen in 13% of the patients. One patient died in the postoperative period from staphylococcal sepsis, giving a mortality rate of 1%. CONCLUSIONS: Laparoscopic splenectomy currently is the procedure of choice for elective splenectomy at our institution. As compared with traditional open splenectomy, laparoscopic splenectomy results in minimal morbidity even in the setting of splenomegaly.

Elective Surgical Procedures↗
PubMed2002

Foraminal and far lateral lumbar disc herniations: surgical alternatives and outcome measures.

Far lateral disc herniations constitute 7-12% of all disc herniations. They may be purely far lateral or extraforaminal in location, located beyond the pedicles, or may include intraforaminal and even intracanalicular components. Occurring predominantly at the L4-L5 and L3-L4 levels in almost equal numbers, they are occasionally noted at L5-S1. Clinical syndromes reflect compression of the superiorly exiting nerve root and ganglion; ie an L4-L5 far lateral disc produces a L4 root syndrome. Clinical complaints often include severe radicular pain accompanied by very positive mechanical signs; Laségue and reverse Laségue (femoral stretch test) maneuvers. Neurological deficits, including motor, reflex, and sensory findings, are seen over 75% of the time. Although conservative management is occasionally successful (10%), surgery is usually required. The extent of stenosis and attendant degenerative changes dictate whether laminectomy, hemilaminectomy or laminotomy are required along with one of several facet resection options; full facetectomy, the intertransverse approach, medial facetectomy, or an extreme lateral procedure. Postoperatively, patients' neurological outcomes based on both surgeon and patient based outcome measures (SF-36), were comparable for the different surgical procedures which had been based on the individual patient's pathology.

Diskectomy↗
PubMed2004

Ureterocystoneostomy (UCN) and subureteral collagen injection (SCIN): combined one-stage correction of high-grade bilateral vesicoureteral reflux (VUR) in children.

The treatment of vesicoureteral reflux (VUR) is still a controversial issue. The efficacy of medical treatment appears to be equal to that of operative procedures in avoiding new formation of renal scars. However, there are generally accepted indications for operative procedures including bilateral high-grade VUR, especially in young patients. Ureteral reimplantation (UCN) is the operative treatment of choice in cases with high-grade VUR. Alternatively in cases with lower-grade VUR, injection of bulking agents under the refluxive orifice can be performed. It is also generally accepted that UCN with extravesical preparation of the ureter and the bladder should not be done bilaterally in a one-stage procedure. Postoperative bladder dysfunction may result due to detrimental neurogenic effects. In this study we report on our operative procedure in cases with bilateral high-grade VUR, during which we perform intra/extravesical UCN (mod. Leadbetter-Politano) of the higher-grade refluxive ureter, and (open) subureteral collagen injection (SCIN) of the lower-grade refluxive orifice as a combined one-stage procedure. In this study 50% of the patients had no VUR on either side after the first combined procedure. 15% of the patients showed significant down-grading of VUR of the injected side. These patients underwent a 2nd endoscopic SCIN. 35% of the patients showed no change of VUR of the injected side after the first procedure; these patients underwent reimplantation of this side in another operation. Accordingly, 50% of patients with bilateral high-grade VUR required a 2nd operative procedure under full anesthesia to achieve loss of VUR on both sides. None of the patients showed bladder dysfunction postoperatively. Mean follow-up after the last operative correction was 29.9 months (6 - 84 months).

Algorithms↗