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PubMed1994

Reoperative cardiac valve surgery: a multivariable analysis of risk factors.

From December 1983 to March 1992, of 1650 patients who underwent a cardiac valve procedure 41 (2.5%) underwent reoperation on prosthetic heart valves. The indications for reoperation were: structural degeneration (13 patients, 32%), non-structural dysfunction (nine patients, 22%), prosthetic valve endocarditis (seven patients, 17%), valve thrombosis (four patients, 10%), native valve pathology (three patients, 7%), aortic ascending pathology (five patients, 12%). The hospital mortality rate for mitral valve reoperation was 12% (two of 17) and for reoperation on the aortic prosthesis 26% (five of 19). No deaths occurred for associated mitral and aortic replacement (zero of five). The mortality rate for associated procedures was 24% (four of 17) versus 12% (three of 24) for isolated procedures. Preoperative and operative variables were analysed to determine risk factors for hospital mortality. New York Heart Association functional class, ascites, endocarditis and surgical timing had a univariate influence on operative mortality. The pulmonary capillary wedge pressure and preoperative creatinine level were also higher in non-survivors. Elective reoperation had a mortality rate of 7%, while that for emergency procedures was 38%. Multivariable analysis indicated a longer extracorporeal circulation time and the urgent-emergency status as predictors of mortality. Reoperation before severe haemodynamic impairment occurs is recommended.

Aortic Valve↗
PubMed1989

Antibody to endotoxin is associated with decreased frequency of postoperative infection.

According to previous studies the presence of preoperative antibodies to gram-negative lipopolysaccharides has a protective effect against postoperative infection and pyrexia in patients undergoing urologic and cardiac surgical procedures. Preoperative serum specimens collected from 86 women awaiting major gynecologic surgery were tested for the presence of antiendotoxin by a qualitative method. These patients were closely followed up in the postoperative period and any evidence of pyrexia or infection was noted. There were 21 (24%) patients who had preexisting antibodies. Of the women studied, 47 (55%) had some form of postoperative infection, of which 32 (37%) were exclusively a result of gram-negative bacteria. There was a significant association (p less than 0.05) between postoperative infection and the absence of preexisting antibodies. This association was particularly striking (p less than 0.02) when postoperative urinary tract infections were considered. There was no association between postoperative pyrexia and the absence of preexisting antibody. Our results confirm the findings of previous studies to evaluate the protective role of antiendotoxin in surgical procedures. In the future immunization may be considered an adjunct or alternative to prophylactic antibiotics.

Antibodies, Bacterial↗
PubMed2003

Comparison of robotic-assisted and manual implantation of a primary total hip replacement. A prospective study.

BACKGROUND: Robotic-assisted total hip replacement has become a common method of implantation, especially in Europe. It frequently has been postulated that robotic reaming would result in an improved clinical outcome due to the better fit of the prosthesis, but that has never been demonstrated in a prospective study, to our knowledge. The purpose of this study was to compare robotic-assisted implantation of a total hip replacement with conventional manual implantation. METHODS: One hundred and fifty-four patients scheduled for total hip replacement were randomly assigned to undergo either conventional manual implantation of an S-ROM prosthesis (eighty patients) or robotic-assisted implantation of such a prosthesis (seventy-four patients). The five-axis ROBODOC was used for the robotic-assisted procedures. Preoperatively as well as at three, six, twelve, and twenty-four months after surgery, the scores according to the Harris and Merle d'Aubigné systems and the Mayo clinical score were determined. Radiographs made at these intervals were analyzed for evidence of loosening, prosthetic alignment, and heterotopic ossification. RESULTS: Thirteen (18%) of the seventy-four attempted robotic implantations had to be converted to manual implantations as a result of failure of the system. The duration of the robotic procedures was longer than that of the manual procedures (mean and standard deviation,107.1 +/- 29.1 compared with 82.4 +/- 23.4 minutes, p < 0.001). Limb-length equality (mean discrepancy, 0.18 +/- 0.30 compared with 0.96 +/- 0.93 cm, p < 0.001) and varus-valgus orientation of the stem (mean angle between the femur and the shaft of the prosthesis, 0.34 degrees +/- 0.67 degrees compared with 0.84 degrees +/- 1.23 degrees, p < 0.001) were better after the robotic procedures. At six months, slightly more heterotopic ossification was seen in the group treated with robotic implantation. The group treated with robotic implantation had a better Mayo clinical score at six and twelve months and a better Harris score at twelve months; however, by twenty-four months, no difference was found between the groups with regard to any of the three scores. Dislocation was more frequent in the group treated with robotic implantation: it occurred in eleven of the sixty-one patients in that group compared with three of eighty in the other group (p < 0.001). Recurrent dislocation and pronounced limping were indications for revision surgery in eight of the sixty-one patients treated with robotic implantation compared with none of the seventy-eight (excluding two with revision for infection) treated with manual insertion (p < 0.001). Rupture of the gluteus medius tendon was observed during all of the revision operations. CONCLUSIONS: The robotic-assisted technology had advantages in terms of preoperative planning and the accuracy of the intraoperative procedure. Disadvantages were the high revision rate; the amount of muscle damage, which we believe was responsible for the higher dislocation rate; and the longer duration of surgery. This technology must be further developed before its widespread usage can be justified.

Aged↗
PubMedDate not supplied

Prognostic relevance of histomorphological parameters and DNA content and their therapeutic consequences in esophageal carcinoma: a multivariate approach.

BACKGROUND/AIMS: Despite recent advances in surgical and multidisciplinary treatment, the prognosis for patients with esophageal carcinoma remains poor. The low prognostic accuracy of even surgical pathological TNM staging suggests that additional parameters would be useful in determining the prognosis. METHODOLOGY: We undertook a retrospective analysis of 115 patients who had undergone transhiatal and transthoracic esophageal resection due to squamous cell carcinoma of the esophagus. In addition to TNM classification and the usual morphological criteria, a quantitative DNS analysis using Image DNA cytometry was performed. At the time of DNA analysis, histomorphological parameters and survival time was not known. RESULTS: The main prognostic parameter was the curativity (R classification) of the operation. Using only patients who had had R0 resection, a multivariate analysis was performed. Parameters included: patient age; preoperative ASA classification; tumor localization; pN category; number of intra-thoracal lymph nodes removed; pT category; pM category; grading; lymphangiosis; ploidy; operative procedure, and the development of postoperative complications identifying the ploidy, and the depth of tumor infiltration of prognostically independent factors. CONCLUSIONS: In the case of a diploid or tetraploid DNA content, tumor resection is recommended even in the case of lymph node metastasis at the truncus coeliacus. Patients with a diploid or tetraploid tumor without distant metastasis and tumor stage pT1-pT3 may, after curative (RO) transthoracic resection with two-field lymph node dissection, have an advantage over patients having a transmediastinal procedure in terms of long-term follow up. In cases of aneuploid DNA content, tumor resection shows no advantage over palliative non-operative procedures. Preoperative radio- or chemotherapy may improve the prognosis of these patients.

Adolescent↗
PubMedDate not supplied

Improving the total hip replacement process at University of Alberta Hospitals.

UNLABELLED: In October 1988, the University of Alberta Hospitals (UAH) embarked on a Value Improvement Process (VIP) study, a forerunner to the hospital's total quality management (TQM) initiative, to improve the total hip replacement procedure. Cost analysis and comparisons with similar hospitals helped a cross-functional team identify 12 areas for improvement. The team significantly decreased costs and length of stay by standardizing preoperative procedures, decreasing the number of suppliers providing prosthetic devices, and implementing other improvements. RESULTS: The overall cost of performing a total hip replacement decreased 21.2 percent. Preoperative length of stay decreased 48.1 percent, and postoperative length of stay decreased 9.4 percent. Total expenditures on orthopedic units involved in the study decreased 20.3 percent. Length of stay for all orthopedic patients also decreased from 8.6 days to 7.47 days. The number of open beds decreased 7.7 percent. The level of staff satisfaction with the study averaged 4.9 out of possible score of 5.

Academic Medical Centers↗
PubMed2005

[Transvaginal urethrolysis for urethral obstruction after anti-incontinence surgery].

PURPOSE: To analyse the success of transvaginal urethrolysis in resolving voiding dysfunction in patients following an anti-incontinence procedure. MATERIALS AND METHODS: A retrospective chart review was performed on 20 patients who had undergone transvaginal urethrolysis for urethral obstruction following an anti-incontinence procedure. Preoperatively, a history was taken, pelvic examination and urodynamic were done. Mean patient age was 48 years, and the median time between the anti-incontinence procedure and the urethrolysis was nine months. Four patients had urinary retention and had irritative voiding symptoms. Previous surgery included pubovaginal sling in eleven patients, retropubic urethropexy in three and bladder neck suspension in six cases. Mean length of follow up after urethrolysis was 14 months. The urodynamic study demonstrated voiding flow rate of 9.9 ml/s and detrusor pressures at maximum flow of 48cmH20. RESULTS: Of the 20 patients 14 (70%) had relief of symptoms after a single urethrolysis, while two patients underwent a second transvaginal urethrolysis, with placement of a Martius flap between the urethra and the symphysis. There was no correlation between preoperative parameters examined and the outcome from urethrolysis. CONCLUSION: Our data support transvaginal urethrolysis for the treatment of urethral obstruction after anti-incontinence surgery. It is effective and minimally invasive technique with good results that should be considered if voiding dysfunction does not resolve spontaneously.

Adult↗
PubMed2000

Determinants of patient satisfaction in postmastectomy breast reconstruction.

In today's increasingly competitive health care marketplace, consumer satisfaction has become an important measure of quality. Furthermore, measures of satisfaction with treatment inteerventions are influential factors in determining patients' and payers' choices of health care. This study sought to evaluate satisfaction with postmastectomy breast reconstruction and to assess the effects of procedure type and timing on patient satisfaction. As part of the Michigan Breast Reconstruction Outcome Study, patients undergoing first-time mastectomy reconstruction were prospectively evaluated, including cohorts of women choosing expander/implant, pedicle TRFAM flap, and free TRAM flap procedures. Preoperatively and 1 year postoperatively, participants completed a questionnaire that collected a variety of health status information. The postoperative questionnaire had an additional seven items assessing both general satisfaction with reconstruction (five items) and aesthetic satisfaction (two items) as separate subscales. Patients were asked to respond to each item using a five-point Likert scale. Item responses ranged from 1, indicating high satisfaction, to 5, reflecting low satisfaction. In the data analysis, only patients responding with a 1 or 2 for all of the items within a subscale were classified as "satisfied" for the subscale. To assess the effects of procedure type (implant, pedicle TRAM flap, and free TRAM flap) and timing (immediate versus delayed) on satisfaction and to control for possible confounding effects from other independent variables, multiple logistic regression was employed. In our analysis, odds ratios and associated 95 percent confidence intervals were calculated for each independent variable in the regression. Statistical significance was designated at the p < or = 0.05 level. A total of 212 patients were followed during the period of 1994 to 1997, including 141 immediate and 71 delayed reconstructions. The study population consisted of 49 expander/implant, 102 pedicle TRAM flap, and 61 free TRAM flap reconstruction patients. The analysis showed a significant association between procedure type and patient satisfaction. TRAM flap patients (both free and pedicle) appeared to have significantly greater general and aesthetic satisfaction compared with expander/implant patients (p = 0.03 and 0.001, respectively). Furthermore, pedicle TRAM flap patients were more aesthetically satisfied than those with free TRAM flaps (p = 0.072). The other independent variables of age and procedure timing did not appear to significantly affect either general or aesthetic satisfaction. However, preoperative physical activity was positively correlated with general satisfaction at the p = 0.034 level. The choice of procedure seems to have a significant effect on both aesthetic and general patient satisfaction with breast reconstruction. In this study, autogenous tissue reconstructions produced higher levels of patient aesthetic and general satisfaction compared with implant techniques. Pedicle and free TRAM flap patients do not seem to differ significantly in general satisfaction. However, women receiving pedicle TRAM flaps reported greater aesthetic satisfaction compared with patients undergoing free TRAM flaps. Furthermore, patient age and procedure timing may not have an effect on patient satisfaction with breast reconstruction.

Adult↗
PubMed2002

Long-term results of surgical management of proximal interphalangeal joint contracture.

To evaluate the long-term results of surgical treatment of proximal interphalangeal (PIP) joint contractures, 68 PIP joints were retrospectively reviewed with a minimum follow-up period of 24 months. Preoperative and intraoperative factors were studied for outcomes and subjected to statistical analysis. Among the total group the average improvement was 7.5 degrees. When grouped by diagnosis into simple (less severe diagnoses) and complex (more severe diagnoses) the average degrees gained were 17.2 degrees and 0.5 degrees, respectively. The statistically significant factors that were identified that affected results were age, number of prior procedures, preoperative flexion, removal of an exostosis, number of structures addressed, and preoperative arc of motion. The second surgery (joints requiring repeat release or salvage procedure) rates were 35% overall, 29% simple, and 39% complex; the difference was not significant. The best surgical candidate is a patient younger than 28 years with a less severe diagnosis and who has preoperative maximum flexion measurement < 43 degrees.

Adolescent↗
PubMed1999

Visual and anatomic outcomes associated with posterior segment complications after ganciclovir implant procedures in patients with AIDS and cytomegalovirus retinitis.

PURPOSE: To determine anatomic and visual acuity outcomes of posterior segment complications after ganciclovir implant surgery. METHODS: We reviewed the medical records of 63 patients with acquired immunodeficiency syndrome who had active cytomegalovirus retinitis in 82 eyes and who underwent 110 consecutive ganciclovir implant procedures. Preoperative and postoperative visual acuity, type of postoperative complication, treatment, and lines of visual acuity change were determined. RESULTS: Thirty-eight eyes of 19 patients had bilateral ganciclovir implant procedures, and 25 eyes of 19 patients underwent two or more ganciclovir implant procedures. Thirteen (12%) of 110 ganciclovir implant procedures developed posterior segment complications: rhegmatogenous retinal detachment in six, vitreous hemorrhage in four, endophthalmitis in two, and cystoid macular edema with epiretinal membrane in one. Treatment included pars plana vitrectomy with silicone oil in two cases and without silicone oil in three cases, scleral buckling in one, intravitreal antibiotic injection in two, and laser photocoagulation in two. Overall, median visual acuity was 20/25 preoperatively. Median follow-up was 6 months for all eyes and 7 months for eyes with complications. Postoperative median visual acuity was 20/25 for eyes without complications vs 20/40 at 1 month, 20/60 at 3 and 6 months, and 20/100 at 12 months in eyes with complications (P < .001). More eyes with than without complications lost 2 or more lines of visual acuity (P < .001). CONCLUSION: Postoperative complications occurred in 12% of the ganciclovir implant procedures and were associated with decreased visual acuity despite treatment.

AIDS-Related Opportunistic Infections↗
PubMed2001

Treatment of symptomatic primary chylous disorders.

PURPOSE: Primary chylous disorders (PCDs) are rare. Rupture of dilated lymph vessels (lymphangiectasia) may result in chylous ascites, chylothorax, or leakage of chyle through chylocutanous fistulas in the lower limbs or genitalia. Chyle may reflux through incompetent lymphatics, causing lymphedema. To assess the efficacy of surgical treatment, we reviewed our experience. METHODS: The clinical data of 35 patients with PCDs treated between January 1, 1976, and August 31, 2000, were reviewed retrospectively. RESULTS: Fifteen men and 20 women (mean age, 29 years; range, 1 day-81 years) presented with PCDs. Sixteen (46%) patients had chylous ascites, and 19 (54%) had chylothorax (20 patients), and of these, 10 (29%) had both. In 16 patients, reflux of chyle into the pelvic or lower limb lymphatics caused lymphedema (14, 88%) or lymphatic leak through cutaneous fistulae (11, 69%). Presenting symptoms included lower-limb edema (19, 54%), dyspnea (17, 49%), scrotal or labial edema (15, 43%), or abdominal distention (13, 37%). Primary lymphangiectasia presented alone in 23 patients (66%), and it was associated with clinical syndromes or additional pathologic findings in 12 (yellow nail syndrome in 4, lymphangiomyomatosis in 3, unknown in 3, Prasad syndrome (hypogammaglobulinemia, lymphadenopathy, and pulmonary insufficiency) in 1, and thoracic duct cyst in 1). Twenty-one (60%) patients underwent 26 surgical procedures. Preoperative imaging included computed tomography scan in 15 patients, magnetic resonance imaging in 3, lymphoscintigraphy in 12, and lymphangiography in 14. Fifteen patients underwent 18 procedures for chylous ascites or pelvic reflux. Ten (56%) procedures were resection of retroperitoneal/mesenteric lymphatics with or without sclerotherapy of lymphatics, 4 (22%) were lymphovenous anastomoses or grafts, 3 (17%) were peritoneovenous shunts, and 1 (6%) patient had a hysterectomy. Six patients underwent eight procedures for chylothorax, including thoracotomy with decortication and pleurodesis (4 procedures), thoracoscopic decortication (1 patient), ligation of thoracic duct (2 procedures), and resection of thoracic duct cyst (1 patient). Postoperative mean follow-up was 54 months (range, 0.3-276). Early complications included wound infections in 3 patients, elevated liver enzymes in 1, and peritoneovenous shunt occlusion with innominate vein occlusion in 1. All patients improved initially, but four (19%) had recurrence of symptoms at a mean of 25 months (range, 1-43). Three patients had postoperative lymphoscintigraphy confirming improved lymphatic transport and diminished reflux. One patient died 12 years postoperatively, from causes unrelated to PCD. CONCLUSIONS: More than half of the patients with PCDs require surgical treatment, and surgery should be considered in patients with significant symptoms of PCD. Lymphangiography is recommended to determine anatomy and the site of the lymphatic leak, especially if lymphovenous grafting is planned. All patients had initial benefit postoperatively and two thirds of patients demonstrated durable clinical improvement after surgical treatment.

Adult↗
PubMedDate not supplied

Heart transplantation in patients requiring preoperative mechanical support.

Since January 1985, the members of the Heart Transplant Program at Washington University Medical Center, St. Louis, have performed 53 transplants in 50 patients. Thirteen patients have required preoperative mechanical support. These patients ranged in age from 32 to 58 years, with a mean of 47 years. Seven patients had undergone a total of 12 prior cardiac surgical procedures. Preoperative diagnosis was coronary artery disease in nine patients, cardiomyopathy in three, and valvular heart disease in one. Two patients had mechanical ventilatory support before operation. Five patients required preoperative intraaortic balloon counterpulsation (IABP). Five patients required left ventricular assistance with the Bio-Medicus centrifugal pump (Bio-Medicus Inc., Eden Prairie, Minnesota). Two of these patients had the left ventricular assist device (LVAD) inserted at the end of a failed cardiac procedure. One patient required the extracorporeal membrane oxygenator (ECMO) for right ventricular decompensation and cardiac arrest 4 hours after a seemingly successful orthotopic transplantation. Twelve of the 13 patients (92%) who required mechanical assistance of circulation and/or respiration before operation underwent a successful transplant. One patient who had IABP support perioperatively did not survive surgery. All patients who had a bridge to transplantation with the LVAD and the one patient with a bridge to transplant with ECMO are long-term survivors of transplantation. There has been one late death from cardiac causes in a patient who had IABP support before operation; the death was presumed to be from acute rejection, though this could not be documented at autopsy. Actuarial survival in this group is 82% at 12 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1994

Subclavian revascularization. A quarter century experience.

OBJECTIVE: Twenty-five years of experience with subclavian revascularizations were reviewed to determine the long-term patency rates of different extrathoracic approaches. SUMMARY BACKGROUND DATA: Although it is generally agreed that proximal subclavian stenosis should be treated by an extrathoracic route whenever possible, the optimum procedure is debated. Alternatives include subclavian carotid bypass, subclavian-to-subclavian or axillo-axillary bypasses, and the authors' preferred technique of subclavian carotid transposition (SCT). METHODS: Records were researched for the past 25 years in a single specialty surgical clinic for extrathoracic subclavian revascularizations. One hundred ninety such procedures were identified, and hospital charts and office medical records were reviewed for procedure, preoperative symptoms, blood pressure differentials, and postoperative complications. Patency was determined by physical examination, differential blood pressures, Doppler spectral analysis, duplex examinations, and arteriography. RESULTS: Bypass procedures were used infrequently, and although the results are reported, they are excluded from any analysis. Subclavian carotid transposition was used in 178 procedures. All anastomoses were found to be patient at follow-up, except for one, which failed at 26 months. Mean follow-up was 46 months, with five patients lost to follow-up. Overall mortality rate was 2.2%, with the mortality falling to 1.1% if only subclavian carotid transposition patients are included. CONCLUSIONS: Subclavian carotid transposition should be the treatment of choice for routine subclavian carotid occlusive disease because of its exceptional long-term patency and low morbidity.

Adult↗
PubMed1997

Differential involvement of left temporolateral and temporomesial structures in verbal declarative learning and memory: evidence from temporal lobe epilepsy.

A wealth of animal and human research has pointed to a significant involvement of the temporal lobes in memory processing, and yet the different functional roles of temporal cortical vs. mesial structures remain unclear. We studied verbal declarative memory, by using a word list paradigm that differentiates among learning (immediate recall), memory (delayed recall), and recognition, in epilepsy patients being considered for surgical resection of the left temporal lobe. Verbal memory was evaluated preoperatively and during the recording of intracranial event related potentials and postoperatively after selective hippocampectomy, temporal cortical lesionectomy, or anterior two-thirds en bloc temporal lobe resection procedures. Preoperative differences in verbal memory performance as a function of differences in underlying neuropathology, concurrent event-related potentials, and specific patterns of postoperative memory impairments lead to converging evidence that verbal declarative memory relies on a synergistic interaction of at least two functionally distinct brain systems. Material-specific data acquisition, or working memory, is mediated by neocortical temporal structures, whereas long-term consolidation/retrieval is particularly mediated by temporomesial structures. In contrast to the left temporal neocortex, the function of the temporomesial system appears to be material nonspecific. Apparently, its preferential involvement in verbal memory is due to its close interaction with overlying neocortical structures that are specialized for language processing.

Adult↗
PubMed2002

Long-term results of endopyeloureterotomy using the transpelvic extraureteral approach.

OBJECTIVES: To review our clinical results to confirm the long-term efficacy of the operative technique of endopyeloureterotomy using the transpelvic extraureteral approach that we developed. METHODS: We treated 123 patients with ureteropelvic junction obstruction or upper ureteral stenosis by percutaneous endopyeloureterotomy using the transpelvic extraureteral approach between 1988 and 1999. All were followed up for at least 1 year (mean 58 months). Sixty-eight patients were male and 55 female between the ages of 3 and 78 years (mean 36). We evaluated the efficacy of our procedure preoperatively and then regularly every 6 to 12 months postoperatively using excretory urography and technetium-99m DTPA renography. RESULTS: Our results showed that 115 (90.6%) of 127 procedures relieved the obstruction without any severe complications. In the 107 cases of ureteropelvic junction obstruction, we alleviated the stricture in 96 (90%). In the 20 cases of upper ureteral stenosis, our procedure alleviated the stricture in 19 (95%). In the 47 cases of a stenotic segment of 2 cm or more in length, 43 of our procedures led to a significant improvement (91.5%). Long-term follow-up of the 123 patients revealed late recurrence in 5 patients, despite the initial success. CONCLUSIONS: Percutaneous endopyeloureterotomy using the transpelvic extraureteral approach should be considered the first choice of treatment for ureteropelvic junction obstruction and upper third ureteral stenosis, even if the stenotic segment is 2 or more cm long.

Adolescent↗
PubMed2001

Results of the tension-free vaginal tape procedure for the treatment of type II stress urinary incontinence at a minimum followup of 1 year.

PURPOSE: We evaluated the safety and efficacy of the tension-free vaginal tape procedure for treating type II stress urinary incontinence in females. MATERIALS AND METHODS: Between April 1998 and April 1999, 62 women 28 to 86 years old (mean age 62.8) were treated consecutively for stress urinary incontinence with the tension-free vaginal tape procedure. Preoperative evaluation included history, physical examination and multichannel video urodynamics. All patients had type II stress urinary incontinence, none had preoperative detrusor instability or significant pelvic prolapse and in 16 previous surgery for stress incontinence had failed. RESULTS: All patients were followed at least 12 months after the procedure (median 16.2). A total of 42 and 20 women received spinal and local anesthesia, respectively. We noted 6 bladder perforations, including 5 in patients with a history of surgery for stress urinary incontinence. Blood loss was less than 200 cc in all cases. We observed no prolonged postoperative pain, infection or sling rejection. Post-void residual urine was less than 100 cc the day after surgery in 59 cases. Only 3 patients self-catheterized a maximum of 4 days. At followup 54 women (87.1%) were cured of stress urinary incontinence, 6 were improved (9.6%) and 2 had failure (3. 3%), while 4 (6.4%) had new onset detrusor instability without evidence of bladder outlet obstruction. CONCLUSIONS: The tension-free vaginal tape procedure appears to be a minimally invasive, safe and effective treatment for type II stress urinary incontinence. A history of surgery for stress incontinence seems to be a risk factor for bladder perforation.

Adult↗
PubMed1989

Management of Hirschsprung's disease: curative surgery before 3 months of age.

Curative surgery of Hirschsprung's disease (HD) was performed in 32 infants younger than 3 months of age from January 1, 1977, December 31, 1986. There were 24 males, seven of whom presented with total colonic aganglionosis. Preoperative relief of obstruction was carried out by only enemas in 25 patients (81%), with addition of total parenteral nutrition of 8 to 27 days in case of severe enterocolitis. Colostomy was never performed as a routine procedure. Preoperative morbidity occurred in three cases: one enterocolitis and two sigmoid performations that were successfully treated by colostomy. Weight at operation ranged from 3.3 to 6.0 kg (mean, 4.9 kg). Swenson's (25), Duhamel's (5), and Soave's procedures (2) were performed. There was no mortality. Follow-up varied from 2 to 10 years. Postoperative morbidity occurred in five patients (one anastomotic leak, two stenosis, one volvulus, and one recurrent enterocolitis). All other patients are considered as definitively cured. Comparison with data in the literature permits one to advocate primary corrective treatment of HD without decompression in infants less than 3 months of age.

Age Factors↗
PubMed1988

Toward a selection of the most appropriate procedure in the treatment of complete rectal prolapse.

Defecographic evaluation was performed in 30 patients with rectal prolapse to assess the effect of posterior rectopexy on rectal function and to arrive at a selection of the best procedure. Preoperative defecography revealed rectal intussusception in all patients. Postoperative control studies showed adequate rectal fixation to the anterior sacral surface. Intussusception no longer occurred. Rectal stenosis due to the surgical procedure was absent. The described technique of posterior rectopexy eliminates the prolapse mechanism without creating new disorders and is therefore a rational procedure. Advocation of new procedures should also be based on results of colorectal tests that assess the effect of the procedures on rectal function.

Adult↗
PubMedDate not supplied

The effect of total shoulder arthroplasty on self-assessed health status is comparable to that of total hip arthroplasty and coronary artery bypass grafting.

The purpose of this study was to assess the impact of total shoulder arthroplasty on the self-assessed health status of a large series of patients with glenohumeral osteoarthritis. In 91 patients we were able to compare the 8 quantitative domains of Short Form-36 (SF-36) before surgery and at 30 to 60 months after surgery. These preoperative and postoperative scores were compared with data from an age- and gender-matched control population. These results were also compared with those reported for patients who underwent other common, effective surgical procedures. Preoperative SF-36 values were significantly lower than population controls for 6 of 8 SF-36 domains (physical function, social function, physical role function, emotional role function, vitality, and comfort). Patients improved significantly in 4 of 8 SF-36 domains at 30 to 60 months after total shoulder arthroplasty: physical role function (P <.01), comfort (P <.01), social function (P <.01), and mental health (P <.05). Although the improvements were significant and similar to the postoperative scores reported for total hip arthroplasty and coronary bypass procedures, the scores did not reach those of the general population.

Aged↗