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At least 145 records · Page 8Linked to original sources
PubMed1981

Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) in the evaluation of suspected pancreatic carcinoma: diagnostic limitations and contemporary roles.

The accuracy of ERCP and PTC in the diagnosis of pancreatic carcinoma was evaluated in a series of 376 and 112 patients, respectively. ERCP had a sensitivity of 94% and a specificity of 97%; PTC had a sensitivity of 100% and a specificity of 96%. Prior to the introduction of CT, these highly accurate examinations were the first major diagnostic procedures performed in patients with suspected pancreatic carcinoma. CT has had a significant impact on the role of ERCP and PTC and has replaced them as the initial procedure of choice. The current indications for ERCP and PTC were evaluated in a series of 211 patients with suspected pancreatic disease who were studied initially by CT. ERCP is now used to evaluate patients in whom CT is normal, equivocal, or technically unsatisfactory. PTC is used as a preoperative procedure for precise definition of biliary anatomy or for percutaneous placement of a palliative biliary drainage catheter.

Biopsy↗
PubMed1975

Role of preoperative administration of bleomycin and radiation in the treatment of esophageal cancer.

The preoperative use of Bleomycin (BLM) alone or combined with irradiation in the treatment of esophageal cancer was evaluated in 58 patients who underwent surgical removal of the lesion for the past three and a half years. Histologic study showed such preoperative treatment is effective in inducing favorable changes in neoplastic cells in 69 per cent (40/58) of the primary lesions and in a significant number of involved lymph nodes of the second or the third groups. The study clearly suggests that preoperative Bleomycin administration combined with irradiation may be an useful adjunct preoperative procedure in esophageal cancer.

Adult↗
PubMedDate not supplied

[Usefulness of clinical, radiologic, and endoscopic studies in chronic diseases of the terminal ileum: analysis of 36 cases].

With the purpose of defining which is the most frequent chronic pathology of the terminal ileum in a reference center (INNSZ), and establish the diagnostic accuracy of the preoperative procedures used, 36 resection specimens were reviewed histopathologically. The diseases found in decreasing frequency were: Crohn's disease, tuberculosis, carcinoids, lymphomas, endometriosis and leiomyomas. Seventy-seven percent of the cases were benign and the rest malignant. The number of cases in which the preoperative diagnosis was right or included among the differential diagnosis was as follows: clinical study 44%, radiological study 48%, endoscopical study 32% and histological study by means of endoscopic biopsy 20%. The most frequent differential diagnosis were Crohn's disease, tuberculosis and intestinal lymphoma. It is concluded that chronic disease of the ileum represents frequently a diagnostic problem due to their clinical, endoscopical and radiological similarities which may only be solved by histological analysis of the surgical specimens.

Biopsy↗
PubMed2003

Preoperative chemoradiation for locally advanced rectal adenocarcinoma-the University of Florida experience.

To evaluate the efficacy of preoperative radiotherapy alone or combine with chemotherapy. Between 1975 to 1997, 318 patients with locally advanced rectal adenocarcinomas were treated with preoperative radiation therapy. Between 1991 and 1997, approximately 60% of patients received fluorouracil (5-FU)-based adjuvant chemotherapy. Patients treated since 1991 had improved downstaging compared with those treated prior to 1991. Patients treated between 1991 and 1997 were also more likely to undergo a sphincter preserving surgical procedure. Preoperative chemoradiation probably results in improved downstaging and survival compared with preoperative irradiation alone.

Adenocarcinoma↗
PubMed2003

Management of intraoperative complications associated with autogenous patellar tendon graft anterior cruciate ligament reconstruction.

With the increasing number of anterior cruciate ligament (ACL) reconstructions being performed each year in the United States, sound surgical technique and preoperative planning are essential to decrease complications. Most intraoperative complications associated with ACL surgery are preventable with adequate planning and a reproducible surgical technique. When an autogenous bone-patellar tendon-bone graft is used for ACL reconstruction, pitfalls may occur at each step during the surgical procedure--preoperative assessment, graft harvest, notch preparation, tunnel preparation, graft passage and fixation, and rehabilitation. An array of options should be available for fixation of a patellar tendon graft, as well as alternative graft sources and graft preparation techniques.

Anterior Cruciate Ligament↗
PubMed1996

Results following secondary intraocular lens implantation in children.

BACKGROUND: Placement of a secondary intraocular lens (IOL) in a child may be considered in children with congenital monocular cataracts who have had complete opacities removed early in life and who later become contact lens intolerant, in eyes that have received trauma which precluded placement of a primary IOL, and in young adults who have bilateral aphakia who become resistant to use of contact lenses or spectacles. METHODS: Clinical records of all children in our practice who received a secondary IOL between January 1988 and December 1994 were reviewed. Indications, biometry, type of procedures, preoperative and postoperative acuity, refractive error, binocular status, and complications were studied. RESULTS: During the 7-year period, 242 cataract operations were performed. Fifty-nine eyes received a lens implant, and 28 of these were secondary implants. There was a mean interval between the initial cataract operation and the procedure for the secondary implant of 77 months. The mean follow-up was 35 months (range, 3 to 71) for the 28 eyes that received a secondary implant. Two received anterior chamber implants. Eight eyes had insufficient capsular support for an IOL. Six implants were placed in the posterior chamber and required suture fixation to the sclera. Twenty of 28 eyes had a measurable improvement in visual acuity. Only 1 eye had a decrease in visual acuity of 2 lines. Fifteen patients (54%) had a final refraction within 1.50 diopters of the fellow eye, and 75% were within 3.00 diopters. During the follow-up period, 2 eyes developed glaucoma. One had a transient pressure elevation, and the second has required 2 filtration procedures. Three patients required a Nd: YAG capsulotomy. Six patients demonstrated Worth fusion at distance and near, but only 3 patients demonstrated 200 seconds of arc or better stereo acuity. CONCLUSION: Placement of contemporary-style, secondary intraocular lenses in children and young adults appears to provide a safe and effective alternative for correction of aphakia in children who become contact lens or spectacle-intolerant.

Adolescent↗
PubMed1995

Preoperative factors of prognostic significance in gastric cancer.

This study was undertaken to investigate the ability of local anatomical and primary histological features of gastric cancers, as well as DNA analysis, to predict prognosis. Using multivariate analysis, results indicate that location of a tumor in the gastric cardia, poor differentiation, involvement of adjacent organs, and aneuploidy are all independent predictors of survival. All of the factors studied can be determined by endoscopic procedures preoperatively on patients with gastric cancers and could be helpful in selecting some patients for perioperative adjunctive therapies.

Adenocarcinoma↗
PubMed2000

Myocardial ischemia detected by transesophageal echocardiography in a patient undergoing peripheral vascular surgery.

Prevention and early treatment of myocardial ischemia remain among the primary goals of the anesthesiologist taking care of high-risk patients, such as those undergoing vascular surgery. Guidelines have been published to assist in directing preoperative evaluation and optimization of cardiovascular status. Although perioperative monitoring allows early detection of ischemic events, all monitors have limitations that must be understood before they can be used effectively. We present a case of severe intraoperative myocardial dysfunction detected only by transesophageal echocardiography in a patient undergoing a peripheral vascular procedure. Preoperative and intraoperative management is also discussed.

Aged↗
PubMed2004

Treatment of severe chronic venous insufficiency using the subfascial endoscopic perforator vein procedure.

BACKGROUND: Before 1985, corrective surgical procedures for patients with chronic venous insufficiency and venous ulcers were performed using long incisions through diseased skin and subcutaneous tissues. The procedure, involving ligation of incompetent perforator veins, known as "the Linton operation," often was complicated by wound infections and poor healing. This changed in 1985 when G. Hauer demonstrated a new surgical technique for direct visual identification of the incompetent perforator veins using an endoscope in the subfascial space. This seminal contribution marked the advent of subfascial endoscopic perforator vein surgery (SEPS). METHODS: From 1996 to 2004, the authors group prospectively collected data on 110 patients with chronic venous insufficiency who underwent a SEPS procedure. Preoperative assessment of the limb's vascular status consisted of color-flow duplex ultrasound imaging and ascending and descending phlebography to locate vein valve incompetence, along with venous mapping. The ages of the patients ranged from 42 to 82 years (mean, 60 years). A total of 128 limbs underwent the SEPS procedure in the cohort of 110 patients. According to CEAP classification for venous limb disease, 60 limbs belonged to group C5 (skin changes, pigmentation, venous eczema, lipodermatosclerosis, healed ulcer) and 68limbs to group C6 (skin changes and active ulceration). RESULTS: The 110 patients underwent 128 SEPS procedures without significant morbidity. Of the 68 limbs in class C6, 54 showed ulcer healing within the follow-up period of 12 weeks. The remaining 14 limbs in class C6 achieved ulcer healing within 24 weeks. In this latter group, 10 patients had venous ulcers larger than 4 cm in diameter. These patients underwent a split-thickness skin graft at the time the SEPS procedure was performed. The grafts remained healed during a 2-year follow-up period. CONCLUSIONS: This study demonstrated the effectiveness of the SEPS procedure when incorporated into the overall treatment strategy for patients with chronic venous insufficiency. Minimal postoperative complications accompanied by ulcer healing and relief of lower extremity symptoms were achieved for all the patients, underscoring the important role of incompetent perforator veins in the formation of chronic venous insufficiency.

Adult↗
PubMedDate not supplied

Influence of preoperative transpulmonary gradient on late mortality after orthotopic heart transplantation.

We reviewed the transpulmonary gradient, pulmonary arterial systolic pressure, pulmonary vascular resistance (Wood units), and pulmonary vascular resistance index (Wood units X Body surface area), recorded preoperatively in 109 recipients aged 44.6 +/- 13.5 (mean +/- SD) years who underwent orthotopic heart transplantation between March 1984 and March 1988, to identify which measure of pulmonary hypertension most accurately predicts poor outcome after orthotopic heart transplantation. These recipients were followed up as many as 57 (24.7 +/- 14.5) months after their transplant procedure. Preoperative hemodynamic values were as follows: transpulmonary gradient, 10.4 +/- 4.7 mm Hg; pulmonary artery systolic pressure, 53.6 +/- 14.8 mm Hg; pulmonary vascular resistance, 2.7 +/- 1.8 Wood units; pulmonary vascular resistance index, 4.9 +/- 2.7. Nineteen recipients died within 1 year after orthotopic heart transplantation. Causes of death were acute rejection (8), chronic rejection (1), infection (2), nonspecific orthotopic heart transplant failure (4), bowel ischemia (1), pancreatitis (1), lymphoma (1), and liver failure (1). Preoperative pulmonary arterial systolic pressure, pulmonary vascular resistance, and pulmonary vascular resistance index were not predictive of 1-month, 6-month, or 1-year mortality. One-month mortality rates of orthotopic heart transplant recipients with transpulmonary gradient greater than or equal to 12 mm Hg and of those with transpulmonary gradient less than 12 mm Hg were not significantly different (11% vs 3%; p = 0.12). The 6-month mortality rate of orthotopic heart transplant recipients with transpulmonary gradient greater than or equal to 12 mm Hg, however, was five times greater than that of orthotopic heart transplant recipients with transpulmonary gradient less than 12 mm Hg (24% vs 5%; p = 0.003), and 12-month mortality of orthotopic heart transplant recipients with transpulmonary gradient greater than or equal to 12 mm Hg was increased sevenfold when compared with that of orthotopic heart transplant recipients with transpulmonary gradient less than 12 mm Hg (36% vs 5%; p = 0.0005). These results suggest that presently used measures of pulmonary hypertension do not predict mortality in the first month after orthotopic heart transplantation, but that elevated preoperative transpulmonary gradient is associated with a significant increase in mortality at 6 and 12 months after orthotopic heart transplantation. Prospective randomized trials are needed to determined whether extended preload and afterload reduction before and/or after transplant will favorably influence long-term prognosis of orthotopic heart transplant recipients with elevated preoperative transpulmonary gradient.

Adult↗
PubMed1998

[Meigs' syndrome: is it possible to make a preoperative diagnosis?].

Two cases of Meigs' syndrome are reported, one following an ovarian fibrothecoma and the other an ovarian fibroma. The benign condition was suggested prior to surgery in one of the two patients because of a solid tumor of the ovary without peritoneal implant on CT-scan, and no malignant cells in ascitic fluid and on a fine needle biopsy. To differentiate this benign pathology from a malignant process enables to avoid useless surgical procedures. Preoperative evaluation, including serum CA 125 level, ultrasound examination and CT-scan, allows rarely to suggest the Meigs' syndrome. Nevertheless, this syndrome may be suspected when faced with an important pleural effusion, a very elevated CA-125 serum level, a negative cytologic examination of the ascitic effusion and no peritoneal implant on CT-scan.

Female↗
PubMed1997

Role of fine-needle aspiration cytology in the preoperative evaluation of smooth muscle tumors.

A preliminary study was undertaken to assess the feasibility and the diagnostic role of fine-needle aspiration cytology (FNAC) in the preoperative evaluation of eight uterine smooth muscle tumors manifesting as single large masses with signs of growth. Percutaneous FNAC was performed under echographic control with a 22-gauge needle and the material was stained according to conventional techniques. Histology of surgically resected specimens was available for final diagnosis and comparative analysis in all the cases, including five leiomyomas (LM), one smooth muscle tumor of uncertain malignant potential (TUMP), and two low-grade leiomyosarcomas (LMS). Cellularity, as indicated by the density (crowding) of nuclei reflecting the amount of cytoplasmic volume, and the cohesiveness of the tissue fragments in the smears appeared to be the most important diagnostic parameters in the distinction between LM and LMS. LM usually showed few scattered poorly cellular fragments of highly cohesive tapering cells without nuclear crowding and with abundant cytoplasm. LMS usually showed a large number of single cells and fragments of loosely arranged tapering cells with nuclear enlargement and crowding and ill-defined scanty cytoplasm. Borderline forms such as TUMP were hardly distinguishable from LMS and LM. FNAC appears to be a feasible preoperative procedure in uterine smooth muscle tumors and may play a diagnostic role, especially in distinguishing frankly benign from overtly malignant forms.

Biopsy, Needle↗
PubMed2006

Endoscopic radial artery harvest for coronary artery bypass surgery.

BACKGROUND/PURPOSE: Coronary artery bypass grafting (CABG) provides better long-term patency than percutaneous intervention in patients with significant coronary artery disease. The radial artery is the second most common arterial conduit used for CABG in Western countries. However, radial artery harvesting necessitates a large surgical wound and has gained few patients' acceptance in subtropical areas. This study investigated the use of the minimally invasive approach of endoscopic radial artery harvest for CABG, and the surgical results at the harvest site. METHODS: An endoscopic harvest program for radial arteries was implemented in this hospital in September 2003. During the first 12 months of the program until September 2004, 122 patients underwent the procedure. Preoperative evaluation included Allen's test and the modified palmar arch perfusion test. The age of patients ranged from 32 to 88 years old. Patients were excluded from participation if they had undergone recent transradial catheterization, had end-stage renal disease or documented peripheral artery occlusive disease. The VasoView system was utilized for the procedure. Details of the surgical techniques used were recorded and analyzed. RESULTS: Using the endoscopic technique, 122 radial arteries were harvested successfully. The mean resting length of the harvested radial artery was 15.7 cm. No obvious arterial injury was visually confirmed. All radial arteries were used for CABG, except for two which were noted to have atherosclerotic plaques causing stenoses. Forty-seven patients presented with mild numbness over the dorsum of the thumb base, which improved significantly during the 3-month follow-up. No arterial insufficiency in the forearms or hands was noted. CONCLUSION: Endoscopic harvest of the radial artery is technically demanding, but excellent results can be achieved. The endoscopic approach can provide suitable conduits in a less invasive way than the open harvest technique.

Adult↗
PubMed1996

Radiotherapy for stage T3b transitional cell carcinoma of the bladder.

The role of radiotherapy for the treatment of clinical stage T3b transitional cell carcinoma of the bladder is controversial. The options range from definitive radiotherapy alone, to preoperative radiotherapy and cystectomy, to chemotherapy and radiation for bladder preservation. Our data show that long-term local control after definitive radiotherapy is only 27% and that death attributable to local-regional failure in this setting is 43%. Thus, definitive radiotherapy is only used in patients who are considered poor candidates for surgical and chemotherapy procedures. Preoperative radiotherapy (PREOP) has been studied in a number of randomized series, all of which failed to establish an improvement in patient outcome over those treated with radical cystectomy alone (CYST). However, these studies are subject to criticism, mostly because of poor patient accrual and low numbers of patients available for the analyses. A retrospective review of patients treated at MD Anderson Cancer Center indicates that local control is superior with PREOP as compared with CYST. An analysis of the impact of local control on distant metastasis rates in patients treated with CYST showed that local control was an independent correlate of distant metastasis and survival. Thus, preoperative radiotherapy may be beneficial to patients with late-stage muscle-invasive bladder cancer by securing local control and reducing distant metastasis rates as a result. The success of bladder preservation for stage T3b patients rests with the ability to select patients with radiosensitive tumors. To this end, the immunohistochemical staining status of tumor p53 and pRB was investigated in patients treated with PREOP. Abnormal pRB expression was very strongly related to radiation response, whereas altered p53 expression was associated with high distant metastasis-free and overall survival rates. These two molecular markers were complementary and show promise in facilitating the selection of late-stage patients for bladder preservation.

Carcinoma, Transitional Cell↗
PubMed1986

Pharyngeal diverticula.

A series of 73 hypopharyngeal (Zenker's) diverticula is reported and the choice of treatment and technique of excision are discussed. The problems of excision include operation on an infected site with limited access but few patients are unfit for the procedure. Preoperatively the sac should be packed and the oesophagus stented. The side of approach is unimportant as the condition is essentially midline. Cricopharyngeal myotomy appears to reduce the recurrence rate, possibly by improving coordination of pharyngeal contraction and upper oesophageal relaxation. The use of electrocoagulation is not recommended as 20% of patients require repeated general anaesthesia and the procedure fails in 13%. For all but the smallest pouches, excision is the treatment of choice.

Aged↗
PubMedDate not supplied

Ross procedure for aortic insufficiency due to doubly committed subarterial ventricular septal defect in adults.

A 52-year-old female, with aortic insufficiency due to doubly committed subarterial ventricular septal defect (VSD) underwent a successful surgical repair by the Ross procedure. Preoperatively, she developed congestive heart failure because of less compliance to oral medication, raising concerns regarding life-threatening thromboembolism if she undergoes mechanical valve replacement. Despite the pulmonary autograft being defective, there were no difficulties in completing the surgery. The defect of pulmonary autograft and the VSD was closed by an expanded polytetrafluoroethylene patch. She tolerated the procedure well and now enjoys improved quality of life. We present a discussion of the indication of Ross procedure in the rare presentation of congenital heart disease, as well as several issues raised in this case.

Aortic Valve↗
PubMed1988

Thoracic disc herniation. Surgical treatment in 23 patients.

The authors' surgical procedure for the treatment of symptomatic thoracic disc herniation has consisted of total discectomy of the involved intervertebral disc, followed by intervertebral body fusion using autogenous iliac bone through an anterior approach. The authors prefer the extrapleural approach to the thoracic vertebrae because of simplified postoperative care with minimum surgical interference with respiratory function. During the past 16 years, 23 patients with symptomatic thoracic disc herniation have been treated by this procedure. Preoperatively all 23 patients presented with some measure of paraplegia, with difficulty in walking. Their clinical presentation was analyzed and diagnostic aids to the thoracic disc herniation by radiographic examinations were assessed. The radiographic abnormality of ossification of the yellow ligament (OYL) coinciding with the involved thoracic disc level was noted. The results in all 23 patients with this procedure were favorable. Based on the results of this series, this procedure is recommended for the treatment of symptomatic thoracic disc herniation.

Adult↗
PubMed1998

Helical CT and CT angiography for the identification of crossing vessels at the ureteropelvic junction.

In comparison with pyeloplasty, endourologic procedures for the treatment of ureteropelvic junction obstruction offer good success rates with less morbidity and a shorter hospitalization; however, studies have found lower success rates and increased complications in patients with crossing vessels. Conventional diagnostic angiography and intravenous urography have both been used to identify crossing vessels at the UPJ; but, a reliable, less invasive, less costly, and simpler preoperative procedure to identify crossing vessels is needed. Helical CT with CT angiography is a promising noninvasive technique for the identification of crossing vessels at the ureteropelvic junction, which can be used for surgical planning of endourologic treatment of UPJ obstruction.

Humans↗