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At least 127 records · Page 7Linked to original sources
PubMed2003

Prospective randomized study comparing amoxicillin-clavulanic acid with cefazolin as antimicrobial prophylaxis in laparotomic gynecologic surgery.

BACKGROUND: To compare amoxicillin-clavulanic acid with cefazolin as ultra-short-term prophylaxis in laparotomic gynecologic surgery. MATERIALS AND METHODS: A prospective randomized study was conducted to compare two antimicrobial regimens in surgical prophylaxis of laparotomic surgery. Patients were randomly allocated to receive amoxicillin-clavulanic acid (2.2 g) [Group A] or cefazolin (2 g) [Group B] as a single dose 30 min before surgery. Each patient was assessed daily until discharge to evidence febrile status and the presence of infections at the operative site, urinary tract, and respiratory tract. RESULTS: In the amoxicillin-clavulanic acid (Group A) and cefazolin (Group B) groups, overall 346 and 352 patients, respectively, were evaluable for prophylactic efficacy at hospital discharge. Infectious complications were infrequent in both arms. Febrile morbidity occurred in 21 (6.1%) and 26 (7.4%) patients, respectively, in the amoxicillin-clavulanic acid and cefazolin groups. Wound infection and urinary tract infection were also higher, but not significantly in the cefazolin group (0.5% vs. 1.1% and 2.0% vs. 2.5%, respectively). There was one respiratory tract infection (0.2%) in Group B, and no septic death in either groups. CONCLUSION: Ultra-short-term prophylaxis with both amoxicillin-clavulanic acid and cefazolin is safe in elective laparotomic gynecologic surgery.

Adult↗
PubMed1975

Major gynecologic surgery in the elderly female 65 years of age and older.

A total of 185 cases were reviewed of major gynecologic surgery performed upon women 65 years of age and older from 1970 to 1973 at a 350 bed community hospital. Each private staff physician operated upon his private patient. There were 112 vaginal operations performed, mostly for pelvic relaxation problems, and 73 abdominal operations. Forty-two patients had surgery for cancer. There were nine postoperative complications and only two deaths. It can be concluded from this study that the elderly female can tolerate major gynecologic surgery very well in a modern-day hospital setting.

Age Factors↗
PubMed2001

[Non-closure of the visceral peritoneum during abdominal gynecological surgery].

OBJECTIVES AND STUDY DESIGN: The analysis of influence of closure and nonclosure of the visceral peritoneum during abdominal gynecological surgery was done. MATERIALS AND METHODS: A postoperative course and late consequences (occurrence of adhesions) in the 427 patients were studied. There were two groups of patients: I group--203 patients who had visceral peritoneum closed, II group--224 patients who had visceral peritoneum non closed. RESULTS: There were not significant differences in postoperative course in both groups. In the group where the visceral peritoneum was not closed occurrence of the adhesions was significantly decreased, when compared the group where the visceral peritoneum was closed. CONCLUSIONS: 1. Nonclosure of the visceral peritoneum doesn't increase the incidence of early postoperative complications. 2. Nonclosure of the visceral peritoneum during abdominal gynecological surgery decreased the incidence of adhesions. 3. Nonclosure of the visceral peritoneum prevents dislocation and ligation of the ureter.

Adult↗
PubMed1976

[Influence of gynecologic surgery on the blood concentration of adenosine phosphate].

Blood concentrations of ATP, ADP and AMP studied before and immediately after incomplicated gynecologic surgery due to not malignant indications showed the following changes: 1. The initial blood concentration values ranged within the physiological limits and were not therefore essentially influenced by gynecologic diseases. 2. There was a short-term non significant increase of ATP blood concentrations after the operation. 3. After more extensive surgical operations there was a significant short-term decrease of ADP and AMP concentrations that however, approached pre-operation values within 24 hours. 4. The values of ATP/ADP and ATP/AMP coefficients increased significantly after the operation but decreased again within 24 hours. It may be concluded that gynecologic surgery itself as well as attendant circumstances do not induce metabolic changes unfavorably influencing the adenosinephophate system in the blood.

Adenosine Diphosphate↗
PubMed1995

Ureteral injury in gynecologic surgery: a ten-year review in a community hospital.

OBJECTIVE: Our purpose was to review and analyze ureteral injuries incidental to gynecologic surgery in a community hospital. STUDY DESIGN: During the study period from Jan. 1, 1983, through Dec. 31, 1992, all patient records in which ureteral injury resulted from gynecologic surgery were reviewed. The operative procedure, pathologic result, location of injury, and type of repair were studied. Additionally, the time of recognition and diagnostic methods in these ureteral injuries were analyzed. RESULTS: Nineteen ureteral injuries were incurred during the performance of 4665 gynecologic surgical procedures, an incidence of 0.4%. Patients ranged in age from 23 to 70 years. Recognition of the ureteral injury occurred intraoperatively in 10 patients and was delayed from 1 to 16 days in 9 patients. Six of the ureteral injuries were repaired by end-to-end anastomosis, 3 by deligation, and 10 by ureteroneocystostomy. Immediate postoperative urinary integrity was found in all patients. CONCLUSION: Gynecologic surgical procedures in this study resulted in a 0.4% incidence of ureteral injury, and repair of these injuries was successful in all cases for the short term.

Adult↗
PubMed1982

Suture materials currently used in obstetric-gynecologic surgery in the United States: a questionnaire survey.

Questionnaires on the material and the size of sutures used in obstetric-gynecologic surgery were sent to the directors of 110 residency programs in the specialty in medical schools in the United States. Replies were received from 80 (73%) programs. The findings indicate that the use of chromic catgut still predominates, but that the newer synthetic absorbable materials such as polyglycolic acid and polyglactin 910 are becoming popular for some procedures, including certain steps in abdominal closure and in reconstructive tubal surgery. The increasing use of these materials for hysterectomy and cesarean section, heretofore exclusively the domain of chromic catgut, suggests that there is possibly under way a reorientation of attitudes about the materials used for sutures in obstetric-gynecologic surgery. The characteristics of catgut and of synthetic absorbable materials are herein described and compared in relation to their current use.

Abdomen↗
PubMed1997

Ultrasonography of the ureter during laparoscopic gynecological surgery.

The purpose of this study was to evaluate the ultrasonographic appearance and normal function of the ureter during gynecological surgery. The study group consisted of 14 gynecological patients scheduled for laparoscopy and 12 patients scheduled for laparotomy. Under standardized anesthesia conditions before pelvic surgery, the appearance, location, dimensions and peristaltic activity of the ureter were examined using a 7.5-MHz flexible laparoscopic linear transducer probe. Imaging of the ureter was possible in all cases. The ureteral lumen, mucosa, subepithelial connective tissue and muscular layer could be imaged as a tubular structure with low-level echoes. The separate layers, however, could not be differentiated by ultrasonography. The ureteral diameters at resting phase did not differ between the open surgery and laparoscopy groups. During peristaltic activity the maximal diameter was smaller in the laparoscopy group. The mean number of peristaltic waves was 23 +/- 7 waves per 5 min and this did not differ significantly between the open and laparoscopic surgery groups. Intermittent periods of retrograde flow were detected in 21 of the 26 patients. As seen in this study, ureteral location and function can be ultrasonographically evaluated during surgery and laparoscopic conditions do not have much influence on the ureter. The role of laparoscopic ultrasonography in lowering the incidence of ureteral complications in gynecological surgery needs further study.

Animals↗
PubMed1995

The omentoplasty: a neglected ally in gynecologic surgery.

Although the omentum is extensively used in general, reconstructive and thoracic surgery as a pedicled omentoplasty, little information exists about the utility of such a procedure in general and radical gynecologic surgery. In this paper we review the properties of the omentum which may be useful in gynecologic surgery. The omentum is highly vasculated and rich in thromboplastin, an excellent property for treating difficult to handle abdominal or pelvic abscesses and for inducing hemostasis. Furthermore, it appears that the omentum has a trophical effect on the surrounding tissue, making it very useful in reconstruction procedures. Moreover, elevating the small intestines out of the true pelvis paves the way for high dose (brachy)radiotherapy with less radiation enteritis. The technique of the pedicled omentoplasty is straightforward and takes 20-30 min extra operating time. We use pedicled omentoplasty for covering large operating fields instead of reperitonealization, to prevent radiation enteritis, as a matrix for grafting, to treat serious intraperitoneal infections and to facilitate hemostasis. Our experience of 48 omentoplasty procedures in gynecology is described.

Enteritis↗
PubMed1992

Subarachnoid and intramedullary cysts secondary to epidural anesthesia for gynecological surgery.

Three women who received epidural anesthesia for gynecological surgery developed spinal arachnoiditis leading to subarachnoid cysts and cord cavitation. MRI was useful to show the subarachnoid and intramedullary cysts, as well as to monitor lesion extent and progress. Associated MRI findings were a Chiari anomaly in 1 case and a tethered cord in another. Two cases underwent surgery: 1 improved, but the other suffered progressive neurological deterioration. Although the 3rd patient had no treatment, there was spontaneous reduction in cavity size and clinical improvement. Careful handling of this procedure is urged to avoid such severe complications in young mothers.

Adult↗
PubMed1976

[Progress and change in geriatric gynecological surgery (author's transl)].

Two periods of geriatric gynecological surgery (1947-1959 and 1960-1972) at the University Women's Hospital in Hamburg-Eppendorf were compared in regard to the age of the patient, surgical indications, surgical procedure, anesthetic technique, preoperative and postoperative morbidity, length of hospitalization and mortality rate. During a period of 26 years, 1514 women over the age of 60 were treated surgically. During the first period, 489 women were treated, and in the second period, 1,025. This 109.6% increase has been confirmed statistically. The increase in geriatric surgical cases stems basically from the increase in the number of surgical patients over the age of 70. The increase in breast carcinoma during the second period (from 43 to 348 operations) is most conspicuous. This is an increase of 809.3%. On the basis of this disproportionately large increase in breast surgery, more women were treated surgically in the University Women's Hospital in Hamburg-Eppendorf for breast carcinoma during the second period, than for carcinoma of the reproductive organs. Vulva carcinoma and craurosis vulvae were also more frequently considered to be an indication for surgical treatment. The total number of women who were surgically treated for prolapsed uterus and vagina remained more or less constant. In the analyzing the surgical records, it should be emphasized that, in the second observation period, two-thirds of these cases were treated by performing a vaginal hysterectomy with anterior and posterior vaginoplasty. For older patients, palliative surgical measures for prolapsed uterus and vagina were abandoned in favor of more definitive methods. The postoperative morbidity and mortality rate remained more or less constant for both periods. The postoperative period of hospitalization was slightly longer while the preoperative period was slightly shorter. The statistically confirmed increase in geriatric surgery during the last 13 years at the University Women's Hospital in Hamburg-Eppendorf clearly shows how important geriatric surgery has become. The immediate consequences are an increased workload for physicians, nursing staff and physical therapists.

Age Factors↗
PubMed2006

[A randomized study comparing amoxicillin-clavulanic acid with cefazolin as antimicrobial prophylaxis in laparotomic gynecologic surgery].

AIM: The aim of this paper was to compare amoxicillin-clavulanic acid with cefazolin as ultra-short term prophylaxis in laparotomic gynecologic surgery. METHODS: A prospective randomized study was conducted to compare 2 antimicrobial regimens in the surgical prophylaxis of laparotomic surgery. Patients were randomly allocated to receive amoxicillin-clavulanic acid (2.2 g, group A) or cefazolin (2 g, group B) as a single dose 30 min before surgery. Each patient was assessed daily until discharge to evidence febrile status and the presence of infections at the operative site, urinary tract and respiratory tract. RESULTS: In the amoxicillin-clavulanic acid (group A) and cefazolin (group B) groups, overall 346 and 352 patients, respectively, were evaluable for prophylactic efficacy at hospital discharge. Infectious complications were infrequent in both arms. Febrile morbidity occurred in 21 (6.1%) and 26 (7.4%) patients respectively in the amoxicillin-clavulanic acid and cefazolin groups. Wound infection and urinary tract infection were also higher, but not significantly in the cefazolin group (1.1% versus 0.5% and 2.5% versus 2%, respectively). There was one respiratory tract infection (0.2%) in group B and no septic death in either groups. CONCLUSIONS: Ultra-short term prophylaxis with both amoxicillin-clavulanic acid and cefazolin is safe in elective laparotomic gynecologic surgery.

Adult↗
PubMed2002

Antimicrobial prophylaxis in laparotomic gynecologic surgery: a prospective randomized study comparing amoxicillin-clavulanic acid with cefazolin.

A prospective randomized study was conducted at the Department of Obstetrics and Gynecology, University of Bari to compare two antimicrobial regimens, amoxicillin-clavulanic acid with cefazolin as ultra-short term prophylaxis in laparotomic gynecologic surgery. Patients were randomly allocated to receive a single dose of amoxicillin-clavulanic acid (2.2 g) [Group A] or cefazolin (2 g) [Group B] 30 minutes before surgery. Each patient was assessed daily until discharge for fever and the presence of infection of the surgical wound, urinary tract and respiratory tract. In the amoxicillin-clavulanic acid (Group A) and cefazolin (Group B) groups, overall 258 and 253 patients, respectively were evaluable for prophylactic efficacy at hospital discharge. Infectious complications were infrequent in both arms. Febrile morbidity occurred in 16 (6.3%) and 21 (8.1%) patients respectively in the amoxicillin-clavulanic acid and cefazolin groups. Wound infection and urinary tract infection were also higher but not significantly in the cefazolin group (0.8% versus 0% and 2.7% versus 2.0% respectively). There was no respiratory tract infection or septic death in either group. It is concluded that ultra-short term prophylaxis with both amoxicillin-clavulanic acid and cefazolin is safe and effective in elective laparotomic gynecologic surgery.

Adult↗
PubMed1999

The role of bacterial vaginosis in infection after major gynecologic surgery.

PURPOSE: Previous studies have reported an association between bacterial vaginosis (BV) and postoperative fever and infection. This prospective study investigated whether the intermediate or definite stages of BV are risk factors for postoperative infection after major gynecologic surgery. METHODS: Vaginal cultures were obtained preoperatively from 175 women undergoing gynecologic surgery. The diagnostic criteria for BV were based on Nugent's standardized method of Gram stain interpretation. Postoperative fever was defined as at least one temperature equal to 101.0 degrees F or greater, or two or more temperatures more than 6 hours apart equal to 100.4 degrees F or greater. RESULTS: Thirty-six percent of the positive-BV group developed a postoperative fever, compared with 20% of the Lactobacillus-predominant group and 12% of the intermediate-BV group (P = 0.017). The differences between the positive-BV group and the Lactobacillus-predominant group, and between the positive-BV group and the intermediate-BV group, with respect to postoperative fever, were statistically significant (P = 0.045 and P = 0.007, respectively). The difference between the intermediate-BV group and the Lactobacillus-predominant group was not statistically significant (P = 0.28). CONCLUSIONS: Although the association between BV and postoperative febrile morbidity could be a spurious result of confounding with other variables, it may be prudent for the surgeon to identify patients with BV and treat them preoperatively.

Bacterial Infections↗
PubMed1997

[Gynecologic surgery in geriatric patients].

UNLABELLED: To establish a precise definition for the geriatric patient, results difficult, since the age limits change constantly and arbitrary way, but given that women are living longer, supposedly the rate of gynecologic surgery is increasing. OBJECTIVE: To inform the experience obteined in our service, from geriatric patients, with surgical intervention, and compare the results with published articles from other national gynecology services. MATERIALS AND METHODS: In the gynecology service of Specialties Hospital "Dr. Miguel Dorantes Mesa" from the S.S., in Xalapa Veracruz, México, a retrospective study was performed, from 76 cases of patients with gynecologic surgery. The research variables were: 60 years old or older, personal pathologic data, gynecologic and obstetrics, occupation, preoperative diagnosis, type of intervention, anatomopathologic diagnosis, anesthesia employed, complications during of after surgery, days in the hospital, hemoglobin and hematocrit. RESULTS: Most of the patients were 65 to 70 years old, 100% housewives, pelvic statics alterations were present in most cases (53.9%), followed by pre-malignant and malignant diseases of the cervix, the abdominal hysterectomy was indicated in 29 cases, 65.7% had personal pathologic data, the anatomopathologic study confirmed 85% of the cases, days-hospital average was 5.8. CONCLUSION: Survivorship does not depend by type of surgery or age, if not to concomitant illness.

Age Factors↗
PubMed2002

Perioperative changes in plasma antithrombin activity and platelet counts in patients undergoing gynecologic surgery.

The relationships among perioperative changes in plasma antithrombin (AT) activity, platelet counts, and clinical risk factors for postoperative thromboembolism has not been studied extensively in gynecologic patients. AT activity and platelet counts were determined preoperatively and on postoperative days 1 and 7 in 74 patients who underwent gynecologic surgery. The relationships between each clinical risk factor for postoperative thromboembolism and the decrease in AT activity and platelet count were analyzed using a univariate logistic regression model. No clinically significant thromboembolism occurred in any patient. AT activity and platelet counts decreased significantly on postoperative day 1 and exceeded preoperative levels on day 7. Postoperative patients with malignancy were more likely to exhibit decreased AT activity. AT activity decreased significantly with increases in operating time and blood loss. Known risk factors for postoperative thromboembolism did not appear to be associated with postoperative decreases in platelet counts. Transient hyperconsumption of AT and platelets occurs immediately after gynecologic surgery. Surgery-induced AT deficiency may contribute to postoperative thromboembolism in patients with long operating times and significant blood loss.

Adult↗
PubMed2003

Bowel preparation for gynecological surgery.

Bowel preparation is an established practice before abdominal surgery. Most surgeons would use both antibiotic prophylaxis and mechanical bowel preparation (MBP) before bowel surgery. In the literature, however, there is no evidence to support the use of MBP before elective colorectal surgery. Some randomized studies and a meta-analysis report a significantly higher incidence of wound infection in patients receiving MBP versus no bowel preparation. As to gynecological surgery, data are scanty, and there is a single randomized study reporting no advantage of MBP over no bowel preparation. Based on these evidences, the routine use of MBP should be reconsidered both in general and gynecological surgery.

Antibiotic Prophylaxis↗
PubMedDate not supplied

Effect of preoperative epidural morphine administration on desflurane requirements during gynecologic surgery.

BACKGROUND AND OBJECTIVES: The goal of this study is to examine the influence of epidural morphine on the end-tidal desflurane concentration titrated to maintain the bispectal index (BIS) values between 40 and 60 during gynecologic surgery. METHODS: Forty patients undergoing transabdominal hysterectomy under general anesthesia were randomly and prospectively assigned to 1 of 2 study groups: group saline (group S) and group morphine (group M). After placing an epidural catheter at L3-4 or L4-5, patients received either 10 mL of saline or 4 mg of morphine in 10 mL of saline approximately 60 minutes before anesthesia induction. Anesthesia maintenance was provided with desflurane and nitrous oxide in oxygen with a ratio of 2:1 by an anesthesiologist blinded to the group. Measurements included BIS value, end tidal desflurane concentration, heart rate, and blood pressure before surgery and every 10 minutes during surgery. RESULTS: Although there was a tendency to slightly lower end-tidal desflurane concentrations in the morphine group, this difference did not reach statistical significance at any time. In the morphine group, the heart rate was lower than in the saline group at 20, 30, 40, and 50 minutes of surgery (P < .05). BIS values were similar throughout surgery. CONCLUSIONS: Preoperative administration of epidural morphine does not reduce desflurane requirements in patients undergoing gynecologic surgery.

Adult↗