Home About us Contact
|
Home About us Contact | ||
|
|
||
Operative Intervention (operative + intervention)
Selected AbstractsFree Fluid in Morison's Pouch on Bedside Ultrasound Predicts Need for Operative Intervention in Suspected Ectopic PregnancyACADEMIC EMERGENCY MEDICINE, Issue 8 2007Chris Moore MD BackgroundEctopic pregnancies are frequently present in women who present to the emergency department with pregnancy and abdominal pain or bleeding, a subset of whom may require operative intervention. ObjectivesTo prospectively determine if emergency physician (EP)-performed transabdominal pelvic ultrasonography (US) with determination of free abdominal fluid in the hepatorenal space predicted the need for operative intervention. MethodsPatients who were suspected to have an ectopic pregnancy were prospectively enrolled over a ten-month period. An EP-performed bedside transabdominal pelvic US that included a view of the hepatorenal space (Morison's pouch) for free fluid. The EP US was classified as intrauterine pregnancy (IUP) or no definitive IUP, with Morison's pouch classified as positive or negative. The majority of patients had a subsequent transvaginal pelvic US performed by the Department of Radiology. Patients were followed up for radiology results, need for operative intervention, and ultimate outcome of the pregnancy. ResultsThere were 242 patients enrolled, with an average time to complete the EP US of 4 minutes and 27 seconds. There were 28 ectopic pregnancies diagnosed (11.6%), of which 18 patients underwent operative intervention. Free fluid in Morison's pouch was identified in ten patients, nine of whom underwent operative intervention, yielding a positive likelihood ratio of 112 (95% confidence interval = 15 to 831) for patients with suspected ectopic pregnancy who required operative intervention. ConclusionsFree intraperitoneal fluid found in Morison's pouch in patients with suspected ectopic pregnancy may be rapidly identified at the bedside by EP-performed US and predicts the need for operative intervention. [source] Phenol Chemical Matricectomy Is Less Painful, with Shorter Recovery Times but Higher Recurrence Rates, Than Surgical Matricectomy: A Patient's ViewDERMATOLOGIC SURGERY, Issue 8 2010JESSICA C. HASSEL DR MED BACKGROUND Ingrown toenails have a tendency for recurrence. Operative interventions can be successful, and several procedures are in use. OBJECTIVE Retrospective evaluation, to reveal differences in postoperative pain, time to recovery, and satisfaction with the cosmetic outcome in patients treated with a phenol (PCM) or surgical matricectomy (SM). MATERIALS & METHODS All matricectomy patients at the Dermatology Department of the Ludwigshafen City Hospital between 2004 and 2008 were interviewed over the telephone. Of 72 evaluable patients with a total of 112 ingrown nail sides, 33 were treated with PCM and 39 with SM. The patient group consisted of 40.3% women, the median age was 31. RESULTS Patients after PCM indicated two points less postoperative pain on an analogue scale from 0 to 10 (p<.001). In the PCM group, more patients recovered from the operation in less than 1 week (p=.007). Patient evaluation of cosmetic outcome was not different between the groups (p=.76), but recurrence rates were significantly higher in the PCM group (31.5%, vs 6.9% in the SM group, p=.006) CONCLUSION Both matricectomies have advantages and disadvantages. We should discuss these issues with our patients to help them decide on the kind of matricectomy. The authors have indicated no significant interest with commercial supporters. [source] Trauma Team Activation Criteria as Predictors of Patient Disposition from the Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 1 2004Michael A. Kohn MD Many trauma centers use mainly physiologic, first-tier criteria and mechanism-related, second-tier criteria to determine whether and at what level to activate a multidisciplinary trauma team in response to an out-of-hospital call. Some of these criteria result in a large number of unnecessary team activations while identifying only a few additional patients who require immediate operative intervention. Objectives: To separately evaluate the incremental predictive value of individual first-tier and second-tier trauma team activation criteria for severe injury as reflected by patient disposition from the emergency department (ED). Methods: This was a prospective cohort study in which activation criteria were collected prospectively on all adult patients for whom the trauma team was activated during a five-month period at an urban, Level 1 trauma center. Severe injury disposition ("appropriate" team activation) was defined as immediate operative intervention, admission to the intensive care unit (ICU), or death in the ED. Data analysis consisted of recursive partitioning and multiple logistic regression. Results: Of the 305 activations for the mainly physiologic first-tier criteria, 157 (51.5%) resulted in severe injury disposition. The first-tier criterion that caused the greatest increase in "inappropriate" activations for the lowest increase in "appropriate" activations was "age > 65." Of the 34 additional activations due to this criterion, seven (20.6%) resulted in severe injury disposition. Of the 700 activations for second-tier, mechanism-related criteria, 54 (7.7%) resulted in ICU or operating room admissions, and none resulted in ED death. The four least predictive second-tier criteria were "motorcycle crash with separation of rider,""pedestrian hit by motor vehicle,""motor vehicle crash with rollover," and "motor vehicle crash with death of occupant." Of the 452 activations for these four criteria, only 18 (4.0%) resulted in ICU or operating room admission. Conclusions: The four least predictive second-tier, mechanism-related criteria added little sensitivity to the trauma team activation rule at the cost of substantially decreased specificity, and they should be modified or eliminated. The first-tier, mainly physiologic criteria were all useful in predicting the need for an immediate multidisciplinary response. If increased specificity of the first-tier criteria is desired, the first criterion to eliminate is "age > 65." [source] Impact of Helical Computed Tomography on the Outcomes of Emergency Department Patients with Suspected AppendicitisACADEMIC EMERGENCY MEDICINE, Issue 8 2003Sam S. Torbati MD Abstract Objectives: To assess the impact of an emergency department (ED) guideline employing selective use of helical computed tomography (CT) on clinical outcomes of female patients with suspected appendicitis. Methods: All patients presenting with suspected appendicitis were prospectively enrolled and managed in accordance with a guideline incorporating selective use of helical CT. Although not the objective of this investigation, male patients were included for purposes of comparison. Patients with clinically evident appendicitis were referred to the surgical service, and patients with equivocal presentations were studied with helical CT. Patients were followed to final surgical or clinical outcomes. Outcome measures included time from ED presentation to laparotomy and rate of appendiceal perforation. These measures were compared with those of a historical cohort of patients preceding the use of helical CT. Results: A total of 310 consecutive patients with suspected appendicitis were enrolled; 92 had appendicitis. Sixty patients were referred to the surgical service without helical CT, and 41 had appendicitis (68%). Helical CT was performed on 250 patients; 51 had appendicitis (20%). For males, the mean interval from ED presentation to laparotomy was 559 minutes (95% CI = 444 to 674 minutes) during guideline use and 480 minutes (95% CI = 405 to 555 minutes) before. This interval for females was 433 minutes (95% CI = 326 to 540 minutes) during guideline use and 710 minutes (95% CI = 558 to 862 minutes) before. Appendiceal perforation rate for males was 0.25 (95% CI = 0.14 to 0.36) during guideline use and 0.38 (95% CI = 0.29 to 0.47) before; perforation rate for females was 0.06 (95% CI =,0.05 to 0.17) during guideline use and 0.23 (95% CI = 0.14 to 0.32) before. Helical CT had 92% sensitivity, 97% specificity, and 96% accuracy in diagnosing appendicitis. Conclusions: Helical CT is highly accurate in detecting appendicitis in patients with equivocal ED presentations. The use of a guideline employing selective helical CT was associated with a decline in the time from ED presentation to operative intervention in females. [source] Comparison of two laser fluorescence devices for the detection of occlusal caries in vivoEUROPEAN JOURNAL OF ORAL SCIENCES, Issue 4 2007Felix Krause Laser fluorescence measurements have been shown to be well suited for caries diagnosis. The aim of this study was to compare two laser fluorescence devices and to correlate the respective values with the visual and radiographic assessment and with the extent of the carious lesion. Ninety-four clinically non-cavitated occlusal carious lesions in the premolars and molars of 82 patients were examined. Laser fluorescence values on the surface were measured with a conventional laser fluorescence system and a novel laser fluorescence pen device. When operative intervention at a site was indicated, the extent of caries was determined after its removal. Readings obtained with both systems were significantly different with an interdevice factor of 0.64. Sensitivity and specificity for operative care were 92.6% and 53.7%, respectively, for the conventional, and 88.9% and 53.7%, respectively, for the pen device. For both devices, a correlation between laser fluorescence values and the visual and radiographic assessment and with the extent of the lesion was shown. The study indicates that the novel laser fluorescence device seems to be suitable for occlusal caries diagnosis. However, proposed guidelines for the clinical use of laser fluorescence readings of the conventional device cannot be transferred to the novel pen system. [source] Necrotizing fasciitis of the head and neck: A report of two patients and reviewHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2002Deowall Chattar-Cora MD Abstract Background Necrotizing fasciitis is a disfiguring condition that can be fatal. The head and neck region is rarely affected. However, when involved, the functional and cosmetic sequelae can be considerable. Materials and Methods We present two case histories, discuss salient diagnostic points, treatment, and review published data on this topic. Results With a timely diagnosis we were able to diagnose and appropriately treat these patients. Conclusions Necrotizing fasciitis is a disfiguring condition that can be fatal if not diagnosed in a timely fashion. Diagnosis and treatment require a high index of suspicion, immediate operative intervention, broad-spectrum antibiotics, and appropriate supportive care. © 2002 Wiley Periodicals, Inc. [source] Abdominal compartment syndrome: a new indication for operative intervention in severe acute pancreatitisINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 12 2005K. Wong Summary The current management of severe acute pancreatitis (SAP) is maximal conservative therapy within an intensive care environment. The only commonly accepted indication for operative intervention is the presence of infected pancreatic necrosis. We present a case wherein a laparotomy performed for treatment of abdominal compartment syndrome (ACS) arising in the setting of SAP in the absence of pancreatic necrosis prevented early mortality and discuss the diagnosis and treatment of ACS as a new indication for operative intervention in SAP. [source] Cell traffic between donor and recipient following rat limb allograftJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 1 2005Keiichi Muramatsu Abstract Although cell traffic from the graft into the recipient and from the recipient into the graft had been noticed in allogeneic organ transplantation, little is known following whole-limb allografting. This study was conducted to define cell migration between donor and recipient. Sixty-seven vascularized hind limb allotransplantations were performed in rat sex-mismatched pairs and the recipient animals were treated with FK506 immunosuppression. The ratio of donor and recipient cells was evaluated by semi-quantitative PCR using the specific primers of the Y-chromosome. Allografted limbs had no rejection episode until the final assessment. The male recipient cells were detected in female limb grafts not at 1 week but at 48 weeks after transplantation. The male donor cells were detected in the humerus and tibia in the female recipient but not in the gastrocnemius muscle and leg skin. Our results demonstrated that recipient-derived cells gradually migrated into the grafted bone, muscle and skin cells with the duration of time. Donor-derived cells migrated into the healthy bones but not into the healthy muscle and skin. Because active regeneration occurs in the grafted limb to compensate graft damage secondary to ischemia and operative intervention, recipient-derived cells may mediate a muscular and dermo-epidermal renewal. © 2004 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved. [source] Cap gun burns in childrenJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 7-8 2007Deborah AE Maze Aim: To document the frequency of cap gun burns in children and identify strategies for prevention of this mechanism of injury. Methods: Retrospective case note review of children under 16 years of age treated at The Children's Hospital at Westmead between January 1999 and December 2004 with burns secondary to toy cap guns. Results: Five boys were treated over the 5-year study period. None was supervised at the time of injury and in three cases the caps appeared to explode with minimal handling. All burn wounds healed without operative intervention and only one child suffered permanent sequelae from the burn injury. Conclusion: Cap gun burns appear a rare mechanism of burn injury not previously reported. Recently produced caps may be more susceptible to spontaneous explosion. Adequate adult supervision may have prevented some of the injuries. There appears be a need for greater awareness regarding the dangers of these toys. [source] Penetrating injuries in children: Is there a message?JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 5 2002AJA Holland Objectives: To determine the frequency, management and outcome of penetrating trauma in children. Methods: A retrospective review of penetrating injuries in children under 16 years of age admitted to the Children's Hospital at Westmead (CHW), and deaths reported to the New South Wales Paediatric Trauma Death (NPTD) Registry, from January 1988 to December 2000. Patient details, circumstances of trauma, injuries identified, management and outcome were recorded. Results: Thirty-four children were admitted to the CHW with penetrating injuries during the 13-year period. This represented 0.2% of all trauma admissions, but 3% of those children with major trauma. The injury typically involved a male, school-age child that fell onto a sharp object or was assaulted with a knife or firearm by a parent or person known to them. Twenty-five children (75%) required operative intervention for their injuries and 14 survivors (42%) suffered long-term morbidity. Thirty children were reported to the NPTD Registry over the same interval, accounting for 2.3% of all trauma deaths in New South Wales. Of these, a significant minority was injured by falls from a mower or a tractor towing a machine with blades. Conclusions: Penetrating injuries are uncommon, but cause serious injury in children. There are two clear groups: (i) those dead at the scene or moribund on arrival, in whom prevention must be the main aim; and (ii) those with stable vital signs. Penetrating wounds should be explored in the operating theatre to exclude major injury. Young children should not ride on mowers or tractors. [source] The Psychological Impact of Implantable Cardioverter-Defibrillator Recalls and the Durable Positive Effects of CounselingPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 8 2009JOHN D. FISHER M.D. Background: It is known that patients with lifesaving devices such as implantable cardioverter-defibrillators (ICDs) may be alarmed and worried by recalls or alerts related to their ICDs. Objectives: This study aimed to determine whether counseling has any short- or long-term benefits, and to look for characteristics that identify those most worried and those most in need of counseling. Methods: Among 100 patients with recall or alert ICDs, 14 were pacer dependent; 50 had ICDs for 1° prevention and 22 were women. Patients completed a survey indicating how worried they were on learning of the recall or alert (0,10 scale). After counseling and advice in accordance with manufacturer guidelines, patients were asked to indicate their level of worry, and were again asked after 6 months. Results: For all patients, the "worry level" at the initial interview was 5.0±3.7, falling to 2.2±3.0 after counseling (P < 0.001) and 1.4±2.3 after 6 months (P < 0.001 vs both earlier levels). There were no significant differences between those implanted for 1° versus 2° prevention or for pacer dependency. Women were initially more worried than men, but not for the long term. The 49 patients whose ICDs could be managed by reprogramming or software fix had significant reduction in worry after counseling and at 6 months compared to others. The 18 patients recommended for operative intervention remained more concerned after counseling (3.5±3.3 vs 1.9±2.9, P = 0.043). Conclusions: Patients' concerns resulting from ICD recalls or alerts can be reduced by appropriate counseling. Those patients whose ICDs could be reprogrammed to safer parameters had the most reduction in worry levels. [source] Regular Tracheostomy Tube Changes to Prevent Formation of Granulation TissueTHE LARYNGOSCOPE, Issue 1 2003Kathleen Yaremchuk MD Abstract Objectives/Hypothesis Tracheostomy is a commonly performed operative procedure that has been described since 2000 b.c. The early indications for tracheostomy were for upper airway obstruction, usually occurring in young people as a result of an infectious process. Recently, tracheostomies are more commonly performed in the critically ill patient to assist in long-term ventilatory support. Granulation tissue at the stoma and the trachea has been described as a late complication resulting in bleeding, drainage, and difficulty with maintaining mechanical ventilatory support. Study Design The present report is of an observational study of a newly implemented policy that required regular changing of tracheostomy tubes. Comparable groups of patients were compared before and after this procedural change to document complications. Data collection consisted of chart reviews of all admissions for 1 year before the policy change and the subsequent 2 years. Complication rates were compared using standard statistical techniques. Methods A policy change was instituted that required all tracheostomy tubes to be changed every 2 weeks in conjunction with a detailed evaluation of the tracheostomy stoma. Charts were reviewed the year before the change in policy and in the subsequent 2 years to determine the incidence of granulation tissue requiring operative intervention. Results The number of patients requiring surgical intervention secondary to granulation tissue showed a statistically significant decrease (P = .02). A review of policies and procedures from the six largest hospitals in southeastern Michigan had no recommendations for routine tracheostomy tube changes. Conclusions A policy requiring a routine change of tracheostomy tubes results in fewer complications from granulation tissue. Tracheostomy tube changes to prevent granulation tissue and its complications. [source] The impact of intra-operative transoesophageal echocardiography on cardiac surgical practiceANAESTHESIA, Issue 9 2009A. A. Klein Summary The use of transoesophageal echocardiography during cardiac surgery has increased dramatically and it is now widely accepted as a routine monitoring and diagnostic tool. A prospective study was carried out between September 2004 and September 2007, and included all patients in whom intra-operative echocardiography was performed, 2 473 (44%) out of a total of 5 591 cases. Changes to surgery were subdivided into predictable (where echocardiographic examination was planned specifically to guide surgery) and unpredictable (new pathology not diagnosed pre-operatively). A change in the planned surgical procedure was documented in 312 (15%) cases. In 216 (69%) patients the changes were predictable and in 96 (31%) they were unpredictable. The number of predictable changes increased between 2004,5 and 2006,7 (8% vs 13%, p = 0.025). In these cases, intra-operative echocardiography was specifically requested by the surgeon to help determine the operative intervention. This has implications for consent and operative risk, which have yet to be fully determined. [source] Prosthesis related sepsis following laparoscopic adjustable gastric bandingANZ JOURNAL OF SURGERY, Issue 7-8 2010Michael Facek Abstract Background:, Laparoscopic adjustable gastric banding (LAGB) is well-recognized as a superior method to achieving durable weight loss in the medium term when compared with non-surgical methods of weight loss. In this paper, we described the clinical presentation and outcomes of patients presenting with band or band-adjustment reservoir sepsis from our series from a single institution. Methods:, We conducted a retrospective review of prospectively collected clinical, anthropometric and biochemical data from patients who underwent LAGB placement over a five-year period at a metropolitan teaching hospital. Those patients requiring surgical intervention for prosthesis-related sepsis were included in the review. Results:, Of the 445 patients in this series, 10 (2.2%) developed prosthesis sepsis and required operative intervention. Three (0.7%) presented with reservoir sepsis requiring removal of the reservoir. One had band erosion identified and the entire prosthesis removed. In seven (1.5%) of the patients, infections occurred at the gastric band. Two patients presented with purulent peritonitis and underwent immediate band removal. The remainder presented with band abscesses and either had their band removed (three patients) or left in position and the sepsis treated with drainage and antibiotics (two patients). Conclusions:, In our current series, a small proportion of LAGB patients developed prosthesis-related infection that typically required port or band removal and usually occurred early in the post-operative course. We have modified our prophylactic antibiotic regime and surgical technique as a result of this review. In selected cases of band infection, bands were salvaged with subsequent acceptable weight loss, suggesting that LAGB salvage in the presence of sepsis may be achievable in some patients. [source] Benign scrotal pathology: should all patients undergo surgery?BJU INTERNATIONAL, Issue 3 2001V.S. Menon Objective To evaluate the justification for operative intervention in patients undergoing surgery for benign scrotal pathology, and to assess the associated morbidity. Patients and methods Consecutive patients in two surgical firms who underwent surgery for benign intrascrotal pathology over a 5-year period were studied retrospectively. Results In all, 102 patients were included in the study (mean age 51.6 years, range 16,86). Most patients had either epididymal cysts (59) or hydroceles (31) or a combination of the two (eight). Some patients (37) underwent ultrasonography before surgery. The indications for surgery were deemed to be strong in 25% of patients but weak or absent in the remainder. Complications occurred in 31 patients, being minor in 18, but significant in 13, resulting in four re-admissions to hospital. There was no significant difference in the complication rate between those patients with strong indications for surgery (37%) and those with weak indications (28%). Conclusions Surgery for benign intrascrotal pathology is frequently undertaken for weak clinical indications and carries significant associated morbidity. This could be avoided in many cases by simple reassurance. Judicious use of ultrasonography is advised. A policy of selective surgical intervention is strongly advocated. [source] Free Fluid in Morison's Pouch on Bedside Ultrasound Predicts Need for Operative Intervention in Suspected Ectopic PregnancyACADEMIC EMERGENCY MEDICINE, Issue 8 2007Chris Moore MD BackgroundEctopic pregnancies are frequently present in women who present to the emergency department with pregnancy and abdominal pain or bleeding, a subset of whom may require operative intervention. ObjectivesTo prospectively determine if emergency physician (EP)-performed transabdominal pelvic ultrasonography (US) with determination of free abdominal fluid in the hepatorenal space predicted the need for operative intervention. MethodsPatients who were suspected to have an ectopic pregnancy were prospectively enrolled over a ten-month period. An EP-performed bedside transabdominal pelvic US that included a view of the hepatorenal space (Morison's pouch) for free fluid. The EP US was classified as intrauterine pregnancy (IUP) or no definitive IUP, with Morison's pouch classified as positive or negative. The majority of patients had a subsequent transvaginal pelvic US performed by the Department of Radiology. Patients were followed up for radiology results, need for operative intervention, and ultimate outcome of the pregnancy. ResultsThere were 242 patients enrolled, with an average time to complete the EP US of 4 minutes and 27 seconds. There were 28 ectopic pregnancies diagnosed (11.6%), of which 18 patients underwent operative intervention. Free fluid in Morison's pouch was identified in ten patients, nine of whom underwent operative intervention, yielding a positive likelihood ratio of 112 (95% confidence interval = 15 to 831) for patients with suspected ectopic pregnancy who required operative intervention. ConclusionsFree intraperitoneal fluid found in Morison's pouch in patients with suspected ectopic pregnancy may be rapidly identified at the bedside by EP-performed US and predicts the need for operative intervention. [source] Surgical exposures for distal humerus fractures: A reviewCLINICAL ANATOMY, Issue 8 2008J. Whitcomb Pollock Abstract The majority of distal humerus fractures have complex fracture patterns, with displaced articular segments, requiring operative intervention. The goals of surgery are anatomic reduction and rigid internal fixation via an operative approach that balances maximum required exposure with minimum soft tissue or bony disruption that may necessitate postoperative protection. The selection of a surgical approach depends on multiple factors, including, facture pattern, extent of articular involvement, associated soft tissue injury, rehabilitation protocols, and surgeon preference. This review focuses on the various surgical approaches to the distal humerus. Clin. Anat. 21:757,768, 2008. © 2008 Wiley-Liss, Inc. [source] Third look surgery and beyond for appendiceal malignancy with peritoneal disseminationJOURNAL OF SURGICAL ONCOLOGY, Issue 1 2003Faheez Mohamed MBChB, MRCS Abstract Background and Objectives Second look surgery has been previously studied in patients with recurrent peritoneal dissemination from appendiceal malignancy. However, selection criteria for third, fourth, and subsequent reoperations are not available. Methods Five hundred and one patients with epithelial peritoneal surface malignancy of appendiceal origin underwent treatment with cytoreductive surgery and intraperitoneal chemotherapy during an 18-year period. Forty-five of these patients (8.9%) underwent three or more operative interventions. A critical statistical analysis of the impact of selected clinical features on survival was performed from a prospective database. Results Overall 5-year survival of these 45 patients was 70%. Five- and ten-year survival rates for patients with three interventions were 60 and 48%, for four interventions were 78 and 36%, and for five or more interventions were 100 and 80%. Sites of recurrent disease, histopathologic type of tumor, and lymph node status had no impact on survival. A complete second and third cytoreduction was associated with an improved 5-year survival rate. Conclusions Prolonged survival in patients with three or more reoperations was significantly associated with a complete cytoreduction. However, after four or more interventions, the effects of tumor biology may predominate. Although 5-year survival is likely with multiple reoperations, prolonged follow-up shows that cancer cure is a rare event. J. Surg. Oncol. 2003;83:5,13. © 2003 Wiley-Liss, Inc. [source] The effect of fundal pressure manoeuvre on intrauterine pressure in the second stage of labourBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2002Catalin S. Buhimschi Objective To investigate the relationship between intrauterine pressure and the application of a standardised fundal pressure manoeuvre, and to determine the maternal, fetal and labour characteristics that modulate the relationship. Design Prospective measurement of intrauterine pressure during the second stage of labour. Setting North American university hospital. Population Forty full-term women in spontaneous labour were studied during the second stage. Each woman acted as her own control. All women laboured with requested epidural analgesia. Methods A fundal pressure manoeuvre was performed so as to standardise the level of force and the surface area of application. Intrauterine pressure was measured using a sensor,tip catheter. Five interventions were analysed: 1. valsalva during a uterine contraction; 2. fundal pressure and valsalva during a contraction; 3. fundal pressure during a contraction without valsalva; 4. fundal pressure in the absence of uterine contractions; and 5. valsalva in the absence of uterine contractions. Results Women in the second stage of labour transiently increased their expulsive force (as reflected by intrauterine pressure) by 86% of their baseline contraction using valsalva and fundal pressure simultaneously. The efficiency by which both contraction-enhancing manoeuvres increased intrauterine pressure was directly related to gestational age and inversely related to myometrial thickness. Conclusion Fundal pressure applied under controlled conditions significantly increases intrauterine pressure in some, but not all women. Simultaneous measurement of intrauterine pressure, to maintain feedback during application will create a ,controlled environment' for the obstetrician and reassurance that this manoeuvre can be applied in a controlled fashion. Future delineation of the group of women that could benefit from fundal pressure, as well as the group that is refractory is essential to avoid unnecessary or delayed operative interventions. [source] Trabeculectomy and Mitomycin C (Trab-MMC) for uveitic glaucoma: post surgical interventionsACTA OPHTHALMOLOGICA, Issue 2007A LOCKWOOD Purpose: To examine the outcome of patients at who underwent trabeculectomy and MMC for refractory uveitic glaucoma and determine the post operative interventions required Methods: The Birmingham ReGAE (Research into Glaucoma and Ethinicity) Project is an open, prospective, consecutive series of patients who had undergone trabeculectomy with MMC. The surgery was performed by a single surgical team at the Birmingham and Midland Eye Centre Results: Twenty eyes of 25 patients with uveitic glaucoma underwent Trab-MMC for uncontrolled IOP despite maximally tolerated medical treatment. Mean follow-up was 650 days. Mean pre-op IOP was 26.7 mmHg and post-op was 11.5 mmHg. 92 % of trabeculectomies reached complete success (IOP , 21 mmHg without medication). Subconjunctival injections of 5-fluorouracil were performed on 10 eyes (36 %). Bleb needling revision was performed on 5 eyes (18 %).Visual loss > 2 lines occurred in 1 case (3.8%) due to delayed hypotony maculopathy Conclusions: Trabeculectomy and Mitomycin C is effective in this complex series of patients but do require considerable post surgery manipulation [source] | |||||||||||||