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At least 1,621 records · Page 90Linked to original sources
PubMed1993

Comparative vascular audit using the POSSUM scoring system.

Comparative audit using overall mortality and morbidity figures can be misleading as they do not take into account variations in surgical procedure and patient fitness. To examine these effects we have compared vascular surgery in two differing hospitals, during a similar 9-month period, using the POSSUM scoring system. In one unit, 255 patients underwent vascular surgery with an operative mortality of 9.4%, and morbidity of 37.3%. In the other unit, 89 patients underwent vascular procedures with an operative mortality of 20.2% and morbidity of 47.2%. At first sight there appear to be significant differences in operative outcome between the two units. However, analysis using the POSSUM system predicts a mortality rate of 10.2% for unit A and 20.2% for unit B (morbidity rates of 38.4% for unit A and 50.6% for unit B). Receiver operating curve (ROC) analysis demonstrated no significant difference between the two units (see Table III). POSSUM analysis may be of use in comparative audit.

England↗
PubMed1989

[Carotid endarterectomy].

Carotid endarterectomy was performed 77 times in 73 symptomatic patients. In 67 of them there had been 1 or more transient ischemic attacks (TIA), in 4 transient atypical symptoms, and in 2 mild persistent neurological deficits. After operation 1 died of a stroke and 1 had a nonfatal myocardial infarction. In 3.3% of 33 low-risk patients (Sundt's classes 1 and 2) there was mild postoperative neurological deficit. The rate of neurological complications was much higher in 40 high-risk patients (classes 2 and 3), including 5 with postoperative stroke. Followup averaged 21.5 months (longest 54 months), the 5-year survival (by extrapolation from a life table analysis curve) was 87%, and there was only 1 fatal stroke. Those who recovered from operation without complications had an 86% chance of having no further neurological problems.

Carotid Arteries↗
PubMed2001

Emergency surgery for obstructing colorectal cancers: a comparison between right-sided and left-sided lesions.

BACKGROUND: Fifteen to twenty percent of patients with primary colorectal cancers present with intestinal obstruction. Traditionally, different approaches have been used in the management of right-sided and left-sided colonic obstruction. Recently, single-stage resection with primary anastomosis in left colonic obstruction has been shown to have good results. The objective of this study was to compare the operative results of patients who had emergency operations for right-sided and left-sided obstructions from primary colorectal cancers. STUDY DESIGN: This is a retrospective study including 243 patients who underwent emergency operations for obstructing colorectal cancers from 1989 to 1997. Primary resection of the tumor-bearing segment followed by primary anastomosis was attempted when the conditions were feasible. The operative results of patients with right-sided tumors were compared with those of patients with left-sided tumors. RESULTS: One hundred seven patients had obstruction at or proximal to the splenic flexure (right-sided lesions), and 136 had lesions distal to the splenic flexure (left-sided lesions). The primary resection rate was 91.8%. Of the 223 patients with primary resection, primary anastomosis was possible in 197 patients. Among the 101 primary anastomoses in patients with left-sided obstruction, segmental resection with on-table lavage was performed in 75 patients and subtotal colectomy was performed in 26. The overall operative mortality rate was 9.4%, although that of the patients with primary resection and anastomosis was 8.1%. The anastomotic leakage rate for those with primary resection and anastomosis was 6.1%. There were no differences in the mortality or leakage rates between patients with right-sided and left-sided lesions (mortality: 7.3% versus 8.9%, p = 0.79; leakage: 5.2% versus 6.9%, p = 0.77). Colocolonic anastomosis did not show a significant difference in leakage rate when compared with ileocolonic anastomosis (6.1% versus 6.0%, p = 1.0). CONCLUSIONS: This study showed that primary resection and anastomosis for left-sided malignant obstruction, either by segmental resection with on-table lavage or subtotal colectomy, was not more hazardous than primary anastomosis for right-sided obstruction. The single-stage procedure should be the objective for the treatment of patients with obstructing colorectal cancers, except when patients are hemodynamically unstable during surgery or when the condition of the bowel is not optimal for primary anastomosis.

Adult↗
PubMed1998

A software program to calculate Goodman and Kruskal's gamma: a method to monitor surgical-site infection rates.

Several studies have described a need for a valid statistical methodology to facilitate interhospital and intrahospital infection rates for their operative procedures. Physician awareness of postoperative surgical-site infection rates has been demonstrated as an effective means to reduce infection rates in both high- and low-risk surgical patients. This article presents a new software program that allows for simple data entry and provides results including the gamma statistic, sample size, variance, standard error, and Z value and P value of the gamma result. This software also provides a data interpretation table, allowing infectious disease department physicians or staff to determine if a significant relation exists between operative procedure infection rates and patient risk factors.

Hospitals↗
PubMed1990

Primary nonfunction. Is there a contribution from the back table bath?

A persistent problem in orthotopic liver transplantation (OLT) is primary nonfunction (PNF) of the hepatic allograft. In most instances the cause of the failure is unknown. In an attempt to minimize these graft failure, modifications in the procurement and operative procedure have been investigated. One change in the procedure at the University of Nebraska Medical Center has been the monitoring of the temperature of the fluid in the back table bath during preparation of the donor liver. Our initial procedure involved creating an ice slurry of lactated Ringer's solution and ice slush in which the donor liver was then prepared. The temperature of this ice slurry was retrospectively found to be from -3 degrees C to -1 degrees C (group I). In this group there was a higher-than-expected incidence of PNF. To investigate whether the temperature of the back table bath influenced the incidence of PNF, beginning with transplant No. 42 the preparation of the back table bath was modified. The bath was created by adding a small amount of PlasmaLyte slush to 2 L of PlasmaLyte (group II). The temperature of the bath was maintained at 2-4 degrees C. Data were collected on 100 consecutive liver transplants. All transplants were performed using standard techniques, the operation for the two groups differing only as described above. Transaminase levels were followed as an index of the allograft function and were expected to begin to normalize within 2-3 days after transplantation. While both groups display this trend, transaminase levels in group II were significantly lower postoperatively than group I levels (P less than 0.05). Preoperative values were similar. There were 7 PNFs in group I; 0 in group II (P less than 0.005). We feel that the change in the back table procedure has positively influenced the function of the hepatic allografts, and we conclude that transplant centers need to monitor the temperature at which all allografts are stored and prepared, and the cognizant that this may influence the postoperative function of the transplanted liver.

Adult↗
PubMed2002

Outcome of endovascular abdominal aortic aneurysm repair in patients with conditions considered unfit for an open procedure: a report on the EUROSTAR experience.

OBJECTIVE: Endovascular abdominal aortic aneurysm repair (EAR) can be performed in patients whose conditions were previously considered unfit for conventional treatment of the aneurysm. However, because the life span in this category of patients often is limited because of serious comorbidity, the efficacy of EAR in prolonging life expectancy remains uncertain. This study involves the evaluation of preoperative risk classification and an assessment of the outcome of interventions. METHODS: The data of 3075 patients, who underwent operation in 101 European institutions that collaborated in the EUROSTAR Registry, were assessed. Only the patients who had been prospectively enrolled in the registry were used for this analysis. Patient characteristics, operative risk factors, procedural details, and types of devices were correlated with preoperative estimates of operative risk, early and late mortality, complications, and primary and secondary outcome success rates. In addition, the intermediate-term survival rates in patients with unfit conditions with EAR (observed series) and with conservative approaches of the aneurysms (rupture rates as derived from the literature) were compared in a mathematical model. RESULTS: Of the overall study group, 2525 patients were at "normal" risk for a surgical procedure (group A), 399 patients had conditions that were considered unfit for open surgery (group B), and 151 patients had conditions that were unfit for general anesthesia (group C). Both unfit categories had significantly more comorbid factors and larger aneurysms than did the patients in good medical condition. Differences were observed in comorbidities between the two high-risk categories, groups B and C. Factors that influenced the abdominal approach (previous laparotomies, hostile abdomen, and obesity) and local anatomic factors (eg, retroperitoneal fibrosis, inflammatory aneurysm, dissections, and enterostomy) were present in 19% of the patients with conditions that were unfit for open surgery and in only 1% of the category unfit for anesthesia. In contrast, severe pulmonary disease was present in 33% of the patients with conditions that were unfit for anesthesia as opposed to 11% of the patients with conditions that were unfit for open surgery. The early and late mortality rates were significantly higher in the unfit categories (groups B and C). Life table results showed a 3-year survival rate of 83% in patients at normal operative risk and of 68% in patients with unfit conditions (P =.0001). An independent correlation with late death was shown for the clinical classification into high-risk groups B and C, pulmonary disease, team experience of less than 60 procedures, and the diameter of the aneurysm. In groups B and C, aneurysms smaller than 6.0 cm were associated with a 2-year survival rate of 80% and larger aneurysms with a rate of 68% (P =.02). This difference was caused by an increased non-aneurysm-related mortality rate in the group with aneurysms of more than 6 cm. The mathematical model showed an advantage of EAR with regard to the reduction of the death rate in patients with unfit conditions as compared with no intervention after 1 year. The advantage of EAR was observed in patients with AAAs between 5 and 6 cm and with larger aneurysms. CONCLUSION: Early and late mortality rates were increased in patients with the preoperative clinical diagnosis "unfit for open surgery and general anesthesia" as compared with patients at "normal" operative risk. EAR appeared of potential benefit in patients with unfit conditions, regardless of the aneurysm diameter. The life expectancy of patients at high risk who are considered for EAR should be longer than 1 year before any realistic gain in life span can be anticipated.

Age Factors↗
PubMedDate not supplied

Early experience utilizing the in situ saphenous vein technique in 54 patients.

We have compared our early and late experience utilizing in situ saphenous vein bypass graft for lower extremity arterial occlusive disease in 54 patients who underwent in situ femoral to popliteal and distal bypass grafts between July of 1983 and February 1985. There were 3 femoral to above-knee popliteal bypasses, 27 femoral to below-knee popliteal bypass grafts, 12 femoral to anterior tibial dorsalis pedis bypass grafts, 10 femoral to posterior tibial bypass grafts and 2 femoral to peroneal in situ bypass grafts. The operative indications were progressive disabling claudication in 8 (15%) and limb salvage in 46 (85%). Eighty-nine percent of the limb salvage patients had 0-1 vessel runoff by arteriogram. Cumulative life table patency of the 54 in situ bypass grafts was 79% at 20 months. One hundred percent of the patients who were operated on for disabling claudication had patent grafts at 20 months. Seventy-eight percent of the limb salvage patients had patent grafts. Fourteen of the limb salvage patients required amputation and of these 14, 10 had patent grafts at the time of amputation. There were 8 deaths in the series. Our results demonstrate that a definite learning curve exists with this technique, however, once established, long-term patency and improved limb salvage statistics can be obtained.

Aged↗
PubMed2005

Bilateral dismembered laparoscopic pediatric pyeloplasty via a transperitoneal 4-port approach.

PURPOSE: Laparoscopic pyeloplasty is gaining acceptance for the treatment of ureteropelvic junction obstruction in the pediatric population, with success rates approaching those of traditional open pyeloplasty. We report our technique with a transperitoneal 4-port approach and positioning method, allowing bilateral laparoscopic dismembered pyeloplasty with 1 uninterrupted sterile field. MATERIALS AND METHODS: Two children were diagnosed with bilateral ureteropelvic junction obstruction. Following cystoscopic ureteral stent placement operative positioning was achieved with intravenous pressure infuser bags placed under each side of the patient and rotation of the table to a lateral decubitus position. Four-port transperitoneal access was used to perform bilateral dismembered pyeloplasty with interrupted 6-zero polyglactin sutures. RESULTS: Both patients had bilateral crossing vessels to the lower pole of the kidneys. Total operative time was 268 minutes and 284 minutes for the 8-year-old and the 14-year-old, respectively. The ureteral stents were removed separately at 6 and 8 weeks after repair with the patients under sedation. CONCLUSIONS: Bilateral laparoscopic pyeloplasty appears feasible for the pediatric patient.

Adolescent↗
PubMed1995

Value of computed tomography in patients with persistent vertigo after stapes surgery.

RATIONALE AND OBJECTIVES: The value of computed tomography was evaluated in 14 patients with persistent vertigo after otosclerosis operation. METHODS: High-resolution computed tomography was performed with 1-mm slice thickness and table feed in the axial and coronal planes. RESULTS: Computed tomography scans showed in 13 case findings that related to symptoms. An air bubble at the end of the prosthesis as a new, indirect sign of a perilymphatic fistula was found in 6 cases. An incorrect position of the stapes prostheses was diagnosed in 7 patients. One patient had recurrence of otosclerosis, and two others developed scarring around the prosthesis. In 1 case, an incus necrosis was found. Some patients showed two signs simultaneously. The computed tomography results were confirmed by retympanotomy in 12 cases. CONCLUSIONS: Computed tomography proved to be a valuable method in the diagnosis of persistent vertigo after otosclerosis operation. The indication for a repeat operation was facilitated by the use of computed tomography.

Follow-Up Studies↗
PubMed2004

Division of incompetent perforator veins and subfascial interposition of a polypropylene foil in post-thrombotic syndrome. Preliminary results.

AIM: The safety, feasibility and early efficacy of subfascial endoscopic perforator surgery was gradually accepted for patients who had severe chronic venous insufficiency but, in the literature, the recurrence rate of ulceration is about 10-40%, especially in patients with previous deep vein thrombosis (DVT). METHODS: From October 1998 to February 2002, 205 patients with 280 inferior leg ulcers were followed; 115 had venous ulcers but only 20 patients had chronic ulcers with previous DVT; 4 patients were excluded and only 16 patients (9 female, 7 male, mean age 61 years) with 18 chronic ulcers were included. These patients underwent sub-aponeurotic interruption of perforating veins with blind technique in association with subfascial interposition of a hand-made polypropylene foil. Eight of these patients had persistent non-healing ulcers at the time of surgery and 10 had chronic recurrent ulceration healed at the time of the surgical procedure. All patients were assessed clinically and with duplex scanning. RESULTS: The follow-up was done clinically and with eco-Doppler from 6 to 38 months with a mean follow up period of 23.2 months. The healing rate was 100%. The 2-year life table incidence of ulcer recurrence was 0%. Hospital stay ranged from 1-2 days, early operative complications included extensive ecchymosis in 1 patient, oedema in 3 patients. CONCLUSION: The division of perforating veins, with the subfascial support of a polypropylene foil give promising results in the treatment of venous ulcers in post-thrombotic syndrome with low morbidity and short hospital stay.

Angioscopy↗
PubMed2002

Arterioportal fistulae following segmental liver transplantation in a child.

We report a case of arterio-portal fistulae in a 12-month-old-child following a segmental liver transplantation. The fistula, probably the result of mass ligature of a vascular pedicle during back table allograft reduction, is to our knowledge the first such case reported. Diagnosed on the third post-operative day, the fistula was successfully managed with transcatheter coil embolization. The child is well and asymptomatic, 33 months after transplantation. In addition to those seen in whole organ transplantation, there are a few complications specifically related to segmental transplantation. These complications, although infrequent, are a direct consequence of the back table liver partition, as in the case herein reported.

Arteriovenous Fistula↗
PubMed1987

New generation shock wave lithotripsy.

Extracorporeal shock wave lithotripsy has been clinically successful for more than 5 years. Currently, several devices commonly termed second generation lithotriptors are under experimental or clinical trials. We present a prototype multifunctional urological table that uses a new mode of shock wave generation along with local coupling to the patient. The results of the first 400 treatments are presented after a brief description of pre-clinical experiments. The prototype has been in operation since March 1986. Particular attention is paid to adjuvant endourological measures, which all have been performed on the same table.

Animals↗
PubMed1997

Natural history of infrainguinal vein graft stenosis relative to bypass grafting technique.

PURPOSE: To determine whether the incidence of vein graft stenosis is related to bypass grafting technique and thus modification of postoperative surveillance protocols may be required. METHODS: From 1991 to 1996, 338 infrainguinal vein bypasses constructed using in situ (n = 131), reversed (n = 120), nonreversed translocated (n = 48), or spliced/upper extremity vein (n = 39) grafting techniques were evaluated by intraoperative duplex scanning to optimize bypass construction and serially thereafter to detect developing vein graft stenoses. Bypass procedures were performed in 322 patients for critical limb ischemia (83%), claudication (13%), or popliteal aneurysm (4%). Using life-table analysis, graft patency and revision/failure rates were compared relative to grafting technique, need for operative revision, and intraoperative duplex scan results. RESULTS: Three-year primary and secondary graft patency rates were higher (p < 0.001) for in situ bypass grafts (85%/97%) compared with reversed (57%/83%), nonreversed translocated (62%/78%), or alternative (51%/76%) vein bypass grafts. During a mean follow-up interval of 19 months, the incidence of graft revision was higher for reversed saphenous (23%) and alternative (28%) vein bypass grafts compared with in situ (10%) or nonreversed (16%) saphenous vein bypass grafts. Despite a normal intraoperative graft duplex scan, the revision/failure rate of reversed vein grafts was 2.5 times greater than in situ/nonreversed translocated vein conduits (primary patency rate at 3 years, 60% vs 87%, p = 0.009). Bypass grafts modified at operation on the basis of duplex scanning were two times more likely to require postoperative revision than grafts with normal intraoperative scans. CONCLUSIONS: The incidence of postoperative graft stenosis and need for revision varies with bypass grafting technique. Reversed vein bypasses and grafts modified at operation may be more prone than in situ vein bypass grafts to develop stenosis and thus require intensive surveillance. Infrainguinal vein graft failure and the need for revision may be reduced by the adoption of bypass grafting techniques that include valve lysis and intraoperative duplex scan assessment.

Adult↗
PubMed1994

Distal bypass for limb salvage: comparative study in patients below and above 80 years of age.

Revascularization for chronic lower extremity ischemia in patients of 80 years and older is controversial. To better define operative risk and outcome after peripheral vascular procedures in the elderly, our experience from January 1990 to December 1992 was reviewed. We compared two groups of patients: group I with 26 patients (28 revascularizations) 80 years of age and older (84 +/- 3 years) and group II with 29 patients (32 revascularizations) younger than 80 years (70 +/- 8 year). The two groups were similar with regard to risk factors, surgical indication (rest pain and/or gangrene) and type of graft (in situ vein: 35, reversed vein: 12, PTFE: 13). Fourteen femoro-popliteal bypasses, 17 femoro-tibial bypasses (8 to the anterior tibial artery and 9 to the posterior tibial artery) and 29 femoro-peroneal bypasses were performed. The operative mortality rate was 11.5% in group I and 6.9% in group II. The cumulative life-table survival rate at 24 months was 39.5% in group I and 55% in group II. Primary patency rate at 24 months was 64% in group I and 67% in group II. Secondary patency rate at 24 months was 74.5% in group I and 73% in group II. Limb salvage at 24 months was 80% in group I and 83% in group II. Comparison of the older and younger groups showed no statistically significant difference in mortality rate, graft patency and limb salvage. Operative mortality and graft patency were not different with regard to age of patients.

Age Factors↗
PubMed1984

Cardiac rhythm after the Mustard operation for complete transposition of the great arteries.

The Mustard operation corrects the effects of congenital transposition of the great arteries by creating an intraarterial baffle to direct pulmonary venous blood to the tricuspid orifice and systemic venous blood to the mitral orifice. To identify the long-term effects of this procedure, we followed 372 patients with complete transposition of the great arteries who survived the Mustard operation for at least three months. The mean follow-up period was 4.5 years (range, 0.4 to 15.9); the mean age at operation was 2.0 years. Mean resting heart rates were consistently lower than those for age-matched normal children. Seventy-six per cent of the patients had sinus rhythm during the year of operation--a figure that decreased to 57 per cent by the end of the eighth postoperative year. Twenty-five patients died during the follow-up period, nine suddenly. Life-table analysis revealed a cumulative survival rate of 91 per cent for 11 years and 71 per cent for 15 years after the operation. No strong risk factor for sudden unexpected death identified. This study demonstrates that extended survival among patients with transposition can be expected after the Mustard operation. However, over time there is a decreasing prevalence of normal sinus rhythm in survivors, as well as a small risk of sudden death.

Actuarial Analysis↗
PubMed1995

[Gynecological operations in high-risk patients (a preliminary report)].

The incidence of post-operative complication has been studied in women with concurrent nor-gynaecological and gynecological diseases, such as: vascular diseases (varices, phlebothromboses, thrombophlebitis), hypertension, changes in cardiac status (age-associated. Angina pectoris, cardiac decompensations). ECG changes,valvular defects, increased blood sugar, pulmonary diseases, etc. The study was held retrospectively over 326 female patients who had undergone operations for the period 1992-1993.

Adult↗
PubMedDate not supplied

[Practical methods of long-term normovolemic hemodilution].

Permanent haemodilution aims at lowering the level of blood viscosity during several weeks by maintaining the haemotocrity at about 30-32 per cent. In surgery this is achieved at the end of the operation, before the patient comes to, by replacing the necessary quantities of blood, calculated using a table, by the equivalent quantity of a fluid gelatine solution. In non-surgery it is achieved in the same way but in several successive stages. Experience shows that when done in this way, haemodilution is easily practicable, rarely counter-indicated, and almost always well tolerated.

Blood Volume↗
PubMed1989

Prospective controlled vagotomy trial for duodenal ulcer. Results after 11-15 years.

A prospective, randomized, controlled trial was conducted to compare truncal vagotomy and drainage (TV), selective vagotomy and drainage (SV) and parietal cell vagotomy (PCV) as elective treatment for duodenal ulcer. Between 11 and 15 years after operation, 248 patients were available for study of the recurrent ulceration rate by a life table method, and 197 patients could be studied with regard to postvagotomy symptoms. The recurrent ulcer rates were 28.5% for TV, 37.4% for SV, and 39.3% for PCV. These differences were not statistically significant. The incidence of severe postvagotomy symptoms was as follows: dyspepsia, 18.4% for TV, 20.5% for SV, 8.6% for PCV; dumping, 5.9% for TV, 19.6% for SV, 2.2% for PCV; diarrhea, 9.8% for TV, 11.8% for SV, 4.4% for PCV. The incidence of severe dumping was significantly less frequent among the PCV patients than the SV group. The differences did not reach statistical significance in any of the other groups. There was no significant difference in the Visick gradings among the three groups either before or after treatment of the failures. About two thirds of the patients in each group were finally satisfied with their operation, often after second operations or prolonged medical treatment. It is concluded that none of the three forms of vagotomy can be recommended as the standard operative treatment of duodenal ulceration.

Clinical Trials as Topic↗