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PubMed2000

Laparoscopic surgery with intraoperative autologous blood transfusion in patients with heavy hemoperitoneum due to ectopic pregnancy.

Patients with ectopic pregnancy complicated by heavy hemoperitoneum generally undergo immediate laparotomy, and homologous blood transfusion is sometimes started before the operation. Two women underwent laparoscopic surgery for heavy hemoperitoneum (2600 and 1900 ml) due to ectopic pregnancy. The aspirated blood was reinfused during operation through a leukocyte-reduction filter after lavage with an autologous blood-salvage transfusion apparatus.

Adult↗
PubMed1977

Autologous blood in the treatment of intraoperative hemorrhage.

Severe hemorrhage associated with major trauma and vascular procedures is seen frequently in our operating rooms. Immediate autotransfusion has enabled us to safely and adquately correct blood losses without placing overwhelming demands on our blood bank. Since October 1973, a device capable of retrieving, filtering and reinfusing blood lost during operation has been used on 51 patients (major trauma, 20; ectopic pregnancy, 2; portacaval shunt, 9; peripheral vascular surgery, 20). From 700 to 20,000 cc's of blood were reinfused. Platelets, hematocrit, fibrinogen, free plasma hemoglobin, bilirubin, and creatinine showed no significant changes as compared to preoperative values in 39 survivors. There were 12 deaths. Eight died postoperatively as a result of their injuries, 3 of uncontrollable bleeding and one of renal failure. This study shows that autotransfusion, when used with proper operating technique, is a most satisfactory technique for restoring blood volume in severe trauma cases and elective vascular operations. This method provides a rapid, simple way of reinfusing fresh blood, free of hepatitis contamination with minimal derangement in cellular and plasma coagulation parameters.

Adult↗
PubMed1985

The acute effects of cigarette smoke exposure on experimental skin flaps.

Random vascular patterned caudally based McFarlane-type skin flaps were elevated in groups of Fischer 344 rats. Groups of rats were then acutely exposed on an intermittent basis to smoke generated from well-characterized research filter cigarettes. Previously developed smoke inhalation exposure protocols were employed using a Maddox-ORNL inhalation exposure system. Rats that continued smoke exposure following surgery showed a significantly greater mean percent area of flap necrosis compared with sham-exposed groups or control groups not exposed. The possible pathogenesis of this observation as well as considerations and correlations with chronic human smokers are discussed. Increased risks of flap necrosis by smoking in the perioperative period are suggested by this study.

Animals↗
PubMed2001

Bleb window cryopexy for the management of oversized, misplaced blebs.

PURPOSE: To describe a new technique for revising oversized blebs after trabeculectomy. METHODS: A chart review of consecutive patients undergoing bleb window cryopexy was conducted. Patients with symptomatic oversized blebs were candidates for the technique, regardless of the intraocular pressure. Under topical anesthesia, the bleb was incised and a 3 mm x 3 mm conjunctival window was removed using 0.12 forceps and Vannas scissors. Light cryotherapy was applied to the sclera through the window. A soft bandage contact lens was then placed for compression, and a patch was applied. All patients were given antibiotic drops the first day after surgery. Topical corticosteroid drops were used to minimize postoperative inflammation. Outcome measures included relief of symptoms, adequate control of intraocular pressure, and restoration of filtering bleb function without further antiglaucoma medication or surgical bleb revision. RESULTS: Nine patients met the inclusion criteria. All patients had flattening of the bleb with symptomatic relief within 2 weeks. No loss of bleb function occurred. One patient developed aqueous misdirection after the procedure. CONCLUSION: Early results showed that bleb window cryopexy is safe and effective. This minimally invasive technique can be useful for selected patients with large. symptomatic, overhanging blebs.

Aged↗
PubMed2006

Comparison of hard tissue density changes around implants assessed in digitized conventional radiographs and subtraction images.

OBJECTIVES: The aim of this in vivo study was to compare peri-implant bone density assessed by the mean gray value of the histogram in digitized conventional radiographs and two digital subtraction images (DSI) methods: linear and logarithmic. MATERIAL AND METHODS: Thirty-four patients were monitored by standardized periapical radiographs 1 week after surgery and 4 months later. The radiographs were digitized and manipulated by means of EMAGO software. Linear and logarithmic DSI were obtained, and a filter was added to the logarithmic image. Control and test regions were selected and the mean value of the gray level of the histogram of these selected areas was obtained. This process was carried out in the digitized conventional radiographs (DCR) and the two methods of DSI. After that, the images were divided into two groups, with and without bone loss, and statistical analysis was performed. RESULTS: The results indicate that differences between the jaws did not reach significance, in all the images and in the two groups with and without bone loss. Furthermore, there was no statistically significant difference between the radiographic density assessed in the DCR and the two methods of subtraction images. CONCLUSIONS: Monitoring of peri-implant bone density by the mean gray value of the histogram in a selected area can be assessed either by linear and logarithmic DSI or by DCR.

Alveolar Bone Loss↗
PubMedDate not supplied

Macular edema and visual loss after macular pucker surgery with ICG-assisted internal limiting membrane peeling.

PURPOSE: To describe the occurrence of massive macular edema and visual loss after indocyanine green-assisted (ICG) macular pucker surgery. METHODS/RESULTS: A 74 years old female presented with a macular pucker and a hypertrophy of the retinal pigment epithelium (RPE) in her left eye. The preoperative visual acuity (VA) was 20/100. Surgery consisted of cataract extraction, lens implantation and standard pars plana vitrectomy with peeling of epiretinal tissue followed by the removal of the internal limiting membrane (ILM) remnants stained using a 0.05% ICG solution. One day after surgery, VA was counting fingers. There was an extensive macular edema and retinal thickening with hyperfluorescence during fluorescein angiography and pronounced autofluorescence using ICG filters. During follow up, the macular edema resolved completely, but VA decreased to 20/800 at six months postoperatively. There was a central scotoma and unstable fixation seen during microperimetry. DISCUSSION: This case report indicates that ICG might come into contact with bare retina if injected following removal of epiretinal membranes. Whether the observed RPE hypertrophy might have contributed to the pathogenesis of the adverse effect described remains hypothetical.

Aged↗
PubMed1992

Decompression of the optic nerve sheath for vision-threatening papilledema caused by dural sinus occlusion.

Obstruction of the dural sinuses produces a clinical syndrome that resembles pseudotumor cerebri. In these patients, unremitting papilledema can cause blindness. We performed decompression of the optic nerve sheath in four patients who had occlusion of the dural sinuses. The operation achieved rapid relief of papilledema and recovery of vision. In three patients, fenestration of the nerve sheath of only one eye resulted in resolution of papilledema in both eyes. The procedure appears to relieve papilledema by filtering small quantities of cerebrospinal fluid into the orbit. It did not lower cerebrospinal fluid pressure in three patients who underwent lumbar puncture after surgery. Optic nerve sheath decompression is an effective operation for salvage of vision in patients with obstruction of the dural sinuses.

Adult↗
PubMed1976

[Surgery in a plastic air-filled chamber. Current possibilities].

The authors have made an assessment of the use of an isolating operation chamber in 137 operations, primarily for the insertion of prostheses the the hip or knee, but also for the shoulder. The isolating chamber can be used equally well for hip, knee, shoulder or other surgery. The unit is made in the form of a plastic balloon, the air inside is sterile. Inflation is maintained by air passed through filters said to give complete sterility. The chamber is fitted with gloves to allow work to be done inside it. It is adherent to the skin of the patient and its wall is incised at the same time as the skin. The result is a very satisfactory isolation of the wound, eliminating faults in aseptic technique but requiring fresh sterilisation for each new procedure. Their assessment has shown that this enclosure can be used without any major problem of adaptation.

Antisepsis↗
PubMed1992

Combined cataract-glaucoma surgery using the THC:YAG (holmium) laser ab interno without gonioscopy.

We describe a simple method of combined cataract-glaucoma surgery, involving use of the THC:YAG (holmium) laser ab interno, without gonioscopy, in which the initial cataract incision remains small and the glaucoma filtering procedure can be completed relatively quickly, with minimal surgical manipulation of the conjunctiva. In a series of 15 eyes (13 patients) with visually significant cataracts and medically uncontrolled glaucoma, followed for an average of 14 weeks (range, 1 to 26 weeks), 13 of the 15 eyes had decreased IOP. Visual acuity was improved in 9 eyes, remained the same in 4 eyes (with age-related macular degeneration), and was worse in 2 eyes (with opacification of the posterior capsule sufficient to account for the decrease in acuity).

Aged↗
PubMed2006

Fibrin glue for preventing immediate postoperative hypotony following glaucoma drainage implant surgery.

PURPOSE: To prevent a leak of aqueous around the tube in the immediate postoperative period after glaucoma drainage implant (GDI) surgery. METHODS: A total of 42 eyes of 34 consecutive patients with refractory glaucoma requiring single-plate Molteno implantation were retrospectively reviewed. Peritubular filtration was checked intraoperatively in all filtered eyes. Fibrin glue was used over the scleral flap intraoperatively in every eye with peritubular leakage. All Molteno tubes were completely closed with an absorbable ligature. RESULTS: Peritubular filtration was detected in 11 eyes of 11 patients. All 11 eyes maintained intraocular pressure (IOP) >or= 16 mmHg in the immediate postoperative phase. The mean IOP on the first postoperative day was 30.5 +/- 10 mmHg. After an average follow-up of 6 months, the mean IOP in these 11 eyes was 19.1 +/- 6 mmHg. No complications or Seidel-positive aqueous leak were observed during the follow-up period. CONCLUSIONS: Results suggest that intraoperative use of fibrin glue is a viable option for reducing peritubular filtration and preventing immediate postoperative hypotony after GDI surgery.

Female↗
PubMed2005

Lymphatic drainage patterns on early versus delayed breast lymphoscintigraphy performed after injection of filtered Tc-99m sulfur colloid in breast cancer patients undergoing sentinel lymph node biopsy.

The axillary lymph node status is the most important predictor of prognosis and aids in breast cancer treatment planning. Patients with breast cancer now frequently undergo sentinel lymph node (SLN) biopsy rather than axillary lymph node dissection to determine the status of the regional lymph nodes. However, the optimal timing of radionuclide injection relative to the timing of SLN biopsy remains controversial. The objective of this study was to compare the lymphatic drainage patterns on lymphoscintigraphy performed at 15 minutes to 4 hours and at 18 to 24 hours after injection of filtered Tc-99m sulfur colloid, and to determine whether, over time, radiocolloid migrates to second-echelon nodes that are not the SLNs. Fifteen women with breast cancer (mean age, 55 years; range, 38-78 years) were scheduled to undergo SLN biopsy after each received an injection of 18.5 MBq (0.5 mCi) filtered Tc-99m sulfur colloid into the breast parenchyma surrounding the tumor or biopsy cavity. Both early (15 minutes to 4 hours after radionuclide injection) and delayed (18-24 hours after radionuclide injection) lymphoscintigraphy was performed in each patient. SLN biopsy was performed, followed by completion axillary lymph node dissection and planned breast surgery. In each patient the patterns of distribution of the radionuclide in the lymph nodes were the same on early and delayed lymphoscintigrams. These findings, that the distributions of radionuclide in lymph nodes are identical on early and delayed images obtained after injection of filtered Tc-99m sulfur colloid, suggest that performing SLN biopsy on the day after injection does not diminish the accuracy of the technique in predicting the potential site of metastasis in the regional lymph nodes in patients undergoing this procedure for breast cancer.

Adult↗
PubMed1989

[Diagnostic viewpoints in deep leg-/pelvic venous thrombosis].

In 60 to 90% of patients with deep vein thrombosis, successful recanalization with prevention of postthrombotic syndrome and decreased risk of pulmonary embolism can be achieved through early diagnosis and aggressive treatment, thrombolysis or surgical correction. In our experience, if treatment is delayed more than four days after onset, the results are unfavorable; in the latter case, provided necrotizing inflammation is not present, we treat only with anticoagulation. The indication for surgery is considered established if thrombolytic treatment is contraindicated, in the presence of necrotizing inflammation, if thrombolysis is unsuccessful and for recurrent pulmonary embolism which is carried out mostly with a caval filter. Anticoagulation alone in most patients will not lead to successful results. Sixty percent of deep vein thromboses arise ascending from lower leg thromboses. Further points of predilection are the junctions of the popliteal vein, the veins in the inguinal region and the caval bifurcation. In principle, any calf pain should suggest the possibility of beginning lower leg thrombosis. With regard to the history, it is important to know if the event is the first of its kind or recurrent (Table 1). Additionally, deep vein thrombosis may be suspected in the presence of local trauma, in women on contraceptives, in patients with hemoblastoses, after surgery in the lower pelvic or leg region and, in particular in women, in the presence of pelvic venous impediment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1980

Evaluation of sintered titanium fiber composite as a subperiosteal implant.

Seventy-two sintered titanium fiber composite implants were placed subperiosteally and anchored intraosseously on the lateral aspect of 12 dog mandibles. The implants were covered with either Millipore filter, silicone, or left uncovered. Analysis after the animals were killed showed that bone growth into the subperiosteal portion of the implants was maximal at three to six weeks after implantation and remained at a depth of 380 mu through 24 weeks in a majority of the implants. Bone growth into the intraosseous portion also peaked at three to six weeks and remained at 190 to 380 mu through 24 weeks. Covering the implants slowed the rate of osseous ingrowth but did not affect the depth. The implants were well tolerated and the material holds promise for use in oral and maxillofacial surgery.

Animals↗
PubMed1976

Argon laser application to the angle structures in the glaucomas.

The argon laser beams' effect on angle structures was studied in 20 uncontrolled glaucomatous eyes. Nineteen eyes became hypotensive quickly, but in 15, the elevated tension returned during the 20 to 40 day follow-up period. Four eyes sustained low pressures throughout the ten-month follow-up period. Two were of babies with congenital glaucoma, one had simple glaucoma following an unsuccessful filtering operation, and one was aphakic following congenital cataract extraction. Ten eyes were medically controlled postoperatively, and six were failures that had to undergo further surgery. Outflow facility measurements revealed an increase in C values during the hypotensive period. The C values were reduced later, with the decrease corresponding to the increase in intraocular pressures. The hypotensive effect together with the increase in outflow facility was probably related to laser-induced openings in the angle structures. The varying results at the later stages depended on whether or not these openings remained opened, or became partially or completely closed during healing.

Adolescent↗
PubMed1996

Straight-entrance, sclerocorneal valve incision with horizontal sutures for poly(methyl methacrylate) intraocular lenses.

Self-sealing sclerocorneal tunnel incisions with an external frown entry are widely used for implantation of poly(methyl methacrylate) intraocular lenses. Although safe and effective, these incisions have certain drawbacks. We developed a wound construction in which a straight external incision is used in conjunction with a tension-free, infinity-type suture. Out of 100 consecutive cases, only two did not seal satisfactorily at the conclusion of surgery but were tight upon placement of re-enforcing sutures. Postoperatively, the valve remained tight in all cases; there were no cases of hypotony, filtering bleb, flat chamber, or pupil capture or endophthalmitis indicating transient leakage. Flattening in the vertical and steepening in the horizontal meridian were minor and nonprogressive.

Cornea↗
PubMed2001

Intraocular pressure and medication control after clear corneal phacoemulsification and AcrySof posterior chamber intraocular lens implantation in patients with filtering blebs.

PURPOSE: To determine whether clear corneal phacoemulsification and the implantation of a copolymer acrylic (AcrySof, Alcon, Fort Worth, TX) intraocular lens will maintain the intraocular pressure (IOP) and number of medications in patients with a previous filtering bleb. PATIENTS AND METHODS: This retrospective analysis included 69 consecutive patients with previous trabeculectomy who had a copolymer acrylic intraocular lens implanted during cataract surgery between 1995 and 1999 by a single surgeon (A.C.S.C.). RESULTS: Mean IOP significantly decreased from 26.03 mm Hg (range, 14.5-70 mm Hg; n = 69) before trabeculectomy to 13.58 +/- 3.98 mm Hg (range, 5-24 mm Hg; n = 69) before the cataract extraction. After cataract extraction, the mean IOP increased significantly by 1.49 mm Hg (n = 67; P = 0.0013), by 1.85 mm Hg (n = 57; P = 0.0005), and by 1.01 mm Hg (n = 67; P = 0.042) after 6 months, after 1 year, and at the patient's last appointment, respectively. When patients whose pressures were purposely increased during cataract surgery were not included (n = 5), the mean increase at the last appointment was not significantly increased (0.54 mm Hg; n = 62; P = 0.25). The average number of antiglaucoma medications decreased from 2.93 (range, 1-5; n = 69) before trabeculectomy to 0.36 (range, 0-2; n = 69) before cataract surgery. This mean decreased to 0.34 (range, 0-2; n = 67; P = 0.8366) 6 months after cataract surgery and increased to 0.49 (range, 0-3; n = 57; P = 0.1029) and 0.62 (range, 0-3; n = 67; P = 0.0006) after 1 year and at the last appointment, respectively. Of the total study population, two (2.9%) patients required additional glaucoma surgery and 14 (20.3%) patients required additional antiglaucoma medications as compared with their precataract levels. CONCLUSIONS: Clear corneal phacoemulsification and the implantation of a copolymer acrylic (AcrySof, Alcon) posterior chamber intraocular lens statistically increased the number of medications and IOP of patients in our study. These increases, although statistically significant, did not cause a clinically significant deterioration in IOP control.

Acrylates↗
PubMed1994

Transpulmonary systemic fat embolism. Studies in mongrel dogs after cemented arthroplasty.

We investigated the source of intravascular fat in systemic organs (brain, heart, and kidney) after massive pulmonary fat embolism during cemented arthroplasty. We used a bilateral cemented arthroplasty (BCA) in anesthetized mongrel dogs that simulates a cemented total-hip replacement procedure. We hypothesized that deformable fat globules could pass through the lung vasculature under high pulmonary artery pressure (Ppa). Using quantitative morphometry, we showed that the size of pulmonary vessel occluded by fat decreased from 12.8 +/- 15.2 microns 1 min after BCA to 4.9 +/- 5.1 microns at 120 min after BCA (p < 0.01). Ultrastructural studies demonstrated no evidence of acute inflammation around fat-occluded pulmonary vessels 3 h after BCA. Intravascular fat was found in all brain, heart, and kidney specimens examined 3 h after BCA (n = 6). No anesthetized animal in the "sham" (no BCA) group (n = 3) had intravascular fat at the same time period. Radiolabeled microspheres (15 microns diameter) did not reach the systemic circulation (< 1% nonentrapment) under the high Ppa after BCA. No patent foramen ovale was found in any dog at postmortem examination. We conclude that fat globules can traverse the pulmonary circulation within 3 h of orthopedic surgery. The difference between solid microspheres and fat in transpulmonary passage suggests that the composition, perhaps the deformability, of embolic material influences the lung's filtering capacity.

Animals↗
PubMed1993

[Charcoal and isoflurane alveolar washout in low-flow circuit].

The inclusion of charcoal filters in anaesthetic low-flow systems contributes to the acceleration of the kinetics of isoflurane (Forane). In twenty subjects, scheduled for extra- and intracranial surgery, ventilated with a low-flow system (Ohmeda Excel OAV7750 with rebreathing cassette) with a mean total flow of 0.7 l/min, awakening was complete within 5 minutes from stopping isoflurane and including charcoal in the circuit. At the awakening, the expiratory concentration of isoflurane was 0.23% (95% confidence intervals: 0.19-0.27%): these values are similar to those of MACawake of isoflurane after fast alveolar washout. The use of charcoal during low-flow anaesthesia makes low-flow systems more flexible in their use; the anaesthetic level is more easily controllable and accidental overdosing of volatile anaesthetics can be immediately removed.

Adult↗