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At least 1,297 records · Page 72Linked to original sources
PubMed1987

The reoperative potential of infrainguinal bypass: long-term limb and patient survival.

The present study reviews the fate of patients undergoing reoperation after failure of infrainguinal bypass grafts. During a 10-year period, 202 patients with failed distal bypass grafts had 389 infrainguinal reoperative procedures, an average of 1.9 reoperations per patient. Including the initial procedure and subsequent reoperations, a total of 591 operations were performed in this group. Secondary bypass was performed in 101 patients, a tertiary procedure in 51, a fourth bypass in 30, and more than four operations were required in 20 patients. Reoperation was performed to treat severe ischemia (rest pain, ulceration, or gangrene) in 377 of 389 cases (97%). Repetitive bypass was performed with autogenous vein in 21 cases (7.4%), composite grafts in 16 patients (5.6%), and polytetrafluoroethylene in 247 cases (87%). The remaining 105 reoperations were thrombectomy in 77 cases, thrombectomy plus distal angioplasty in 20 cases, and profundaplasty in eight cases. The distal anastomosis was to the popliteal artery in 14% of reoperative cases and to the tibial or peroneal artery in 59%. Mean follow-up for all patients was 70 months. Four operative deaths occurred in 389 reoperations (1.0%), and there were 35 late deaths. The cumulative life-table 5-year survival rate for all patients was 80%. The operative morbidity rate was 12.3%, including wound infection in 3.1% and hematoma in 6.4%. Sixty-seven cases required major amputation, below-knee in 48 (72%) and above-knee in 19 (28%). The 5-year limb salvage rate was 59%. Cumulative graft patency was 37% at 5 years. The 80% 5-year survival rate may reflect aggressive management of associated carotid and coronary artery disease. The demonstrated long survival indicates that recurrent ischemia after distal bypass failure requires attention. In this study, re-operation provided long-term limb salvage in most cases without significant compromise in patient safety or amputation level if amputation was required.

Amputation, Surgical↗
PubMed1985

Wedge resection as an alternative procedure for peripheral bronchogenic carcinoma in poor-risk patients.

Although lobectomy is the procedure of preference for patients with peripheral, clinical Stage I bronchogenic carcinomas, wedge resection of the tumor may be a satisfactory alternative in poor-risk patients. Between 1965 and 1982, 197 patients with peripheral bronchogenic carcinomas were operated upon. Clinical staging was established by radiography, bronchoscopy, and mediastinoscopy. Ninety-seven patients underwent lobectomies and 100 had wedge resections. The decision to perform the wedge resection was made preoperatively in the majority of cases based on the assessment of operative risks. Compared to lobectomy patients, those who had wedge resections were older (70.3 +/- 0.5 versus 64.9 +/- 0.5 years, p less than 0.001) and had a lower 1 second forced expiratory volume (1.56 +/- 0.03 versus 1.94 +/- 0.03 ml, p less than 0.001), a lower arterial oxygen tension (70.5 +/- 1.1 versus 75.6 +/- 1.2 mm Hg, p less than 0.01), and a higher arterial carbon dioxide tension (41.7 +/- 0.6 versus 38.7 +/- 0.3 mm Hg, p less than 0.001). Despite their compromised preoperative respiratory functional status, the wedge resection group had a 30 day operative mortality (3% versus 2.1%) and morbidity comparable to those of the lobectomy group. Actuarial life-table analysis indicates the cumulative survival rate at 2 years after operation to be virtually identical between wedge and lobectomy groups (72% versus 74%), and even at 6 years the differences in survival rates (69% versus 75%) were not statistically significant. We conclude, therefore, that by performing wedge resections in selected poor-risk patients, one may reduce the operative mortality and morbidity to an acceptable range without seriously compromising their long-term survival.

Aged↗
PubMed1993

[The importance of monitoring and correcting the hydromineral status in general anesthesia in children].

Specific physiological features of the child's organism necessitate a preoperative assessment of hydromineral and acidobasic status and its correction in order to reduce intraoperative complications and accelerate postoperative recovery. The analysis was carried out in children who were operated on in general anesthesia in the period of one year. Their hydromineral and acidobasic status was assessed. On the basis of the clinical picture and laboratory analyses we assessed the dehydration and metabolical changes and made the corrections preoperatively. Given are tables for the compensation of basic physiological liquid and electrolyte quantities, a guide for the assessment and the correction of the dehydration levels and the correction of metabolical changes. We also gave tables for the compensation of liquid during the operation in general anesthesia. In the conclusion we review basic principles in the preparation for an urgent operation in general anesthesia in relation to hydromineral and acidobasic status as well as the administration of liquid during the operation.

Adolescent↗
PubMed1988

Long-term results of tympanic membrane repair.

Long-term results of tympanic membrane repair were analyzed in 605 patients operated upon from 1970 to 1975. By survival life table analysis, 81% closure of perforations was found at 11 years, and only 74% of patients had normally healed tympanic membranes. Children less than 10 years of age and with anterior perforations healed more poorly. A second group of patients--all with anterior perforations operated upon from 1982 to 1984-showed autologous temporalis fascia to be superior to homograft dura as the graft material. Analysis of results also showed a 60% chance of perforation closure at revision operation. These results are believed to represent an accurate and realistic assessment of tympanic membrane repair by use of survival life table analysis.

Actuarial Analysis↗
PubMed2006

Task analysis of the preincision surgical period: an independent observer-based study of 1558 cases.

Intense production pressure has focused on the preincision period (from patient-on-table to incision) as an important component of overall operating room efficiency. We conducted a prospective study in which trained independent observers measured the performance of anesthesiologists, surgeons, and nursing staff to determine anesthesia release time (ART, patient-on-table until release for surgical preparation) and surgical preparation time (SPT, start surgical preparation to incision) and the factors, including delays, that affect their duration. We enrolled 1558 patients undergoing elective surgery in a tertiary medical center. The mean ART was 21 +/- 16 min. Mean SPT was 22 +/- 13 min, and mean case length was 207 +/- 123 min. Significant variation was seen in both ART (range, 1-115 min) and SPT (range, 1-130 min). Multivariate regression analysis revealed ASA physical status, age, level of resident training, invasive monitoring, case length, and case number in the room were all positive predictors of ART duration (P < 0.05). In contrast, gender, body mass index, number of anesthesia personnel concurrently in the room, and number of rooms covered per anesthesia attending were not predictors for ART (P > 0.05). Delays affected both ART and SPT and were encountered in 24.5% of all procedures (surgery 66.8%, anesthesiology 21.7%, and logistical 11.5%). For operating room scheduling purposes, we conclude that assigning a constant fixed duration for anesthetic induction is inappropriate and will result in creating erroneous administrative expectations.

Adult↗
PubMed1994

Twenty years after parietal cell vagotomy or selective vagotomy antrectomy for treatment of duodenal ulcer. Final report.

OBJECTIVE: This study was a prospective, randomized evaluation of parietal cell vagotomy (PCV) and selective vagotomy-antrectomy (SV-A) in the treatment of duodenal ulcer. BACKGROUND DATA: Operative treatment of duodenal ulcer is associated with mortality and mechanical and metabolic morbidity. At the time that surgeons appear to have succeeded in developing operations with low morbidity and mortality, the number of patients requiring elective operation has decreased partly because of the simultaneous, dramatic improvement in medical therapy. Nevertheless, surgical therapy still is important, especially in certain socioeconomic environments. METHODS: After a pilot study of PCV, 200 patients with duodenal ulcers were randomized to PCV or SV-A. One surgeon was responsible for the operations and follow-up studies. An attempt was made to evaluate all patients annually in the hospital. Gastric analyses were performed on each visit, for which the patient gave his/her consent. RESULTS: There was no operative mortality. The recurrence rate-by-life table analysis was less (p < 0.003) after SV-A than PCV. Dumping was greater (p < 0.001), and there was no difference in the frequency of diarrhea after SV-A compared with PCV. The percentage of patients with grades Visick I or Visick II was not different for the two operations, but more patients were graded Visick I after PCV than after SV-A. CONCLUSIONS: Selective vagotomy-antrectomy and parietal cell vagotomy are effective and safe operations, when used appropriately. Selective vagotomy-antrectomy is preferable for patients with pyloric and prepyloric ulcers and pyloric obstruction. Parietal cell vagotomy is the authors' choice for duodenal ulcer patients because of the occasional patient who becomes disabled by SV-A.

Duodenal Ulcer↗
PubMed1998

Risk assessment: a means for linking HACCP plans and public health.

HACCP plan adoption has greatly enhanced the food industry's ability to systematically design programs to ensure the microbiological safety of foods. Yet, this widening acceptance of the HACCP system has revealed several areas where its application is limited due to reliance on qualitative consideration of hazards and their control. In particular, HACCP planning is limited both conceptually and practically by its inability to quantify the potential combined influence of multiple control-point deviations and to relate the successful operation of a HACCP system to a measurable public-health impact. Recent advances in quantitative microbiological risk assessment appear to offer a means of overcoming these limitations. The integration of HACCP plans with the development of dynamic risk-assessment models offers a means for considering the entire farm-to-table continuum and for relating food-manufacturing operations to public health goals. Such capabilities may be critical to establishing equivalence among HACCP systems.

Food Handling↗
PubMed1995

Nonreamed interlocked intramedullary tibial nailing. One community's experience.

Forty-nine acute displaced tibial fractures (31 closed, 18 open: 5 Grade I, 7 Grade II, 4 Grade IIIA, and 2 Grade IIIB) were treated in 1 community with a standard operative protocol using a distractor without a fracture table, and an unreamed interlocked tibial nail. Forty-six fractures healed (94%). Complications included 3 nonunions (6%), 2 deep infections (4%), 9 delayed unions (18%), 4 angular malunions (8%), 2 rotatory malunions (4%), and 12 interlocking screws bent or broke (24%). Twenty-eight patients (57%) required at least 1 additional operation to obtain union, most commonly dynamization of a statically locked nail. The authors conclude that unreamed tibial nails provide adequate stabilization of displaced tibial fractures and can be used in the management of most open or closed tibial fractures. However, static locking is required in axially unstable fractures. Early dynamization or exchange nailing and bone grafting should be considered to hasten union and avoid screw failure. The distractor is an excellent adjunctive technique for reduction and alignment of tibial shaft fractures during intramedullary nailing.

Adolescent↗
PubMed1992

Descending thoracic aorta-to-iliofemoral artery bypass as an alternative to aortoiliac reconstruction.

During the last 3 decades subcutaneous extraanatomic bypass, despite its limited durability, has been the favored alternative to infrarenal aortofemoral bypass. Meanwhile, the descending thoracic aorta has been scarcely used as an inflow source for aortoiliac reconstruction. Over the past 8 years we performed 16 bypasses from the descending thoracic aorta to the iliofemoral vessels for occlusive disease. Our experience combined with that found in the English-language literature totaled 141 patients. In 79 patients (56%) the indication for surgery was failure or infection of an abdominal aortofemoral graft. Previous abdominal operations, sepsis, radiation therapy, the presence of abdominal stomas, or an unsuitable infrarenal aorta were the indications in the remaining cases. The combined operative mortality rate was 6.4%. The life-table primary graft patency was 98% at 1 year, 88% at 2 years, and 70.4% at 5 years. Bypass from the descending thoracic aorta to the iliofemoral artery uses an inflow source superior to other extraanatomic reconstructions, does not require aortic cross-clamping, avoids the abdominal cavity, and places the graft remote to the skin and intestine. The operative mortality and patency rates compare favorably to those of other extraanatomic or remedial aortic reconstructions. Descending thoracic aorta to iliofemoral artery bypass is a superb alternative to abdominal aortofemoral bypass, carries a low mortality rate, has an excellent short-term patency, and features unique characteristics for long-term durability.

Adult↗
PubMed1997

Treatment of frontal sinus osteoma using a craniofacial approach.

Osteoma is one of most common benign tumors of the nose and paranasal sinuses, with the frontal sinus being its most frequent location. It may be locally destructive and aggressive with possible intracranial complications. Osteoma of the frontal sinus comprises 57% of all osteomas in the paranasal sinuses. In 1939, Childrey reviewed 3,510 consecutive sinus radiographs taken for any reason and found an incidence of 0.43% of paranasal sinus osteomas. There are many operative approaches for frontal sinus osteomas, such as external frontoethmoidal approach and osteoplastic frontal sinusectomy, both with high recurrence rates. Those traditional operative methods cannot radically eradiate the osteoma grown in the posterior table of the frontal sinus. From July 1991 to June 1992, three patients with symptomatic frontal sinus osteomas were operated by a craniofacial approach. One patient is presented here in detail. A coronal incision is used and is found to be beneficial both in surgical exposure and in reconstruction with a calvarial bone graft. The patient has been followed for 3.5 years without osteoma recurrence.

Bone Neoplasms↗
PubMed1975

Palliation of tricuspid atresia. Potts-Smith, Glenn, and Blalock-Taussig shunts.

Aortopulmonary (Potts-Smith), subclavian-pulmonary (Blalock-Taussig), and cavopulmonary (Glenn) shunts are the commonly performed operations for palliation of tricuspid atresia. A total of 104 patients with tricuspid atresia have undergone these procedures, either alone or in combination over a 28-year-period at the Hospital for Sick Children, Toronto. Operative risk is high in the first six months of life (44%), reasonable after six months of age (7.4%), and low for reoperation (3.5%). Long-term palliation of the 75 survivors (mean follow-up, 8,5 years) is compared for the three operative groups and charted on an actuarial table. Potts shunt offers superior long-term palliation. Therefore, as an overall plan of management, a Potts shunt with restriction of its anastomotic growth is the initial procedure of choice. When the patient outgrows the Potts shunt, a Glenn anastomosis is constructed. Ideally, the combination of these two shunts will produce a balanced circulation offering excellent long-term palliation.

Adolescent↗
PubMed1993

Relationship between age and the time of surgery and prognosis after gastrectomy for gastric cancer.

We did a retrospective study to assess the influence of age on the prognosis in 1,537 patients with gastric cancer and who underwent gastrectomy. The patients were classified into 7 groups by age at the time of surgery, and the relative survival rates were calculated after correcting for each patient's sex, age, and the operative calendar year, based on the life table data for the general Japanese population. The overall prognoses in patients under age 30 and over age 80 years were poor (for ages under 30 years, 30-39, 40-49, 50-59, 60-69, 70-79, and over 80 years, the 5-year survival rates were 32.1%, 55.9%, 54.8%, 54.3%, 48.6%, 50.8%, and 31.5%, respectively). The poor prognoses in the youngest patients could be attributed to a high frequency of aggressive stage of the tumor. After curative gastrectomy, although the prognoses were excellent for every category in the first and second postoperative year, patients over age 80 years had a relatively poor prognosis after the third postoperative check-up. The poor prognoses in the oldest patients were attributed to the number of deaths due to other diseases. We conclude that for the very young or old subjects, age is a significant prognostic factor for those treated by gastrectomy for gastric cancer.

Adult↗
PubMed1992

Surgical experiences with giant intracranial aneurysms.

The common method of presentation of intracranial aneurysms is at the time of their rupture (with subarachnoid haemorrhage) or on the occasion of their compression of neighbouring structures. While giant aneurysms may occasionally present with subarachnoid haemorrhage, their more common methods of presentation are due to their space occupying and neighbourhood effects. Giant aneurysms are commonly defined as those with a diameter larger than 2.5 cm. Previously this diameter was assessed either by arteriography, so that size meant internal diameter, or by the displacement of surrounding structures, as for example, small perforating vessels, which could be attributed positively to the presence of a larger mass. Before CT scanning however, the factor of a very considerable larger aneurysm, partly occluded by clot could occasionally cause unexpected operative difficulty. The advent of CT scan and now especially MR imaging has made the prediction of the size of the aneurysm much easier and the extent of the intra-aneurysmal clot also clearly definable. This paper describes one surgeon's experience with 64 giant cerebral aneurysms operated on in the last 10 years (Table 1). It has emerged from this experience that the most satisfactory method of handling the lesion is to remove the intra-aneurysmal clot and clip the neck of the aneurysm, and the steps necessary to secure this laudable design from the burden of the paper.

Cerebral Angiography↗
PubMed2006

A new technique for bile duct reconstruction in liver transplantation.

Biliary complications are one of the most important problems in liver transplantation. Despite various refinements of surgical technique, liver transplantation is associated with significant numbers of biliary problems. In this article, we describe our novel "intraoperative transhepatic biliary catheter insertion" technique for biliary reconstruction in 29 patients, since November 2004 comparing results before and after its implementation. 5-F Kumpe catheter is inserted into the biliary system in two steps. The first is completed at the back table, and the second during the recipient operation. The grafts were from cadavers in 10 cases, with the remaining ones from living donors. Ten patients received whole-liver grafts, 11 received a right lobe, and eight received a left-lateral lobe or left lobe. The mean weight of the living donor grafts was 598 g (range = 270 to 975 g). The mean graft weight-to-body weight ratio in the living donor liver transplantations was 1.6% +/- 1.0% (range, 0.8% to 4.1%). Intraoperative transhepatic biliary catheter insertion was performed with a duct-to-duct anastomosis in 27 cases and with a Roux-en-Y hepaticojejunostomy in two cases. The only biliary complication was one case (3.4%) of bile leakage from the anastomotic site. This rate is significantly lower than that for duct-to-duct biliary reconstructions prior to the new catheter technique (13.0%; P < .05). This new technique of biliary reconstruction with intraoperative biliary catheter insertion has significantly reduced our biliary complication rate. Transhepatic biliary stenting prevents biliary complications and makes it simple to maintain percutaneous access in case such problems arise. However, further studies are needed to compare incidence rates of biliary complications when our novel technique is used versus other surgical techniques.

Bile Ducts↗
PubMed1985

Posterior capsulotomy in sulcus-fixated versus bag-fixated intraocular lenses in diabetic patients.

Forty-one diabetic patients who had modified J-loop lenses with ten-degree angulation implanted in the ciliary sulcus and 58 diabetic patients who had the same style lenses implanted in the capsular bag had posterior capsulotomy performed on the table or later at predetermined intervals. The operation was performed with a cystotome needle or with the Nd:YAG laser on the first postoperative day or later. The study indicates that the development of new or the worsening of old diabetic iris and retinal changes, as well as cystoid macular edema, were much less if the intraocular lens was implanted in the capsular bag, at least nine months elapsed between cataract surgery and capsule interruption, and topical indomethacin and topical steroid treatment was given preoperatively and postoperatively. There was little difference in diabetic progression between cystotome needle and YAG laser posterior capsulotomy.

Aged↗
PubMed2003

Therapeutic approaches to prion diseases.

Prion diseases are unique in that they comprise sporadic, genetic, and iatrogenically or environmentally acquired forms. When disease is acquired by peripheral route, neuroinvasion occurs via at least two different neural pathways (vague and splanchnic nerves) and is usually preceded by prion propagation in secondary lymphoid organs. Conversely, in the other etiologic forms, PrPSc formation occurs within, and is apparently limited to, the CNS. Longitudinal studies on experimental scrapie indicate that substantial neuropathologic changes (i.e., glial activation and nerve cell degeneration) already are present before the onset of symptoms and are topographically related to PrPSc deposits. Accordingly, any effective intervention should start during the preclinical stage of disease, and be aimed at preventing neuroinvasion or PrPSc propagation in the CNS. Unfortunately, no tests are available currently to detect presymptomatic individuals, except for carriers of pathogenic mutations of the PRNP gene. Inhibition of PrPSc formation can be achieved through (1) abrogation of PrPC synthesis or prevention of its transport to the cell surface; (2) stabilization of the PrPC structure to make its conformational change unfavorable; (3) sequestration of PrPSc; (4) reversion of PrPSc to a protease-sensitive form; or (5) interference with the interaction between PrPC, PrPSc, and other macromolecules that feature in the conversion process. The compounds that have some effectiveness in in vitro, cell culture, or animal models of prion disease seem to operate through one of these mechanisms (see Table 1); however, even the most effective drugs only work when administered at the time of infection or very short thereafter, and these conditions are incurable at present. The heterogeneity and complexity of the etiopathogenesis of prion diseases suggest that various strategies and a combination of several compounds with different modes of actions are likely necessary for prevention and treatment. Major efforts should be focused on the development of preclinical diagnostic tests in conjunction with immunization strategies for diseases acquired by peripheral route and identification of more effective compounds for the other etiological forms.

Animals↗
PubMed1995

Suggested set-up and layout of instruments and equipment for advanced operative laparoscopy.

Crucial elements that ensure the organization and smoothness of a laparoscopic procedure are clear communication among well-trained endoscopy team members, properly maintained equipment, and a sensible layout of the instruments. The team consists of the surgeon, surgical assistant, circulator, scrub nurse, laser nurse, and anesthesiologist. To promote continuity and interaction and to ensure a systematic, pleasant pace for laparoscopic procedures, the team should establish a specific routine, as well as set-up and layout of tables, equipment, and instruments. Key ingredients for advanced operative laparoscopy to be performed with optimum efficiency and effectiveness are the best organization and placement of the equipment, instrumentation, and team in a particular setting in the operating room.

Anesthesiology↗
PubMed2003

Worth continuing doing ex situ liver graft splitting? A single-center analysis.

Grafts for split liver transplantation can be prepared in situ during the retrieval operation, or ex situ on the back table. The in situ technique has theoretical advantages because it minimizes the cold ischemic time and allows excellent hemostasis at the cut surface. However, in situ liver division prolongs the retrieval procedure, may precipitate hemodynamic instability in the donor, and may cause logistical difficulties for some centers. This report is a single-center analysis comparing results of ex situ liver division (group I: 1992-97; and group II: 1998-2001) before and after a new protocol for liver graft division was introduced in our center. Eighty-nine split liver transplants (SLT) were reviewed retrospectively. Vascular complications were less common in group II (3.3% vs. 20%; p = 0.04), and 1-year graft survival increased from 59% to 78% (p = 0.03). Since 1998, 1-year graft survival of SLT has been similar to that of conventional liver graft transplantation in our center (78% and 74%, respectively). In conclusion, good results can be achieved from splitting livers ex situ and this procedure should be considered when the in situ technique is not feasible.

Adolescent↗