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The ballottement of adipose tissue in the leg has certain typical post-operative consequences: enlarged bruises, deep haematoma, canalicular haematoma, and sub-cutaneous induration are frequent and difficult to prevent using compression, which is often ineffective.
BACKGROUND: Splenectomy has been associated with increased morbidity after gastrectomy for gastric cancer. Resection of proximal versus distal tumors is associated with a higher morbidity. Because splenectomy is more commonly performed in resection of proximal tumors, these analyses may be biased. The aim of this study was to describe the association of splenectomy with complications in patients undergoing resection of proximal gastric and gastroesophageal junction (GEJ) cancers. METHODS: From July 1985 to August 2001, 335 patients underwent resection of proximal gastric or GEJ (type II and III) cancers. Clinical and pathologic factors were retrieved from a prospective database. RESULTS: Overall morbidity was 59% (infectious complications, 41%; noninfectious complications, 36%), and mortality was 4.5%. Splenectomy was associated with a higher rate of infectious complications (57% vs. 33%; P <.01) but not of noninfectious complications (39% vs. 34%; not significant) or mortality (4% vs. 5%; not significant). Splenectomy was also associated with a higher rate of infectious complications on multivariate analysis (hazard ratio, 2.4; P <.01). CONCLUSIONS: Morbidity after resection of proximal gastric and GEJ cancer is significant; splenectomy is associated with increased morbidity, but not mortality, in these patients. Because these complications can be managed without an increase in mortality, splenectomy should be performed when indicated by the extent of the tumor.
Most complications after inguinal hernia repair are transitory and do not affect the functional outcome. On the other hand, some last longer or become permanent and will be a daily problem for the patient as well as the attending physician. Most prevalent and difficult to treat is pain. Bruising and hematoma are banal and usually resolved spontaneously. Infection can prolong care and promote recurrence. Recurrence seems less frequent after mesh repair, whether by traditional or laparoscopic surgery. Potential complications specific to laparoscopic hernia repair, rare but sometimes severe, must be weighed against the benefits expected by the patient. The patient must be duly informed of the risks and advantages of each technique, whether traditional, laparoscopic, with or without prosthetic material.
The use of prosthetic meshes in incisional hernias repairs is now very attractive, particularly for wide fascial defects; nevertheless the presence of a foreign body and placement technique may be responsible for complications sometimes leading to failure. To evaluate technical problems and complications in incisional hernia surgery the authors reviewed their 5 year experience in 70 patients; 39 mesh repairs and 31 direct sutures of the abdominal wall were performed. Local complications (fistulas, wound hematoma or infections) were more frequent in the former group; PTFE meshes showed a lower resistance to infections, particularly in diabetics, and in three patients partial or total removal was mandatory. Prosthetic meshes showed a marked reduction of recurrences in incisional hernia surgery, but their use leads to more local complications than direct repair; the authors believe that mesh placement must be evaluated for every single patient and not used as a routine procedure.
Application of thermometry, polarography and liquid crystal technique for evaluation of microcirculation in the maxillofacial area in patients receiving combined treatment for cancer of the said site aids assessment of the viability of tissues and, thus, planning reconstructive surgery.
Experience in prediction of surgical outcomes is summarized. Preliminary results of elective treatment of various surgical diseases are reviewed. Over the last 14 years some theoretical problems of prediction (surgical risk) were solved by the authors and decision making in critical situations is illustrated. Surgical outcomes in 500 patients operated on from 1972 to 2002 (30 years) were analyzed depending on a number of factors--age, severity of combined diseases and surgery traumaticity. It is noted that qualitative assessment of surgical risk is not enough for decision on the method of surgical treatment. It is necessary to create adequate and simple classification of criteria of postoperative prognosis in elective surgery able to realize quantitative assessment of surgical risk.
OBJECTIVE: The purpose of this study was to evaluate the significance of diabetes mellitus as a risk factor for postoperative major morbidity and mortality after surgery for critical lower limb ischemia (CLI). SUBJECTS: A national vascular registry (Finnvasc)-based survey included 5709 operations for CLI from 1991 through 1999. Of these operations, 2508 (44%) were performed on diabetics. Tissue loss was the indication for surgery in 77% of diabetics and in 52% of nondiabetics. The proportion of femorodistal bypasses was 43% in diabetics and 24% in nondiabetics, whereas the proportion of reconstructions for aortofemoral arterial occlusive disease was 16% in diabetics and 34% in nondiabetics. RESULTS: Thirty-day mortality was 4.5% in diabetics and 3.4% in nondiabetics ( P = .05). The rate for early below-knee amputation was 6.5% in diabetics and 3.3% in nondiabetics ( P < .001). Independent factors for postoperative death were aortofemoral reconstruction (odds ratio [OR], 4.0), preoperative cardiac risk factor (OR, 3.1), primary surgery (OR, 2.0), renal insufficiency (OR, 1.9), urgent surgery (OR, 1.7), and age (OR, 1.3). Diabetes was an independent risk factor for postoperative below-knee amputation (OR, 1.7), cardiac complications (OR, 1.5), and superficial wound infection (OR, 1.3). There was an inverse association between diabetes and acute graft occlusion (OR, 0.8). Independent risk factors for early postoperative mortality in diabetes were aortofemoral reconstruction (OR, 2.5), urgent surgery (OR, 2.0), male gender (OR, 2.0), renal insufficiency (OR, 1.9), cardiac risk factor (OR, 1.7), and age (OR, 1.4). In nondiabetics independent risk factors for early postoperative mortality were aortofemoral reconstruction (OR, 4.5), cardiac risk factor (OR, 3.6), primary surgery (OR, 2.6), and extra-anatomic bypass (OR, 2.3). CONCLUSIONS: Diabetes was not an independent risk factor for early postoperative mortality in CLI as there was an increased morbidity in diabetics associated with old age, male gender, known coronary artery disease, and renal insufficiency, as well as urgent surgery. As diabetics have increased proclivity for these factors, special attention needs to be paid to their preoperative assessments.
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8,738 cases of acute appendicitis, all operated on emergency, have been examined considering their total mortality (3 cases), and their post-operative complications (2.04%), secondary especially to the septic character of this disease. Diagnosis and treatment of acute appendicitis still require a particular attention and care.
OBJECTIVE: The purpose of this study was to examine the association between intensive care unit nurse (ICU) staffing and the likelihood of complications for patients undergoing abdominal aortic surgery. DESIGN: The study is a retrospective review of hospital discharge data linked to data on ICU organizational characteristics. SETTING: Research took place in ICUs in non-federal, short-stay hospitals in Maryland. PATIENTS: Study included 2606 patients undergoing abdominal aortic surgery in Maryland between January 1994 and December 1996. OUTCOME MEASURES: Outcome measures included cardiac, respiratory, and other complications. RESULTS: Cardiac complications occurred in 13% of patients, respiratory complications occurred in 30%, and other complications occurred in 8% of patients. Multiple logistic regression revealed a statistically significant increased likelihood of respiratory complications (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.50-3.60) in abdominal aortic surgery patients cared for in ICUs with low- versus high-intensity nurse staffing, an increased likelihood of cardiac complications (OR, 1.78; CI, 1.16-2.72) and other complications (OR, 1.74; CI, 1.15-2.63) in ICUs with medium- versus high-intensity nurse staffing, after controlling for patient and organizational characteristics. CONCLUSIONS: Within the range of ICU nurse staffing levels present in Maryland hospitals, decreased nurse staffing was significantly associated with an increased risk of complications in patients undergoing abdominal aortic surgery.
The authors give an account of twelve cases of inflammatory acute abdominal attacks which complicated the course after abdominal operations. Although rare complications are involved, they are very serious and to a certain extent instructive. In the conclusion the authors summarize some diagnostic, therapeutic and assessment rules for these uncommon situations.
Oral thyroid preparations, which were first administered in 1892 to treat myxedema, are the oldest effective endocrine medications. Since thyroxin became available, such drugs have been dispensed without a physician's prescription and have come to be mistakenly referred to as "diet pills". Self-prescription of such products can cause changes in thyroid function, with systemic repercussions. We report the case of a woman who took thyroid extracts, among other diet drugs to enhance weight loss without medical supervision. The patient failed to report taking such drugs during the preanesthetic visit. Interrupting therapy several days before surgery produced a state of hypothyroidism that led to marked postoperative hemodynamic changes necessitating transfer to the intensive care unit.
A case of acute renal failure following radical nephrectomy for hypernephroma in a 72-year-old man is presented. It is postulated that this was a direct result of vascular weakness from preoperation treatment of the overdistended vessels by repeated venepuncture over too short a period, with resultant loss of vascular tone.
The Authors report a case of internal strangulated hernia in a patient operated of colposacropexy for vaginal prolapse following total hysterectomy. The diagnosis was formularized by abdominal TC consenting the surgical treatment by bowel loop resection completed by pelvic floor reconstruction.
The results of the treatment of 79 patients with an associated cranio-cerebral trauma complicated by shock and blood loss were analyzed. All the patients were operated urgently. A complex of measures which enabled the lethality to be reduced by 17,3% is described.
To examine the intra- and postoperative morbidity of radical retropubic prostatectomy we analyzed the first 320 consecutive patients with clinical stages T1b, T2a-c and negative lymph nodes by frozen section. Patient age varied from 42 to 75 years (mean 63.5 years). In 74.7% the estimated blood loss was less than 1500 ml. With a preoperative autologous blood collection program the intraoperative blood requirement for homologous blood units was only 15%. Intraoperative complications included rectal injuries with vesical rectal fistulas in 2.5% and ureteral injuries in 1.6%. Within the perioperative period the mortality rate was 0.9%. At 12 months after surgery 199 of 218 men (90.9%) were continent, 5.1% had minimal urinary incontinence, and only 4.6% had urinary incontinence grade III. Postoperatively, PSA (prostate-specific antigen) decreased to < 0.5% in 90.4% of the patients after radical prostatectomy. At 12 months after operation PSA was < 0.5 ng/ml in 83.4%. We conclude that radical retropubic prostatectomy is a safe procedure for the curative treatment of localized prostate cancer.
The authors report 3 cases of subdural tension pneumocephalus developed after surgery for subdural chronic hematomas. The mechanisms involved in the pathogenesis of this complication are discussed; the importance of the computed tomography in the assessment of the subdural tension pneumocephalus is stressed. Surgery is always indicated in cases of increased tension of the air collection and generally resolves the neurological deficits.
OBJECTIVE: To analysis various complications of 30 patients of breast augmentation by injected polyacrylamide hydrogel and discuss the treatment through periareolar incision. METHODS: All patients were classified according to the different complications. Open suction technique and partial mastectomies via periareolar incisions were performed in all patients, Only one patient had immediately breast reconstruction with prosthesis, five patients received secondarily breast prostheses implantation via a axillary incision. RESULT: All the symptoms were relieved after remove of polyacrylamide hydrogel. CONCLUSIONS: Polyacrylamide hydrogel should be prohibited for injected breast augmentation at present. A double-blinded randomized clinical study, controlled animal experiments and a large sample questionnaire survey for complications are necessary. The periareolar approach is valuable technique and can remove polyacrylamide hydrogel as completely as possible.