Home About us Contact
|
Home About us Contact | ||
|
|
||
Complex Surgical Procedures (complex + surgical_procedure)
Selected AbstractsQuantification of urinary 8-iso-prostaglandin F2, using liquid chromatography,tandem mass spectrometry during cardiac valve surgeryJOURNAL OF CLINICAL LABORATORY ANALYSIS, Issue 4 2010Yun-Hui Teng Abstract Oxidative stress is an unavoidable event during many complex surgical procedures. 8-iso-prostaglandin F2, (8-iso-PGF2,) is a reliable biomarker for the evaluation of oxidative stress in vivo. The aim of this study is to develop simple and accurate liquid chromatography,tandem mass spectrometry (LC-MS/MS) methods for the detection of urinary 8-iso-PGF2, in samples collected from patients who received a cardiopulmonary bypass (CPB) during cardiac valve surgery. Urine samples of 14 patients with cardiac valve diseases were collected before, during, and after CPB. The level of 8-iso-PGF2, was detected via selected-reaction monitoring triple quadrupole MS/MS and the result was compared with 12 healthy volunteers. The method's detection limit (3S/N) was 0.25,pg for 8-iso-PGF2,, with a linear working range of 0.25,20,ng/ml. For patients with cardiac valve disease, the 8-iso-PGF2, levels before the bypasses were the same as those of healthy individuals (P>0.05) and the 8-iso-PGF2, levels during and after CPB were significantly higher than those before the bypasses (P<0.05). In conclusion, we present a simple and specific protocol for LC-MS/MS quantification of urinary 8-iso-PGF2, collected during CPB. Using this technique, it would be feasible to assess the levels of oxidative stress during cardiac surgery and thereby helpful for the management of oxidative injury. J. Clin. Lab. Anal. 24:237,245, 2010. © 2010 Wiley-Liss, Inc. [source] Is there an easier way to autograft skin in chronic leg ulcers? ,Minced micrografts', a new techniqueJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 10 2008P Boggio Abstract Background Chronic venous leg ulcers represent an urgent and increasing problem for public health. The use of skin autografts results in a greater therapeutic success in healing chronic ulcers. Objective A simple method of skin autografting that could permit a wider use of skin grafts in outpatients is needed. A new technique allowing skin autografting in a simple one-step process, without complex surgical procedures or expensive technical supplies, is presented. Methods A small, full-thickness skin specimen taken from the patient is finely minced and spread on his leg ulcer bed allowing to cover a surface many times wider than the sample itself. Results This method induces faster re-epithelization of chronic leg ulcers that failed to heal despite good conservative local therapy and give the possibility to repair very large ulcers with small fragments of skin. A clinical case is shown as an example out of 20 ulcers we recently treated. Conclusion Our preliminary report shows that this technique results in a greater therapeutic success (18 of 20 cases) in healing chronic leg ulcers, a common pathology that often affects outpatients treated for very long periods at home or in the Dermatologist's office. In our experience, this new and successful reparative possibility makes ,mince grafting' a recommendable procedure. [source] Review article: the abdominal compartment syndromeALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2008S. M. LERNER Summary Background, The term abdominal compartment syndrome refers to hypoperfusion and ischaemia of intra-abdominal viscera and structures caused by raised intra-abdominal pressure. It occurs most commonly following major trauma and complex surgical procedures, but can also occur in their absence. Definitive treatment is decompression at laparotomy. Prevention and recognition of abdominal compartment syndrome are crucial to avoid additional morbidity and mortality. Postinjury abdominal compartment syndrome continues to complicate current resuscitation methods and new strategies for resuscitating critically ill patients need to be explored in addition to more accurate monitoring of intra-abdominal pressure. Aim, To examine the published literature regarding the pathogenesis, diagnosis and management of the abdominal compartment syndrome. Methods, A comprehensive review of the literature was undertaken. Results, This syndrome is an important complication of major trauma and surgery as well as being recognized in critically-ill medical patients. It requires prompt recognition with a view to decompression at laparotomy. Conclusions, The abdominal compartment syndrome is an important complication of trauma, surgery and resuscitation. Key to its management are its prompt recognition and abdominal decompression. [source] The Superior Petrosal Triangle as a Constant Anatomical Landmark for Subtemporal Middle Fossa Orientation,THE LARYNGOSCOPE, Issue 8 2003Robert Sean Miller MD Abstract Objectives/Hypothesis Anatomical landmarks including the arcuate eminence and the superficial petrosal nerve serve as orienting landmarks for middle fossa dissection. However, because of considerable variation among patients, these landmarks are not always readily identifiable. We expand on a previously described method for identifying the head of the malleus as a constant anatomical landmark to optimize exposure when employing a middle fossa approach. Methods We completed an anatomical study using 10 preserved human cadaveric temporal bones to define the anatomical relationship among the root of the zygoma, the posterior,lateral lip of the foramen spinosum, and the bony tegmen over the head of the malleus. Subsequently, 5 fresh whole human cadaveric heads (10 temporal bones) were dissected using a surgically oriented anterior petrosectomy,middle fossa approach to evaluate the consistency of localizing the head of the malleus. Results We defined the superior petrosal triangle as a stable anatomical relationship. Our cadaveric data demonstrated that the distance from the root of the zygoma to the head of the malleus was 18.7 mm (SD = 1.7 mm) and the distance from the foramen spinosum to the head of the malleus was 19.2 mm (SD = 1.0 mm). The intersection of an arc transcribed 19 mm from the root of the zygoma and an arc transcribed 19 mm from the foramen spinosum localized the head of the malleus within 2.5 mm (SD = 2.4 mm). Conclusions The landmarks defined by the superior petrosal triangle represent a means to localize the bony tegmen over the head of the malleus. Identification of the head of the malleus as a landmark in middle fossa surgery when other landmarks are not recognizable optimizes patient safety and surgeon confidence during complex surgical procedures. [source] Surgical Excision of Acoustic Neuroma: Patient Outcome and Provider CaseloadTHE LARYNGOSCOPE, Issue 8 2003Fred G. Barker II Abstract Objectives/Hypothesis For many complex surgical procedures, larger hospital or surgeon caseload is associated with better patient outcome. We examined the volume,outcome relationship for surgical excision of acoustic neuromas. Study Design Retrospective cohort study. Methods The Nationwide Inpatient Sample (1996 to 2000) was used. Multivariate regression analyses were adjusted for age, sex, race, payer, geographic region, procedure timing, admission type and source, medical comorbidities, and neurofibromatosis status. Results At 265 hospitals, 2643 operations were performed by 352 identified primary surgeons. Outcome was measured on a four-level scale at hospital discharge: death (0.5%) and discharge to long-term care (1.2%), to short-term rehabilitation (4.4%), and directly to home (94%). Outcomes were significantly better after surgery at higher-volume hospitals (OR 0.47 for fivefold-larger caseload, P <.001) or by higher-volume surgeons (OR 0.46, P <.001). Of patients who had surgery at lowest-volume-quartile hospitals, 12.3% were not discharged directly home, compared with 4.1% at highest-volume-quartile hospitals. There was a trend toward lower mortality for higher-volume hospitals (P = .1) and surgeons (P = .06). Of patients who had surgery at lowest-caseload-quartile hospitals, 1.1% died, compared with 0.6% at highest-volume-quartile hospitals. Postoperative complications (including neurological complications, mechanical ventilation, facial palsy, and transfusion) were less likely with high-volume hospitals and surgeons. Length of stay was significantly shorter with high-volume hospitals (P = .01) and surgeons (P = .009). Hospital charges were lower for high-volume hospitals (by 6% [P = .006]) and surgeons (by 6% [P = .09]). Conclusion For acoustic neuroma excision, higher-volume hospitals and surgeons provided superior short-term outcomes with shorter lengths of stay and lower charges. [source] Centralization and the relationship between volume and outcome in knee arthroplasty proceduresANZ JOURNAL OF SURGERY, Issue 4 2010Nicholas E. Marlow Abstract Background:, Centralization aims to reduce adverse patient outcomes by concentrating complex surgical procedures in specified hospitals. Objectives:, This review assessed the efficacy of centralization for knee arthroplasty by examining the relationship between hospital and surgeon volume and patient outcomes. Data Sources and Review Methods:, The systematic review identified studies using multiple databases, including Medline and Embase. Two independent researchers ensured studies met the inclusion criteria. Morbidity, mortality, length of stay, financial outcomes and statistical rigour were examined. Correlations between volume and outcome were reported. Results:, Twelve primary knee arthroplasty studies examined hospital volume, which was significantly associated with decreased morbidity (five of seven studies), mortality (two of five studies) and length of stay (two of three studies). Three primary knee arthroplasty studies examined surgeon volume, which was significantly associated with decreased morbidity (two of three studies), mortality (zero of two studies) and length of stay (one of one study). Two revision knee arthroplasty studies examined hospital volume. One study examined but did not test for significance between hospital volume and patient morbidity; both studies examined volume and patient mortality reporting inconclusive results; and one study reported no significant association between volume and length of stay. None of the revision knee arthroplasty studies examined surgeon volume. Conclusions:, Significant associations between increased hospital and surgeon volume and improved patient outcomes were reported. However, when these results were separated by arthroplasty type, the association appeared tenuous. Judgements regarding centralization of knee arthroplasty should be made with caution until further evidence is published. [source] | ||||||||||