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Major Surgical Procedures (major + surgical_procedure)
Selected AbstractsSurgical resection of colorectal liver metastasesCOLORECTAL DISEASE, Issue 6 2001M. A. Memon Background Liver metastases are a major cause of death in patients with colorectal carcinoma. The only curative option available at present is surgery. This review article discusses the current state of evidence for the effectiveness of liver resection for patients with liver metastases from colorectal cancer. Methods Medline, Embase, Current Contents and Science Citation Index databases were used to search English language articles published on the subject of liver resection for colorectal metastases in the last 20 years. Results Liver resection has a five year survival of 16,49% and 10 year survival of 17,33% with an operative mortality rate of 0,9%. Two factors appear to be clearly associated with poorer outcome , involved resection margins and the presence of extrahepatic disease (including hilar and coeliac axis lymph nodes) at the time of liver resection. None of the other factors related to the patients, their primary tumour or the metastases themselves have been conclusively shown to adversely effect long-term survival. Conclusions Liver resection is a feasible, safe and effective procedure which carries an acceptable morbidity and mortality and does have a major impact on the survival of these patients. The decision on resectability of colorectal metastases should be decided by the ability to leave at least 2,3 segments of liver free from metastases with uninvolved resection margins, together with the general fitness of the patient to undergo a major surgical procedure. [source] Primary vesical actinomycosis: A case report and literature reviewINTERNATIONAL JOURNAL OF UROLOGY, Issue 10 2007Sabah Al-Kadhi Abstract: Pelvic actinomycosis is a chronic granulomatous infection caused by the gram-positive anaerobic bacteria, Actinomyces Israelli. Vesical lesions, particularly without any obvious source of infection, are rare. We report a case of primary vesical actinomycosis which presented as a bladder mass, giving suspicion of malignancy. Repeated trans-urethral deep resections and histo-pathological examinations revealed the true nature of the mass, which was treated by medical means. A high index of suspicion of potentially benign bladder lesions, particularly in a younger age group of patients, is advocated, to prevent unnecessary major surgical procedures. [source] A systematic review of COX-2 inhibitors compared with traditional NSAIDs, or different COX-2 inhibitors for post-operative painACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2004J. Rømsing Background:, We have reviewed the analgesic efficacy of cyclooxygenase-2 (COX-2) inhibitors compared with traditional non-steroidal anti-inflammatory drugs (NSAIDs), different COX-2 inhibitors, and placebo in post-operative pain. Methods:, Randomized controlled trials were evaluated. Outcome measures were pain scores and demand for supplementary analgesia 0,24 h after surgery. Results:, Thirty-three studies were included in which four COX-2 inhibitors, rofecoxib 50 mg, celecoxib 200 and 400 mg, parecoxib 20, 40 and 80 mg, and valdecoxib 10, 20, 40, 80 mg were evaluated. Ten of these studies included 18 comparisons of rofecoxib, celecoxib, or parecoxib with NSAIDs. Rofecoxib 50 mg and parecoxib 40 mg provided analgesic efficacy comparable to that of the NSAIDs in the comparisons, and with a longer duration of action after dental surgery but possibly not after major procedures. Celecoxib 200 mg and parecoxib 20 mg provided less effective pain relief. Four studies included five comparisons of rofecoxib 50 mg with celecoxib 200 and 400 mg. Rofecoxib 50 mg provided superior analgesic effect compared with celecoxib 200 mg. Data on celecoxib 400 mg were too sparse for firm conclusions. Thirty-three studies included 62 comparisons of the four COX-2 inhibitors with placebo and the COX-2 inhibitors significantly decreased post-operative pain. Conclusion:, Rofecoxib 50 mg and parecoxib 40 mg have an equipotent analgesic efficacy relative to traditional NSAIDs in post-operative pain after minor and major surgical procedures, and after dental surgery these COX-2 inhibitors have a longer duration of action. Besides, rofecoxib 50 mg provides superior analgesic effect compared with celecoxib 200 mg. [source] Systemic AL amyloidosis with acquired factor X deficiency: A study of perioperative bleeding risk and treatment outcomes in 60 patients,AMERICAN JOURNAL OF HEMATOLOGY, Issue 3 2010Carrie A. Thompson Systemic light-chain (AL) amyloidosis may be associated with acquired factor X (FX) deficiency and optimal management of this coagulopathy is unknown. We reviewed our experience with 60 patients with isolated FX deficiency (,50%) due to AL amyloidosis that underwent an invasive procedure between 1975 and 2007. They were classified as having severe (<10%; n = 6), moderate (10,25%; n = 15), or mild (26,50%; n = 39) FX deficiency. The patients underwent a total of 112 procedures, 19 (17%) of which were managed with periprocedural treatment with one or more hemostatic agents. There were complications in 14 (13%) procedures (bleeding = 12, thrombosis = 1, death = 1). Baseline FX level was not predictive of bleeding risk; the only association with postintervention bleeding was central venous catheter placement. However, bleeding complications were relatively infrequent, particularly in patients with mild or moderate FX deficiency undergoing nonvascular procedures. Activated recombinant factor VII might be considered in patients undergoing major surgical procedures, but further experience is needed. Optimal management of AL patients with FX deficiency undergoing invasive procedures remains to be determined. Am. J. Hematol., 2010. © 2009 Wiley-Liss, Inc. [source] Acute renal failure in the surgical settingANZ JOURNAL OF SURGERY, Issue 3 2003Paul Carmichael Acute renal failure (ARF) is an unwelcome complication of major surgical procedures that contributes to surgical morbidity and mortality. Acute renal failure associated with surgery may account for 18,47% of all cases of hospital-acquired ARF. The overall incidence of ARF in surgical patients has been estimated at 1.2%, although is higher in at-risk groups. Mortality of patients with ARF remains disturbingly high, ranging from 25% to 90%, despite advances in dialysis and intensive care support. Appreciation of at-risk surgical populations coupled with intensive perioperative care has the capacity to reduce the incidence of ARF and by implication mortality. Developments in understanding the pathophysiology of ARF may eventually result in newer therapeutic strategies to either prevent or accelerate recovery from ARF. At present the best form of treatment is prevention. In this review the epidemiology, pathophysiology, diagnosis, treatment and possible prevention of ARF will be discussed. [source] | ||||||||||