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With selected examples from general surgery, a better statistical elaboration of patient's data by means of operation and complication classification is demonstrated. The use of an operation and a complication key is presented. The advantage of such a classification key in documentation is the possibility of maintaining an accurate yearly review of all therapeutical methods in surgery.
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Treatment of osteitis after surgical removal of the third molar of the mandible is still a clinical problem. A total of 140 patients undergoing operations for removal of an impacted third molar of the mandible, were included in a double-blind study. Placebo or antibiotics - azidocillin, erythromycin, clindamycin and doxycycline - were given to the patients preoperatively and for the following 7 days. The concentrations in serum, alveolar serum and mandibular bone were measured and the postoperative courses - pain, trismus, swelling and wound-healing - were recorded. No correlation was obtained between the antibiotic concentration and the postoperative complaints, except in the azidocillin group on day 2, in which fewer complaints were noticed in patients with high concentrations of the drug at the time of operations. The 80 patients in the antibiotic groups responded significantly better with respect to wound-healing than the 60 patients in the placebo groups. Only 15 operations lasted more than 15 min and the three of them which subsequently resulted in alveolitis were in the placebo groups. Antibiotics significantly reduced pain on day 7 postoperatively. In general, no statistically significant differences in trismus and swelling could be demonstrated between the patient groups. However, there was a significant difference between the placebo and doxycycline groups with respect to swelling (day 2 postoperative, P < 0.01; day 5 postoperative, P < 0.05). Thus systemically administered antibiotics offered only slight advantages in routine operations of impacted third mandibular molars, but could decrease the rate of infections after traumatic operations.
The paper presents 78 patients with stenosis of the middle thoracic segment of the esophagus. The substitute, being pedunculated intestinal graft, was brought to the neck through the retrosternal space. Early post-operative complications occurred in 8.9% of patients. Post-operative mortality rate was 7.6%. The most dangerous complication after esophageal plastic surgery is blood supply insufficiency. It was observed in 2 cases. Other complications included anastomotic leaks and respiratory distress syndrome. The authors emphasize that frequency of post-operative complications and mortality are related with the patient general condition and extent of the surgery.
It was established that in patients with perforative pyloroduodenal ulcer by the moment of operation there appear considerable changes in the immune system responsible for the development of pyo-inflammatory processes in 29% of the patients. Clinical results of the action of the CO2 laser ray on the visceral, parietal peritoneum and the laparotomy wound are described in patients with perforative pyloroduodenal ulcer. Especially favourable effect of the therapeutic correction of the immune system and laser ray during operation on the postoperative course is noted.
A retrospective review of the early complications of primary cleft lip and palate surgery in one Plastic Surgery Unit was conducted and the results are presented. Out of 164 primary procedures performed there was an overall complication rate of 26.2%. The life-threatening complications were all related to the respiratory system and all but one of these occurred within 2 days of operation.
A personal computer program to monitor surgical wound infections and other complications in orthopedics was developed. Internationally accepted definitions were used. The program was tested in four Danish orthopedic wards. The test period was from 1 January 1988 to 30 June 1989. Results from four wards consisting of 4,346 wounds in 3,570 patients are presented. The overall superficial wound infection rate was 2.4%, deep wound infection rate was 0.9%, other infection rate was 3.1%, and other complications were developed in 4.3% of the cases. In contrast to previous computer systems presented, this system also registers other nosocomial infections, and other complications. We found the system easy to use, and during the period, the overall registration rate was over ninety percent. If a registration system is introduced in the ward, a combined system which registers all infections and complications is preferable, instead of a simple wound infection system.
A relatively simple technically and effective own method of corrective operation of sella floor in cases of cerebrospinal fluid rhinorrhoea after transsphenoid operations for pituitary tumours is presented. This complication developed in 12 cases in a group of 720 patients operated on in the years 1973-1990. The described method was applied in 9 cases.
In 144 pull-through-operations performed for anorectal-atresia, following complications were observed: pneumonia 11%, sepsis 8.3%, peritonitis 5%, bowel obstruction 5%, osteomyelitis 1%, retraction of the pulled-through colon 4%, anal stenosis 16%, secondary megacolon 9%, fistula relapse 8%, mucosal prolapse 4%. Recto-urethral, recto-vesical- and recto-vaginal fistula relapses are managed by interposition of the gracile muscle. Anal stenoses and secondary megacolon are prevented by a sufficiently long postoperative bougienage.
Several medical complications can occur after scoliosis surgery in children and adolescents. New surgical techniques have allowed greater degrees of scoliosis correction but have also increased the possibility of postsurgical deficit due to their greater aggressivity. We analyzed the early postsurgical complications of scoliosis surgery in a pediatric intensive care unit over a 10-year period. Seventy-six surgical procedures were performed. Of these, no complications occurred in 55 (73%). Chest X-ray revealed pulmonary atelectasia in 8 patients (10%) and pleural effusion in 7 patients (9%). Symptoms and signs of infection related to surgery were observed in only 6 children (8%). The absence of severe medical complications may be related to new surgical techniques and an experienced team.
Excimer laser photorefractive keratectomy has become an increasingly popular surgical treatment for the correction of myopia. Unfortunately, no surgical technique can be entirely without complications. This article discusses the problems encountered following PRK for myopia in two main sections: those primarily refractive or optical in nature and those causing medical problems.
Of 342 patients operated on for gastroduodenal perforative ulcer the complications have occurred in 63 (18.4%) and a progressive peritonitis in particular--in 45 (71.4%). In 4 (2.8%) of patients a peritonitis progress was noted after truncal vagotomy and ulcer excision conduction without the infection-toxical shock signs.
We studied the utility of electron beam computed tomography as a screening test for the cardiovascular risk of elective vascular surgery. In 45 patients undergoing principally carotid and aortic surgical procedures, coronary artery calcification was prevalent and severe, and related to the clinically predicted cardiovascular risk of the procedure. However, only the clinically predicted surgical risk, and not coronary artery calcification, was related to the incidence of perioperative cardiovascular complications.
Lung or lobe torsion is a rare condition that must be included in the differential diagnosis when a partial or complete shadow is detected on the lung. We report a case of this rare complication after chest surgery. The bedside radiograph provided initial evidence of torsion. CT verified the diagnosis of lower lobe torsion. Prompt recognition and intervention is imperative in order to save the affected lung.
Functions of the digestive tract were studied in 46 patients by an original method worked out by the authors. Its diagnostic and prognostic significance is shown.
Augmentation mammoplasty is one of the most popular and frequently performed aesthetic operations. The implants are not, however, without complications; and many have been reported in order to this surgical procedure: hematoma, infection, seroma, capsular contracture, rupture ... Current surgical practices and modern implants used for breast augmentation produce fewer complications than procedures and devices of the past. The aim of this work is to index most common post operative breast complications. The prevention and the treatment procedure of these complications are also reported. A good knowledge of all these points seems to be essential to improve the quality of the final results and patients satisfaction.
From 1. 1. 1971--30. 6. 1977 (6.5 years) 4,169 aseptic orthopaedic operations were performed in the Orthopädische Universitätsklinik Düsseldorf. 42 complications of wound healing have been observed (1%)9 Without an ultrasteril operationbox it is also possible to reduce the complications of wound healing in orthopaedic surgery. It is important to know the principles of asepsis and antisepsis, the method of our preoperative preparation of patients is described; the indication of prophylaxis of chemotherapeutic agents should be severe.
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