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Postoperative Outcome (postoperative + outcome)
Selected AbstractsSafety of, and biological and functional response to, a novel metallic implant for the management of focal full-thickness cartilage defects: Preliminary assessment in an animal model out to 1 yearJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 5 2006Carl A. Kirker-Head Abstract Focal full-thickness cartilage lesions of the human medial femoral condyle (MFC) can cause pain and functional impairment. Affected middle-aged patients respond unpredictably to existing treatments and knee arthroplasty may be required, prompting risk of revision. This study assesses the safety of, and biological and functional response to, a metallic resurfacing implant which may delay or obviate the need for traditional arthroplasty. The anatomic contour of the surgically exposed MFC of six adult goats was digitally mapped and an 11 mm diameter full-thickness osteochondral defect was created. An anchor-based Co,Cr resurfacing implant, matching the mapped articular contour, was implanted. Each goat's contralateral unoperated femorotibial joint was used as a control. Postoperative outcome was assessed by lameness examination, radiography, arthroscopy, synoviocentesis, necropsy, and histology up to 26 (n,=,3) or 52 (n,=,3) weeks. By postoperative week (POW) 4, goats demonstrated normal range of motion, no joint effusion, and only mild lameness in the operated limb. By POW 26 the animals were sound with only occasional very mild lameness. Arthroscopy at POW 14 revealed moderate synovial inflammation and a chondral membrane extending centrally across the implant surface. Radiographs at POWs 14 to 52 implied implant stability in the operated joints, as well as subchondral bone remodeling and mild exostosis formation in the operated and contralateral unoperated joints of some goats. By POW 26, histology revealed new trabecular bone abutting the implant. At POWs 26 and 52 MFC cartilage was metachromatic and intact in the operated and unoperated femorotibial joints. Proximal tibiae of some operated and unoperated limbs demonstrated limited subchondral bone remodeling and foci of articular cartilage fibrillation and thinning. The chondral membrane crossing the prosthesis possessed a metachromatic matrix containing singular and clustered chondrocytes. Our data imply the safety, biocompatibility, and functionality of the implant. Focal articular damage was documented in the operated joints at POWs 26 and 52, but lesions were much reduced over those previously reported in untreated defects. Expanded animal or preclinical human studies are justified. © 2006 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res [source] Preliminary experiences of the triple tibial osteotomy procedure: tibial morphology and complicationsJOURNAL OF SMALL ANIMAL PRACTICE, Issue 5 2009A. I. C. Renwick Objective: To document the effect of variable tibial morphology on the planning and execution of the triple tibial osteotomy (TTO) procedure in dogs and complications encountered while becoming familiar with the technique. Methods: The records of 21 consecutive cases that had a TTO performed were reviewed. Preoperative tibial morphology was assessed. Modifications in the described technique and complications were documented. Postoperative outcome was evaluated using a client-based questionnaire. Results: The size of the tibial wedge ostectomy was modified because of variable tibial morphology in four dogs (19 per cent) to avoid over or under correction of the tibial plateau angle (TPA). Intraoperatively, fracture through the caudal tibial cortex occurred in nine cases (41 per cent) and through the distal tibial crest cortex in four cases (18 per cent). Major complications occurred in five (23 per cent) of cases with four (18 per cent) requiring further surgery. The client questionnaire results demonstrated significant improvements in all parameters and no significant difference from the preinjury status. Clinical Significance: TPA measurement is recommended when planning a TTO to avoid over or under correction of the TPA. Despite frequent minor complications, it appears that the TTO is an effective procedure for management of cranial cruciate ligament rupture in the dog. [source] The intrinsic transit time of free microvascular flaps: Clinical and prognostic implicationsMICROSURGERY, Issue 2 2010Charlotte Holm M.D., Ph.D. Background: Microscope-integrated indocyanine green near-infrared videoangiography (ICGA) is a new method for the intraoperative assessment of vascular flow through microvascular anastomoses. The intrinsic transit time (ITT) describes the time period from the dye appears at the arterial anastomosis (t1) till it reaches the suture line of the venous anastomosis (t2). As the transit time reflects blood flow velocity within the flap, prolonged ITT might correlate with low blood flow and a higher rate of postoperative thrombosis. We performed a clinical trial evaluating the association between intraoperative free flap transit time and early anastomotic complications in elective microsurgery. Methods: One hundred consecutive patients undergoing elective microsurgical procedures underwent intraoperative ICG angiography (ICGA). In patients with anastomotic patency, angiograms were retrospectively reviewed and the intrinsic transit time was calculated. Postoperative outcome was registered and compared with the ITT. End points included early reexploration surgery and flap loss within the first 24 hours after surgery. Results: Fourteen patients were excluded from the study due to technical anastomotic failure. The overall flap failure rate was 6% (5/86); the incidence of early re-exploration surgery was 10% (9/86). With a median of 31 seconds patients with an uneventful postoperative course showed significantly shorter ITTs than patients with flap loss or early postoperative reexploration (median: >120 seconds). An optimal cut-off value of ITT > 50 seconds was determined to be strongestly associated with a significantly increased risk of at least one positive end point. Conclusions: This study demonstrates a significant predictive value of the intrinsic flap transit time for the development of flap compromise and early re-exploration surgery. © 2009 Wiley-Liss, Inc. Microsurgery, 2010. [source] Surgical Outcomes of Drillout Procedures for Complex Frontal Sinus Pathology,THE LARYNGOSCOPE, Issue 5 2007Pete S. Batra MD Abstract Objectives: The purpose of this report is two-fold: 1) to determine the incidence and 2) to determine the efficacy of drillout procedures in the management of frontal sinus disease in a tertiary rhinology practice. Study Design: Retrospective data analysis. Methods: Chart review was performed for all patients undergoing frontal sinus surgery from May 1999 to April 2004. The incidence of drillout surgery was determined. Demographic data, symptomatology, type of drillout procedure, and primary pathology were determined. Postoperative outcome was assessed based on subjective symptomatology and objective endoscopic patency. Results: A total of 186 patients underwent 207 frontal sinus procedures during this time period; 25 patients (13.4%) required a total of 30 (14.5%) drillout procedures. The patient population had previously undergone an average of 3.2 procedures; four cases were primary and 26 were revision procedures. The breakdown of the procedures was as follows: Draf III, 17; Draf IIB, 7; and transseptal frontal sinusotomy, 6. The major indications included mucoceles (11 cases), chronic frontal sinusitis (6 cases), and tumors (5 cases). Postoperatively, presenting symptomatology resolved in 32%, improved in 56%, and remained unchanged in 12% of the patients. Endoscopic patency of the neo-ostium was noted in 23 cases (92%). Average follow-up was 16.3 months. Conclusions: In this series, drillout procedures were successfully used in 25 patients as an important adjunct to the standard endoscopic techniques for management of complex frontal sinus disease. Because the procedure was used only 30 times during a 5-year period, it was reserved for specific circumstances in carefully selected patients. [source] Randomized clinical trial of splenectomy versus splenic preservation in patients with proximal gastric cancerBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 5 2006W. Yu Background: Preservation or removal of the spleen during total gastrectomy for proximal gastric cancer is a matter of debate. Methods: A randomized clinical trial included patients with gastric adenocarcinoma who underwent total gastrectomy either with (104 patients) or without (103) splenectomy. Postoperative outcome in the two groups was compared, including morbidity, mortality and survival. Results: Gastrectomy combined with splenectomy tended to be associated with slightly higher morbidity and mortality rates, a slightly greater incidence of lymph node metastasis at the splenic hilum and along the splenic artery, and marginally better survival, but there were no statistically significant differences between the groups. Splenectomy had no impact on survival in patients with metastatic lymph nodes at the hilum of the spleen or in those with metastatic lymph nodes along the splenic artery. Conclusion: These results do not support the use of prophylactic splenectomy to remove macroscopically negative lymph nodes near the spleen in patients undergoing total gastrectomy for proximal gastric cancer. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Surgical treatment of haemorrhoidal disease with CO2 laser and Milligan,Morgan cold scalpel techniqueCOLORECTAL DISEASE, Issue 7 2006L. C. Pandini Abstract Objective, To prospectively compare immediate postoperative results of the surgical treatment of haemorrhoidal disease (HD) by Milligan,Morgan technique using either the CO2 laser or cold scalpel. Methods, Forty patients with grade III/IV HD were prospectively randomized to undergo surgical treatment (Milligan,Morgan) using either the CO2 laser (group A) or the cold scalpel method (group B). Data were compared regarding postoperative pain, complications, healing time, return to normal activity and patient satisfaction. Patients were blinded to treatment method until the completion of the study. Postoperative outcomes were assessed by patient questionnaire and outpatient follow-up visits. Pain was assessed by Visual Analogue Scale and analgesic consumption. Results, Twenty patients were randomized into each group and were comparable relative to mean age, gender and grade of HD. There were no statistically significant differences regarding postoperative pain measured (P =0.17) or consumption of oral (P = 0.741) and parenteral analgesics (P = 0.18) between the two groups. Mean pain score at the first bowel movement was significantly higher in group A (P = 0.035), although the use of analgesics was similar in both the groups. There were no differences regarding complications, mean healing time, return to normal activities and patient satisfaction. Conclusion, There were no differences in the immediate results after Milligan,Morgan haemorrhoidectomy using either the CO2 laser or cold scalpel regarding postoperative pain, complications, healing time, return to normal activities or patient satisfaction. [source] The effect of preoperative weight loss and body mass index on postoperative outcome in patients with esophagogastric carcinomaDISEASES OF THE ESOPHAGUS, Issue 7 2009J. Skipworth SUMMARY Studies have shown that weight loss is associated with adverse outcomes in all treatment modalities for esophagogastric carcinoma. Because of the increased prevalence of obesity and the effectiveness of perioperative nutrition, a number of patients are now obese or have normal body mass index (BMI) at the time of treatment. We investigated the relationship between weight loss, BMI, and outcome of surgery for patients with esophagogastric carcinoma. Data were collected over a 38-month period for all patients diagnosed with operable esophagogastric cancer at two UK centers. All patients underwent resection by a single Consultant Upper Gastrointestinal Surgeon and the use of perioperative jejunal feeding was universal. Ninety-three patients (57 male) underwent esophagogastric resection; 48 had no preoperative weight loss (34 with a BMI > 25 and 14 with a BMI < 25). Forty-five patients had preoperative weight loss (20 with BMI > 25 and 25 with BMI < 25). There was no significant difference in complication rates, median hospital stay, or mortality between the four groups. A significantly higher number of patients displaying preoperative weight loss were found to have stage III disease, but difference in survival of up to 3 years did not reach statistical significance on multivariate analysis. Preoperative weight loss and low BMI did not significantly influence the complication rate, perioperative mortality rate, length of hospital stay, or short-term prognosis. We conclude that preoperative weight loss can not be reliably used as an independent predictor of poor outcome in patients undergoing surgery for esophagogastric carcinoma. However, patients with preoperative weight loss and low BMI are more likely to have advanced disease. [source] Treatment results of bisphosphonate-related osteonecrosis of the jaws,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 9 2008Arno Wutzl MD Abstract Background. Osteonecrosis of the jaws occurs after the administration of bisphosphonates. An unequivocal treatment strategy is yet to be devised. We assess the treatment of patients with bisphosphonate-related osteonecrosis of the jaws (BRONJ). Methods. The investigators studied a prospective cohort of 58 patients 6 months after surgical treatment of BRONJ. Outcome variables were the status of the mucosa, the visual analog score of pain, and prosthetic rehabilitation. Preoperative staging results were compared with the postoperative outcome and statistically evaluated. Results. Of 58 patients, 41 surgically treated patients could be followed up after a mean period of 189 (±23) days. Twenty-four (58.5%) were free of pain and had an intact mucosa. A statistically significant improvement was registered between preoperative and postoperative staging (p <.01); 11 of 12 patients who had been treated with a flap procedure for soft tissue closure had an intact mucosa. Conclusions. This is the first prospective study to report the outcome of treatment in a cohort of patients with BRONJ. Minimal resection of necrotic bone and local soft tissue closure might be a feasible treatment strategy in patients with established BRONJ. © 2008 Wiley Periodicals, Inc. Head Neck 2008 [source] Patient preparation before surgery for cholangiocarcinomaHPB, Issue 3 2008E. Oussoultzoglou Abstract Aim. Multiorgan dysfunction is often encountered in jaundiced patients and may compromise the postoperative outcome after liver resection for cholangiocarcinoma (CCA). The aim of the present study was to elucidate evidence-based medicine regarding the benefit of the available preoperative treatments currently used for the preparation of patients before surgery for hilar CCA. Material and methods. An electronic search using the Medline database was performed to identify relevant articles relating to renal dysfunction, bacterial translocation, hemostasis impairment, malnutrition, liver failure, and postoperative outcome in jaundiced patients undergoing liver resection for CCA. Results. There is grade B evidence to expand the extracellular water volume and to administer oral synbiotic supplements. Intravenous vitamin K administration is an effective treatment. Perioperative nutritional support should be administered preferably by the enteral route in severely malnourished patients with compromised liver function undergoing extended liver resection (grade A evidence). There is only grade C evidence to recommend a portal vein embolization in patients with CCA when the future remnant liver volume is <40%. Conclusions. A simplified scheme that might be useful in the management of patients presenting with obstructive jaundice was presented. Despite surgical technique improvements, preparation of patients for surgery will continue to be one of the major determinants for the postoperative prognosis of jaundiced patients. [source] Preoperative smoking cessation: a questionnaire studyINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 12 2007D. Owen Summary Background:, Preoperative smoking cessation has been shown to improve postoperative outcomes. Methods:, A total of 120 anonymous questionnaires were distributed to non-vascular surgeons practising in four centres in the UK asking about their smoking cessation advice practices, and whether they appreciated both the benefits of preoperative smoking cessation, and the efficacy of smoking cessation interventions. Results:, Eighty-three questionnaires were returned (response rate 69%). Twenty-three gastrointestinal surgeons, 11 orthopaedic surgeons, 9 breast surgeons, 12 plastic surgeons, 13 neurosurgeons and 15 urologists took part in this study. Eighty-eight per cent of respondents had not referred any elective patients to smoking cessation services in the previous month. Most non-vascular surgeons underestimated both the benefits of preoperative smoking cessation on outcome, and the efficacy of smoking cessation interventions. Conclusions:, This survey demonstrates that non-vascular surgeons underestimate the fact that preoperative smoking cessation can improve postoperative outcome, and that smoking cessation interventions are successful in helping patients to quit smoking. They largely do not refer patients to smoking cessation services. In order for patients to benefit postoperatively from this intervention it would be necessary to educate surgeons about the scale of the benefit, and the efficacy of smoking cessation interventions or to set up systematic frameworks to offer smoking cessation advice to preoperative patients who smoke. [source] Orthotopic Cardiac Transplantation: Comparison of Outcome Using Biatrial, Bicaval, and Total TechniquesJOURNAL OF CARDIAC SURGERY, Issue 1 2005Jeffrey A. Morgan M.D. More recently, however, bicaval and total techniques have been devised in an attempt to improve cardiac anatomy, physiology, and postoperative outcome. A bicaval approach preserves the donor atria and combines the standard left atrial anastomosis with a separate bicaval anastomosis. Total orthotopic heart transplantation involves complete excision of the recipient atria with separate bicaval end-to-end anastomoses, as well as pulmonary venous anastomoses. The aim of this study was to conduct a literature review of studies that compared the three surgical techniques (biatrial, bicaval, and total) for performing orthotopic cardiac transplantation. Numerous outcome variables were evaluated, and included post-transplant survival, atrial dimensions, atrioventricular valvular insufficiency, arrhythmias, pacing requirements, vasopressor requirements, and hospital stay. Methods: We conducted a Medline (Pubmed) search using the terms "biatrial and cardiac transplantation,""bicaval and cardiac transplantation," and "total technique and cardiac transplantation," which yielded 192 entries: 39 of these were studies that compared surgical techniques and were included in the review. Results: There was overwhelming evidence that the bicaval technique provided anatomic and functional advantages, with improvements in post-transplant survival, atrial geometry, and hemodynamics, as well as decreased valvular insufficiency, arrhythmias, pacing requirements, vasopressor requirements, and hospital stay. Conclusions: The bicaval technique was superior to both biatrial and total techniques for numerous outcome variables. To further elucidate this issue, a prospective randomized trial comparing the three techniques, with long-term follow-up, is warranted. [source] Beating Heart Ischemic Mitral Valve Repair and Coronary Revascularization in Patients with Impaired Left Ventricular FunctionJOURNAL OF CARDIAC SURGERY, Issue 5 2003Edvin Prifti M.D., Ph.D. Materials and Methods: Between January 1993 and February 2001, 91 patients with LVEF between 17% and 35% and chronic ischemic MVR (grade III,IV), underwent MV repair in concomitance with coronary artery bypass grafting (CABG) Sixty-one patients (Group I) underwent cardiac surgery with cardioplegic arrest, and 30 patients (Group II) underwent beating heart combined surgery. Aortic valve insufficiency was considered a contraindication for the on-pump/beating heart procedure. Mean age in Group I was 64.4 ± 7 years and in Group II, 65 ± 6 years (p = 0.69). Results: The in-hospital mortality in Group I was 8 (13%) patients versus 2 (7%) patients in Group II (p > 0.1). The cardiopulmonary bypass (CPB) time was significantly higher in Group I (p < 0.001). In Groups I and II, respectively (p > 0.1), 2.5 ± 1 and 2.7 ± 0.8 grafts per patient were employed. Perioperative complications were identified in 37 (60.7%) patients in Group I versus 10 (33%) patients in Group II (p = 0.025). Prolonged inotropic support of greater than 24 hours was needed in 48 (78.7%) patients (Group I) versus 15 (50%) patients (Group II) (p = 0.008). Postoperative IABP and low cardiac output incidence were significantly higher in Group I, p = 0.03 and p = 0.027, respectively. Postoperative bleeding greater than 1000 mL was identified in 24 patients (39.4%) in Group I versus 5 (16.7%) in Group II (p = 0.033). Renal dysfunction incidence was 65.6% (40 patients) in Group I versus 36.7% (11 patients) in Group II (p = 0.013). The echocardiographic examination within six postoperative months revealed a significant improvement of MV regurgitation fraction, LV function, and reduced dimensions in both groups. The postoperative RF was significantly lower in Group II patients 12 ± 6 (%) versus 16 ± 5.6 (%) in Group I (p = 0.001). The 1, 2, and 3 years actuarial survival including all deaths was 91.3%, 84.2%, and 70% in Group I and 93.3%, 87.1%, and 75% in Group II (p = ns). NYHA FC improved significantly in all patients from both groups. Conclusion. We conclude that patients with impaired LV function and ischemic MVR may undergo combined surgery with acceptable mortality and morbidity. The on/pump beating heart MV repair simultaneous to CABG offers an acceptable postoperative outcome in selected patients. [source] Low Systemic Vascular Resistance After Cardiopulmonary Bypass: Incidence, Etiology, and Clinical ImportanceJOURNAL OF CARDIAC SURGERY, Issue 5 2000T. Carrel M.D. The etiology is not completely elucidated and the clinical importance remains speculative. Methods: In this prospective clinical trial, we assessed the incidence of postoperative low systemic vascular resistance in 800 consecutive patients undergoing elective coronary artery bypass grafting and/or valve replacement. We have attempted to identify the predictive factors responsible for the presence of low systemic vascular resistance and we have examined the subsequent postoperative outcome of those patients who developed early postoperative vasoplegia. The severity of vasoplegia was divided into three groups according either to the value of systemic resistance and/or the dose of vasoconstrictive agents necessary to correct the hemodynamic. Results: Six hundred twenty-five patients (78.1%) did not develop vasoplegia, 115 patients (14.4%) developed a mild vasoplegia, and 60 patients (7.5%) suffered from severe vasoplegia. Low systemic vascular resistance did not affect hospital mortality but was the cause for delayed extubation and prolonged stay on the intensive care unit IICU). Logistic regression analysis identified temperature and duration of cardiopulmonary bypass, total cardioplegic volume infused, reduced left ventricular function, and preoperative treatment with angiotensin-converting enzyme (ACE)-inhibitors, out of 25 parameters, as predictive factors for early postoperative vasoplegia. Conclusion. The occurrence of low systemic vascular resistance following cardiopulmonary bypass is as high as 21.8%. The etiology of this clinical condition is most probably multifactorial. Mortality is not affected by vasoplegia, but there is a trend to higher morbidity and prolonged stay in the ICU. [source] Magnetic Resonance Analysis of Postsurgical Temporal LobectomyJOURNAL OF NEUROIMAGING, Issue 3 2001Taoufik M. Alsaadi MD ABSTRACT Background and Purpose. The effect of temporal lobe transection area, volume of postoperative gliosis, and surgical technique on patients' seizure-free outcome is unknown. The authors studied the effects of these variables on patients' seizure-free outcome. Methods. A retrospective review of magnetic resonance imaging examinations acquired 3 to 18 months after temporal lobe resection was carried out for 18 patients with intractable temporal lobe seizures and known postsurgical outcomes for more than 2 years. The total volume of radiologically probable gliosis evident on axial proton-density-weighted images was calculated for each patient using software on an independent console. The total area of temporal lobe surface transected by the scalpel was calculated as well, using sagittal T1-weighted images. The total volume of gliosis, the total area of transected temporal lobe, and the specific type of surgery (sparing vs no sparing of the superior temporal gyrus) were then correlated with the postsurgical outcome of the patients. An examiner with no prior knowledge of the patients' postsurgical outcomes carried out the above calculations and measurements. The patients' postoperative outcome was defined using Engel classifications, and patients were divided into two groups: group A with Engel class 1 (n= 9) and group B with Engel classes 2,4 (n= 9). Results. The mean volumes of postoperative gliosis were not significantly different between group A (3592.3 mm3) and group B (4270 mm3). The mean area of transected temporal lobe was also similar between group A (1865.2 mm2) and group B (1930 mm2). With regard to surgical technique, there were 5 subjects who had the superior temporal gyrus resected and 13 who did not. Eighty percent of patients with the superior temporal gyrus resected were Engel class 1 or 2, whereas only 20% were of Engel class 3 or 4. Conclusion. The authors found no clear association between postoperative outcome and residual temporal lobe gliosis, the surgical technique, or the total area of temporal lobe transected by the scalpel. [source] Pneumonectomy: four case studies and a comparative reviewJOURNAL OF SMALL ANIMAL PRACTICE, Issue 9 2004J. M. Liptak Pneumonectomy is the resection of all lung lobes in either the left right lung field. The surgical technique and postoperative results pneumonectomy for clinical disease have not been reported in companion animals. Pneumonectomy was performed in three dogs and one cat to treat pulmonary or pleural disease, and the postoperative outcome compared with the complications and results reported in the human literature. One dog died immediately postoperatively due to suspected respiratory insufficiency and the remaining three animals survived the perioperative period. Postoperative complications were reported in two animals. Cardiac complications occurred in the cat, with perioperative arrhythmias and progressive congestive heart failure. Gastrointestinal complications were diagnosed in one dog, with mediastinal shift oesophageal dysfunction. Left- and right-sided pneumonectomy is feasible in companion animals, and the postoperative outcome and complications encountered in this series were similar to those reported in humans. [source] Postreperfusion syndrome during liver transplantation for cirrhosis: Outcome and predictorsLIVER TRANSPLANTATION, Issue 5 2009Catherine Paugam-Burtz During orthotopic liver transplantation (OLT), a marked decrease in blood pressure following unclamping of the portal vein and liver reperfusion is frequently observed and is termed postreperfusion syndrome (PRS). The predictive factors and clinical consequences of PRS are not fully understood. The goal of this study was to identify predictors of PRS and morbidity/mortality associated with its occurrence during OLT in patients with cirrhosis. During a 3-year period, all consecutive OLT procedures performed in patients with cirrhosis were studied. Exclusion criteria were OLT for acute liver failure, early retransplantation, combined liver/kidney transplantation, and living-donor related transplantation. PRS was defined as a decrease in the mean arterial pressure of more than 30% of the value observed in the anhepatic stage, for more than 1 minute during the first 5 minutes after reperfusion of the graft. Transplantation was performed with preservation of the inferior vena cava with or without temporary portocaval shunt. Associations between PRS and donor and recipient demographic data, recipient operative and postoperative outcomes were tested with bivariate statistics. Independent predictors of PRS were determined in multivariable logistic regression analysis. Of the 75 patients included in the study, 20 patients (25%) developed PRS. In a multivariable analysis, absence of a portocaval shunt [odds ratio (95% confidence interval) = 4.42 (1.18-17.6)] and duration of cold ischemia [odds ratio (95% confidence interval) = 1.34 (1.07-1.72)] were independent predictors of PRS. Patients who experienced PRS displayed more postoperative renal failure and lower early (<15 days after OLT) survival (80% versus 96%; P = 0.04). In conclusion, the absence of portocaval shunt and the duration of cold ischemia were independent predictors of intraoperative PRS. PRS was associated with significant adverse postoperative outcome. These results provide realistic clinical targets to improve patient outcome after OLT for cirrhosis. Liver Transpl 15:522,529, 2009. © 2009 AASLD. [source] Does middle hepatic vein omission in a right split graft affect the outcome of liver transplantation?LIVER TRANSPLANTATION, Issue 6 2007A comparative study of right split livers with, without the middle hepatic vein Preservation of the middle hepatic vein (MHV) for a right split liver transplantation (SLT) in an adult recipient is still controversial. The aim of this study was to evaluate the graft and patient outcomes after liver transplantation (LT) using a right split graft, according to the type of venous drainage. From February 2000 to May 2006, 33 patients received 34 cadaveric right split liver grafts. According to the type of recipient pairs (adult/adult or adult/child), the right liver graft was deprived of the MHV or not. The first group (GI, n = 15) included grafts with only the right hepatic vein (RHV) outflow, the second (GII, n = 18) included grafts with both right and MHV outflows. The 2 groups were similar for patient demographics, initial liver disease, and donor characteristics. In GI and GII, graft-to-recipient-weight ratio (GRWR) was 1.2 ± 0% and 1.6 ± 0.3% (P < 0.05), and cold ischemia time was 10 hours 55 minutes ± 2 hours 49 minutes and 10 hours 47 minutes ± 3 hours 32 minutes, respectively (P = not significant). Postoperative death occurred in 1 patient in each group. Vascular complications included anastomotic strictures: 2 portal vein (PV), 1 hepatic artery (HA), and 1 RHV anastomotic strictures; all in GI. Biliary complications occurred in 20% and 22% of the patients, in GI and GII, respectively (P = not significant). There were no differences between both groups regarding postoperative outcome and blood tests at day 1-15 except for a significantly higher cholestasis in GI. At 1 and 3 yr, patient survival was 94% for both groups and graft survival was 93% for GI and 90% for GII (P = not significant). In conclusion, our results suggest that adult right SLT without the MHV is safe and associated with similar long-term results as compared with those of the right graft including the MHV, despite that early liver function recovered more slowly. Technical refinements in outflow drainage should be evaluated in selected cases. Liver Transpl 13:829,837, 2007. © 2007 AASLD. [source] The small remnant liver after major liver resection: How common and how relevant?LIVER TRANSPLANTATION, Issue 9 2003Cengizhan Yigitler The maximum extent of hepatic resection compatible with a safe postoperative outcome is unknown. The study goal was to determine the incidence and impact of a small remnant liver volume after major liver resection in patients with normal liver parenchyma. Among 265 major hepatectomies performed at our institution (1998 to 2000), 138 patients with normal liver and a remnant liver volume (RLV) systematically calculated from the ratio of RLV to functional liver volume (FLV) were studied. Patients were divided into five groups based on RLV-FLV ratio from ,30% to ,60%. Kinetics of postoperative liver function tests were correlated with RLV. Postoperative complications were stratified by RLV-FLV ratios. Ninety patients (65%) underwent resection of up to four Couinaud segments. The RLV-FLV ratio was ,60% in 94 patients (68%) including only 13 (9%) with RLV-FLV ,30%. There was no linear correlation between the number of resected segments and the RLV-FLV. Postoperative serum bilirubin but not prothrombin time correlated with extent of resection. The incidence of complications including liver failure was not different among groups. Analysis of the four groups with a RLV-FLV ratio <60% showed a trend toward more complications and a longer intensive care unit stay in patients with the smallest RLVs. After major hepatectomy in patients with normal livers, the proportion of patients with a small remnant liver is low and not directly related to the number of segments resected. Although the rate of postoperative complications, including liver failure, did not directly correlate with the volume of remaining liver, the postoperative course was more difficult for patients with smaller remnants. Therefore preoperative portal vein embolization should be considered in patients who will undergo extended liver resection who have (1) injured liver or (2) normal liver when the planned procedure will be complex or when the anticipated RLV-FLV will be <30%. (Liver Transpl 2003;9:S18-S25.) [source] Chondrosarcomas of the Jugular ForamenTHE LARYNGOSCOPE, Issue 10 2008Mario Sanna MD Abstract Objectives/Hypothesis: Chondrosarcomas of the jugular foramen are extremely rare tumors. Our review of the literature revealed eleven previously reported cases. The aim of this study is to describe the presenting symptoms, radiographic findings, operative procedures, and postoperative outcome of five histologically confirmed cases of chondrosarcomas arising from the jugular foramen. A review of the literature is also presented. Study Design: Retrospective study of an quaternary referral otology and skull base private center. Methods: Five cases of surgically treated and pathologically confirmed jugular foramen chondrosarcomas were identified. The follow-up of the series ranged from 23 to 42 months (mean, 32.8 ± 7.7 months). Results: A single stage procedure was adopted in all the cases. Two patients underwent type A infratemporal approaches, one patient underwent a transotic approach extending to the neck with ligature of the internal jugular vein, one patient underwent a petro-occipital transigmoid approach, and one patient underwent a combined petro-occipital transigmoid,transotic approach. Gross total tumor removal was achieved in all patients. The most common complications were lower cranial nerve deficits. To date, no recurrence or residual tumors have been observed at radiological controls. Conclusions: We believe that the primary treatment for chondrosarcomas of the jugular foramen is gross total surgical resection of the tumor. It is our philosophy to reserve postoperative radiotherapy for patients with histologically aggressive tumors, as well as in cases with subtotal resection and recurrent tumors. [source] Influence of Age on the Surgical Outcome After Endoscopic Sinus Surgery for Chronic Rhinosinusitis With Nasal PolyposisTHE LARYNGOSCOPE, Issue 6 2007Jae Yong Lee MD Abstract Objectives: To determine whether patient age is associated with the surgical outcome after endoscopic sinus surgery (ESS) with polypectomy. Study Design: A prospective, controlled case series. Materials and Methods: This study consisted of 60 patients who were diagnosed as having chronic rhinosinusitis (CRS) with nasal polyposis (NP) that was refractory to medical treatment. Three groups were classified according to patient age: pediatric (5,18 yr), adult (19,65 yr), and geriatric (over 65 yr). We collected 20 patients in each age group after applying the exclusion criteria. The extent of the polyps and the Lund-Mackay score were calculated for each patient, and they underwent ESS with polypectomy. We compared the objective endoscopic findings and subjective improvements in symptoms among the groups 6 months after the procedure. Results: There were no statistical differences in polyp extent or Lund-Mackay score between the three age groups. The objective surgical outcome based on the endoscopic findings was worst in the pediatric group (45%), whereas the geriatric group showed the best results (90%). The differences in objective outcome among the three groups were significant, and patient age was a predictive variable for surgical result based on multiple logistic regression analysis. No major complications occurred, and the overall improvement in subjective symptoms was statistically significant in all three age groups at 6 months postoperatively. The subjective surgical outcome did not differ statistically between the groups, with the exception of olfactory disturbance. Conclusions: The results of the present study suggest that patient age influences the objective postoperative outcome in the endoscopic treatment of CRS with NP, and that ESS is an effective and reliable method for improving the subjective symptoms in patients of all age groups despite the statistically different objective surgical outcomes between the groups. [source] Sex Differences in Outcomes of Sinus Surgery,THE LARYNGOSCOPE, Issue 7 2006Sabrina Mendolia-Loffredo MS Abstract Purpose: Sex has been demonstrated to affect outcome in many diseases. Our current aim is to investigate the relationship between sex and outcomes of endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS). Methods: Forty-four males and 73 females undergoing ESS for CRS with a mean follow-up of 1.4 years were evaluated prospectively. Computed tomography (CT), endoscopy, and quality of life (QOL) assessment was performed. Univariate analyses were performed to evaluate whether sex was predictive of outcome. Multiple logistic regression analysis was performed to evaluate sex association with patient factors predictive of outcome. Results: Although no sex differences in CT and endoscopy were observed (CT, P = .107 and endoscopy, P > .1), females consistently scored worse than males on disease-specific QOL pre- and postoperatively. Importantly, there was no effect of sex on improvement/change scores for the QOL instruments. Predictive Models and Multiple Logistic Regression Analysis: Sex was not found to be predictive of QOL or endoscopic outcome. Female sex was, however, associated with acetylsalicylic acid (ASA) intolerance and depression, both factors that have been associated with poorer outcome. Conclusion: Despite similarities in objective disease measures, females report significantly worse QOL scores pre- and postoperatively. Postoperative improvement did not differ by sex, nor was sex predictive of postoperative outcome. Sex differences in QOL reflect sex differences in ASA intolerance and depression, both more prevalent in females. [source] GS28P LAPAROSCOPIC CHOLECYSTECTOMY FOR OBESE PATIENTSANZ JOURNAL OF SURGERY, Issue 2007S. W. Li Background Laparoscopic surgery is often perceived to be more difficult for obese patients. Middlemore Hospital has unique patient population with high prevalence of obesity. This is a pilot study to compare the outcome of obese and non-obese patients who had laparoscopic cholecystectomy in our institution. Our hypothesis is that obese patients do not suffer more adverse postoperative outcome. Methods We reviewed all patients undergoing acute and elective cholecystectomy from January 2004 to December 2006, 100 obese patients were identified. The control group consists of 100 non-obese patients matched for age, sex and type of admission. Outcome assessed includes length of recovery period, complication and conversion rate. Results Over the three year period there were 1400 cholecystectomies, of which 96% were commenced laparoscopically. Overall conversion rate was 3.8%. The obese group has increased rate of wound complication (10% vs 2%, p = 0.037) and conversion rate (8% vs 3.5%, p = 0.28). The two study groups have similar median length of postoperative stay of 4 days. Conclusion This confirms our hypothesis that it is safe for obese patients to have laparoscopic cholecystectomy. However there is increased risk of conversion and wound complication. [source] Outcomes of emergency common bile duct exploration: impact of preoperative endoscopic decompressionANZ JOURNAL OF SURGERY, Issue 6 2003Joyce S. B. Koh Background: Emergency common bile duct exploration (CBDE) is still required in patients acutely ill with complicated biliary tract stone disease when endoscopic decompression fails to reverse their condition. This study looks at the clinical profile of patients requiring emergency CBDE and examines the various factors influencing the postoperative outcome. Methods: Clinical records of patients with emergency CBDE in Singapore General Hospital from January 1991 to December 1998 were reviewed. Factors influencing postoperative outcomes, for example, pre-existing medical problems, hepatic para-meters, the impact of endoscopic procedures (if any) and indications for surgery, were correlated with postoperative morbidity and 30-day mortality. Results: The records of 100 patients were available for review. Major indications for emergency CBDE were cholangitis (51%) and intraoperative findings of common bile duct obstruction during emergency laparotomy (23%). Six patients had emergency CBDE because of iatrogenic complication of attempted therapeutic endoscopic retrograde cholangiopancreaticography (ERCP) for biliary stones. Overall mortality was 14.0% and 8.0% had retained stones. Mortality was significantly influenced by age, prior biliary disease, preoperative endoscopic biliary decompression in acute cholangitis (33.3%vs 9.4%, P = 0.035) and endoscopic complications. Conclusions: Among patients requiring emergency CBDE, uncomplicated preoperative endoscopic biliary decompression benefits patients with acute cholangitis. [source] Viral reactivation is not related to septic complications after major surgical resections,APMIS, Issue 4 2008T. VOGEL Anastomotic leakage and septic complications are the most important determinants of postoperative outcome after major surgical resections. Malignant diseases and surgical trauma can influence immune responses and the ability to react against infectious factors, such as bacteria and viruses. Comparable immune suppression can cause viral reactivation in transplantation and trauma patients. In this prospective study, patients who underwent major surgical resections for oesophageal or pancreatic cancer were investigated for the potential involvement of viral reactivation in the development of septic complications. 86 patients (40 oesophageal resections, 27 pancreatic resections, 19 surgical explorations) were included. Viral antigens, viral DNA, antibodies against viral structures (IgG, IgM, IgA) and, in part, viral cultivation were performed for CMV, EBV, HSV1, HSV2, HZV6 and VZV in serum, urine, sputum and swabs from buccal mucosa preoperatively and at postoperative days 1, 3 and 5. Test results were compared with the postoperative outcome (30-day morbidity, in-hospital mortality) and clinical scores (SOFA, TISS). For statistical analyses Student's t -tests and Chi2 -tests were used. The overall complication rate was 19.8% (30-day morbidity) with an in-hospital mortality of 1.2% (1/86 patients). Postoperatively, anti-CMV-IgG titres were significantly reduced (p<0.05) and remained suppressed in patients with septic complications. Anti-CMV-gB-IgG were also reduced, but showed considerable interindividual differences. Anti-CMV-IgA and -IgM did not show significant alterations in the postoperative course. In addition, direct viral detection methods did not support viral reactivation in patients in any of the investigated groups. The reduction of anti-CMV antibodies is likely caused by an immune suppression, specifically by reduced B-cell counts after major surgical interventions. Viral reactivation, however, did not occur in the early postoperative period as a specific risk for septic complications. [source] Mechanical Aortic Valve Replacement in Children and Adolescents After Previous Repair of Congenital Heart DiseaseARTIFICIAL ORGANS, Issue 11 2009Aron-Frederik Popov Abstract Due to improved outcome after surgery for congenital heart defects, children, adolescents, and grown-ups with congenital heart defects become an increasing population. In order to evaluate operative risk and early outcome after mechanical aortic valve replacement (AVR) in this population, we reviewed patients who underwent previous repair of congenital heart defects. Between July 2002 and November 2008, 15 (10 male and 5 female) consecutive patients (mean age 14.5 ± 10.5 years) underwent mechanical AVR. Hemodynamic indications for AVR were aortic stenosis in four (27%), aortic insufficiency in eight (53%), and mixed disease in three (20%) after previous repair of congenital heart defects. All patients had undergone one or more previous cardiovascular operations due to any congenital heart disease. Concomitant cardiac procedures were performed in all of them. In addition to AVR, in two patients, a mitral valve exchange was performed. One patient received a right ventricle-pulmonary artery conduit replacement as concomitant procedure. The mean size of implanted valves was 23 mm (range 17,29 mm). There were neither early deaths nor late mortality until December 2008. Reoperations were necessary in five (33%) and included implantation of a permanent pacemaker due to complete atrioventricular block in two (15%), mitral valve replacement with a mechanical prosthesis due to moderate to severe mitral regurgitation in one (7%), aortocoronary bypass grafting due to stenosis of a coronary artery in one (7%), and in one (7%), a redo subaortic stenosis resection was performed because of a secondary subaortic stenosis. At the latest clinical evaluation, all patients were in good clinical condition without a pathological increased gradient across the aortic valve prosthesis or paravalvular leakage in echocardiography. Mechanical AVR has excellent results in patients after previous repair of congenital heart defects in childhood, even in combination with complex concomitant procedures. Previous operations do not significantly affect postoperative outcome. [source] Delayed surgery for acute severe colitis is associated with increased risk of postoperative complications,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2010J. Randall Background: This study determined the long-term outcome after colectomy for acute severe ulcerative colitis (ASUC) and assessed whether the duration of in-hospital medical therapy is related to postoperative outcome. Methods: All patients who underwent urgent colectomy and ileostomy for ASUC between 1994 and 2000 were identified from a prospective database. Patient details, preoperative therapy and complications to last follow-up were recorded. Results: Eighty patients were identified, who were treated with intravenous steroids for a median of 6 (range 1,22) days before surgery. Twenty-three (29 per cent) also received intravenous ciclosporin. There were 23 complications in 22 patients in the initial postoperative period. Sixty-eight patients underwent further planned surgery, including restorative ileal pouch,anal anastomosis in 57. During a median follow-up of 5·4 (range 0·5,9·0) years, 48 patients (60 per cent) developed at least one complication. Patients with a major complication at any time during follow-up had a significantly longer duration of medical therapy before colectomy than patients with no major complications (median 8 versus 5 days; P = 0·036). Conclusion: Delayed surgery for patients with ASUC who do not respond to medical therapy is associated with an increased risk of postoperative complications. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Predicting postoperative morbidity by clinical assessmentBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2005P. M. Markus Background: The aim of this study was to determine the accuracy of prediction of the surgeon's ,gut-feeling' in estimating postoperative outcome. Methods: A prospective series of 1077 consecutive patients undergoing major hepatobiliary or gastrointestinal surgery were studied. Patients having elective (n = 827) and emergency (n = 250) procedures were included. The surgeon predicted the development of postoperative complications immediately after completion of surgery on a scale from 0 to 100 per cent. These predictions were compared with the actual outcome and with predictions made using the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM). The Portsmouth predictor equation (P-POSSUM) was applied for the estimation of mortality. Results: The observed morbidity and mortality rates were 29·5 and 3·4 per cent respectively. POSSUM predicted a morbidity rate of 46·4 per cent and P-POSSUM a mortality rate of 6·9 per cent. The surgeon's gut-feeling was more accurate in the prediction of morbidity at 32·1 per cent. On the basis of gut-feeling, surgeons overpredicted morbidity in elective surgery, but underestimated the risk of complications in the emergency setting. The (P)-POSSUM scoring system overpredicted morbidity and mortality for elective and emergency operations. Conclusion: The surgeon's gut-feeling is a good predictor of postoperative outcome, especially after elective surgery. (P)-POSSUM overpredicted morbidity and mortality in this series of major gastrointestinal and hepatobiliary operations. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Randomized controlled trial of acute normovolaemic haemodilution in aortic aneurysm repairBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2001L. Wolowczyk Background: Previous studies have suggested that acute normovolaemic haemodilution (ANH) reduces the need for heterologous blood transfusion in abdominal aortic aneurysm (AAA) surgery and may thus improve postoperative outcome by reducing the systemic inflammatory response. Controlled studies are lacking. The aim of this randomized controlled trial was to evaluate the effects of ANH on the systemic inflammatory response, clinical outcome and use of bank blood after AAA repair. Methods: Patients undergoing elective AAA repair were randomized to ANH (n = 16) or control (n = 18) groups. Intraoperative cell salvage and heterologous blood were used in both groups according to predetermined transfusion triggers. Inflammatory markers in serum and urine were measured to assess the acute-phase response. Clinical outcome was determined using mortality, morbidity and the incidence of the systemic inflammatory response syndrome (SIRS). Results: There was no difference between the ANH and control group in serial measurements of median (range) white cell count (maximum at 2 days after operation: 11·9 (7·7,21·4) versus 10·3 (7·8,20·6) × 109 l,1; P = 0·25), serum C-reactive protein level (maximum at 3 days: 150 (1,274) versus 169 (7,238) mg ml,1; P = 0·76), interleukin 6 level (maximum at 6 h: 142 (32,793) versus 105 (29,509) pg ml,1; P = 0·89), total antioxidant capacity (lowest at 1 h: 0·83 (0·67,1·22) versus 0·83 (0·68,1·23) mmol l,1; P = 0·45) or urinary albumin/creatinine ratio (maximum at 30 min after clamp release: 41 (2,923) versus 124 (4,376) mg ml,1; P = 0·10). SIRS was observed in ten of 16 patients having ANH and in 11 of 18 control patients (P = 0·99). There was no significant difference in mortality and morbidity between the groups. Similarly, there was no difference in median (range) blood loss (ANH 1800 (400,12 000) ml versus control 1600 (500,7500) ml; P = 0·55), use of cell salvage (600 (0,4740) versus 520 (0,2420) ml; P = 0·60) or heterologous blood transfusion (2 (0,32) versus 2 (0,9) units; P = 0·68). Conclusion: In the setting of a randomized controlled trial ANH added no additional benefit, when used in combination with cell salvage, in reducing the requirements for heterologous blood transfusion, and made no impact on systemic inflammatory response and clinical outcome after AAA repair. © 2001 British Journal of Surgery Society Ltd [source] Computer-assisted dosage calculation for strabismus therapy in myopic patientsACTA OPHTHALMOLOGICA, Issue 1 2008Martina Koch Abstract. Purpose:, The published dosage recommendations for the surgical correction of horizontal strabismus in non-myopic patients show large, unexplained differences. For patients with high myopia, the situation becomes even more complex because the increase in the size of the bulb also affects the geometry of the oculomotor muscles. In this study, we wanted to investigate whether computer simulations of the oculomotor plant can be used to find accurate surgical parameters. Methods:, In a retrospective study, we investigated pre- and postoperative strabismus patterns in 13 patients affected by convergent (seven patients) or divergent (six patients) strabismus and high myopia. Postoperative checks were made 1 day, 1 week, 3 months and 1,6 years after the operation. For each patient, we simulated the presurgical strabismus pattern with SEE++ (see ,Further Information' for manufacturer details), a biomechanical simulation program of the oculomotor plant. The individual results of the simulations were then compared to the measured postoperative strabismus patterns. Results:, We found a trend of under-correction in the postoperative situation, resulting in four patients having a large remaining strabismus angle of more than 5 degrees. The computer simulations were able to reproduce this under-correction, and suggested an increase in dosage. Conclusion:, We conclude that realistic biomechanical simulations of the oculomotor plant can predict the postoperative result for myopic patients accurately. The results of the computer simulation correlate well with the postoperative outcome of the patient. [source] Surgical treatment of esophageal leiomyoma located near or at the esophagogastric junction via a thoracoscopic approachDISEASES OF THE ESOPHAGUS, Issue 2 2009Z. G. Li SUMMARY Esophageal leiomyoma can be enucleated safely and effectively by minimally invasive surgery. The laparoscopic approach has been a conventional option for this kind of tumor located near or at the esophagogastric (EG) junction. The aims of this study were to evaluate the surgical outcome of thoracoscopic resection of leiomyoma at the EG junction, and discuss factors affecting the incidence of postoperative gastroesophageal reflux. Fourteen patients who underwent thoracoscopic resection of esophageal leiomyoma located near or at the EG junction (<4 cm above the esophageal hiatus) from January 2002 to August 2007 were reviewed retrospectively. Tumor characteristics, surgical methods, and postoperative outcomes were evaluated. A left approach of video-assisted thoracoscopy was used in 13 patients; a right approach was used for the other patient, whose multiple tumors were located in the EG junction and mid-esophagus. Postoperative recovery was uneventful in all patients, with no mucosa leakage or other significant complications. Mean tumor size was 3.2 cm (1.2,6.0 cm). Of the 14 patients, two had serpiginous leiomyoma, two had multiple tumors, and the others had solitary tumors. Mean postoperative stay in hospital was 7 days (4,11 days). Postoperative dysphagia was not reported, although gastroesophageal reflux was noted in one patient. Thoracoscopic resection of esophageal leiomyomas near or at the EG junction is feasible, with a low prevalence of postoperative gastroesophageal reflux. [source] | |||||||||||||||||||||||||