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Surgical Complications (surgical + complications)

Distribution by Scientific Domains

Medical Sciences	98%

Distribution within Medical Sciences

Surgery & Surgical Specialties	20%
Implant Dentistry	4%
Allergy & Clinical Immunology	3%
16 Other Subdomains	49%

Selected Abstracts

"Reading Man Flap" Design for Reconstruction of Circular Infraorbital and Malar Skin Defects

DERMATOLOGIC SURGERY, Issue 11 2008
TAMER SEYHAN MD
BACKGROUND Surgical complications such as lid retraction and ectropion from graft or flap scar contracture make reconstruction of skin defects in the malar and infraorbital regions challenging. OBJECTIVE A new flap design, the reading man flap, was used to overcome these problems. The Limberg and bilobed flap were compared with the reading man flap. METHODS The reading man flap consists mainly of a superiorly based quadrangular flap and an inferiorly based triangular flap. Malar and infraorbital circular skin defects measuring 14 × 14 to 40 × 40 mm were reconstructed with a reading man flap in 13 patients. The defects occurred after basal cell carcinoma in all patients. The Limberg flap, bilobed flap, and reading man flap were planned for same-sized defects on the abdominoplasty resection material. The results were compared in terms of total scar area, scar length, and total healthy skin area discarded. RESULTS When comparing the 3 flap designs, the reading man flap was the most suitable flap in terms of total scar area and length. CONCLUSION The reading man flap can be used to reconstruct malar and infraorbital circular defects with good cosmetic results and without creating any tractional forces to the eyelids. [source]

Arterial dissection complicating tonsillectomy

DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 9 2003
E Wraige MRCPCH
Tonsillectomy is a frequently performed surgical procedure. Surgical complications can be serious. We report the case of a 7,year-old female who experienced an arterial ischaemic cerebral infarction following elective adenotonsillectomy. [source]

Surgical complications and medium-term outcome results of tension-free vaginal tape: A prospective study of 313 consecutive patients

NEUROUROLOGY AND URODYNAMICS, Issue 1 2004
Ishai Levin
Abstract Objective A prospective study was undertaken to examine the incidence of surgical complications and medium-term outcomes of tension-free vaginal tape (TVT) surgery in a large, heterogeneous group of stress-incontinent women. Methods Surgery was tailored according to preoperative clinical and urodynamic findings: stress-incontinent women underwent TVT surgery, whereas those with concomitant urogenital prolapse underwent combined TVT and prolapse repair. Post-operatively the patients were scheduled for evaluation at 1, 3, 6, and 12 months, and annually thereafter. All underwent urodynamics at 3 months post-operatively. Results Three hundred and thirteen consecutive patients were prospectively studied. The mean follow-up period was 21.4,±,13.5 months. Sixteen (5.1%) cases of intravesical passage of the prolene tape occurred in our series, two of which were diagnosed at 3 and 15 months post-operatively. Eight (2.5%) patients had post-operative voiding difficulties, necessitating catheterization for more than 7 days. However, transvaginal excision of the tape was required in one case only. Vaginal erosion of the tape was diagnosed in four (1.3%) patients, all of whom were successfully treated by local excision of the eroded tape. Outcome analysis was restricted to 241 consecutive patients with at least 12 months of follow-up. Subjectively, 16 (6.6%) patients had persistent mild stress urinary incontinence, although urodynamics revealed asymptomatic sphincteric incontinence in 17 (7%) other patients. De-novo urge incontinence developed post-operatively in 20 (8.3%) patients. Conclusions The TVT procedure is associated with good medium-term cure rates, however, it is not free of troublesome complications and the patients should be informed accordingly. Only well-trained surgeons, familiar with pelvic anatomy, surgical alternatives, and endoscopic techniques should perform the operation. Neurourol. Urodynam. 23:7,9, 2004. © 2003 Wiley-Liss, Inc. [source]

Pediatric renal transplantation in a South African teaching hospital: A 20-year perspective

PEDIATRIC TRANSPLANTATION, Issue 4 2006
G. J. Pitcher
Abstract:, Introduction:, Renal transplantation is established as the standard of care for end-stage renal failure (ESRF) in the developed world. In emerging nations, the appropriateness of such costly interventions has been questioned. We undertook an analysis of all renal transplants undertaken under the care of the pediatric nephrology service at the Johannesburg Hospital, South Africa, in order to establish the outcomes of a transplantation service in a resource-constrained environment in a developing country. Methods:, This was a retrospective review of renal transplantation undertaken at a single teaching hospital in Johannesburg, part of the University of the Witwatersrand. Two hundred and eighty-two transplants were performed between 1984 and 2003. Demographic characteristics of the transplanted population, diagnosis, morbidity, graft survival, and mortality were recorded. Results:, Overall 1-, 5-, and 10-yr graft survival was 82, 44, and 23%. Overall 1-, 5-, and 10-yr patient survival was 97, 84, and 68%. The median graft survival for all transplantation episodes was 4.38 yr; 70% of patients survive 10 yr and 54% survive 20 yr or more. Although early graft survival was good, there was a more rapid rate of graft loss than when compared to results from developed centers with much poorer results at 5 and 10 yr. Causes of ESRF show marked variation between the races, and black patients have significantly worse outcomes than others. Compared with white patients, black recipients received fewer living donor kidneys (26 vs. 10%, p = 0.0019), a greater proportion of totally mismatched organs (56 vs. 36%, p = 0.015), less pre-emptive transplantation (7 vs. 35%, p = 0.0001) and experienced a higher rate of primary non-function (13 vs. 3%, p = 0.004). Surgical complications of transplantation occurred in 9% of recipients, but rarely led to graft loss. Conclusion:, Pediatric renal transplantation in Johannesburg can be accomplished with low complication rates, but medium and long-term graft survival is poor when compared with contemporary results achieved in developed countries. The difficulties of undertaking such complex, multidisciplinary interventions in a developing nation are daunting, but we believe that renal transplantation should still be the treatment of choice for all children with ESRF. The poorer outcomes in black recipients can be addressed by increasing education in our communities and expanding the pool of appropriate donors. Better institutional support would allow for improved long-term patient care. [source]

Lymphatic Mapping and Sentinel Lymphadenectomy for 106 Head and Neck Lesions: Contrasts Between Oral Cavity and Cutaneous Malignancy,

THE LARYNGOSCOPE, Issue S109 2006
FACS, Francisco J. Civantos MD
Abstract Objectives: The objectives of this prospective series were to present our results in 106 sequential cases of lymphatic mapping and sentinel lymph node biopsy (SLNB) in the head and neck region and contrast the experience in oral cancer with that for cutaneous lesions. Hypotheses: SLNB has an acceptably low complication rate in the head and neck. Lymphatic mapping and gamma probe-guided lymphadenectomy can improve the management of malignancies of the head and neck by more accurate identification of the nodal basins at risk and more accurate staging of the lymphatics. For appropriately selected patients, radionuclide lymphatic mapping may safely allow for minimally invasive sentinel lymphadenectomy without formal completion selective lymphadenectomy. Methods: One hundred six patients underwent intralesional radionuclide injection and radiologic lymphoscintigraphy (LS) on Institutional Review Board-approved protocols and 103 of these underwent successful SLNB. These included 35 patients with malignant melanoma, 10 cutaneous squamous cell carcinomas, four lip cancers, eight Merkel cell carcinomas, two rare cutaneous lesions, and 43 oral cancers. Mean follow up was 24 months. Patients with oral cavity malignancy underwent concurrent selective neck dissection after narrow-exposure sentinel lymph node excision. In this group, the SLNB histopathology could be correlated with the completion neck specimen histopathology. Patients with cutaneous malignancy underwent SLNB alone and only received regional lymphadenectomy based on positive histology or clinical indications. Data were tabulated for anatomic drainage patterns, complications, histopathology, and patterns of cancer recurrence. Results: Surgical complications were rare. No temporary or permanent dysfunction of facial or spinal accessory nerves occurred with sentinel node biopsy. Lymphatic drainage to areas dramatically outside of the expected lymphatic basins occurred in 13.6%. Predictive value of a negative sentinel node was 98.2% for cutaneous malignancies (based on regional recurrence) and 92% with oral cancer (based on pathologic correlation). Gross tumor replacement of lymph nodes and redirection of lymphatic flow represented a significant technical issue in oral squamous cell carcinoma. Sixteen percent of patients with oral cancer were upstaged from N0 to N1 after extended sectioning and immunohistochemistry of the sentinel node. Conclusions: LS and SLNB can be performed with technical success in the head and neck region. Complications are minimal. More accurate staging and mapping of lymphatic drainage may improve the quality of standard lymphadenectomy. The potential for minimally invasive surgery based on this technology exists, but there is a small risk of missing positive disease. Whether the failure rate is greater than that of standard lymphadenectomy without gamma probe guidance is not known. New studies need to focus on refinements of technique and validation of accuracy as well as biologic correlates for the prediction of metastases. [source]

Technical Aspects of Unilateral Dual Kidney Transplantation from Expanded Criteria Donors: Experience of 100 Patients

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2010
B. Ekser
One option for using organs from donors with a suboptimal nephron mass, e.g. expanded criteria donors (ECD) kidneys, is dual kidney transplantation (DKT). In adult recipients, DKT can be carried out by several techniques, but the unilateral placement of both kidneys (UDKT) offers the advantages of single surgical access and shorter operating time. One hundred UDKT were performed using kidneys from ECD donors with a mean age of 72 years (Group 1). The technique consists of transplanting both kidneys extraperitoneally in the same iliac fossa. The results were compared with a cohort of single kidney transplants (SKT) performed with the same selection criteria in the same study period (Group 2, n = 73). Ninety-five percent of UDKTs were positioned in the right iliac fossa, lengthening the right renal vein with an inferior vena cava patch. In 69% of cases, all anastomoses were to the external iliac vessels end-to-side. Surgical complications were comparable in both groups. At 3-year follow-up, patient and graft survival rates were 95.6 and 90.9% in Group 1, respectively. UDKT can be carried out with comparable surgical complication rates as SKT, leaving the contralateral iliac fossa untouched and giving elderly recipients a better chance of receiving a transplant, with optimal results up to 3-years follow-up. [source]

Surgical complications: car crashes and the credit crunch

ANZ JOURNAL OF SURGERY, Issue 9 2010
Jaykar R. Panchmatia MA (Hons), MB BChir (Cantab), MRCS (Eng)
No abstract is available for this article. [source]

Randomized clinical trial of single-incision laparoscopic cholecystectomy versus minilaparoscopic cholecystectomy

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 7 2010
P.-C. Lee
Background: Transumbilical single-incision laparoscopic cholecystectomy (SILC) and minilaparoscopic cholecystectomy (MLC) are both increasingly being used to treat symptomatic gallstones. The present study compared SILC and MLC with respect to outcome in a prospective randomized trial. Methods: Seventy patients with symptomatic cholelithiasis were randomized to SILC or MLC (35 in each group). The primary outcome measure was postoperative pain. Secondary outcomes were duration of operation, complications, postoperative analgesic requirements, length of hospital stay, cosmetic result, wound length and time to return to work. Results: Surgical complications, postoperative pain scores, analgesic requirements and time to return to work were similar for both procedures. Statistically significant advantages of SILC were a shorter hospital stay, shorter total wound length and better cosmetic appearance. Duration of operation was significantly shorter for MLC. Conclusion: SILC is superior to MLC in terms of cosmetic outcome, but not in postoperative pain and requirement for analgesics. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Reduction of postoperative morbidity and mortality in patients with rectal cancer following the introduction of a colorectal unit

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 2 2001
Dr K. Smedh
Background: Surgery for rectal cancer is associated with high morbidity and mortality rates. The reason for this has been much debated. This population-based study reports the findings on postoperative morbidity and mortality after rectal cancer surgery following the introduction of a centralized colorectal unit in a county central hospital, supervised by a colorectal surgeon using the most recent techniques. Methods: All consecutive patients with rectal cancer who underwent surgery at four county hospitals in the Västmanland county in Sweden during 1993,1996 (n = 133) were compared with patients who underwent surgery at the new colorectal unit in the county central hospital from 1996 to 1999 (n = 144). Results: The number of operating surgeons was reduced from 26 to four. The postoperative mortality rate decreased from 8 to 1 per cent (P = 0·002) and the total postoperative complication rate was reduced from 57 to 24 per cent (P < 0·001). Surgical complications dropped from 37 to 11 per cent (P < 0·001). The relaparotomy rate fell from 11 to 4 per cent (P < 0·05). Postoperative stay in hospital was reduced from a median of 13 to 9 days (P < 0·001). Conclusion: The new organization, with centralized rectal cancer surgery using modern techniques, reduced postoperative mortality and overall morbidity rates to less than half. © 2001 British Journal of Surgery Society Ltd [source]

Outcomes of autoconjunctival grafting for primary pterygia when performed by consultant compared with trainee ophthalmologists

CLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 9 2006
Jonathon J Farrah MBBS(Hons)
Abstract Purpose:, To define rates of recurrence and surgical complications of primary pterygia excision with autoconjunctival grafting when the surgery is performed by consultant ophthalmologists compared with trainee ophthalmologists. Methods:, A total of 174 patients with primary pterygia treated by excision and autoconjunctival grafting were included for analysis. Patients were divided into two groups according to whether their surgery was performed by a consultant ophthalmologist (group A) or a trainee ophthalmologist (group B). Data were collected with respect to demographics, surgical complications and recurrence. Recurrence rates were analysed utilizing Fisher's exact test. Additionally, Kaplan,Meier survival curves for interval censored data were constructed. Surgical complications were analysed utilizing Fisher's exact test. Results:, The recurrence rate in group A was 6.8% and in group B was 19.4%. This difference was statistically significant (P = 0.05). The rate of surgical complication occurring in group A was 6.6% and in group B was 23.3% and this was also statistically significant (P = 0.005). No relationship was found between either patient age or the size of pterygium and recurrence or complications in either group A or group B. Conclusion:, Autoconjunctival grafting is regarded as the gold standard for preventing pterygium recurrence following excision. This study suggests that the experience of the surgeon can influence success rates and complications. There is a significant learning curve indicating the need to supervise trainee surgeons. [source]

Clinical Assessment and Surgical Implications of Anatomic Challenges in the Anterior Mandible

CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 4 2003
Nuri Mraiwa BDS
ABSTRACT Background: The anterior mandible is generally considered a rather safe surgical area, involving few risks of damage to vital anatomic structures. Nevertheless, both neurosensory disturbances and hemorrhages have been reported after implant surgery in that particular area. Purpose: With the increasing demand for oral implant placement, the anatomy of the anterior mandible should receive more attention. This review will focus on the anatomic peculiarities of the anterior mandible and the related clinical implications. Methods: The scientific evidence on the anatomic, histologic, physiologic, and clinical aspects of the neurovascularization of the anterior mandible will be reviewed. Results: Surgical complications may be attributed to the existence of a mandibular incisive canal with a true neurovascular supply. Potential risks may also be related to the presence of the lingual foramen and anatomic variations, such as an anterior looping of the mental nerve. Conclusions: Preoperative radiographic planning for oral implant placement in the anterior mandible should therefore not only consider all esthetic and functional demands but should also pay particular attention to the anatomic peculiarities of this region to avoid any neurovascular complications. [source]

End-to-side caval anastomosis in adult piggyback liver transplantation

CLINICAL TRANSPLANTATION, Issue 5 2006
Wojciech G. Polak
Abstract:, No consensus exists regarding the optimal reconstruction of the cavo-caval anastomosis in piggyback orthotopic liver transplantation (PB-LT). The aim of this study was to analyze our experience with end-to-side (ES) cavo-cavostomy. Outcome parameters were patient and graft survival and surgical complications. During the period 1995,2002 146 full-size PB-LT in 137 adult patients were performed with ES cavo-cavostomy without the routine use of temporary portocaval shunt (TPCS). In 12 patients (8%) this technique was used for implantation of second or third grafts. Veno-venous bypass was not used in any case and TPCS was performed only in eight patients (6%). One-, three- and five-yr patient and graft survival were 84%, 79% and 75%, and 81%, 74% and 69%, respectively. The median number of intraoperative transfusion of packed red blood cells (RBC) was 2.0 (range 0,33) and 30% of the patients (n = 43) did not require any RBC transfusion. Surgical complications of various types were observed after 49 LT (34%) and none of the complications was specifically related to the technique of ES cavo-cavostomy. Our experience indicates that PB-LT with ES cavo-cavostomy is a safe procedure, can safely be performed without the routine use of a TPCS, has a very low risk of venous outflow obstruction and can also be used effectively during retransplantations. [source]

Laparoscopy in the management of closed loop sigmoid volvulus

COLORECTAL DISEASE, Issue 4 2008
T. Cartwright-Terry
Abstract Objective, To investigate the feasibility and surgical outcome of elective laparoscopic surgery for acute closed loop sigmoid volvulus. Method, A prospectively electronic database of colorectal laparoscopic procedures identified nine consecutive patients with sigmoid volvulus managed by colonoscopic decompression followed by same admission laparoscopic recto-sigmoidectomy. Results, Between January 2001 and February 2007, nine patients, ASA I (one), II (four), III (four) with sigmoid volvulus were treated: seven were women. Their age distribution was 37,87 years (median 64). The volvulus was the first episode in one patient, the second episode for four and the third (or more) for the remainder. The median operation time was 115 min (45,145). No anastomosis was de-functioned. Postoperative analgesia was parenteral paracetamol (eight) supplemented by 10 mg oral morphine in one case; a ninth patient received patient controlled parenteral morphine for 36 h. Complications included: ileus (one), myocardial infarct (one) and wound infection (one). There was one death on day 32 from a brainstem infarct. Seven had an uncomplicated recovery. The median postoperative stay was 4 days (2,32). Conclusion, Laparoscopic recto-sigmoidectomy postcolonoscopic decompression is a good option for patients with sigmoid volvulus. Surgical complications are minimal and recovery is quick. [source]

The Impact of Herbal Medicines on Dermatologic Surgery

DERMATOLOGIC SURGERY, Issue 8 2001
Lawrence K. Chang MD
Background. In recent years herbal medicines and supplements have become increasingly popular. With their increased popularity, more publications are warning about the potential harmful effects of some of these products. Objective. To present scientific evidence of the benefits and surgical risks of herbal products. Methods. A Medline search and review of the literature was performed. Results. Many herbal medicines are relevant in dermatologic surgery since Ginkgo biloba, garlic, ginger, ginseng, feverfew, and vitamin E may increase the risk of bleeding, and ephedra may potentiate the side effects of epinephrine. Conclusion. Dermatologists should be aware of these herbal products and their uses. Many of these products prescribed by alternative medicine physicians or purchased over the counter should be discontinued prior to dermatologic surgery to minimize the risk of surgical complications. [source]

Vagus nerve stimulation for treatment of epilepsy in Rett syndrome

DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 8 2006
Angus A Wilfong MD, Assistant Professor
This case series presents the outcomes of seven females with Rett syndrome and medically refractory epilepsy who were treated with adjunctive vagus nerve stimulation (VNS) therapy for a minimum of 12 months. Patients ranged in age from 1 to 14 years (median age 9y) at the time of implantation, had experienced seizures for a median period of approximately 6 years, and had failed at least two trials of antiepileptic drugs before receiving VNS. The median number of seizures per month was 150 (range 12,3600). At 12 months, six females had ,50% reduction in seizure frequency. VNS was safe and well tolerated, with no surgical complications and no patients requiring explantation of the device. Quality of life outcomes of note among these patients included reports at 12 months of increased alertness among all seven patients. No change in mood or communication abilities was noted. [source]

Distal esophagitis in patients with mustard-gas induced chronic cough

DISEASES OF THE ESOPHAGUS, Issue 4 2006
M. Ghanei
SUMMARY., Although confounded by some factors such as medications or surgical complications, the relationship between esophageal pathology and pulmonary disorders has been the subject of many studies. The present study sought to investigate the said relationship in patients inflicted by respiratory disorders induced by mustard gas (MG). A case group of patients complaining of respiratory complications and chronic coughs following MG exposure, and a control group of patients with chronic coughs but without a history of MG exposure were studied. All the case and control subjects had symptoms of gastro-esophageal reflux disease. Chest high resolution tomography (HRCT) was performed to evaluate the existence of pulmonary disorders. Endoscopy and histological studies were carried out to determine the severity of esophagitis in both groups presenting with gastroesophageal reflux. Ninety male patients, who had met our criteria, along with 40 male control cases underwent the diagnostic procedures. The frequency of endoscopic esophagitis findings in the chemically exposed group was significantly higher than that in the control group (70.0%vs. 42.5%). A pathological evaluation revealed that the frequency of esophagitis in the cases was more than that in the controls (32.3%vs. 14.2%). Chest HRCT evaluation demonstrated that half the case group had more than 25% air trapping in expiratory films, mostly compatible with bronchiolitis obliterans (BO). In addition, they were suffering from asthma, chronic bronchitis and bronchiectasis. Bronchiolitis obliterans, along with other lung disorders, can be considered as contributors in the pathogenesis of esophagitis in MG exposed patients. [source]

Medical malpractice and the thyroid gland

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 6 2003
Daniel D. Lydiatt DDS
Abstract Background. A medical malpractice litigation "crisis" exists in this country. Analyzing litigation trends through verdict summaries may help understand causes. Methods. Jury verdict reviews from 1987,2000 were obtained from a computerized database. Reviews compile data on defendants, plaintiffs, allegations of wrongdoing, and verdict summaries. Results. Thirty suits from nine states occurred. Plaintiffs were women in 80% of the cases, with a median age of 41. Fifty percent of patients (15 of 30) had a bad outcome, (9 of 30 dead, 4 of 30 with neurologic deficits, 1 blind, and 1 alive with cancer). Thirty percent alleged surgical complications, mostly recurrent laryngeal nerve injury, and 75% of cancer patients alleged a delay, either through falsely negative biopsies or no biopsy taken. Respiratory events occurred in 43% and frequently resulted in large awards. Conclusions. The liberal use of fine-needle aspiration and documentation of surgical risks may help reduce litigation. Complications and bad outcomes do not indicate negligence. Analysis may contribute to risk management strategies or litigation reform. © 2003 Wiley Periodicals, Inc. Head Neck 25: 429,431, 2003 [source]

Expandable metal stents in chronic pancreatitis

HPB, Issue 1 2003
JJ French
Background Biliary obstruction in chronic pancreatitis may be relieved by the insertion of a biliary endoprosthesis. Stenting is usually achieved with a plastic device, but self-expandable metal stents may also be used. Case outlines Two patients are described with severe chronic pancreatitis complicated by biliary obstruction and portal vein thrombosis, who underwent insertion of metallic biliary endoprostheses. In both patients the endoprostheses became occluded, at 12 and 7 months respectively, which necessitated open operation. Both patients experienced surgical complications and one patient died postoperatively. Discussion The use of metal endoprostheses in chronic pancreatitis may result in occlusion, necessitating open operation. Such stents should be used with caution in these patients, who are likely to be high-risk surgical candidates. [source]

Eosinophilic gastroenteritis: presentation of two patients with unusual affect of terminal ileum and caecum with manifestations of acute abdomen and literature review

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 4 2004
A. Charalabopoulos
Summary Eosinophilic gastroenteritis is a rare disease; the long-term personal history with digestive symptoms and the course of the disease with relapses and remissions is the key for the disease to be suspected. Endoscopy, CT scan and sonographic studies may provide important indirect signs of the disease and in combination with histological examination the diagnosis can be achieved. The administration of corticosteroids is an important factor for the treatment or the remission of the disease. In this study two cases with unusual location of the disease, on the terminal ileum and caecum, are presented and a literature review is attempted. The disease process, clinical and laboratory findings as well as the surgical approach used are described. Eosinophilic gastroenteritis is a very rare disease with its surgical complications. The disease is a non-surgical disease, thus presurgical diagnosis is important because the entity discussed can be under control by conservative treatment. A high disease suspicious index must be kept in the physicians' mind. [source]

Our experience with third renal transplantation: Results, surgical techniques and complications

INTERNATIONAL JOURNAL OF UROLOGY, Issue 12 2007
Mohammad Hossein Nourbala
Background: Despite the popularity of kidney transplantation in the current era, second and third kidney transplantation are not yet widely accepted and practiced. Each center has its own regulations and experiences and there is no accepted protocol for third kidney transplantation. We report here our 15 years of experience with third kidney transplantation. Methods: This is a report of all the third kidney transplantations performed in Baqiyatallah Hospital, Tehran, Iran, between 1991 and 2006. Demographic data, surgical techniques, complications and outcomes are reported. Results: Of the nine third kidney transplant patients, six were male. The median age was 43 years (32,52). All of the patients received kidney from living donors. All operations were performed by a midline incision and the grafts were placed at the midline, in the intraperitoneal space. For arterial anastomosis, we used internal iliac, right common iliac and both the right external iliac and inferior mesenteric artery in 4, 4 and 1 case(s), respectively. For venous anastomosis, we used vena cava, common iliac and external iliac veins in 3, 5 and 1 case(s), respectively. During the follow up period (38 months), 6 grafts (66.6%) were functioning. None of the graft rejections were due to surgical complications. Wound dehiscence occurred in two patients. No other surgical complications including infection, lymphocele or hemorrhage were observed. Conclusion: Third kidney transplantation is a field that has not been fully explored. The rate of complications seems to be not much higher than the first transplantation. Defining a standard protocol seems necessary. [source]

Interview with a Quality Leader: Dale W. Bratzler, DO, MPH on Performance Measures

JOURNAL FOR HEALTHCARE QUALITY, Issue 2 2010
Jason Trevor Fogg
Abstract: Dale Bratzler, DO, MPH, currently serves as the President and CEO of the Oklahoma Foundation for Medical Quality (OFMQ). In addition, he provides support as the Medical Director of the Patient Safety Quality Improvement Organization Support Center at OFMQ. In these roles, he provides clinical and technical support for local and national hospital quality improvement initiatives. He is a Past President of the American Health Quality Association and a recent member of the National Advisory Council for the Agency for Healthcare Research and Quality. Dr. Bratzler has published extensively and frequently presents locally and nationally on topics related to healthcare quality, particularly associated with improving care for pneumonia, increasing vaccination rates, and reducing surgical complications. He received his Doctor of Osteopathic Medicine degree at the Kansas City University of Medicine and Biosciences, and his Master of Public Health degree from the University of Oklahoma Health Sciences Center College of Public Health. Dr. Bratzler is board certified in internal medicine. [source]

Ischemic Preconditioning: Fact or Fantasy?

JOURNAL OF CARDIAC SURGERY, Issue 6 2002
Christopher D. Raeburn M.D.
In the ensuing years, surgeons have learned to discriminate a biochemical/metabolic/functional spectrum of cardiac states ranging from healthy myocardium to "stunned" or "hibernating" heart to the modes of "apoptotic" or "necrotic" cardiomyocyte death. It is now clear that "protective cardiac preconditioning" influences all of these cardiac states. The cellular mechanisms of preconditioning (PC) are now sufficiently understood to permit clinical application. Ligation of adrenergic, adenosine, bradykinin or opioid receptors involves signaling via both tyrosine and calcium-dependent protein kinases (PKC), which activate mitochondrial ATP-dependent potassium channels. Subsequently, the release of oxygen radicals induces nuclear translocation of transcriptional regulators, which transform the cardiomyocyte into a more resilient cell. Although preconditioning was initially recognized as protecting only against infarction, PC also limits postischemic dysrhythmias and enhances contractile function. Phase I (safety) and phase II (efficacy) clinical trials now persuasively support pharmacological preconditioning as a safe mode of preventing postcardiac surgical complications. Indeed, preconditioning is currently being proposed as adjunctive to hypothermic perfusates in protecting against the obligate organ ischemia during transplantation. [source]

A systematic review of the success of sinus floor elevation and survival of implants inserted in combination with sinus floor elevation

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 2008
Part I: Lateral approach
Abstract Objectives: The objectives of this systematic review were to assess the survival rate of grafts and implants placed with sinus floor elevation. Material and Methods: An electronic search was conducted to identify studies on sinus floor elevation, with a mean follow-up time of at least 1 year after functional loading. Results: The search provided 839 titles. Full-text analysis was performed for 175 articles resulting in 48 studies that met the inclusion criteria, reporting on 12,020 implants. Meta-analysis indicated an estimated annual failure rate of 3.48% [95% confidence interval (CI): 2.48%,4.88%] translating into a 3-year implant survival of 90.1% (95% CI: 86.4%,92.8%). However, when failure rates was analyzed on the subject level, the estimated annual failure was 6.04% (95% CI: 3.87%,9.43%) translating into 16.6% (95% CI: 10.9%,24.6%) of the subjects experiencing implant loss over 3 years. Conclusion: The insertion of dental implants in combination with maxillary sinus floor elevation is a predictable treatment method showing high implant survival rates and low incidences of surgical complications. The best results (98.3% implant survival after 3 years) were obtained using rough surface implants with membrane coverage of the lateral window. [source]

Major elective joint replacement surgery: socioeconomic variations in surgical risk, postoperative morbidity and length of stay

JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 3 2010
Jennifer Hollowell PhD
Abstract Background, Patient deprivation is associated with greater need for total hip and knee replacement surgery (THR/TKR) and a higher prevalence of risk factors for surgical complications. Our aim was to examine associations between deprivation and aspects of the inpatient episode for patients undergoing these procedures. Methods, We analysed socioeconomic variations in preoperative surgical risk, postoperative morbidity and length of stay for 655 patients undergoing elective THR/TKR at a large metropolitan hospital. Surgical risk was assessed using the orthopaedic version of the POSSUM scoring system, postoperative morbidity was assessed using the postoperative morbidity survey, and socioeconomic status was measured using the Index of Multiple Deprivation. We adjusted for age, sex, surgical site and primary vs. revision surgery. Results, We found only a modest, clinically insignificant socioeconomic gradient in preoperative surgical risk and no socioeconomic gradient in postoperative morbidity. There was a strong socioeconomic gradient in length of stay, but only for patients undergoing TKR. This was due to deprived patients being more likely to remain in hospital without morbidity following TKR. Conclusions, Our findings suggest differential selection of healthier patients for surgery. Hospitals serving deprived communities may have excess, unfunded costs because of the increased length of stay of socioeconomically disadvantaged patients. [source]

The value of microsurgery in liver research

LIVER INTERNATIONAL, Issue 8 2009
Maria-Angeles Aller
Abstract The use of an operating microscope in rat liver surgery makes it possible to obtain new experimental models and improve the already existing macrosurgical models. Thus, microsurgery could be a very valuable technique to improve experimental models of hepatic insufficiency. In the current review, we present the microsurgical techniques most frequently used in the rat, such as the portacaval shunt, the extrahepatic biliary tract resection, partial and total hepatectomies and heterotopic and orthotopic liver transplantation. Hence, reducing surgical complications allows for perfecting the resulting experimental models. Thus, liver atrophy related to portacaval shunt, prehepatic portal hypertension secondary to partial portal vein ligation, cholestasis by resection of the extrahepatic biliary tract, hepatic regeneration after partial hepatectomies, acute liver failure associated with subtotal or total hepatectomy and finally complications derived from preservation or rejection in orthotopic and heterotopic liver transplantation can be studied in more standardized experimental models. The results obtained are therefore more reliable and facilitates the flow of knowledge from the bench to the bedside. Some of these microsurgical techniques, because of their simplicity, can be performed by researchers without any prior surgical training. Other more complex microsurgical techniques require in-depth surgical training. These techniques are ideal for achieving a complete surgical training and more select microsurgical models for hepatology research. [source]

Late surgical complications following liver transplantation

LIVER TRANSPLANTATION, Issue S2 2009
Paige M. Porrett
Key Points 1. Biliary strictures and incisional hernias are the most common surgical complications encountered late after liver transplantation. 2. Anastomotic biliary strictures are amenable to endoscopic intervention and rarely need surgical intervention. 3. The presence of a biliary stricture mandates an evaluation of the patency of the hepatic artery. 4. Ischemic-type intrahepatic strictures are common indications for retransplantation. 5. Recipients of living related liver transplantation and donation after cardiac death allografts are at the highest risk for biliary and vascular complications late after transplantation. Liver Transpl 15:S12,S18, 2009. © 2009 AASLD. [source]

Systematic grading of surgical complications in live liver donors,

LIVER TRANSPLANTATION, Issue 6 2007
Yasuhiko Sugawara
[source]

Surgical complications and medium-term outcome results of tension-free vaginal tape: A prospective study of 313 consecutive patients

Lymphocytotoxic crossmatch in pediatric living donor liver transplantation

PEDIATRIC TRANSPLANTATION, Issue 2 2009
Takeshi Saito
Abstract:, To investigate the relationship between the pretransplant LCT results and the outcome after pediatric LDLT in a single center. The clinical data of 76 children undergoing 79 LDLTs including three retransplantations from May 2001 to January 2006 were retrospectively analyzed. All of the children had end-stage liver disease, and their median age was 1.4 yr (range, six months to 16.5 yr). Immunosuppressive therapy consisted of cyclosporine- or FK-based regimens with steroids. The children were classified into two groups (positive or negative) according to the pretransplant LCT results. The incidences of post-transplant surgical complications and of rejection episodes were compared. The relationship between the pretransplant LCT results and patient and graft survival rates was also analyzed. Seventy-nine pretransplant crossmatch tests were done; 13 (16.5%) were positive, and 66 (83.5%) were negative. No significant difference was found in the pretransplant clinical factors between two crossmatch groups. There was no significant difference between the groups in the incidence of vascular and biliary tract complications, in the rate of early or steroid-resistant cellular rejections, or in one- and three-yr patient (91.7%, 91.7%, respectively, in the positive group, 93.5%, 93.5%, respectively, in the negative group, p = 0.80) and graft (92.3%, 92.3%, respectively, in the positive group, 88.8%, 86.4%, respectively, in the negative group, p = 0.63) survival. The present study demonstrates that there is no reason to do pretransplant LCT to select the living donor for pediatric LDLT. [source]

Liver transplantation for progressive familial intrahepatic cholestasis: Clinical and histopathological findings, outcome and impact on growth

PEDIATRIC TRANSPLANTATION, Issue 6 2007
Sema Aydogdu
Abstract:, In this study, we analyze the demographic features, clinical and histopathological findings in patients who underwent liver transplantation for progressive familial intrahepatic cholestasis. We also analyze outcome and impact of liver transplantation on growth and bone mineral content. Most of the patients were presented with jaundice mainly beginning within the first six months. At the time of initial admission; eight patients had short stature (height SD score <2), and four patients had weight SD score <2. Liver transplantation were performed at the age of 43.2 ± 27 months (range 9 to 96 mfonths), 6.5 ± 3.5 months later after the first admission. Infection, surgical complications and osmotic diarrhea associated with severe metabolic acidosis were noted in 41.4%, 16.6% and 33.3%, respectively. One patient developed posttransplant lymphoproliferative disorder. Overall; 1 year graft and patient survival was 69.2% and 75%, respectively. At the end of the 1st year only 2 patients had height SD score <2. Linear regression of height gain against increase in total body BMD measured at the time of transplantation and 1 year after liver transplantation gave a coefficient r = 0.588 (p = 0.074). No correlation was found between the height gain and age and PELD score at time of transplantation, and no difference was noted between the sexes and donor type. Liver transplantation is effective treatment modality with good outcome and little morbidity, and increases the growth acceleration in patients with PFIC associated with cirrhosis. [source]