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PubMed2002

Long-term results of primary avulsion of posterior urethral valves using a Fogarty balloon catheter.

PURPOSE: Posterior urethral valves are the most common cause of bladder outlet obstruction in infancy and cause renal failure in 25% to 30% of these children before adolescence. Transurethral ablation under direct vision is the most commonly used method of treatment for posterior urethral valves. Since 1987 we have used a Fogarty balloon catheter for primary avulsion of the posterior urethral valves in our patients. We evaluate the long-term results of this technique. MATERIALS AND METHODS: During 14 years (1987 to 2001) 35 consecutive patients with posterior urethral valves underwent primary valve avulsion using a Fogarty balloon catheter. In 21 patients diagnosis was made prenatally, while the remaining 14 patients (6 newborns and 8 children with median age of 6 months) presented with urinary tract infection and renal failure. Vesicoureteral reflux was present in 22 (63%) of the 35 patients involving 34 renal units. Primary valve avulsion was performed using a 4Fr Fogarty balloon catheter under fluoroscopic control in all patients. Postoperative voiding cystourethrography was done 2 weeks after valve avulsion. RESULTS: None of the patients demonstrated any evidence of periurethral extravasation during the procedure. Postoperative voiding cystourethrography showed effective relief of valvular obstruction and good urethral drainage in 34 patients. In the remaining patient residual valve required transurethral ablation under direct vision. Vesicoureteral reflux resolved spontaneously in 12 of the 22 (54%) patients (20 renal units) and after an antireflux procedure in 4 (7 units). Two patients (3 renal units) are on antibiotic prophylaxis and 4 underwent nephroureterectomy for nonfunctioning dysplastic kidneys. At followup (1 to 14 years) all patients demonstrated a good urinary stream with no evidence of urethral stricture. Renal function did not improve in 5 (14%) of the 35 patients, 1 of whom has already undergone renal transplantation and another is awaiting transplantation. CONCLUSIONS: Fogarty balloon catheter technique is a simple, safe and effective alternative to primary endoscopic transurethral ablation of posterior urethral valves.

Adolescent↗

PubMed2001

Anterior spinal cord injury with preserved neurogenic 'motor' evoked potentials.

OBJECTIVE: To describe two cases in which intraoperative monitoring of neurogenic 'motor' evoked potentials (NMEPs) did not identify a spinal cord injury that resulted in paraplegia. METHODS: Bilateral tibial nerve somatosensory evoked potential (SEP) and NMEP testing was performed in two patients during spinal deformity corrective surgery using standard stimulation and recording parameters. These potentials were obtained repetitively throughout the primary procedures and were performed again during a subsequent procedure that took place after the discovery of paraplegia. RESULTS: SEP and NMEP signals were preserved in both patients and no adverse events were identified during the initial procedures. Postoperatively, paraplegia was identified immediately upon recovery from anesthesia and preserved posterior column function was apparent on clinical exam. In the procedures following the discovery of paraplegia, SEP and NMEP signals remained comparable with signals elicited in the initial surgeries. CONCLUSIONS: Based on these cases and previously published experimental evidence, we conclude that while 'NMEPs' remain a useful second test of spinal cord function, they are not reliable indicators of motor tract function. An alternate term, such as 'spinally-elicited peripheral nerve responses' should be used.

Adult↗

PubMed1991

Complications of third molar surgery among university students.

The authors analyzed complications during and after 145 consecutive operative removals of mandibular third molars performed on 109 healthy university students in Finland. The operations were all performed by the same oral surgeon under similar conditions and with similar postoperative procedures. The rate of intraoperative complications was 9%. All complications could be taken care of during the operations, and all the postoperative complications were reversible. Swelling was the most common postoperative complication and was related to the length and difficulty of the operation. Trismus at the control visit (6th postoperative day) was also related to the length of the operation. Mandibular lateral movement was more restricted to the nonoperated than to the operated side. Alveolitis sicca dolorosa (ASD) was diagnosed as true ASD in 5% of the cases and as nonspecific ASD in 15% of the cases.

Adult↗

PubMed1977

Evaluation of the use of freeze-dried skin allografts in the treatment of human mucogingival problems.

The purpose of this investigation was to evaluate the clinical responses to freeze-dried skin allografts when used to correct mucogingival problems in humans. FDS was obtained by the NMRI Tissue Bank after processing by standard procedures. The recipient sites were prepared using the standard partial thickness dissection with apical periosteal separation. Rehydrated FDS was sutured into place to completely cover the recipient sites. Routine postoperative procedures were performed. Evaluations were made by means of calibrated periodontal probe measurements, Kodachromes, and radiographs preoperatively and up to 12 months postoperatively. Fourteen patients received 24 FDS allografts over a total of 56 tooth sites. All treated teeth showed a substantial increase (greater than 2 mm) in the width of the zone of keratinized gingiva at all postoperative time periods (2.88 +/- 1.57 mm at 12 months). Other findings included a mean gain of attachment of 0.40 +/- 1.08 mm, a mean decrease in recession of 0.12 +/- 0.91 mm, and mean decrease in pocket depth of 0.33 +/- 0.53 mm. Patient comfort was good, and there were no untoward sequelae, even in patients receiving multiple grafts. This study indicates that FDS allografts are an acceptable and beneficial material for treatment of mucogingival problems in humans.

Evaluation Studies as Topic↗

PubMed2002

Preincisional bupivacaine in posttonsillectomy pain relief: a randomized prospective study.

OBJECTIVE: To determine the effect of preincisional bupivacaine hydrochloride infiltration on postoperative pain after tonsillectomy. DESIGN: Prospective, randomized, double-blind clinical trial. SETTING: A secondary/tertiary referral center in Christchurch, New Zealand. PATIENTS: A volunteer sample of 70 patients, aged 16 to 42 years, with recurrent tonsillitis. Seven patients were excluded. INTERVENTIONS: After randomization, one group received 5 mL of 0.5% bupivacaine hydrochloride in the peritonsillar space, with the patient under general anesthesia. The other group received 5 mL of isotonic sodium chloride solution, with the patient under general anesthesia. Both groups underwent surgery with a standardized surgical and anesthetic technique. MAIN OUTCOME MEASURES: Postoperative pain was assessed with a visual analog scale at 15 minutes and 1, 4, 12, 16, and 24 hours after the procedure. Postoperative analgesic requirement, length of admission, and antiemetic requirement were also assessed. RESULTS: No statistical difference was found between the 2 groups for postoperative pain by means of the visual analog scale at any time interval, nor was any statistical difference found for the other variables measured. A trend toward less pain in the immediate postoperative period in the group receiving bupivacaine was noted. CONCLUSION: No statistically significant benefit is found for use of preincisional bupivacaine in tonsillectomy.

Adolescent↗

PubMed2006

Allergic fungal sinusitis in children.

BACKGROUND: Allergic fungal sinusitis (AFS) has been characterized in adults presenting with chronic sinusitis. Rare reports allude to a similar disease in children. OBJECTIVE: To characterize the features of AFS in children. METHODS: Children referred to otolaryngology clinics at Arkansas and LeBonheur Children's Hospitals for chronic sinusitis during a 12-year period were studied. This retrospective analysis reviews the following: clinical presentation, laboratory evaluations, radiographic and pathologic findings, and surgical intervention. Twenty patients (age range, 7-18 years; mean age, 12.5 years; median age, 16 years) met previously published criteria for AFS. Thirteen patients were male and 7 were female. Thirteen were African American and 7 were white. RESULTS: Presentation at diagnosis included the following: atopy (n = 20), nasal symptoms (n = 20), recurrent sinusitis (n = 18), nasal polyps (n = 18), recurrent headaches (n = 12), asthma (n = 11), proptosis (n = 10), and ocular symptoms (n = 10). All had radiographic evidence of sinusitis and allergy to fungal organisms. IgE levels were elevated in 8 of 9 patients, and 10 of 15 patients had eosinophilia. Surgical specimens demonstrated allergic mucin (n = 11), Charcot-Leyden crystals (n = 2), hyphae or fungal debris (n = 9), and fungal growth (n = 17). All patients underwent endoscopic sinus surgery, with 11 requiring multiple surgical procedures. Postoperatively, 19 patients received intranasal and oral steroids, and all had nasal saline washes. Eleven patients (9 who had undergone multiple surgical procedures) were treated with immunotherapy. Relapse was seen in 55% of patients at 1 year of follow-up. CONCLUSION: AFS presents with a higher incidence of proptosis in children when compared with adults. Typically, AFS occurs in atopic children with refractory sinus disease, requiring a high index of suspicion for evaluation and aggressive treatment.

Adolescent↗

PubMed2006

Measures to prevent complications of distally based neurovascular sural flaps.

Several publications in recent years have proven unbroken popularity of superficial sural artery flaps for the coverage of defects of the lower leg and proximal foot. However, complications are being discussed rarely. The realistic complication rate is up to 59%, given corresponding comorbidities, risk factors, or performance errors. Twelve distally based neurovascular sural flaps were used for reconstruction of heel, ankle, and lower-leg defects between 2003 and 2005. The following pre- and postoperative procedures were performed as a routine: An additional arteriography was done preoperatively to prove the patency of the peroneal artery. Acoustic Doppler ultrasound was used to identify the lesser saphenous vein and the concomitant vessels (perforators of the peroneal artery) of the sural nerve. An enlarged skin paddle with a tail of skin over the pedicle at the point of rotation was harvested intraoperatively to take pressure off the vessels and facilitate primary closure. Postoperatively, external fixation provides strict immobilization of the affected leg. Following these measures, no flap loss was observed in the presented series, and only few minor complications occurred.

Adolescent↗

PubMed1992

Ethmoidectomy decompression for the treatment of Graves' optic neuropathy.

When orbital decompression becomes necessary in Graves' optic neuropathy, medial wall decompression is a necessary component of the decompression procedure. The ethmoidectomy approach allows more direct visualization of the posterior ethmoids and sphenoids to effect maximum decompression. This is particularly important in cases in which computed tomography shows the medial rectus muscle to be enlarged posteriorly in the orbit. The procedure provides excellent visualization of the medial rectus. As with any medial wall decompression procedure, postoperative restriction of horizontal motility is a frequent complication, often necessitating more than one subsequent operation. The authors describe their experience with the procedure in 25 patients with Graves' optic neuropathy.

Adult↗

PubMed2006

Treatment of dens fracture in adults: A report of thirty-two cases.

Thirty-two adult patients with dens fractures (30 type II and 2 type III) were treated from 1983 to 2002 at the authors' institutions. The age of the patients ranged from 23 to 58 years. The postoperative follow-up period ranged from 1 to 10 years. The objective of this retrospective study was to evaluate the effectiveness of the osteosynthesis after screw fixation and postoperative bracing. In the 32 cases, 19 patients underwent single screw and 13 underwent double screw fixation. Postoperatively, light head halter traction was applied with the patients in bed for 1 to 4 weeks followed by a halo-vest for 8 to 14 weeks. Fractures healed in 9 weeks on average. There were no cases of delayed union. The overall results were excellent in 26 cases (81.3%), good in 5 (15.6%), and fair in 1 (3.1%) patient (who had a type Il fracture). There were no difference in dens union patterns between those receiving one-screw and two-screw fixation, and there were no complications during or after the operative procedure. Postoperatively there were no restriction of motion in the neck and no residual neck pain. Direct osteosynthesis of the fractured dens with screws is an effective procedure for unstable type II and III fracture of the dens. Postoperative external immobilization with a cervical brace seems to be an important contributing factor to the equal fusion rates in both groups of patients.

Adult↗

PubMed1994

The pectoralis major myocutaneous flap in reconstructive head and neck surgery revisited: a recent experience.

Although the pectoralis major myocutaneous flap (PMMF) has proved to be a reliable method of reconstruction for the head and neck surgeon, the current emphasis in tissue replacement has shifted to microvascular free-tissue transfer. This has prompted us to review retrospectively all PMMFs performed for reconstruction following head and neck cancer resection at the University of Connecticut Health Center over a recent four-year period. A total of 24 flaps were utilized consecutively in 23 patients, following a variety of ablative procedures. Postoperative complications occurred in 14 of the 24 flaps (59%), and 11 of the 14 patients who experienced postoperative complications had received previous radiation therapy. Seven of the complications were felt to be major because they prolonged hospital stay, or they required secondary reconstructive procedures (four of seven cases). There were no instances of total flap failure. In our experience, the PMMF has proved to be reliable and useful in a variety of head and neck reconstructive procedures. We conclude that the PMMF remains an excellent option for repair of defects resulting from head and neck cancer resection.

Adult↗

PubMed1998

Limbal cell autograft transplantation for severe ocular surface disorders.

BACKGROUND: Limbal cell transplantation may improve the visual outcome after chemical trauma and ocular surface diseases. METHODS: Nine eyes of nine consecutive patients (eight males and one female, age 9-60 years), underwent limbal autograft transplantation (LAUT). In five cases LAUT was done for severe chemical burns in the acute stage (group 1). In four patients with old chemical trauma LAUT was performed years after the trauma (group 2). Penetrating keratoplasty (PKP) was carried out within 6 months after LAUT in three patients of group 2. Preoperatively, the visual acuity in all the patients except one was counting fingers. Postoperatively, patients were treated with topical antibiotics, topical corticosteroids and oral steroids. Oral cyclosporin was used after penetrating keratoplasty. RESULTS: No complications were observed during the surgical procedure. Postoperatively, the epithelialization was complete between days 7 and 12. The inflammatory response subsided within 3 months and the stromal neovascularization decreased. Visual acuity improved in all the nine cases, ranging from 6/6 to 6/30. The decreased visual acuity was due to corneal haze, scars and vascularization. Following PKP, the three grafts remained clear with intact epithelium. No complications were observed during the follow-up period from 7 to 60 months. CONCLUSIONS: Limbal cell transplantation is an efficacious procedure for rehabilitation of visual acuity after severe chemical trauma.

Acids↗

PubMed1983

Removal of common bile duct stones after emergency drainage of the gall bladder.

Because of the hazards associated with cholecystectomy and choledochotomy in acute biliary tract disease, cholecystostomy may be performed as an emergency procedure. Postoperative tube cholangiography in such patients may show calculi in the biliary ducts. The percutaneous extraction of these calculi prior to cholecystectomy simplifies the elective surgical procedure.

Cholangiography↗

PubMed2006

Small intestinal submucosa (SIS) graft urethroplasty: short-term results.

OBJECTIVE: We evaluated the use of small intestinal submucosa (SIS) graft in penile and bulbar urethroplasties. METHODS: From 2003 to 2004, 20 men (mean age, 41 yr) with anterior urethral strictures underwent urethroplasty using SIS (COOK) as an inlay or onlay patch graft. Stricture location was penile in 1 patient, bulbar in 16, and penile-bulbar in 3. Average stricture and graft lengths were 3 and 5.7 cm, respectively. A dorsal inlay graft was performed in 14 cases, ventral onlay graft in 1, and dorsal inlay plus ventral onlay in 5. Clinical outcome was considered successful if no postoperative procedure was needed. RESULTS: Mean follow-up period was 21 mo (range: 13-35 mo). Seventeen cases (85%) were successful and 3 (15%) were failures. No postoperative complications were related to the use of heterologous graft material, such as infection or rejection. Sixteen successes (94%) were bulbar repairs and one a penile-bulbar repair, with stricture and graft average lengths 2.6 and 5.35 cm, respectively. Cystoscopy at 3 mo revealed adequate calibre lumens, but SIS grafted areas were not completely replaced by urothelium. The three failures were penile and penile-bulbar urethral repairs with stricture and graft average lengths of 5.7 and 7.7 cm, respectively. Recurrences showed fibrous tissue involving the grafted area with extension into the penile and bulbar urethra. CONCLUSIONS: In our short-term results, SIS seems to be a versatile material that may have a role in select urethral reconstructions. Longer follow-up and further investigations in select patients are needed before widespread use is advocated.

Adult↗

PubMed2005

Comparing results of residents and attending surgeons to determine whether laparoscopic colectomy is safe.

BACKGROUND: This study was undertaken to compare the technical success and outcomes of laparoscopic colectomy performed by resident surgeons (RS) and attending surgeons (AS). METHODS: A review of 451 consecutive laparoscopic colectomies performed by 2 surgeons either with or without a general surgery resident. Data reviewed included demographics, diagnoses, operative data, and outcomes. Comparison was made between patients operated on by RS under attending surgeon supervision, and patients operated on by AS alone. RESULTS: Of 451 patients, 324 were operated on by RS and 127 by AS. The mean age and preoperative diagnoses were similar between groups. Operative time was significantly longer in the RS group (155 minutes vs. 128 minutes, P < .05). Blood loss was slightly higher in RS groups but was not statistically significant (191 mL vs. 174 mL, P = .31). The incidence of conversion to an open procedure, postoperative complications, and length of stay were similar between groups. CONCLUSIONS: Supervised RS can safely perform laparoscopic colectomy with results similar to AS. RS take longer to perform the procedure than AS.

Adult↗

PubMed1998

Does N-acetylcysteine improve hemodynamics and graft function in liver transplantation?

The release of toxic oxidative free radicals induced by ischemia and reperfusion may jeopardize liver graft function. N-acetylcysteine (NAC) has shown protective effects on hypothermic and warm ischemia reperfusion liver injury in animals. NAC improves hemodynamics and survival rates in patients with fulminant hepatic failure. The aim of this study was to investigate whether intraoperative treatment with NAC would improve hemodynamics and postoperative graft function in liver transplantation. Sixty patients with chronic end-stage liver disease were included in a prospective randomized placebo-controlled study. NAC or the same volume of 5% glucose was started during the anhepatic phase. Hemodynamic data and calculated tissue oxygenation parameters were compared throughout the procedure. Postoperative graft function was assessed by measurements of aminotransferases, prothrombin time, and monoethylglycinexylidide test over the 3 first postoperative days. Patient demographics were similar before the infusion of NAC or glucose. Hemodynamic parameters, oxygen consumption, oxygen delivery, oxygen extraction ratio, and lactates were not different throughout the procedure. One hour after the revascularization of the hepatic artery, the oxygen extraction ratio by the liver was similar (17% +/- 7.6% v 17% +/- 6.2%) in both groups. Postoperative graft function was comparable within the 3 first postoperative days. This study failed to show any beneficial effect of the intraoperative administration of NAC on hemodynamics and graft function in liver transplantation in patients with chronic liver disease.

Acetylcysteine↗

PubMed1994

Hysteroscopic metroplasty.

Between February 1990 and June 1993 40 patients underwent hysteroscopic metroplasty for septate uterus. Twenty-six patients had previous miscarriages (65%) and fourteen were infertile (35%). Hysteroscopic section of uterine septa was performed by means of Hamou resectoscope with sorbitol-mannitol solution as distending medium. Surgical outcome was excellent without intraoperative and postoperative morbidity. After 40-60 days the uterine cavity was completely epithelialized without intrauterine adhesions in all the cases. One patient had incomplete septum section that required a second procedure. Postoperative reproductive outcome was evaluated in 26 patients: the cumulative pregnancy and birth rate was 73% and 86%, respectively. Five patients delivered by cesarean section (39%). In the infertile group the pregnancy and birth rate was much lower (44% and 75%, respectively) than in previous miscarriage group (88% and 91%, respectively). Infertile patients do not seem to be cured by hysteroscopic metroplasty; however, in these cases the endoscopic operation should be performed, because it may prevent subsequent miscarriage. Hysteroscopic metroplasty by means of Hamou resectoscope is a very successful, quick, simple and safe procedure that may replace abdominal metroplasty.

Abortion, Spontaneous↗

PubMed1997

Intraoperative ultrasound-guided transhepatic lithotomy. A new alternative surgical procedure for the management of residual hepatic stones.

BACKGROUND: The high incidence of residual stones has been a major problem in the treatment of hepatolithiasis. Although various imaging techniques have been used to locate the stones, and many different postoperative procedures have been used as remedial modalities to remove the residual calculi, results have been far from satisfactory. OBJECTIVES: To remove obstinate hepatic stones and reduce the incidence of residual calculi. DESIGN: Prospective clinical trial. SETTING: Medical university-affiliated hospital. PATIENTS AND METHODS: Ten patients who had residual intrahepatic stones after conventional operative procedures underwent intraoperative ultrasound (IOUS)-guided transhepatic lithotomy between July 1988 and July 1995. This surgical technique includes accurately locating stones with IOUS, choosing a surgical approach path under the guidance of IOUS while avoiding critical blood vessels and uninvolved biliary tracts, dividing hepatic parenchyma to the involved biliary ducts, and removing the obstinate calculi using the real-time image of IOUS, which is able to monitor the movement of the lithotomy instruments without interruption. MAIN OUTCOME MEASURES: Clinical practical value of IOUS-guided transhepatic lithotomy in the treatment of residual hepatic stones. RESULTS: Complete removal of the stones was achieved in all 10 patients. There were no severe complications or mortality at a median follow-up of 39 months. CONCLUSIONS: IOUS-guided transhepatic lithotomy can greatly decrease the incidence of residual hepatic stones. It is accurate and safe. As a new surgical procedure, IOUS-guided transhepatic lithotomy should be an alternative modality in the management of hepatolithiasis, although the long-term benefits still need to be observed.

Adult↗

PubMed2002

Off-pump coronary artery bypass surgery--initial experience in Gdansk: a brief review.

BACKGROUND: Before the introduction of cardiopulmonary bypass (CPB), coronary artery bypass grafting (CABG) procedures were performed on a beating heart. In 1967, Kolessov first reported "off-pump" revascularization of the left anterior descending artery (LAD). This technique was later abandoned when the use of cardioplegia and the heart-lung machine allowed a motionless and bloodless operative field. This study reports our initial clinical experience in off-pump coronary bypass surgery performed at the Department of Cardiac Surgery of the Medical University of Gdansk, Poland. METHODS: This study enrolled all consecutive patients who were operated on at our institution without CPB between January 1998 and December 2001. Patients were selected for the off-pump procedure individually by the surgeon. Demographics, operative procedures, postoperative mortality, morbidity, and early outcomes were analyzed. The observation period included 30 postoperative days. RESULTS: An average of 1.8 grafts per patient were completed. Conversion to CPB was required in 4.1% of patients. Complete revascularization was attained in 91% of the procedures. Surgical mortality was 1.3% and perioperative myocardial infarction was reported in 2.4%. CONCLUSIONS: In selected patients, off-pump CABG may be used as a suitable and safe alternative to conventional on-pump coronary surgery and permits complete revascularization with comparable short-term results.

Adult↗