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Sample records for surgical graft complications

  1. Surgical complications and graft survival in pediatric kidney transplant recipients treated with a steroid-free protocol

    DEFF Research Database (Denmark)

    Jensen, Kristian Kiim; Røder, O; Bistrup, C

    2013-01-01

    The outcome of pediatric kidney transplantation depends on several factors, among these are the complications, which occur in relation to the surgical procedure. In this study, we present our experience with pediatric kidney transplantation in a steroid-free immunosuppression regimen, from...

  2. [Living donor transplantation. Surgical complications].

    Science.gov (United States)

    Karam, Georges

    2008-02-01

    Although nephrectomy by open surgery is the most used technique for the extraction of kidney transplants in the living donor, nephrectomy under laparaoscopy is increasingly practiced. Laparoscopic nephrectomy is less invasive and performed under videoscopy control, after insufflation of the peritoneal cavity. Three to four incisions are done in order to enter the surgical instruments. The kidney is extracted through a horizontal sus-pubic incision. The exposition is either exclusively transperitoneal, retroperitoneal or hand assisted. The advantages of laparoscopy are esthetical, financial due to a shorter hospitalisation and a quicker recovery, as well a confort for the donor. The disadvantages are a longer warm ischemia time and possibly a higher risk of delayed graft function. Randomised studies having compared laparoscopy and open surgery in the living donor have not find any significant difference regarding the per- and perioperative in the complications.

  3. Surgical Complications of Cochlear Implantation

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    Basir Hashemi

    2010-03-01

    Full Text Available Cochlear implantation is a method used for the treatment ofpatients with profound hearing loss. This procedure may theaccompanied by some major or minor complications. Weevaluated the surgical complications of cochlear implantationin Fars province (south of Iran. A total of 150 patients withcochlear implantation were enrolled in the present study. Mostof the patients were pre-lingual children and most of our deviceswere nucleus prosthesis. We had three device failuresand four major complications, including one misplaced electrode,one case of meningitis, one case of foreign body reactionto suture and one case with extensive hematoma. Thesecomplications were managed successfully by surgical interventionor re-implantation. Facial nerve damage or woundbreakdown was not seen. Minor complications including smallhematoma, edema, stitch infection and dizziness were found in15 cases, which were managed medically. In our center, therate of minor complications was comparable to other centersin the world. But the rate of major surgical complications waslower than other centers.

  4. [Surgical complications of pancreatectomy].

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    Sauvanet, A

    2008-01-01

    The mortality for pancreatectomy has decreased to a very low level in recent years but morbidity remains high. The most frequent post-operative complications of pancreaticoduodenectomy (PD) are delayed gastric emptying (DGE) in 20% and pancreatic fistula (PF) in 10-15%. DGE is associated with other abdominal complications in half the cases; these must be delineated by CT scan and specifically treated. Isolated DGE usually resolves within three weeks with the use of nasogastric suction and pro-kinetic drugs. FP following PD may be preventable with the use of temporary trans-jejunal intubation of Wirsung's duct or by intussusception of the pancreatic margin into the jejunal lumen. FP occurring after PD will heal with conservative management (total parenteral nutrition, peripancreatic drainage, somatostatin analogues) in 80-90% of cases but secondary complications such as peritonitis, arterial erosion and pseudo-aneurysm may be life-threatening. Early hemorrhage (in the first 48-72 hours) must be treated by re-operation. Late hemorrhage (usually secondary to PF) and ischemic complications are rare (3% and 1% respectively), difficult to treat, and associated with high mortality. PF is also the main complication of distal pancreatectomy and enucleation of pancreatic tumors (10-20% and 30% respectively). These PF resolve with conservative treatment in more than 95% of cases but may justify an ERCP sphincterotomy if drainage is prolonged. After medial pancreatectomy, PF occurs in 20-30% of cases, arising from either of the two transected pancreatic surfaces.

  5. [Treatment of tibial pseudoarthrosis. Complications after intramedullary, allogeneic fibular grafting].

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    Helfen, T; Prall, W C; Mutschler, W; Thaller, P H

    2015-04-01

    A 24-year-old woman underwent cosmetic bilateral tibial lengthening with severe complications. In all, 15 operations, including allogeneic fibular grafting of both tibia, were required to treat unstable bilateral non-union, malalignment, and osteomyelitis of the right tibia.The present article describes the surgical strategy of revision to achieve good recovery with full consolidation and proper alignment of the lower leg. Furthermore, the indications for allogeneic bone grafting, which was described by Erich Lexer 100 years ago, are discussed. For surgical revision, a T-external fixator was used on the right leg, while a customized tibial nail was used on the left leg. Using these techniques, full consolidation and proper alignment was achieved. Allogeneic bone grafts in upper extremity defects cannot be recommended.

  6. Surgical complications in pediatric and adolescent renal transplantation

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    El Atat Rabih

    2010-01-01

    Full Text Available To report the surgical complications among our pediatric and adolescent renal transplants and to compare these results with other reported series in the literature. A total of 50 pediatric and adolescent renal transplants were included in this study. There were 30 boys and 20 girls with a mean age of 13 years (range 6 - 18 years. 70% of patients received their kidneys from living donors. Two patients underwent renal re-transplantation. Among the 52 transplantations, 17 surgical complications were encountered in 15(30% patients. The incidence of urological and vascular complications was respectively 13.2% and 18.9%. These complications included vesico-ureteral reflux (9.4%, urinary leakage (3.8%, lymphocele (5.8%, peri-renal hematoma (1.9%, renal artery stenosis (3.7%, and thrombosis of the allograft (7.5%. The patients with vesico-ureteral reflux were treated by antibiotic prophylaxis. In four recipients, thrombosis of the allo-graft with subsequent graft loss occurred. The graft survival rate was 90% in 1 year, 77% in 5 years and 40% in 10 years follow-up. The patient survival rate was 94.4% in 1 year and 84% after 8 years follow-up. We conclude that surgical complications can be minimized if basic principles of careful transplant techniques are used. Prompt identification and treatment of any complication are critical for graft and patient survival.

  7. Complications associated with malnutrition in elective surgical ...

    African Journals Online (AJOL)

    Complications associated with malnutrition in elective surgical patients in a Malaysian setting. ... Tropical Journal of Pharmaceutical Research ... Purpose: To identify the level of malnutrition and complications observed in Malaysia. Methods: A ...

  8. Relationship between patient complaints and surgical complications

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    Murff, H J; France, D J; Blackford, J; Grogan, E L; Yu, C; Speroff, T; Pichert, J W; Hickson, G B

    2006-01-01

    Background Patient complaints are associated with increased malpractice risk but it is unclear if complaints might be associated with medical complications. The purpose of this study was to determine whether an association exists between patient complaints and surgical complications. Methods A retrospective analysis of 16 713 surgical admissions was conducted over a 54 month period at a single academic medical center. Surgical complications were identified using administrative data. The primary outcome measure was unsolicited patient complaints. Results During the study period 0.9% of surgical admissions were associated with a patient complaint. 19% of admissions associated with a patient complaint included a postoperative complication compared with 12.5% of admissions without a patient complaint (p = 0.01). After adjusting for surgical specialty, co‐morbid illnesses and length of stay, admissions with complications had an odds ratio of 1.74 (95% confidence interval 1.01 to 2.98) of being associated with a complaint compared with admissions without complications. Conclusions Admissions with surgical complications are more likely to be associated with a complaint than surgical admissions without complications. Further research is necessary to determine if patient complaints might serve as markers for poor clinical outcomes. PMID:16456204

  9. Assessing Donor Site Complications of Iliac Crest Bone Graft in Treatment of Scaphoid Nonunion

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    Davod Jafari

    2016-07-01

    Full Text Available Background Bone grafting is a common surgical technique to augment bone regeneration in orthopedic surgery. Autologous bone graft harvesting is the reliable treatment option and iliac crest is the most common harvesting site for healing bone fractures. However, the results of iliac crest bone graft harvesting are associated with morbidity and a number of complications. Objectives The aim of this study was to assess donor site complications of scaphoid nonunion, to find clinical outcomes and the impact of iliac crest bone graft on age, gender, pain, numbness, itching, nerve injury and scar appearance of patients. Methods In a prospective review of 61 cases of iliac crest bone graft procedures at the Shafa hospital from 2013 to 2014, complications including pain, infection, hematoma, stress fracture, hypertrophic scars, numbness area and itching were assessed clinically. Results Pain identified as the most common complication. The most common complications following postoperative pain at the donor site that reduced after six weeks were: numbness 3.27%, unsatisfactory scar appearance 3.27% and itching discomfort 1.63%. Conclusions Harvesting of iliac crest bone graft can be the ideal way to prepare graft procedures required surgery scaphoid nonunion fractures with minimal complications. Nevertheless, with an adequate preoperative planning and appropriate surgical technique, the prevalence of these complications can be reduced.

  10. [Orthognathic surgery: surgical failures and complications].

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    Guyot, Laurent

    2016-03-01

    Orthognathic surgery procedures mark the endpoint of lengthy orthodontic-surgical preparations and herald the completion of treatment for patients and their families. The main types of procedure are full maxillary Le Fort I osteotomies, mandibular osteotomies and chin surgery. To ensure a successful outcome, all require a favorable environment and extreme technical skill. But, like all surgical operations, they are also subject to peri- and post-operative complications resulting from treatment hazards or errors. Whatever the cause, surgical complications can entail failures in the management of the malformation. By seeking to understand and analyzing these complications, we can already help to prevent and reduce the contingent risks of failure.

  11. Surgical treatment of complicated traumatic aneurysm and arteriovenous fistula

    Institute of Scientific and Technical Information of China (English)

    乔正荣; 时德

    2003-01-01

    Objective: To evaluate the surgical methods and the outcome of management for traumatic arterial aneurysm (TAA) and traumatic arteriovenous fistula (TAVF). Methods: A total of 121 patients with TAA or TAVF were treated by surgery. Clinical, operative and postoperative data were collected and analyzed retrospectively. Results: The surgical techniques included aneurysmectomy and arterial end-to-end anastomosis or vascular grafting or artery ligation, aneurysm ligation and bypass, vascular repair, fistula excision and vascular ligation or vascular grafting or repair and so on. One patient died (0.83%). The follow-up rates of TAA and TAVF were 65.7% and 60% respectively. Conclusions: Complicated TAA and TAVF in different sites should be treated with different methods.

  12. Common surgical complications in degenerative spinal surgery.

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    Papadakis, Michael; Aggeliki, Lianou; Papadopoulos, Elias C; Girardi, Federico P

    2013-04-18

    The rapid growth of spine degenerative surgery has led to unrelenting efforts to define and prevent possible complications, the incidence of which is probably higher than that reported and varies according to the region of the spine involved (cervical and thoracolumbar) and the severity of the surgery. Several issues are becoming progressively clearer, such as complication rates in primary versus revision spinal surgery, complications in the elderly, the contribution of minimally invasive surgery to the reduction of complication rate. In this paper the most common surgical complications in degenerative spinal surgery are outlined and discussed.

  13. Postoperative Complications Following Gingival Grafts: A Prospective Cohort Study

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    Alexandra ROMAN

    2011-12-01

    Full Text Available Aim: Treating gingival recessions (GRs is a challenge for the practitioner who must take into consideration objective clinical factors, subjective symptoms and also factors related to the patient’s expectations. The aim of this study was to evaluate the postoperative complications associated with connective tissue graft (CTG plus coronally advanced flap (CAF and free gingival graft (FGG used to cover GRs and to compare post-operative morbidities for the two groups of procedures. Material and Methods: A total of 17 patients diagnosed with Miller class 1 to 3 GRs ≥2mm were surgically treated using CTG plus CAF or FGG. When minimum 2 mm of keratinized gingiva was present apically to GR, CTG plus CAF was used. FGG was chosen to cover GRs when keratinized gingiva was absent. Post-operative complications were evaluated with a questionnaire with six questions given to the patients at 14 days follow-up visit. The study used a 1 to 10 visual analogic scale (VAS and the levels of outcomes were classified as “none to minimum” “moderate” and “very important/severe”. Results: A total of 21 procedures, 10 CTG plus CAG and 11 FGG were included in the analysis. No palatal bleeding and no severe pain or swelling were recorded. The patients experienced more pain in the grafted area than in the donor area, for both surgical techniques, with a mean value of 3.09 (1.3 standard deviation sd versus 2.27 (1.4 sd for CTG plus CAF group and of 3.7 (2.21 sd versus 2.9 (1.7 sd for FGG group, respectively. CTG plus CAF generated significantly higher scores of tumefaction than FGG, the mean values being 2.45 (0.93 sd and 4 (2.21 sd (t-value=2.12, p<0.05 respectively. Conclusion: The complications associated with the two periodontal surgical approaches seem manageable and clinically acceptable.

  14. Surgical management of complications of multimodal therapy.

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    Chui, Chan-Hon

    2012-08-01

    Multimodality therapies that include surgery, chemotherapy, radiotherapy, and various newer forms of targeted therapies have been commonly applied in childhood cancers. Such modalities are associated with complications that may adversely affect the outcome of cancer treatment. Acute complications that require surgical management form the focus of our discussion. These patients are often compromised by immunosuppression, thrombocytopenia, and malnutrition. The complications discussed include typhlitis, invasive aspergillosis (IA), pancreatitis, hemorrhagic cystitis, gastrointestinal hemorrhage, necrotizing skin and soft-tissue infections, and perianal infection. Familiarity with the spectrum of complications and their appropriate management approaches will minimize the patients' morbidity.

  15. Surgical complications of typhoid fever: enteric perforation.

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    Santillana, M

    1991-01-01

    Typhoid fever remains a prevalent disease in developing nations as the result of adverse socioeconomic factors. The most frequent complication, and principal cause of mortality, is perforation of the terminal ileum. This report presents our experience with 96 patients surgically treated at Cayetano Heredia University Hospital in Lima, Peru from 1972 to 1986. The clinical characteristics and the diverse surgical procedures utilized in the management of these patients are reviewed.

  16. Surgical treatment for complicated acetabular fractures

    Institute of Scientific and Technical Information of China (English)

    Ning An; Yang Yanmin

    2004-01-01

    Objective: To sum up the surgical approaches and clinical outcome of complicated acetabular fractures. Methods: 17 patients with complicated acetabular fractures (including 4 cases of transverse with posterior wall fractures, 7 cases of posterior column and wall fractures, 4 cases of anterior and posterior columns fractures, 1 cases of T-type fracture and 1 cases of anterior column with posterior hemitransverse fractures) underwent open reduction and internal fixation with screws and plates by Kocher-Langenbeck (8 cases), ilio-inguinal (2 cases), extended iliofemoral (4 cases) or ilio-inguinal combined with K-L approaches (3 cases). Results: 12 patients with anatomical reduction, 4 patients with satisfactory reduction and 1 patient with non-satisfactory reduction. 15 out of 17 cases were followed up for 6 months to 5 years, and the excellent and good rate was 70.5%. Conclusion: Surgical treatment for complicated acetabular fractures can get a satisfactory reduction and a good clinical outcome.

  17. Multimodality Imaging of Normal Hepatic Transplant Vasculature and Graft Vascular Complications

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    Jeffrey H Roberts

    2011-01-01

    Full Text Available Orthotopic liver transplantation is an important treatment option for patients with end-stage liver disease. Advances in surgical technique, along with improvements in organ preservation and immunosuppression have improved patient outcomes. Post-operative complications, however, can limit this success. Ultrasound is the primary imaging modality for evaluation of hepatic transplants, providing real-time information about vascular flow in the graft. Graft vascular complications are not uncommon, and their prompt recognition is crucial to allow for timely graft salvage. A multimodality approach including CT angiography, MRI, or conventional angiography may be necessary in cases of complex transplant vascular anatomy or when sonography and Doppler are inconclusive to diagnose the etiologies of these complications. The purpose of this article is to familiarize radiologists with the normal post-transplant vascular anatomy and the imaging appearances of the major vascular complications that may occur within the hepatic artery, portal vein, and venous outflow tract, with an emphasis on ultrasound.

  18. Surgical thrombectomy for thrombosed dialysis grafts: comparison of adjunctive treatments.

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    Liu, Yun-Hen; Hung, Yen-Ni; Hsieh, Hung-Chang; Ko, Po-Jen

    2008-02-01

    Vascular surgeons often encounter dialysis graft failure in hemodialysis patients during their daily practice. Despite advances in percutaneous treatment, there remains a role for surgical thrombectomy of thrombosed dialysis grafts. This study was designed to investigate the long-term outcome of dialysis graft thrombectomy and to examine the indications for and effectiveness of therapies adjuvant to Fogarty thrombectomy. Surgical outcomes of 590 consecutive dialysis graft thrombectomies performed between 2001 and 2003 were retrospectively reviewed. The 590 cases were classified into four groups based on the procedure performed adjuvant to Fogarty thrombectomy: group A, surgical thrombectomy by Fogarty thrombectomy catheter alone; group B, thrombectomy plus intraoperative angioplasty of graft outlet; group C, thrombectomy plus sequential balloon angioplasty in subsequent intervention; group D, thrombectomy plus graft outlet surgical revision. Age, gender, co-morbidity, and primary patency of grafts were reviewed and analyzed. The four groups exhibited similar demographic features and comorbidities (p>0.05). Mean primary patency in the four groups was 1.99+/-4.02, 7.21+/-7.61, 8.35+/-9.53, and 7.26+/-6.99 (months), respectively. Survival curves for each group were determined by Kaplan-Meier methods. Primary patency in group A was statistically inferior to all of the other three groups, whereas groups B, C, and D did not significantly differ with regard to graft patency. Surgical thrombectomy alone is inadequate for treating a thrombosed dialysis graft. The underlying graft outlet stricture requires direct surgical revision or balloon angioplasty during surgery or intervention in the angiography suite to ensure long-term patency of the graft.

  19. Surgical treatment of Chiari malformation complicated with basilar impression

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    Yuan MA

    2011-02-01

    Full Text Available Objective To evaluate the therapeutic effect of small craniotomic posterior fossa decompression combined with occipital-cervical bone graft fusion and internal fixation on Chiari malformation complicated with basilar impression.Methods The clinical data of 16 cases(7 males and 9 females,aged 17 to 65 years,mean 36.4 of Chiari malformation complicated with basilar impression from 2006 to 2010 were retrospectively analyzed.The diagnoses for all the patients were confirmed by radiology.Small craniotomic posterior fossa decompression was performed in all patients,cerebellar tonsils were resected,and then one-stage occipital-cervical bone graft fusion using autogenous iliac bone and internal wiring fixation were performed.Neck support was used for 3 months after surgery.Results Symptoms were significantly improved in all cases after surgical operation.No patient died or infected.Cerebrospinal fluid leakage was found at draining site in one case.Transient pain of scapular and chest was found in one case and disappeared spontaneously.A 6-months follow-up showed that 6 patients were cured,9 improved and 1 unchanged according to Symon and Lavender standard.Postoperative MRI showed the reconstructed cisterna magna was clear in all patients,no cerebellar ptosis was found,and the occipital-cervical graft bone was fused.Conclusion In patients with Chiari malformation complicated with basilar impression,small craniotomic posterior fossa decompression combined with one-stage occipital-cervical bone graft fusion and internal wiring fixation has a clear and definite effect,it can increase the volume of posterior fossa and alleviate the ventral brain stem compression simultaneously,and reconstruct the stability of cranio-cervical junction.

  20. [Surgical complications in 479 renal transplantations].

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    Borrego, J; Burgos, F J; Galmes, I; Orofino, L; Rodríguez Luna, J M; Marcen, R; Fernández, E; Escudero, A; Ortuño, J

    1994-04-01

    Exposition of results obtained from the review of the surgical complications found in a series of 479 renal transplantations performed between 1978 and 1992 in our centre, although some of them lack clinical relevance. There was fluid accumulation in 69 patients, distributed between 31 perirenal haematoma. 17 lymphocele, 13 urinoma, 5 perirenal abscesses and 3 mixed. 27.7% required no action. Frequency of renal rupture was 18 cases, 9 due to acute rejection and 9 to vascular thrombosis. Incidence of urinary obstruction was 4.8% with 5.8% of urinary fistula. With regard to the surgical wound, 9 infections, 7 haematomas, 1 eventration and 1 necrotizing fasciitis were observed. Vascular complications consisted in 10 arterial thrombosis, 10 venous thrombosis, 5 mixed thrombosis and 31 arterial stenosis. Treatment instituted for the various cases, its evolution, and an statistical study of risk factors are illustrated.

  1. Percutaneous treatment of complications occurring during hemodialysis graft recanalization

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    Sofocleous, Constantinos T. E-mail: constant@pol.net; Schur, Israel; Koh, Elsie; Hinrichs, Clay; Cooper, Stanley G.; Welber, Adam; Brountzos, Elias; Kelekis, Dimitris

    2003-09-01

    Introduction/objective: To describe and evaluate percutaneous treatment methods of complications occurring during recanalization of thrombosed hemodialysis access grafts. Methods and materials: A retrospective review of 579 thrombosed hemodialysis access grafts revealed 48 complications occurring during urokinase thrombolysis (512) or mechanical thrombectomy (67). These include 12 venous or venous anastomotic ruptures not controlled by balloon tamponade, eight arterial emboli, 12 graft extravasations, seven small hematomas, four intragraft pseudointimal 'dissections', two incidents of pulmonary edema, one episode of intestinal angina, one procedural death, and one distant hematoma. Results: Twelve cases of post angioplasty ruptures were treated with uncovered stents of which 10 resulted in graft salvage allowing successful hemodialysis. All arterial emboli were retrieved by Fogarty or embolectomy balloons. The 10/12 graft extravasations were successfully treated by digital compression while the procedure was completed and the graft flow was restored. Dissections were treated with prolonged Percutaneous Trasluminal Angioplasty (PTA) balloon inflation. Overall technical success was 39/48 (81%). Kaplan-Meier Primary and secondary patency rates were 72 and 78% at 30, 62 and 73% at 90 and 36 and 67% at 180 days, respectively. Secondary patency rates remained over 50% at 1 year. There were no additional complications caused by these maneuvers. Discussions and conclusion: The majority of complications occurring during percutaneous thrombolysis/thrombectomy of thrombosed access grafts, can be treated at the same sitting allowing completion of the recanalization procedure and usage of the same access for hemodialysis.

  2. Complications of grafts used in female pelvic floor reconstruction: Mesh erosion and extrusion

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    Tanya M Nazemi

    2007-01-01

    Full Text Available Introduction: Various grafts have been used in the treatment of urinary incontinence and pelvic prolapse. Autologous materials such as muscle and fascia were first utilized to provide additional anatomic support to the periurethral and pelvic tissues; however, attempts to minimize the invasiveness of the procedures have led to the use of synthetic materials. Complications such as infection and erosion or extrusion associated with these materials may be troublesome to manage. We review the literature and describe a brief overview of grafts used in pelvic floor reconstruction and focus on the management complications specifically related to synthetic materials. Materials and Methods: We performed a comprehensive review of the literature on grafts used in pelvic floor surgery using MEDLINE and resources cited in those peer-reviewed manuscripts. The results are presented. Results: Biologic materials provide adequate cure rates but have associated downfalls including potential complications from harvesting, variable tissue quality and cost. The use of synthetic materials as an alternative graft in pelvic floor repairs has become a popular option. Of all synthetic materials, the type I macroporous polypropylene meshes have demonstrated superiority in terms of efficacy and fewer complication rates due to their structure and composition. Erosion and extrusion of mesh are common and troublesome complications that may be managed conservatively with observation with or without local hormone therapy, with transvaginal debridement or with surgical exploration and total mesh excision, dependent upon the location of the mesh and the mesh type utilized. Conclusions: The ideal graft would provide structural integrity and durability with minimal adverse reaction by the host tissue. Biologic materials in general tend to have fewer associated complications, however, the risks of harvesting, variable integrity of allografts, availability and high cost has led to the

  3. Successful Multistaged Surgical Management of Secondary Aortoesophageal Fistula With Graft Infection.

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    Afifi, Rana O; Mushtaq, Harith H; Sandhu, Harleen K; Khalil, Kamal; Safi, Hazim J; Estrera, Anthony L

    2016-06-01

    Secondary aortoenteric fistula is a rare and dreaded complication of aortic graft replacement. This case demonstrates successful management of a patient with thoracic aortic graft infection resulting in aortoesophageal fistula and the feasibility of combined endovascular approach as a temporary measure to stabilize the patient in extremis, followed by a definitive surgical repair. The patient had a remote history of descending aortic repair and an emergent thoracic endovascular aortic repair for upper gastrointestinal bleeding 2 months ago. We performed a three-staged operation involving extraanatomic bypass, total infected aortic graft excision, and primary closure of the esophageal perforation with muscle flap coverage, from which he eventually recovered.

  4. Complications in skin grafts when continuing antithrombotic therapy prior to cutaneous surgery requiring skin grafting

    DEFF Research Database (Denmark)

    Jarjis, Reem Dina; Jørgensen, Lone; Finnerup, Kenneth

    2015-01-01

    Abstract The risk of postoperative bleeding and wound healing complications in skin grafts among anticoagulated patients undergoing cutaneous surgery has not been firmly established. The objective was to examine the literature and assess the risk of postoperative bleeding or wound healing...... studies were of prospective and retrospective design. Most of the reviewed studies suggest that the use of antithrombotic therapy can increase the risk of bleeding complications in skin grafts. These complications are only wound threatening and not life threatening. Therefore, this is of concern mostly...... complications in skin grafts among anticoagulated patients, compared with patients who discontinue or patients who are not receiving antithrombotic therapy prior to cutaneous surgery requiring skin grafting. A systematic review examining the effect of antithrombotic therapy on cutaneous surgery was performed...

  5. SURGICAL COMPLICATION OF ASCARIDOSIS IN ISFAHAN

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    H. Emami

    1977-03-01

    Full Text Available Ascaris infestation is still prevalent in the world. In Isfahan approximately 77.7 to 90.3 percent of the population is infected. In this communication surgical complications of ascariasis in a series of 29 patients observed in Soraya Hospital of Isfahan during five year period since 1971 are reported. Intestinal obstruction was the commonest complication leading to operation (22 cases. The diagnosis was based on clinical and radiologic grounds and was confirmed at operation. In these situations enterotomy or resection of the gut was associated with high mortality. Three cases of intestinal perforation, two cases of appendicitis, one case of biliary obstruction and liver abscess and a case of acute pancreatitis due to ascariasis are also reported.

  6. Preoperative implant planning considering alveolar bone grafting needs and complication prediction using panoramic versus CBCT images

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    Guerrero, Maria Eugenia; Jacobs, Reinhilde [OIC, OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven (Belgium); Noriega, Jorge [Master of Periodontology, Universidad San Martin de Porres, Lima (Peru)

    2014-09-15

    This study was performed to determine the efficacy of observers' prediction for the need of bone grafting and presence of perioperative complications on the basis of cone-beam computed tomography (CBCT) and panoramic radiographic (PAN) planning as compared to the surgical outcome. One hundred and eight partially edentulous patients with a need for implant rehabilitation were referred for preoperative imaging. Imaging consisted of PAN and CBCT images. Four observers carried out implant planning using PAN image datasets, and at least one month later, using CBCT image datasets. Based on their own planning, the observers assessed the need for bone graft augmentation as well as complication prediction. The implant length and diameter, the need for bone graft augmentation, and the occurrence of anatomical complications during planning and implant placement were statistically compared. In the 108 patients, 365 implants were installed. Receiver operating characteristic analyses of both PAN and CBCT preoperative planning showed that CBCT performed better than PAN-based planning with respect to the need for bone graft augmentation and perioperative complications. The sensitivity and the specificity of CBCT for implant complications were 96.5% and 90.5%, respectively, and for bone graft augmentation, they were 95.2% and 96.3%, respectively. Significant differences were found between PAN-based planning and the surgery of posterior implant lengths. Our findings indicated that CBCT-based preoperative implant planning enabled treatment planning with a higher degree of prediction and agreement as compared to the surgical standard. In PAN-based surgery, the prediction of implant length was poor.

  7. [Surgical complications of nephrectomy in living donors].

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    Rabii, R; Joual, A; Fekak, H; Moufid, K; el Mrini, M; Benjelloun, S; Khaleq, K; Idali, B; Harti, A; Barrou, L; Fatihi, M; Benghanem, M; Hachim, J; Ramdani, B; Zaid, D

    2002-05-01

    Renal transplantation from a living donor is now considered the best treatment for chronic renal failure. We reviewed the operative complications in 38 living related donor nephrectomies performed at our institution over the past 14 years. The mean age of our donors was 30 years old with age range between 18 and 58 years old and female predominance (55.2%). These swabs were realized by a posterolateral lumbar lombotomy with resection of the 11 third. The left kidney was removed in 34 donors (90%), surgical complications were noted in 39.4% of the cases: one case of wound of inferior vena cava (2.6%), one case of release of the renal artery clamp (2.6%), four cases of pleural grap (10.5%), one case of pneumothorax (2.6%), one case of pleurisy (2.6%), three cases of urinary infection (7.8%), three cases of parietal infection (7.8%) and one case of patient pain at the level of the wound (2.6%). There were no mortalities. We conclude that the morbidity of living donor nephrectomy is negligible compared with the advantages for the recipient.

  8. Surgical Outcome of Autogenic Hard Palate Grafts in Lower Eyelid Reconstruction

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    İlke Bahçeci Şimşek

    2013-12-01

    Full Text Available Purpose: To evaluate the surgical outcome of autogenic hard palate mucosal grafts (HPMGs in full-thickness lower eyelid reconstruction following tumor excision. Material and Method: The medical records of patients who had full-thickness lower eyelid tumor excision between 2005 and 2009 were retrospectively reviewed. Seven patients who had HPMG for posterior lamellar reconstruction were included in the study. Graft complications like necrosis, contraction, excessive mucous discharge, and potential problems in the graft harvesting site and technique were evaluated. Results: Seven eyelid reconstructions with HPMG were performed on 4 female and 3 male patients with an age range of 48 to 71 years at surgery. The patients were followed for 6 to 56 months. Two patients had inferior eyelid retraction - one of them was severe and the other one was mild. None of the patients had HPMG necrosis. Donor site haemorrhage occurred in two patients which was controlled with direct pressure and cauterization in the early postoperative period. Discussion: HPMGs have been the golden standard for the reconstruction of posterior lamellar eyelid defects. The main problem about these grafts is that the oral cavity is an unusual region for ophthalmologists with potential complications arising from the hard palate. Comprehension of the anatomy, proper surgical technique, and postoperative care can decrease the rate of these complications. (Turk J Ophthalmol 2013; 43: 442-5

  9. Computational Model of Aortic Valve Surgical Repair using Grafted Pericardium

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    Hammer, Peter E.; Chen, Peter C.; del Nido, Pedro J.; Howe, Robert D.

    2012-01-01

    Aortic valve reconstruction using leaflet grafts made from autologous pericardium is an effective surgical treatment for some forms of aortic regurgitation. Despite favorable outcomes in the hands of skilled surgeons, the procedure is underutilized because of the difficulty of sizing grafts to effectively seal with the native leaflets. Difficulty is largely due to the complex geometry and function of the valve and the lower distensibility of the graft material relative to native leaflet tissue. We used a structural finite element model to explore how a pericardial leaflet graft of various sizes interacts with two native leaflets when the valve is closed and loaded. Native leaflets and pericardium are described by anisotropic, hyperelastic constitutive laws, and we model all three leaflets explicitly and resolve leaflet contact in order to simulate repair strategies that are asymmetrical with respect to valve geometry and leaflet properties. We ran simulations with pericardial leaflet grafts of various widths (increase of 0%, 7%, 14%, 21% and 27%) and heights (increase of 0%, 13%, 27% and 40%) relative to the native leaflets. Effectiveness of valve closure was quantified based on the overlap between coapting leaflets. Results showed that graft width and height must both be increased to achieve proper valve closure, and that a graft 21% wider and 27% higher than the native leaflet creates a seal similar to a valve with three normal leaflets. Experimental validation in excised porcine aortas (n=9) corroborates the results of simulations. PMID:22341628

  10. Stepwise surgical approach to diabetic partial foot amputations with autogenous split thickness skin grafting

    Directory of Open Access Journals (Sweden)

    Crystal L. Ramanujam

    2016-06-01

    Full Text Available In the surgical treatment of severe diabetic foot infections, substantial soft tissue loss often accompanies partial foot amputations. These sizeable soft tissue defects require extensive care with the goal of expedited closure to inhibit further infection and to provide resilient surfaces capable of withstanding long-term ambulation. Definitive wound closure management in the diabetic population is dependent on multiple factors and can have a major impact on the risk of future diabetic foot complications. In this article, the authors provide an overview of autogenous skin grafting, including anatomical considerations, clinical conditions, surgical approach, and adjunctive treatments, for diabetic partial foot amputations.

  11. Surgical Apgar Score Predicts Postoperative Complications in ...

    African Journals Online (AJOL)

    neurotrauma patients by using an effective scoring system can reduce ... complications was 7.04 while for patients with complications was ... their SAS for purposes of risk stratification; high risk. (0-4), medium .... Deep Venous. Thrombosis. 0.

  12. Autogenous tibial strut grafts used in severe kyphoscoliosis:surgical policies and preliminary results

    Institute of Scientific and Technical Information of China (English)

    CHEN Hui; QIU Yong; WANG Bin; YU Yang; ZHU Ze-zhang ZHU Li-hua

    2005-01-01

    Background Surgery for severe kyphoscoliosis is frequently unsatisfying because of loss of correction, high rate of pseudarthrosis and neurological complications.Several authors reported that the anterior fusion with strut grafts might improve the surgical outcome.This article describes and assesses the surgical strategies and the application of autogenous tibial strut in the treatment of severe kyphoscoliosis.Results The mean preoperative and postoperative kyphosis was 82°and 52°respectively, and the mean scoliosis was 84°and 44°respectively.Complications included pseudarthrosis (2 cases, one with graft fracture and the other with hook displacement), posterior elements fractures (4), pleura penetrations (3, in the plastic surgery of the thoracic cage), dura tear (2), exudative pleuritis (2, in the anterior surgery), and tibia fracture of the harvesting site (1).The mean loss of correction in coronal and sagittal plane was 6° and 7° respectively.Except for 1 case, the patients with incomplete paraplegia showed improvements to varying extents.Conclusion Autogenous tibial strut can provide excellent support to the kyphoscoliotic spine: it reduces pseudarthrodic rate, loss of correction and complications of graft harvest, it also prevents the occurrence of neurological impairment.

  13. Surgical treatment of Peyronie's disease with small intestinal submucosa graft patch.

    Science.gov (United States)

    Cosentino, M; Kanashiro, A; Vives, A; Sanchez, J; Peraza, M F; Moreno, D; Perona, J; De Marco, V; Ruiz-Castañe, E; Sarquella, J

    2016-05-01

    The objective of the study was to report our results using a porcine small intestinal submucosa graft (Surgisis ES, Cook Medical) for tunica albuginea substitution after plaque incision. We retrospectively evaluated patients surgically treated at our institution for Peyronie's disease (PD) by means of plaque incision and porcine small intestinal submucosa grafting (Surgisis) between 2009 and 2013. At the same time a literature review was conducted, searching for similar reports and results. Forty-four patients were identified who had been diagnosed with PD between 2009 and the beginning of 2013, and had been treated with corporoplasty, plaque incision and grafting with Surgisis for a severe curvature of the penis. Curvature of the penis was dorsal in 40 patients (90%) and laterally on the right in 4 patients (10%). Mean duration of surgery was 165 min (range 90-200). Mean size of the graft was 6.5 cm(2) and the mean follow-up was 19.2 months (range 11-48). In patients with severe curvature of the penis due to PD and the need for corporoplasty with plaque incision and graft placement, Surgisis represents a good option with a low risk of complications, below the rate described with previously investigated graft tissues.

  14. Human pericardium graft in the management of bleb's complication performed in childhood: a case report

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    Koutsandrea Chrysanthi

    2011-09-01

    Full Text Available Abstract Background To report a case with hypotony due to late leakage of the filtering bleb performed during childhood and treated surgically using human pericardium graft. Case Presentation A man with hypotony related to bleb's leakage in his right eye was presented. During his childhood trabeculectomy was performed to manage ocular hypertension due to pediatric glaucoma. Biomicroscopy revealed choroidal tissue incarcerated in the sclerectomy under the conjunctiva. Bleb revision was performed. Human pericardium graft was used to cover the sclerectomy and a new bleb with controlled outflow was created. The intraocular pressure (IOP and Seidel test represent the main outcomes. Intraoperative and postoperative complications were recorded. Fifteen days postoperatively the IOP was of 7 mmHg and the bleb seemed to filter properly. Five months later the IOP was 9 mmHg and no complications were noticed. During the follow up time, the Seidel test was negative. Conclusion We used human pericardium graft with no complications in a case of bleb leakage performed for pediatric glaucoma.

  15. Complications of surgical treatment of cervical carcinoma

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    F.S. Abrão

    1997-01-01

    Full Text Available A total of 302 patients with stage Ib and IIa cervical carcinoma were submitted to radical hysterectomy and lymphadenectomy during the period from 1980 to 1994. The morbidity rate was 37.5% and the mortality rate 0.6%. The most common intraoperative complications were injuries to the great pelvic vessels and the most frequent postoperative complications involved the urinary tract. The leading causes of morbidity were urinary infection (20.8%, bladder dysfunction (9.2% and ureteral fistulas (2.9%. Although the rate of complications was high, morbidity has been decreasing over the last five years. Thus, radical hysterectomy continues to be one of the methods for the treatment of early cervical carcinoma that presents an acceptable 5-year survival rate.

  16. Laparoscopic appendectomy for complicated acute appendicitis does not result in increased surgical complications

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    Yueh-Ming Lin

    2012-07-01

    Conclusion: This study demonstrated no increase in surgical complications after LA in patients with complicated acute appendicitis when compared with those who had uncomplicated disease. Therefore, LA may be considered the first-choice treatment option for both uncomplicated and complicated acute appendicitis.

  17. Surgical complications and their implications for surgeons' well-being.

    Science.gov (United States)

    Pinto, A; Faiz, O; Bicknell, C; Vincent, C

    2013-12-01

    Healthcare professionals can be seriously affected when they are involved in major clinical incidents. The impact of such incidents on staff is of particular relevance to surgery, as the operating room is one of the highest-risk areas for serious complications. This qualitative study aimed to assess the personal and professional impact of surgical complications on surgeons. This single time point study involved semistructured, individual interviews with general and vascular surgeons, consultants and senior registrars from two National Health Service organizations in London, UK. Twenty-seven surgeons participated. Many were seriously affected by major surgical complications. Surgeons' practice was also often affected, not always in the best interest of their patients. The surgeons' reactions depended on the preventability of the complications, their personality and experience, patient outcomes and patients' reactions, as well as colleagues' reactions and the culture of the institution. Discussing complications, deconstructing the incidents and rationalizing were the most commonly quoted coping mechanisms. Institutional support was generally described as inadequate, and the participants often reported the existence of strong institutional blame cultures. Suggestions for supporting surgeons in managing the personal impact of complications included better mentoring, teamwork approaches, blame-free opportunities for the discussion of complications, and structures aimed at the human aspects of complications. Those involved in the management of surgical services need to consider how to improve support for surgeons in the aftermath of major surgical incidents. © 2013 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.

  18. A Systemic Review of Autologous Fat Grafting Survival Rate and Related Severe Complications

    Institute of Scientific and Technical Information of China (English)

    Nan-Ze Yu; Jiu-Zuo Huang; Hao Zhang; Yang Wang; Xiao-Jun Wang; Ru Zhao; Ming Bai

    2015-01-01

    Objective:Clinical application ofautologous fat grafting (AFG) is quickly expanding.Despite the widely acceptance,long-term survival rate (SR) of AFG remains a question not yet solved.Meanwhile,although rare,severe complications related to AFG including vision loss,stroke even death could be seen in the literature.Data Sources:A comprehensive research of PubMed database to June 2013 was performed according to guidelines of the American Society of Plastic Surgeons Fat Graft Task Force Assessment Methodology.Articles were screened using predetermined inclusion and exclusion criteria.Study Selection:Data collected included patient characteristics,surgical technique,donor site,recipient site,graft amount,and quantified measurement methods.Patient cohorts were pooled,and SR was calculated.All the severe complications were also summarized according to the different clinical characteristics.Results:Of 550 articles,16 clinical articles and 10 animal studies met the inclusion criteria and provided quantified measurement methods.Totally,596 patients were included.SR varied from 34% to 82% in breast and 30-83% in the facial area.Nude mice were applied to investigate human fat grafting SR (38.3-52.5% after 15 weeks).Rabbits were commonly used to study animal AFG SR (14.00-14.56% after 1-year).Totally,21 severe complications were reported,including death (2),stroke (10),vision loss (11,8 of which accompanied with stroke),sepsis (3),multiple abscess (1) and giant fat necrotic cyst (2).Ten of these complications happened within 10 years.Conclusions:There is no unified measurement method to evaluate fat graft SR until now and no clinical evidence to show better SR according to different donor and recipient cite.Body mass index change between pre-and postoperation may be the bias factor in evaluating fat SR.Fat embolisms of the ophthalmic artery and the middle cerebral artery are the most severe complication of AFG and still lack of effective treatment.

  19. [Late complication of surgical repair of aortic coarctation: ruptured pseudoaneurysm of the aorta treated by thoracic endovascular aortic repair].

    Science.gov (United States)

    Varejka, P; Lubanda, J C; Prochazka, P; Heller, S; Beran, S; Dostal, O; Charvat, F; Horejs, J; Semrad, M; Linhart, A

    2010-06-01

    Aortic coarctation is a frequent congenital defect requiring early surgical treatment. Late complications of these surgical procedures can be fatal as in the case of a ruptured anastomotic pseudoaneurysm. We present a case of a 49-year-old man presenting with hemorrhagic shock due to this complication who was successfully treated by endovascular techniques with implantation of two stent grafts. This case illustrates the fact that endovascular aortic repair is feasible, certainly less invasive and very efficient for this type of complication when used in an experienced center.

  20. Hysterectomy in women with obesity: complications related to surgical site.

    Science.gov (United States)

    Naveiro-Fuentes, Mariña; Rodríguez-Oliver, Antonio; Maroto-Martín, María T; González-Paredes, Aida; Aguilar-Romero, María T; Mozas-Moreno, Juan

    2017-02-01

    The aim of this study was to describe the trends in surgical routes in obese women who underwent hysterectomy for benign disease at our center and compare complications in different groups. Retrospective study done between 2011 and 2015 in women with a Body Mass Index≥30 who underwent hysterectomy for benign disease at Virgen de las Nieves Universitary Hospital in Granada, Spain. We studied three groups based on the surgical route chosen for hysterectomy: vaginal, abdominal or laparoscopic. The rates of intraoperative and postoperative complications, major complications, reintervention and days of hospital stay were compared. Abdominal hysterectomy was associated with the highest risk of postoperative complications and the longest hospital stay. Laparoscopic hysterectomy had a higher risk than vaginal hysterectomy of major complications. There were no significant differences between groups for any of the other variables. In obese women vaginal hysterectomy was associated with the lowest morbidity, and should be the approach of choice whenever feasible.

  1. Contemporary Review of Grafting Techniques for the Surgical Treatment of Peyronie's Disease.

    Science.gov (United States)

    Hatzichristodoulou, Georgios; Osmonov, Daniar; Kübler, Hubert; Hellstrom, Wayne J G; Yafi, Faysal A

    2017-02-28

    Peyronie's disease (PD) is a benign fibrotic disorder of the tunica albuginea of the penis, which can cause penile pain, curvature, shortening, erectile dysfunction, and psychological distress. Surgery is indicated when penile curvature prevents satisfactory sexual intercourse. Plaque incision or excision with grafting has been suggested as an option in patients with a penile curvature greater than 60°, a shortened penis, and/or an hourglass or complex deformity. To provide an overview of recent studies reporting outcomes of grafting techniques and to report advances in the development of new grafting materials for PD surgery. A literature review was performed through PubMed from 2011 through 2016 regarding grafting techniques for PD. Key words used for the search were grafting techniques, grafts, graft materials, Peyronie's disease, surgical outcomes, and surgical therapy. To report on novel and promising graft materials for PD and to discuss surgical techniques, outcomes, and limitations. Discussed outcomes include postoperative penile straightening, shortening, erectile function, glans sensation, and patient satisfaction. Various surgical techniques and grafting materials can be used for the coverage of the tunica albuginea defect after partial plaque excision or incision. Autologous and non-autologous grafts have been used in this setting. A major advantage of the available "off-the-shelf" grafts is that they do not require donor site harvesting, thus decreasing morbidity and operative time. Tissue-engineered grafts represent the future, but more research is needed to further improve surgical handling and postoperative outcomes. Patients opting for grafting techniques should have sufficient erectile rigidity preoperatively. Surgeon experience, careful patient selection, patient preference, and type of penile deformity affect the choice of graft and surgical approach used. Hatzichristodoulou G, Osmonov D, Kübler H, et al. Contemporary Review of Grafting

  2. Surgical management for achalasia after coronary artery bypass graft using the right gastroepiploic artery: a case report.

    Science.gov (United States)

    Muranushi, Ryo; Miyazaki, Tatsuya; Saito, Hideyuki; Kuriyama, Kengo; Yoshida, Tomonori; Kumakura, Yuji; Honjyo, Hiroaki; Yokobori, Takehiko; Sakai, Makoto; Sohda, Makoto; Kuwano, Hiroyuki

    2017-12-01

    The right gastroepiploic artery is commonly used in coronary artery bypass grafting. Appropriate strategies are required when performing upper abdominal surgeries after the right gastroepiploic artery has been used in coronary artery bypass grafting because compressing or injuring the graft may cause myocardial ischemia and fatal arrhythmias. To our knowledge, this is the first reported case of surgery for achalasia performed after coronary artery bypass grafting using the right gastroepiploic artery. We have discussed the surgical procedure and particular intraoperative considerations. A 62-year-old man who had undergone coronary artery bypass grafting using the right gastroepiploic artery presented with achalasia. Because medication and balloon dilation had been ineffective and he was having difficulty ingesting food, we performed a Heller-Dor procedure via laparotomy. The right gastroepiploic artery was not damaged during this surgery, and there were no perioperative cardiovascular complications. Adequate control of symptoms was achieved. When performing upper abdominal surgeries after coronary artery bypass grafting with the right gastroepiploic artery, it is necessary to investigate the patient carefully preoperatively and adapt the intraoperative procedure to minimize risk of injury to the graft and consequent cardiovascular complications.

  3. Predisposing factors and surgical outcome of complicated liver hydatid cysts

    Institute of Scientific and Technical Information of China (English)

    Alper; Akcan; Erdogan; Sozuer; Hizir; Akyildiz; Zeki; Yilmaz; Ahmet; Ozturk; Altay; Atalay

    2010-01-01

    AIM: To evaluate the predisposing factors for peritoneal perforation and intrabiliary rupture and the effects of these complications on surgical outcome in liver hydatid disease.METHODS: A total of 372 patients with liver hydatid cysts who had undergone surgical treatment were evaluated retrospectively. Twenty eight patients with peritoneal perforation, 93 patients with spontaneous intrabiliary perforation, and 251 patients with noncomplicated hydatid cysts were treated in our clinics.RESULTS: When the pred...

  4. Ahmed glaucoma valve implant: surgical technique and complications

    Directory of Open Access Journals (Sweden)

    Riva I

    2017-02-01

    Full Text Available Ivano Riva,1 Gloria Roberti,1 Francesco Oddone,1 Anastasios GP Konstas,2 Luciano Quaranta3 1IRCCS “Fondazione GB Bietti per l’Oftalmologia”, Rome, Italy; 21st University Department of Ophthalmology, Glaucoma Unit, AHEPA Hospital, Thessaloniki, Greece; 3Department of Medical and Surgical Specialties, Section of Ophthalmology, University of Brescia, Brescia, Italy Abstract: Implantation of Ahmed glaucoma valve is an effective surgical technique to reduce intraocular pressure in patients affected with glaucoma. While in the past, the use of this device was reserved to glaucoma refractory to multiple filtration surgical procedures, up-to-date mounting experience has encouraged its use also as a primary surgery for selected cases. Implantation of Ahmed glaucoma valve can be challenging for the surgeon, especially in patients who already underwent previous multiple surgeries. Several tips have to be acquired by the surgeon, and a long learning curve is always needed. Although the valve mechanism embedded in the Ahmed glaucoma valve decreases the risk of postoperative hypotony-related complications, it does not avoid the need of a careful follow-up. Complications related to this type of surgery include early and late postoperative hypotony, excessive capsule fibrosis around the plate, erosion of the tube or plate edge, and very rarely infection. The aim of this review is to describe surgical technique for Ahmed glaucoma valve implantation and to report related complications. Keywords: glaucoma, surgical technique, glaucoma drainage devices, Ahmed glaucoma valve, complications

  5. Impact of graft steatosis on the post-transplantation biliary complications for living donor liver transplant recipients in China.

    Science.gov (United States)

    Li, Hong-Yu; Wei, Yong-Gang; Li, Bo; Yan, Lv-Nan; Wen, Tian-Fu; Zhao, Ji-Chun; Xu, Ming-Qing; Wang, Wen-Tao; Ma, Yu-Kui; Yang, Jia-Yin

    2012-06-01

    After living donor liver transplantation (LDLT), the prevalence of complications related to the biliary system is 6-35%. In spite of great improvements in both surgical techniques and postoperative and long-term medical treatment, the biliary complications are still considered a relatively high risk for LDLT. The aim of this retrospective study was to analyze the incidence of biliary complications and identify predisposing risk factors. The clinical and follow-up data of 175 adult patients receiving LDLT (right lobe or left lobe) between 2002 and December 2008 were collected and retrospectively analyzed. Patients were divided into 2 groups: with biliary complications (n=30) and without biliary complications (n=145). Thirty patients (17.1%) had post-transplantation biliary complications. Eight patients (4.6%) were diagnosed with bile leakage, while 24 patients (13.7%) developed biliary stricture. Percentage of steatosis of the graft and hepatic artery thrombosis after LDLT were two factors upon univariate analysis (p=0.034, p=0.01, respectively). In multivariate logistic analysis, 20-50% macrovesicular steatosis emerged as a new defined risk factor by us (p=0.001). There was no difference in patient survival rate in different groups and sorts of graft steatosis (p>0.05). We consider that using a graft with macro-vesicular steatosis in 20-50% should be put on the table carefully, balancing both sides of positive and negative.

  6. Colorectal cancer complicated by perforation. Specific features of surgical tactics

    Directory of Open Access Journals (Sweden)

    S. N. Shchaeva

    2015-01-01

    Full Text Available Objective: to assess the immediate results of surgical interventions for colorectal cancer complicated by perforation.Materials and methods. The immediate results of surgical treatment were retrospectively analyzed in 56 patients with colorectal cancer complicated by perforated colon cancer, who had been treated at Smolensk surgical hospitals in 2001 to 2013. Patients with diastatic perforation of the colon in the presence of decompensated obturation intestinal obstruction of tumor genesis were not included into this investigation.Results. The immediate results of uni- and multistage surgical interventions were analyzed in relation to the extent of peritonitis and the stage of colon cancer. More satisfactory immediate results were observed after multistage surgical treatment. Following these interventions, a fatal outcome of disseminated peritonitis in the presence of performed colorectal cancer was recorded in 8 (53.3 % cases whereas after symptomatic surgery there were 11 (67.8 % deaths. A fatal outcome was noted in 1 case (7.7 % after multistage surgery.Discussion. The results of surgical treatment in the patients with perforated colorectal cancer are directly related to the degree of peritonitis and the choice of surgical tactics.

  7. Experiences with surgical treatment of ventricle septal defect as a post infarction complication

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    Stich Kathrin

    2009-01-01

    Full Text Available Abstract Background Complications of acute myocardial infarction (AMI with mechanical defects are associated with poor prognosis. Surgical intervention is indicated for a majority of these patients. The goal of surgical intervention is to improve the systolic cardiac function and to achieve a hemodynamic stability. In this present study we reviewed the outcome of patients with post infarction ventricular septal defect (PVSD who underwent cardiac surgery. Methods We analysed retrospectively the hospital records of 41 patients, whose ages range from 48 to 81, and underwent a surgical treatment between 1990 and 2005 because of PVSD. Results In 22 patients concomitant coronary artery bypass grafting (CAGB was performed. In 15 patients a residual shunt was found, this required re-op in seven of them. The time interval from infarct to rupture was 8.7 days and from rupture to surgery was 23.1 days. Hospital mortality in PVSD group was 32%. The mortality of urgent repair within 3 days of intractable cardiogenic shock was 100%. The mortality of patients with an anterior VSD and a posterior VSD was 29.6% vs 42.8%, respectively. All patients who underwent the surgical repair later than day 36 survived. Conclusion Surgical intervention is indicated for a majority of patients with mechanical complications. Cardiogenic shock remains the most important factor that affects the early results. The surgical repair of PVSD should be performed 4–5 weeks after AMI. To improve surgical outcome and hemodynamics the choice of surgical technique and surgical timing as well as preoperative management should be tailored for each patient individually.

  8. Chronic graft-versus-host disease complicated by nephrotic syndrome.

    Science.gov (United States)

    Wang, Hsin-Hui; Yang, An-Hang; Yang, Ling-Yu; Hung, Giun-Yi; Chang, Jei-Wen; Wang, Chun-Kai; Lee, Tzong-Yann; Tang, Ren-Bin

    2011-09-01

    Chronic graft-versus-host disease (cGVHD) is one of the most frequent and serious complications of allogeneic hematopoietic stem cell transplantation (HSCT). Nephrotic syndrome (NS) is an uncommon and underrecognized manifestation of cGVHD. We report a patient who developed NS 18 months after allogeneic bone marrow transplantation. The onset of NS was accompanied by active manifestations of cGVHD, and immunosuppressants had not been tapered recently. Renal biopsy revealed membranous nephropathy. The patient failed to improve with three combined immunosuppressants (prednisolone, cyclosporine, and mycophenolate mofetil), but achieved partial remission after intravenous immunoglobulin (IVIG) infusion. Twenty-four months after the diagnosis of NS, the patient was still in hematological remission, with normal serum creatinine level, urinary protein loss of 0.7-1.9 g/day and mild oral mucositis. Our report suggests that NS can be a cGVHD-related immune disorder in HSCT patients. Monitoring of renal parameters, especially proteinuria, is important in cGVHD patients. Our case indicated that post-transplant NS, occurring without history of tapering or following immunosuppressant withdrawal, presents a more severe activity of cGVHD and a relatively severe clinical course. IVIG may modify and control the refractory GVHD-related NS, and can be one of the choices of treatment. Copyright © 2011. Published by Elsevier B.V.

  9. Chronic graft-versus-host disease complicated by nephrotic syndrome

    Directory of Open Access Journals (Sweden)

    Hsin-Hui Wang

    2011-09-01

    Full Text Available Chronic graft-versus-host disease (cGVHD is one of the most frequent and serious complications of allogeneic hematopoietic stem cell transplantation (HSCT. Nephrotic syndrome (NS is an uncommon and underrecognized manifestation of cGVHD. We report a patient who developed NS 18 months after allogeneic bone marrow transplantation. The onset of NS was accompanied by active manifestations of cGVHD, and immunosuppressants had not been tapered recently. Renal biopsy revealed membranous nephropathy. The patient failed to improve with three combined immunosuppressants (prednisolone, cyclosporine, and mycophenolate mofetil, but achieved partial remission after intravenous immunoglobulin (IVIG infusion. Twenty-four months after the diagnosis of NS, the patient was still in hematological remission, with normal serum creatinine level, urinary protein loss of 0.7–1.9 g/day and mild oral mucositis. Our report suggests that NS can be a cGVHD-related immune disorder in HSCT patients. Monitoring of renal parameters, especially proteinuria, is important in cGVHD patients. Our case indicated that post-transplant NS, occurring without history of tapering or following immunosuppressant withdrawal, presents a more severe activity of cGVHD and a relatively severe clinical course. IVIG may modify and control the refractory GVHD-related NS, and can be one of the choices of treatment.

  10. [Special surgical complications in chronic inflammatory bowel diseases].

    Science.gov (United States)

    Kroesen, A J

    2015-04-01

    After colorectal and anorectal interventions for chronic inflammatory bowel diseases, specific complications can occur.In Crohn's disease these complications mainly occur after proctocolectomy. Pelvic sepsis can be prevented by omentoplasty with fixation inside the pelvis. A persisting sepsis of the sacral cavity can be treated primarily by dissection of the anal sphincter which ensures better drainage. In cases of chronic sacral sepsis, transposition of the gracilis muscle is a further effective option. Early recurrence of a transsphincteric anal fistula should be treated by reinsertion of a silicon seton drainage.Complications after restorative proctocolectomy are frequent and manifold (35%). The main acute complications are anastomotic leakage and pelvic sepsis. Therapy consists of transperineal drainage of the abscess with simultaneous transanal drainage. Late complications due to technical and septic reasons are still a relevant problem even 36 years after introduction of this operative technique. A consistent approach with detailed diagnostic and surgical therapy results in a 75% rescue rate of ileoanal pouches.

  11. Analysis of surgical and perioperative complications in seventy-five right hepatectomies for living donor liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Salvatore Gruttadauria; James Wallis Marsh; Giovan Battista Vizzini; Fabrizio di Francesco; Angelo Luca; Riccardo Volpes; Amadeo Marcos; Bruno Gridelli

    2008-01-01

    AIM:To present an analysis of the surgical and perioperative complications in a series of seventyfive right hepatectomies for living-donation (RHLD)performed in our center.METHODS:From .lanuary 2002 to September2007,we performed 75 RHLD,defined as removal of a portion of the liver corresponding to Couinaud segments 5-8,in order to obtain a graft for adult to adult living-related liver transplantation (ALRLT).Surgical complications were stratified according to the most recent version of the Clavien classification of postoperative surgical complications.The perioperative period was defined as within 90 d of surgery.RESULTS:No living donor mortality was present in this series,no donor operation was aborted and no donors received any blood transfusion.Twentythree (30.6%) living donors presented one or more episodes of complication in the perioperative period.Seven patients (9.33%) out of 75 developed biliary complications,which were the most common complications in our series.CONCLUSION:The need to define,categorize and record complications when healthy individuals,such as living donors,undergo a major surgical procedure,such as a right hepatectomy,reflects the need for prompt and detailed reports of complications arising in this particular category of patient.Perioperative complications and post resection liver regeneration are not influenced by anatomic variations or patient demographic.

  12. Surgical complications in zygomatic implants: A systematic review.

    Science.gov (United States)

    Molinero-Mourelle, P; Baca-Gonzalez, L; Gao, B; Saez-Alcaide, L-M; Helm, A; Lopez-Quiles, J

    2016-11-01

    The use of zygomatic implants in the prosthetic rehabilitation of the patient with severe maxillary bone atrophy is another therapeutic alternative, not exempt from complications. The main objective of this review is to analyze and describe the most frequent surgical complications associated with the use of zygomatic implants. An electronic database search on PubMed, along with a manual search, without taking into account date nor language, was undertaken by two observers, selecting studies that comprised a study period from 6 to 12 months, any type of clinical trial, and series that included a follow-up and/or review period during the aforementioned margin, that mentioned at least two types of complications. Out of the initial search that yielded 455 studies, 67 were considered potentially relevant for the present study, out of which 14 were finally selected. Out of the most frequent surgical complications, sinusitis (3,9%) and failure in osseointegration (2,44%) are highlighted. The analysis of the results shows that the most frequent complications are sinusitis and failure in osseointegration of the zygomatic implant. However, a standardised data collection system for the data on complications is needed.

  13. The surgical treatment of a rare complication: gallstone ileus.

    Science.gov (United States)

    Donati, Marcello; Cardì, Francesco; Brancato, Giovanna; Calò, Piergiorgio; Donati, Angelo

    2010-01-01

    The authors describe 3 cases of gallstone ileus observed in two different hospitals and evaluate the current rarity of this complication of the biliary lithiasis and/or of cholangiocarcinomas. There were two cases of stones at the ileal level and one case in the left colon. In one case a single surgical intervention was carried out while in the other a two-step strategy was adopted. Notwithstanding the fact that the correct strategy to adopt is still controversial in literature, the authors discuss the single and double step strategies and propose that the second intervention of the 2-step strategy should not be performed in high risk surgical patients.

  14. Syrian war shrapnel injury: cubital nerve defect grafting during humanitarian surgical mission. Clinical case presentation

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    Argentina Vidrașcu

    2016-07-01

    Full Text Available Background and aim of this clinical case presentation is to reveal the importance of early nerve injury diagnosis and surgical treatment in war wounded patients. Methods. The author treated patients in Amman Charity Hospital were among different plastic surgery cases where limb nerve injuries with nerve grafting indication. The presented case was treated with autologus sural nerve graft. Results were evaluated at 3 months after the surgery and revealed detectable nerve conductibility at the Electromiography test. In conclusion, in cases with delayed nerve repair surgical treatment in war wounded patients, the vascularised nerve graft can be a better solution for nerve defect surgical treatment.

  15. Surgical treatment of colorectal cancer complicated with acute intestinal obstruction

    Directory of Open Access Journals (Sweden)

    S. N. Schaeva

    2016-01-01

    Full Text Available Background. The main reason for urgent complications of colon cancer is an acute intestinal obstruction (AIO. This is complex pathological condition in 90 % of cases caused by colorectal cancer (CRC.Objective – to evaluate radicality of the performed operations in complicated colorectal cancer in general surgical hospitals. Dependence of the severity of intestinal obstruction by tumor localization, its morphological characteristics, determine dependence of the type of the surgical operation performed on the severity of intestinal obstruction.Materials and methods. We have studied the data on 667 patients with colorectal cancer complicated by acute intestinal obstruction. These patients were treated in the period from 2001 to 2013 in general surgical hospital in the territory of Smolensk and Smolensk region. For the processing of the obtained results we have used software Statistica 6.1. Differences were considered statistically at p ≤ 0.05.Results. All the patients were divided into 3 groups by the expression of intestinal obstruction. Group 1 (n = 279 consisted of patients with the presence of decompensated intestinal obstruction (DIO, group 2 (n = 313 consisted of patients with subcompensated intestinal obstruction (SIO, group 3 (n = 75 included patients with compensated intestinal obstruction (CIO. In case of tumor localization in right halfof the colon we most commonly observed clinical picture of acute development of decompensated intestinal obstruction (p = 0.041. Subcompensated intestinal obstruction prevailed in case of tumor localization in left half of the colon and rectal localization. In general surgical hospitals it is not always possible to speak about radicality of surgical treatment, as in a large number of cases (62.5 % the number of examined lymph nodes was less than 4. When DIO patients are admitted in the clinic, the percentage of singlestage operations is equal to 7.5 % (n = 21. In case of DIO and SIO there was a high

  16. Vascular Endograft Infection with Listeria monocytogenes reated with Surgical Debridement but without Graft Removal

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    Beate Tanner-Steinmann

    2011-01-01

    Full Text Available The awareness of Listeria monocytogenes as a pathogen in meningitis and bacteremia in immunosuppressed patients is high. We report a case of vascular graft infection due to Listeria monocytogenes as an example of a less well-known manifestation of listeriosis and focus on the possible treatment procedures emphasizing a management with surgical debridement but preservation of the endograft, in contrast to the gold standard treatment of vascular graft infections which consists of a removal of the graft.

  17. Surgical Management of Ascending Aortic Aneurysm and Its Complications

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    Sisira Sran

    2014-01-01

    Full Text Available Ascending aortic aneurysms involving the proximal aortic arch, arising anywhere from the aortic valve to the innominate artery, represent various problems in which open surgery is generally required. Surgical options include excision of the aortic pathology or wrapping the aneurysm shell with an aortic Dacron graft. Intervention using the latter method can lead to extravasation of blood along the suture lines resulting in continuous bleeding within the periprosthetic space. The Cabrol technique was developed as a method for decompression of postoperative leaks by the formation of a conduit system from the periprosthetic space to the right atrium. The coronary ostia are anastomosed to a second graft in an end-to-end fashion, which is then anastomosed to the ascending aortic conduit side to side. The native aorta is then sewn around the prosthesis, hereby creating a shunt to drain anastomotic leakage. This shunt reduces postsurgical risk of pseudoaneurysm formation and normally closes a few days following surgery. We discuss the case of a patient who underwent Cabrol’s variation and six months later was demonstrated to have a patent shunt.

  18. Pediatric pituitary resection: characterizing surgical approaches and complications.

    Science.gov (United States)

    Hanba, Curtis; Svider, Peter F; Shkoukani, Mahdi A; Sheyn, Anthony; Jacob, Jeffrey T; Eloy, Jean Anderson; Folbe, Adam J

    2017-01-01

    Although there has been extensive study evaluating adult pituitary surgery, there has been scant analysis among children. Our objective was to evaluate a population-based resource to characterize nationwide trends in surgical approach, hospital stay, and complications among children undergoing pituitary surgery. The Kids' Inpatient-Database (KID) files (2009/2012) were evaluated for pituitary gland excisions. Procedure, patient demographics, length of inpatient stay, inpatient costs, hospital setting, and surgical complications were analyzed. A weighted incidence of 1071 cases were analyzed; the majority (77.6%) underwent transsphenoidal resections. These patients had significantly decreased hospital costs and lengths of stay. Patients undergoing transfrontal approaches had significantly greater rates of postoperative diabetes insipidus (DI) (66.5%), panhypopituitarism (38.8%), hydrocephalus, and visual deficits. Among transsphenoidal patients, males had greater rates of postoperative hydrocephalus (5.5%) and panhypopituitarism (17.5%) than females, and patients ≤10 years old had greater rates of these 2 complications (14.5%, 19.4%, respectively) as well as DI (61.3%). A greater proportion of children undergo transfrontal approaches for pituitary lesions than in their adult counterparts. This difference may harbor a potential to influence future sellar resection approaches in children toward a transsphenoidal operation when surgically feasible. Patients undergoing transfrontal procedures have greater risks for many intraoperative and postoperative complications relative to individuals undergoing transsphenoidal resections. Among patients undergoing transsphenoidal approaches, males had significantly greater rates of postoperative hydrocephalus and panhypopituitarism, and younger children had greater rates of postoperative DI, hydrocephalus, and panhypopituitarism. These data reinforce the need for greater vigilance in the postoperative care of younger children

  19. Magnetic resonance imaging of surgically confirmed anterior cruciate ligament graft disruption

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    Collins, Mark S.; Bond, Jeffrey R. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); Unruh, Kenneth P. [Mayo Clinic, Mayo Medical School, Rochester, MN (United States); Mandrekar, Jayawant N. [Mayo Clinic, Department of Biostatistics, Rochester, MN (United States)

    2008-03-15

    To evaluate previously described primary and secondary MRI signs of disruption to anterior cruciate ligament (ACL) grafts in surgically proven cases. We retrospectively analyzed MR images of 48 patients (mean age 29 years) with clinically suspected ACL graft disruption. All patients had surgical confirmation of the MRI findings. The reviewers analyzed the cases blinded to the surgical results and assessed each of the primary and secondary MRI signs of graft disruption individually. Subsequently, a final impression of the graft integrity based on a comprehensive assessment of all of the primary and secondary findings was made. Utilizing a comprehensive assessment of previously described primary and secondary MR findings of ACL graft disruption, the blinded reviewers were able to identify correctly full-thickness graft tears with test accuracy of 85%, sensitivity of 72%, and specificity of 100%. Individual assessment of the primary finding of graft fiber discontinuity had sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 72%, 100%, 100%, 77% and 85%, respectively, for full-thickness tears. Other individual primary and secondary findings were less reliable; however, the primary findings of marked segmental thinning of the graft and markedly abnormal graft orientation, and the secondary findings of bone contusions in the lateral compartment and large joint effusion, had high specificity and positive predictive value. Of the four missed cases, two had associated arthrofibrosis. The comprehensive assessment of previously described primary and secondary MRI findings of ACL graft disruption has high test specificity and moderately high test accuracy. The presence of graft fiber discontinuity is the most reliable primary or secondary finding when assessed individually. Marked segmental thinning of the graft and abnormal fiber orientation, and the presence of bone contusions in the lateral compartment and large joint effusion

  20. Perioperative complications in liver transplantation using donation after cardiac death grafts: a propensity-matched study.

    Science.gov (United States)

    Pan, Xiongxiong; Apinyachon, Worapot; Xia, Wei; Hong, Johnny C; Busuttil, Ronald W; Steadman, Randolph H; Xia, Victor W

    2014-07-01

    Donation after cardiac death (DCD) is an important source for expanding the donor pool for liver transplantation (LT). Although the long-term outcomes of LT using DCD grafts have been extensively studied, perioperative complications related to DCD grafts are rarely reported. The aim of this study was to determine whether DCD grafts were associated with a higher incidence of postreperfusion complications and worse outcomes in adult LT patients. After institutional review board approval, the medical records of all adult patients who underwent LT at our medical center between 2004 and 2011 were reviewed. Postreperfusion complications and posttransplant outcomes were compared between patients receiving DCD grafts and patients receiving donation after brain death (DBD) grafts. In all, 74 patients received DCD grafts during the study period, and 1369 patients received DBD grafts. An initial comparison showed that many preoperative, prereperfusion, and donor variables in the DCD group differed significantly from those in the DBD group. Propensity matching was chosen so that adjustments could be made for the differences. A postmatching analysis showed that the preoperative, prereperfusion, and donor variables no longer differed between the 2 groups. The postreperfusion requirements for blood products and vasopressors, the posttransplant ventilation times, the incidence of posttransplant acute renal injury, and the 30-day and 1-year patient and graft survival rates were comparable between the 2 groups. However, patients receiving DCD grafts experienced significantly higher rates of hyperkalemia (33.8% versus 18.9%, P grafts remained a risk factor for postreperfusion hyperkalemia and PRS. A prophylactic regimen aimed at decreasing postreperfusion hyperkalemia and PRS is recommended for the management of LT using DCD grafts.

  1. Surgical skill and complication rates after bariatric surgery.

    Science.gov (United States)

    Birkmeyer, John D; Finks, Jonathan F; O'Reilly, Amanda; Oerline, Mary; Carlin, Arthur M; Nunn, Andre R; Dimick, Justin; Banerjee, Mousumi; Birkmeyer, Nancy J O

    2013-10-10

    Clinical outcomes after many complex surgical procedures vary widely across hospitals and surgeons. Although it has been assumed that the proficiency of the operating surgeon is an important factor underlying such variation, empirical data are lacking on the relationships between technical skill and postoperative outcomes. We conducted a study involving 20 bariatric surgeons in Michigan who participated in a statewide collaborative improvement program. Each surgeon submitted a single representative videotape of himself or herself performing a laparoscopic gastric bypass. Each videotape was rated in various domains of technical skill on a scale of 1 to 5 (with higher scores indicating more advanced skill) by at least 10 peer surgeons who were unaware of the identity of the operating surgeon. We then assessed relationships between these skill ratings and risk-adjusted complication rates, using data from a prospective, externally audited, clinical-outcomes registry involving 10,343 patients. Mean summary ratings of technical skill ranged from 2.6 to 4.8 across the 20 surgeons. The bottom quartile of surgical skill, as compared with the top quartile, was associated with higher complication rates (14.5% vs. 5.2%, Pbariatric surgeons varied widely, and greater skill was associated with fewer postoperative complications and lower rates of reoperation, readmission, and visits to the emergency department. Although these findings are preliminary, they suggest that peer rating of operative skill may be an effective strategy for assessing a surgeon's proficiency.

  2. Using vacuum in the treatment of surgical wounds complications

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    Drašković Miroljub

    2011-01-01

    Full Text Available Background/Aim. Using vacuum in medicine has been known from long ago, however, it has not been used for the treatment of wounds. The first experiments in this field were performed by Wagner Fleischmann, University of Ulm, Ulm, West Germany, in 1993. The aim of this study was to present our clinical experience with the treatment of surgical wounds complications in vascular patients by the use of controled vacuum. Method. In a period October 2006 - December 2009 a total of 18 patients with infection and surgical wound dehiscence were treated by the use of vacuum. Vacuum was applied to wounds by placing a polyurethane sponge on them and by fixing a polyurethane foil and a sponge to the surrounding healthy skin so to completely airtight wounds. Over a foil vacuum of - 150 mmHg was applied for a 5-day period, and on the day 6 a foil and a sponge were removed. Results. In all the 18 wounds treated by the use of vacuum secondary wound closing was achieved with no complications and with a significantly shortened time period treatment. Wound infections were healed using this method and only in 2 patients antibiotics were used at the same time. Conclusion. The use of vacuum in the treatment of operative wounds complications is an easy and reliable method contributing significantly to wounds better healing.

  3. Determining the Oncologic Safety of Autologous Fat Grafting as a Reconstructive Modality: An Institutional Review of Breast Cancer Recurrence Rates and Surgical Outcomes.

    Science.gov (United States)

    Cohen, Oriana; Lam, Gretl; Karp, Nolan; Choi, Mihye

    2017-09-01

    The increasing use of autologous fat grafting in breast cancer patients has raised concerns regarding its oncologic safety. This study evaluated patient outcomes and tumor recurrence following mastectomy reconstruction and autologous fat grafting. Retrospective chart review identified patients who underwent mastectomy followed by breast reconstruction from 2010 to 2015. Eight hundred twenty-nine breasts met inclusion criteria: 248 (30.0 percent) underwent autologous fat grafting, whereas 581 (70.0 percent) breasts did not. Patient demographics, cancer characteristics, oncologic treatment, surgical treatment, surgical complications, local recurrence, and distant metastases were analyzed. Autologous fat grafting patients and control patients were of similar body mass index, smoking status, and BRCA status. Patients who underwent fat grafting were significantly younger than control patients and were less likely to have diabetes, hypertension, or hyperlipidemia. The two groups represented similar distributions of BRCA status, Oncotype scores, and hormone receptor status. Patients underwent one to four grafting procedures: one procedure in 83.1 percent, two procedures in 13.7 percent, three in 2.8 percent, and four in 0.4 percent. Mean follow-up time from initial surgery was 45.6 months in the fat grafting group and 38.8 months in controls. The overall complication rate following fat grafting was 9.4 percent. Among breasts undergoing surgery for therapeutic indications, there were similar rates of local recurrence (fat grafting group, 2.5 percent; controls, 1.9 percent; p = 0.747). Interestingly, mean time to recurrence was significantly longer in the fat grafting group (52.3 months versus 22.8 months from initial surgery; p = 0.016). Autologous fat grafting is a powerful tool in breast reconstruction. This large, single-institution study provides valuable evidence-based support for its oncologic safety. Therapeutic, III.

  4. Surgical treatment of Chiari I malformation complicated with syringomyelia

    Science.gov (United States)

    BAO, CHANGSHUN; YANG, FUBING; LIU, LIANG; WANG, BING; LI, DINGJUN; GU, YINGJIANG; ZHANG, SHULING; CHEN, LIGANG

    2013-01-01

    The aim of this study was to evaluate the curative effects of various surgical procedures on Chiari I malformation (CMI) complicated with syringomyelia. A total of 185 patients with CMI complicated with syringomyelia who received treatment between January 1997 and December 2011 were recruited. All patients underwent posterior fossa decompression in which the lamina of the first cervical vertebra was removed, with the removal of the second or third depending on the severity of the cerebellar tonsil herniation. Of the patients, 76 underwent large-bone-window decompression and duraplasty, while 109 underwent small-bone-window decompression, displaced cerebellar tonsil resection and duraplasty. The curative effects of the different surgical procedures were analyzed retrospectively. Clinical symptoms were eliminated or improved in 156 patients (84.3%) by the time of discharge from hospital. A total of 148 patients were evaluated using magnetic resonance imaging (MRI) which revealed that the cisterna magna was reconstructed in 92 patients and spinal syrinx was reduced in 75. Follow-up was performed on 147 patients (79.5%) for between 3 months and 12 years. During the follow-up, symptoms were eliminated or improved in 110 patients (74.8%), not improved in 26 (17.7%) and deteriorated in 11 (7.5%). MRI was performed on 95 patients during follow-up examinations and the cisterna magna was reconstructed in 87 patients and spinal syrinx was reduced in 79. Small-bone-window decompression plus duraplasty is an effective surgical procedure for treating CMI complicated with syringomyelia and intraoperative cerebellar tonsillectomy significantly aids patient recovery. PMID:23251294

  5. [Autologous fat grafting in the surgical management of painful scar: preliminary results].

    Science.gov (United States)

    Baptista, C; Iniesta, A; Nguyen, P; Legré, R; Gay, A-M

    2013-10-01

    The purpose of this study was to report our experience about the effectiveness of autologous fat injections in the management of painful scars. Between 2010 and 2012, all patients with persistent incisional pain despite a well-conduced 6 months medical treatment received an autologous fat graft according to the technique originally described by Coleman. Results interpretation was based on pain improvement thanks to a Visual Analogic Scale (VAS), postoperative patient satisfaction, reduction on analgesics intake and quality of life improvement. Eleven patients were included, the mean quantity of fat injected was 11cm(3). Nine patients (1.5%) benefited from a complete or significant pain decrease, 74.5% reported being very satisfied or satisfied with the result. The mean reduction of VAS was 3.5 points. We did not observe any complication. Autologous fat grafting is an innovative therapeutic approach and appears to be an attractive concept in the management of scar neuromas resistant to drug treatment, by providing an easy effective and safe surgical treatment.

  6. The scalp as a donor site for split-thickness skin graft: a rare complication case report.

    Science.gov (United States)

    Robert, N; May, P; Binder, J P; Revol, M; Servant, J M

    2011-05-01

    The scalp is a useful and reliable donor site for the paediatric burn population that can be harvested several times with minimal morbidity. However, the scalp cannot be used as skin graft donor site with impunity. Scalp alopecia and chronic folliculitis can be observed among the complications. In these cases, the reconstruction phase offers different surgical procedures such as primary closure, staged excision or tissue expansion. We report the case of a patient (29-years-old), treated 20 years ago for second-degree burns covering up to 20% total body surface area (TBSA) by using thin split-thickness skin grafts of his scalp. As a teenager, he developed multiple episodes of folliculitis at the donor site of the scalp and then of recurrent abscesses, resistant to all existing medical treatments. Surgical treatment consisted in the skin excision of his scalp donor site which was immediately covered by a thin split-thickness skin graft. Four months after surgery, the patient was satisfied with the functional and aesthetic result. Copyright © 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  7. KYPHECTOMY IN PATIENTS WITH MYELOMENINGOCELE: SURGICAL RESULTS AND COMPLICATIONS

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    Pedro Araujo Petersen

    2015-09-01

    Full Text Available Objectives:The lumbar kyphosis in patients with myelomeningocele is a complex deformity whose treatment is mainly surgical. The objective of this study is to summarize the results and complications obtained by the group in 2012 with respect to this group of patients.Method:Performed a retrospective analysis of the medical records and radiographs of patients consecutively operated in 2012. The technique was originally described by Dunn-McCarthy and consists of kyphectomy and posterior fixation using S-shaped Luque rods through the foramina of S1 associated with pedicle screws in the thoracic spine.Results:Six patients were included in the study. The age at surgery was 11 years and 7±22 months and the weight was 29.1±11.9 kg. The procedure lasted 271±87 minutes, with the removal of one or two (mean 1.5 vertebrae from the apex of the kyphosis. Hospitalization time was 10±9 days. The lumbar kyphosis measuring 116.3±37 degrees preoperatively was reduced to 62.5±21 degrees. All patients began to sit without support and to lie in the supine position. Four patients developed postoperative infection and required surgical debridement at the follow-up. One patient had the implant removed after a year due to loosening of the rod in the sacrum.Conclusion:The surgical technique allows excellent functional results in the correction of lumbar kyphosis in patients with myelomeningocele despite high complication rates. It is necessary to conduct studies with a larger number of patients and duration of follow-up to assess whether the use of pedicle screws will decrease the rate of loosening and pseudoarthrosis.

  8. Ureteric complications in live related donor renal transplantation - impact on graft and patient survival

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    A Srivastava

    2004-01-01

    Full Text Available Objective : The study was performed with an aim to determine the incidence of ureteric complications in live related donor renal transplantation, and to study the effect of ureteric complications on long term graft and patient survival. Patients And Methods: Records of 1200 consecutive live related renal transplants done from 1989-2002 were reviewed. Twenty-six ureteric complications were noted to occur and treatment modalities employed were documented. In the non complication group sufficient data for evaluation was available in 867 patients. Survival analysis were performed using Kaplan-Meier techniques. Results: The overall incidence of urological complications is 2.9%. Complications occurred at a mean interval of 31.9 days after renal transplantation. Ureteric complications occurred in 2% patients with stented and 7.7% patients with non stented anastomosis (p=0.001. Mean follow up following renal transplantation was 37.4 months. Survival analysis showed that ureteric complications did not increase the risk of graft fai lu re or patient death. Conclusions: Ureteric complications in live related donor renal transplantation occurred in 2.9 % patients and did not impair graft and patient survival.

  9. Surgical issues in lung transplantation: options, donor selection, graft preservation, and airway healing.

    Science.gov (United States)

    Daly, R C; McGregor, C G

    1997-01-01

    To present an overview of the surgical issues in lung transplantation, including the historical context and the rationale for choosing a particular procedure for a specific patient, we reviewed and summarized the current medical literature and our personal experience. Several surgical options are available, including single lung transplantation; double lung transplantation; heart-lung transplantation; bilateral, sequential single lung transplantation; and (recently) single lobe transplantation. Although single lung transplantation is preferred for maximal use of the available organs, bilateral lung transplantation is necessary for septic lung diseases and may be appropriate for pulmonary hypertension and bullous emphysema. Heart-lung transplantation is performed for Eisenmenger's syndrome and for primary pulmonary hypertension with severe right ventricular failure. General factors for consideration in assessment of compatibility of the donor and potential recipient include ABO blood group, height (the donor should be within +/- 20% of the recipient's height), and length of the lungs (determined on an anteroposterior chest roentgenogram). Graft preservation and minimal duration of ischemia are important. Complications associated with airway healing are related to ischemia of the donor bronchus. We have addressed the issue of donor bronchial ischemia by direct revascularization of the donor bronchial arteries with use of the recipient's internal thoracic artery. Currently, lung transplantation offers a realistic therapeutic option to patients with end-stage pulmonary parenchymal or vascular disease.

  10. A Novel Surgical Technique for Augmented Corticotomy-Assisted Orthodontics: Bone Grafting With Periosteum.

    Science.gov (United States)

    Ma, Zhi-Gui; Yang, Chi; Xie, Qian-Yang; Xi, Qian-Yang; Ye, Zhou-Xi; Ye, Zhou-Xie; Zhang, Shan-Yong; Abdelrehem, Ahmed

    2016-01-01

    To introduce grafting fixed with the periosteum (dumpling technique) as an alternative surgical technique for augmented corticotomy-assisted orthodontics in the lower anterior region and evaluate the preliminary outcomes. Eleven patients (9 women, 2 men; mean age, 21.4 yr) with a thin alveolus or alveolar defect in the lower anterior region by clinical and radiographic examination underwent an augmented corticotomy using the new dumpling technique. Cone-beam computerized tomography was used to evaluate morphologic changes of the lower anterior ridge before treatment (T0) and 1 week (T1) and 6 months (T2) after the bone-augmentation procedure. Repeated-measures analysis of variance with Bonferroni multiple-comparison test was used to compare variables at each time point. No severe postsurgical complications occurred in any patient. The mean alveolar bone thickness of the labial plate increased from T0 to T1 (P .05). No significant differences were found in root length of the lower anterior teeth at these 3 time points (P > .05). In this preliminary study, the dumpling technique for augmented corticotomy-assisted surgical orthodontics showed alveolar bone augmentation by increasing the vertical alveolar height and the horizontal bone thickness in the labial aspect of the anterior mandibular area. However, long-term follow-up is necessary. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  11. Treatment of gingival recession in two surgical stages: Free gingival graft and connective tissue grafting.

    Science.gov (United States)

    Henriques, Paulo Sergio Gomes; Nunes, Marcelo Pereira; Pelegrine, Andre Antonio

    2011-01-01

    This report describes a clinical case of severe Miller Class II gingival recession treated by two stages of surgery that combined a free gingival graft and connective tissue grafting. First, a free gingival graft (FGG) was performed to obtain an adequate keratinized tissue level. Three months later, a connective tissue graft (CTG) was performed to obtain root coverage. The results indicated that the FGG allows for a gain in the keratinized tissue level and the CTG allows for root coverage with decreased recession level after 16 months. Therefore, for this type of specific gingival recession, the combination of FGG and CTG can be used.

  12. Surgical anatomy of the retroperitoneal spaces, Part V: Surgical applications and complications.

    Science.gov (United States)

    Mirilas, Petros; Skandalakis, John E

    2010-04-01

    Knowledge of the surgical anatomy of the retroperitoneum is crucial for surgery of the retroperitoneal organs. Surgery is essential for treatment of retroperitoneal pathologies. The list of these diseases is extensive and comprises acute and chronic inflammatory processes (abscess, injury, hematoma, idiopathic fibrosis), metastatic neoplasms, and primary neoplasms from fibroadipose tissue, connective tissue, smooth and striated muscle, vascular tissue, somatic and sympathetic nervous tissue, extraadrenal chromaffin tissue, and lymphatic tissue. The retroperitoneum can be approached and explored by several routes, including the transperitoneal route and the extraperitoneal route. The retroperitoneal approach to the iliac fossa is used for ectopic renal transplantation. Safe and reliable primary retroperitoneal access can be performed for laparoscopic exploration. The anatomic complications of retroperitoneal surgery are the complications of the organs located in several compartments of the retroperitoneal space. Complications may arise from incisions to the somatic wall, somatic nerves, blood and lymphatic vessels, lymph nodes, visceral autonomous plexuses, and neighboring splanchna.

  13. Surgical apgar score predicts early complication in transfemoral amputees

    DEFF Research Database (Denmark)

    Wied, Christian; Foss, Nicolai Bang; Kristensen, Morten T

    2016-01-01

    AIM: To assess whether the surgical apgar score (SAS) is a prognostic tool capable of identifying patients at risk of major complications following lower extremity amputations surgery. METHODS: This was a single-center, retrospective observational cohort study conducted between January 2013...... and April 2015. All patients who had either a primary transtibial amputation (TTA) or transfemoral amputation (TFA) conducted at our institution during the study period were assessed for inclusion. All TTA patients underwent a standardized one-stage operative procedure (ad modum Persson amputation......) performed approximately 10 cm below the knee joint. All TTA procedures were performed with sagittal flaps. TFA procedures were performed in one stage with amputation approximately 10 cm above the knee joint, performed with anterior/posterior flaps. Trained residents or senior consultants performed...

  14. Spiral CT of Non-Graft Post Cardiac Surgery Complications: A Pictorial Essay

    Directory of Open Access Journals (Sweden)

    S. Shirani

    2010-06-01

    Full Text Available Spiral CT is a rapidly growing method for noninvasive visualization of post-operative complications, including post-operative complications in CABG (coronary artery bypass graft. In the recent years, several different, yet more efficient types have been introduced with progressive improvement in the diagnostic accuracy in the detection of post-operative complications. The introduction of 64-slice technology, which allows high resolution as well as reconstructed images, has resulted in further progress in the diagnostic process. This kind of diagnostic equipment will spread rapidly in the world. Although studies with large numbers of patients regarding spiral CT as a routine diagnostic method have not been reported, there is great need for it all over the world. In this article, we intend to review the spiral CT findings of non-graft complications in patients after cardiac surgery.

  15. Late Complication after Superficial Femoral Artery (SFA) Aneurysm: Stent-graft Expulsion Outside the Skin

    Energy Technology Data Exchange (ETDEWEB)

    Pecoraro, Felice, E-mail: felicepecoraro@libero.it; Sabatino, Ermanno R.; Dinoto, Ettore; Rosa, Giuliana La; Corte, Giuseppe; Bajardi, Guido [University of Palermo, Vascular Surgery Unit (Italy)

    2015-10-15

    A 78-year-old man presented with a 7-cm aneurysm in the left superficial femoral artery, which was considered unfit and anatomically unsuitable for conventional open surgery for multiple comorbidities. The patient was treated with stent-graft [Viabhan stent-graft (WL Gore and Associates, Flagstaff, AZ)]. Two years from stent-graft implantation, the patient presented a purulent secretion and a spontaneous external expulsion through a fistulous channel. No claudication symptoms or hemorrhagic signs were present. The pus and device cultures were positive for Staphylococcus aureus sensitive to piperacillin/tazobactam. Patient management consisted of fistula drainage, systemic antibiotic therapy, and daily wound dressing. At 1-month follow-up, the wound was closed. To our knowledge, this is the first case of this type of stent-graft complication presenting with external expulsion.

  16. An Alternative Treatment Strategy for Complicated Chronic Wounds: Negative Pressure Therapy over Mesh Skin Graft

    Directory of Open Access Journals (Sweden)

    Michele Maruccia

    2017-01-01

    Full Text Available Extensive skin defect represents a real problem and major challenge in plastic and reconstructive surgery. On one hand, skin grafts offer a practical method to deal with skin defects despite their unsuitability for several complicated wounds. On the other hand, negative pressure wound therapy (NPWT, applied before skin grafting, promotes granulation tissue growth. The aim of the study is to evaluate the improvement in wound healing given by the merger of these two different approaches. We treated 23 patients for large wounds of multiple factors. Of these, 15 were treated with the application of V.A.C.® Therapy (KCI Medical S.r.l., Milan, Italy, in combination with skin grafts after a prior unsuccessful treatment of 4 weeks with mesh skin grafts and dressings. Another 8 were treated with only mesh skin graft. Pain reduction and wound area reduction were found statistically significant (p<0.0009, p<0.0001. Infection was resolved in almost all patients. According to our study, the use of the negative pressure wound therapy over mesh skin grafts is significantly effective especially in wounds resistant to conventional therapies, thereby improving the rate of skin graft take.

  17. [Pleural hernia of an esophageal graft--late postoperative complication].

    Science.gov (United States)

    Grabowski, K; Lewandowski, A; Moroń, K; Strutyńska-Karpińska, M; Błaszczuk, J; Machała, R

    1997-01-01

    Pleural hernia of the oesophageal substitute from pedicled intestinal segment is one of the late postoperative complications. 13 cases of patients with oesophagus reconstructed because of lye ingestion stenosis are presented. Problems concerning diagnosis and treatment of pleural hernia are analysed. Eight patients with minor symptoms were treated conservatively. Five patients were operated, two of them from acute necrosis of the substitute. Necrosis was caused by incarceration of the bowel and torsion of the mesentery. Elective operative treatment consisted of reduction of hernia sac contents, closing of the hernia orifice, chest drainage and temporary gastronomy. In patient operated as an emergency cases necrotic part of substitute was removed. This resulted in oesophageal exclusion in the neck, creating gastronomy. Chest drainage was also performed.

  18. Open Surgical Repair After Endovascular Treatment with Endologix Stent Graft: A Case Report

    Directory of Open Access Journals (Sweden)

    Ižsa Coskun

    2016-01-01

    Full Text Available Endovascular treatment of abdominal aortic aneurysm repair is increasingly being used today. We report a 72-year-old male patient who underwent open surgical repair due to separation of IntuTrak Powerlink XL (Endologix endovascular stent graft four months after endovascular intervention for abdominal aortic aneurysm with 9.5 cm diameter.

  19. Transient cortical blindness: a benign but devastating complication after coronary angiography and graft study.

    Science.gov (United States)

    Sridhar, Ganiga Srinivasaiah; Sadiq, Muhammad Athar; Wan Ahmad, Wan Azman; Supuramaniam, Chitra; Undok, Abdul Wahab; Abidin, Imran Zainal; Chee, Kok Han

    2014-10-01

    Transient cortical blindness after coronary angiography and bypass graft is a very rare complication. In this report we present the case of a 63-year-old man who developed transient cortical blindness within 30 minutes of coronary angioplasty and graft study, but subsequently recovered within 72 hours without any neurological deficit. A plain computed tomography brain scan showed bilateral symmetrical subarachnoid hyperdensities in the posterior cerebral circulation area suspicious of subarachnoid bleed. However, magnetic resonance imaging and magnetic resonance angiography scans were normal. Excess contrast volume causing direct neurotoxicity seems to be the most probable cause, but the exact mechanism is unclear.

  20. Endovascular stent graft for treatment of complicated spontaneous dissection of celiac artery: Report of two cases

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Ung Rae; Lee, Young Hwan [Dept. of Diagnostic Radiology, Catholic University of Daegu School of Medicine, Daegu (Korea, Republic of); Kim, Young Hwan [Dept. of Diagnostic Radiology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu (Korea, Republic of)

    2013-06-15

    We report 2 cases of complicated spontaneous dissection of the celiac artery, which were successfully treated by a stent graft. The first patient was a 47-year-old man who presented with acute abdominal pain. CT scan showed ruptured saccular aneurysm with surrounding retroperitoneal hematoma. The second patient was a 57-year-old man with progressive dissecting aneurysm. Endovascular stent graft was placed in the celiac trunk to control bleeding, and to prevent rupture in each patient. Follow-up CT scans showed complete obliteration of a dissecting aneurysm.

  1. Vaginal-sparing ventral buccal mucosal graft urethroplasty for female urethral stricture: A novel modification of surgical technique

    Science.gov (United States)

    Gani, Johan; Chee, Justin

    2016-01-01

    Purpose To present a novel modification of surgical technique to treat female urethral stricture (FUS) by a vaginal-sparing ventral buccal mucosal urethroplasty. Recurrent FUS represents an uncommon, though difficult clinical scenario to manage definitively. A variety of surgical techniques have been described to date, yet a lack of consensus on the optimal procedure persists. Materials and Methods We present a 51-year-old female with urethral stricture involving the entire urethra. Suspected etiology was iatrogenic from cystoscopy 17 years prior. Since then, the patient had undergone at least 25 formal urethral dilations and periods of self-dilation. In lithotomy position, the urethra was dilated to accommodate forceps, and ventral urethrotomy carried out sharply, exposing a bed of periurethral tissue. Buccal mucosa was harvested, and a ventral inlay technique facilitated by a nasal speculum, was used to place the graft from the proximal urethra/bladder neck to urethral meatus without a vaginal incision. Graft was sutured into place, and urethral Foley catheter inserted. Results The vaginal-sparing ventral buccal mucosal graft urethroplasty was deemed successful as of last follow-up. Flexible cystoscopy demonstrated patency of the repair at 6 months. At 10 months of follow-up, the patient was voiding well, with no urinary incontinence. No further interventions have been required. Conclusions This case describes a novel modification of surgical technique for performing buccal mucosal urethroplasty for FUS. By avoiding incision of the vaginal mucosa, benefits may include reduced: morbidity, urinary incontinence, and wound complications including urethro-vaginal fistula. PMID:27437540

  2. Imaging and management of complications of open surgical repair of abdominal aortic aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Nayeemuddin, M. [Department of Interventional Radiology, City General Hospital, University Hospital of North Staffordshire NHS Trust, Stoke-On-Trent (United Kingdom); Pherwani, A.D. [Department of Vascular Surgery, City General Hospital, University Hospital of North Staffordshire NHS Trust, Stoke-On-Trent (United Kingdom); Asquith, J.R., E-mail: john.asquith@uhns.nhs.uk [Department of Interventional Radiology, City General Hospital, University Hospital of North Staffordshire NHS Trust, Stoke-On-Trent (United Kingdom)

    2012-08-15

    Open repair is still considered the reference standard for long-term repair of abdominal aortic aneurysms (AAA). In contrast to endovascular aneurysm repair (EVAR), patients with open surgical repair of AAA are not routinely followed up with imaging. Although complications following EVAR are widely recognized and routinely identified on follow-up imaging, complications also do occur following open surgical repair. With frequent use of multi-slice computed tomography (CT) angiography (CTA) in vascular patients, there is now improved recognition of the potential complications following open surgical repair. Many of these complications are increasingly being managed using endovascular techniques. The aim of this review is to illustrate a variety of potential complications that may occur following open surgical repair and to demonstrate their management using both surgical and endovascular techniques.

  3. Evaluation of surgical complications after cochlear implantation in Fars center, south of Iran

    Directory of Open Access Journals (Sweden)

    2008-06-01

    Full Text Available Introduction: Cochlear implant, which used in patients with profound hearing loss, may followed by some major or minor complications. These complications depend on age of patient, kind of device, kind of incision, surgical technique and surgeon’s skill. Major complications mostly need surgical intervention for treatment and, may persist for long time. Minor complications need medical treatment and don’t need surgical intervention. Materials and Methods: In this descriptive study between 2004-2007, 100 patients subjected to cochlear implantation were evaluated for post operative complications. Results: Overall complication rate was 14%. We had 4 major complications, including 2 device failure, one misplaced electrode and one cases with major hematoma .These complications managed successfully by surgical intervention or reimplantation. Facial nerve damage or wound breakdown were not seen in these patients. Minor complications including small hematoma, edema, wound infection, dizziness were seen in 10 cases that managed medically. Conclusion: In the recent years complications of cochlear implantation are reduced with increasing surgeon’s skill, new surgical methods and development in device technology.  

  4. Impact of surgical complications on length of stay after hip fracture surgery

    DEFF Research Database (Denmark)

    Foss, Nicolai Bang; Palm, Henrik; Krasheninnikoff, Michael;

    2006-01-01

    BACKGROUND: Rehabilitation after hip fracture may be lengthy, with bed-day consumption accounting for up to 85% of the total cost of admission to hospital. Data suggest that surgical complications requiring reoperation may lead to an excessively long in-patient stays. However, the overall impact...... of surgical complications has not been examined in detail. METHODS: All 600 consecutive patients included were admitted with primary hip fracture and received primary surgical intervention with multimodal rehabilitation. Surgical complications were audited and classified as being due to a patient fall......, infection or suboptimal surgery, stratified into either requiring reoperation or not allowing mobilisation because of instability. RESULTS: Of the 600, 116 (19.3, 95% CI 16-22%) patients underwent reoperation or immobilisation; 27.1% of bed-day consumption resulted from surgical complications. The audit...

  5. Kidney clamp, perfuse, re-implant: a useful technique for graft salvage after vascular complications during kidney transplantation.

    Science.gov (United States)

    Mekeel, Kristin L; Halldorson, Jeffery B; Berumen, Jennifer A; Hemming, Alan W

    2015-04-01

    Although intra-operative vascular complications during renal transplantation are rare, injuries associated with prolonged ischemia may lead to graft threatening early and late complications. This series describes a novel technique for intra-operative repair of vascular complications in five patients over a three-yr period. The method consists of rapid graft nephrectomy and re-preservation of the graft with cold University of Wisconsin solution, which allows for controlled/precise back table repair of the vascular injury without incurring prolonged warm ischemia time. In three cases, the donor renal vein (2) and donor renal artery (1) were damaged and required back table reconstruction. In two cases, the recipient iliac artery needed reconstruction. Three of the five cases used deceased donor iliac vessels from another donor for reconstruction. Two patients required postoperative dialysis for delayed graft function for three to nine d (average six d) and two patients had slow graft function. All grafts were functioning at 17 months (mean) after transplant, with a median serum of 1.61 mg/dL (0.74-3.69). This series demonstrates the effectiveness of kidney clamp, perfuse, resuscitate as an effective intra-operative technique to salvage grafts after vascular injury. Although the grafts may suffer from delayed or slow graft function, excellent long-term function is attainable.

  6. ANALYSIS OF EFFECT AND COMPLICATION ON SURGICAL TREATMENT OF CAROTID BODY TUMORS IN 46 CASES

    Institute of Scientific and Technical Information of China (English)

    郑月宏; 刘暴; 李拥军; 刘昌伟; 管珩

    2003-01-01

    Objective. To describe the effects of surgical treatment and complications in 46 patients with carotid body tumor (CBT). Method. Retrospective study on surgical treatment and complications was carried out in 46 cases of CBT which were surgically treated with different kind of procedures. Result. All procedures performed successfully except that the CBT was not excised in 4 cases. No operative mortality was observed. There were 2 postoperative hemiplegia, 4 hypoglossal nerve impairment,2 glossopharyngeal nerve impairment, 1 vagus nerve impairment, and 1 accessory nerve impairment. One patient presented postoperative cranial nerve impairment in glossopharyngeal, vagus and hypoglossal nerves. Two patients developed local recurrence during the long-term follow-up. Conclusion. Complete surgical excision was possible in each patient if the diagnosis had been correctly made through selective preoperative angiography, vessel ultrasound Doppler and other examinations.Reasonable surgical procedure and Matas training were necessary to the successful surgical treatment and thus decrease the complicative incidence rate of carotid chemodectomas.

  7. Surgical intervention for complications caused by late radiation damage of the small bowel; a retrospective analysis

    Energy Technology Data Exchange (ETDEWEB)

    Halteren, H.K. van; Gortzak, E.; Taal, B.G.; Helmerhorst, Th.J.M.; Aleman, B.M.P.; Hart, A.A.M.; Zoetmulder, F.A.N. (Nederlands Kanker Inst. ' Antoni van Leeuwenhoekhuis' , Amsterdam (Netherlands))

    1993-08-01

    The authors studied the records of 46 patients who had been operated on between 1974 and 1990 in the Netherlands Cancer Institute because of complications due to late radiation damage of the small bowel. The following factors led to an increase in complication-risk: hypalbuminemia. more than one laparotomy prior to irradiation and a short interval (< 12 months) between irradiation and surgical intervention. The following factors related to a poorer survival: incomplete resection of the primary tumor and a short interval (< 12 months) between irradiation and surgical intervention. The type f surgical intervention did not have cumulative prognostic value in relation to complication-risk or survival. (author).

  8. Crohn′s disease: Multimodality Imaging of Surgical Indications, Operative Procedures, and Complications

    Directory of Open Access Journals (Sweden)

    B Kolar

    2011-01-01

    Full Text Available Surgical management is considered for specific indications in Crohn′s disease and a wide variety of surgeries is performed. The purpose of this pictorial essay is to depict manifestations of Crohn′s disease that indicates surgery, various surgical procedures that are performed, and the complications arising from these surgical procedures. Surgical indications including obstruction due to strictures or adhesions, fistulae and abscesses, and surgeries for these conditions, such as, ileocecectomy, stricturoplasty, small bowel resection, fecal diversion, segmental colectomy, and lysis of adhesions and their complications will be discussed and their imaging will also be illustrated.

  9. Long-Term Surgical Complications in the Oral Cancer Patient: a Comprehensive Review. Part I

    Directory of Open Access Journals (Sweden)

    Antonia Kolokythas

    2010-07-01

    Full Text Available Objectives: Oral and oropharyngeal cancer remains among the top ten most common malignancies in the United States and worldwide. Over the last several decades the approach to treatment of oral cancer has changed very little with regards to primary tumour extirpation while the approach to the “at risk” lymph nodes has evolved significantly. Perhaps the most significant change in the surgical treatment of cancer is the introduction of free flap for reconstruction post resection. Despite these surgical advances, oral cancer ablation, still results in the sacrifice of several functional and aesthetic organs. The aim of this article was to provide a comprehensive review of the potential long-term complications associated with surgical treatment of oral cancer and their management.Material and Methods: The available English language literature relevant to long-term surgical complications associated with surgical treatment of oral cancer was reviewed. The potential common as well as rarer complications that may be encountered and their treatment are summarized.Results: In total 50 literature sources were obtained and reviewed. The topics covered in the first part of this review series include ablative surgery complications, issues with speech, swallowing and chewing and neurologic dysfunction.Conclusions: The early complications associated with oncologic surgery for oral cancer are similar to other surgical procedures. The potential long-term complications however are quite challenging for the oncologic team and the patient who survives oral cancer, primarily due to the highly specialized regional tissues involved in the surgical field.

  10. Anesthetic and surgical complications in 219 cases of myotonic dystrophy.

    Science.gov (United States)

    Mathieu, J; Allard, P; Gobeil, G; Girard, M; De Braekeleer, M; Bégin, P

    1997-12-01

    The objective of this study was to assess the frequency, type, and severity of perioperative complications after a first surgery under general anesthesia in patients with myotonic dystrophy (DM) and to measure the association with suspected risk factors. Numerous cases of perioperative complications in DM patients have been reported. Hazards have been associated with the use of thiopentone, suxamethonium, neostigmine, and halothane. A retrospective study of perioperative complications was conducted for 219 DM patients who had their first surgery under general anesthesia at the Chicoutimi Hospital. The overall frequency of complications was 8.2% (18 of 219). Most complications (16 of 18) were pulmonary, including five patients with acute ventilatory failure necessitating ventilatory support, four patients with atelectasis, and three patients with pneumonia. Using multivariate analysis, we found that the risk of perioperative pulmonary complications (PPC) was significantly higher after an upper abdominal surgery (odds ratio (OR), 24.4; 95% CI, 4.0 to 149.3) and for patients with a severe muscular disability, as assessed by the presence of proximal limb weakness (OR, 14.1; 95% CI, 1.5 to 134.4). The likelihood of PPC was not related to any specific anesthetic drug. Because of the increased risk of PPC, careful monitoring during the early postoperative period, protection of upper airways, chest physiotherapy, and incentive spirometry are mandatory in all symptomatic DM patients, particularly those with a severe muscular disability or those who have undergone an upper abdominal surgery.

  11. A Systematic Review on Complications of Tissue Preservation Surgical Techniques in Percutaneous Bone Conduction Hearing Devices

    NARCIS (Netherlands)

    Verheij, Emmy; Bezdjian, Aren; Grolman, Wilko; Thomeer, Hans

    OBJECTIVE:: To investigate skin-related postoperative complications from tissue preservation approaches in percutaneous bone conduction device (BCD) implantations. DATA SOURCES:: PubMed, Embase, and Cochrane Library. STUDY SELECTION:: We identified studies on BCDs including the opted surgical

  12. Survey of early complications of primary skin graft and secondary skin graft (delayed) surgery after resection of burn waste in hospitalized burn patients.

    Science.gov (United States)

    Enshaei, A; Masoudi, N

    2014-09-18

    Burning is the second most common cause of home injuries in Iran that is often the cause of conflicts between children and young adults. Burning can lead to early and late complications that scar and contracture are the most common. Burn waste treatment is done by two methods: excision and then skin graft after the formation of granulation tissue; and excision and graft simultaneously that in this study, these two methods are compared. This was performed as a quasi-experimental analysis and retrospective study on all patients who were hospitalized for burn scar. All patients who have associated with weak eningimmune diseases such as diabetes, acquired immunodeficiency or congenital, taking steroids and patients undergoing chemotherapy etc. are excluded. The method of grafting in patients is primary graft procedure that was compared with patients who are treated using secondary graft. Data collected through review of patients' hospital and clinic chart. The mean burn percentage in the primary repair group was 14.4% and in the delayed repair group was 16.6%, respectively. The incidence of hematoma in both groups was zero. Skin necrosis and graft rejection and infection in the primary repair group was in 3.7% of patients and in the delayed repair group was in 1.2% of cases (P=0.5) CONCLUSION: Based on the findings of this study, no difference was observed between the two methods of excision and primary graft with delayed graft in the incidence of graft rejection. Due to the shorter treatment of primary graft and patient satisfaction and also according to the findings of this study excision and primary graft method seems appropriate method for treating old waste burning. 

  13. Repair process of surgical defects filled with autogenous bone grafts in tibiae of diabetic rats

    Directory of Open Access Journals (Sweden)

    Jônatas Caldeira Esteves

    2008-10-01

    Full Text Available From a biological standpoint, the best material for reconstruction of bone defects is the autogenous bone graft. However, as tissue healing is affected under diabetic conditions, major changes might take place in the revascularization, incorporation, replacement and remodeling phases of the grafted area. The purpose of this study was to assess the bone healing process in surgical wounds prepared in tibiae of diabetic rats and filled with autogenous bone. Forty male rats (Rattus norvegicus albinus, Wistar were randomly assigned to receive an endovenous injection (penile vein of either citrate buffer solution (Group 1 - control; n=20 or streptozotocin dissolved in citrate buffer solution (35 mg/kg to induce diabetes (Group 2 - diabetic; n=20. After determination of glycemia, the animals were anesthetized and the anterolateral regions of the tibiae of both limbs were shaved, antisepsis was performed and longitudinal incisions were made in each limb. The tibiae were exposed and two 2mm-diameter surgical cavities were prepared: one in the right limb, filled with particulate autogenous bone and the other in the left limb, filled with blood clot. The animals were euthanized at 10 and 30 postoperative days. The anatomic pieces were obtained, submitted to laboratory processing and sections were stained by hematoxylin and eosin and Masson's Trichrome for histomorphologic and histometric analyses. In both groups, the wounds filled with autogenous bone graft showed better results than those filled with blood clot. The control group showed higher new bone formation in wounds filled with autogenous bone graft at 30 days than the diabetic group, but without statistical significance. It may be concluded that, in general, the new bone formation occurred with autogenous graft was quantitatively similar between control and diabetic groups and qualitatively better in the control group.

  14. Complication rate after circumcision in a paediatric surgical setting should not be neglected

    DEFF Research Database (Denmark)

    Thorup, Jørgen; Thorup, Sebastian Cortes; Ifaoui, Inge Botker Rasmussen

    2013-01-01

    As a consequence of the discussion on whether the health benefits of newborn male circumcision outweigh the risks and the discrepancies in reported figures of complications, we evaluated our results from a paediatric surgical department.......As a consequence of the discussion on whether the health benefits of newborn male circumcision outweigh the risks and the discrepancies in reported figures of complications, we evaluated our results from a paediatric surgical department....

  15. Thromboembolic Complications after Zenith{sup ®} Low Profile Endovascular Graft for Infrarenal Abdominal Aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Urlings, T. A. J., E-mail: t-urlings@hotmail.com [Medical Center Westeinde, Department of Radiology (Netherlands); Vries, A. C. de, E-mail: a.de.vries@mchaaglanden.nl; Mol van Otterloo, J. C. A. de, E-mail: a.de.molvanotterloo@mchaaglanden.nl; Eefting, D., E-mail: d.eefting@mchaaglanden.nl [Medical Center Westeinde, Department of Vascular Surgery (Netherlands); Linden, E. van der, E-mail: e.van.der.linden@mchaaglanden.nl [Medical Center Westeinde, Department of Radiology (Netherlands)

    2015-06-15

    PurposeThe purpose of this study was to objectify and evaluate risk factors for thromboembolic complications after treatment with a Zenith{sup ®} Low Profile Endovascular Graft (Zenith LP). Results were compared with those in the recent literature on endovascular aortic repair (EVAR) and with the thromboembolic complications in the patient group treated with a Zenith Flex Endovascular Graft in our institute in the period before the use of the Zenith LP.Materials and MethodsAll consecutive patients who were suitable for treatment with a Zenith LP endograft between October 2010 and December 2011 were included. The preprocedural computed tomography scan (CT), procedural angiographic images, and the postprocedural CT scans were evaluated for risk factors for and signs of thromboembolic complications. All patients treated between December 2007 and November 2012 with a Zenith Flex endograft were retrospectively evaluated for thromboembolic complications.ResultsIn the study period 17 patients were treated with a LP Zenith endograft. Limb occlusion occurred in 35 % of the patients. Limb occlusions occurred in 24 % of the limbs at risk (one limb occluded twice). In one patient two risk factors for limb occlusion were identified. Between December 2007 and November 2012, a total of 43 patients were treated with a Zenith Flex endograft. No limb occlusion or distal embolization occurred.ConclusionDespite that this was a small retrospective study, the Zenith LP endograft seems to be associated with more frequent thromboembolic complications compared with the known limb occlusion rates in the literature and those of the patients treated with a Zenith Flex endograft in our institute.

  16. A Study of Surgical Management of Diabetic Limb Complications Among Rural Population

    OpenAIRE

    2012-01-01

    Surgical complication of diabetes mellitus has been a common clinical problem among the rural population because of illiteracy and poor health education. The present study was undertaken to evaluate patients with respect to age, sex, presentation and to do other specific investigations. The patients were treated by conservative or surgical methods, and the outcome was monitored.

  17. Late surgical complications to endophthalmitis after cataract surgery in the post-EVS era

    DEFF Research Database (Denmark)

    Solborg Bjerrum, Søren; Kiilgaard, Jens Folke; Dornonville de la Cour, Morten

    2015-01-01

    BACKGROUND: To compare the risk of surgical complications after primary surgical intervention for postoperative endophthalmitis after cataract surgery (PE) in cases that underwent a pars plana vitrectomy (PPV) or a vitreous tap (VT) in Denmark in the calendar period 1 January 2000 to 30 June 2011...

  18. [Orthotopic liver transplant in rats. Surgical technique, complications and treatment].

    Science.gov (United States)

    Lausada, Natalia R; Gondolesi, G E; Ortiz, E; Dreizzen, E; Raimondi, J C

    2002-01-01

    The orthotopic rat liver transplant model is a widely used technique in transplantation research. It has many advantages over other animal transplant models because of its availability and low cost. However, it must be emphasized that success with the rat model requires thorough training. The aim of this paper is to describe the microsurgical technique involved in 60 rat liver transplants and to discuss the complications and their treatments. Forty-nine liver transplants were performed at the Experimental Laboratory of the University Hospital, Ontario, Canada (ELUH) and 11 were performed at the Laboratorio de Trasplante de Organos de la Facultad de Ciencias Médicas de La Plata, Buenos Aires. Argentina (LTO). Among the transplants performed at the ELUH, the observed complications were haemorrhage (n = 4), pneumothorax (n = 1), anastomotic failure (n = 15), bile leak (n = 3), and bile duct necrosis (n = 9). The remaining 17 rats at the ELUH were healthy at day 7 after surgery. Animal survival immediately postop, at 24 hours postop and at 7 days postop was achieved with the 9th, 20th and 21st transplants respectively. At the LTO, 3 rats died as a result of anaesthetic complications. Seven-day animal survival was achieved with the 11th transplant. We beleive that the description of the orthotopic rat liver transplantation technique, as well as the discussion regarding complications and their management, can be useful for researchers interested in performing liver transplantation in rats.

  19. Registration and analysis of surgical complications: Bearing the burden of broken butterflies

    NARCIS (Netherlands)

    Visser, A.

    2015-01-01

    The research in this thesis focussed on the quality of the complication registration in hospitalised surgical patients, in particular as to the recording of detailed information about the incidence, number and grade of occurring complications. Additionally, the voids in the current complicationregis

  20. Potential Long-Term Complications of Endovascular Stent Grafting for Blunt Thoracic Aortic Injury

    Directory of Open Access Journals (Sweden)

    Larry E. Miller

    2012-01-01

    Full Text Available Blunt thoracic aortic injury (BTAI is a rare, but lethal, consequence of rapid deceleration events. Most victims of BTAI die at the scene of the accident. Of those who arrive to the hospital alive, expedient aortic intervention significantly improves survival. Thoracic endovascular aortic repair (TEVAR has been accepted as the standard of care for BTAI at many centers, primarily due to the convincing evidence of lower mortality and morbidity in comparison to open surgery. However, less attention has been given to potential long-term complications of TEVAR for BTAI. This paper focuses on these complications, which include progressive aortic expansion with aging, inadequate stent graft characteristics, device durability concerns, long-term radiation exposure concerns from follow-up computed tomography scans, and the potential for (Victims of Modern Imaging Technology VOMIT.

  1. Comparison of Axillary Loop and Straight Grafts Patency and Their Complications for Hemodialylis Access

    Directory of Open Access Journals (Sweden)

    J KHoshnevis

    2011-08-01

    Full Text Available Introduction & Objective: Dialysis vascular access complications are important causes of morbidity in chronic hemodialysis patients. The aim of the present study was a comparison of auxillary loop and atraight grafts patency and its complications for hemodialysis access. Materials & Methods: In this cohort study conducted at Shahid Beheshti Medical University, 58 patients who underwent placement of loop or straight access grafts were included in the study. Demographics, primary and secondary patency rates and complications like thrombosis, infection, bleeding, steal syndrome and other complications were compared in these two groups. The collected data was analyzed by the SPSS statistical software using the chi-square test, t-test, and logistic regression. Results: Thrombosis rates were 51.1% and 53.8% in straight and loop groups respectively (P=0.862, steal syndrome rates were 2.2% and 7.7% in straight and loop groups respectively (P=0.341, psudoanevrism were 11.1% and 23.1% in straight and loop groups respectively (P=0.270, bleeding rates were 4.4% and 0% in straight and loop groups respectively (P=0.439, infection rate were 8.9% and 7.7% in straight and loop groups respectively (P=0.892, and primary patency rate after 1 month were 88.9% and 92.3% respectively (P=0.721, and primary patency rate after 24 month were 31% and 55.5% respectively (P=0.058. Secondary patency rate after 3 month were 75.6% and 92.3% respectively (P=0.189, and secondary patency rate after 24 month were 37.9% and 66.7% respectively (P=0.044. Conclusion: PTFE vascular graft seems to be an appropriate vascular access and is a promising alternative when upper extremity arteriovenous fistulas cannot be constructed. Additionally, there was no significant different between two groups for complications and early patency, but late patency was better in loop group. More study is necessary for final judgment.

  2. Unusual Complication of Surgical Abortion with Pelvic Extrusion of Fetal Head: A Case Report

    OpenAIRE

    Begum, Jasmina; Samal, Sunita; Ghose, Seetesh

    2015-01-01

    Unsafe abortion is one of the causes of maternal mortality and morbidity in developing countries. The complications mostly results following unsafe abortion procedure done by unskilled provider with or without minimal medical knowledge in rural part of developing countries. These complications can endanger the life of mother if proper medical or surgical interventions are not offered in time. A majority of these complications remains confidential. The uterine perforation is one of the serious...

  3. Preoperative intervention reduces postoperative pulmonary complications but not length of stay in cardiac surgical patients: a systematic review

    Directory of Open Access Journals (Sweden)

    David Snowdon

    2014-06-01

    Full Text Available Question: Does preoperative intervention in people undergoing cardiac surgery reduce pulmonary complications, shorten length of stay in the intensive care unit (ICU or hospital, or improve physical function? Design: Systematic review with meta-analysis of (quasi randomised trials. Participants: People undergoing coronary artery bypass grafts and/or valvular surgery. Intervention: Any intervention, such as education, inspiratory muscle training, exercise training or relaxation, delivered prior to surgery to prevent/reduce postoperative pulmonary complications or to hasten recovery of function. Outcome measures: Time to extubation, length of stay in ICU and hospital (reported in days. Postoperative pulmonary complications and physical function were measured as reported in the included trials. Results: The 17 eligible trials reported data on 2689 participants. Preoperative intervention significantly reduced the time to extubation (MD -0.14 days, 95% CI -0.26 to -0.01 and the relative risk of developing postoperative pulmonary complications (RR 0.39, 95% CI 0.23 to 0.66. However, it did not significantly affect the length of stay in ICU (MD -0.15 days, 95% CI -0.37 to 0.08 or hospital (MD -0.55 days, 95% CI -1.32 to 0.23, except among older participants (MD -1.32 days, 95% CI -2.36 to -0.28. When the preoperative interventions were separately analysed, inspiratory muscle training significantly reduced postoperative pulmonary complications and the length of stay in hospital. Trial quality ranged from good to poor and considerable heterogeneity was present in the study features. Other outcomes did not significantly differ. Conclusion: For people undergoing cardiac surgery, preoperative intervention reduces the incidence of postoperative pulmonary complications and, in older patients, the length of stay in hospital. [Snowdon D, Haines TP, Skinner EH (2014 Preoperative intervention reduces postoperative pulmonary complications but not length of stay in

  4. Impact of surgical complications on length of stay after hip fracture surgery

    DEFF Research Database (Denmark)

    Foss, Nicolai Bang; Palm, Henrik; Krasheninnikoff, Michael

    2006-01-01

    BACKGROUND: Rehabilitation after hip fracture may be lengthy, with bed-day consumption accounting for up to 85% of the total cost of admission to hospital. Data suggest that surgical complications requiring reoperation may lead to an excessively long in-patient stays. However, the overall impact...... showed that 64 complications (55%) were due to suboptimal surgery, 18 (16%) to infection, 6 (5%) to falls and 28 (24%) to no obvious cause. CONCLUSION: Surgical complications secondary to primary hip fracture surgery account for 27.1% of total hospital bed consumption within 6 months. Approximately, 50......, infection or suboptimal surgery, stratified into either requiring reoperation or not allowing mobilisation because of instability. RESULTS: Of the 600, 116 (19.3, 95% CI 16-22%) patients underwent reoperation or immobilisation; 27.1% of bed-day consumption resulted from surgical complications. The audit...

  5. EFFECT OF CHECKLIST ON THE OCCURRENCE OF POSTOPERATIVE COMPLICATION ON SURGICAL PATIENT

    Directory of Open Access Journals (Sweden)

    Birhanemeskel Tegene Adankie

    2017-01-01

    Full Text Available Background: Surgical safety checklists (SSCs are designed to improve inter professional communications and ultimately avoiding catastrophic errors that often characterizes the culture of surgical teams. However, data on effect of surgical checklists implementation are scarce in the study area. The purpose of this research project was to directly examine the effect of utilization surgical safety checklist on patient outcomes at University of Gondar Hospital, in Northwest Ethiopia. Material and methods: Institution based cross sectional study was done at Gondar university teaching hospitals from January to May 2013. We reviewed medical records of all consecutive patients admitted to the surgery department (N=403. For those who have clinical symptoms of surgical site infection a laboratory diagnosis were performed to compare occurrences of all postoperative complication among patients with and without utilization of surgical safety checklist. Results: During the study period from 403 patients operated, SSCs were attached for only 158 (39.2% of the surgical patients. Post-operative complication were observed in 238 (59 % of the patients and postoperative fever was the major complication accounting for 70 (17.3% of all the complication. Surgical wound infection and pneumonia accounted for 47(16.6% and 33(11.7% respectively. S. aurous was the predominant isolated bacteria accounted for 7(30%, In addition, a statistically non-significant 11.2% decline the rate of surgical wound infection in the checklist group. In a logistic regression model of postoperative fever, the SSCs emerged as a significant independent predictor of this outcome: (OR = 0.49, 95% CI 0.31–0.75, and P value = 0.001. Conclusions and recommendation: patients with checklist have observed significant reductions of post operative complication particularly bacterial infection. It is possible to some extent that the improved usage of check list and preoperative prophylactic antibiotics

  6. Acute suppurative parotitis: a dreadful complication in elderly surgical patients.

    Science.gov (United States)

    Lampropoulos, Pavlos; Rizos, Spyros; Marinis, Athanasios

    2012-08-01

    Acute suppurative parotitis (ASP) is a severe infection seen particularly in elderly surgical patients. Factors that increase the risk of ASP include post-operative dehydration, debilitating conditions, and immunosuppressed states. Case report and literature review. An 82-year-old female patient was admitted because of paralytic ileus, dehydration, and poor oral hygiene, and was in distress. After two days of hospitalization, the patient developed a progressive painful swelling of her right parotid gland and fever up to 39.0°C. Computed tomography scanning showed an abscess in the parotid gland. Because of her progressive clinical deterioration, the patient underwent operative drainage of the abscess and removal of the necrotic material. Unfortunately, she suffered multiple organ dysfunction syndrome and died. Acute suppurative parotitis requires prompt aggressive treatment that nevertheless may fail.

  7. Complicated hydatid cysts of the lung:surgical treatment in Kurdistan of Iraq

    Institute of Scientific and Technical Information of China (English)

    Abdulqadir Maghded Zangana; Bashar Hanna Saqat

    2009-01-01

    Objective:To review the problems encountered in surgical treatment of complicated pulmonary hydatid cysts and to evaluate the functional results in the surgery of complicated hydatid cysts.Methods:The medical re-cords for 89 patients with complicated pulmonary hydatidosis were retrospectively investigated.The series con-sisted of 47 male and 42 female patients with a mean age of 32 ±8 years.Study performed during January 2000 to December 2007,all patients were treated surgically.Data related to surgical procedures performed,postop-erative morbidity,hospitalization time,and cyst recurrence were collected from each individual's records,and the group findings were compared.Results:Among these cysts,58 were perforated,23 were infected,and 13 were cysts with pleural complications.Cystotomy plus capitonnage was the most frequently performed operative technique (n =43),followed by cystotomy plus closure of bronchial openings (n =28),pericystectomy plus capitonnage (n =13),decortications (n =7),lobectomy and segmentectomy (n =3).The 11 cases with co-existing liver cysts were approached by right thoracophrenotomy.Postoperative complications developed in 12 patients (13.4%).Conclusion:Surgery is the primary mode of treatment for patients with pulmonary hydatid disease.Complicated cases have higher rates of preoperative and postoperative complications and require longer hospitalization time and more extensive surgical procedures than uncomplicated cases.This underlines the need for immediate surgery in any patient who is diagnosed with pulmonary hydatidosis when it is indicated.

  8. Obstetrical complications in pregnant medical and surgical residents.

    Science.gov (United States)

    Behbehani, Sadikah; Tulandi, Togas

    2015-01-01

    Objectif : Les résidentes enceintes sont exposées à des risques de complications obstétricales. Notre étude avait pour objectif d’évaluer l’incidence et le type des complications obstétricales constatées dans le cadre de la résidence, ainsi que leurs facteurs contributifs possibles. Méthodes : Nous avons mené une étude de cohorte rétrospective au moyen d’un questionnaire Web que nous avons fait parvenir à 190 programmes de résidence, tant en médecine qu’en chirurgie, de partout en Amérique du Nord. Ce questionnaire a été distribué à toutes les résidentes et nous avons demandé aux participantes de ne remplir le questionnaire que si elles avaient déjà connu une grossesse. Le questionnaire comptait 10 questions à choix multiple et était principalement axé sur les complications de grossesse auxquelles les résidentes pourraient avoir eu à faire face avant et pendant leur résidence. Les résultats ont été comparés à ceux qui ont été obtenus par 3 767 femmes enceintes d’âge semblable. Résultats : Le taux de complications obstétricales chez les résidentes qui étaient de garde pendant jusqu’à six nuits par mois (43/163 ou 26,4 %) était considérablement inférieur à celui des résidentes qui étaient de garde pendant plus de six nuits par mois (37/75 ou 49,3 %) (P grossesse, de décollement placentaire et de retard de croissance intra-utérin. Conclusion : La grossesse pendant la résidence compte un taux d’issues obstétricales indésirables plus élevé que la moyenne. Le fait de cumuler un plus grand nombre d’heures en salle d’opération et le fait d’être de garde pendant plus de six nuits par mois sont associés à des complications obstétricales. De surcroît, les résidentes enceintes sont plus susceptibles de connaître des troubles hypertensifs de la grossesse, un retard de croissance intra-utérin, un décollement placentaire et une fausse couche qu’une cohorte de femmes enceintes d

  9. Relationship between surgical time and postoperative complications in senile patients with hip fractures

    Institute of Scientific and Technical Information of China (English)

    MA Ren-shi; GU Gui-shan; WANG Cheng-xue; ZHU Dong; ZHANG Xi-zheng

    2010-01-01

    Objective:To elucidate the relationship between surgical time and postoperative complications in senile patients with hip fractures, and try to find out other factors which are related to these complications.Methods: Sixty-two patients, 28 males aged from 65 to 72 years with a mean age of 76.3 years and 34 females aged from 65 to 95 years with a mean age of 78.1 years, who had undergone orthopedic surgery because of hip fractures,were enrolled in a retrospective cohort study. The surgical time and pattern, the type of fracture, preoperative comorbidities, American Society of Anesthesiologists (ASA) score and the volume of blood transfusion during operation were obtained from these patients who were followed up by telephone calls for postoperative complications.All the patients were followed up at least for 1 year and were divided into subgroups according to their clinical characteristics and the results were analyzed by the Statistical Analysis System software.Results:There was no significant difference in the morbidity of postoperative eomplications with the gender,age,surgical time and pattern,or ASA score. There was significant difference in the morbidity of postoperative complications related to preoperative comorbidities and the volume of blood transfusion. There was a significant causality between preoperative comorbidities and postoperative complications. The morbidity of postoperative complications was 1.651 times higher in patients with preoperative comorbidities than those without.Conclusions:There is no relationship between the surgical time and postoperative complications in senile patients who received surgery for hip fracture within 1 year.No correlation is found between the postoperative complications and gender,age,type of fracture, surgical pattern,ASA score and the volume of blood transfusion. Preoperative comorbidities are an independent predictor for postoperative complications.

  10. Cervical diverticulitis: a novel complication of a neonatal colonic interposition graft following oesophagectomy.

    Science.gov (United States)

    Punwani, Vishal V; Ong, Eugene; Hii, Michael W

    2015-09-09

    A 47-year-old woman presented to a tertiary emergency department with an 8-day history of odynophagia, a 4 cm swelling on her left neck and intermittent fevers. Shortly following her birth, a congenital oesophageal atresia had been managed surgically with colonic interposition graft. Contrast CT of the neck demonstrated several large diverticula within her interposition graft at the level of the cervical vertebrae. A colocutaneous fistula was identified between the colon and left neck, with an associated abscess. The patient received intravenous meropenem followed by abscess drainage. A high output fistula developed at the drainage site, and the patient required intravenous fluids and stoma placement to manage fluid discharge. She left the hospital after a 17-day stay. At 6-month follow-up, the wound was erythematous, but the patient was otherwise well. We believe that this is the first reported case of diverticular disease arising in what was originally neonatal colon interposed for oesophageal atresia at birth.

  11. Graft-Versus-Host Disease after Liver Transplantation Complicated by Systemic Aspergillosis with Pancarditis

    Directory of Open Access Journals (Sweden)

    Joseph Romagnuolo

    2000-01-01

    Full Text Available Acute graft-versus-host disease (GVHD is a common complication after bone marrow transplantation, with characteristic rash and diarrhea being the most common features. After liver transplantation, however, this phenomenon is very rare. Most transplant patients are on a variety of medications, including immunosuppressants; therefore, the differential diagnosis of skin rash or diarrhea is broad. A 37-year-old man who underwent liver transplantation for primary biliary cirrhosis, and developed a rash and watery diarrhea, is presented. Skin and colonic biopsies confirmed acute GVHD. A pulse of intravenous steroids was given. The skin rash improved, but he developed pancytopenia. His course was complicated by central line infection, jugular and subclavian vein thrombosis, pseudomembranous colitis, recurrent bacteremia, cholestasis on total parenteral nutrition and cytomegalovirus infection. After the onset of pleuritic chest pain and clinical sepsis, spiral computed tomography scan of his chest and abdomen revealed septic infarcts in multiple organs. Despite empirical treatment with amphotericin B, he died of multiorgan dysfunction syndrome within 72 h. Autopsy revealed systemic aspergillosis with pancarditis, endocardial vegetations, and septic pulmonary, splenic, hepatic and renal infarcts. The pathogenesis and experience with this rare, but often fatal, complication of liver transplantation are reviewed. In contrast to GVHD after bone marrow transplantation, pancytopenia is common and liver dysfunction is rare. One should have a high level of suspicion in the liver transplant recipient presenting with rash and/or diarrhea.

  12. Medical versus surgical abortion efficacy, complications and leave of absence compared in a partly randomized study

    DEFF Research Database (Denmark)

    Rørbye, Christina; Nørgaard, Mogens; Nilas, Lisbeth

    2004-01-01

    antibiotic treatment, leave of absence and number of contacts to the health care system were obtained from mailed questionnaires. The number of complications was identical after the two methods, but surgical abortion was associated with a higher success rate [97.7% (708/725) vs. 94.1% (386/410), p ... gemeprost) or a surgical abortion (vacuum aspiration in general anesthesia). One hundred eleven of these women were randomized for abortion method. Surgical interventions and complications leading to readmission within the following 15 weeks were identified through a computer system. Information about......] and also with a higher risk of antibiotic treatment than medical abortion [7.8% (37/467) vs. 3.7% (13/356), p leave of absence was shorter in women choosing a medical (1 day) than a surgical termination (2 days), p

  13. Medical versus surgical abortion efficacy, complications and leave of absence compared in a partly randomized study

    DEFF Research Database (Denmark)

    Rørbye, Christina; Nørgaard, Mogens; Nilas, Lisbeth

    2004-01-01

    antibiotic treatment, leave of absence and number of contacts to the health care system were obtained from mailed questionnaires. The number of complications was identical after the two methods, but surgical abortion was associated with a higher success rate [97.7% (708/725) vs. 94.1% (386/410), p ...To provide optimal information to women choosing between early medical and surgical abortion, rigorous comparisons of the two methods are warranted. We compared the outcome of 1135 consecutive women with gestational age (GA) ... gemeprost) or a surgical abortion (vacuum aspiration in general anesthesia). One hundred eleven of these women were randomized for abortion method. Surgical interventions and complications leading to readmission within the following 15 weeks were identified through a computer system. Information about...

  14. Design of a scale for measuring post-surgical complications in third molar surgery.

    Science.gov (United States)

    Aravena, P C; Astudillo, P; Manterola, C

    2014-08-01

    The aim of this study was to design a scale for measuring the extent and severity of post-surgical complications in third molar surgery. A multi-stage study using a quantitative methodology and qualitative interview strategy was employed. The degree of importance of signs and symptoms in the evaluation of post-surgical complications was initially observed using a self-report questionnaire administered to maxillofacial surgeons and surgical residents at the International Conference of Oral and Maxillofacial Surgeons in 2011. Then, using exploratory factor analysis, the items and components of the scale were established, with internal consistency determined using Cronbach's alpha. Finally, a group of experts performed a face validity analysis and provided conceptual definitions for the items and components. Thirty-six signs and symptoms were evaluated by 100 respondents, with the most relevant being 'suppuration' and 'abscess'. Factor analysis of the results identified three factors, defined as 'secondary complication', 'soft tissue infection', and 'osseous involvement' (Cronbach's alpha>0.7). Finally, a preliminary scale was designed comprised of these three components and 10 items. In this way, a preliminary scale for measuring post-surgical complications was designed to standardize the semiological concepts of post-surgical assessment. This scale will be assessed in a future investigation.

  15. Complications in the surgical management of children with malignant solid tumors.

    Science.gov (United States)

    Davidoff, Andrew M; Fernandez-Pineda, Israel

    2016-12-01

    With improvement in the outcomes for children with cancer has come an increasing focus on minimizing the morbidity from therapeutic interventions, including surgical procedures, while continuing to have a high likelihood of cure. Thus, an appreciation for the potential complications of surgery, both acute and long term, is critical when considering the risks and benefits of any procedure performed on a child with cancer. Although not meant to be an exhaustive review, here we discuss the most common and significant surgical complications that may occur when performing diagnostic, therapeutic, or supportive procedures in children with the most common malignant solid tumors. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Delirium as a complication of the surgical intensive care

    Science.gov (United States)

    Horacek, Rostislav; Krnacova, Barbora; Prasko, Jan; Latalova, Klara

    2016-01-01

    Background The aim of this study was to examine the impact of somatic illnesses, electrolyte imbalance, red blood cell count, hypotension, and antipsychotic and opioid treatment on the duration of delirium in Central Intensive Care Unit for Surgery. Patients and methods Patients who were admitted to the Department of Central Intensive Care Unit for Surgery in the University Hospital Olomouc from February 2004 to November 2008 were evaluated using Riker sedation–agitation scale. Their blood pressure, heart rate, respiratory rate, and peripheral blood oxygen saturation were measured continually, and body temperature was monitored once in an hour. The laboratory blood tests including sodium, potassium, chlorides, phosphorus, urea and creatinine, hemoglobin, hematocrit, red and white blood cell count, and C-reactive protein, albumin levels and laboratory markers of renal and liver dysfunction were done every day. All measurements were made at least for ten consecutive days or longer until the delirium resolved. Results The sample consisted of 140 consecutive delirious patients with a mean age of 68.21±12.07 years. Delirium was diagnosed in 140 of 5,642 patients (2.48%) admitted in CICUS in the last 5 years. The median duration of delirium was 48 hours with a range of 12–240 hours. Statistical analysis showed that hyperactive subtype of delirium and treatment with antipsychotics were associated with prolonged delirium duration (hyperactive 76.15±40.53 hours, hypoactive 54.46±28.44 hours, mixed 61.22±37.86 hours; Kruskal–Wallis test: 8.022; Ppiracetam 46.96±18.42 hours; Kruskal–Wallis test: 17.39, P<0.0005), and history of alcohol abuse (with a history of abuse 73.63±45.20 hours, without a history of abuse 59.54±30.61 hours; Mann–Whitney U=1,840; P<0.05). One patient had suffered from complicated postoperative hypostatic pneumonia and died due to respiratory failure (patient with hypoactive subtype). According to the backward stepwise multiple regression

  17. Delirium as a complication of the surgical intensive care

    Directory of Open Access Journals (Sweden)

    Horacek R

    2016-09-01

    (hypotension 40.41±30.23 hours versus normotension 70.47±54.98 hours; Mann–Whitney U=1,512; P<0.05, administration of antipsychotics compared to other drugs (antipsychotics 72.83±40.6, benzodiazepines 42.00±20.78, others drugs, mostly piracetam 46.96±18.42 hours; Kruskal–Wallis test: 17.39, P<0.0005, and history of alcohol abuse (with a history of abuse 73.63±45.20 hours, without a history of abuse 59.54±30.61 hours; Mann–Whitney U=1,840; P<0.05. One patient had suffered from complicated postoperative hypostatic pneumonia and died due to respiratory failure (patient with hypoactive subtype. According to the backward stepwise multiple regression, the best significant predictors of duration of the delirium were the hypotension, type of psychopharmacs, type of delirium, the daily dose of opioids, a combination of psychopharmacs, history of alcohol abuse, plasma level of potassium, anemia, hyperpyrexia, and plasma level of albumin, reaching statistical significance (analysis of variance: F=5.205; df=24; P<0.005; adjusted r2=0.637.Conclusion: The hyperactive type of delirium, hypotension, usage of antipsychotics, the higher daily dose of opioids, a combination of psychopharmacs, history of alcohol abuse, low blood levels of potassium, anemia, hyperpyrexia, and hypoalbuminemia in the CICUS were associated with longer duration of delirium.Keywords: delirium, care duration, intensive care, risk factors, treatment, antipsychotics

  18. [Mathematical analysis of complicated course of acute surgical diseases of abdominal cavity organs].

    Science.gov (United States)

    Vozniuk, S M; Pol'ovyĭ, V P; Sydorchuk, R I; Palianytsia, A S

    2013-03-01

    In this paper we analyze the results of diagnosis and treatment of 130 patients with acute surgical diseases of the abdominal cavity, complicated by peritonitis. We proposed the method of estimating the severity of the patients using a coefficient of status severity (C(SS)), developed a scale for prediction of complicated outcomes of acute surgical pathology of the abdominal cavity and abdominal sepsis, which is adapted to the working conditions of local clinics. Using the C(SS) and the scale prediction, allowed timely identification of patients' risk group with possible complicated course, assign adequate treatment, reduce postoperative complications by 5%, relaparotomies by 4.4%, decrease postoperative mortality by 3.9%.

  19. Medical versus surgical abortion efficacy, complications and leave of absence compared in a partly randomized study

    DEFF Research Database (Denmark)

    Rørbye, Christina; Nørgaard, Mogens; Nilas, Lisbeth

    2004-01-01

    To provide optimal information to women choosing between early medical and surgical abortion, rigorous comparisons of the two methods are warranted. We compared the outcome of 1135 consecutive women with gestational age (GA) ... gemeprost) or a surgical abortion (vacuum aspiration in general anesthesia). One hundred eleven of these women were randomized for abortion method. Surgical interventions and complications leading to readmission within the following 15 weeks were identified through a computer system. Information about...... extra unscheduled consultation apart from a routine follow-up visit. We conclude that the chance of a primary successful termination at GA

  20. Imaging of aortic stent grafts and their complications; Bildgebung von Aortenendoprothesen und deren Komplikationen

    Energy Technology Data Exchange (ETDEWEB)

    Krauss, M.; Ritter, W.; Baer, I. [Klinikum Nuernberg Sued (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie; Heilberger, P.; Schunn, C.; Raithel, D. [Klinikum Nuernberg Sued (Germany). Klinik fuer Gefaesschirurgie

    1998-10-01

    Purpose: To determine the optimal postoperative imaging modality for the follow-up of patients with endoluminal aortic stent grafts. Material and Methods: From August 1994 to November 1997, 214 patients (194 male and 20 female) with abdominal and thoracic aortic aneurysms were treated with endovascular stent grafts. 137 patients (129 male, 8 female) with 89 tube grafts and 48 bifurcated grafts (45 EVT, 88 Stentor/Vanguard, 3 Chuter, 1 Talent) were evaluated with contrast-enhanced spiral-CT, duplex ultrasound, and DSA at a mean follow-up of 11.1 months. Results: We found 12 persistent primary endoleaks (8.8%), 17 secondary endoleaks (12.4%), 8 limb occlusions (5.8%), 28 endoluminal thrombi lining the stent graft (20.4%), and 26 suture breakages of the stent frame (19%). In 9 patients (6.6%) the proximal end of the stent partially covered the renal arteries. In 3 patients (2.2%) a partial renal infarction was seen. Spiral-CT was able to demonstrate all the above changes except for 3 sidebranch endoleaks that were documented by duplex ultrasound only and 8 suture breaks seen on abdominal plain films only. The median aneurysm diameter decreased from 48 mm pre-operatively to 46 mm at 24 months post-operatively in patients with endoleaks and from 44 mm to 36 mm in patients without endoleak. For several patients the decreasing aneurysm diameter did not reliably correlate with complete exclusion of the aneurysm. Conclusion: For follow-up of endoluminal aortic stent grafts contrast-enhanced spiral-CT is superior to duplex ultrasound. DSA is necessary only for patients with complications requiring a secondary intervention. (orig.) [Deutsch] Ziel: Bestimmung des optimalen bildgebenden Verfahrens zur postoperativen Nachsorge von Patienten mit Aortenendoprothesen. Material und Methoden: Zwischen August 1994 und November 1997 wurden 214 Patienten (194 Maenner, 20 Frauen) mit abdominellen und thorakalen Aortenaneurysmen endovaskulaer behandelt. 137 Patienten (129 Maenner, 8

  1. Unusual Complication of Surgical Abortion with Pelvic Extrusion of Fetal Head: A Case Report.

    Science.gov (United States)

    Begum, Jasmina; Samal, Sunita; Ghose, Seetesh

    2015-11-01

    Unsafe abortion is one of the causes of maternal mortality and morbidity in developing countries. The complications mostly results following unsafe abortion procedure done by unskilled provider with or without minimal medical knowledge in rural part of developing countries. These complications can endanger the life of mother if proper medical or surgical interventions are not offered in time. A majority of these complications remains confidential. The uterine perforation is one of the serious but preventable complications of surgical abortion. A 21-year-old woman G4P2L2A1, presented in the emergency ward with complaints of lower abdominal pain for four days after attempting twice surgical termination of pregnancy at 19 weeks of gestation for an unwanted pregnancy. Transabdominal sonography and MRI revealed uterine rent with pelvic extrusion of fetal head. Emergency laparotomy with removal of fetal head and uterine rent repair was done. This case illustrates the importance of maintaining a high index of suspicion by the gynaecologist for uterine perforation in patient presenting with abdominal pain a few days after undergoing surgical abortion, also shows the complementary role of sonography and MRI in evaluation of the similar patient and this case also highlights the rampant illegal unsafe abortion procedure in rural India despite of legalization of abortion act.

  2. Surgical aspects and complications of continuous intraperitoneal insulin infusion with an implantable pump

    NARCIS (Netherlands)

    Haveman, Jan Willem; Logtenberg, Susan J. J.; Kleefstra, Nanne; Groenier, Klaas H.; Bilo, Henk J. G.; Blomme, Adri M.

    2010-01-01

    Continuous intraperitoneal insulin infusion (CIPII) with an implantable pump is safe and effective in selected subjects with diabetes. Our aim was to assess surgical experience and complications with CIPII. We performed a retrospective longitudinal observational cohort study of patients that started

  3. Anatomical and surgical findings and complications in 100 consecutive maxillary sinus floor elevation procedures

    NARCIS (Netherlands)

    Zijderveld, S.A.; van den Bergh, J.P.A.; Schulten, E.A.J.M.; ten Bruggenkate, C.M.

    2008-01-01

    Purpose To investigate the prevalence of anatomical and surgical findings and complications in maxillary sinus floor elevation surgery, and to describe the clinical implications. Patients and Methods One hundred consecutive patients scheduled for maxillary sinus floor elevation were included. The pa

  4. Surgical aspects and complications of continuous intraperitoneal insulin infusion with an implantable pump

    NARCIS (Netherlands)

    Haveman, Jan Willem; Logtenberg, Susan J. J.; Kleefstra, Nanne; Groenier, Klaas H.; Bilo, Henk J. G.; Blomme, Adri M.

    Continuous intraperitoneal insulin infusion (CIPII) with an implantable pump is safe and effective in selected subjects with diabetes. Our aim was to assess surgical experience and complications with CIPII. We performed a retrospective longitudinal observational cohort study of patients that started

  5. Gastrointestinal complications after cardiac transplantation. Potential benefit of early diagnoses and prompt surgical intervention.

    Science.gov (United States)

    Kirklin, J K; Holm, A; Aldrete, J S; White, C; Bourge, R C

    1990-01-01

    Acute gastrointestinal (GI) illnesses are unusual but potentially fatal complications following cardiac transplantation. A retrospective study was performed to analyze the frequency, etiology, and severity of GI complications and the potential impact of early diagnosis and prompt surgical intervention when appropriate. Between 1981 and July 1, 1988, 31 GI complications (pancreatic, 6; colonic, 6; gastroduodenal, 6; biliary, 5; esophageal, 3; appendiceal, 2; hernia, 2; and splenic, 1) occurred in 26 patients undergoing 32 cardiac transplants. Complications were most common (14 of 31 patients, 45%) within the first 30 days after transplantation. Seventeen GI complications were treated medically (2 deaths), 2 with elective surgery and 12 with emergent operations (3 deaths). The overall mortality rate was 16%. All patients who underwent emergent operations within 3 days of onset of symptoms survived; the mean interval of onset between symptoms and operation in the nonsurvivors was 10 +/- 3.8 days. We infer that among patients requiring urgent surgical intervention, successful outcome is enhanced by intense surveillance for early symptoms, prompt diagnostic evaluation, and early surgical intervention. PMID:2339915

  6. Assessment of surgical portosystemic shunts and associated complications: The diagnostic and therapeutic role of radiologists

    Energy Technology Data Exchange (ETDEWEB)

    Taslakian, Bedros, E-mail: btaslakian@gmail.com [Department of Radiology, American University of Beirut Medical Center, Riad El-Solh 1107 2020—PO Box: 11-0236, Beirut (Lebanon); Faraj, Walid, E-mail: wf07@aub.edu.lb [Department of General Surgery, American University of Beirut Medical Center, Riad El-Solh 1107 2020—PO Box: 11-0236, Beirut (Lebanon); Khalife, Mohammad, E-mail: mk12@aub.edu.lb [Department of General Surgery, American University of Beirut Medical Center, Riad El-Solh 1107 2020—PO Box: 11-0236, Beirut (Lebanon); Al-Kutoubi, Aghiad, E-mail: mk00@aub.edu.lb [Department of Radiology, American University of Beirut Medical Center, Riad El-Solh 1107 2020—PO Box: 11-0236, Beirut (Lebanon); El-Merhi, Fadi, E-mail: fe19@aub.edu.lb [Department of Radiology, American University of Beirut Medical Center, Riad El-Solh 1107 2020—PO Box: 11-0236, Beirut (Lebanon); Saade, Charbel, E-mail: cs39@aub.edu.lb [Department of Radiology, American University of Beirut Medical Center, Riad El-Solh 1107 2020—PO Box: 11-0236, Beirut (Lebanon); Hallal, Ali, E-mail: ah05@aub.edu.lb [Department of General Surgery, American University of Beirut Medical Center, Riad El-Solh 1107 2020—PO Box: 11-0236, Beirut (Lebanon); Haydar, Ali, E-mail: ah24@aub.edu.lb [Department of Radiology, American University of Beirut Medical Center, Riad El-Solh 1107 2020—PO Box: 11-0236, Beirut (Lebanon)

    2015-08-15

    Highlights: • Portal hypertension is the pathological increase in portal venous pressure. • Surgical portosystemic shunting is an accepted methods to decrease portal venous pressure. • Surgical portosystemic shunts are divided into selective and nonselective. • Shunt thrombosis is a serious complication, resulting in shunt dysfunction. • Imaging is essential in the assessment of the shunt function and anatomy. - Abstract: Surgical portosystemic shunting, the formation of a vascular connection between the portal and systemic venous circulation, has been used as a treatment to reduce portal venous pressure. Although the use of portosystemic shunt surgery in the management of portal hypertension has declined during the past decade in favour of alternative therapies, and subsequently surgeons and radiologists became less familiar with the procedure, it remains a well-established treatment. Knowledge of different types of surgical portosystemic shunts, their pathophysiology and complications will help radiologists improve communication with surgeons and enhance their understanding of the diagnostic and therapeutic role of radiology in the assessment and management of these shunts. Optimal assessment of the shunt is essential to determine its patency and allow timely intervention. Both non-invasive and invasive imaging modalities complement each other in the evaluation of surgical portosystemic shunts. Interventional radiology plays an important role in the management of complications, such as shunt thrombosis and stenosis. This article describes the various types of surgical portosystemic shunts, explains the anatomy and pathophysiology of these shunts, illustrates the pearls and pitfalls of different imaging modalities in the assessment of these shunts and demonstrates the role of radiologists in the interventional management of complications.

  7. Complement activation in coronary artery bypass grafting patients without cardiopulmonary bypass - The role of tissue injury by surgical incision

    NARCIS (Netherlands)

    Gu, YJ; Mariani, MA; Boonstra, PW; Grandjean, JG; van Oeveren, W

    1999-01-01

    Study objectives: Complement activation is a trigger in inducing inflammation in patients who undergo coronary artery bypass grafting (CABG) and is usually thought to be induced by the use of cardiopulmonary bypass (CPB), In this study, we examined whether tissue injury caused by chest surgical inci

  8. The tent pole splint: a bone-supported stereolithographic surgical splint for the soft tissue matrix expansion graft procedure.

    Science.gov (United States)

    Cillo, Joseph E; Theodotou, Nicholas; Samuels, Marc; Krajekian, Joseph

    2010-06-01

    This report details the use of computer-aided planning and intraoperative stereolithographic direct-bone-contact surgical splints for the accurate extraoral placement of dental implants in the soft tissue matrix expansion (tent pole) graft of the severely resorbed mandible.

  9. Effects of Cataract Surgery on Endothelium in Transplanted Corneal Grafts: Comparison of Extracapsular Cataract Extraction and Phacoemulsification for Complicated Cataract after Penetrating Keratoplasty.

    Science.gov (United States)

    Zhou, Hong-Wei; Xie, Li-Xin

    2016-09-05

    The endothelium should be carefully evaluated when choosing a surgical technique for cataract removal. Therefore, we aimed to study the effects of different cataract surgery techniques on endothelial cell loss in transplanted corneal grafts. A total of 54 patients who received complicated cataract surgery in post-penetrating keratoplasty (PKP) eyes at the Shandong Eye Institute between February 2001 and June 2014 were included, and clinical records were reviewed. Baseline demographic details, clinical characteristics, endothelial cell density (ECD), and best-corrected visual acuity (BCVA) were recorded. Wilcoxon rank-sum test and Wilcoxon signed-rank test were used to test the equality of medians. A regression model was constructed to compare the reduced rate of ECD. Of the 54 eyes included in this study, extracapsular cataract extraction (ECCE) was performed in 34 eyes of 33 patients (ECCE group) whereas phacoemulsification was performed in 20 eyes of 20 patients (phacoemulsification group). There was no significant difference in the median age (P = 0.081) or preoperative ECD (P = 0.585) between the two groups. At 6 months after cataract surgery, ECD in ECCE group was significantly higher than that in phacoemulsification group (P = 0.043). In addition, the endothelial cell loss rate in ECCE group was significantly lower than that in phacoemulsification group at 2 months (P = 0.018), 4 months (P ECCE group (P ECCE in transplanted corneal grafts (P ECCE is more suitable than phacoemulsification in cataract surgery in complicated cataract after PKP.

  10. Long-Term Surgical Complications in the Oral Cancer Patient: a Comprehensive Review. Part II

    Directory of Open Access Journals (Sweden)

    Antonia Kolokythas

    2010-07-01

    Full Text Available Objectives: Surgery remains the preferred treatment for the majority of oral cancers. The aim of the present article was to provide a comprehensive review of complications associated with surgical treatment of oral cancer including hardware failure; complications associated with choice of reconstruction, donor site morbidity as well as functional and aesthetic issues that impact on the quality of life.Material and Methods: The available English language literature relevant to complications associated with surgical treatment of oral cancer was reviewed. Complications associated with potential for disfigurement, choice of reconstruction, donor site morbidity as well as functional and aesthetic issues that impact on the quality of life are summarized.Results: In total 35 literature sources were obtained and reviewed. The topics covered in the second part of this review series include hardware failure, scars and fistula formation; complications associated with choice of reconstruction, donor site morbidity as well as functional and aesthetic issues.Conclusions: Cancer resection should be planned around two very important concepts. First and foremost is the eradication of disease. This should be the ultimate goal of the ablative team and all potential complications that may be the result of appropriately executed oncologic resection should be discussed in details with the patient. Adequate reconstruction of the defects with restoration of form and function is the second, but not of less importance, goal for the successful care of the head and neck cancer patient.

  11. Reducing biliary complications in adult-to-adult living donor liver transplantation using right lobe graft: experience of 124 cases

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    The aim of this paper is to summarize our experience of using right lobe liver grafts to reduce biliary complications in adult-to-adult(A-A)living donor liver transplantation(LDLT).From January 2002 to October 2007,124 adult patients underwent living donor liver transplantation using right lobe grafts at the West China Hospital,Sichuan University Medical School,China.There was no death in all donors.Biliary reconstruction for 178 hepatic duct orifices from 124 donor grafts was performed which included 106 reconstructions of duct-toduct anastomoses and 72 cholangiojejunostomy.Nine recipients had biliary complications including six bile leakages(four from the anastomotic site and two from the cut surface of the liver graft)and three biliary strictures.With the improved techniques for biliary reconstruction,we have achieved good results in 124 recipients of A-A LDLT.We ascribe our success to the introduction of microsurgical techniques and the use of fixed operators which help in decreasing the biliary complications of LDLT.

  12. Outcome and Complications in Surgical Treatment of Lumbar Stenosis or Spondylolisthesis in Geriatric Patients.

    Science.gov (United States)

    Lee, Jin-Young; Moon, Seong-Hwan; Suh, Bo-Kyung; Yang, Myung Ho; Park, Moon Soo

    2015-09-01

    Development of anesthesiology and improvement of surgical instruments enabled aggressive surgical treatment even in elderly patients, who require more active physical activities than they were in the past. However, there are controversies about the clinical outcome of spinal surgery in elderly patients with spinal stenosis or spondylolisthesis. The purpose of this study is to review the clinical outcome of spinal surgery in elderly patients with spinal stenosis or spondylolisthesis. MEDLINE search on English-language articles was performed. There were 39685 articles from 1967 to 2013 regarding spinal disease, among which 70 dealt with geriatric lumbar surgery. Eighteen out of 70 articles dealt with geriatric lumbar surgery under the diagnosis of spinal stenosis or spondylolisthesis. One was non-randomized prospective, and other seventeen reports were retrospective. One non-randomized prospective and twelve out of seventeen retrospective studies showed that old ages did not affect the clinical outcomes. One non-randomized prospective and ten of seventeen retrospective studies elucidated postoperative complications: some reports showed that postoperative complications increased in elderly patients, whereas the other reports showed that they did not increase. Nevertheless, most complications were minor. There were two retrospective studies regarding the mortality. Mortality which was unrelated to surgical procedure increased, but surgical procedure-related mortality did not increase. Surgery as a treatment option in the elderly patients with the spinal stenosis or spondylolisthesis may be reasonable. However, there is insufficient evidence to make strong recommendations regarding spinal surgery for geriatric patients with spinal stenosis and spondylolisthesis.

  13. Assessment of surgical portosystemic shunts and associated complications: The diagnostic and therapeutic role of radiologists.

    Science.gov (United States)

    Taslakian, Bedros; Faraj, Walid; Khalife, Mohammad; Al-Kutoubi, Aghiad; El-Merhi, Fadi; Saade, Charbel; Hallal, Ali; Haydar, Ali

    2015-08-01

    Surgical portosystemic shunting, the formation of a vascular connection between the portal and systemic venous circulation, has been used as a treatment to reduce portal venous pressure. Although the use of portosystemic shunt surgery in the management of portal hypertension has declined during the past decade in favour of alternative therapies, and subsequently surgeons and radiologists became less familiar with the procedure, it remains a well-established treatment. Knowledge of different types of surgical portosystemic shunts, their pathophysiology and complications will help radiologists improve communication with surgeons and enhance their understanding of the diagnostic and therapeutic role of radiology in the assessment and management of these shunts. Optimal assessment of the shunt is essential to determine its patency and allow timely intervention. Both non-invasive and invasive imaging modalities complement each other in the evaluation of surgical portosystemic shunts. Interventional radiology plays an important role in the management of complications, such as shunt thrombosis and stenosis. This article describes the various types of surgical portosystemic shunts, explains the anatomy and pathophysiology of these shunts, illustrates the pearls and pitfalls of different imaging modalities in the assessment of these shunts and demonstrates the role of radiologists in the interventional management of complications.

  14. Arthroscopic grafting of scaphoid nonunion - surgical technique and preliminary findings from 23 cases.

    Science.gov (United States)

    Cognet, J-M; Louis, P; Martinache, X; Schernberg, F

    2017-02-01

    We report our experience with the arthroscopic treatment of 23 cases of scaphoid nonunion. We explain the surgical technique and describe the different steps needed to achieve bone union. We report our initial clinical and radiological results. This was a prospective non-randomized study. Inclusion criteria were a scaphoid nonunion without radiocarpal arthritis, without any time limit and without any selection as to nonunion location. Before the operation, patients underwent an X-Ray and CT scan or MRI. Schernberg's classification was used to evaluate the location of the nonunion. Internal fixation was performed with a screw or K-wires. Bone grafts were taken from the dorsal side of the distal radius using a T-Lok™ bone marrow biopsy needle (Argon Medical Devices, Plano, TX, USA). A CT scan was performed 3 months after the operation to determine whether union was achieved. Pain, strength and range of motion were evaluated before and after the operation. The patients' smoking habits were also documented. The average follow-up was 17.3 months (4-41). There were 20 men and 3 women with an average age of 26 years (17-63). The average duration of nonunion before the operation was 17 months (6-60). Based on Schernberg's classification, there was one type I, 12 type II and 10 type III nonunions. Wrist strength increased from 32 to 41kg. Union was obtained in all patients after an average of 4 months (3-12). Numerous treatments have been described for treating scaphoid nonunion: Matti-Russe, Fisk-Fernadez bone graft, vascularized bone graft, bone substitutes, etc. The success rate varies depending on the technique and study design. We have described an arthroscopic technique for treating scaphoid nonunion with very promising preliminary results. Arthroscopic debridement is needed to ensure good quality bone at the graft site, while preserving extrinsic vascularization. Traction is used during the operation to restore the scaphoid height, once debridement has been

  15. Pain Intensity and Patients’ Acceptance of Surgical Complication Risks With Lumbar Fusion

    Science.gov (United States)

    Bono, Christopher M.; Harris, Mitchel B.; Warholic, Natalie; Katz, Jeffrey N.; Carreras, Edward; White, Andrew; Schmitz, Miguel; Wood, Kirkham B.; Losina, Elena

    2014-01-01

    Study Design Cross-sectional study with prospective recruitment Objective To determine the relationship of pain intensity (back and leg) on patients’ acceptance of surgical complication risks when deciding whether or not to undergo lumbar spinal fusion. Background To formulate informed decisions regarding lumbar fusion surgery, preoperative discussions should include a review of the risk of complications balanced with the likelihood of symptom relief. Pain intensity has the potential to influence a patient’s decision to consent to lumbar fusion. We hypothesized that pain intensity is associated with a patient’s acceptance of surgical complication risks. Methods Patients being seen for the first time by a spine surgeon for treatment of a non-traumatic or non-neoplastic spinal disorder completed a structured questionnaire. It posed 24 scenarios, each presenting a combination of risks of 3 complications (nerve damage, wound infection, nonunion) and probabilities of symptom relief. For each scenario, the patient indicated whether he/she would/would not consent to a fusion for low back pain (LBP). The sum of the scenarios in which the patient responded that he or she would elect surgery was calculated to represent acceptance of surgical complication risks. A variety of other data were also recorded, including age, gender, education level, race, history of non-spinal surgery, duration of pain, and history of spinal injections. Data were analyzed using bivariate analyses and multivariate regression analyses. Results The mean number of scenarios accepted by 118 enrolled subjects was 10.2 (median 8, standard deviation 8.5, range 0 to 24, or 42.5% of scenarios). In general, subjects were more likely to accept scenarios with lower risks and higher efficacy. Spearman’s rank correlation estimates demonstrated a moderate association between the LBP intensity and acceptance of surgical complication risks (r=0.37, p=0.0001) while leg pain intensity had a weak but positive

  16. Risk for surgical complications after previous stereotactic body radiotherapy of the spine.

    Science.gov (United States)

    Roesch, Johannes; Cho, John B C; Fahim, Daniel K; Gerszten, Peter C; Flickinger, John C; Grills, Inga S; Jawad, Maha; Kersh, Ronald; Letourneau, Daniel; Mantel, Frederick; Sahgal, Arjun; Shin, John H; Winey, Brian; Guckenberger, Matthias

    2017-09-11

    Stereotactic body radiotherapy (SBRT) for vertebral metastases has emerged as a promising technique, offering high rates of symptom relief and local control combined with low risk of toxicity. Nonetheless, local failure or vertebral instability may occur after spine SBRT, generating the need for subsequent surgery in the irradiated region. This study evaluated whether there is an increased incidence of surgical complications in patients previously treated with SBRT at the index level. Based upon a retrospective international database of 704 cases treated with SBRT for vertebral metastases, 30 patients treated at 6 different institutions were identified who underwent surgery in a region previously treated with SBRT. Thirty patients, median age 59 years (range 27-84 years) underwent SBRT for 32 vertebral metastases followed by surgery at the same vertebra. Median follow-up time from SBRT was 17 months. In 17 cases, conventional radiotherapy had been delivered prior to SBRT at a median dose of 30 Gy in median 10 fractions. SBRT was administered with a median prescription dose of 19.3 Gy (range 15-65 Gy) delivered in median 1 fraction (range 1-17) (median EQD2/10 = 44 Gy). The median time interval between SBRT and surgical salvage therapy was 6 months (range 1-39 months). Reasons for subsequent surgery were pain (n = 28), neurological deterioration (n = 15) or fracture of the vertebral body (n = 13). Open surgical decompression (n = 24) and/or stabilization (n = 18) were most frequently performed; Five patients (6 vertebrae) were treated without complications with vertebroplasty only. Increased fibrosis complicating the surgical procedure was explicitly stated in one surgical report. Two durotomies occurred which were closed during the operation, associated with a neurological deficit in one patient. Median blood loss was 500 ml, but five patients had a blood loss of more than 1 l during the procedure. Delayed wound healing was reported in two

  17. Predictors of Wound Complications following Radiation and Surgical Resection of Soft Tissue Sarcomas

    Directory of Open Access Journals (Sweden)

    Drake G. LeBrun

    2017-01-01

    Full Text Available Wound complications represent a major source of morbidity in patients undergoing radiation therapy (RT and surgical resection of soft tissue sarcomas (STS. We investigated whether factors related to RT, surgery, patient comorbidities, and tumor histopathology predict the development of wound complications. An observational study of patients who underwent STS resection and RT was performed. The primary outcome was the occurrence of any wound complication up to four months postoperatively. Significant predictors of wound complications were identified using multivariable logistic regression. Sixty-five patients representing 67 cases of STS were identified. Median age was 59 years (range 22–90 and 34 (52% patients were female. The rates of major wound complications and any wound complications were 21% and 33%, respectively. After adjusting for radiation timing, diabetes (OR 9.6; 95% CI 1.4–64.8; P=0.02, grade ≥2 radiation dermatitis (OR 4.8; 95% CI 1.2–19.2; P=0.03, and the use of 3D conformal RT (OR 4.6; 95% CI 1.1–20.0; P=0.04 were associated with an increased risk of any wound complication on multivariable analysis. These data suggest that radiation dermatitis and radiation modality are predictors of wound complications in patients with STS.

  18. Complications of surgical extraction of ankylosed primary teeth and distal shoe space maintainers.

    Science.gov (United States)

    Kirshenblatt, S; Kulkarni, G V

    2011-01-01

    The purpose of this report was to present the iatrogenic complications that may result from the management of ankylosed primary teeth as well as describe the case of a patient with an ankylosed primary mandibular left second molar which was surgically extracted and an adjacent primary first molar that was cemented with a distal shoe space maintainer. Aggressive surgical removal of the ankylosed tooth caused damage to the developing crown of the successor. Improper placement of the appliance caused perforation of the developing tooth follicle. Orthodontic therapy and a polycarbonate temporary crown were used to restore occlusion. Nonsurgical extractions and alternative appliances should be considered when treating patients with ankylosed primary second molars.

  19. Complication rate after circumcision in a paediatric surgical setting should not be neglected

    DEFF Research Database (Denmark)

    Thorup, Jørgen; Thorup, Sebastian Cortes; Ifaoui, Inge Botker Rasmussen

    2013-01-01

    INTRODUCTION: As a consequence of the discussion on whether the health benefits of newborn male circumcision outweigh the risks and the discrepancies in reported figures of complications, we evaluated our results from a paediatric surgical department. MATERIAL AND METHODS: Patient file data from...... children who had undergone ritual circumcision in the 1996-2003 period were retrieved. Complications recorded until December 2011 were noted. RESULTS: Circumcision in 315 boys aged from 3 weeks to 16 years (median five years) were evaluated. A total of 16 boys (5.1%) had significant complications......, including three incomplete circumcisions requiring re-surgery, two requiring re-surgery six months and five years postoperatively due to fibrotic phimosis and two requiring meatotomy due to meatal stenosis two and three year postoperatively. Acute complications included two superficial skin infections one...

  20. Noninvasive indocyanine green plasma disappearance rate predicts early complications, graft failure or death after liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Lutz Schneider; Martin Spiegel; Sebastian Latanowicz; Markus A Weigand; Jan Schmidt; Jens Werner; Wolfgang Stremmel; Christoph Eisenbach

    2011-01-01

    BACKGROUND: Early  detection  of  graft  malfunction  or postoperative  complications  is  essential  to  save  patients  and organs after orthotopic liver transplantation (OLT). Predictive tests  for  graft  dysfunction  are  needed  to  enable  earlier implementation  of  organ-saving  interventions  following transplantation. This study was undertaken to assess the value of indocyanine green plasma disappearance rates (ICG-PDRs) for predicting postoperative complications, graft dysfunction, and patient survival following OLT. METHODS: Eighty-six patients undergoing OLT were included in this single-centre trial. ICG-PDR was assessed daily for the first 7 days following OLT. Endpoints were graft loss or death within 30 days and postoperative complications, graft loss, or death within 30 days. RESULTS: Postoperative complications of 31 patients included deaths (12 patients) or graft losses. ICG-PDR was significantly different in patients whose endpoints were graft loss or death beginning from day 3 and in those whose endpoints were graft-loss,  death,  or  postoperative  complications  beginning  from day  4  after  OLT.  For  day  7  measurements,  receiver  operating characteristic  curve  analysis  revealed  an  ICG-PDR  cut-off  for predicting  death  or  graft  loss  of  9.6%  per  min  (a  sensitivity of 75.0%, a specificity of 72.6%, positive predictive value 0.35, negative predictive value 0.94). For prediction of graft loss, death, or postoperative complications, the ICG-PDR cut-off was 12.3% per min (a sensitivity of 68.9%,

  1. [Is local bone graft sufficient to maintain the surgical correction in adolescent idiopathic scoliosis curves?].

    Science.gov (United States)

    Mardomingo, A; Sánchez-Mariscal, F; Alvarez, P; Pizones, J; Zúñica, L; Izquierdo, E

    2013-01-01

    The purpose of this study was to compare postoperative clinical and radiological results in adolescent idiopathic scoliosis curves treated by posterior arthrodesis using autogenous bone graft from iliac crest (CI) versus only local autograft bone (HL). A retrospective matched cohort study was conducted on 73 patients (CI n=37 and HL n=36) diagnosed with adolescent idiopathic scoliosis and treated surgically by posterior arthrodesis. The mean post-operative follow-up was 126 months in the CI group vs. 66 months in the HL group. The radiographic data collected consisted of preoperative, postoperative, and final follow-up antero-posterior and lateral full-length radiographs. Loss of correction and quality of arthrodesis were evaluated by comparing the scores obtained from the Spanish version of the SRS-22 questionnaire. There were significant differences in the post-operative results as regards the correction of the Cobb angle of the main curve (HL 61 ± 15% vs. CI 51 ± 14%, P<.004), however a greater loss of correction was found in the local bone group (CI 4.5 ± 7.3° vs. HL 8.5 ± 6.3°, P=.02). There were no significant differences as regards the correction of the Cobb angle of the main curve at the end of follow-up. There were no clinical differences between the two groups in the SRS-22 scores. At 5 years of follow-up, there was a statistically significant greater loss of radiographic correction at the end of final follow-up in the local bone graft group. However clinical differences were not observed as regards the SRS-22 scores. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  2. Surgical risks and perioperative complications of instrumented lumbar surgery in patients with liver cirrhosis

    Directory of Open Access Journals (Sweden)

    Tung-Yi Lin

    2014-02-01

    Full Text Available Background: Patients with liver cirrhosis have high surgical risks due to malnutrition, impaired immunity, coagulopathy, and encephalopathy. However, there is no information in English literature about the results of liver cirrhotic patients who underwent instrumented lumbar surgery. The purpose of this study is to report the perioperative complications, clinical outcomes and determine the surgical risk factors in cirrhotic patients. Methods: We retrospectively reviewed 29 patients with liver cirrhosis who underwent instrumented lumbar surgery between 1997 and 2009. The hepatic functional reserves of the patients were recorded according to the Child-Turcotte-Pugh scoring system. Besides, fourteen other variables and perioperative complications were also collected. To determine the risks, we divided the patients into two groups according to whether or not perioperative complications developed. Results: Of the 29 patients, 22 (76% belonged to Child class A and 7 (24% belonged to Child class B. Twelve patients developed one or more complications. Patients with Child class B carried a significantly higher incidence of complications than those with Child class A (p = 0.011. In the Child class A group, patients with 6 points had a significantly higher incidence of complications than those with 5 points (p = 0.025. A low level of albumin was significantly associated with higher risk, and a similar trend was also noted for the presence of ascites although statistical difference was not reached. Conclusion: The study concludes that patients with liver cirrhosis who have undergone instrumented lumbar surgery carry a high risk of developing perioperative complications, especially in those with a Child-Turcotte-Pugh score of 6 or more.

  3. Risk factors of surgical site infections in patients with Crohn's disease complicated with gastrointestinal fistula.

    Science.gov (United States)

    Guo, Kun; Ren, Jianan; Li, Guanwei; Hu, Qiongyuan; Wu, Xiuwen; Wang, Zhiwei; Wang, Gefei; Gu, Guosheng; Ren, Huajian; Hong, Zhiwu; Li, Jieshou

    2017-05-01

    Surgical site infection (SSI) is the most common complication following surgical procedures. This study aimed to determine risk factors associated with SSI in patients with Crohn's disease (CD) complicated with gastrointestinal fistula. This was a retrospective review of patients who underwent surgical resection in gastrointestinal fistula patients with CD between January 2013 and January 2015, identified from a prospectively maintained gastrointestinal fistula database. Demographic information, preoperative medication, intraoperative findings, and postoperative outcome data were collected. Univariate and multivariate analysis was carried out to assess possible risk factors for SSI. A total of 118 patients were identified, of whom 75.4% were men, the average age of the patients was 34.1 years, and the average body mass index (BMI) was 18.8 kg/m(2). The rate of SSI was 31.4%. On multivariate analysis, preoperative anemia (P = 0.001, OR 7.698, 95% CI 2.273-26.075), preoperative bacteria present in fistula tract (P = 0.029, OR 3.399, 95% CI 1.131-10.220), and preoperative enteral nutrition (EN) fistula tract, and preoperative EN fistula complicated with CD. Preoperative identification of these risk factors may assist in risk assessment and then to optimize preoperative preparation and perioperative care.

  4. Endoscopic or Surgical Approach to Cure Pancreatitis and Its Complications: The History Continues

    Directory of Open Access Journals (Sweden)

    Raffaele Pezzilli

    2008-07-01

    Full Text Available Endoscopic and surgical treatment are the two main techniques for the treatment of pancreatitis, mainly represented by the persistent pain not responding to medical treatment and the complications associated with pain, such as pseudocysts and ductal stenosis. However, the dilemma is related to the procedures we use to treat these complications: surgical or endoscopic approach? Probably the treatment of choice is based on the expertise available in the various centers, but we also need an evidence-based approach. Thus, in 2007 [1], I commented on the paper of Cahen et al. [2] with enthusiasm for two reasons: the first was that, for the first time, a comparative study on the long term results of endoscopic vs. surgical treatment of chronic pancreatitis patients was carried out, and the second was that the follow-up period was sufficient to assess the results of the two different treatments, not only from a medical point of view but also considering the patient reported outcomes using the SF-36 questionnaire. For the same reasons, I invite you to read, with attention, the paper of Varadarajulu et al. [3] reporting the data of the clinical outcomes of EUS-guided cystgastrostomy in comparison to surgical cystgastrostomy for the management of patients with uncomplicated pancreatic pseudocysts; the authors also evaluated the cost analysis of each treatment modality. Unfortunately, this was a retrospective case-controlled study carried out in a tertiary-referral center.

  5. [The surgical complications of typhoid fever: a report of 10 cases].

    Science.gov (United States)

    González Ojeda, A; Pérez Ríos, A; Rodríguez, M; de la Garza Villaseñor, L

    1991-01-01

    This is a retrospective review of 10 consecutive patients with intra-abdominal complications of typhoid fever requiring surgical treatment, during a four-year period at the Instituto Nacional de la Nutrición Salvador Zubirán. There were 7 males and 3 females with an average age of 33.9 years. In 80 per cent of the cases Salmonella typhi was obtained in blood and bone narrow cultures. Five cases developed terminal ileum perforations, 4 massive bleeding related to ulcerated typhoid ileitis and one patient was operated on with the preoperative diagnosis of acute abdomen during the course of severe, toxic, typhoid fever. At laparotomy, no abnormalities were found. Five patients were treated with right hemicolectomy, 3 with local resections and primary closure, and another one, with segmental terminal ileum resection and end to end anastomosis. One patient died of mixed shock and multiple organ failure. This event was secondary to partial dehiscence of the ileo-transverse anastomosis and massive bleeding. Four patients had complications; a) pneumonia, b) urinary tract infection, c) splenic abscess that required splenectomy and: d) intestinal obstruction. All patients were treated with chloramphenicol. We found a high morbidity and mortality rate of the typhoid fever complications. The surgical resection and specific antibiotic therapy are the most effective treatment, however, complications can appear during its treatment.

  6. Autologous Graft versus Host Disease: An Emerging Complication in Patients with Multiple Myeloma

    Directory of Open Access Journals (Sweden)

    Anu Batra

    2014-01-01

    Full Text Available Autologous graft versus host disease (autoGVHD is a rare transplant complication with significant morbidity and mortality. It has been hypothesized that patients with multiple myeloma might be predisposed to autoGVHD through dysregulation of the immune response resulting from either their disease, the immunomodulatory agents (IMiDs used to treat it, or transplant conditioning regimen. Hematopoietic progenitor cell (HPC products were available from 8 multiple myeloma patients with biopsy-proven autoGVHD, 16 matched multiple myeloma patients who did not develop autoGVHD, and 7 healthy research donors. The data on number of transplants prior to developing autoGVHD, mobilization regimens, exposure to proteasome inhibitors, use of IMiDs, and class I human leukocyte antigen types (HLA A and B were collected. The HPC products were analyzed by flow cytometry for expression of CD3, CD4, CD8, CD25, CD56, and FoxP3. CD3+ cell number was significantly lower in autoGVHD patients compared to unaffected controls (P=0.047. On subset analysis of CD3+ cells, CD8+ cells (but not CD4+ cells were found to be significantly lower in patients with autoGVHD (P=0.038. HLA-B55 expression was significantly associated with development of autoGVHD (P=0.032. Lower percentages of CD3+ and CD8+ T-cells and HLA-B55 expression may be predisposing factors for developing autoGVHD in myeloma.

  7. Association of previous Cesarean delivery with surgical complications after a hysterectomy later in life

    DEFF Research Database (Denmark)

    Lindquist, Sofie A. I.; Shah, Neel; Overgaard, Charlotte

    2017-01-01

    Importance: In recent decades, the global rates of cesarean delivery have rapidly increased. Nonetheless, the influence of cesarean deliveries on surgical complications later in life has been understudied. Objective: To investigate whether previous cesarean delivery increases the risk...... of reoperation, perioperative and postoperative complications, and blood transfusion when undergoing a hysterectomy later in life. Design, Setting, and Participants: This registry-based cohort study used data from Danish nationwide registers on all women who gave birth for the first time between January 1, 1993......, and December 31, 2012, and underwent a benign, nongravid hysterectomy between January 1, 1996, and December 31, 2012. The dates of this analysis were February 1 to June 30, 2016. Exposure: Cesarean delivery. Main Outcomes and Measures: Reoperation, perioperative and postoperative complications, and blood...

  8. Graft placement with an omental flap for ruptured infective common iliac aneurysm in a patient with a continuous flow left ventricular assist device: alternative surgical approach avoiding driveline injury and pathogen identification by 16S ribosomal DNA gene analysis.

    Science.gov (United States)

    Akiyama, Masatoshi; Hayatsu, Yukihiro; Sakatsume, Ko; Fujiwara, Hidenori; Shimizu, Takuya; Akamatsu, Daijirou; Kakuta, Risako; Gu, Yoshiaki; Kaku, Mitsuo; Kumagai, Kiichiro; Kawamoto, Shunsuke; Goto, Hitoshi; Ohuchi, Noriaki; Saiki, Yoshikatsu

    2016-12-01

    Patients supported by mechanical circulatory support have to wait for longer periods for heart transplantation in Japan. Infective events are a major complication and influence survival. Here, we present the case of a patient with an implantable left ventricular assist device for 6 months who had the complication of ruptured infective common iliac aneurysm. Graft placement with an omental flap was successfully performed via the alternative surgical approach to avoid percutaneous driveline injury. In samples of aortic specimens, 16S ribosomal DNA gene analysis identified Helicobacter cinaedi. Complete removal of the infected tissue and correct pathogen identification may have been relevant to the good clinical course.

  9. The impact on hospitals of reducing surgical complications suggests many will need shared savings programs with payers.

    Science.gov (United States)

    Krupka, Dan C; Sandberg, Warren S; Weeks, William B

    2012-11-01

    Reducing the complications that patients experience following surgery has garnered renewed attention from the medical and policy community. Reducing surgical complications is, foremost, critically important for patients. Moreover, in a competitive environment increasingly characterized by transparency of outcomes, the surgical complication rate is an important measure of hospital performance that could strongly influence choices of care and care sites made by patients and payers. However, programs to achieve such improvements can reduce hospital revenues, as reimbursements to treat patients for complications decrease. In this article we examine the business case for hospitals' consideration of programs to reduce surgical complications. We found that if a hospital's surgical inpatient volume is not growing, such a program results in negative cash flow. We also found that if a hospital's surgical volume is growing, and if the hospital can sufficiently reduce the average length-of-stay for surgical patients without complications, the cash flow could be positive. We recommend that hospitals with limited growth prospects that are nonetheless contemplating a surgical complication reduction program establish agreements with payers to share in any savings generated by the program.

  10. Surgical outcome and complications following cleft lip and palate repair in a teaching hospital in Nigeria

    Directory of Open Access Journals (Sweden)

    Taiwo O Abdurrazaq

    2013-01-01

    Full Text Available Background: Measurement of treatment outcome is important in estimating the success of cleft management. The aim of this study was to assess the surgical outcome of cleft lip and palate surgery. Patients and Methods: The surgical outcome of 131 consecutive patients with cleft lip and palate surgeries between October 2008 and December 2010 were prospectively evaluated at least 4 weeks postoperatively. Data collected included information about the age, sex, type of cleft defects, and type of surgery performed as well as postoperative complications. For cleft lip repair, the Pennsylvania lip and nose (PLAN score was used to assess the surgical outcome, while the integrity of the closure was used for cleft palate repair. Results: A total of 92 patients had cleft lip repair and 64 had palate repair. Overall, 68.8% cases of cleft lip and palate repair had good outcomes; 67.9% of lip repairs had good lip and nose scores, while 70.2% of palatal repair had a good surgical outcome. Oro-fistula was observed in 29.8% of cleft palate repairs Inter-rater reliability coefficient was substantially significant. Conclusions: The fact that 25.7% of those treated were aged >1 year suggests a continued need to enlighten the public on the availability of cleft lip and palate expertise and treatment. Although an overall good treatment outcome was demonstrated in this study, the nasal score was poorer than the lip score. Complication rate of about 14% following surgical repair is consistent with previous reports in the literature.

  11. Minimally invasive surgical treatment of patients with bilateral pulmonary tuberculosis complicated with pleural empyema

    Directory of Open Access Journals (Sweden)

    Korpusenko I.V

    2015-03-01

    Full Text Available Objective of our study was to increase the effectiveness of surgical treatment of bilateral destructive pulmonary tuberculosis complicated by pleural empyema by using VTS-technologies. The study was done in Dnepropetrovsk regional clinical therapeutic and prophylactic association "Phthisiology" in the period from 2008 to 2013. A retrospective analysis of 43 cases of bilateral destructive pulmonary tuberculosis complicated by pleural empyema on one side and dissemination focus or limited destructive process on contralateral side has been performed. Selected cases were divided into 2 groups: main (eighteen cases where the following procedures were done: performed transsternal occlusion of the main bronchus, sanation of empyema cavity using videothoracosopy, in 30-45 days followed by pleuropneumectomy with usage of minithoracothomy and control (nineteen cases who had undergone drainage of the empyema cavity, sanation, in 45-60 days followed by pleuropmeumectomy with usage of anterolateral access. The distribution of main and control groups for analyzed parameters was representative. Sanation of pleural cavity with videothoracosopy usage compared with Bulau’s drainage provides better antibacterial effect, effective sanitation of the pleural cavity as evidenced by following changes: significant decrease in the number of microbial cells; normalization of total white blood cells count and rod-shaped granulocytes in the peripheral blood 10 days after treatment; normalization of leukocyte intoxication index. The use of minimally invasive surgical treatment allowed to reduce intraoperative complications by 2 times, amount of intraoperative blood loss and hemotrasfusions by 1.5 times, postoperative mortality by 2.5 times. Pleural cavity sanation with videothoracoscopy usage with following pneumoectomy leads to reduce in the incidence and severity of postoperative complications. The most promising is stage-by-stage surgical approach with consecutive use

  12. Individualized Risk of Surgical Complications: An Application of the Breast Reconstruction Risk Assessment Score

    Science.gov (United States)

    Mlodinow, Alexei S.; Khavanin, Nima; Hume, Keith M.; Simmons, Christopher J.; Weiss, Michael J.; Murphy, Robert X.; Gutowski, Karol A.

    2015-01-01

    Background: Risk discussion is a central tenet of the dialogue between surgeon and patient. Risk calculators have recently offered a new way to integrate evidence-based practice into the discussion of individualized patient risk and expectation management. Focusing on the comprehensive Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database, we endeavored to add plastic surgical outcomes to the previously developed Breast Reconstruction Risk Assessment (BRA) score. Methods: The TOPS database from 2008 to 2011 was queried for patients undergoing breast reconstruction. Regression models were constructed for the following complications: seroma, dehiscence, surgical site infection (SSI), explantation, flap failure, reoperation, and overall complications. Results: Of 11,992 cases, 4439 met inclusion criteria. Overall complication rate was 15.9%, with rates of 3.4% for seroma, 4.0% for SSI, 6.1% for dehiscence, 3.7% for explantation, 7.0% for flap loss, and 6.4% for reoperation. Individualized risk models were developed with acceptable goodness of fit, accuracy, and internal validity. Distribution of overall complication risk was broad and asymmetric, meaning that the average risk was often a poor estimate of the risk for any given patient. These models were added to the previously developed open-access version of the risk calculator, available at http://www.BRAscore.org. Conclusions: Population-based measures of risk may not accurately reflect risk for many individual patients. In this era of increasing emphasis on evidence-based medicine, we have developed a breast reconstruction risk assessment calculator from the robust TOPS database. The BRA Score tool can aid in individualizing—and quantifying—risk to better inform surgical decision making and better manage patient expectations. PMID:26090295

  13. A STUDY OF POST-SURGICAL COMPLICATIONS IN ACUTE ABDOMEN CONDITIONS

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    Bhooma Reddy Muthyala

    2016-09-01

    Full Text Available BACKGROUND The most common causes of the acute abdomen are acute appendicitis which may be perforated, typhoid ileal perforation, acute intestinal obstruction, gastroduodenal perforations, nonspecific abdominal pain, abdominal injuries, and acute cholecystitis. A summary of all the acute complications taken together will be the fact that all are associated with post-surgical complications. A sincere effort has been made to study the post-operative complications that a surgeon encounters while treating the acute abdomen cases. This study is intended to help the practising surgeons who deal with such complications. It also is intended to help the doctors who practice to identify such complications and thus refer the patients for immediate intervention. METHODS This study was conducted in the Department of General Surgery, Government Medical College, Nizamabad, Telangana. This study was done from June 2013 to May 2016. One hundred sixty patients who were admitted in the hospital after surgery for acute abdominal conditions were considered for the study. Thorough clinical examination was conducted and the complications that were encountered were noted and the complications were treated as per the need of the hour. The complications faced by the treating surgeon in each and every entity that was discussed earlier was duly noted and statistical analysis was conducted. All the statistical analysis was done using the latest SPSS software 2015 (California. RESULT In our study, the mean age of the study population was found to be 29.8 years. That means the majority of the patients who turn up in the Department of Emergency is young and generally in the third decade of life. In Acute Intestinal Obstruction and blunt abdominal injuries, significance of mortality is high (p<0.05. CONCLUSION The study was successful in proving that abdominal injuries are the main factors of causing morbidity and mortality in the younger generation. The surgical mode of

  14. An unusual case of fistula formation and thrombosis between arteriovenous graft and a native vein

    Directory of Open Access Journals (Sweden)

    Young Sub Kim

    2016-03-01

    Full Text Available Arteriovenous graft for hemodialysis vascular access is a widely used technique with many advantages. However, it has crucial complications with graft thrombosis and infection. We recently experienced an unusual case of arteriovenous graft complication involving graft thrombosis related to fistula formation between the graft and the natural vein with infection. We diagnosed this condition using Doppler ultrasound and computed tomography angiography. Successful surgical treatment including partial graft excision and creation of a secondary arteriovenous fistula using an inadvertently dilated cephalic vein was performed. The dialysis unit staff should keep this condition in mind and try to prevent this complication.

  15. Total laparoscopic hysterectomy in morbidly obese women with endometrial cancer anaesthetic and surgical complications.

    Science.gov (United States)

    O'Gorman, T; MacDonald, N; Mould, T; Cutner, A; Hurley, R; Olaitan, A

    2009-01-01

    To assess the feasibility, associated anaesthetic and surgical morbidity in all morbidly obese women with endometrial cancer treated with total laparoscopic hysterectomy bilateral salpingo-oophorectomy (TLHBSO). Data was collected prospectively and analysed retrospectively on all morbidly obese women who had TLHBSO between February 2003 and January 2007. One case was converted to laparotomy. The mean postoperative stay was 4.04 (3-7) days. The only postoperative surgical complication was an incisional port site hernia. Comorbidities were present in 76% (26/34) of women, 29% (10/34) had a single comorbid condition, and 26% (9/34) had two. A further 21% (7/34) had more than two. There were no major anaesthetic complications. Patients with a BMI > 50 required ventilation with high airway pressure despite using ventilatory strategies to keep them to a minimum. TLHBSO in the obese population is safe in the hands of experienced surgeons and anaesthetists. The safety of a total laparoscopic approach in the surgical management of uterine cancer remains to be demonstrated in prospective randomised trials.

  16. Endovascular repair of postoperative vascular graft related complications after aorto-iliac surgery

    DEFF Research Database (Denmark)

    Duvnjak, Stevo; Andersen, P E; Larsen, K E

    2014-01-01

    with anastomotic pseudoaneurysms without leak, of which three had proximal anastomotic pseudoaneurysms and one had distal iliac anastomotic pseudoaneurysm. Implanted stent graft were Endurant (Medtronic) bifurcated endoprostheses in three patients and Excluder (Gore) prosthesis in a two cases. Tubular Medtronic...

  17. A Novel Surgical Technique for Fixation of Recurrent Acromioclavicular Dislocations: AC Dog Bone Technique in Combination with Autogenous Semitendinosus Tendon Graft

    Directory of Open Access Journals (Sweden)

    Patrick Holweg

    2017-01-01

    Full Text Available Various surgical techniques have been described for the fixation of acromioclavicular (AC dislocations. However, recurrent dislocation is one of the main complications associated with the majority of these techniques. We report a case of postoperative AC joint redislocation. In order to overcome recurrent dislocation after revision surgery, a reconstruction of the conoid and trapezoid ligament with the use of a free tendon graft in combination with a FiberTape was provided within a novel surgical technique. After 12 months, the patient was very satisfied with the functional outcome. The patient achieved excellent results in the Constant (98 points, SPADI (0 points, and QuickDASH score (0 points. The described technique results in an anatomic reconstruction of the AC joint. The nonrigid nature of the intervention seems to restore the normal arthrokinematics by reconstructing the coracoclavicular ligaments with an autograft which is then protected by the AC Dog Bone artificial ligaments during the healing period. The arthroscopic approach to the AC joint with minimal exposure reduces the risks and complications of the intervention. This is the first case in literature that utilizes the artificial dog bone ligament securing the autograft in an anatomic AC reconstruction.

  18. Complications of the Latarjet procedure.

    Science.gov (United States)

    Gupta, Ashish; Delaney, Ruth; Petkin, Kalojan; Lafosse, Laurent

    2015-03-01

    The Latarjet procedure is an operation performed either arthroscopically or open for recurrent anterior shoulder instability, in the setting of glenoid bone loss; with good to excellent functional results. Despite excellent clinical results, the complication rates are reported between 15 and 30 %. Intraoperative complications such as graft malpositioning, neurovascular injury, and graft fracture can all be mitigated with meticulous surgical technique and understanding of the local anatomy. Nonunion and screw breakage are intermediate-term complications that occur in less than 5 % of patients. The long-term complications such as graft osteolysis are still an unsolved problem, and future research is required to understand the etiology and best treatment option. Recurrent instability after the Latarjet procedure can be managed with iliac crest bone graft reconstruction of the anterior glenoid. Shoulder arthritis is another complication reported after the Latarjet procedure, which poses additional challenges to both the surgeon and patient.

  19. The influence of sarcopenia on survival and surgical complications in ovarian cancer patients undergoing primary debulking surgery

    NARCIS (Netherlands)

    Rutten, I.J.; Ubachs, J.; Kruitwagen, R.F.P.M.; Dijk, D.P. van; Beets-Tan, R.G.; Massuger, L.F.A.G.; Oude Damink, S.W.; Gorp, T. Van

    2017-01-01

    BACKGROUND: Sarcopenia, severe skeletal muscle loss, has been identified as a prognostic factor in various malignancies. This study aims to investigate whether sarcopenia is associated with overall survival (OS) and surgical complications in patients with advanced ovarian cancer undergoing primary

  20. [Arterial and portal venous complications after HPB surgical procedures: Interdisciplinary management].

    Science.gov (United States)

    Arend, J; Schütte, K; Peglow, S; Däberitz, T; Popp, F; Benedix, F; Pech, M; Wolff, S; Bruns, C

    2015-06-01

    The surgical treatment of hepatopancreatobiliary (HPB) diseases requires complex operative procedures. Within the last decades the morbidity (36-50 %) and mortality (surgery shows an increased rate of complications. Postoperative bleeding has a major effect on the outcome and the incidence is 6.7 % after pancreatic surgery and 3.2 % after hepatobiliary surgery. The major causes of early postoperative hemorrhage are related to technical difficulties in surgery whereas late onset postoperative hemorrhage is linked to anastomosis insufficiency, formation of fistulae or abscesses due to vascular arrosion or formation of pseudoaneurysms. In many cases, delayed hemorrhage is preceded by a self-limiting sentinel bleeding. The treatment is dependent on the point in time, location and severity of the hemorrhage. The majority of early postoperative hemorrhages require surgical treatment. Late onset hemorrhage in hemodynamically stable patients is preferably treated by radiological interventions. After interventional hemostatic therapy 8.2 % of patients require secondary procedures. In the case of hemodynamic instability or development of sepsis, a relaparotomy is necessary. The treatment concept includes surgical or interventional remediation of the underlying cause of the hemorrhage. Other causes of postoperative morbidity and mortality are arterial and portal venous stenosis and thrombosis. Following liver resection, thrombosis of the portal vein occurs in 8.5-9.1 % and in 11.6 % following pancreatic resection with vascular involvement. Interventional surgical procedures or conservative treatment are suitable therapeutic options depending on the time of diagnosis and clinical symptoms. The risk of morbidity and mortality after HPB surgery can be reduced only in close interdisciplinary cooperation, which is particularly true for vascular complications.

  1. Post liposuction Mycobacterium abscessus surgical site infection in a returned medical tourist complicated by a paradoxical reaction during treatment

    Directory of Open Access Journals (Sweden)

    Siong H. Hui

    2015-12-01

    Full Text Available Rapidly growing mycobacterial skin and soft tissue infections are known to complicate cosmetic surgical procedures. Treatment consists of more surgery and prolonged antibiotic therapy guided by drug susceptibility testing. Paradoxical reactions occurring during antibiotic therapy can further complicate treatment of non-tuberculous mycobacterial infections. We report a case of post liposuction Mycobacterium abscessus surgical site infection in a returned medical tourist and occurrence of paradox during treatment.

  2. Post Liposuction Mycobacterium Abscessus Surgical Site Infection in a Returned Medical tourist Complicated by a Paradoxical Reaction During Treatment.

    Science.gov (United States)

    Hui, Siong H; Noonan, Lisa; Chavada, Ruchir

    2015-12-22

    Rapidly growing mycobacterial skin and soft tissue infections are known to complicate cosmetic surgical procedures. Treatment consists of more surgery and prolonged antibiotic therapy guided by drug susceptibility testing. Paradoxical reactions occurring during antibiotic therapy can further complicate treatment of non-tuberculous mycobacterial infections. We report a case of post liposuction Mycobacterium abscessus surgical site infection in a returned medical tourist and occurrence of paradox during treatment.

  3. Duration of smoking cessation for the prevention of surgical wound healing complications

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    Barbara Vieira Cavichio

    2014-02-01

    Full Text Available The study aimed to find scientific evidence about the duration of preoperative smoking cessation required to reduce surgical wound healing complications. An integrative review was performed in the databases, Latin American and Caribbean Literature on Health Sciences (LILACS and Medical Literature Analysis and Retrieval System Online (MEDLINE, from 08/17/2012 to 09/17/2012, using the keywords: tobacco use cessation and wound healing; tobacco use cessation and preoperative period; tobacco use cessation and perioperative period (LILACS and tobacco use cessation and perioperative period; tobacco use cessation and wound healing (MEDLINE. Out of the 81 eligible studies, 12 were included. The duration of smoking cessation needed to reduce healing complications was at least four weeks (four studies with level of evidence I, three studies with level of evidence II, two studies with level of evidence IV, and one study with level of evidence VII.

  4. Loss of reduction and complications of coracoclavicular ligament reconstruction with autogenous tendon graft in acute acromioclavicular dislocations.

    Science.gov (United States)

    Choi, Nam Hong; Lim, Seok Min; Lee, Sang Young; Lim, Tae Kang

    2017-04-01

    This study was conducted to report loss of reduction and complications after single-tunnel coracoclavicular (CC) ligament reconstruction with autogenous semitendinosus tendon graft for acute acromioclavicular (AC) joint dislocations. This retrospective study included patients with acute, unstable AC dislocations (surgery within 6 weeks after trauma). We excluded patients with chronic injury and distal clavicle fractures with CC ligaments disruption. We measured the CC distance on anteroposterior radiographs of both clavicles, preoperatively, immediately postoperatively, and at the final follow-up visit. We evaluated clinical outcomes using the American Shoulder and Elbow Surgeons Shoulder Assessment and the University of California, Los Angeles Shoulder Rating Scale scores and perioperative complications. There were 30 patients (27 men and 3 women) with mean age of 41 years (range, 19-70 years). The mean follow-up period was 31 months (range, 12-186 months). Mean CC distance was 15.5 ± 3.7 mm (84% ± 14% of the contralateral shoulder) preoperatively, 8.9 ± 2.6 mm (9% ± 40%) immediately postoperatively (P 25% increase of CC distance) developed in 14 patients (47%), and complications occurred in 6 patients (20%), including 3 distal clavicle fractures through the tunnel. Final clinical scores were significantly lower in patients with complications (27 vs. 33 of the University of California, Los Angeles assessment [P < .001] and 81 vs. 95 of the American Shoulder and Elbow Surgeons Shoulder assessment [P < .001]). In acute AC joint dislocation, single-tunnel CC ligament reconstruction using autogenous tendon graft resulted in loss of reduction rate of 47% and a complication rate of 20%. The development of complications adversely affected clinical outcomes. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  5. Arthroscopically assisted Latarjet procedure: A new surgical approach for accurate coracoid graft placement and compression

    OpenAIRE

    Ettore Taverna; Henri Ufenast; Laura Broffoni; Guido Garavaglia

    2013-01-01

    The Latarjet procedure is a confirmed method for the treatment of shoulder instability in the presence of bone loss. It is a challenging procedure for which a key point is the correct placement of the coracoid graft onto the glenoid neck. We here present our technique for an athroscopically assisted Latarjet procedure with a new drill guide, permitting an accurate and reproducible positioning of the coracoid graft, with optimal compression of the graft onto the glenoid neck due to the perfect...

  6. Arthroscopically assisted Latarjet procedure: A new surgical approach for accurate coracoid graft placement and compression

    OpenAIRE

    Ettore Taverna; Henri Ufenast; Laura Broffoni; Guido Garavaglia

    2013-01-01

    The Latarjet procedure is a confirmed method for the treatment of shoulder instability in the presence of bone loss. It is a challenging procedure for which a key point is the correct placement of the coracoid graft onto the glenoid neck. We here present our technique for an athroscopically assisted Latarjet procedure with a new drill guide, permitting an accurate and reproducible positioning of the coracoid graft, with optimal compression of the graft onto the glenoid neck due to the perfect...

  7. Complications after Surgical Procedures in Patients with Cardiac Implantable Electronic Devices: Results of a Prospective Registry

    Science.gov (United States)

    da Silva, Katia Regina; Albertini, Caio Marcos de Moraes; Crevelari, Elizabeth Sartori; de Carvalho, Eduardo Infante Januzzi; Fiorelli, Alfredo Inácio; Martinelli Filho, Martino; Costa, Roberto

    2016-01-01

    Background: Complications after surgical procedures in patients with cardiac implantable electronic devices (CIED) are an emerging problem due to an increasing number of such procedures and aging of the population, which consequently increases the frequency of comorbidities. Objective: To identify the rates of postoperative complications, mortality, and hospital readmissions, and evaluate the risk factors for the occurrence of these events. Methods: Prospective and unicentric study that included all individuals undergoing CIED surgical procedures from February to August 2011. The patients were distributed by type of procedure into the following groups: initial implantations (cohort 1), generator exchange (cohort 2), and lead-related procedures (cohort 3). The outcomes were evaluated by an independent committee. Univariate and multivariate analyses assessed the risk factors, and the Kaplan-Meier method was used for survival analysis. Results: A total of 713 patients were included in the study and distributed as follows: 333 in cohort 1, 304 in cohort 2, and 76 in cohort 3. Postoperative complications were detected in 7.5%, 1.6%, and 11.8% of the patients in cohorts 1, 2, and 3, respectively (p = 0.014). During a 6-month follow-up, there were 58 (8.1%) deaths and 75 (10.5%) hospital readmissions. Predictors of hospital readmission included the use of implantable cardioverter-defibrillators (odds ratio [OR] = 4.2), functional class III­-IV (OR = 1.8), and warfarin administration (OR = 1.9). Predictors of mortality included age over 80 years (OR = 2.4), ventricular dysfunction (OR = 2.2), functional class III-IV (OR = 3.3), and warfarin administration (OR = 2.3). Conclusions: Postoperative complications, hospital readmissions, and deaths occurred frequently and were strongly related to the type of procedure performed, type of CIED, and severity of the patient's underlying heart disease. PMID:27579544

  8. Surgical complications of primary rhegmatogenous retinal detachment: a meta-analysis.

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    Zhiping Lv

    Full Text Available To investigate the surgical complications of scleral buckling (SB and pars plana vitrectomy (PPV performed on primary rhegmatogenous retinal detachment (RRD and to discover which surgical procedures bring fewer complications.An electronic literature search using the PubMed database, ISI Web of Knowledge and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials and observational studies comparing SB with PPV on primary RRD. Outcome measures included intra-operative complications and early and late post-operative complications.During the operation, significantly less subretinal hemorrhage occurred in the PPV group than in the SB group (OR = 4.71; 95%CI, 1.33-16.64; p = 0.02 and the hypotony incidence was significantly higher in the SB group (OR = 18.24; 95%CI, 2.37-140.44; p = 0.005; however, the occurrence of iatrogenic breaks was significantly lower in the SB group (OR = 0.05; 95%CI, 0.01-0.21; p<0.0001. In the early stage of post-operation, significantly higher incidence of choroidal detachment was identified in the SB group than in the PPV group (OR = 10.19; 95%CI, 2.36-44.09; p = 0.002; patients undergoing SB had significantly higher odds of residual subretinal fluid (OR = 14.71; 95%CI, 1.84-117.32; p = 0.01; the occurrence of high intraocular pressure was significantly lower in the SB group (OR = 0.46; 95%CI, 0.23-0.89; p = 0.02; and no significant difference was shown in the incidence of epithelia defect (p = 0.37 between the two groups. In the late stage of post-operation, the incidence of diplopia/extraocular muscle dysfunction was significantly higher in the SB group (OR = 4.04; 95%CI, 1.30-12.52; p = 0.02; and significantly less cataract was observed in the SB group (OR = 0.20; 95%CI, 0.14-0.30; p<0.00001; no significant difference was found in the incidences of cystoid macular edema (p = 0.65, macular pucker (p = 0.52, post-operative proliferative vitreoretinopathy (p = 0.73 and epiretinal membrane

  9. Arthroscopically assisted Latarjet procedure: A new surgical approach for accurate coracoid graft placement and compression

    Directory of Open Access Journals (Sweden)

    Ettore Taverna

    2013-01-01

    Full Text Available The Latarjet procedure is a confirmed method for the treatment of shoulder instability in the presence of bone loss. It is a challenging procedure for which a key point is the correct placement of the coracoid graft onto the glenoid neck. We here present our technique for an athroscopically assisted Latarjet procedure with a new drill guide, permitting an accurate and reproducible positioning of the coracoid graft, with optimal compression of the graft onto the glenoid neck due to the perfect position of the screws: perpendicular to the graft and the glenoid neck and parallel between them.

  10. Arthroscopically assisted Latarjet procedure: A new surgical approach for accurate coracoid graft placement and compression.

    Science.gov (United States)

    Taverna, Ettore; Ufenast, Henri; Broffoni, Laura; Garavaglia, Guido

    2013-07-01

    The Latarjet procedure is a confirmed method for the treatment of shoulder instability in the presence of bone loss. It is a challenging procedure for which a key point is the correct placement of the coracoid graft onto the glenoid neck. We here present our technique for an athroscopically assisted Latarjet procedure with a new drill guide, permitting an accurate and reproducible positioning of the coracoid graft, with optimal compression of the graft onto the glenoid neck due to the perfect position of the screws: perpendicular to the graft and the glenoid neck and parallel between them.

  11. Complications of fat grafts growth after weight gain: report of a severe diplopia.

    Science.gov (United States)

    Duhoux, Alexandre; Chennoufi, Mehdi; Lantieri, Laurent; Hivelin, Mikael

    2013-07-01

    A 47 years old woman underwent autologous fat grafting to treat a 5×4 cm depression of the lower lid and the upper cheek secondary resection of squamous cell carcinoma and subsequent coverage by full thickness skin graft. 20 mL of autologous fat were harvested from lower abdomen, centrifuged and injected subcutaneously. The patient then gained a total of 15 kg over a period of 24 months. Eye dystopia developed while the grafted area became convex. MRI confirmed subcutaneous fat mass going to the orbital floor through the inferior septal defect. The fat excess was removed through a trans-conjonctival approach allowing for a progressive regression of diplopia after 2 months while the oedema reduced. The overall follow up from the resection-coverage and last examination was 5 years. In this case with a context of noticeable weight gain, the growth of a fat graft trapped between a sclerous plane and the eye, that penetrated the orbital cavity through a septal defect led have led to exophthalmos, ocular dystopia and diplopia. Systematic overcorrection in autologous fat grafting should be prevented, especially in functional areas and on low body mass index patient that might gain weight.

  12. Improved surgical technique for laparoscopic Roux-en-Y gastric bypass reduces complications at the gastrojejunostomy.

    Science.gov (United States)

    Suter, Michel; Donadini, Andrea; Calmes, Jean-Marie; Romy, Sébastien

    2010-07-01

    Roux-en-Y gastric bypass (RYGBP) is one of the most commonly performed bariatric procedures for morbidly obese patients. It is associated with effective long-term weight loss, but can lead to significant complications, especially at the gastrojejunostomy (GJS). All the patients undergoing laparoscopic RYGBP at one of our two institutions were included in this study. The prospectively collected data were reviewed retrospectively for the purpose of this study, in which we compared two different techniques for the construction of the GJS and their effects on the incidence of complications. In group A, anastomosis was performed on the posterior aspect of the gastric pouch. In group B, it was performed across the staple line used to form the gastric pouch. A 21-mm circular stapler was used in all patients. A total of 1,128 patients were included between June 1999 and September 2009-639 in group A and 488 in group B. Sixty patients developed a total of 65 complications at the GJS, with 14 (1.2%) leaks, 42 (3.7%) strictures, and 9 (0.8%) marginal ulcers. Leaks (0.2% versus 2%, p = 0.005) and strictures (0.8% versus 5.9%, p < 0.0001) were significantly fewer in group B than in group A. Improved surgical technique, as we propose, with the GJS across the staple line used to form the gastric pouch, significantly reduces the rate of anastomotic complications at the GJS. A circular 21-mm stapler can be used with a low complication rate, and especially a low stricture rate. Additional methods to limit complications at the GJS are probably not routinely warranted.

  13. Open versus minimally invasive surgical approaches in pediatric urology: Trends in utilization and complications.

    Science.gov (United States)

    Tejwani, Rohit; Young, Brian J; Wang, Hsin-Hsiao S; Wolf, Steven; Purves, J Todd; Wiener, John S; Routh, Jonathan C

    2017-06-01

    relationships between different diagnosis codes. Despite these limitations, we note that the NIS database is rigorously monitored and audited for coding accuracy and, therefore, represents a reasonably reliable panorama of the characteristics of an inpatient surgical cohort. However, it is important to note that the choice of operative modality is, undoubtedly, multifactorial and patient/setting-specific. There is increasing use of MIS for pediatric urology procedures, although utilization rates vary among procedures. MIS was associated with a lower postoperative complication rate than for open procedures. Higher-volume MIS centers have a lower complication rate than lower-volume centers. Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  14. Increased capture of pediatric surgical complications utilizing a novel case-log web application to enhance quality improvement.

    Science.gov (United States)

    Fisher, Jason C; Kuenzler, Keith A; Tomita, Sandra S; Sinha, Prashant; Shah, Paresh; Ginsburg, Howard B

    2017-01-01

    Documenting surgical complications is limited by multiple barriers and is not fostered in the electronic health record. Tracking complications is essential for quality improvement (QI) and required for board certification. Current registry platforms do not facilitate meaningful complication reporting. We developed a novel web application that improves accuracy and reduces barriers to documenting complications. We deployed a custom web application that allows pediatric surgeons to maintain case logs. The program includes a module for entering complication data in real time. Reminders to enter outcome data occur at key postoperative intervals to optimize recall of events. Between October 1, 2014, and March 31, 2015, frequencies of surgical complications captured by the existing hospital reporting system were compared with data aggregated by our application. 780 cases were captured by the web application, compared with 276 cases registered by the hospital system. We observed an increase in the capture of major complications when compared to the hospital dataset (14 events vs. 4 events). This web application improved real-time reporting of surgical complications, exceeding the accuracy of administrative datasets. Custom informatics solutions may help reduce barriers to self-reporting of adverse events and improve the data that presently inform pediatric surgical QI. Diagnostic study/Retrospective study. Level III - case control study. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. [Amyand's hernia and complicated appendicitis; case presentation and surgical treatment choice].

    Science.gov (United States)

    García-Cano, Eugenio; Martínez-Gasperin, José; Rosales-Pelaez, César; Hernández-Zamora, Valeria; Montiel-Jarquín, José Álvaro; Franco-Cravioto, Fernando

    2016-01-01

    A caecal appendix within an inguinal hernia, with or without appendicitis, is defined as Amyand's hernia. In 1% of inguinal hernias an appendix without inflammation can be found, however, the prevalence of appendicitis in a hernia sac is only 0.08-0.13%. Male of 43 years old, began two days before admission with pain in the right inguinal region. He was scheduled for surgery due to a complication of a right inguinal hernia. The surgical findings were Amyand's hernia, necrotic spermatic cord, and perforated appendix. Surgical repair was performed with a favourable outcome, and he was discharged on the fourth postoperative day. Most of Amyand's hernia exhibit characteristics of incarcerated or strangulated inguinal hernia. Even acute appendicitis or perforated appendix within the hernia sac does not reflect specific symptoms or signs, therefore, a preoperative clinical diagnosis of Amyand's hernia is difficult to achieve. In our case, the patient had perforated appendicitis, developing necrosis of the spermatic cord. Orchiectomy, appendectomy, and inguinal hernia repair was performed without placing mesh. Due to the controversy on the use of mesh in contaminated abdominal wall defects, it was not indicated here, due to the high risk of wound infection and appendicular fistula. An extremely rare condition is presented, with a surgical choice that led to a favourable outcome. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  16. STUDY OF COMPLICATIONS IN SURGICAL MANAGEMENT OF METACARPAL AND PHALANGEAL FRACTURES

    Directory of Open Access Journals (Sweden)

    Hemanth

    2016-06-01

    Full Text Available BACKGROUND AND OBJECTIVES Hand fractures if not treated properly will result in deformity, stiffness and loss of function leading to functional deformity. Fracture healing in hand is not an isolated goal, rather it is the functional result that is of paramount importance. Recent studies have shown good functional results with surgical treatment of metacarpal fractures using K-wires and mini-external fixators as compared to the conservative treatment. METHODS This is a prospective study of 60 cases of metacarpal and phalangeal fractures treated surgically with mini-external fixators and K-wires, admitted to Bowring and Lady Curzon Hospital and Victoria Hospital attached to Bangalore Medical College and Research Institute from Oct. 2013 to Sep. 2015. RESULTS We followed up all the patients and the duration ranged from 12 weeks to 20 weeks (Mean 16 weeks. All fractures eventually united. We had totally 7 complications, which included superficial infection. (1 , stiffness of MCP joints. (1 , non-union. (2 , mal-union. (2 and gangrene. (2 We had no case of any purely implant related complications like K-wire migration or pin-tract infection. Fifth and fourth metacarpals were most commonly involved in our series. Out of 60 patients 33 patients (54.54% had excellent result, 19 patients (31.81% had good result and 8 patients (13 .63% had poor result. INTERPRETATION AND CONCLUSION Displaced metacarpal fractures treated surgically by mini-external fixator. K-wire gives excellent result in terms of union, recovery of daily activities and stiffness. There will be fewer chances of infection and early bone union in case of CRIF with K-wire than ORIF with K-wire. However, stiffness of hand joints, especially metacarpo-phalangeal joint is of major concern and physiotherapy plays a major role to combat stiffness.

  17. Out-of-office hours' elective surgical intensive care admissions and their associated complications.

    Science.gov (United States)

    Morgan, David J R; Ho, Kwok Ming; Ong, Yang Jian; Kolybaba, Marlene L

    2017-06-12

    The 'weekend' effect is a controversial theory that links reduced staffing levels, staffing seniority and supportive services at hospitals during 'out-of-office hours' time periods with worsening patient outcomes. It is uncertain whether admitting elective surgery patients to intensive care units (ICU) during 'out-of-office hours' time periods mitigates this affect through higher staffing ratios and seniority. Over a 3-year period in Western Australia's largest private hospital, this retrospective nested-cohort study compared all elective surgical patients admitted to the ICU based on whether their admission occurred 'in-office hours' (Monday-Friday 08.00-18.00 hours) or 'out-of-office hours' (all other times). The main outcomes were surgical complications using the Dindo-Clavien classification and length-of-stay data. Of the total 4363 ICU admissions, 3584 ICU admissions were planned following elective surgery resulting in 2515 (70.2%) in-office hours and 1069 (29.8%) out-of-office hours elective ICU surgical admissions. Out-of-office hours ICU admissions following elective surgery were associated with an increased risk of infection (P = 0.029), blood transfusion (P = 0.020), total parental nutrition (P office hours ICU admissions were also associated with an increased hospital length-of-stay, with (1.74 days longer, P office hours ICU admissions following elective surgery is common and associated with serious post-operative complications culminating in significantly longer hospital length-of-stays and greater transfers with important patient and health economic implications. © 2017 Royal Australasian College of Surgeons.

  18. Perioperative Surgical Complications and Learning Curve Associated with Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Single-Institute Experience

    OpenAIRE

    Park, Yung; Lee, Soo Bin; Seok, Sang Ok; Jo, Byung Woo; Ha, Joong Won

    2015-01-01

    Background As surgical complications tend to occur more frequently in the beginning stages of a surgeon's career, knowledge of perioperative complications is important to perform a safe procedure, especially if the surgeon is a novice. We sought to identify and describe perioperative complications and their management in connection with minimally invasive transforaminal lumbar interbody fusion (TLIF). Methods We performed a retrospective chart review of our first 124 patients who underwent mi...

  19. Surgical Management of Infective Endocarditis Complicated by Embolic Stroke: Practical Recommendations for Clinicians.

    Science.gov (United States)

    Yanagawa, Bobby; Pettersson, Gosta B; Habib, Gilbert; Ruel, Marc; Saposnik, Gustavo; Latter, David A; Verma, Subodh

    2016-10-25

    There has been an overall improvement in surgical mortality for patients with infective endocarditis (IE), presumably because of improved diagnosis and management, centered around a more aggressive early surgical approach. Surgery is currently performed in approximately half of all cases of IE. Improved survival in surgery-treated patients is correlated with a reduction in heart failure and the prevention of embolic sequelae. It is reported that between 20% and 40% of patients with IE present with stroke or other neurological conditions. It is for these IE patients that the timing of surgical intervention remains a point of considerable discussion and debate. Despite evidence of improved survival in IE patients with earlier surgical treatment, a significant proportion of patients with IE and preexisting neurological complications either undergo delayed surgery or do not have surgery at all, even when surgery is indicated and guideline endorsed. Physicians and surgeons are caught in a common conundrum where the urgency of the heart operation must be balanced against the real or perceived risks of neurological exacerbation. Recent data suggest that the risk of neurological exacerbation may be lower than previously believed. Current guidelines reflect a shift toward early surgery for such patients, but there continue to be important areas of clinical equipoise. Individualized clinical assessment is of major importance for decision making, and, as such, we emphasize the need for the functioning of an endocarditis team, including cardiac surgeons, cardiologists, infectious diseases specialists, neurologists, neurosurgeons, and interventional neuroradiologists. Here, we present 2 illustrative cases, critically review contemporary data, and offer conceptual and practical suggestions for clinicians to address this important, common, and often fatal cardiac condition. © 2016 American Heart Association, Inc.

  20. Less invasive surgical correction of adult degenerative scoliosis. Part II: Complications and clinical outcome.

    Science.gov (United States)

    Scheufler, Kai-Michael; Cyron, Donatus; Dohmen, Hildegard; Eckardt, Anke

    2010-12-01

    Surgical correction of adult degenerative scoliosis is a technically demanding procedure with a considerable complication rate. Extensive blood loss has been identified as a significant factor linked to unfavorable outcome. To report on the complication profile and clinical outcomes obtained with less invasive image-guided surgical correction of degenerative (de novo) scoliosis in a high-risk population. Thirty patients (age, 64-88 years) with progressive postural impairment, back pain, radiculopathy, and neurogenic claudication caused by degenerative scoliosis were treated by less invasive image-guided correction (3-8 segments) by multisegmental transforaminal lumbar interbody fusion and facet fusions. With a mean follow-up of 19.6 months, intraoperative blood loss, curve correction, fusion and complication rates, duration of hospitalization, incidence of hardware-related problems, and clinical outcome parameters were assessed using multivariate analysis. Satisfactory multiplanar correction was obtained in all patients. Mean intraoperative blood loss was 771.7±231.9 mL, time to full ambulation was 0.8±0.6 days, and length of stay was 8.2±2.9 days. After 12 months, preoperative SF12v2 physical component summary scores (20.2±2.6), visual analog scale scores (7.5±0.8), and Oswestry disability index (57.2±6.9) improved to 34.6±3.9, 2.63±0.6, and 24.8±7.1, respectively. The rate of major and minor complications was 23.4% and 59.9%, respectively. Ninety percent of patients rated treatment success as excellent, good, or fair. Less invasive image-guided correction of degenerative scoliosis in elderly patients with significant comorbidity yields a favorable complication profile. Significant improvements in spinal balance, pain, and functional scores mirrored expedited ambulation and early resumption of daily activities. Less invasive techniques appear suitable to reduce periprocedural morbidity, especially in elderly patients and individuals with significant

  1. Elderly donor liver grafts are not associated with a higher incidence of biliary complications after liver transplantation : results of a national multicenter study

    NARCIS (Netherlands)

    Westerkamp, Andrie C.; Korkmaz, Kerem S.; Bottema, Jan T.; Ringers, Jan; Polak, Wojciech G.; van den Berg, Aad P.; van Hoek, Bart; Metselaar, Herold J.; Porte, Robert J.

    2015-01-01

    Background: Liver transplantation with livers grafts from elderly donors has been associated with a higher risk of biliary complications. The aim of this study was to examine whether our national protocol could contribute to a lower incidence of biliary complications. Methods: All adult recipients i

  2. Surgical treatment of localized gingival recessions using coronally advanced flaps with or without subepithelial connective tissue graft

    Science.gov (United States)

    Bellver-Fernández, Ricardo; Martínez-Rodriguez, Ana-María; Gioia-Palavecino, Claudio; Caffesse, Raul-Guillermo

    2016-01-01

    Background A coronally advanced flap with subepithelial connective tissue graft is the gold standard surgical treatment of gingival recessions, since it offers a higher probability of achieving complete root coverage compared with other techniques. However, optimum short- and middle-term clinical results have also been obtained with coronally advanced flaps alone. The aim of the present study was to evaluate the results obtained by the surgical treatment of localized gingival recessions using coronally advanced flaps with or without subepithelial connective tissue graft. Material and Methods The reduction of recession height was assessed, together with the gain in gingival attachment apical to the recession, and total reduction of recession, in a comparative study of two techniques. Twenty-two gingival recessions were operated upon: 13 in the control group (coronally advanced flap) and 9 in the test group (coronally advanced flap associated to subepithelial connective tissue graft). Results After 18 months, the mean reduction of recession height was 2.2 ± 0.8 mm in the control group and 2.3 ± 0.7 mm in the test group, with a mean gain in gingival attachment of 1.3 ± 0.9 mm and 2.3 ± 1.3 mm, respectively. In percentage terms, the mean reduction of recession height was 84.6 ± 19.6% in the control group and 81.7 ± 17.8% in the test group, with a mean gain in gingival attachment of 20.5 ± 37.4% and 184.4 ± 135.5%, respectively. Conclusions Significant reduction of gingival recession was achieved with both techniques, though the mean gain in gingival attachment (in mm and as a %) was greater in test group. Key words:Gingival recession, coronally advanced flap, subepthelial connective tissue graft. PMID:26595836

  3. TO EVALUATE THE SURGICAL OUTCOME OF NON-UNION CLAVICLE USING PLATE AND SLIVERS OF AUTOLOGOUS ILIAC CREST CORTICOCANCELLOUS BONE GRAFT

    Directory of Open Access Journals (Sweden)

    Mohammed

    2016-03-01

    Full Text Available INTRODUCTION Clavicle fracture is one of the most common fracture presenting to the fracture clinic, accounting for about 5-10% of all the adult trauma reported but still the controversy exists with regards to the definitive management. AIM To evaluate the surgical outcome of nonunion clavicle in patients treated previously with surgical management or conservative management, using plate and slivers of autologous iliac crest corticocancellous bone. DESIGN Retrospective analysis of patients operated between May 2005 and February 2013 for nonunion of the clavicle. METHODS AND MATERIALS Twenty patients who were operated between May 2005 and February 2013 for nonunion of the clavicle at our hospital were recruited for our study and followup data was collected from our hospital records till their last outpatient visit. Inclusion criteria included patients with no evidence of radiological union, persistence of pain, cosmetic deformity, dysfunction or gross movement at the fracture site even after 16 weeks of conservative treatment or in cases of primary fixation failure. STATISTICAL ANALYSIS All Statistical analyses were made using Statistical Package Software for Social Sciences (SPSS version 17.0 software (Chicago, IL, USA for descriptive data. Chi2 test was used to compare the categorical data. RESULTS At the end of an average followup of 19 months, the average Visual Analogue Score for pain was 1.9±2.2 (range 0-6, the mean ASES score was 81±18.5 (51-100, and the mean Constant–Murley score was 80±17 (51-100. All the patients had a stable radiological union at the end of the followup period. There were no complications pertaining to the hardware or infection. CONCLUSION Treatment of nonunion of clavicle by using corticocancellous bone is well documented; however, use of iliac corticocancellous bone graft shaped in long slivers will give mechanical stability to the plate reconstruct in addition to providing a scaffold for new bone formation than

  4. Combined HLA matched limbal stem cells allograft with amniotic membrane transplantation as a prophylactic surgical procedure to prevent corneal graft rejection after penetrating keratoplasty: case report

    Directory of Open Access Journals (Sweden)

    Paolo Capozzi

    2014-09-01

    Full Text Available Purpose. To determine if the use of combined HLA matched limbal stem cells allograft with amniotic membrane transplantation (AMT is a safe and effective prophylactic surgical procedure to prevent corneal graft after penetrating keratoplasty (PK. Methods. We report the case of a 17 years old patient with a history of congenital glaucoma, trabeculectomy and multiple corneal graft rejections, presenting total limbal cell deficiency. To reduce the possibility of graft rejection in the left eye after a new PK, a two step procedure was performed. At first the patient underwent a combined HLA matched limbal stem cells allograft (LAT and AMT and then, 10 months later, a new PK. Results. During 12 months of follow-up, the corneal graft remained stable and smooth, with no sign of graft rejection. Conclusions. In our patient, the prophylactic use of LAT from HLA-matched donors and AMT before PK, may result in a better prognosis of corneal graft survival.

  5. Patients’ satisfaction and prevalence of complications on surgical extraction of third molar

    Science.gov (United States)

    Lee, Crystal TY; Zhang, Shinan; Leung, Yiu Yan; Li, Samantha KY; Tsang, Cissy C; Chu, Chun-Hung

    2015-01-01

    Objectives To study patients’ satisfaction and prevalence of complications in surgical extraction of impacted third molar by senior dentists and recently graduated dentists in a university dental clinic. Method Patients who had impacted third molar extraction in a university dental clinic by two associate dentists who had 15 years of experience were evaluated in this study. Patients’ age, sex, history of pericoronitis, tooth extracted, and radiographic assessment of the impacted tooth were recorded. Immediately after suture removal, the patients were invited to indicate their satisfaction on a Likert scale of 1–5. Results A total of 546 patients received extraction, and 251 patients were operated by associate dentists. Patient satisfaction was higher among those who had noncomplicated surgery (P=0.007), short treatment time (Pprevalence of seeking postsurgical emergency appointments was 9.2%. The reasons were severe pain (4.8%), swelling (2.6%), bleeding (2.4%), alveolar osteitis (0.9%), paresthesia (0.9), and trismus (0.5%). The prevalence of postsurgical complication(s) in associate dentists and senior dentists was 11.6% and 7.1%, respectively (P=0.050). The mean satisfaction scores for associate dentists and senior dentists were 4.17 and 3.95, respectively (P=0.002). Conclusion Although a higher rate of postsurgical complications was observed among the patients treated by the recently graduated dentists, their patients’ satisfaction scores were higher than that of the senior dentists. Around 9% of patients attended postsurgical emergency appointments, and their common reason was severe pain. PMID:25709411

  6. Patients' satisfaction and prevalence of complications on surgical extraction of third molar.

    Science.gov (United States)

    Lee, Crystal Ty; Zhang, Shinan; Leung, Yiu Yan; Li, Samantha Ky; Tsang, Cissy C; Chu, Chun-Hung

    2015-01-01

    To study patients' satisfaction and prevalence of complications in surgical extraction of impacted third molar by senior dentists and recently graduated dentists in a university dental clinic. Patients who had impacted third molar extraction in a university dental clinic by two associate dentists who had 15 years of experience were evaluated in this study. Patients' age, sex, history of pericoronitis, tooth extracted, and radiographic assessment of the impacted tooth were recorded. Immediately after suture removal, the patients were invited to indicate their satisfaction on a Likert scale of 1-5. A total of 546 patients received extraction, and 251 patients were operated by associate dentists. Patient satisfaction was higher among those who had noncomplicated surgery (P=0.007), short treatment time (Pprevalence of seeking postsurgical emergency appointments was 9.2%. The reasons were severe pain (4.8%), swelling (2.6%), bleeding (2.4%), alveolar osteitis (0.9%), paresthesia (0.9), and trismus (0.5%). The prevalence of postsurgical complication(s) in associate dentists and senior dentists was 11.6% and 7.1%, respectively (P=0.050). The mean satisfaction scores for associate dentists and senior dentists were 4.17 and 3.95, respectively (P=0.002). Although a higher rate of postsurgical complications was observed among the patients treated by the recently graduated dentists, their patients' satisfaction scores were higher than that of the senior dentists. Around 9% of patients attended postsurgical emergency appointments, and their common reason was severe pain.

  7. Posttraumatic growth in post-surgical coronary artery bypass graft patients

    Directory of Open Access Journals (Sweden)

    Catherine A Waight

    2015-02-01

    Full Text Available Recent research in posttraumatic growth has been applied to people with life-threatening illnesses to optimise recovery. There is a lack of research exploring posttraumatic growth in coronary artery bypass graft patients. This article describes the recovery experience of 14 coronary artery bypass graft patients (13 males and 1 female at their first outpatient review post-surgery. Grounded theory analysis was used to develop a model of distinct and shared pathways to growth depending on whether patients were symptomatic or asymptomatic pre-coronary artery bypass graft. Outcomes of posttraumatic growth in this sample included action-based healthy lifestyle growth and two forms of cognitive growth: appreciation of life and new possibilities. The model of posttraumatic growth developed in this study may be helpful in guiding future research into promoting posttraumatic growth and behaviour change in coronary artery bypass graft patients.

  8. Block bone graft fixation (onlay): a modification of the surgical technique.

    Science.gov (United States)

    Gealh, Walter Cristiano; dos Santos, Pâmela Letícia; Pereira, Cassiano Costa Silva; Okamoto, Tetuo; Antoniali, Cristina; Okamoto, Roberta

    2014-03-01

    Several reconstructive methods of the alveolar ridge have been reported to make possible future rehabilitations with implants. Many of these methods come from studies done in animals, mainly rats. With this clinical practice based on scientific evidence, any experimental procedure that can be undertaken in real life is fundamental. Thus, any research that emulates as closely as possible those techniques used in humans are important. This study describes the modification of the technique for block bone graft fixation (onlay) in rats using the "lag screw"-type technique, normally used in clinical procedures for grafts in humans. The conclusion was that the execution of the described procedures minimizes interference of blood flow in the area because of the maintenance of the muscle insertion in the buckle aspect of the most anterior region of the mandible, providing better stability to the graft and better contact interface of the graft and receptor bed.

  9. Posttraumatic growth in post-surgical coronary artery bypass graft patients

    Directory of Open Access Journals (Sweden)

    Catherine A Waight

    2015-02-01

    Full Text Available Recent research in posttraumatic growth has been applied to people with life-threatening illnesses to optimise recovery. There is a lack of research exploring posttraumatic growth in coronary artery bypass graft patients. This article describes the recovery experience of 14 coronary artery bypass graft patients (13 males and 1 female at their first outpatient review post-surgery. Grounded theory analysis was used to develop a model of distinct and shared pathways to growth depending on whether patients were symptomatic or asymptomatic pre-coronary artery bypass graft. Outcomes of posttraumatic growth in this sample included action-based healthy lifestyle growth and two forms of cognitive growth: appreciation of life and new possibilities. The model of posttraumatic growth developed in this study may be helpful in guiding future research into promoting posttraumatic growth and behaviour change in coronary artery bypass graft patients.

  10. [Surgical treatment of complicated gastrointestinal forms of non-Hodgkin lymphomas].

    Science.gov (United States)

    Iarŭmov, N; Terziev, I; Gachev, N; Gegova, A; Vasilev, N; Evtimov, R; Stoianov, S

    2002-01-01

    Authors represent their experience in surgical treatment of gastrointestinal forms of No-Hodgkin's lymphomas (NHL) combined with adjuvant therapy. We also represent an Ann Arbor Staging System and an Updated Kiel Classification. From 1991 to 2001 we analyzed 39 patients with different localization of gastro-intestinal NHL's lymphomas. In this aspect more common are stomach's lymphomas--27 patients (71%); small bowel's lymphomas--3 patients (8%); more uncommon are the localizations in colon--3 patients (8%), predominantly in caecum and right colon; rectum--3 patients (5%). Add to thus we described one mechanical icterus caused lymphoma, one multi-lobular spleen lymphoma and one case of anterior abdominal wall lymphoma. All patients underwent surgery. Eight of them were operated as an emergency cases. Operative treatment of NHL isn't radical but in combination with adjuvant therapy can be life saving event in complicated forms.

  11. A Procedure of Combination of Sequential Internal Thoracic Artery Grafting and Cooley's Technique for Complicated Case With Multi-vessel Disease,Left Ventricular Aneurysm and Mitral Regurgitation

    Institute of Scientific and Technical Information of China (English)

    Meng-ya LIANG; Guang-xian CHEN; Zhong-kai WU; Xi ZHANG

    2009-01-01

    @@ INTRODUCTION Left ventricular aneurysm and ischemic mitral regurgitation are two of most common complications of acute myocardial infarction (AMI).Combination of both these two fatal complications is not rare and the management of these complicated cases is always a challenge to cardiac surgeon because of its relatively high mortality[1]. We reported a rare case of AMI in which a singlestage correction of mitral valve replacement with preservation of mitral apparatus, sequential left internal thoracic artery (ITA) grafting and Cooley's technique.

  12. Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery

    DEFF Research Database (Denmark)

    Meyhoff, Christian S; Wetterslev, Jørn; Jorgensen, Lars N

    2009-01-01

    CONTEXT: Use of 80% oxygen during surgery has been suggested to reduce the risk of surgical wound infections, but this effect has not been consistently identified. The effect of 80% oxygen on pulmonary complications has not been well defined. OBJECTIVE: To assess whether use of 80% oxygen reduces...... Control and Prevention. Secondary outcomes included atelectasis, pneumonia, respiratory failure, and mortality. RESULTS: Surgical site infection occurred in 131 of 685 patients (19.1%) assigned to receive 80% oxygen vs 141 of 701 (20.1%) assigned to receive 30% oxygen (odds ratio [OR], 0.94; 95......% confidence interval [CI], 0.72-1.22; P = .64). Atelectasis occurred in 54 of 685 patients (7.9%) assigned to receive 80% oxygen vs 50 of 701 (7.1%) assigned to receive 30% oxygen (OR, 1.11; 95% CI, 0.75-1.66; P = .60), pneumonia in 41 (6.0%) vs 44 (6.3%) (OR, 0.95; 95% CI, 0.61-1.48; P = .82), respiratory...

  13. Cochlear implantation in Pendred syndrome and non-syndromic enlarged vestibular aqueduct – clinical challenges, surgical results, and complications

    DEFF Research Database (Denmark)

    Mey, Kristianna; Bille, Michael; Cayé-Thomasen, Per

    2016-01-01

    , and post-operative complications were retrieved. RESULTS: Complications occurred in 36% of implantations; 5% hereof major complications. Gushing/oozing from the cochleostoma occurred in 10% of implantations and was related to transient, but not prolonged post-operative vertigo. CONCLUSION: Intra......-operative risks of gushing/oozing and post-operative vertigo are the primary clinical issues in PS/NSEVA patients regarding CI. Nonetheless, the surgical success rate is high and the major complication rate is low; similar to studies of unselected series of CI recipients....

  14. FAILURE AND COMPLICATION FOLLOWING SURGICAL TREATMENT OF SCOLIOSIS——AN ANALYSIS OF 101 CASES

    Institute of Scientific and Technical Information of China (English)

    林进; 仉建国; 叶启彬; 沈健雄; 邱贵兴

    1999-01-01

    Complications occur frequently after surgical treatment of scoliosis. In order to prevent from them effectively, 101 cases with failure and po6toperatlve-compllcations were analysed. They included rod fracture in 22 cases(15 Harrington reds,4 Zielke rods,and 3 Luque rods);recurrence of curve severity in 12 cases;broken or loossened luque wires in 15 eases;loss of thoracic kyphosis(flat hack) in 6 cases ;progressive kyphosis with or without paraplegia following incorrect posterior decompression in 5 cases;and increased unbalance of shoulders after instrumentatioa in 2 cases due to neglect of the tilting of the first thoracic vertebra. Infection cocurred in 8 cases(incision infection 7 cases,deep wound infection in 1 case);and pneumothorax in 1 case. They were induced by hiomechanical factors in 23 cases(22. 8% ) ,incorrect selection of indications in 29 cases(28. 7%),operational mistakes in 37 cases(36. 6%),internal fixation factors in 15 cases(14. 9%). The authors hold that there are quite a lot of factors leading to occurrencee of complications and the effective way tor prevention from them is to undezstand the factors and main technical points related to internal fixation.

  15. Surgical complications of radical retropubic prostatectomy: A single institutional experience of seven years

    Directory of Open Access Journals (Sweden)

    Neeraj K Goyal

    2007-01-01

    Full Text Available Aim: To determine the surgical complications of open retropubic radical prostatectomy. Materials and Methods: Fifty-nine cases of localized prostate cancer underwent retropubic radical prostatectomy in our department in the last seven years. Standard technique of open retropubic radical prostatectomy as described by Walsh was used. During follow-up cancer control and quality of life indices (potency and urinary continence were noted. Result: Postoperative recovery of all patients except one was excellent. This patient required cardio-respiratory support and nine units of blood transfusion. Forty-nine out of 52 patients were continent, two had stress incontinence and one was totally incontinent at one year. Bladder neck contracture was present in eight out of 52 patients at one year. Forty-five patients were impotent at one year with or without oral tablet sildenafil. Cancer control was present in 45 out of 52 cases. Seven cases had biochemical failure at one year. Conclusion: Though retropubic radical prostatectomy is the standard treatment for early prostate cancer it is not without complications. It has a steep learning curve. More number of cases and refinement in technique is required to achieve world-class results.

  16. Advances in the management of the surgical complications for congenital cataract.

    Science.gov (United States)

    Ma, Fangqin; Wang, Qi; Wang, Lihua

    2012-12-01

    The greatest concern in children with cataracts is irreversible visual loss. The timing of congenital cataract surgery is critical for the visual rehabilitation. Cataract surgery in children remains complex and challenging. The incidence of complications during or after operation is higher in children than adults. Some complications could be avoided by meticulous attention to surgical technique and postoperative care, and others were caused by more exuberant inflammatory response associated with surgery on an immature eye or the intrinsic eyes abnormalities. Utilizing of advanced techniques and timely applying topical corticosteroids and cycloplegic agents can reduce the occurrence of visual axis opacification. Operation on children with strabismus or nystagmus, and applying occlusion therapy on amblyopic eyes can balance the visual inputs to the two eyes. Diagnosis of glaucoma following congenital cataract surgery requires lifelong surveillance and continuous assessment of the problem. So cataract surgeries in children are not the end of journey, but one step on the long road to visual rehabilitation. This paper describes recent evidence from the literature regarding the advance of management after congenital cataract surgery.

  17. Patients’ satisfaction and prevalence of complications on surgical extraction of third molar

    Directory of Open Access Journals (Sweden)

    Lee CTY

    2015-02-01

    Full Text Available Crystal TY Lee, Shinan Zhang, Yiu Yan Leung, Samantha KY Li, Cissy C Tsang, Chun-Hung Chu Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, People’s Republic of China Objectives: To study patients’ satisfaction and prevalence of complications in surgical extraction of impacted third molar by senior dentists and recently graduated dentists in a university dental clinic. Method: Patients who had impacted third molar extraction in a university dental clinic by two associate dentists who had <2 years of experience and two senior dentists who had >15 years of experience were evaluated in this study. Patients’ age, sex, history of pericoronitis, tooth extracted, and radiographic assessment of the impacted tooth were recorded. Immediately after suture removal, the patients were invited to indicate their satisfaction on a Likert scale of 1–5. Results: A total of 546 patients received extraction, and 251 patients were operated by associate dentists. Patient satisfaction was higher among those who had noncomplicated surgery (P=0.007, short treatment time (P<0.001, and had no postsurgical emergency appointments (P<0.001. The prevalence of seeking postsurgical emergency appointments was 9.2%. The reasons were severe pain (4.8%, swelling (2.6%, bleeding (2.4%, alveolar osteitis (0.9%, paresthesia (0.9, and trismus (0.5%. The prevalence of postsurgical complication(s in associate dentists and senior dentists was 11.6% and 7.1%, respectively (P=0.050. The mean satisfaction scores for associate dentists and senior dentists were 4.17 and 3.95, respectively (P=0.002. Conclusion: Although a higher rate of postsurgical complications was observed among the patients treated by the recently graduated dentists, their patients’ satisfaction scores were higher than that of the senior dentists. Around 9% of patients attended postsurgical emergency appointments, and their common reason was severe pain. Keywords: dental satisfaction, dentistry

  18. Association of Previous Cesarean Delivery With Surgical Complications After a Hysterectomy Later in Life.

    Science.gov (United States)

    Lindquist, Sofie A I; Shah, Neel; Overgaard, Charlotte; Torp-Pedersen, Christian; Glavind, Karin; Larsen, Thomas; Plough, Avery; Galvin, Grace; Knudsen, Aage

    2017-08-09

    In recent decades, the global rates of cesarean delivery have rapidly increased. Nonetheless, the influence of cesarean deliveries on surgical complications later in life has been understudied. To investigate whether previous cesarean delivery increases the risk of reoperation, perioperative and postoperative complications, and blood transfusion when undergoing a hysterectomy later in life. This registry-based cohort study used data from Danish nationwide registers on all women who gave birth for the first time between January 1, 1993, and December 31, 2012, and underwent a benign, nongravid hysterectomy between January 1, 1996, and December 31, 2012. The dates of this analysis were February 1 to June 30, 2016. Cesarean delivery. Reoperation, perioperative and postoperative complications, and blood transfusion within 30 days of a hysterectomy. Of the 7685 women (mean [SD] age, 40.0 [5.3] years) who met the inclusion criteria, 5267 (68.5%) had no previous cesarean delivery, 1694 (22.0%) had 1 cesarean delivery, and 724 (9.4%) had 2 or more cesarean deliveries. Among the 7685 included women, 3714 (48.3%) had an abdominal hysterectomy, 2513 (32.7%) had a vaginal hysterectomy, and 1458 (19.0%) had a laparoscopic hysterectomy. In total, 388 women (5.0%) had a reoperation within 30 days after a hysterectomy. Compared with women having vaginal deliveries, fully adjusted multivariable analysis showed that the adjusted odds ratio of reoperation for women having 1 previous cesarean delivery was 1.31 (95% CI, 1.03-1.68), and the adjusted odds ratio was 1.35 (95% CI, 0.96-1.91) for women having 2 or more cesarean deliveries. Perioperative and postoperative complications were reported in 934 women (12.2%) and were more frequent in women with previous cesarean deliveries, with adjusted odds ratios of 1.16 (95% CI, 0.98-1.37) for 1 cesarean delivery and 1.30 (95% CI, 1.02-1.65) for 2 or more cesarean deliveries. Blood transfusion was administered to 195 women (2.5%). Women having

  19. Alternative surgical treatment of paralytic lagophthalmos using autogenic cartilage grafts and canthopexy.

    Science.gov (United States)

    Friedhofer, Henri; Coltro, Pedro Soler; Vassiliadis, Aneta Hionia; Nigro, Marcelus Vinícius; Saito, Fábio Lopes; Moura, Tatiana; Faria, José Carlos; Ferreira, Marcus Castro

    2013-08-01

    This study aims to analyze the use of autogenic auricular cartilage grafts as weight for the upper eyelid in conjunction with lateral canthopexy for patients with mild paralytic lagophthalmos. This procedure was also accompanied by elevation of the lower eyelid using the cartilage graft for moderate cases. We conducted a retrospective study including case series of 30 patients with paralytic lagophthalmos from 1997 to 2010. For mild cases, cartilage from the auricular scapha was placed in pretarsal space of the upper eyelid and cartilage from the concha was inserted in preaponeurotic space and then sutured to the levator aponeurosis in conjunction with lateral canthopexy. For moderate cases, lower eyelid was also elevated by suturing cartilage graft to tarsum and resting it by the inferior orbital rim. All patients had some degree of keratopathy before the intervention. After treatment, they presented with evident clinical improvement, reduction of eye symptoms, and resolution of keratopathy. During the mean postoperative follow-up of 37.3 months, none of the patients presented with cartilage graft exposition, reabsorption, visibility, infection, or warping. Complete eye closure was achieved in 24 (80%) patients, whereas the remaining 6 (20%) patients had residual asymptomatic lagophthalmos. The intervention using autogenic auricular cartilage grafts explained in this study was only effective for the treatment of mild and moderate cases of paralytic lagophthalmos. This outpatient surgery is associated with low morbidity and achievement of functional and aesthetic improvement.

  20. Searching for predictors of surgical complications in critically ill surgery patients in the intensive care unit: a review.

    Science.gov (United States)

    Meyer, Zainna C; Schreinemakers, Jennifer M J; de Waal, Ruud A L; van der Laan, Lijckle

    2015-09-01

    We reviewed the use of the levels of C-reactive protein, lactate and procalcitonin and/or the Sequential Organ Failure Assessment score to determine their diagnostic accuracy for predicting surgical complications in critically ill general post-surgery patients. Included were all studies published in PubMed from inception to July 2013 that met the following inclusion criteria: evaluation of the above parameters, describing their diagnostic accuracy and the risk stratification for surgical complications in surgical patients admitted to an intensive care unit. No difference in the Sequential Organ Failure Assessment scores was seen between patients with or without complications. The D-lactate levels were significantly higher in those who developed colonic ischemic complications after a ruptured abdominal aortic aneurysm. After gastro-intestinal surgery, contradictory data were reported, with both positive and negative use of C-reactive protein and procalcitonin in the diagnosis of septic complications. However, in trauma patients, the C-reactive protein levels may help to discriminate between those with and without infectious causes. We conclude that the Sequential Organ Failure Assessment score, lactate concentration and C-reactive protein level have no significant predictive value for early postoperative complications in critically ill post-surgery patients. However, procalcitonin seems to be a useful parameter for diagnosing complications in specific patient populations after surgery and/or after trauma.

  1. Cervical necrotizing fasciitis as a complication of acute epiglottitis managed with minimally aggressive surgical intervention: Case report.

    Science.gov (United States)

    Gollapalli, Rajesh Babu; Naiman, Ana Nusa; Merry, David

    2015-07-01

    Cervical necrotizing fasciitis secondary to epiglottitis is rare. The standard treatment of this severe condition has long been early and aggressive surgical debridement and adequate antimicrobial therapy. We report the case of an immunocompetent 59-year-old man who developed cervical necrotizing fasciitis as a complication of acute epiglottitis. We were able to successfully manage this patient with conservative surgical treatment (incision and drainage, in addition to antibiotic therapy) that did not involve aggressive debridement.

  2. Surgical Outcomes of Anterior Cervical Fusion Using Deminaralized Bone Matrix as Stand-Alone Graft Material: Single Arm, Pilot Study.

    Science.gov (United States)

    Chung, Ho-Jung; Hur, Jung-Woo; Ryu, Kyeong-Sik; Kim, Jin-Sung; Seong, Ji-Hoon

    2016-09-01

    To investigate the safety and efficacy of demineralized bone matrix (DBM) as a bone graft substitute for anterior cervical discectomy and fusion (ACDF) surgery. Twenty consecutive patients treated with ACDF using stand-alone polyestheretherketone (PEEK) cages (Zero-P) with DBM(CGDBM100) were prospectively evaluated with a minimum of 6 months of follow-up. Radiologic efficacy was evaluated with a 6-point scoring method for osseous fusion using plain radiograph and computed tomogrpahy scans. Clinical efficacy was evaluated using the visual analogue scale (VAS), Owestry disability index (ODI), and short-form health questionnaire-36. The safety of the bone graft substitute was assessed with vital sign monitoring and a survey measuring complications at each follow-up visit. There were significant improvements in VAS and ODI scores at a mean 6-month follow-up. Six months after surgery, solid fusion was achieved in all patients. Mean score on the 6-point scoring system was 5.1, and bony formation was found to score at least 4 points in all patients. There was no case with implant-related complications such as cage failure or migration, and no complications associated with the use of CGDBM100. ACDF using CGDBM100 demonstrated good clinical and radiologic outcomes. The fusion rate was comparable with the published results of traditional ACDF. Therefore, the results of this study suggest that the use of a PEEK cage packed with DBM for ACDF is a safe and effective alternative to the gold standard of autologous iliac bone graft.

  3. Complications from a Distal Bicep Repair: A Meta-Analysis of a Single Incision Versus Double Incision Surgical Technique

    OpenAIRE

    Toossi, Nader; Amin, Nirav Hasmukh; Cerynik, Douglas L.; Jones, Morgan H.

    2014-01-01

    Objectives: Anatomical reinsertion of the distal biceps is critical for restoring elbow flexion and forearm supination strength. Surgical techniques utilizing one and two incisions have been reported in the literature, describing complications and outcomes. However, which technique is associated with a lower complication rate remains unclear. Methods: A systematic review was conducted using the PubMed, Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), SPORTSDiscus, a...

  4. Surgical Treatment of Orbital Blowout Fractures: Complications and Postoperative Care Patterns.

    Science.gov (United States)

    Shew, Matthew; Carlisle, Michael P; Lu, Guanning Nina; Humphrey, Clinton; Kriet, J David

    2016-11-01

    Orbital fractures are a common result of facial trauma. Sequelae and indications for repair include enophthalmos and/or diplopia from extraocular muscle entrapment. Alloplastic implant placement with careful release of periorbital fat and extraocular muscles can effectively restore extraocular movements, orbital integrity, and anatomic volume. However, rare but devastating complications such as retrobulbar hematoma (RBH) can occur after repair, which pose a risk of permanent vision loss if not addressed emergently. For this reason, some surgeons take the precaution of admitting patients for 24-hour postoperative vision checks, while others do not. The incidence of postoperative RBH has not been previously reported and existing data are limited to case reports. Our aim was to examine national trends in postoperative management and to report the incidence of immediate postoperative complications at our institution following orbital repair. A retrospective assessment of orbital blowout fractures was undertaken to assess immediate postoperative complications including RBH. Only patients treated by a senior surgeon in the Department of Otolaryngology were included in the review. In addition, we surveyed AO North America (AONA) Craniomaxillofacial faculty to assess current trends in postoperative management. There were 80 patients treated surgically for orbital blowout fractures over a 9.5-year period. Nearly all patients were observed overnight (74%) or longer (25%) due to other trauma. Average length of stay was 17 hours for those observed overnight. There was one (1.3%) patient with RBH, who was treated and recovered without sequelae. Results of the survey indicated that a majority (64%) of responders observe postoperative patients overnight. Twenty-nine percent of responders indicated that they send patients home the same day of surgery. Performance of more than 20 orbital repairs annually significantly increased the likelihood that faculty would manage patients on

  5. Transplantation of an eight-organ multivisceral graft in a patient with frozen abdomen after complicated Crohn's disease

    Institute of Scientific and Technical Information of China (English)

    Andreas Pascher; Jochen Klupp; Sven Kohler; Jan M Langrehr; Peter Neuhaus

    2006-01-01

    To report an extended multivisceral transplantation (MVTx) including right kidney and ascending colon in a patient with complicated Crohn's disease (CD).A 36-year old female suffering from short bowel syndrome and frozen abdomen due to fistulizing CD after multiple abdominal operations underwent MVTx of eight organs including stomach, pancreatoduodenal complex, liver, intestine, ascending colon, right kidney,right adrenal gland, and greater omentum in November 2003. Immunosuppression consisted of alemtuzumab,tacrolimus and steroids. The patient was off parenteral nutrition by postoperative wk 3. She experienced one episode of pneumonia. The patient recovered completely and discharged 2.5 mo and was doing well 30 mo after MVTx. This is one of the very rare cases in which a complete mulitivisceral graft of eight abdominal organs was transplanted orthotopically.

  6. Surgical sealant in the prevention of early vein graft injury in an ex vivo model

    NARCIS (Netherlands)

    Stooker, W; Niessen, HWM; Jansen, EK; Fritz, J; Wildevuur, WR; Van Hinsbergh, VWM; Wildevuur, CRH; Eijsman, L

    2003-01-01

    Background: The amelioration of the adaptation process (arterialisation) of the vein graft wall to the arterial circulation in coronary artery bypass surgery by using extravascular support is clearly established in animal models and in in vitro and ex vivo set-ups. This support consists of some form

  7. [Surgical complications in drug body-packers: an uncommon but potentially lethal emergency].

    Science.gov (United States)

    Álvarez Llano, Laura; Rey Valcárcel, Cristina; Mohamed Al-Lal, Yusef; Sánchez Rodríguez, Teresa; García Marín, Andrés; Pérez Díaz, María Dolores; Turégano Fuentes, Fernando

    2012-11-01

    Drug trafficking by means of introducing packets of illegal substances in body cavities carries a risk of suffering from a gastrointestinal obstruction and/or severe poisoning in the person who transports them. Spain is considered as the port of entry to Europe for drugs, and some Spanish hospitals have experience in managing these types of patients. Two hospitals in Madrid, including the Gregorio Marañón University General Hospital (HGUGM), received these potential patients from the Madrid Barajas airport. To analyse the results of the conservative treatment and the need for surgery in "body-packers". A retrospective, observational study of patients diagnosed as a body-packer between January 2000 and December 2008. Those with gastrointestinal symptoms, signs of poisoning, or positive for drugs of abuse, were admitted to the Custodial Unit of our hospital. The conservative treatment consisted of digestive rest and imaging studies until expulsion from the body. Asymptomatic patients were discharged from the Emergency Department. A total of 549 patients, with a median age of 31 years, and of whom 81% were males, were hospitalised during this period. Less than half (40%) showed positive for drugs in the urine, with cocaine in 80% of the cases. Of the 549 patients with initial conservative treatment, 27 (4.9%) had serious complications (16, bowel obstruction, and 11 with signs of poisoning). Of these, 23 required surgery (the 16 obstructions and 7 of the poisonings); 2 were successfully treated in ICU, and 2 died before surgery (0.4%) of the cases. The most frequent surgical treatment was enterotomy and/or gastrostomy to extract the packets. Thirteen (56%) of those operated on had associated morbidity (11 abdominal infections and 2 nosocomial infections). Conservative treatment is safe in 95% of the patients. A small percentage required surgical treatment, basically for gastrointestinal obstruction or severe poisoning. Copyright © 2011 AEC. Published by Elsevier

  8. Vascular Complications and Bleeding After Transfemoral Transcatheter Aortic Valve Implantation Performed Through Open Surgical Access.

    Science.gov (United States)

    Leclercq, Florence; Akodad, Mariama; Macia, Jean-Christophe; Gandet, Thomas; Lattuca, Benoit; Schmutz, Laurent; Gervasoni, Richard; Nogue, Erika; Nagot, Nicolas; Levy, Gilles; Maupas, Eric; Robert, Gabriel; Targosz, Frederic; Vernhet, Hélène; Cayla, Guillaume; Albat, Bernard

    2015-11-01

    Major vascular complications (VC) remain frequent after transcatheter aortic valve implantation (TAVI) and may be associated with unfavorable clinical outcomes. The objective of this study was to evaluate the rate of VC after transfemoral TAVI performed using an exclusive open surgical access strategy. From 2010 to 2014, we included in a monocentric registry all consecutive patients who underwent transfemoral TAVI. The procedures were performed with 16Fr to 20Fr sheath systems. VC were evaluated within 30 days and classified as major or minor according to the Valve Academic Research Consortium 2 definition. The study included 396 patients, 218 were women (55%), median age was 85 years (81 to 88), and the median logistic Euroscore was 15.2% (11 to 23). The balloon-expandable SAPIEN XT and the self-expandable Medtronic Core Valve prosthesis were used in 288 (72.7%) and 108 patients (27.3%), respectively. The total length of the procedure was 68 ± 15 minutes including 13 ± 5 minutes for the open surgical access. Major and minor VC were observed in 9 (2.3%) and 16 patients (4%), respectively, whereas life-threatening and major bleeding concerned 18 patients (4.6%). The median duration of hospitalization was 5 days (interquartile range 2 to 7), significantly higher in patients with VC (7 days [5 to 15], p strategy, with a particular advantage observed in high-risk bleeding patients. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Comparative analyses of postoperative complications and prognosis of different surgical procedures in stage II endometrial carcinoma treatment

    Directory of Open Access Journals (Sweden)

    Yin H

    2016-02-01

    Full Text Available Hongmei Yin,1 Ting Gui2 1Department of Obstetrics and Gynecology, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, Shandong, 2Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China Objective: To investigate the impact of surgical resection extent on the postoperative complications and the prognosis in patients with stage II endometrial cancer. Methods: A total of 54 patients were retrospectively reviewed, 35 patients underwent subradical hysterectomy and 19 patients received radical hysterectomy, both with simultaneous bilateral salpingo-oophorectomy and pelvic and paraaortic lymphadenectomy. Results: Comparing the surgical outcomes in subradical hysterectomy group vs radical hysterectomy group, there were no significant differences in operative time, estimated blood loss, and hospital stay. After surgery, 37.1% vs 36.8% patients received postoperative radiotherapy in the subradical hyster­ectomy group vs radical hysterectomy group, without statistically significant difference. As for postoperative complications, the early postoperative complication rate in patients who underwent subradical hysterectomy was 14.3%, significantly lower than that in patients submitted to radical hysterectomy (14.3% vs 42.1%, with P=0.043. However, there was no significant difference in late postoperative complication rate between the two surgical procedures. Regarding the clinical prognosis, patients receiving the subradical hysterectomy showed similar survival to their counterparts undergoing the radical procedures. The relapse rate was 5.71% vs 5.26%, respectively, without significant difference. There were no deaths in both surgical groups. Conclusion: For stage II endometrial carcinoma, subradical hysterectomy presented with less early postoperative complications and similar survival duration and recurrence

  10. Can we predict postoperative complications in elderly Chinese patients with hip fractures using the surgical risk calculator?

    Directory of Open Access Journals (Sweden)

    Wang X

    2017-09-01

    Full Text Available Xiao Wang, Bin Jiang Zhao, Yue Su Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China Purpose: Hip fractures are associated with poor prognosis in elderly patients partly due to the high rate of postoperative complications. This study was aimed to investigate whether the surgical risk calculator is suitable for predicting postoperative complications in elderly Chinese patients with hip fractures.Methods: The incidence of postoperative complications among 410 elderly patients with hip fractures was predicted by the surgical risk calculator and then compared with the actual value. The risk calculator model was evaluated using the following three metrics: Hosmer–Lemeshow test for the goodness-of-fit of the model, receiver operating characteristic curve (ROC (also referred as C-statistic for the predictive specificity and sensitivity, and the Brier’s score test for predictive accuracy.Results: Preoperative risk factors including gender, age, preoperative functional status, American Society of Anesthesiologists grade, hypertension, dyspnea, dialysis, previous cardiovascular history, and cerebrovascular disease were positively correlated with the incidence of postoperative complications in elderly patients with hip fractures. The predicted complication incidence rate was well matched with the actual complication rate by Hosmer–Lemeshow test. The model had high sensitivity and specificity for predicting the mortality rate of these patients with a C-statistic index of 0.931 (95% CI [0.883, 0.980]. The surgical calculator model had an accuracy of 90% for predicting the reoperation rate (Brier’s score <0.01.Conclusions: The surgical risk calculator could be useful for predicting mortality and reoperation in elderly patients with hip fracture. Patients and surgeons may use this simple calculator to better manage the preoperative risks. Keywords: hip fracture, femoral head fracture, elder age, surgical

  11. Effects of Cataract Surgery on Endothelium in Transplanted Corneal Grafts: Comparison of Extracapsular Cataract Extraction and Phacoemulsification for Complicated Cataract after Penetrating Keratoplasty

    Institute of Scientific and Technical Information of China (English)

    Hong-Wei Zhou; Li-Xin Xie

    2016-01-01

    Background:The endothelium should be carefully evaluated when choosing a surgical technique for cataract removal.Therefore,we aimed to study the effects of different cataract surgery techniques on endothelial cell loss in transplanted comeal grafts.Methods:A total of 54 patients who received complicated cataract surgery in post-penetrating keratoplasty (PKP) eyes at the Shandong Eye Institute between February 2001 and June 2014 were included,and clinical records were reviewed.Baseline demographic details,clinical characteristics,endothelial cell density (ECD),and best-corrected visual acuity (BCVA) were recorded.Wilcoxon rank-sum test and Wilcoxon signed-rank test were used to test the equality of medians.A regression model was constructed to compare the reduced rate of ECD.Results:Of the 54 eyes included in this study,extracapsular cataract extraction (ECCE) was performed in 34 eyes of 33 patients (ECCE group) whereas phacoemulsification was performed in 20 eyes of 20 patients (phacoemulsification group).There was no significant difference in the median age (P =0.081) or preoperative ECD (P =0.585) between the two groups.At 6 months after cataract surgery,ECD in ECCE group was significantly higher than that in phacoemulsification group (P =0.043).In addition,the endothelial cell loss rate in ECCE group was significantly lower than that in phacoemulsification group at 2 months (P =0.018),4 months (P < 0.001),and 6 months (P < 0.001) after cataract surgery.Endothelial cell loss rate after cataract surgery increased over the 6-month study duration in both ECCE group (P < 0.00 l) and phacoemulsification group (P < 0.001),but phacoemulsification resulted in a greater reduction in ECD than that of ECCE in transplanted corneal grafts (P < 0.001).There was no significant difference in postoperative BCVA between the two groups (P =0.065).Conclusion:ECCE is more suitable than phacoemulsification in cataract surgery in complicated cataract after PKP.

  12. Leiomyosarcoma of inferior vena cava involving bilateral renal veins: Surgical challenges and reconstruction with upfront saphenous vein interposition graft for left renal vein outflow

    Directory of Open Access Journals (Sweden)

    Rishi Nayyar

    2010-01-01

    Full Text Available Leiomyosarcoma of inferior vena cava (IVC involving bilateral renal veins presents a surgical challenge. Herein, we report the successful management of two such cases using restoration of left renal venous outflow by saphenous vein interposition graft as first step of surgery. Then radical resection of tumor and right kidney was done. IVC was lastly reconstructed using Gore-Tex graft. This report highlights the surgical challenges to ensure radical resection. Furthermore, the importance of restoring left renal outflow in presence of concomitant right nephrectomy is discussed. Both the patients were disease free at six months with no loss of left renal glomerular filtration rate.

  13. Prospective clinical study of surgical management of varicose veins of lower limb and its complications

    Directory of Open Access Journals (Sweden)

    Nagaraj H.

    2014-02-01

    Methods: Two years prospective study was conducted in our institution from May 2007 to April 2009. During this period 62 cases of varicose veins of lower limbs were admitted to our hospital of which 50 cases were selected and were studies in detail. After thorough clinical examination and relevant investigation they are all subjected to surgical management. Results: Out of 50 cases studied, 21 (42% had only long saphenous vein involvement, 7 (14% had short saphenous vein involvement and in 5 (10% cases both short and long saphenous system were involved. In addition to long saphenous vein involvement, incompetent perforators were present in 17 (34% cases. Among them prominent veins and pain were the main complain in 38 (78% patients. Itching and pigmentation were present in 4 (8% patients. Ankle edema was present in 6 (12% patients. Pain and ulceration of lower leg were present in 2 (4% patients. After clinical assessment appropriate surgical procedures were followed for each of patients. These cases were followed for 3 year durations. Out of 50 patients 7 (14% patients had recurrence of varicose vein. 7 (14% patient complained of recurrence of pain after 2 years of surgery but no appearance of varicose vein. One patient (2% complained of persistence of pigmentation after surgery. 2 (4% patients complained of persistence of ankle edema and there was complete healing of ulcer which was present earlier. Conclusions: Commonest age group of varicose vein of lower limb was 20 to 40 years. Definite relationship exists between the occupation and the incidence of varicose veins. The patients were in the occupation which required standing for long time had the higher chances of varicose vein. Severity of the symptoms is not proportional to the duration of varicose veins. The involvement of long saphenous vein is more common than the short saphenous vein. Since our study shows very low percentage of recurrence and symptoms related to varicose vein the surgical line of

  14. Complications in the use of the mandibular body, ramus and symphysis as donor sites in bone graft surgery. A systematic review

    Science.gov (United States)

    Cobo-Vázquez, Carlos; Monteserín-Matesanz, Marta; López-Quiles, Juan

    2016-01-01

    Background To develop a systematic review by assessing and comparing the different complications that occurs in bone graft surgery using the mandibular body, ramus and symphysis as donor sites. Material and Methods In order to respond to the following question, a systematic review was developed: does the use of intraoral mandibular body and ramus as donor sites in bone graft surgery, produce fewer and less severe complications in comparison to the use of the mandibular symphysis in patients that present bone resorption that needs augmentation using autologous grafts? The review was carried out between January 1990 and 2015, during which only clinical essays with a minimum follow-up period of six months were included. Results The initial search yielded a total of 2912 articles, of which 6 were finally selected. In total, 259 graft surgeries were performed; 118 using the mandibular body and ramus as donor sites, and 141, the symphysis. The most frequent complications that arose when using the mandibular symphysis were temporary sensory alterations in the anterior teeth (33.87%), followed by sensory alterations of the skin and mucosa (18.57%). As for the mandibular body and ramus donor sites, the most frequent complications relate to temporary sensory alterations of the mucosa (8.19%) and to minor postoperative bleeding (6.55%). Conclusions The analyzed results show a higher prevalence and severity of complications when using mandibular symphysis bone grafts, producing more discomfort for the patient. Therefore, it would be advisable to perform further clinical essays due to the lack of studies found. Key words:Alveolar ridge augmentation, autogenous bone, mandibular bone grafts, chin, mandibular symphysis, mandibular ramus. PMID:26827063

  15. Pancreatic surgical biopsy in 24 dogs and 19 cats: postoperative complications and clinical relevance of histological findings.

    Science.gov (United States)

    Pratschke, K M; Ryan, J; McAlinden, A; McLauchlan, G

    2015-01-01

    To assess the immediate postoperative complications associated with pancreatic biopsy in dogs and cats and review the clinical relevance of biopsy findings. Retrospective review of clinical records from two referral institutions for cases undergoing pancreatic biopsy between 2000 and 2013. Twenty-four dogs and 19 cats that had surgical pancreatic biopsy had sufficient detail in their clinical records and fulfilled the inclusion criteria. Postoperative complications were seen in 10 cases of which 5 were suggestive of post-surgical pancreatitis. Two patients were euthanased within 10 days of surgery because of the underlying disease; neither suffered postoperative complications. Pancreatic pathology was found in 19 cases, 7 cases showed no change other than benign pancreatic nodular hyperplasia, and no abnormalities were seen in 18 cases. Complications may be encountered following surgical pancreatic biopsy, although the risk should be minimal with good surgical technique. Pancreatic biopsy may provide a useful contribution to case management but it is not clear whether a negative pancreatic biopsy should be used to rule out pancreatic disease. Dogs were more likely to have no significant pathology found on pancreatic biopsy than cats, where chronic pancreatitis was the most common finding. © 2014 British Small Animal Veterinary Association.

  16. Safety of elective colorectal cancer surgery : Non-surgical complications and colectomies are targets for quality improvement

    NARCIS (Netherlands)

    Henneman, Daniel; Ten Berge, Martijn G.; Snijders, Heleen S.; Van Leersum, Nicoline J.; Fiocco, Marta; Wiggers, Theo; Tollenaar, Rob A. E. M.; Wouters, Michel W. J. M.

    2014-01-01

    Background Mortality following severe complications (failure-to-rescue, FTR) is targeted in surgical quality improvement projects. Rates may differ between colon- and rectal cancer resections. Methods Analysis of patients undergoing elective colon and rectal cancer resections registered in the Dutch

  17. Coarctation of the Aorta as a Complication of Surgical Ligation of Patent Ductus Arteriosus in a Premature Infant

    Science.gov (United States)

    Qasim, Amna; Jain, Sunil K.; Jiwani, Amyn K.

    2017-01-01

    Surgical ligation of a patent ductus arteriosus (PDA) is a commonly performed procedure. Complications are infrequent and most commonly include recurrent laryngeal nerve injury and rarely ligation of left pulmonary artery. We report a case of accidental ligation of the descending thoracic aorta leading to a clinically significant coarctation. PMID:28386503

  18. The Impact of Sarcopenia on Survival and Complications in Surgical Oncology: A Review of the Current Literature

    Science.gov (United States)

    JOGLEKAR, SAVITA; NAU, PETER N.; MEZHIR, JAMES J.

    2016-01-01

    Sarcopenia is the subclinical loss of skeletal muscle and strength and has been extensively studied in both the cancer and surgical literature. Specifically, sarcopenia has gained significant recognition as an important prognostic factor for both complications and survival in cancer patients. Herein, we review the current literature to date highlighting the specific impact of sarcopenia in patients undergoing oncologic procedures. PMID:26310812

  19. Searching for predictors of surgical complications in critically ill surgery patients in the intensive care unit: a review

    NARCIS (Netherlands)

    Meyer, Z.C.; Schreinemakers, J.M.J.; Waal, R.A. de; Laan, L. van der

    2015-01-01

    We reviewed the use of the levels of C-reactive protein, lactate and procalcitonin and/or the Sequential Organ Failure Assessment score to determine their diagnostic accuracy for predicting surgical complications in critically ill general post-surgery patients. Included were all studies published in

  20. The impact of sarcopenia on survival and complications in surgical oncology: A review of the current literature.

    Science.gov (United States)

    Joglekar, Savita; Nau, Peter N; Mezhir, James J

    2015-10-01

    Sarcopenia is the subclinical loss of skeletal muscle and strength and has been extensively studied in both the cancer and surgical literature. Specifically, sarcopenia has gained significant recognition as an important prognostic factor for both complications and survival in cancer patients. Herein, we review the current literature to date highlighting the specific impact of sarcopenia in patients undergoing oncologic procedures.

  1. Surgical-site infections and postoperative complications: agreement between the Danish Gynecological Cancer Database and a randomized clinical trial

    DEFF Research Database (Denmark)

    Antonsen, Sofie L; Meyhoff, Christian Sylvest; Lundvall, Lene

    2011-01-01

    OBJECTIVE: Surgical-site infections are serious complications and thorough follow-up is important for accurate surveillance. We aimed to compare the frequency of complications recorded in a clinical quality database with those noted in a randomized clinical trial with follow-up visits. DESIGN......-operation, urinary tract infection, pneumonia and sepsis. RESULTS: Surgical-site infection was found in 21 of 222 patients (9.5%) in the PROXI trial versus 6 of 222 patients (2.7%) in the DGCD (p ... registered in the PROXI trial, but not in the DGCD. Agreements between secondary outcomes were very varying (kappa-value 0.77 for re-operation, 0.37 for urinary tract infections, 0.19 for sepsis and 0.18 for pneumonia). CONCLUSIONS: The randomized trial reported significantly more surgical-site infections...

  2. Surgical complications specific to monopolar electrosurgical energy: engineering changes that have made electrosurgery safer.

    Science.gov (United States)

    Odell, Roger C

    2013-01-01

    Monopolar electrosurgical energy is the most commonly used energy source during laparotomic and laparoscopic surgery. The clinical application of monopolar energy is not without risk. Monopolar electrosurgical energy was introduced into surgical practice at the turn of the 20th century. Alternate site burns during laparotomic application were the most common complication for the first half century (i.e., ground point burns and dispersive electrode burns [1920-1970]). The aims of this article were to discuss historic design flaws associated with the most common alternate site burns, ground point burns, and dispersive electrode burns and the technological advancements introduced to mitigate these risks to the patient and to discuss current design flaws associated with stray energy burns during laparoscopy because of insulation failure and capacitive coupling and the technological advancements introduced to eliminate these risks to the patient. Today, insulation failure and capacitive coupling are the most common reasons for electrosurgical injury during laparocopic procedures. There is a need for advanced technology such as active electrode monitoring to address these invisible risks to the surgeon and their patients. In addition, the laparoscopic surgeon should be encouraged to study the basic biophysics involved in electrosurgery.

  3. Adjacent tooth trauma in complicated mandibular third molar surgery: Risk degree classification and digital surgical simulation

    Science.gov (United States)

    Ye, Zhou-Xi; Yang, Chi; Ge, Jing

    2016-01-01

    Analysis of adjacent tooth resistance is essential in wisdom teeth extraction to prevent adjacent tooth trauma, however it lacks adequate attention nowadays. This study aims at suggesting special extraction methods based on adjacent tooth resistance analysis for prevention of adjacent tooth damage. In this study, 136 complicated mandibular third molars extracted using piezosurgery were reviewed and classified based on the adjacent teeth resistances shown in orthopantomogram (OPG) during their mesio-distal rotations: degree I refers to teeth with no adjacent teeth resistance; degree II refers to teeth with resistance released after mesial-half crown sectioning; degree III refers to teeth which still had resistance after mesial-half crown sectioning. With the use of surgical simulations using cone beam computerized tomography (CBCT) reconstruction, all teeth in degree I were designed to rotate mesio-distally; 86.36%(38/44) teeth in degree II were designed to rotate mesio-distally after mesio-half crown sectioning; 69.09%(36/55) teeth in degree III were designed to rotate bucco-lingually. All teeth were extracted successfully, and only one adjacent tooth was subluxated due to the incomplete bone removal. Our study suggested that in order to prevent adjacent teeth trauma, complete bone removal is of importance, and impacted teeth with higher adjacent teeth trauma risks should consider bucco-lingual rotations. PMID:27974819

  4. Adjacent tooth trauma in complicated mandibular third molar surgery: Risk degree classification and digital surgical simulation.

    Science.gov (United States)

    Ye, Zhou-Xi; Yang, Chi; Ge, Jing

    2016-12-15

    Analysis of adjacent tooth resistance is essential in wisdom teeth extraction to prevent adjacent tooth trauma, however it lacks adequate attention nowadays. This study aims at suggesting special extraction methods based on adjacent tooth resistance analysis for prevention of adjacent tooth damage. In this study, 136 complicated mandibular third molars extracted using piezosurgery were reviewed and classified based on the adjacent teeth resistances shown in orthopantomogram (OPG) during their mesio-distal rotations: degree I refers to teeth with no adjacent teeth resistance; degree II refers to teeth with resistance released after mesial-half crown sectioning; degree III refers to teeth which still had resistance after mesial-half crown sectioning. With the use of surgical simulations using cone beam computerized tomography (CBCT) reconstruction, all teeth in degree I were designed to rotate mesio-distally; 86.36%(38/44) teeth in degree II were designed to rotate mesio-distally after mesio-half crown sectioning; 69.09%(36/55) teeth in degree III were designed to rotate bucco-lingually. All teeth were extracted successfully, and only one adjacent tooth was subluxated due to the incomplete bone removal. Our study suggested that in order to prevent adjacent teeth trauma, complete bone removal is of importance, and impacted teeth with higher adjacent teeth trauma risks should consider bucco-lingual rotations.

  5. Frontal sinus mucocele with orbital complications: Management by varied surgical approaches

    Science.gov (United States)

    Aggarwal, Sushil Kumar; Bhavana, Kranti; Keshri, Amit; Kumar, Raj; Srivastava, Arun

    2012-01-01

    A mucocele of a para-nasal sinus is an accumulation of mucoid secretion and desqua-mated epithelium within the sinus with distension of its walls and is regarded as a cyst like expansile and destructive lesion. If the cyst invades the adjacent orbit and continues to expand within the orbital cavity, the mass may mimic the behavior of many benign growths primary in the orbit. The frontal sinus is most commonly involved, whereas sphenoid, ethmoid, and maxillary mucoceles are rare. Floor of frontal sinus is shared with the superior orbital wall which explains the early displacement of orbit in enlarging frontal mucoceles. Frontal sinus mucoceles are prone to recurrences if not managed adequately. Here, we are evaluating different approaches used to manage various stages of frontal mucoceles which presented to us with orbital complications. Three cases of frontal sinus mucocele are discussed which presented to our OPD with different clinical symptoms and all cases were managed by different surgical approaches according to their severity. We also concluded that it is prudent to collaborate with the neurosurgeons for adequate management of such complex mucoceles by a craniotomy approach. PMID:23293669

  6. Standardized surgical techniques for adult living donor liver transplantation using a modified right lobe graft: a video presentation from bench to reperfusion.

    Science.gov (United States)

    Hwang, Shin; Ha, Tae-Yong; Ahn, Chul-Soo; Moon, Deok-Bog; Kim, Ki-Hun; Song, Gi-Won; Jung, Dong-Hwan; Park, Gil-Chun; Lee, Sung-Gyu

    2016-08-01

    After having experienced more than 2,000 cases of adult living donor liver transplantation (LDLT), we established the concepts of right liver graft standardization. Right liver graft standardization intends to provide hemodynamics-based and regeneration-compliant reconstruction of vascular inflow and outflow. Right liver graft standardization consists of the following components: Right hepatic vein reconstruction includes a combination of caudal-side deep incision and patch venoplasty of the graft right hepatic vein to remove the acute angle between the graft right hepatic vein and the inferior vena cava; middle hepatic vein reconstruction includes interposition of a uniform-shaped conduit with large-sized homologous or prosthetic grafts; if the inferior right hepatic vein is present, its reconstruction includes funneling and unification venoplasty for multiple short hepatic veins; if donor portal vein anomaly is present, its reconstruction includes conjoined unification venoplasty for two or more portal vein orifices. This video clip that shows the surgical technique from bench to reperfusion was a case presentation of adult LDLT using a modified right liver graft from the patient's son. Our intention behind proposing the concept of right liver graft standardization is that it can be universally applicable and may guarantee nearly the same outcomes regardless of the surgeon's experience. We believe that this reconstruction model would be primarily applied to a majority of adult LDLT cases.

  7. Physical therapy for post coronary artery bypass grafting complications -A Case Report

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    Anitha Kumari Abbina

    2013-04-01

    Full Text Available Background:This case report describes about the female patient who came with cough, breathlessness and neck pain after one month following coronary artery bypass grafting to the cardiology department. Chest radiograph was taken and diagnosed it as pleural effusion with atelectasis of left lower lobe. Later therapeutic thoracentesis was done to aspirate the fluid and referred the case to physiotherapy. Thorough physical examination showed reduced neck mobility due to trigger points and spasm of the neck muscles which are causing pain, and also breathlessness on walking, on percussion dull note on left lower lobe, on auscultation crackles are heard with diminished breath sounds over the left lower lobe, altered chest symmetry reduced chest expansion of the lower chest. To reduce neck pain and improve neck mobility she was treated with cryostretches,trigger point release technique, myofascial release and muscle energy techniques. She was treated with positioning, chest percussion, vibration and shaking, deep breathing exercises, thoracic expansion exercises, segmental breathing to lower lobes, incentive spirometry every one hour ten times, trunk and thoracic mobilityexercises were done twice in a day to reduce breathlessness. After 15 days again x-ray was taken where lung was re-expanded and also there are free movements of the neck without pain.

  8. 1期手术治疗主动脉缩窄合并心内畸形%Surgical treatment for coarctation of aorta complicated with intracardiac abnormalities

    Institute of Scientific and Technical Information of China (English)

    王冲; 伯平; 司安家; 程明

    2012-01-01

    Objective To study the efficacy of surgical treatment for coarctation of aorta (COA) complicated with intracardiac abnormalities. Methods Twelve patients with COA complicated with intracardiac abnormalities who underwent surgical treatment from April 2008 to April 2011 were included in the study. Two patients were accompanied by VSD,three associated with PDA,seven with VSD and PDA and two patients with diffuse hypoplasia of aortic arch. All patients underwent one - stage repair. One patient received left posterolateral thoracotomy combined with median sternotomy. Eleven patients received single median sternotomy and excision of coarctation. End to side or end to end anastomoses was used in 8 patients,aortoplasty with patch graft was used in 3 patients,and a bypass with artificial graft was used in 1 patient. Results There was no death in all patients. All patients were followed up from 3 to 48 months. The results of all patients were satisfactory. The follow - up echocardiography showed that there was no coarctation and false a-neurysm. Conclusion The appropriate surgical management according to the age of patients has satisfactory effect on coa and associated intracardiac abnormalities. The surgical methods should be selected according to the disease course,presence of complications and measures should be taken to avoid complication such as recurrence and formation of aneurysm.%目的 探讨主动脉缩窄合并心内畸形的外科治疗方法.方法 2008年4月~2011年4月共手术治疗CoA合并其他心内畸形12例,其中合并VSD 2例,ASD 3例,VSD+ PDA 7例,合并主动脉弓发育不良2例.全组均行一期矫治,1例采用胸骨正中切口加左后外侧切口进行矫治,11例行胸骨正中单一切口.其中8例患者动脉缩窄段切除端端或端侧吻合,3例患者补片扩大成形,1例行人工血管植入.结果 全组无手术死亡,均顺利出院.随访3~40月,术后恢复良好.超声复查无吻合口狭窄,无吻合处动脉瘤形

  9. Preserving the socket dimensions with bone grafting in single sites: an esthetic surgical approach when planning delayed implant placement.

    Science.gov (United States)

    Irinakis, Tassos; Tabesh, Moe

    2007-01-01

    Recent advancements in barrier membranes, bone grafting substitutes, and surgical techniques have led to a predictable arsenal of treatment methods for clinicians who practice implant dentistry. The contemporary clinician is supplied with proven knowledge, substantiated materials, and instrument inventory that allows implant placement in cases that used to be reserved for the specialist in the past because of their complexity. Nowadays, postextraction alveolar ridge maintenance can be a predictable procedure and can certainly aid the clinician in preventing ridge collapse, thereby allowing for implant placement in a position that satisfies esthetics and function. Extraction socket maintenance for future implant therapy does not rule out immediate implant placement but rather provides an additional option when treatment planning implant patients. This article will focus on the concept of extraction socket preservation using regenerative materials. It will describe a technique suggested by the authors to resist bone resorption and soft tissue shrinkage following tooth extraction.

  10. Semitendinosus and gracilis free muscle-tendon graft for repair of massive rotator cuff tears: surgical technique.

    Science.gov (United States)

    Gigante, Antonio; Bottegoni, Carlo; Milano, Giuseppe; Riccio, Michele; Dei Giudici, Luca

    2016-01-01

    Massive rotator cuff tears are difficult to treat surgically due to retraction, degeneration and fraying of the ends of torn tendons, severe fatty infiltration and atrophy of the respective muscles. Procedures developed to close the gap between the rotator cuff and the greater tuberosity of the humerus, such as soft tissue release may be inadequate for large tears. Human or porcine dermal allografts still have uncertain benefits, and tendon transfers seem to be associated with poor outcomes, donor site morbidity and altered mechanics. Reverse total shoulder arthroplasty has limited durability and is not indicated in young patients with high functional demands. We developed a new technique for repairing massive rotator cuff tears by semitendinosus and gracilis myotendinous grafting. This novel therapeutic option allows massive rotator cuff tears to be repaired using autologous material that is adequate and adaptable, making it possible to cover any width of defect. The technique is low-invasive and not technically demanding, with minimal donor site morbidity.

  11. Hybrid Graft Anterior Cruciate Ligament Reconstruction: A Predictable Graft for Knee Stabilization.

    Science.gov (United States)

    Alvarez-Pinzon, Andres M; Barksdale, Leticia; Krill, Michael K; Leo, Brian M

    2015-06-01

    Trauma to the anterior cruciate ligament (ACL) is a season-ending injury and involves months of activity modification and rehabilitation. The annual incidence of ACL tears in the United States is approximately 200,000, which allows for a broad range of individualized treatment options. Various surgical techniques, including transtibial and independent tunnel drilling, allograft and autograft tissue, and various implants, have been described in the literature. This article describes the indications and technique for a hybrid soft tissue graft for ACL reconstruction. Autologous grafts eliminate the risk of disease transmission and have recently been shown to have a lower rerupture rate, particularly in younger, active patients; however, the harvesting of autologous hamstring grafts carries a risk of donor-site morbidity, iatrogenic injury of the graft, and inadequate graft size. In contrast to a traditional autologous soft tissue graft, the hybrid graft allows for graft size customization for a desired reconstruction, especially in cases where autograft hamstrings may be iatrogenically damaged or of inadequate size when harvested. The goal of a hybrid graft ACL reconstruction is to provide a favorable-sized graft with clinical outcomes comparable with autologous soft tissue grafts. In contrast to a traditional autologous soft tissue graft, this technique provides another option in the event of unforeseen deficiencies or complications associated with harvesting and preparation of the autologous gracilis and semitendinosis soft tissue graft.

  12. Buccal mucosal graft urethroplasty for proximal bulbar urethral stricture: A revisit of the surgical technique and analysis of eleven consecutive cases

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    Irekpita Eshiobo

    2016-01-01

    Full Text Available Background: Urethral stricture disease is prevalent, and many surgical techniques have been developed to treat it. Currently, urethroplasty for bulbar strictures implies ventral or dorsal stricturotomy and a buccal mucosa graft (BMG patch. Objective: To describe the surgical approach of the ventral patch BMG urethroplasty for proximal bulbar urethral stricture and to analyze 11 consecutive cases for whom the technique was used. Patients and Methods: The diagnosis of urethral stricture was confirmed with a combined retrograde urethrography and micturating cystourethrography. A single team exposed the urethra, harvested, and planted the BMG in the lithotomy position under general anesthesia. The oral preoperative preparation was done with oraldene (hexetidine mouth wash three times daily beginning from the 2nd preoperative day. The buccal mucosa was harvested from the left inner cheek in all the patients. The donor site was left unclosed but packed with wet gauze. Data related to age, preoperative adverse conditions, stricture length, urine culture result, perineal/oral wound complications, postoperative residual urine volume, and duration of hospital stay were recorded. Results: Eleven patients with proximal bulbar urethral stricture had BMG urethroplasty from August 2013 to October 2015. Stricture length ranged from 2 to 5 cm. In six (54% of the men, the stricture resulted from urethritis thereby constituting the most common etiology of urethral stricture in this study. The preoperative adverse conditions were age above 70 in three, diabetes mellitus in two, severe dental caries in one, and recurrent stricture in two. All of them were able to resume reasonable oral intake 72 h postoperatively. One (9.2% had perineal wound infection, while two (18.2% still had mild pain at donor site 4 weeks postoperatively. Ten (90.9% of the 11 patients had <30 ml residual urine volume at 2 months of follow-up. Conclusion: Urethritis is still a common cause of

  13. Neurological complications in thyroid surgery: a surgical point of view on laryngeal nerves.

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    EMANUELA eVARALDO

    2014-07-01

    Full Text Available The cervical branches of the vagus nerve that are pertinent to endocrine surgery are the superior and the inferior laryngeal nerves: their anatomical course in the neck places them at risk during thyroid surgery. The external branch of the superior laryngeal nerve (EB is at risk during thyroid surgery because of its close anatomical relationship with the superior thyroid vessels and the superior thyroid pole region. The rate of EB injury (which leads to the paralysis of the cricothyroid muscle varies from 0 to 58%. The identification of the EB during surgery helps avoiding both an accidental transection and an excessive stretching. When the nerve is not identified,the ligation of superior thyroid artery branches close to the thyroid gland is suggested, as well as the abstention from an indiscriminate use of energy-based devices that might damage it. The inferior laryngeal nerve (RLN runs in the tracheoesophageal groove toward the larynx, close to the posterior aspect of the thyroid. It is the main motor nerve of the intrinsic laryngeal muscles, and also provides sensory innervation to the larynx. Its injury finally causes the paralysis of the omolateral vocal cord and various sensory alterations: the symptoms range from mild to severe hoarseness, to acute airway obstruction and swallowing impairment. Permanent lesions of the RNL occur from 0.3 to 7% of cases, according to different factors. The surgeon must be aware of the possible anatomical variations of the nerve which should be actively searched for and identified. Visual control and gentle dissection of RLN are imperative. The use of intraoperative nerve monitoring has been safely applied but, at the moment, its impact in the incidence of RLN injuries has not been clarified. In conclusion, despite a thorough surgical technique and the use of intraoperative neuromonitoring, the incidence of neurological complications after thyroid surgery cannot be suppressed, but should be maintained in a

  14. Patient outcomes and surgical complications in coccidioidomycosis-related hydrocephalus: an institutional review.

    Science.gov (United States)

    Hardesty, Douglas A; Ramey, Wyatt; Afrasiabi, Mohammad; Beck, Brian; Gonzalez, Omar; Moran, Ana; Nakaji, Peter

    2014-10-01

    Coccidioidomycosis is a common fungal infection in the southwestern US. Hydrocephalus is a serious complication of cranial coccidioidomycosis, and the surgical management of coccidioidomycosis-related hydrocephalus has unique challenges. The authors reviewed their institutional experience with hydrocephalus in the setting of coccidioidomycosis. The authors retrospectively identified 44 patients diagnosed with coccidioidomycosis-related hydrocephalus at their institution since 1990, who underwent a total of 99 shunting procedures. The authors examined patient demographics, type of shunt and valve used, pressure settings, failure rates, medical treatment, ventricular response to shunting, and other variables. The majority of patients were young (average age 37 years) men (male/female ratio 28:16) with a mean follow-up of 63 months. Patients of Asian and African descent were overrepresented in the cohort compared with regional demographic data. The overall shunt failure rate during follow-up was 50%, and the average number of revisions required if the shunt failed was 2.5 (range 1-8). Low to moderate draining pressures (mean 88 mm H2O) were used in this cohort. Fourteen patients received intrathecal antifungals, and a trend of initiating intrathecal therapy after need for a shunt revision was observed (p = 0.051). The majority of shunt failures (81%) were due to mechanical blockages in the drainage system. Most patients (59%) had at least partial persistent postoperative ventriculomegaly despite successful CSF diversion. Four patients (9%) died due to coccidioidomycosis during the follow-up period. Coccidioidomycosis-related hydrocephalus more often affected young males in the study's cohort, especially those of African and Asian descent. Despite the best medical therapy, there was a high rate of shunt failure due to clogged catheters or valves due to the underlying disease process. Many patients continued to have ventriculomegaly even with adequate CSF diversion. The

  15. Complications after Surgical Procedures in Patients with Cardiac Implantable Electronic Devices: Results of a Prospective Registry.

    Science.gov (United States)

    Silva, Katia Regina da; Albertini, Caio Marcos de Moraes; Crevelari, Elizabeth Sartori; Carvalho, Eduardo Infante Januzzi de; Fiorelli, Alfredo Inácio; Martinelli, Martino; Costa, Roberto

    2016-09-01

    Complications after surgical procedures in patients with cardiac implantable electronic devices (CIED) are an emerging problem due to an increasing number of such procedures and aging of the population, which consequently increases the frequency of comorbidities. To identify the rates of postoperative complications, mortality, and hospital readmissions, and evaluate the risk factors for the occurrence of these events. Prospective and unicentric study that included all individuals undergoing CIED surgical procedures from February to August 2011. The patients were distributed by type of procedure into the following groups: initial implantations (cohort 1), generator exchange (cohort 2), and lead-related procedures (cohort 3). The outcomes were evaluated by an independent committee. Univariate and multivariate analyses assessed the risk factors, and the Kaplan-Meier method was used for survival analysis. A total of 713 patients were included in the study and distributed as follows: 333 in cohort 1, 304 in cohort 2, and 76 in cohort 3. Postoperative complications were detected in 7.5%, 1.6%, and 11.8% of the patients in cohorts 1, 2, and 3, respectively (p = 0.014). During a 6-month follow-up, there were 58 (8.1%) deaths and 75 (10.5%) hospital readmissions. Predictors of hospital readmission included the use of implantable cardioverter-defibrillators (odds ratio [OR] = 4.2), functional class III--IV (OR = 1.8), and warfarin administration (OR = 1.9). Predictors of mortality included age over 80 years (OR = 2.4), ventricular dysfunction (OR = 2.2), functional class III-IV (OR = 3.3), and warfarin administration (OR = 2.3). Postoperative complications, hospital readmissions, and deaths occurred frequently and were strongly related to the type of procedure performed, type of CIED, and severity of the patient's underlying heart disease. Complicações após procedimentos cirúrgicos em portadores de dispositivos cardíacos eletrônicos implantáveis (DCEI) são um

  16. Diagnostic value of color Doppler ultrasonography and MDCT angiography in complications of hemodialysis fistulas and grafts

    Energy Technology Data Exchange (ETDEWEB)

    Cansu, Aysegul, E-mail: drcansu@gmail.com [Department of Radiology, Karadeniz Technical University, School of Medicine, Farabi Hospital, 61080 Trabzon (Turkey); Soyturk, Mehmet; Ozturk, Mehmet Halil; Kul, Sibel [Department of Radiology, Karadeniz Technical University, School of Medicine, Farabi Hospital, 61080 Trabzon (Turkey); Pulathan, Zerrin [Department of Cardiovascular Surgery, Karadeniz Technical University, School of Medicine, Farabi Hospital, 61080 Trabzon (Turkey); Dinc, Hasan [Department of Radiology, Karadeniz Technical University, School of Medicine, Farabi Hospital, 61080 Trabzon (Turkey)

    2013-09-15

    Purpose: The purpose of the study was to compare the diagnostic value of color Doppler ultrasonography (CDUS) and multidetector computed tomography (MDCT) angiography against that of digital subtraction angiography (DSA) or surgery in the evaluation of failing hemodialysis arteriovenous fistulas (AVFs). Materials and methods: CDUS and MDCT angiography were performed with 41 patients (24 men, 17 women; mean age 55.8) with dysfunctional hemodialysis fistulas. The presence of stenosis, thrombosis, aneurysm, pseudoaneurysm and seroma were recorded. The sensitivity, specificity, positive and negative predictive values (PPV and NPV) and accuracy of CDUS and MDCT angiography were calculated both individually and in combination for the detection of vascular segments with significant stenosis, thrombosis, aneurysms, pseudoaneurysms, perivascular complications and stenosis subgroups. Results: Sixty-four segmental lesions were diagnosed by DSA or surgery. Sensitivity, specificity, PPV, NPV and accuracy of CDUS for all vascular tree lesions were 85.9%, 99.2%, 96.4%, 96.7% and 94.5%, respectively. For MDCT angiography the figures were 96.8%, 99.6%, 98.4%, 99.2% and 98.5%, respectively. When both tests were used in combination, sensitivity, specificity, PPV, NPV and accuracy for all vascular tree lesions rose to 100%. Conclusion: Combined use of MDCT and CDUS for diagnosis of AVF dysfunctions is of equivalent value to surgery or DSA, a gold standard technique.

  17. The role of the internal medicine specialist in the management of infective complications in general surgical wards

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    Patrizia Zoboli

    2013-05-01

    Full Text Available BACKGROUND Internal medicine specialists are often asked to evaluate a patient before surgery. Perioperative risk evaluation for elderly patients is important, because complications increase with age. The increasing age of the general population increases the probabilities of surgery in the older patients. The manifestation of a surgical problem, is more likely to be severe and complicated in the elderly patients. In fact, emergency surgery treatment occurs more frequently in the elderly (e.g., it is much more common to see intestinal obstruction complicating colorectal cancer in the elderly compared with a younger population. Old age is an independent factor for long hospital stay after surgery. The role of the preoperative medical consultant is to identify and evaluate a patient’s current medical status and provide a clinical risk profile, in order to decide whether further tests are indicated prior to surgery, and to optimise the patient’s medical condition in the attempt of reducing the risk of complications. The medical consultant must know which medical condition could eventually influence the surgery, achieve a good contact and communication between the medical and surgical team, in order to obtain the best management planning. AIM OF THE STUDY This paper focuses on the rational use of antibiotic prophylaxis and on the treatment of the complications of post-surgery infections (e.g., pulmonary complication, peritonitis, intra-abdominal infection. Specific aspects of pre-operative risk evaluation and peri and post-operative management are discussed. CONCLUSIONS The internal medicin specialist in collaboration with the surgical team is necessary in the peri and post-surgery management.

  18. Influence of Surgical Technique, Performance Status, and Peritonitis Exposure on Surgical Site Infection in Acute Complicated Diverticulitis: A Matched Case-Control Study.

    Science.gov (United States)

    Zonta, Sandro; De Martino, Michela; Podetta, Michele; Viganò, Jacopo; Dominioni, Tommaso; Picheo, Roberto; Cobianchi, Lorenzo; Alessiani, Mario; Dionigi, Paolo

    2015-10-01

    Acute generalized peritonitis secondary to complicated diverticulitis is a life-threatening condition; the standard treatment is surgery. Despite advances in peri-operative care, this condition is accompanied by a high peri-operative complication rate (22%-25%). No definitive evidence is available to recommend a preferred surgical technique in patients with Hinchey stage III/IV disease. A matched case-control study enrolling patients from four surgical units at Italian university hospital was planned to assess the most appropriate surgical treatment on the basis of patient performance status and peritonitis exposure, with the aim of minimizing the surgical site infection (SSI). A series of 1,175 patients undergoing surgery for Hinchey III/IV peritonitis in 2003-2013 were analyzed. Cases (n=145) were selected from among those patients who developed an SSI. control ratio was 1:3. Cases and control groups were matched by age, gender, body mass index, and Hinchey grade. We considered three surgical techniques: T1=Hartman's procedure; T2=sigmoid resection, anastomosis, and ileostomy; and T3=sigmoid resection and anastomosis. Six scoring systems were analyzed to assess performance status; subsequently, patients were divided into low, mild, and high risk (LR, MR, HR) according to the system producing the highest area under the curve. We classified peritonitis exposition as P1=24 h. Univariable and multivariable analyses were performed. The Apgar scoring system defined the risk groups according to performance status. Lowest SSI risk was expected when applying T3 in P1 (OR=0.22), P2 (OR=0.5) for LR and in P1 (OR=0.63) for MR; T2 in P2 (OR=0.5) in LR and in P1 (OR=0.61) in MR; T1 in P3 (OR=0.56) in LR; in P2 (OR=0.63) and P3 (OR=0.54) in MR patients, and in each P subgroup (OR=0.93;0.97;1.01) in HR. Pre-operative assessment based on Apgar scoring system integrated with peritonitis exposure in complicated diverticulitis may offer a ready-to-use tool for reducing SSI

  19. Surgical complications following cochlear implantation in adults based on a proposed reporting consensus

    DEFF Research Database (Denmark)

    Jeppesen, Jonas; Faber, Christian Emil

    2013-01-01

    Abstract Conclusion: The rate of severe complications was low and cochlear implantation is a relatively safe procedure. Standardization is crucial when reporting on cochlear implant complications to ensure comparability between studies. A consensus on the reporting of complications proposed by a ...... occurred following one implantation (0.3%). Transient chorda tympani syndrome (30.8%), vertigo/dizziness (29.5%) and tinnitus (4.9%) were the most frequent minor complications....

  20. Improving wound healing and preventing surgical site complications of closed surgical incisions: a possible role of Incisional Negative Pressure Wound Therapy. A systematic review of the literature.

    Science.gov (United States)

    Scalise, Alessandro; Calamita, Roberto; Tartaglione, Caterina; Pierangeli, Marina; Bolletta, Elisa; Gioacchini, Matteo; Gesuita, Rosaria; Di Benedetto, Giovanni

    2016-12-01

    Advances in preoperative care, surgical techniques and technologies have enabled surgeons to achieve primary closure in a high percentage of surgical procedures. However, often, underlying patient comorbidities in addition to surgical-related factors make the management of surgical wounds primary closure challenging because of the higher risk of developing complications. To date, extensive evidence exists, which demonstrate the benefits of negative pressure dressing in the treatment of open wounds; recently, Incisional Negative Pressure Wound Therapy (INPWT) technology as delivered by Prevena™ (KCI USA, Inc., San Antonio, TX) and Pico (Smith & Nephew Inc, Andover, MA) systems has been the focus of a new investigation on possible prophylactic measures to prevent complications via application immediately after surgery in high-risk, clean, closed surgical incisions. A systematic review was performed to evaluate INPWT's effect on surgical sites healing by primary intention. The primary outcomes of interest are an understanding of INPWT functioning and mechanisms of action, extrapolated from animal and biomedical engineering studies and incidence of complications (infection, dehiscence, seroma, hematoma, skin and fat necrosis, skin and fascial dehiscence or blistering) and other variables influenced by applying INPWT (re-operation and re-hospitalization rates, time to dry wound, cost saving) extrapolated from human studies. A search was conducted for published articles in various databases including PubMed, Google Scholar and Scopus Database from 2006 to March 2014. Supplemental searches were performed using reference lists and conference proceedings. Studies selection was based on predetermined inclusion and exclusion criteria and data extraction regarding study quality, model investigated, epidemiological and clinical characteristics and type of surgery, and the outcomes were applied to all the articles included. 1 biomedical engineering study, 2 animal studies, 15

  1. Unexpected findings and surgical complications in 505 consecutive cochlear implantations: a proposal for reporting consensus

    DEFF Research Database (Denmark)

    Hansen, Søren; Anthonsen, Kristian; Stangerup, Sven-Eric

    2010-01-01

    Cochlear implantation is a safe procedure in experienced hands, as the rate of severe complications is below 2%. Complications differ between children and adults, and transient disequilibrium/vertigo is the most common complication, followed by wound infection, haematoma/oedema and transient chorda...

  2. Surgical repair following trauma to vascular graft causing spinal cord infarction

    Science.gov (United States)

    Vivekanantham, Sayinthen; Phoenix, Gokulan; Khatri, Chetan; Das, Saroj

    2014-01-01

    A 55-year-old woman with a background of vascular disease presented with signs of bilateral limb ischaemia. Following elective axillobifemoral bypass and hospital discharge, accidental axillary trauma causing a chest wall haematoma, the patient underwent an emergency graft repair. Postextubation, she reported with absent sensation in her legs. Spinal cord infarction was diagnosed through clinical assessment and exclusion of other causes. The aetiology of compromise to the spinal cord blood supply is unclear. Possibilities include intraoperative hypotension, inadvertent compromise to blood supply of thoracic radicular arteries, dislodged atherosclerotic emboli or a combination of these factors. Spinal cord infarction recognised early can be treated. Sedation to assist ventilation had obscured the problem early enough to consider treatment. Patients with vascular risk factors should be carefully managed intraoperatively to minimise hypotensive episodes and care should also be taken not to compromise blood flow of radicular arteries. PMID:24739653

  3. Successful treatment of thread-lifting complication from APTOS sutures using a simple MACS lift and fat grafting.

    Science.gov (United States)

    Sapountzis, Stamatis; Kim, Ji Hoon; Li, Tzong-Shiun; Rashid, Abid; Cruz, Pedro Ciudad; Hwang, Yoong Soo

    2012-12-01

    Facial soft tissue lifting with subdermal sutures has a significant attraction for physician and patient alike. The case report describes a 48 year old woman who presented with pain and discomfort over the left cheek after a thread-lift procedure with anti-ptosis (APTOS) sutures performed 13 months previously. The clinical examination showed extrusion of the APTOS thread (Aptos, Moscow, Russia) accompanied by slight soft tissue tightness and tenderness along its course to the temporal area, indicating complete removal of the thread. A simple minimal access cranial suspension lift was performed with the patient under local anesthesia to remove the subdermal sutures together with autologous fat grafting to enhance the aesthetic result. At the 1 year follow-up visit, no complications were reported, and the patient was entirely satisfied with the final result. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  4. Transperitoneal versus extraperitoneal laparoscopic radical prostatectomy during the learning curve: does the surgical approach affect the complication rate?

    Directory of Open Access Journals (Sweden)

    Tiberio M. Siqueira Jr.

    2010-08-01

    Full Text Available Purpose: To compare the perioperative complication rate obtained with the transperitoneal laparoscopic radical prostatectomy (TLRP and with the extraperitoneal LRP (ELRP during the learning curve (LC. Materials and Methods: Data of the initial 40 TLRP (Group 1 were retrospectively compared with the initial 40 ELRP (Group 2. Each Group of patients was operated by two different surgeons. Results: The overall surgical time (175 min x 267.6 min; p < 0.001 and estimated blood loss (177.5 mL x 292.4 mL; p < 0.001 were statistically better in the Group 1. Two intraoperative complications were observed in Group 1 (5% represented by one case of bleeding and one case of rectal injury, whereas four complications (10% were observed in Group 2, represented by two cases of bleeding, one bladder and one rectal injuries (p = 0.675. Open conversion occurred once in each Group (2.5%. Overall postoperative complications were similar (52.5% x 35%; p = 0.365. Major early postoperative complications occurred in three and in one case in Group 1 and 2, respectively. Group 1 had two peritonitis (fecal and urinary, leading to one death in this group. Conclusions: No statistical differences in overall complication rates were observed. The transperitoneal approach presented more serious complications during the early postoperative time and this fact is attributed to the potential chance of intraperitoneal peritonitis not observed with the extraperitoneal route.

  5. Demography, types, outcome and relationship of surgically treated intracranial suppuration complicating chronic suppurative otitis media and bacterial rhinosinusitis

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    Olufemi Emmanuel Idowu

    2014-01-01

    Full Text Available Introduction: Surgically treated intracranial suppurations (ICS are uncommon, life-threatening neurosurgical emergencies. They can result from complication of chronic suppurative otitis media (CSOM and bacterial rhinosinusitis (BRS. The objective of this study was to know the frequency of BRS and CSOM and relate it to its rare complication of surgically treated ICS while also describing the demography, type and outcome of ICS that resulted from BRS and CSOM. Materials and Methods: All patients that presented to the Otorhinolaryngological department and Neurosurgical unit of the same institution with clinical and radiological features of CSOM, BRS, and ICS were prospectively studied over a 5-year period. Patients were followed up for a minimum of 3 months. Results: Two thousand, two hundred and seventy-nine patients presented during the 5-year study period. Of all these patients, 1511 had CSOM (66.3% and 768 (33.7% presented with features of BRS. Eleven (0.73% had ICS complicating their CSOM while 8 (1.04% cases of surgically treated ICS followed BRS. Bacterial rhinosinusitis was not more likely to lead to ICS (P = 0.4348. The Odds ratio (OR of a child ≤ 18 years of age with CSOM developing ICS was 5.24 (95% Confidence interval 1.13-24.34; P = 0.0345, while it was 7.60 (95% Confidence interval 1.52-37.97; P = 0.0134 for children with BRS. Conclusions: The most common type of ICS complicating CSOM and BRS was brain abscess and subdural empyema, respectively. Children are more prone to develop surgical ICS following CSOM and BRS. The proportion of males that had ICS was higher in both CSOM and BRS patients. Optimal outcome is achieved in patients that presented with GCS of 13 and above.

  6. The Nottingham Expectation and Complication score following Surgery (NECS): an universal scale for surgical outcome audit and peer comparison.

    Science.gov (United States)

    Ingale, Harshal; Muquit, Samiul; Al-Helli, Othman; White, Barrie; Basu, Surajit

    2017-04-01

    Consultant Outcomes Publication (COP) is an NHS England initiative for promoting improvements in quality of care. However, at present outcomes are commonly expressed as mortality rates which do not necessarily reflect the performance of surgeons. We developed the Nottingham Expectation and Complication score following Surgery (NECS) to determine the success of surgical treatment from both the clinical perspective and the practical expectations agreed between surgeons and patients during the consent process. This was a pilot study to trial the use of the NECS score. It is a simple expression of overall outcome comprising three clinical domains: S - surgical outcome, T - surgical/technical complications and M - medical complications recorded by the treating clinician, and practical outcome determined by a joint clinical/patient assessment. 107 elective neurosurgical patients were included in this prospective study. 95 completed questionnaires were included. 75% patients achieved the best possible treatment score (S3T3M4). Of the 25% of patients who did not achieve this ideal outcome, the most common cause was either medical deterioration 18%, or technical complications of surgery discussed during the consent process 17%, or both. Surgeons rated their outcomes as expectations exceeded in 2% of cases, met in 92%, partially met in 5% and failed in 1%. Patients rated their outcomes as expectations exceeded in 37%, met in 37%, partially met in 18%, and 5% reported that their expectations were not met or they were worse than before the operation. Bivariate correlation analysis (Pearson's r coefficient) between overall 'expectation score' of patients and surgeons showed moderate correlation with r = .25 (p = .014). NECS score can be used as an indicator to assess technical performance and patient satisfaction. It provides a more balanced quality indicator of the surgical service delivery than COP. It also offers additional advantages for auditing/planning improving

  7. Consideraciones clínicas en la obtención de injertos óseos intraorales: Técnica quirúrgica y evaluación de las complicaciones Considerations for intraoral osseous graft remove: Technique and complications management

    Directory of Open Access Journals (Sweden)

    F. Rocha

    2010-08-01

    Full Text Available Las técnicas de remoción de injertos intraorales están bien descritas en la literatura internacional; sin embargo, siempre es importante recordar las condiciones que pueden influir en la presencia de complicaciones transquirúrgicas y postquirúrgicas. Por otra parte, las técnicas de reconstrucción ósea son realizadas por muchos cirujanos dentistas, con diferentes grados de formación, lo que puede permitir el desconocimiento de algunos puntos importantes cuando se realice el procedimiento quirúrgico. Los autores realizan una revisión de la literatura con énfasis en las condiciones de la técnica quirúrgica, tipos de complicaciones y su manejo. Finalmente, podemos señalar que después de protocolizar las técnicas quirúrgicas, el siguiente paso es el manejo de las complicaciones, que pueden disminuir con una correcta conducta quirúrgica.A technique for intraoral graft remove are well described in the international literature, but always is important to remember the conditions that can influenced for complications in surgical and post surgical time. Considering this, the osseous graft technique are be executed for many dental practitioner, with different type of formation, that can lead to ignorance of some the moment of to realize the surgical procedure. The author´s realize a literature review with emphasis in the conditions of the surgical technique, type of complications and your management. Finally, can be say that after of construed a surgical protocol, the protocol for complications management can be the next way. The complications could be diminished with a properly surgical procedure.

  8. The influence of sarcopenia on survival and surgical complications in ovarian cancer patients undergoing primary debulking surgery.

    Science.gov (United States)

    Rutten, I J G; Ubachs, J; Kruitwagen, R F P M; van Dijk, D P J; Beets-Tan, R G H; Massuger, L F A G; Olde Damink, S W M; Van Gorp, T

    2017-04-01

    Sarcopenia, severe skeletal muscle loss, has been identified as a prognostic factor in various malignancies. This study aims to investigate whether sarcopenia is associated with overall survival (OS) and surgical complications in patients with advanced ovarian cancer undergoing primary debulking surgery (PDS). Ovarian cancer patients (n = 216) treated with PDS were enrolled retrospectively. Total skeletal muscle surface area was measured on axial computed tomography at the level of the third lumbar vertebra. Optimum stratification was used to find the optimal skeletal muscle index cut-off to define sarcopenia (≤38.73 cm(2)/m(2)). Cox-regression and Kaplan-Meier analysis were used to analyse the relationship between sarcopenia and OS. The effect of sarcopenia on the development of major surgical complications was studied with logistic regression. Kaplan-Meier analysis showed a significant survival disadvantage for patients with sarcopenia compared to patients without sarcopenia (p = 0.010). Sarcopenia univariably predicted OS (HR 1.536 (95% CI 1.105-2.134), p = 0.011) but was not significant in multivariable Cox-regression analysis (HR 1.362 (95% CI 0.968-1.916), p = 0.076). Significant predictors for OS in multivariable Cox-regression analysis were complete PDS, treatment in a specialised centre and the development of major complications. Sarcopenia was not predictive of major complications. Sarcopenia was not predictive of OS or major complications in ovarian cancer patients undergoing primary debulking surgery. However a strong trend towards a survival disadvantage for patients with sarcopenia was seen. Future prospective studies should focus on interventions to prevent or reverse sarcopenia and possibly increase ovarian cancer survival. Complete cytoreduction remains the strongest predictor of ovarian cancer survival. Copyright © 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights

  9. Chiari畸形合并颅底凹陷的外科手术治疗%Surgical treatment of Chiari malformation complicated with basilar impression

    Institute of Scientific and Technical Information of China (English)

    马原; 贺伟旗; 程林; 卢敏; 顾建文; 匡永勤; 夏勋; 杨立斌; 张俊海; 程敬民; 杨涛; 黄海东

    2011-01-01

    目的 探讨小骨窗后颅窝减压加枕颈植骨融合内固定术治疗Chiari畸形合并颅底凹陷的手术效果.方法 回顾性分析2006-2010年收治的16例Chiari畸形合并颅底凹陷患者,其中男7例,女9例,年龄17~65岁,平均36.4岁.所有患者均经影像学确诊,手术采取小骨窗后颅窝减压,小脑扁桃体切除,一期取自体髂骨行颈枕植骨融合钢丝内固定,术后行颈托固定3个月.结果 所有患者术后症状均明显改善,无感染或死亡,1例出现引流口脑脊液漏,1例出现一过性肩胛区和胸胁部疼痛,未经治疗自行消失.术后随访6个月,按Symon和Lavender临床标准,治愈6例,好转9例,无效1例.复查MRI显示重建枕大池清晰,无小脑下垂发生,植骨已融合. 结论小骨窗后颅窝减压加枕颈植骨融合钢丝内固定术治疗Chiari畸形合并颅底凹陷效果确切,在增加后颅窝容积同时可减轻脑干腹侧受压,并能重建颅颈交界区稳定性.%Objective To evaluate the therapeutic effect of small craniotomic posterior fossa decompression combined with occipitalcervical bone graft fusion and internal fixation on Chiari malformation complicated with basilar impression. Methods The clinical data of 16 cases (7 males and 9 females, aged 17 to 65 years, mean 36. 4) of Chiari malformation complicated with basilar impression from 2006 to 2010 were retrospectively analyzed. The diagnoses for all the patients were confirmed by radiology. Small craniotomic posterior fossa decompression was performed in all patients, cerebellar tonsils were resected, and then one-stage occipital-cervical bone graft fusion using autogenous iliac bone and internal wiring fixation were performed. Neck support was used for 3 months after surgery. Results Symptoms were significantly improved in all cases after surgical operation. No patient died or infected. Cerebrospinal fluid leakage was found at draining site in one case. Transient pain of scapular and chest was found

  10. Surgical complications in neuromuscular scoliosis operated with posterior- only approach using pedicle screw fixation

    Directory of Open Access Journals (Sweden)

    Singh Surya Udai

    2009-05-01

    Full Text Available Abstract Background There are no reports describing complications with posterior spinal fusion (PSF with segmental spinal instrumentation (SSI using pedicle screw fixation in patients with neuromuscular scoliosis. Methods Fifty neuromuscular patients (18 cerebral palsy, 18 Duchenne muscular dystrophy, 8 spinal muscular atrophy and 6 others were divided in two groups according to severity of curves; group I ( 90°. All underwent PSF and SSI with pedicle screw fixation. There were no anterior procedures. Perioperative (within three months of surgery and postoperative (after three months of surgery complications were retrospectively reviewed. Results There were fifty (37 perioperative, 13 postoperative complications. Hemo/pneumothorax, pleural effusion, pulmonary edema requiring ICU care, complete spinal cord injury, deep wound infection and death were major complications; while atelectesis, pneumonia, mild pleural effusion, UTI, ileus, vomiting, gastritis, tingling sensation or radiating pain in lower limb, superficial infection and wound dehiscence were minor complications. Regarding perioperative complications, 34(68% patients had at least one major or one minor complication. There were 16 patients with pulmonary, 14 with abdominal, 3 with wound related, 2 with neurological and 1 cardiovascular complications, respectively. There were two deaths, one due to cardiac arrest and other due to hypovolemic shock. Regarding postoperative complications 7 patients had coccygodynia, 3 had screw head prominence, 2 had bed sore and 1 had implant loosening, respectively. There was a significant relationship between age and increased intraoperative blood loss (p = 0.024. However it did not increased complications or need for ICU care. Similarly intraoperative blood loss > 3500 ml, severity of curve or need of pelvic fixation did not increase the complication rate or need for ICU. DMD patients had higher chances of coccygodynia postoperatively. Conclusion

  11. Influence of Baseline Characteristics, Operative Conduct and Postoperative Course on 30-day Outcomes of Coronary Artery Bypass Grafting among Patients with Left Ventricular Dysfunction: Results from the Surgical Treatment for Ischemic Heart Failure (STICH) Trial

    Science.gov (United States)

    Wrobel, Krzysztof; Stevens, Susanna R.; Jones, Robert H.; Selzman, Craig H.; Lamy, Andre; Beaver, Thomas M.; Djokovic, Ljubomir T.; Wang, Nan; Velazquez, Eric J.; Sopko, George; Kron, Irving L.; DiMaio, J. Michael; Michler, Robert E.; Lee, Kerry L.; Yii, Michael; Leng, Chua Yeow; Zembala, Marian; Rouleau, Jean L.; Daly, Richard C.; Al-Khalidi, Hussein R.

    2015-01-01

    Background Patients with severe left ventricular (LV) dysfunction, ischemic heart failure and coronary artery disease (CAD) suitable for coronary artery bypass grafting (CABG) are at higher risk for surgical morbidity and mortality. Paradoxically, those patients with the most severe coronary artery disease and ventricular dysfunction who derive the greatest clinical benefit from CABG are also at the greatest operative risk, which makes decision-making regarding whether to proceed to surgery difficult in such patients. To better inform such decision-making, we analyzed the STICH CABG population for detailed information on perioperative risk and outcomes. Methods and Results In both STICH trials (hypotheses), 2136 patients with a left ventricular ejection fraction (LVEF) ≤ 35% and coronary artery disease were allocated to medical therapy, CABG plus medical therapy or CABG with surgical ventricular reconstruction (SVR). Relationships of baseline characteristics and operative conduct with morbidity and mortality at 30 days were evaluated. There were a total of 1460 patients who received surgery, and 346 of them (roughly, one-quarter) of these high-risk patients developed a severe complication within 30 days. Worsening renal insufficiency, cardiac arrest with cardiopulmonary resuscitation, and ventricular arrhythmias were the most frequent complications and those most commonly associated with death. Mortality at 30 days was 5.1% and was generally preceded by a serious complication (65 of 74 deaths). LV size, renal dysfunction, advanced age, and atrial fibrillation/flutter were significant preoperative predictors of mortality within 30 days. Cardiopulmonary bypass time was the only independent surgical variable predictive of 30-day mortality. Conclusions CABG can be performed with relatively low 30-day mortality in patients with LV dysfunction. Serious postoperative complications occurred in nearly 1 in 4 patients and were associated with mortality. Clinical Trial

  12. Newly forming bone graft: a novel surgical approach to the treatment of denuded roots

    Directory of Open Access Journals (Sweden)

    Adriana Campos Passanezi Sant'Ana

    2012-06-01

    Full Text Available Many techniques have been proposed for root coverage. However, none of them presents predictable results in deep and wide recessions. OBJECTIVES: The aim of this case series report is to describe an alternative technique for root coverage at sites showing deep recessions and attachment loss >4 mm at buccal sites. MATERIAL AND METHODS: Four patients presenting deep recession defects at buccal sites (>4 mm were treated by the newly forming bone graft technique, which consists in the creation of an alveolar socket at edentulous ridge and transferring of granulation tissue present in this socket to the recession defect after 21 days. Clinical periodontal parameters, including recession depth (RD, probing depth (PD, clinical attachment level (CAL, bleeding on probing (BOP, plaque index (PI and keratinized gingiva width (KGW were evaluated by a single examiner immediately before surgery and at 1, 3, 6 and 9 months postoperatively. RESULTS: All cases showed reduction in RD and PD, along with CAL gain, although no increase in KGW could be observed. These findings suggest that the technique could favor periodontal regeneration along with root coverage, especially in areas showing deep recessions and attachment loss.

  13. Surgical strategy to avoid ischemic complications of the pyramidal tract in resective epilepsy surgery of the insula: technical case report.

    Science.gov (United States)

    Ikegaya, Naoki; Takahashi, Akio; Kaido, Takanobu; Kaneko, Yuu; Iwasaki, Masaki; Kawahara, Nobutaka; Otsuki, Taisuke

    2017-06-09

    Surgical treatment of the insula is notorious for its high probability of motor complications, particularly when resecting the superoposterior part. Ischemic damage to the pyramidal tract in the corona radiata has been regarded as the cause of these complications, resulting from occlusion of the perforating arteries to the pyramidal tract through the insular cortex. The authors describe a strategy in which a small piece of gray matter is spared at the bottom of the periinsular sulcus, where the perforating arteries pass en route to the pyramidal tract, in order to avoid these complications. This method was successfully applied in 3 patients harboring focal cortical dysplasia in the posterior insula and frontoparietal operculum surrounding the periinsular sulcus. None of the patients developed permanent postoperative motor deficits, and seizure control was achieved in all 3 cases. The method described in this paper can be adopted for functional preservation of the pyramidal tract in the corona radiata when resecting epileptogenic pathologies involving insular and opercular regions.

  14. Surgical outcomes and complications of reconstructive surgery in the female congenital adrenal hyperplasia patient: What every endocrinologist should know.

    Science.gov (United States)

    Wang, Lily C; Poppas, Dix P

    2017-01-01

    Surgical management of classical congenital adrenal hyperplasia (CAH) in 46, XX females has evolved significantly. Virilization of the genitalia of 46, XX females with CAH begins prenatally as a result of excess fetal androgen production. Improved understanding of anatomy and surgical outcomes has driven changes in surgical techniques as well as the timing of surgery. For endocrinologists treating these patients, it is important to understand the outcome of genitoplasty, identify patients who need further treatment and direct these patients to experienced surgeons. We performed a literature search on PubMed of publications addressing CAH and genital reconstruction published in the English language from 1990 to the present. In accordance with our institutional review board, we performed a retrospective analysis of clitoroplasty and/or vaginoplasty procedures performed by a single surgeon at our institution from 1996 to 2015. We found that genital reconstruction in 46, XX CAH patients is associated with few immediate post-operative, infectious, and urinary complications. Vaginal stenosis is a common complication of vaginal reconstruction and requires evaluation by an experienced surgeon. Clitoral pain or decreased sensation can be associated with clitoral recession and clitorectomy. Outcomes in sexual satisfaction and gender identity can also be impacted by surgical technique and success. Long term follow up and patient reported feedback are crucial to our understanding and management of this special group of patients. Improved awareness and understanding of the complications of genital surgery will allow endocrinologists to know what to ask patients and be ready to provide them with a resource with the understanding and experience to help them improve their quality of life.

  15. Cardiac tamponade and para-aortic hematoma post elective surgical myocardial revascularization on a beating heart - a possible complication of the Lima-stitch and sequential venous anastomosis.

    Science.gov (United States)

    Marcinkiewicz, Anna; Jaszewski, Ryszard; Piestrzeniewicz, Katarzyna; Zwoliński, Radosław

    2014-06-04

    Off-pump coronary artery bypass (OPCAB) surgery can be associated with some intrinsic, but relatively rare complications. A pericardial effusion is a common finding after cardiac surgeries, but the prevalence of a cardiac tamponade does not exceed 2% and is less frequent after myocardial revascularization.Authors believe that in our patient an injury of a nutritional pericardial or descending aorta vessel caused by the Lima stitch resulted in oozing bleeding, which gradually leaded to cardiac tamponade. The bleeding increased after introduction of double antiplatelet therapy and caused life-threatening hemodynamic destabilization. According to our knowledge it is the first report of such a complication after OPCAB. We present a case of a 61-year old man, who underwent elective surgical myocardial revascularization on a beating heart. On the 11th postoperative day the patient was readmitted emergently to the intensive care unit for severe chest pain, dyspnoea and hypotension. Coronary angiographic control showed a patency of the bypass grafts and significant narrowing of circumflex artery, treated with angioplasty and stenting. The symptoms and hemodynamic instability exacerbated. A suspicion of dissection of the ascending aorta and para-aortic hematoma was stated on 16-slice cardiac computed tomography. The patient was referred to the Cardiovascular Surgery Clinic. Transthoracic echocardiography revealed cardiac tamponade. On transesophageal echocardiography there were no signs of the ascending aorta dissection, but a possible lesion of the descending aorta with para-aortic hematoma was visualized. Emergent rethoracotomy and cardiac tamponade decompression were performed. 12 days after intervention the control 64-slice computed tomography showed no lesions of the ascending or descending aorta. On one-year follow-up patient is in a good condition, the left ventricular function is preserved and there is no pathology in thoracic aorta on echocardiography. Mechanical

  16. Thoracic air-leakage syndrome in allogeneic stem cell transplant recipients as a late complication of chronic graft-versus-host disease: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jae Wook; Kim, Song Soo; Jo, Daeg Yeon; Yun, Hwan Jung; Lee, Hyo Jin; Kim, Jin Hwan [Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon (Korea, Republic of)

    2016-08-15

    Air-leakage syndrome associated with graft-versus-host disease (GVHD) is a rare complication, but it is also reported as an independent predictor of a worse survival rate after stem cell transplantation. We report two cases of air-leakage syndrome associated with GVHD after allogeneic stem cell transplantation in acute leukemia patients who presented with spontaneous pneumomediastinum and subcutaneous emphysema, and finally death due to respiratory failure seven to eight months later.

  17. Vagal nerve stimulation for refractory epilepsy: the surgical procedure and complications in 100 implantations by a single medical center.

    Science.gov (United States)

    Horowitz, Gilad; Amit, Moran; Fried, Itzhak; Neufeld, Miri Y; Sharf, Liad; Kramer, Uri; Fliss, Dan M

    2013-01-01

    In 1997, the US Food and Drug Administration approved the use of intermittent stimulation of the left vagal nerve as adjunctive therapy for seizure control. Vagal nerve stimulation (VNS) has since been considered a safe and effective treatment for medically intractable seizures. The objective of this study is to present our experience with the surgical procedure and outcomes after VNS insertion in the first 100 consecutive patients treated at the Tel-Aviv "Sourasky" Medical Center (TASMC). All patients who underwent VNS device implantation by the authors at TASMC between 2005 and 2011 were studied. The collected data included age at onset of epilepsy, seizure type, duration of epilepsy, age at VNS device implantation, seizure reduction, surgical complications, and adverse effects of VNS over time. Fifty-three males and 47 females, age 21.2 ± 11.1 years, underwent VNS implantation. Indications for surgery were medically refractory epilepsy. The most common seizure type was focal (55 patients, 55 %). Seizure duration until implantation was 14.4 ± 9 years. Mean follow-up time after device insertion was 24.5 ± 22 months. Complications were encountered in 12 patients. The most common complication was local infection (6 patients, 6 %). Six devices were removed-four due to infection and two due to loss of clinical effect. Currently, 63 patients remain in active long-term follow-up; of these, 35 patients have >50 % reduction in frequency of attacks.VNS is a well-tolerated and effective therapeutic alternative in the management of medically refractory epilepsy. The surgical procedure is safe and has a low complication rate.

  18. Surgical Management of Limb Prosthetic Vascular Graft Exposure%肢体人工血管移植物外露的外科治疗

    Institute of Scientific and Technical Information of China (English)

    吴昊; 吴巍巍; 白明; 曾嵘; 宋小军; 陈宇; 刘昌伟

    2012-01-01

    目的 探讨肢体人工血管移植术后血管移植物外露的危险因素及外科治疗方法.方法 回顾性分析了2006年8月至2011年12月在北京协和医院血管外科诊治的17例肢体人工血管移植术后血管移植物外露患者的临床资料,外科治疗主要包括局部治疗及保留移植物的任意皮瓣或肌皮瓣转移覆盖术.结果 17例患者均行保留移植血管的(肌)皮瓣转移覆盖术,术后14例成功保全了人工血管,切口Ⅰ期愈合,动脉搏动良好,成功率82.4%;3例术后未顺利愈合,最终切除血管移植物.结论 保留血管移植物的(肌)皮瓣转移覆盖术是肢体人工血管移植物外露的有效外科处理手段.%Objective To investigate the risk factors and surgical management of limb prosthetic vascular graft exposure. Methods The clinical data of 17 patients suffering from limb prosthetic vascular graft exposure in Peking Union Medical College Hospital from August 2006 to December 2011 were retrospectively analyzed. Among 17 cases, 5 suffered from prosthetic vascular graft exposure after vascular bypass for the lower limb ischemia, whereas 12 were affected after the artificial graft arteriovenous fistula construction in the upper limbs for hemodialysis. The surgical procedures mainly included the local debridement as well as the local flap and transferred muscle-cutaneous flap reconstruction to preserve the prosthetic vascular graft. Results All 17 patients underwent local flap or muscle-cutaneous flap coverage procedure. After the surgery, the prosthetic vascular graft was successfully salvaged in 14 cases. The total successful rate was 82. 4%. The surgery failed in three patients, in whom the prosthetic vascular grafts were finally removed. Conclusion Local flap and transferred muscle-cutaneous flap reconstruction is an effective surgical management to salvage the exposed grafts.

  19. Improving Public Reporting and Data Validation for Complex Surgical Site Infections After Coronary Artery Bypass Graft Surgery and Hip Arthroplasty

    Science.gov (United States)

    Calderwood, Michael S.; Kleinman, Ken; Murphy, Michael V.; Platt, Richard; Huang, Susan S.

    2014-01-01

    Background  Deep and organ/space surgical site infections (D/OS SSI) cause significant morbidity, mortality, and costs. Rates are publicly reported and increasingly used as quality metrics affecting hospital payment. Lack of standardized surveillance methods threaten the accuracy of reported data and decrease confidence in comparisons based upon these data. Methods  We analyzed data from national validation studies that used Medicare claims to trigger chart review for SSI confirmation after coronary artery bypass graft surgery (CABG) and hip arthroplasty. We evaluated code performance (sensitivity and positive predictive value) to select diagnosis codes that best identified D/OS SSI. Codes were analyzed individually and in combination. Results  Analysis included 143 patients with D/OS SSI after CABG and 175 patients with D/OS SSI after hip arthroplasty. For CABG, 9 International Classification of Diseases, 9th Revision (ICD-9) diagnosis codes identified 92% of D/OS SSI, with 1 D/OS SSI identified for every 4 cases with a diagnosis code. For hip arthroplasty, 6 ICD-9 diagnosis codes identified 99% of D/OS SSI, with 1 D/OS SSI identified for every 2 cases with a diagnosis code. Conclusions  This standardized and efficient approach for identifying D/OS SSI can be used by hospitals to improve case detection and public reporting. This method can also be used to identify potential D/OS SSI cases for review during hospital audits for data validation. PMID:25734174

  20. Can the American College of Surgeons NSQIP surgical risk calculator identify patients at risk of complications following microsurgical breast reconstruction?

    Science.gov (United States)

    O'Neill, Anne C; Bagher, Shaghayegh; Barandun, Marina; Hofer, Stefan O P; Zhong, Toni

    2016-10-01

    The American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP) Surgical Risk Calculator is an open access online tool that estimates the risk of adverse post-operative events for a wide range of surgical procedures. This study evaluates the predictive value of the ACS NSQIP calculator in patients undergoing microvascular breast reconstruction. Details of 759 microvascular breast reconstructions in 515 patients were entered into the online calculator. The predicted rates of post-operative complications were recorded and compared to observed complications identified on chart review. The calculator was validated using three statistical measures described in the original development of the ACS NSQIP model. The calculator predicted that complications would occur in 11.1% of breast reconstructions while the observed rate was 10.5%. Hosmer-Lemeshow test did not find any statistical difference between these rates (p = 0.69) indicating that the calculator accurately measured what is was intended to measure. The area under the receiver operating curve or c-statistic (measure of discrimination) was found to be low at 0.548, indicating the model has random performance in this patient population. The Brier score was higher than that reported in the original ACS calculator development (0.094 vs 0.069) demonstrating poor correlation between predicted probability and actual probability. This study demonstrates that while the ACS NSQIP Universal risk calculator can predict the proportion of patients that will develop complications it cannot effectively discriminate between patients who are at risk of complications and those who are not. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  1. Surgical complications of skin sparing mastectomy and immediate prosthetic reconstruction after neoadjuvant chemotherapy for invasive breast cancer.

    Science.gov (United States)

    Donker, M; Hage, J J; Woerdeman, L A E; Rutgers, E J Th; Sonke, G S; Vrancken Peeters, M-J T F D

    2012-01-01

    Neoadjuvant chemotherapy is gaining acceptance as an option for breast cancer treatment, particularly in young women. These women may seek immediate breast reconstruction after mastectomy even though it is not known whether such preoperative chemotherapy may be detrimental to post-reconstruction wound healing. Therefore, we set out to assess the influence of neoadjuvant chemotherapy for invasive breast cancer on the short-term complications after skin sparing mastectomy and immediate prosthetic reconstruction. The short-term surgical outcome of 48 immediate breast reconstructions in 37 women treated with neoadjuvant chemotherapy from 2006 through 2009 was prospectively compared to that of 215 immediate reconstructions in 176 women who were operated in the same period without neoadjuvant chemotherapy. The overall rate of short-term postoperative complications was significantly less among neoadjuvantly treated women (15% vs. 29%; p = 0.042) but this did not result in a reduction of loss of prostheses (8% vs. 11%; p = 0.566). Because neoadjuvant chemotherapy is not associated with an increase in short-term complications after skin sparing mastectomy and immediate prosthetic reconstruction in patients with invasive breast cancer, such combined surgical therapy may be offered as treatment option for this particular group of patients also. Copyright © 2011 Elsevier Ltd. All rights reserved.

  2. [Maternal and perinatal surgical complications in low platelet count for HELLP syndrome in severe preeclampsia-eclampsia in intensive care].

    Science.gov (United States)

    Basavilvazo Rodríguez, Antonia; Pacheco Pérez, Claudia; Lemus Rocha, Roberto; Martínez Pérez, José Ma; Martínez Martínez, Armando; Hernández-Valencia, Marcelino

    2003-08-01

    The preeclampsia is the first cause of maternal morbility, with increase in the obstetric complications when it is associated to HELLP syndrome, for the low platelets that even involves to the neonate. This study was carried out in the patients accepted in the intensive Adults Cares Unit in the period of one year, surgical complications and the perinatal results were determined in women with low platelet count for HELLP syndrome in preeclampsia-eclampsia. Three groups were formed according to the platelets account and then were analyzed using chi square to determine association among these groups of patients, as well as mean and standard deviation (M +/- DE) to describe results. Forty patients were studied with low platelets by HELLP syndrome in preeclampsia-eclampsia, where the distribution for the group with platelets hipovolemic shock. Also in this group the perinatal mortality was presented in 3 cases (25%) and the asphyxia at the birth with Apgar < 6 was presented in 5 cases (41.7%). A bigger morbility was observed inversely proportional to the account platelets, being the renal failure the cause most frequent of this morbility in the three groups. The low platelets account contribute in a direct way in the obstetric complications, since there are more surgical reinterventions, with bled in the transsurgical and increase in the days of intrahospitalary stay. Also with smaller account platelet, there are bigger prematural index, asphyxia and perinatal mortality in the newborn of mothers with HELLP syndrome.

  3. Changing trends in abdominal surgical complications following cardiac surgery in an era of advanced procedures. A retrospective cohort study.

    Science.gov (United States)

    Ashfaq, Awais; Johnson, Daniel J; Chapital, Alyssa B; Lanza, Louis A; DeValeria, Patrick A; Arabia, Francisco A

    2015-03-01

    Abdominal complications following cardiopulmonary bypass (CPB) procedures may have mortality rates as high as 25%. Advanced procedures such as ventricular assist devices, artificial hearts and cardiac transplantation are being increasingly employed, changing the complexity of interventions. This study was undertaken to examine the changing trends in complications and the impact of cardiac surgery on emergency general surgery (EGS) coverage. A retrospective review was conducted of all CPB procedures admitted to our ICU between Jan. 2007 and Mar. 2010. The procedures included coronary bypass (CABG), valve, combination (including adult congenital) and advanced heart failure (AHF) procedures. The records were reviewed to obtain demographics, need for EGS consult/procedure and outcomes. Mean age of the patients was 66 ± 8.5 years, 71% were male. There were 945 CPB procedures performed on 914 patients during this study period. Over 39 months, 23 EGS consults were obtained, resulting in 10 operations and one hospital death (10% operative mortality). CABG and valve procedures had minimal impact on EGS workload while complex cardiac and AHF procedures accounted for significantly more EGS consultations (p cardiac surgery, advanced technology has increased the volume of complex CPB procedures increasing the EGS workload. Emergency general surgeons working in institutions that perform advanced procedures should be aware of the potential for general surgical complications perioperatively and the resultant nuances that are associated with operative management in this patient population. Copyright © 2015 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  4. Complications and survival after surgical treatment of 214 metastatic lesions of the humerus

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    Wedin, Rikard; Hansen, Bjarne H; Laitinen, Minna;

    2012-01-01

    The humerus is the second most common long-bone site of metastatic bone disease. We report complications, risk factors for failure, and survival of a large series of patients operated on for skeletal metastases of the humerus....

  5. Early surgical outcomes of coronary artery bypass grafting in patients with dialysis-dependent renal failure: Effects of early hemodialysis

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    Chih-Yuan Lin

    2014-01-01

    Full Text Available Background: Coronary artery disease occurs frequently and is a major cause of morbidity and mortality in patients with chronic renal failure. Because the number of patients requiring dialysis for end-stage renal disease (ESRD has increased, the number of patients in this population who require coronary artery bypass grafting (CABG has increased. The aim of this study was to examine the effect of early hemodialysis (HD on the early surgical outcomes of ESRD patients undergoing CABG. Materials and Methods: Fifty-nine dialysis-dependent patients who underwent isolated CABG with cardiopulmonary bypass (CPB were enrolled in this study. These patients were divided into two groups based on the timing of the first postoperation HD session. In the early HD group, HD was performed within 6 h postoperation; in the scheduled HD group, HD was performed >6 h postoperation. The preoperative characteristics, operative variables, and postoperative outcomes were retrospectively analyzed. Results: The time to first HD after CABG was 2.43 ± 1.58 h in the early HD group and 20.68 ± 6.98 h in the scheduled HD group (P < 0.001. There were no significant differences in the operative variables, namely duration of operation, CPB time, and aortic cross-clamp time, between the two groups. The incidence of postoperative pneumonia was higher in the scheduled HD group (31.8% than in the early HD group (2.7%. There was a trend of decreased incidence of postoperative pneumonia in the early HD group with marginal significance from the univariate analysis. The intensive care unit and hospital stay duration of both groups were similar. Nine patients died in the hospital, yielding an overall 30-day mortality of 8.47%. Conclusion: In dialysis-dependent patients who underwent CABG, the short-term outcomes and surgical mortality were acceptable. Dialysis-dependent renal failure should not be considered a contraindication for CABG. Early HD in the postoperative period demonstrated

  6. Surgical reconstruction of complications associated with fronto-ethmoid mucocele surgery.

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    Guibor, P

    1975-01-01

    Devastating complications can occur following an uncomplicated resection of a fronto-ethmoid mucocele, namely, total blepharoptosis, diplopia, and vertical-horizontal extraocular muscle abnormalities. Four stages of reconstructive surgery were required over a two-year period of time to arrive at an acceptable appearance and useful binocular vision. Maximum care must be exercised when resecting a fronto-ethmoid mucocele. Inadvertent trauma to the orbital anatomy may result in a multitude of serious ocular complications.

  7. Impact of GOLD groups of chronic pulmonary obstructive disease on surgical complications

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    Kim HJ

    2016-02-01

    Full Text Available Hyung-Jun Kim,1,2 Jinwoo Lee,1,2 Young Sik Park,1,2 Chang-Hoon Lee,1,2 Sang-Min Lee,1,2 Jae-Joon Yim,1,2 Chul-Gyu Yoo,1,2 Young Whan Kim,1,2 Sung Koo Han,1,2 Sun Mi Choi1,2 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; 2Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea Purpose: Chronic obstructive pulmonary disease (COPD is associated with increased postoperative complications. Recently, the Global Initiative for Chronic Obstructive Lung Disease (GOLD classified COPD patients into four groups based on spirometry results and the severity of symptoms. The objective of this study was to evaluate the impact of GOLD groups on postoperative complications. Patients and methods: We reviewed the medical records of COPD patients who underwent preoperative spirometry between April and August 2013 at a tertiary hospital in Korea. We divided the patients into GOLD groups according to the results of spirometry and self-administered questionnaires that assessed the symptom severity and exacerbation history. GOLD groups, demographic characteristics, and operative conditions were analyzed. Results: Among a total of 405 COPD patients, 70 (17.3% patients experienced various postoperative complications, including infection, wound, or pulmonary complications. Thoracic surgery, upper abdominal surgery, general anesthesia, large estimated blood loss during surgery, and longer anesthesia time were significant risk factors for postoperative complications. Patients in high-risk group (GOLD groups C or D had an increased risk of postoperative complications compared to those in low-risk group (GOLD groups A or B. Conclusion: COPD patients in GOLD groups representing a high exacerbation risk have an increased risk of postoperative complications compared to those with low risk. Keywords: chronic obstructive pulmonary

  8. Retained Intra-Abdominal Surgical Clamp Complicating Emergency Laparotomy: Incidental Finding on Hysterosalpingogram for Evaluation of Tubal Infertility

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    Adebiyi Gbadebo Adesiyun

    2014-01-01

    Full Text Available The finding of intraperitoneal foreign body complicating surgical intervention broadly remains as an issue of safety in the operative room, a source of emotive concern for the patient, and an upsetting but equally embarrassing situation to the surgeon and the team. However, in the media world, it is a source of sumptuous and captivating headline on the newspaper and to the legal profession, an attractive case to prosecute. A middle age teacher presented with secondary infertility. She had emergency laparotomy fifteen years ago for ruptured tubal ectopic pregnancy in a private hospital and postoperative period was uneventful. Amongst other investigations to find out the cause of infertility, she had hysterosalpingography and a radio-opaque clamp was visualized on the films. She was counselled and had laparotomy. A pair of surgical Kocher clamps was retrieved buried in the mesentery.

  9. Myocardial infarction determined by technetium-99m pyrophosphate single-photon tomography complicating elective coronary artery bypass grafting for angina pectoris

    Energy Technology Data Exchange (ETDEWEB)

    Burns, R.J.; Gladstone, P.J.; Tremblay, P.C.; Feindel, C.M.; Salter, D.R.; Lipton, I.H.; Ogilvie, R.R.; David, T.E.

    1989-06-15

    The incidence of acute myocardial infarction (AMI) complicating coronary artery bypass grafting (CABG) has previously been based on concordance of electrocardiographic, enzymatic and scintigraphic criteria. Technetium-99m pyrophosphate (Tc-PPi) single-photon emission computed tomography now enables detection of AMI with high sensitivity and specificity. Using this technique, perioperative AMI was detected in 12 of 58 patients (21%) undergoing successful elective CABG for stable angina pectoris. Stepwise multivariate logistic regression analysis was performed to compare the predictive value of preoperative (New York Heart Association class, left ventricular ejection fraction and use of beta blockers) and intraoperative (number of grafts constructed, use of internal mammary anastomoses, use of sequential saphenous vein grafts, smallest grafted distal vessel lumen caliber and aortic cross-clamp time) variables. Preoperative New York Association class (p = 0.04) and smallest grafted distal vessel lumen caliber (p = 0.03) were significant multivariate predictors of perioperative AMI. Only 1 perioperative patient with AMI (and 1 pyrophosphate-negative patient) developed new Q waves. Serum creatine kinase-MB was higher in patients with AMI by repeated measures analysis of variance (p = 0.0003). Five AMIs occurred in myocardial segments revascularized using sequential saphenous vein grafts, and 7 in segments perfused by significantly stenosed epicardial vessels with distal lumen diameter and perfusion territory considered too small to warrant CABG. At 6-month follow-up, the mean left ventricular ejection fraction increased from 0.61 to 0.65 in Tc-PPI-negative patients (p = 0.01), but not in perioperative patients with AMI.

  10. Outcome and complications of retropubic and transobturator midurethral slings translated into surgical therapeutic indices

    NARCIS (Netherlands)

    R.M. Houwert; J.P.W.R. Roovers; P.L. Venema; H.W. Bruinse; M.G.W. Dijkgraaf; H.A.M. Vervest

    2010-01-01

    OBJECTIVE: We sought to determine and compare surgical therapeutic indices (STIs) of the retropubic tension-free vaginal tape (TVT) and 2 kinds of transobturator tape (TOT), Monarc (American Medical Systems, Minneapolis, MN), and tension-free vaginal tape obturator. STUDY DESIGN: This was a retrospe

  11. Fractures of the posterior wall of the frontal sinus: non-surgical management and complications.

    Science.gov (United States)

    Villafán-Quiroga, Ronald; Cienfuegos-Monroy, Ricardo; Sierra-Martínez, Eduardo

    2010-01-01

    treatment of frontal sinus fractures remains controversial. If the posterior wall is fractured and there is cerebrospinal fluid leak, treatment seeks to restore the integrity of the dura and isolate the intracranial contents through the obliteration of the nasofrontal duct and cranialization. Another group supports nonoperative management CSF leakage is produced. The purpose is to avoid complications of meningitis, fistula and late sequelae. The difficulty lies in predicting which patients will develop complications. The aim of this study is to identify complications in patients with posterior wall fracture of the frontal sinus treated nonsurgically. an observational, cross-sectional, retrospective study was conducted with 20 patients with posterior wall fractures of the frontal sinus treated nonsurgically at the Hospital de Traumatología y Ortopedia Lomas Verdes, Service of Maxillofacial Surgery from January 2007 to October 2009. twenty patients with posterior wall fractures of the frontal sinus were included. There were 17 males and 3 females. Fractures were divided into groups according to their degree of movement and presence of cerebrospinal fluid fistula. Postoperative complications were cerebrospinal fluid fistula and frontal abscess. nonsurgical treatment has proven to be an option, although not free from complications, the most common being CSF fistula and abscess. Future comparative studies should be carried out to define therapeutic strategies usibg clinical monitoring and long-term imaging.

  12. Influence of two different surgical techniques on the difficulty of impacted lower third molar extraction and their post-operative complications

    OpenAIRE

    Mavrodi, Alexandra; Ohanyan, Ani; Kechagias, Nikos; Antonis TSEKOS; Konstantinos VAHTSEVANOS

    2015-01-01

    Background Post-operative complications of various degrees of severity are commonly observed in third molar impaction surgery. For this reason, a surgical procedure that decreases the trauma of bone and soft tissues should be a priority for surgeons. In the present study, we compare the efficacy and the post-operative complications of patients to whom two different surgical techniques were applied for impacted lower third molar extraction. Material and Methods Patients of the first group unde...

  13. Complications of surgical management of upper tract calculi in spina bifida patients: analysis of nationwide data.

    Science.gov (United States)

    Wang, Hsin-Hsiao S; Wiener, John S; Ferrandino, Michael N; Lipkin, Michael E; Routh, Jonathan C

    2015-04-01

    The management of upper urinary tract stones in patients with spina bifida is challenging but poorly described in the literature. We compared urolithiasis interventions and related complications in patients with spina bifida to those in other stone formers using a national database. We retrospectively reviewed the NIS to identify hospital admissions for renal and ureteral stones from 1998 to 2011. We used ICD-9-CM codes to identify urological interventions, including shock wave lithotripsy, ureteroscopy, percutaneous nephrolithotomy and ureteral stent placement. NSQIP data were used to identify postoperative complications. We identified 4,287,529 weighted stone hospital admissions, including 12,315 (0.3%) of patients with spina bifida. Compared to those without spina bifida the patients with spina bifida who had urolithiasis were significantly younger (mean age 34 vs 53 years), more likely to have public insurance (72% vs 44%) and renal vs ureteral calculi (81% vs 58%), and undergo percutaneous nephrolithotomy (27% vs 8%). After adjusting for age, insurance, comorbidity, treatment year, surgery type, stone location and hospital factors patients with spina bifida were more likely to have urinary tract infections (OR 2.5), urinary complications (OR 3.1), acute renal failure (OR 1.9), respiratory complications (OR 2.0), pneumonia (OR 1.5), respiratory insufficiency (OR 3.2), prolonged mechanical ventilation (OR 3.2), sepsis (OR 2.7), pulmonary embolism (OR 3.0), cardiac complications (OR 2.4) and bleeding (OR 1.6). Compared to those without spina bifida the patients with spina bifida who were hospitalized for urolithiasis were younger, and more likely to have renal stones and undergo percutaneous nephrolithotomy. Urolithiasis procedures in patients with spina bifida were associated with a significantly higher risk of in-hospital postoperative complications. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All

  14. [Rosuvastatin in prevention of cardiac complications following surgical treatment of patients with vascular pathology].

    Science.gov (United States)

    Pokrovskiĭ, A V; Kuntsevich, G I; Zotikov, A E; Goloviuk, A L; Burtseva, E A; Ivanov, L O; Suntsov, D S

    2009-01-01

    The article deals with the findings of studying the use of rosuvastatin in patients after endured reconstructive operations on the brachiocephalic arteries and aortofemoral segment in order to prevent cardiac atherothrombotic complications. A total of thirty patients were given "Crestors" at a daily dose of 10 mg for two weeks prior to surgery and for two weeks postoperatively and were found to have a significant decrease in the average levels of total cholesterol and low-density lipoproteins, which was accompanied and followed by certain improvement in the functional state of the vascular wall, with no cardiac complications being observed in either case.

  15. Compartment syndrome of the thigh complicating surgical treatment of ipsilateral femur and ankle fractures

    Science.gov (United States)

    Moore, M. R.; Garfin, S. R.; Hargens, A. R.

    1987-01-01

    A 26-year-old man presented with ipsilateral femur and ankle fractures. The patient was treated with interlocking nail of his femur fracture, followed by open reduction and internal fixation of his ankle fracture under tourniquet control. Postoperatively, the patient developed compartment syndrome of his thigh with elevated pressures, requiring decompressive fasciotomies. This case illustrates the possible complication of treating a femur fracture with intramedullary nailing and then immediately applying a tourniquet to treat an ipsilateral extremity fracture. Because of the complication with this patient, we feel the procedure should be staged, or a tourniquet should be avoided if possible.

  16. Early excision and grafting, an alternative approach to the surgical management of large body surface area levamisole-adulterated cocaine induced skin necrosis.

    Science.gov (United States)

    Miner, Jason; Gruber, Paul; Perry, Travis L

    2015-05-01

    Levamisole-adulterated cocaine as a cause of retiform purpura progressing to full-thickness skin necrosis was first documented in 2003 and currently comprises over 200 reported cases. Whereas, its presentation, pathophysiology, and diagnostic workup have been reasonably well-defined, only one publication has significantly detailed its surgical management. For this reason there exists a relative absence of data in comparison to its reported incidence to suggest a preferred treatment strategy. In the case mentioned, treatment emphasized delayed surgical intervention while awaiting lesion demarcation and the monitoring of autoantibodies. At our institution we offer an alternative approach and present the case of a 34 year old female who presented with 49% TBSA, levamisole-induced skin necrosis managed with early surgical excision and skin grafting. The patient presented three days following cocaine exposure with painful, purpura involving the ears, nose, buttocks, and bilateral lower extremities which quickly progressed to areas of full-thickness necrosis. Lab analysis demonstrated elevated p-ANCA and c-ANCA, as well as leukopenia, decreased C4 complement, and urinalysis positive for levamisole, corroborating the diagnosis. Contrasting the most thoroughly documented case in which the patient underwent first surgical excision on hospital day 36 and underwent 18 total excisions, our patient underwent first excision on hospital day 10 and received only one primary excision prior to definitive autografting. To our knowledge, this is the largest surface area surgically treated that did not result in surgical amputation or autoamputation of limbs or appendages, respectively. We contend that early excision and grafting provides optimal surgical management of this syndrome while avoiding the morbidity seen with delayed intervention.

  17. Surgical complications after open and laparoscopic surgery for perforated peptic ulcer in a nationwide cohort

    DEFF Research Database (Denmark)

    Wilhelmsen, M.; Møller, M H; Rosenstock, S

    2015-01-01

    BACKGROUND: Surgery for perforated peptic ulcer (PPU) is associated with a risk of complications. The frequency and severity of reoperative surgery is poorly described. The aims of the present study were to characterize the frequency, procedure-associated risk and mortality associated...

  18. Extensive pneumothorax, pneumomediastinum and surgical emphysema as a complication of bleomycin therapy

    Energy Technology Data Exchange (ETDEWEB)

    Jain, Tarun P.; Thulkar, Sanjay; Saha, Sanchita [All India Institute of Medical Sciences, Department of Radiology, New Delhi (India); Bakhshi, Sameer; Dominic, Joseph [All India Institute of Medical Sciences, Department of Medical Oncology, New Delhi (India)

    2005-12-01

    Bleomycin is a commonly used chemotherapeutic agent and one of the commonest cytotoxic drugs leading to pulmonary parenchymal damage. It generally leads to interstitial pneumonitis and fibrosis, hypersensitivity reactions and acute respiratory distress syndrome. We describe an 8-year-old boy who, following prolonged bleomycin therapy, demonstrated extensive air dissection and extrapulmonary air, an unusual and fatal complication. (orig.)

  19. Bone grafting simultaneous to implant placement. Presentation of a case.

    Science.gov (United States)

    Peñarrocha-Diago, Miguel; Gómez-Adrián, Maria Dolores; García-Mira, Berta; Ivorra-Sais, Mariola

    2005-01-01

    Bone defects at mandibular alveolar crest level complicate the placement of dental implants in the ideal location. Surgical reconstruction using autologous bone grafts allows implant fixation in an esthetic and functional manner. We describe a patient with large mandibular bone loss secondary to periodontal inflammatory processes. Reconstruction of the mandibular alveolar process was carried out using onlay block bone grafts harvested from the mandible. The grafts were stabilized by positioning the dental implants through them--a procedure that moreover afforded good primary implant fixation. After two years of follow-up the clinical and radiological outcome is good. In the lower jaw, where bone regeneration is complicated, we were able to achieve good results in this patient--minimizing the corresponding waiting time by grafting and placing the implants in the same surgical step.

  20. Economic and organizational sustainability of a negative-pressure portable device for the prevention of surgical-site complications

    Directory of Open Access Journals (Sweden)

    Foglia E

    2017-06-01

    Full Text Available Emanuela Foglia,1 Lucrezia Ferrario,1 Elisabetta Garagiola,1 Giuseppe Signoriello,2 Gianluca Pellino,3 Davide Croce,1,4 Silvestro Canonico3 1Centre for Health Economics, Social and Health Care Management - LIUC University, Castellanza, Italy; 2Department of Mental Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy; 3School of Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy; 4School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South \tAfrica Purpose: Surgical-site complications (SSCs affect patients’ clinical pathway, prolonging their hospitalization and incrementing their management costs. The present study aimed to assess the economic and organizational implications of a portable device for negative-pressure wound therapy (NPWT implementation, compared with the administration of pharmacological therapies alone for preventing surgical complications in patients undergoing general, cardiac, obstetrical–gynecological, or orthopedic surgical procedures.Patients and methods: A total of 8,566 hospital procedures, related to the year 2015 from one hospital, were evaluated considering infection risk index, occurrence rates of SSCs, drug therapies, and surgical, diagnostic, and specialist procedures and hematological exams. Activity-based costing and budget impact analyses were implemented for the economic assessment.Results: Patients developing an SSC absorbed i 64.27% more economic resources considering the length of stay (€ 8,269±2,096 versus € 5,034±2,901, p<0.05 and ii 42.43% more economic resources related to hematological and diagnostic procedures (€ 639±117 versus € 449±72, p<0.05. If the innovative device had been used over the 12-month time period, it would have decreased the risk of developing SSCs; the hospital would have realized an average reduction in health care expenditure equal to −0.69% (−€ 483

  1. Surgical treatment of the non-complicated gastroesophageal reflux: fundoplication without division of the short gastric vessels

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    FELIX Valter Nilton

    2002-01-01

    Full Text Available Background - There is today a significant greater number of laparoscopic antireflux procedures for the surgical treatment of gastroesophageal reflux disease and there are yet controversies about the necessity of division of the short gastric vessels and full mobilization of the gastric fundus to perform an adequate fundoplication. Aim - To verify the results of the surgical treatment of non-complicated gastroesophageal reflux disease performing Rossetti modification of the Nissen fundoplication. Patients and Methods - Fourteen patients were operated consecutively and prospectively (mean age 44.07 years; all had erosive esophagitis without Barrett's endoscopic signals (grade 3, Savary-Miller and they were submitted to the Rossetti modification of the Nissen fundoplication. Endoscopy, esophageal manometry and pHmetry were performed before the procedure and around 18 months postoperatively. Results - There was no morbidity, transient dysphagia average was 18.42 days; there was no register of dehiscence or displacement of the fundoplication and only one patient revealed a light esophagitis at postoperative endoscopy; the others presented a normal endoscopic view of the distal esophagus. All noticed a marked improvement of preoperative symptoms. Lower esophageal sphincter pressure changed from 5.82 mm Hg (preoperative mean to 12 mm Hg (postoperative mean; lower esophageal sphincter relaxing pressure, from 0.38 mm Hg to 5.24 mm Hg and DeMeester score, from 16.75 to 0.8. Conclusion - Rossetti procedure (fundoplication without division of the short gastric vessels is an effective surgical method to treat gastroesophageal reflux disease.

  2. Water jet dissection in neurosurgery: an update after 208 procedures with special reference to surgical technique and complications.

    Science.gov (United States)

    Keiner, Doerthe; Gaab, Michael R; Backhaus, Vanessa; Piek, Juergen; Oertel, Joachim

    2010-12-01

    Water jet dissection represents a promising technique for precise brain tissue dissection with preservation of blood vessels. In the past, the water jet dissector has been used for various pathologies. A detailed report of the surgical technique is lacking. The authors present their results after 208 procedures with a special focus on surgical technique, intraoperative suitability, advantages, and disadvantages. Between March 1997 and April 2009, 208 patients with various intracranial neurosurgical pathologies were operated on with the water jet dissector. Handling of the device and its usefulness and extent of application were assessed. The pressures encountered, potential risks, and complications were documented. The patients were followed 1 to 24 months postoperatively. A detailed presentation of the surgical technique is given. Differences and limitations of the water jet dissection device in the various pathologies were evaluated. The water jet dissector was intensively used in 127 procedures (61.1%), intermittently used in 56 procedures (26.9%), and scarcely used in 25 procedures (12%). The device was considered to be very helpful in 166 procedures (79.8%) and helpful to some extent in 33 procedures (15.9%). In 8 (3.8%) procedures, it was not helpful, and in 1 procedure (0.5%), the usefulness was not documented by the surgeon. The water jet dissector can be applied easily and very safely. Precise tissue dissection with preservation of blood vessels and no greater risk of complications are possible. However, the clinical consequences of the described qualities need to be demonstrated in a randomized clinical trial.

  3. Surgical Techniques to Increase the Apicocoronal Dimension of the Attached Gingiva: A 1-Year Comparison Between the Free Gingival Graft and the Modified Apically Repositioned Flap.

    Science.gov (United States)

    Carnio, João; Camargo, Paulo M; Pirih, Paulo Q

    2015-01-01

    The attached gingiva is a desirable anatomical element for the maintenance of gingival health. The free gingival graft (FGG) and the modified apically repositioned flap (MARF) are predictable surgical techniques often employed to increase the zone of attached gingiva. This randomized study compared the FGG and the MARF in increasing the zone of attached gingiva in contralateral sides of 15 patients 1 year posttreatment. There was an increase in keratinized tissue and attached gingiva in both groups. Gingival recession did not significantly change between pre- and posttreatment levels in either group. The MARF surgical time was approximately half as long as that of the FGG. The authors conclude that both techniques are viable; however, the main advantages of the MARF were decreased surgical time and less postoperative discomfort.

  4. Symptomatic and Asymptomatic Neurological Complications of Infective Endocarditis: Impact on Surgical Management and Prognosis

    Science.gov (United States)

    Delahaye, François; Tattevin, Pierre; Federspiel, Claire; Le Moing, Vincent; Chirouze, Catherine; Nazeyrollas, Pierre; Vernet-Garnier, Véronique; Bernard, Yvette; Chocron, Sidney; Obadia, Jean-François; Alla, François; Hoen, Bruno; Duval, Xavier

    2016-01-01

    Objectives Symptomatic neurological complications (NC) are a major cause of mortality in infective endocarditis (IE) but the impact of asymptomatic complications is unknown. We aimed to assess the impact of asymptomatic NC (AsNC) on the management and prognosis of IE. Methods From the database of cases collected for a population-based study on IE, we selected 283 patients with definite left-sided IE who had undergone at least one neuroimaging procedure (cerebral CT scan and/or MRI) performed as part of initial evaluation. Results Among those 283 patients, 100 had symptomatic neurological complications (SNC) prior to the investigation, 35 had an asymptomatic neurological complications (AsNC), and 148 had a normal cerebral imaging (NoNC). The rate of valve surgery was 43% in the 100 patients with SNC, 77% in the 35 with AsNC, and 54% in the 148 with NoNC (p<0.001). In-hospital mortality was 42% in patients with SNC, 8.6% in patients with AsNC, and 16.9% in patients with NoNC (p<0.001). Among the 135 patients with NC, 95 had an indication for valve surgery (71%), which was performed in 70 of them (mortality 20%) and not performed in 25 (mortality 68%). In a multivariate adjusted analysis of the 135 patients with NC, age, renal failure, septic shock, and IE caused by S. aureus were independently associated with in-hospital and 1-year mortality. In addition SNC was an independent predictor of 1-year mortality. Conclusions The presence of NC was associated with a poorer prognosis when symptomatic. Patients with AsNC had the highest rate of valve surgery and the lowest mortality rate, which suggests a protective role of surgery guided by systematic neuroimaging results. PMID:27400273

  5. Use of bovine pericardium (Tutopatch®) graft for surgical repair of deep melting corneal ulcers in dogs and corneal sequestra in cats.

    Science.gov (United States)

    Dulaurent, Thomas; Azoulay, Thierry; Goulle, Frédéric; Dulaurent, Alice; Mentek, Marielle; Peiffer, Robert L; Isard, Pierre-François

    2014-03-01

    To evaluate the efficacy of bovine pericardium (BP) graft in the treatment of deep melting corneal ulcers in three dogs and corneal sequestra in three cats. Three dogs with keratomalacia affecting the deep third of the stroma and three cats with corneal sequestrum were evaluated and underwent surgery. Following keratectomy, BP material was placed into the keratectomy bed and sutured to the recipient cornea with 9/0 polyglactin suture material. Postoperative treatment with topical and systemic antibiotics, systemic nonsteroidal anti-inflammatory agents, and topical atropine was prescribed. Follow-up examinations were carried out 1, 2 weeks, 1 and 2 months after the surgery and consisted of a complete ophthalmic examination. Optical coherence tomography (OCT) was performed 1 and 2 months after the surgery in one dog and in one cat. At 1 week, corneal neovascularization was present around the BP graft in all cases. Four weeks after the BP graft, in two dogs and in all cats, the vascularization was regressing and the graft was integrated into the cornea, which was regaining transparency. Topical treatment with anti-inflammatory agents was then prescribed for 2 weeks. Two months after the surgery, 5 of 6 corneas in two dogs and three cats had healed with focal corneal scarring. The remaining dog had progression of the keratomalacia involving the deep BP graft that required additional surgery, but became blind. Bovine pericardium graft offers a promising option for surgical reconstruction of the cornea following keratectomy for the management of corneal ulcers and sequestra. © 2013 American College of Veterinary Ophthalmologists.

  6. Complication rate of posterior capsule rupture with vitreous loss during phacoemulsification at a Hawaiian cataract surgical center: a clinical audit

    Directory of Open Access Journals (Sweden)

    Chen M

    2014-02-01

    Full Text Available Ming Chen,1 Kara C LaMattina,2 Thomas Patrianakos,2 Surendar Dwarakanathan2 1Department of Surgery, Division of Ophthalmology, University of Hawaii, Honolulu, HI, USA; 2Division of Ophthalmology, John H Stroger, Jr Hospital of Cook County, Chicago, IL, USA Purpose: To compare the complication rate of posterior capsule rupture (PCR with vitreous loss during phacoemulsification at an ambulatory surgical center with published results as a clinical audit for quality control. Methods: A retrospective chart review of 3,339 consecutive patients who underwent routine phacoemulsification by four experienced private practice surgeons from January 1, 2011 to June 30, 2012 at The Surgical Suites, Honolulu, HI, USA. All cases with PCR and vitreous loss were identified and selected for the study. Risk factors of this complication were further examined. Data were sent to John H Stroger Jr Hospital of Cook County, Division of Ophthalmology, for literature review, analysis, and write-up. Results: Twenty-three of the 3,339 cases incurred PCR and vitreous loss during phacoemulsification, for an incidence rate of 0.68%. Miosis, shallow chamber, restlessness, pseudoexfoliation syndrome, floppy iris syndrome, and zonulopathy were the main causes. In addition, surgeon volume (number of cases was inversely correlated with PCR. Conclusion: The rate of PCR with vitreous loss during phacoemulsification in this study may be lower than other published results done at academic centers. However, there was no compatible study available for comparison, as existing studies performed at academic centers included resident cases. This study identified risk factors for PCR/vitreous loss both preoperatively and postoperatively that may assist in application of preventive measures to decrease rates of PCR/vitreous loss. Keywords: phacoemulsification complications, posterior capsule rupture, vitreous loss, vitrectomy, miosis, pseudoexfoliation, floppy iris syndrome, zonulopathy

  7. Multidetector CT angiography as a noninvasive tool to assess graft patency of surgically reconstructed diffusely diseased coronary arteries

    Directory of Open Access Journals (Sweden)

    Ahmed I. Rezk

    2014-03-01

    Conclusion: Extensive reconstruction of the diffusely diseased LAD using an ITA graft could be performed safely with very encouraging results. MDCT angiography is an excellent non invasive tool not only to evaluate graft patency in the reconstructed LAD but also to detect other findings in asymptomatic patients with diffuse coronary artery disease for better and more close follow up.

  8. Giant venous aneurysm jeopardising internal mammary arterial graft patency.

    Science.gov (United States)

    Van Caenegem, Olivier; le Polain de Waroux, Jean-Benoit; de Kerchove, Laurent; Coche, Emmanuel

    2012-09-01

    The authors report a 79-year old man with a history of coronary bypass surgery, presenting with acute heart failure and elevated troponin. Coronarography revealed a giant saphenous vein graft aneurysm, which was compressing the left internal mammary artery bypass graft. This was confirmed by a multislice enhanced-ECG gated cardiac CT, showing the venous aneurysm responsible for external compression of the arterial graft and its functional occlusion. Myocardial ischaemia, the mechanism leading to cardiac failure, was confirmed by hypoperfusion of the sub-endocardial area shown by the CT. The aneurysm was surgically removed without complications. The patient recovered and his cardiac function improved. This is the first recorded case of compression of the left internal mammary artery by an giant saphenous vein graft aneurysm having triggered severe myocardial ischaemia and heart failure. The authors review the incidence and complications of giant venous bypass graft aneurysms reported in the literature.

  9. Giant Nephrothoracic Abscess: A Misleading Disease, a Surgical Challenge, and an Unexpected Complication

    Directory of Open Access Journals (Sweden)

    Peter Kronenberg

    2014-01-01

    Full Text Available A rare case of perinephric abscess with unilateral secondary pulmonary involvement that was further complicated by spillover of purulent content into the contralateral lung is reported here. Its diagnosis, treatment, and evolution are described and discussed along with certain features of nephropulmonary fistulas. The diagnosis of these abscesses is difficult, largely because of the paucity of primary symptoms and the frequent presence of misleading secondary symptoms. Deceptive cases like this one highlight the importance of its contemplation in every physician’s differential diagnosis.

  10. Surgical complications in 2,840 cases of hemorrhoidectomy by Milligan-Morgan, Ferguson and combined techniques

    Directory of Open Access Journals (Sweden)

    Guilherme de Almeida Santos

    2012-09-01

    Full Text Available The analysis of 2,840 cases of hemorrhoidectomy by open techniques of Milligan-Morgan (2,189 cases, Ferguson (341 cases and mixed (310 cases in 11,043 patients with hemorrhoidal disease (HD allowed the following conclusions. The patients' acceptance of surgical indication for hemorrhoidectomy was 25.7%. Hemorrhoidectomy was more common among women (53.8% than men (46.2%, and more accepted by women (26.5% than men (24.8%. Hemorrhoidectomy was more common in patients of the fourth (27.7%, fifth (21.9% and third (21.0% decades of age. Most patients who agreed to undergo hemorrhoidectomy were those of the second (38.2%, eighth (35.9% and ninth (34.5% decades of age. The overall incidence of surgical complications was 3.0% (87 cases: anal stenosis (1.8%, bleeding (0.8%, worsening of anal hypotonia (0.2%, sepsis (0.1% and systemic complications (0.1%, with no difference among the techniques used. The incidence of surgical complications by Milligan-Morgan technique was 3.0% - stenosis (1.9%, bleeding (1.9%, worsening of anal hypotonia (0.2% and systemic complications (0.04%. The incidence of surgical complications by Ferguson's technique was 3.5% - stenosis (1.7%, bleeding (0.6%, worsening of anal hypotonia (0.6% and sepsis (0.6%. And the incidence of surgical complications by mixed techniques was 2.5% - stenosis (1.0%, bleeding (0.3%, worsening of anal hypotonia (0.3%, sepsis (0.3% and systemic complications (0.3%. The incidence of surgical complications according to gender was 3.0% among women and 3.2% among men, with higher incidence of stenosis in women (2.0% and hemorrhage in men (1.1%. Surgical complications were more observed in the eighth (5.1% and seventh (3.8% decades of age. The incidence of anal stenosis was 1.8%, being 64.0% without hypotonia and 66.0% without anal fissure (66.0%, with annular stenosis as the most common anatomical shape (70.0%. Anal stenosis was more common among women (2.0% presenting mean age of 38.2 years, with no

  11. Comparative Assessment of Preoperative versus Postoperative Dexamethasone on Postoperative Complications following Lower Third Molar Surgical Extraction

    Directory of Open Access Journals (Sweden)

    Hashem M. Al-Shamiri

    2017-01-01

    Full Text Available Aim. To evaluate the effect of preoperative versus postoperative administration of oral Dexamethasone on postoperative complications including pain, edema, and trismus following lower third molar surgery. Methods. 24 patients were divided into two equal groups receiving 8 mg Dexamethasone orally, one group one hour preoperatively and the other group immediately after surgery. Pain was measured using VAS, edema was measured using a graduated tape between 4 fixed points in the face, and the mouth opening was measured using a graduated sliding caliper. Results. In this study pain and trismus records were similar and statistically nonsignificant in both groups. The results had proven that preoperative administration was superior when compared to postoperative administration regarding edema (0.002. Conclusions. Preoperative oral administration of 8 mg Dexamethasone was superior to the postoperative administration of the same dose concerning edema after lower third molar surgery.

  12. A case report of congenital umbilical arteriovenous malformation complicated with liver failure after surgical excision

    Science.gov (United States)

    Han, Ji-Won; Kim, Hyun-Young; Jung, Sung-Eun

    2017-01-01

    Abstract Rationale: Few case reports of umbilical arteriovenous malformation (AVM) have been reported. Herein, we report a neonatal case of umbilical AVM who underwent liver failure after surgical excision. Patient concerns: The patient was a girl delivered at a gestational age of 39+5 weeks showing cyanosis and heart murmur. Diagnoses: Cardiac echography, abdominal ultrasonography (USG), and computed tomography revealed suspecting the umbilical AVM. Interventions: On the eighth day after birth, because of the aggravation of heart failure, emergency surgery for excision of umbilical AVM was performed. Outcomes: In postoperative state, worsened laboratory test of liver function and coagulopathy indicated the liver failure. Abdominal USG revealed that the portal vein (PV) flow primarily occurred from the left PV to the inferior vena cava via ductus venosus and coarse hepatic echogenicity. After conservative management, laboratory findings of liver function and the flow direction of the left PV were normal, as demonstrated by abdominal USG within 50th postoperative day. Lessons: Careful preoperative evaluation of an AVM of a large size with significant blood flow should be performed, and the possibility of liver failure after surgery should always be considered. PMID:28178121

  13. Acellular dermal allograft for vestibuloplasty--an alternative to autogenous soft tissue grafts in preprosthetic surgical procedures: a clinical report.

    Science.gov (United States)

    Bhola, Monish; Newell, Donald H; Hancock, Everett B

    2003-06-01

    Various vestibular extension procedures have been described in the literature over the past 6 decades, including the use of free gingival grafts. An acellular dermal allograft has been used as a substitute for autogenous soft tissue grafts in root coverage procedures. This clinical report describes the use of such an allograft as a substitute for palatal donor tissue in the vestibular extension of an edentulous maxillary arch with multiple frenum attachments before fabrication of a complete denture. In this patient, healing was uneventful, and 6-month clinical observations demonstrated an apical positioning of the mucogingival junction with an increase in vestibular depth, and the absence of multiple frenae. The acellular dermal allograft appears to be a useful substitute for autogenous palatal grafts in preprosthetic surgery. This approach has many advantages over the free gingival graft, including no donor site morbidity, unlimited availability, and better color match.

  14. Natural coniferous resin salve used to treat complicated surgical wounds: pilot clinical trial on healing and costs.

    Science.gov (United States)

    Sipponen, Arno; Kuokkanen, Opri; Tiihonen, Raine; Kauppinen, Harri; Jokinen, Janne J

    2012-06-01

    Resin is a natural product of coniferous trees. Salves manufactured from spruce resin (Picea abies) have been used for centuries to treat wounds and skin infections. We report a pilot clinical trial designed to investigate healing rates, factors that contribute to delayed wound healing, cost-effectiveness, and incidence of allergic reactions when resin salve is used to treat complicated surgical wounds. The trial involved 23 patients in whom wound healing after surgery was delayed. These patients were assigned to resin salve treatment. The primary outcome measure was the number of days to complete wound healing. Secondary objectives included an assessment of factors contributing to delayed wound healing, an estimation of associated costs, and an investigation into the occurrence of allergic reactions related to resin salve therapy. The study achieved a healing rate of 100%. The mean ± SD healing time was 43 ± 24 days. The mean ± SD wound size (length × width × depth) was (29 ± 19) × (12 ± 7) × (4 ± 3) mm. Wound size, use of corticosteroids or other immunosuppressants, and immobilization were statistically significant (P < 0.05) contributors to delayed wound healing and impaired re-epithelialization. The total mean ± SD costs of the resin salve treatment were €45.0 ± 26.0 per patient during the entire treatment period and €1.2 ± 0.5 per treatment day. The rate of allergic reactions was 0%. The results of this pilot trial indicate that complicated surgical wounds may be treated successfully with resin salve. The treatment method is clinically effective and cost-effective, and the rate of allergic reactions is low. © 2012 The International Society of Dermatology.

  15. Prospective Comparison of Magnetic Resonance Imaging, Transrectal and Transperineal Sonography, and Surgical Findings in Complicated Perianal Crohn Disease.

    Science.gov (United States)

    Bor, Renáta; Farkas, Klaudia; Bálint, Anita; Szűcs, Mónika; Ábrahám, Szabolcs; Milassin, Ágnes; Rutka, Mariann; Nagy, Ferenc; Milassin, Péter; Szepes, Zoltán; Molnár, Tamás

    2016-11-01

    Magnetic resonance imaging (MRI) and transrectal sonography are the two accepted imaging modalities for evaluation of perianal fistulas and abscesses. Transperineal sonography is a new technique that is easy to learn and can be performed at any time. The purpose of this study was to prospectively compare the diagnostic accuracy of MRI, transrectal sonography, and transperineal sonography with surgical findings in patients with perianal Crohn disease. All patients with perianal Crohn disease underwent MRI, transrectal sonography, and transperineal sonography within a few days before surgery. Fistulas were classified as simple (43.8%) or complex (52.2%) based on surgical findings. Twenty-three patients with active perianal Crohn disease (12 women and 11 men; mean age, 29.9 years; current therapy: antibiotics, 69.6%; azathioprine, 56.5%; and biologics, 73.9%; previous surgery, 26.1%; and proportion of smokers, 39.1%) were included. Sensitivity values for MRI, transrectal sonography, and transperineal sonography for diagnosis of fistulas were 84.6%, 84.6%, and 100%, respectively. Transperineal sonography was more sensitive for diagnosis of perianal abscesses than MRI and transrectal sonography (100%, 58.8%, and 92.8%). Transperineal sonography is a very accurate diagnostic method with outstanding sensitivity compared with MRI and transrectal sonography for evaluation of complicated perianal Crohn disease. Due to its simplicity and low cost, it is recommended that transperineal sonography be the first diagnostic modality in these cases. © 2016 by the American Institute of Ultrasound in Medicine.

  16. 小儿伤寒的外科并发症%Surgical Complications of Typhoid Fever in Children

    Institute of Scientific and Technical Information of China (English)

    董蒨; 金百祥

    1990-01-01

    Thirteen caese with surgical complication of typhoid fever,intestinal perforation(9),acute cholecystitis(2),splenic abcess(1)and massive intestinal bleeding(1)were treated from 1960 to 1988.These complications presented from 4 to 28 days since running fever.Widal's test was positive in 10 cases.The diagnosis was also established by tb e positive culture of salmonella typh in tbe stool(6),blood(4),and bile juice or pus(8).All cases were operated on,and 3 diedpostoperatively.%本文报道小儿伤寒的外科并发症13例.肠穿孔9例,胆囊炎2例,脾脓肿及肠道大出血各1例.临床表现、wi dal试验、大便、血、脓液或胆汁培养是主要诊断依据.均手术治疗,死亡3例.强调全面实验室检查及早期手术.

  17. Vertebral subluxation during three-column osteotomy in surgical correction of adult spine deformity: incidence, risk factors, and complications.

    Science.gov (United States)

    Qiao, Jun; Xiao, Lingyan; Sun, Xu; Shi, Benlong; Liu, Zhen; Xu, Leilei; Zhu, Zezhang; Qian, Bangping; Qiu, Yong

    2017-08-24

    To investigate incidence, risk factors, and complications of vertebral subluxation (VS) during three-column osteotomy in surgical correction of adult spine deformity. Adult spine deformity patients who underwent three-column osteotomies including VCR, PSO, and other modified types from March 2000 to December 2014 in our center were retrospectively reviewed. The following parameters were measured pre- and postoperatively: Cobb angle of main curve, global kyphosis, sagittal vertical axis, and kyphosis flexibility. Radiographic parameters between groups (VCR vs. PSO and subluxation vs. non-subluxation) were compared. 171 ASD patients were recruited, 18 of which (10.5%) developed sagittal vertebral subluxation at the osteotomy site. 5 of 18 patients (27.8%) developed neurological complications after surgery. For these five patients, two patients got partial recovery, and three got complete recovery at 2-year follow-up. 116 patients underwent PSO, 12 of which (10.3%) developed sagittal vertebral subluxation. In 55 patients receiving VCR, 6 (10.9%) developed sagittal vertebral subluxation. No significant difference was noted between the two groups (P > 0.05). The mean age of VS group was larger than that of non-VS group (46.2 vs. 34.2, P column osteotomies, one-fourth of which would develop neurological deficits. Older age, rigid kyphosis, and the pre-existence of VS were risk factors for developing VS.

  18. The Prevention of Delirium and Complications Associated with Surgical Treatments (PODCAST) study: protocol for an international multicentre randomised controlled trial.

    Science.gov (United States)

    Avidan, Michael S; Fritz, Bradley A; Maybrier, Hannah R; Muench, Maxwell R; Escallier, Krisztina E; Chen, Yulong; Ben Abdallah, Arbi; Veselis, Robert A; Hudetz, Judith A; Pagel, Paul S; Noh, Gyujeong; Pryor, Kane; Kaiser, Heiko; Arya, Virendra Kumar; Pong, Ryan; Jacobsohn, Eric; Grocott, Hilary P; Choi, Stephen; Downey, Robert J; Inouye, Sharon K; Mashour, George A

    2014-09-17

    Postoperative delirium is one of the most common complications of major surgery, affecting 10-70% of surgical patients 60 years and older. Delirium is an acute change in cognition that manifests as poor attention and illogical thinking and is associated with longer intensive care unit (ICU) and hospital stay, long-lasting cognitive deterioration and increased mortality. Ketamine has been used as an anaesthetic drug for over 50 years and has an established safety record. Recent research suggests that, in addition to preventing acute postoperative pain, a subanaesthetic dose of intraoperative ketamine could decrease the incidence of postoperative delirium as well as other neurological and psychiatric outcomes. However, these proposed benefits of ketamine have not been tested in a large clinical trial. The Prevention of Delirium and Complications Associated with Surgical Treatments (PODCAST) study is an international, multicentre, randomised controlled trial. 600 cardiac and major non-cardiac surgery patients will be randomised to receive ketamine (0.5 or 1 mg/kg) or placebo following anaesthetic induction and prior to surgical incision. For the primary outcome, blinded observers will assess delirium on the day of surgery (postoperative day 0) and twice daily from postoperative days 1-3 using the Confusion Assessment Method or the Confusion Assessment Method for the ICU. For the secondary outcomes, blinded observers will estimate pain using the Behavioral Pain Scale or the Behavioral Pain Scale for Non-Intubated Patients and patient self-report. The PODCAST trial has been approved by the ethics boards of five participating institutions; approval is ongoing at other sites. Recruitment began in February 2014 and will continue until the end of 2016. Dissemination plans include presentations at scientific conferences, scientific publications, stakeholder engagement and popular media. The study is registered at clinicaltrials.gov, NCT01690988 (last updated March 2014). The

  19. Identification and Prevention of Medical Legal Risks of Surgical Complications%手术并发症医疗法律风险的识别与防范

    Institute of Scientific and Technical Information of China (English)

    刘玉莹

    2016-01-01

    Surgical complications are the main medical risks in hospitals, and the medical risk prevention and control of surgical complications is the main part of the hospital risk management. From the perspective of proper performance of care duty and informed consent duty , this paper discussed the legal risks of surgical com-plications, and the countermeasures from the perspective of medical administration and medical safety manage-ment.%手术并发症是医院所面对的主要医疗风险,而其防控则是医院风险防控的重点内容。文章从适当履行注意义务和说明义务的角度,探讨手术并发症的法律风险点,并从医疗行政和医疗安全管理角度探讨防范措施。

  20. The role of the neurophysiological intraoperative monitoring to prevention of postoperative neurological complication in the surgical treatment of scoliosis

    Directory of Open Access Journals (Sweden)

    M. A. Khit

    2014-01-01

    Full Text Available Bearing in mind that the technique of surgical treatment of scoliosis and skills are high enough, iatrogenic spinal cord injury is still one of the most feared complication of scoliosis surgery. It is well known that the function of the spinal cord may be estimated by combining somatosensory evoked potentials (SSEP and motor evoked potentials (MEP. We have retrospectively evaluated the results of intraoperative neurophysiological monitoring (IOM in a large population of patients underwent surgical treatment of spinal deformity. Intraoperative neuromonitoring SSEP and transcranial electrostimulation (TES – MEP in conjunction with the assessment of the correct position of the screws was performed in 142 consecutive cases, i. e. all patients who had undergone surgical treatment of idiopathic (127 pts, congenital (10 pts or neurogenic (5 pts scoliosis. A neurophysiological “alarm” was defined as a decrease in amplitude (uni- or bilateral of at least 50 % for SEPs and of 70 % for TES-MEP compared with baseline. Total intravenous anesthesia (TIVA in 138 cases was achieved by infusion of propofol (8–16 mg / kg / h and in 4 cases by halogenate anesthesia – sevoflurane (0.4–1.8 MAC. Seven patients (4.9 % were reported intraoperative neurophysiological parameters significant changes that require action by the surgeons and anesthetists, with deterioration of ostoperative neurologic status in one case. Of these three cases, the amplitude drop SSEPs and TESMEPs-was due, to the pharmacological aspects of anesthetic management, in the other four cases – with surgical procedures (response halo-traction – 1 case, mechanical damage of sheath of the spinal cord by pliers Kerrison – 1case, overcorrection – 2 cases. In five cases (3.5 % required reposting of pedicle screws (1–2 levels. Only one patient (0.7 % had a persistent postoperative neurological disorder (neuropathic pain, respectively from a level of re-reposition of

  1. Emergency coronary artery stenting for coronary dissection complicating diagnostic cardiac catheterisation.

    OpenAIRE

    Knight, C; Stables, R; Sigwart, U

    1995-01-01

    Dissection of a coronary artery is a recognised and significant complication of diagnostic coronary angiography that often requires emergency coronary artery bypass grafting. A coronary stent was used to treat this complication. This technique has potential advantages in terms of speed of reperfusion and availability in centres performing diagnostic angiography without surgical cover on site.

  2. Predicting the risk of death following coronary artery bypass graft made simple: a retrospective study using the American College of Surgeons National Surgical Quality Improvement Program database.

    Science.gov (United States)

    Chung, Paul J; Carter, Timothy I; Burack, Joshua H; Tam, Sophia; Alfonso, Antonio; Sugiyama, Gainosuke

    2015-04-29

    Risk models to predict 30-day mortality following isolated coronary artery bypass graft is an active area of research. Simple risk predictors are particularly important for cardiothoracic surgeons who are coming under increased scrutiny since these physicians typically care for higher risk patients and thus expect worse outcomes. The objective of this study was to develop a 30-day postoperative mortality risk model for patients undergoing CABG using the American College of Surgeons National Surgical Quality Improvement Program database. Data was extracted and analyzed from the American College of Surgeons National Surgical Quality Improvement Program Participant Use Files (2005-2010). Patients that had ischemic heart disease (ICD9 410-414) undergoing one to four vessel CABG (CPT 33533-33536) were selected. To select for acquired heart disease, only patients age 40 and older were included. Multivariate logistic regression analysis was used to create a risk model. The C-statistic and the Hosmer-Lemeshow goodness-of-fit test were used to evaluate the model. Bootstrap-validated C-statistic was calculated. A total of 2254 cases met selection criteria. Forty-nine patients (2.2%) died within 30 days. Six independent risk factors predictive of short-term mortality were identified including age, preoperative sodium, preoperative blood urea nitrogen, previous percutaneous coronary intervention, dyspnea at rest, and history of prior myocardial infarction. The C-statistic for this model was 0.773 while the bootstrap-validated C-statistic was 0.750. The Hosmer-Lemeshow test had a p-value of 0.675, suggesting the model does not overfit the data. The American College of Surgeons National Surgical Quality Improvement Program risk model has good discrimination for 30-day mortality following coronary artery bypass graft surgery. The model employs six independent variables, making it easy to use in the clinical setting.

  3. Early detection of biliary complications and graft rejection in a non-RH Identitical liver transplant recipient from a non-heart-beating donor: a case report.

    Science.gov (United States)

    Turiño-Luque, J; Zambudio-Carroll, N; Muffak-Granero, K; Villegas-Herrera, T; Garrote-Lara, D; Ferrón-Orihuela, J-A

    2012-09-01

    Because of a shortage of organs, non-heart-beating donors have been proposed to be a possible source of grafts for orthotopic liver transplantation. Herein, we have presented a blood group A+ patient with primary biliary cirrhosis, who underwent orthotopic liver transplantation from a non-heart-beating blood group A- donor. On day 5 after transplantation the patient displayed a low hemoglobin levels as well as an increased total bilirubin with progressive encephalopathy, hypotension, and oligoanuria on day 11. The patient responded to steroid treatment. We assume the main cause of organ dysfunction was a passenger lymphocyte syndrome (ABO-Rh incompatibility). Biliary complications were detected at a 6-month follow-up visit by increased hepatic enzymes. We thus concluded that it is useful to take Rh group into account.

  4. Transsylvian selective amygdalohippocampectomy for treatment of medial temporal lobe epilepsy: Surgical technique and operative nuances to avoid complications

    Directory of Open Access Journals (Sweden)

    Timothy J Kovanda

    2014-01-01

    Full Text Available Background: A number of different surgical techniques are effective for treatment of drug-resistant medial temporal lobe epilepsy. Of these, transsylvian selective amygdalohippocampectomy (SA, which was originally developed to maximize temporal lobe preservation, is arguably the most technically demanding to perform. Recent studies have suggested that SA may result in better neuropsychological outcomes with similar postoperative seizure control as standard anterior temporal lobectomy, which involves removal of the lateral temporal neocortex. Methods: In this article, the authors describe technical nuances to improve the safety of SA. Results: Wide sylvian fissure opening and use of neuronavigation allows an adequate exposure of the amygdala and hippocampus through a corticotomy within the inferior insular sulcus. Avoidance of rigid retractors and careful manipulation and mobilization of middle cerebral vessels will minimize ischemic complications. Identification of important landmarks during amygdalohippocampectomy, such as the medial edge of the tentorium and the third nerve within the intact arachnoid membranes covering the brainstem, further avoids operator disorientation. Conclusion: SA is a safe technique for resection of medial temporal lobe epileptogenic foci leading to drug-resistant medial temporal lobe epilepsy.

  5. [Major vascular complications following surgery for a herniated lumbar disk].

    Science.gov (United States)

    Abad, C; Martel, D; Feijóo, J J; Carreira, L

    1993-01-01

    Two cases of arterial injury of the iliac arteries during surgery of the lumbar disc are presented. Both patients were successfully operated, in the first case a primary repair was accomplished, the second patient was treated by means of an ileo-femoral bypass graft. A comment of the pathophysiology, diagnostic and surgical management of this unusual complication is presented.

  6. Arteriovenous shunt graft ulceration with sinus and graft epithelialization

    Directory of Open Access Journals (Sweden)

    Pooja Singhal

    2015-03-01

    Full Text Available Arteriovenous fistula and grafts are used as access sites for patients with chronic kidney disease and are prone for complications. Stent grafts are used to treat access site complications. We report a rare and unusual finding of epithelialization of the sinus tract and the lumen of a polytetrafluoroethylene graft, following ulceration of the overlying skin.

  7. Obesity and urologic complications after renal transplantation

    Directory of Open Access Journals (Sweden)

    Ashkan Heshmatzadeh Behzadi

    2014-01-01

    Full Text Available Although obesity has been associated with improved survival on dialysis, its short-and long-term effects on renal transplantation outcomes remain unclear. Herein, we evaluate the short-term and intermediate long-term effects of obesity on first-time renal transplant patients. A retrospective analysis was performed on 180 consecutive renal transplant recipients from living unrelated donors during 2006-2008 in a major transplantation center in Tehran, Iran. Among these, 34 (18% patients were found to be obese (body mass index ≥30 kg/m 2 . Obese patients were more likely to develop post-transplant renal artery stenosis (RAS (17.6% vs. 2.8%, P <0.001, hematoma (47.9% vs. 17.6, P = 0.009, surgical wound complications (64.7% vs. 9.6%, P <0.001 and renal vein thrombosis (2% vs. 0%, P <0.001. However, the incidence of delayed graft function, lymphocele, urologic complications of ureterovesical junction stenosis or urinary leakage, surgical complications of excessive bleeding or renal artery thrombosis and duration of hospitalization were similar between the two groups. The two-year patient and graft survival were also statistically not different. Renal transplantation in obese recipients is associated with a higher incidence of post-transplant RAS, hematoma, surgical wound complications and renal vein thrombosis, but similar two-year patient and graft survival.

  8. Respiratory physiotherapy and incidence of pulmonary complications in off-pump coronary artery bypass graft surgery: an observational follow-up study

    Directory of Open Access Journals (Sweden)

    Pértega-Díaz Sonia

    2009-07-01

    Full Text Available Abstract Background Heart surgery is associated with an occurrence of pulmonary complications. The aim of this study was to determine whether pre-surgery respiratory physiotherapy reduces the incidence of post-surgery pulmonary complications. Methods Observational study of 263 patients submitted to off-pump coronary artery bypass grafting (CABG surgery at the A Coruña University Hospital (Spain. 159 (60.5% patients received preoperative physiotherapy. The fact that patients received preoperative physiotherapy or not was related to whether they were admitted to the cardiac surgery unit or to an alternative unit due to a lack of beds. A physiotherapist provided a daily session involving incentive spirometry, deep breathing exercises, coughing and early ambulation. A logistic regression analysis was carried out in order to identify variables associated with pulmonary complications. Results Both groups of patients (those that received physiotherapy and those that did not were similar in age, sex, body mass index, creatinine, ejection fraction, number of affected vessels, O2 basal saturation, prevalence of diabetes, dyslipidemia, exposure to tobacco, age at smoking initiation, number of cigarettes/day and number of years as a smoker. The most frequent postoperative complications were hypoventilation (90.7%, pleural effusion (47.5% and atelectasis (24.7%. In the univariate analysis, prophylactic physiotherapy was associated with a lower incidence of atelectasis (17% compared to 36%, p = 0.01. After taking into account age, sex, ejection fraction and whether the patients received physiotherapy or not, we observed that receiving physiotherapy is the variable with an independent effect on predicting atelectasis. Conclusion Preoperative respiratory physiotherapy is related to a lower incidence of atelectasis.

  9. Comparing the Effect of Continuous and Intermittent Irrigation Techniques on Complications of Arterial Catheter and Partial Thromboplastin Time in Patients Following Coronary Artery Bypass Grafting Surgery

    Directory of Open Access Journals (Sweden)

    Sedigheh Arta

    2017-04-01

    Full Text Available Background: Different approaches are available to irrigate the arterial catheter, such as continuous and intermittent techniques. However, there is a disagreement regarding the most appropriate method. Aim: this study aimed to compare the effect of two continuous and intermittent irrigation methods on complications of arterial catheter and partial thromboplastin time (PTT in patients with coronary artery bypass (CABG surgery. Method: This randomized clinical trial was conducted on 60 participants undergoing coronary artery bypass grafting surgery in open-heart surgery ICU at Imam Reza hospital in Mashhad, Iran, in 2016. In continuous group, the arterial catheter was continuously irrigated with heparin solution at the rate of 2cc/h, and in the intermittent group with a syringe containing 5cc heparin solution every 3 hours. In both groups, catheter was monitored and recorded every 3 hours (until 48 hours and 3 times from enrollment in terms of complications of partial thromboplastin time. Data were analyzed using SPSS version 16. Results: The findingsof independent t-test showed that the two groups are homogeneous in age (P =0.48. The result of Fisher's exact test revealed no significant difference between the two groups in terms of average incidence of complications during the first 24 hours (P=0.55 and second 24 hours (P=0.55 after catheterization. Also during the 48 hours after surgery, independent t-test results showed no statistically significant difference in partial thromboplastin time (P=0.53 between the two groups. Implications for Practice: According to the results of the research based on the lack of difference between continuous and intermittent irrigation methods up to 48 hours after catheter replacement in terms of arterial catheter complications, further long-term follow-up researches are recommended.

  10. Analysis and treatment of surgical complications after percutaneous transforaminal endoscopic discectomy for treating lumbar disc herniation and lumbar intervertebral foraminal stenosis

    Directory of Open Access Journals (Sweden)

    Guang HAN

    2016-04-01

    Full Text Available Objective To analyze the causes of surgical complications after treatment of lumbar disc herniation (LDH and lumbar intervertebral foraminal stenosis by percutaneous transforaminal endoscopic discectomy (PTED.  Methods From December 2009 to December 2014, 286 patients with LDH (N = 201 and lumbar intervertebral foraminal stenosis (N = 85 were confirmed by X-ray, CT or MRI and treated by PTED in our hospital. Visual Analogue Scale (VAS was used to evaluate the degree of pain in each paitent before and after operation. The curative effect was evaluated by Macnab score. Surgical complications were recorded to find out the causes and methods to prevent them.  Results All cases were followed up for 3 months, and the VAS score decreased significantly compared with preoperation [1.00 (0.00, 1.05 vs 8.50 (7.75, 9.25; Z = 2.825, P = 0.050]. According to Macnab score, the rate of excellent and good functional recovery was 95.45% (273/286. Procedure-related complications included nerve injury in 8 cases (2.80%, hemorrhage at the operation site and hematoma formation around nerve root in 6 cases (2.10%, rupture of dural sac in one case (0.35%, muscle cramps in 3 cases (1.05%, surgical infection in one case (0.35%, postoperative recurrence in 4 cases (1.40%. All patients with complications were cured after symptomatic treatment. Conclusions The overall effect of percutaneous transforaminal endoscopic discectomy for treating lumbar disc herniation and lumbar intervertebral foraminal stenosis is satisfactory, which has a low incidence rate of postoperative complications. Some tips can effectively reduce the rate of surgical complications such as preoperative evaluation, precise performance, careful hemostasis, shortening the operation time and postoperatively symptomatic treatment, etc. DOI: 10.3969/j.issn.1672-6731.2016.04.007

  11. Thyromental Height Test for Prediction of Difficult Laryngoscopy in Patients Undergoing Coronary Artery Bypass Graft Surgical Procedure

    OpenAIRE

    Nilesh Jain; Sucharita Das; Muralidhar Kanchi

    2017-01-01

    Background: Patients undergoing coronary artery bypass graft (CABG) procedures have higher incidence of difficult laryngoscopy and intubation than general surgery population. Accurate prediction of difficult laryngoscopy in CABG patients is desirable to reduce the hemodynamic response and myocardial oxygen requirements. Recently, thyromental height test (TMHT) has been proposed as one of the highly sensitive and specific bedside tests to predict difficult airway. We, in our prospective observ...

  12. Alveolar graft in the cleft lip and palate patient: review of 104 cases.

    Science.gov (United States)

    Luque-Martín, Estela; Tobella-Camps, María-Luisa; Rivera-Baró, Alejandro

    2014-09-01

    Alveolar bone grafting is a vital part of the rehabilitation of cleft patients. The factors that have been most frequently associated with the success of the graft are the age at grafting and the pre-grafting orthodontic treatment. 1) Describe the cases of alveolar bone grafts performed at the Maxilofacial Unit of Hospital Sant Joan de Déu, Barcelona (HSJD); and 2) Analyze the success/failure of alveolar grafts and related variables. Descriptive retrospective study using a sample of 104 patients who underwent a secondary alveolar graft at the Craniofacial Unit of HSJD between 1998 and 2012. The graft was done by the same surgeon in all patients using bone from the iliac crest. 70% of the patients underwent the procedure before the age of 15 (median 14.45 years); 70% of the graft patients underwent pre-graft maxillary expansion. A total of 100 cases were recorded as successful (median age of 14.58 years, 68 underwent pre-graft expansion) and only 4 were recorded as failures (median age of 17.62 years, 3 underwent pre-graft expansion). We did not find statistically significant differences in age at the time of grafting or pre-surgical expansion when comparing the success and failure groups. We found the success rate of the graft to be 96.2%. The number of failures was too small to establish a statistically significant conclusion in our sample regarding the age at grafting and pre-grafting expansion. The use of alveolar bone grafting from the iliac crest has a very high success rate with a very low incidence of complications. Existing controversies regarding secondary bone grafting and the wide range of success rates found in the literature suggest that it is necessary to establish a specific treatment protocol that ensures the success of this procedure.

  13. Correlation of immunosuppression scheme with renal graft complications detected by dynamic renal scintigraphy; Correlacao do esquema de imunossupressao com complicacoes pos-operatorias de transplantes renais atraves do uso da cintilografia renal dinamica

    Energy Technology Data Exchange (ETDEWEB)

    Martins, Flavia Paiva Proenca [Universidade do Rio de Janeiro (UNIRIO), RJ (Brazil). Inst. Biomedico; Goncalves, Renato Teixeira [Hospital Universitario Clementino Fraga Filho, Rio de Janeiro, RJ (Brazil). Unidade de Transplante Renal; Fonseca, Lea Miriam Barbosa da [Universidade Federal, Rio de Janeiro, RJ (Brazil); Gutfilen, Bianca [Universidade do Estado, Rio de Janeiro, RJ (Brazil). Centro Biomedico]. E-mail: audiocompany@unikey.com.br

    2001-10-01

    Dynamic renal scintigraphy allows the diagnosis of complications in patients submitted to organ transplantation, such as perfusion abnormalities, acute tubular necrosis and rejection. In this study we employed {sup 99m} Tc-DTPA scintigraphy to study patients submitted to kidney transplantation. The results obtained and the clinical findings were conjunctively analyzed in order to detect graft rejection or other complications. The type of immunosuppressive scheme used was also correlated with the observed complications. Fifty-five patients submitted to kidney transplantation from 1989 to 1999 were evaluated. All patients with nephrotoxicity received a 3-drug immunosuppressive scheme. In this study, acute rejection was the most frequent complication (40.4%) observed following transplantation. Thirteen of 15 recipients of cadaveric kidney grafts presented acute tubular necrosis. Only one false-positive case was observed when scintigraphy and clinical findings were not concordant. We suggest carrying out renal scintigraphy to follow-up post-transplantation patients. (author)

  14. The impact of surgical complications on health-related quality of life in women undergoing gynecologic and gynecologic oncology procedures: a prospective longitudinal cohort study.

    Science.gov (United States)

    Doll, Kemi M; Barber, Emma L; Bensen, Jeannette T; Revilla, Matthew C; Snavely, Anna C; Bennett, Antonia V; Reeve, Bryce B; Gehrig, Paola A

    2016-10-01

    There are currently no assessments of the impact of surgical complications on health-related quality of life in gynecology and gynecologic oncology. This is despite complications being a central focus of surgical outcome measurement, and an increasing awareness of the need for patient-reported data when measuring surgical quality. We sought to measure the impact of surgical complications on health-related quality of life at 1 month postoperatively, in women undergoing gynecologic and gynecologic oncology procedures. This is a prospective cohort study of women undergoing surgery by gynecologic oncologists at a tertiary care academic center from October 2013 through October 2014. Patients were enrolled preoperatively and interviewed at baseline and 1, 3, and 6 months postoperatively. Health-related quality of life measures included validated general and disease-specific instruments, measuring multiple aspects of health-related quality of life, including anxiety and depression. The medical record was abstracted for clinical data and surgical complications were graded using validated Clavien-Dindo criteria, and women grouped into those with and without postoperative complications. Bivariate statistics, analysis of covariance, responder analysis, and multivariate modeling was used to analyze the relationship of postoperative complications to change health-related quality of life from baseline to 1 month. Plots of mean scores and change over time were constructed. Of 281 women enrolled, response rates were 80% (n = 231/281) at baseline, and from that cohort, 81% (n = 187/231), 74% (n = 170/231), and 75% (n = 174/231) at 1, 3, and 6 months, respectively. The primary analytic cohort comprised 185 women with completed baseline and 1-month interviews, and abstracted clinical data. Uterine (n = 84, 45%), ovarian (n = 23, 12%), cervical (n = 17, 9%), vulvar (n = 3, 2%), and other (n = 4, 2%) cancers were represented, along with 53 (30%) cases of benign disease. There

  15. Complicações pós-operatórias de pacientes com dissecção de aorta ascendente tratados cirurgicamente Postoperative complications of surgically treated ascending aortic dissection

    Directory of Open Access Journals (Sweden)

    Gustavo Ferreira Almeida

    2011-09-01

    dissecção da aorta ascendente está associada à incidência aumentada de complicações pós-operatórias e tempo de permanência hospitalar, mas a mortalidade em 1 e 6 meses é igual a de pacientes após revascularização miocárdica pareados.OBJECTIVES: Ascending aortic dissection has a poor prognosis if it is not promptly corrected surgically. Even with surgical correction, postoperative management is feared because of its complicated course. Our aim was to describe the incidence of postoperative complications and identify the 1 and 6-month mortality rate of our ascending aortic dissection surgical cohort. Secondarily, a comparison was made between ascending aortic dissection patients and paired-matched patients who received urgent coronary artery bypass graft surgery. METHODS: A retrospective analysis of a prospectively-collected database from February 2005 through June 2008 revealed 12 ascending aortic dissection and 10 elective ascending aortic aneurysm repair patients. These patients were analyzed for demographic and perioperative characteristics. Ascending aortic dissection patients were compared to paired-matched coronary artery bypass graft surgery patients according to age (± 3 years, gender, elective/urgent procedure and surgical team. The main outcome was in-hospital morbidity, defined by postoperative complications, intensive care unit admission and hospital length of stay. RESULTS: Twenty-two patients received operations to correct ascending aortic dissections and ascending aortic aneurysms, while 246 patients received coronary artery bypass graft surgeries. Ascending aortic dissection patients were notably similar to ascending aortic aneurysm brackets, except for longer mechanical ventilation times and lengths of stay in the hospital. After matching coronary artery bypass graft surgery patients to an ascending aortic dissection group, the following significantly worse results were found for the Aorta group: higher incidence of postoperative

  16. Olecranon bone graft: revisited.

    Science.gov (United States)

    Mersa, Berkan; Ozcelik, Ismail Bulent; Kabakas, Fatih; Sacak, Bulent; Aydin, Atakan

    2010-09-01

    Autogenous bone grafts are frequently in use in the field of reconstructive upper extremity surgery. Cancellous bone grafts are applied to traumatic osseous defects, nonunions, defects after the resection of benign bone tumors, arthrodesis, and osteotomy procedures. Cancellous bone grafts do not only have benefits such as rapid revascularization, but they also have mechanical advantages. Despite the proximity to the primary surgical field, cancellous olecranon grafts have not gained the popularity they deserve in the field of reconstructive hand surgery. In this study, the properties, advantages, and technical details of harvesting cancellous olecranon grafts are discussed.

  17. Influence of surgical implantation angle of left ventricular assist device outflow graft and management of aortic valve opening on the risk of stroke in heart failure patients

    Science.gov (United States)

    Chivukula, V. Keshav; McGah, Patrick; Prisco, Anthony; Beckman, Jennifer; Mokadam, Nanush; Mahr, Claudius; Aliseda, Alberto

    2016-11-01

    Flow in the aortic vasculature may impact stroke risk in patients with left ventricular assist devices (LVAD) due to severely altered hemodynamics. Patient-specific 3D models of the aortic arch and great vessels were created with an LVAD outflow graft at 45, 60 and 90° from centerline of the ascending aorta, in order to understand the effect of surgical placement on hemodynamics and thrombotic risk. Intermittent aortic valve opening (once every five cardiac cycles) was simulated and the impact of this residual native output investigated for the potential to wash out stagnant flow in the aortic root region. Unsteady CFD simulations with patient-specific boundary conditions were performed. Particle tracking for 10 cardiac cycles was used to determine platelet residence times and shear stress histories. Thrombosis risk was assessed by a combination of Eulerian and Lagrangian metrics and a newly developed thrombogenic potential metric. Results show a strong influence of LVAD outflow graft angle on hemodynamics in the ascending aorta and consequently on stroke risk, with a highly positive impact of aortic valve opening, even at low frequencies. Optimization of LVAD implantation and management strategies based on patient-specific simulations to minimize stroke risk will be presented

  18. Unfavorable outcome of hematopoietic stem cell transplantation in two siblings with Wolman disease due to graft failure and hepatic complications.

    Science.gov (United States)

    Yanir, Asaf; Allatif, Mahmud Abed; Weintraub, Michael; Stepensky, Polina

    2013-06-01

    Wolman disease (WD) is a fatal storage disease caused by the deficiency of the lysosomal enzyme acid lipase. Only 3 cases of successful treatment by hematopoietic stem cell transplantation (HSCT), are reported. We report a case of two brothers with WD who were treated with HSCT, but both died from hepatic complications. Together they exemplify the obstacles to successful HSCT in WD. We suggest that different strategies should be investigated in order to offer treatment for this disease. Copyright © 2013 Elsevier Inc. All rights reserved.

  19. Meta-analysis of elective surgical complications related to defunctioning loop ileostomy compared with loop colostomy after low anterior resection for rectal carcinoma.

    Science.gov (United States)

    Geng, Hong Zhi; Nasier, Dilidan; Liu, Bing; Gao, Hua; Xu, Yi Ke

    2015-10-01

    Introduction Defunctioning loop ileostomy (LI) and loop colostomy (LC) are used widely to protect/treat anastomotic leakage after colorectal surgery. However, it is not known which surgical approach has a lower prevalence of surgical complications after low anterior resection for rectal carcinoma (LARRC). Methods We conducted a literature search of PubMed, MEDLINE, Ovid, Embase and Cochrane databases to identify studies published between 1966 and 2013 focusing on elective surgical complications related to defunctioning LI and LC undertaken to protect a distal rectal anastomosis after LARRC. Results Five studies (two randomized controlled trials, one prospective non-randomized trial, and two retrospective trials) satisfied the inclusion criteria. Outcomes of 1,025 patients (652 LI and 373 LC) were analyzed. After the construction of a LI or LC, there was a significantly lower prevalence of sepsis (p=0.04), prolapse (p=0.03), and parastomal hernia (p=0.02) in LI patients than in LC patients. Also, the prevalence of overall complications was significantly lower in those who received LIs compared with those who received LCs (p<0.0001). After closure of defunctioning loops, there were significantly fewer wound infections (p=0.006) and incisional hernias (p=0.007) in LI patients than in LC patients, but there was no significant difference between the two groups in terms of overall complications. Conclusions The results of this meta-analysis show that a defunctioning LI may be superior to LC with respect to a lower prevalence of surgical complications after LARRC.

  20. Comprehensive ultrasound assessment of complications post-liver transplantation.

    LENUS (Irish Health Repository)

    O'Brien, J

    2010-04-01

    Human liver transplantation for end-stage liver disease was first performed in 1963. Refinements in surgical technique and new immunosuppressive regimens have improved outcomes. Today, transplant patients have a 5-year survival rate of approximately 75%. Nevertheless, significant complications still occur. Ultrasonography (US), is the initial imaging modality of choice allowing bedside assessment for detection and follow-up of early and delayed graft complications, and facilitating interventional procedures. This review outlines the role of ultrasound in post-transplantation assessment.

  1. Comprehensive ultrasound assessment of complications post-liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    O' Brien, J. [Department of Radiology, Adelaide and Meath Incorporating the National Children' s Hospital, Tallaght, Dublin 24 (Ireland)], E-mail: juliemarobrien@yahoo.com; Buckley, A.R. [Division of Abdominal Imaging, Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia (Canada); Browne, R. [Department of Radiology, Adelaide and Meath Incorporating the National Children' s Hospital, Tallaght, Dublin 24 (Ireland)

    2010-04-15

    Human liver transplantation for end-stage liver disease was first performed in 1963. Refinements in surgical technique and new immunosuppressive regimens have improved outcomes. Today, transplant patients have a 5-year survival rate of approximately 75%. Nevertheless, significant complications still occur. Ultrasonography (US), is the initial imaging modality of choice allowing bedside assessment for detection and follow-up of early and delayed graft complications, and facilitating interventional procedures. This review outlines the role of ultrasound in post-transplantation assessment.

  2. SPY: an innovative intra-operative imaging system to evaluate graft patency during off-pump coronary artery bypass grafting.

    Science.gov (United States)

    Takahashi, Masao; Ishikawa, Toshihiro; Higashidani, Koichi; Katoh, Hiroki

    2004-09-01

    Off-pump coronary artery bypass grafting (CABG) has been rapidly increased, because of its less invasiveness with low complications. However, graft patency rate highly depends on the operators' capability due to technical difficulties. The SPY system, based on the fluorescence of indocyanine green, is an innovative device that permits validation of graft patency intra-operatively. Real time images of grafts are obtained with no need for catheterization, X-rays or iodine contrast medium. High-quality images could be obtained in all 290 grafts of 72 off-pump CABG cases (mean 4.0 grafts per patient). Four anastomoses (1.4%), including two proximal and two distal, were revised because of defects detected by SPY images. In one case, the SPY system revealed no blood flow in a radial sequential graft, although transit-time flow meter measurements showed a diastolic dominant pattern. SPY images provide critical information to surgeons to detect non-patent grafts, allowing them to be revised while the patient is still on the operating table. Using the SPY system, technical failures could be completely resolved during surgery. The use of the SPY system for intra-operative graft validation during off-pump CABG may become the gold standard for surgical management in the near future.

  3. Treatment of Portosystemic Shunt Myelopathy with a Stent Graft Deployed through a Transjugular Intrahepatic Route

    Energy Technology Data Exchange (ETDEWEB)

    Jain, Deepak, E-mail: deepakjain02@yahoo.com; Arora, Ankur, E-mail: aroradrankur@yahoo.com [Institute of Liver and Biliary Sciences, Department of Radiology (India); Deka, Pranjal, E-mail: drpranjaldeka@gmail.com [Institute of Liver and Biliary Sciences, Department of Hepatopancreatobiliary Surgery (India); Mukund, Amar, E-mail: dramarmukund@gmail.com; Bhatnagar, Shorav, E-mail: drshorav@yahoo.com [Institute of Liver and Biliary Sciences, Department of Radiology (India); Jindal, Deepti, E-mail: deepijindal@rediffmail.com; Kumar, Niteen, E-mail: drniteenkumar@gmail.com; Pamecha, Viniyendra, E-mail: viniyendra@yahoo.co.uk [Institute of Liver and Biliary Sciences, Department of Hepatopancreatobiliary Surgery (India)

    2013-08-01

    A case of surgically created splenorenal shunt complicated with shunt myelopathy was successfully managed by placement of a stent graft within the splenic vein to close the portosystemic shunt and alleviate myelopathy. To our knowledge, this is the first report of a case of shunt myelopathy in a patient with noncirrhotic portal fibrosis without cirrhosis treated by a novel technique wherein a transjugular intrahepatic route was adopted to deploy the stent graft.

  4. Comparative analysis of autodermal graft and polypropylene mesh use in large incisional hernia defects reconstruction

    Directory of Open Access Journals (Sweden)

    Stojiljković Danilo

    2013-01-01

    Full Text Available Background. Large defects of the abdominal wall caused by incisional hernia still represent a challenging problem in plastic, reconstructive, and abdominal surgery. For their successful tension-free repair a proper selection of reconstructive material is essential. In the last decades, the use of synthetic meshes was dominant while biological autodermal grafts were rarely used. The aim of the study was to comparatively analyse efficacy and safety of autodermal graft and polypropylene mesh in surgical treatment of large abdominal wall defects. Methods. This prospective comparative clinical study enroled 40 patients surgically treated for large incisional hernia repair in a 10-year period. The patients were divided into two equal groups consisting of 20 subjects and treated either by biological autodermal graft or by synthetic polypropylene mesh. The surgical techniques of reconstruction, duration of surgery, the occurrence of early, minor, and major (severe and delyed complications and hospital stay were analyzed. The average follow-up took 2 years. Results. Statistically significant differences in demographic characteristics of patients and in size of defects were not found. The surgical technique of reconstruction with an autodermal graft was more complicated. The duration of surgery in patients treated with autodermal grafts was significantly longer. There was no statistically significant difference regarding occurrence of early, minor postoperative complications and hospital stay in our study. Two severe complications were registered in the synthetic mesh group: intestinal obstruction and enterocutaneous fistula. The recurrence rate was 10% in the autodermal graft group and 15% in the group with a synthetic mesh. Conclusion. Tension-free repair of large incisional hernia with autodermal grafts was unjustly neglected despite the fact that it is safe and effective. It can be applied in all cases where synthetic mesh are not indicated (presence

  5. Study of diabetic ulcer with surgical complications of diabetes, their outcome and management modalities in 72 cases studied in Navi Mumbai

    Directory of Open Access Journals (Sweden)

    Tanveer Parvez Shaikh

    2015-01-01

    Results: In present study, 30 cases were conservatively managed with meticulous debridement. 13 cases underwent incision and drainage and came for regular follow-up. 10 cases underwent disarticulation of toes. Four patients underwent below knee amputations whereas 8 patients underwent above knee amputations and 7 patients needed split skin grafting for covering of raw area. Conclusions: Patients on irregular medication usually from age group 51-60 majorly male who undergo trauma (lower limb >>upper limb are prone to diabetic ulcer complication. Mortality in these patients is due to complications. Conservative management is the mainstay of this condition followed by I and D and finally amputation. [Int J Res Med Sci 2015; 3(1.000: 122-129

  6. Utility of pulmonary venous flow diastolic deceleration time in an adult patient undergoing surgical closure of atrial septal defect and coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Dharmesh R Agrawal

    2013-01-01

    Full Text Available Acute left ventricular (LV failure has been reported after surgical closure of atrial septal defect (ASD in adult patients. We report acute LV failure in a 56 year old gentleman following coronary artery bypass grafting (CABG and surgical closure of ASD. Transesophageal echocardiography examination of the patient following closure of ASD and CABG showed a residual ASD and a shunt (Qp :Qs = 1.5. The residual ASD was closed after re-institution of cardiopulmonary bypass (CPB under cardioplegic cardiac arrest. However, the patient did not tolerate closure of the residual ASD. The CPB was re-established and under cardioplegic cardiac arrest residual ASD was reopened to create a fenestration. This time patient was weaned easily from CPB. Postoperatively, 16 hours after extubation, patient became hemodynamically unstable, the patient was electively put on ventilator and intra-aortic balloon pump. Later the patient was weaned off successfully from ventilator. Retrospective analysis of pulmonary venous flow diastolic deceleration time (PVDT D recorded during prebypass period measured 102 msec suggestive of high left atrial pressure which indicate possibility of LV failure after ASD closure.

  7. MRI diagnosis of liver grafts complications after liver transplantation%MRI诊断56例肝移植术后移植肝实质并发症

    Institute of Scientific and Technical Information of China (English)

    王劲; 何炳均; 廖碧红; 姜在波; 罗琳; 张亚琴; 陈规划; 杨扬; 单鸿

    2011-01-01

    目的 探讨MRI对肝移植术后移植肝实质并发症的诊断价值.方法 56例肝移植术后患者均接受MR常规序列扫描(Fiesta、Dual-Echo、FSPGR、FS FSE RT、DWI)及LAVA薄层动态增强检查,分析各序列影像表现.结果 肝实质动脉期异常灌注15例;肝内肿瘤复发9例,伴下腔静脉、门静脉及肝静脉癌栓3例;肝局灶性缺血、坏死2例.胆源性肝脓肿2例,肝脏周围炎2例,灶性肝出血2例,局灶性脂肪肝2例,弥漫性脂肪肝1例,肝淤血1例,肝嗜酸性肉芽肿1例,未分化肉瘤1例.结论 MRI可准确反映移植肝实质各种并发症,在其临床诊断及治疗方案的制定中具有重要价值.%Objective To observe the value of MRI in the diagnosis of liver grafts complications after orthotopic liver transplantation. Methods A total of 56 patients after orthotopic liver transplantation underwent MR examination using Fiesta, Dual-Echo, FSPGR, FS FSE RT and DWI. The dynamic contrast-enhanced liver acquisition with volume acceleration (LAVA) was performed, and imaging findings after liver transplantation were analyzed. Results MRI revealed hepatic hyperperfusion in arterial phase (n= 15), liver tumor recurrence (n= 9) with the tumor thrombus in the inferior vena cava and portal vein in 3 cases. There were localized liver ischemia and necrosis (n=2), biliary abscess (n=2), inflammation around the liver (n=2), focal hematoma foci (n=2), localized (n=2) and diffuse fatty infiltration of the liver (n=1), hepatic congestion (n= 1) after living-donor liver transplantation. In addition, liver eosinophilic granuloma (n= 1) and undifferentiated embryonal sarcoma of the liver (n= 1) were found. Conclusion MRI can accurately demonstrate all kinds of liver grafts complications after orthotopic liver transplantation, which is of important value in the guidance of clinical diagnosis and formulating treatment plan.

  8. Perioperative oxygen fraction - effect on surgical site infection and pulmonary complications after abdominal surgery: a randomized clinical trial. Rationale and design of the PROXI-Trial

    DEFF Research Database (Denmark)

    Meyhoff, Christian Sylvest; Wetterslev, Jørn; Jorgensen, Lars N;

    2008-01-01

    A high perioperative inspiratory oxygen fraction may reduce the risk of surgical site infections, as bacterial eradication by neutrophils depends on wound oxygen tension. Two trials have shown that a high perioperative inspiratory oxygen fraction (FiO(2) = 0.80) significantly reduced risk...... complications, such as atelectasis, pneumonia and respiratory failure. The aim of our trial is to assess the potential benefits and harms of a high perioperative oxygen fraction in patients undergoing abdominal surgery....

  9. SIMULTANEOUS PANCREAS-KIDNEY TRANSPLANTATION: EARLY POSTOPERATIVE COMPLICATIONS

    Directory of Open Access Journals (Sweden)

    M.Sh. Khubutia

    2014-01-01

    Full Text Available Aim: evaluation of the incidence of early postoperative complications after simultaneous pancreas-kidney transplantation.Materials and methods. The analysis of early postoperative complications after simultaneous pancreas-kidney transplantation is presented in the paper, the most rational diagnostic algorithms, non-surgical and surgical complications’ treatment; the outcomes of the SPKT are reported.Results. 15,6% of patients experienced surgical complications, 12,5% – immunological complications, 12,5% – infectious complications, 6,25% – complications of the immunosuppressive therapy. 1-year patient survival after SPKT was 91,4%; pancreas graft survival – 85,7%; kidney graft survival – 88,6%.Conclusion. The incidence of early postoperative complications after simultaneous pancreas-kidney transplantation remains signifi cant in spite of progressive improvement of simultaneous pancreas-kidney transplantation due to surgical technique improvement, introduction of new antibacterial and immunosuppressive agents. Data, we recovered, fully correspond to the data obtained from the global medical community.

  10. ACL Revision in Synthetic ACL graft failure

    Science.gov (United States)

    Etcheto, H. Rivarola; Zordán, J.; Escobar, G.; Collazo, C.; Palanconi, M.; Autorino, C.; Salinas, E. Alvarez

    2017-01-01

    The development of synthetic grafts as an alternative to biological grafts for reconstruction of the anterior cruciate ligament dates from 1980. The interest is awakened due to the potential advantages of: The absence of morbidity associated with donor site, and early return to sport. However, this surgical technique has had multiple complications associated with graft: mechanical failures (synthetic graft failure, loss of fixation), synovial foreign body reaction, recurrent stroke, recurrent instability and ultimately, early osteoarthritis. Objectives: We describe the synthetic graft failure LCA, intraoperative findings and details of surgical technique. Methods: Patient 35 years old, with a history of ACL reconstruction four years of evolution in another health center, consultation with the Service knee arthroscopy for acute knee pain left knee during secondary sporting event to a rotation mechanism with fixed foot. On physical examination, presents and positive Lachman maneuver Pivot. Radiografia in a widening of the tibial tunnel is observed. NMR shows a discontinuity of fibers of synthetic graft. Results: First time arthroscopic revision where synthetic plastic LCA identifies with Disruption fiber pattern. Intraoperatively, hypertrophic chronic synovitis localized predominantly in intercóndilo is observed. debridement thereof is performed, and proceeds to the extraction of the synthetic ligament. Then he was made prior cruentado and revival of the edges of the tunnel, filling them with non-irradiated structural bone allograft. At four months as planned and after confirmation by studies incorporating bone graft was performed the second time with the new plastic ACL. It was planned like a primary graft surgery with autologous hamstring prepared in fourfold form, and fixation with modified transtibial technique Biotransfix system proximal and distal screw Biocomposite (arthrex®). A quadruple graft 9 mm was obtained, making good positioning of tunnels and stable

  11. Fatores de risco que afetam as complicações da dissecação da veia safena na revascularização cirúrgica do miocárdio The risk factors affecting the complications of saphenous vein graft harvesting in aortocoronary bypass surgery

    Directory of Open Access Journals (Sweden)

    Monir Abbaszadeh

    2008-09-01

    complications were analyzed and compared with the entire cohort of patients, undergoing similar bypass procedures during the same period. RESULTS: Lower extremity wound complications occurred in 68 patients (1.7%, 43 of them required additional surgical interventions. There were 17 wound debridements, nine skin grafts, one angioplasty, 11 fasciotomies, three vascular procedures, and two free tissue transfers. Of 13 variables evaluated by multivariate analysis, female gender, BMI, use of internal thoracic artery graft, peripheral vascular disease, the use of postoperative intraaortic balloon pump and preexisting hyperlipidemia were identified as significant independent predictors of major leg wound complications (p<0.05. CONCLUSIONS: The causes of major leg wound complications after saphenous vein harvest for coronary artery bypass graft procedures are multifactorial. To minimize these complications, we recommend vascular evaluations before saphenous vein harvest, attention to proper surgical technique, and careful harvest site section.

  12. Trends and variations in the rates of hospital complications, failure-to-rescue and 30-day mortality in surgical patients in New South Wales, Australia, 2002-2009.

    Directory of Open Access Journals (Sweden)

    Lixin Ou

    Full Text Available BACKGROUND: Despite the increased acceptance of failure-to-rescue (FTR as an important patient safety indicator (defined as the percentage of deaths among surgical patients with treatable complications, there has not been any large epidemiological study reporting FTR in an Australian setting nor any evaluation on its suitability as a performance indicator. METHODS: We conducted a population-based study on elective surgical patients from 82 public acute hospitals in New South Wales, Australia between 2002 and 2009, exploring the trends and variations in rates of hospital complications, FTR and 30-day mortality. We used Poisson regression models to derive relative risk ratios (RRs after adjusting for a range of patient and hospital characteristics. RESULTS: The average rates of complications, FTR and 30-day mortality were 13.8 per 1000 admissions, 14.1% and 6.1 per 1000 admission, respectively. The rates of complications and 30-day mortality were stable throughout the study period however there was a significant decrease in FTR rate after 2006, coinciding with the establishment of national and state-level peak patient safety agencies. There were marked variations in the three rates within the top 20% of hospitals (best and bottom 20% of hospitals (worst for each of the four peer-hospital groups. The group comprising the largest volume hospitals (principal referral/teaching hospitals had a significantly higher rate of FTR in comparison to the other three groups of smaller-sized peer hospital groups (RR = 0.78, 0.57, and 0.61, respectively. Adjusted rates of complications, FTR and 30-day mortality varied widely for individual surgical procedures between the best and worst quintile hospitals within the principal referral hospital group. CONCLUSIONS: The decrease in FTR rate over the study period appears to be associated with a wide range of patient safety programs. The marked variations in the three rates between- and within- peer hospital groups

  13. Root coverage in class I gingival recession defects, combining rotated papillary pedicle graft and coronally repositioned flap, using a micro surgical approach: A clinical evaluation

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    Latha Tella

    2009-01-01

    Full Text Available Background: The purpose of this case study was to evaluate the success and predictability of a rotated papillary pedicle graft in combination with the coronally advanced flap using surgical loupe (2.5X magnification for the treatment of Miller′s class I gingival recession. Materials and Methods: Fifteen systemically healthy patients with isolated gingival recession underwent the procedure. The probing depth, percentage root coverage, width of the keratinized gingiva and the gain in clinical attachment, papilla width, papilla height, area of the papilla at the donor site, were recorded at baseline, 3 months and 12 months. Results: All parameters except probing pocket depth, significantly improved from baseline to 12 months. The mean recession defect of 2.67 ± 0.03 mm present at baseline reduced to 0.13 ± 0.35 mm at the end of the 3 rd months and stabilized at 0.27 ± 0.59 mm at 12 months. The mean reduction in recession depth was 2.40 ± 0.03 mm at the end of the study. Complete recession coverage was obtained in 13 of the 15 (87% of the cases treated with a mean percentage recession coverage at 12 months being 86 ± 35.19%. The gain in the width of the keratinized gingiva was 1.33 ± 0.13 mm at the end of the study. There was no postoperative morbidity from where the graft was harvested at the end of the study period. Conclusion: The use of magnification in mucogingival surgery resulted in achieving a high degree of success and predictability as well as an excellent esthetic outcome.

  14. Surgical time and complications of total transvaginal (total-NOTES, single-port laparoscopic-assisted and conventional ovariohysterectomy in bitches

    Directory of Open Access Journals (Sweden)

    M.A.M. Silva

    2015-06-01

    Full Text Available The recently developed minimally invasive techniques of ovariohysterectomy (OVH have been studied in dogs in order to optimize their benefits and decrease risks to the patients. The purpose of this study was to compare surgical time, complications and technical difficulties of transvaginal total-NOTES, single-port laparoscopic-assisted and conventional OVH in bitches. Twelve bitches were submitted to total-NOTES (NOTES group, while 13 underwent single-port laparoscopic-assisted (SPLA group and 15 were submitted to conventional OVH (OPEN group. Intra-operative period was divided into 7 stages: (1 access to abdominal cavity; (2 pneumoperitoneum; approach to the right (3 and left (4 ovarian pedicle and uterine body (5; (6 abdominal or vaginal synthesis, performed in 6 out of 12 patients of NOTES; (7 inoperative time. Overall and stages operative times, intra and postoperative complications and technical difficulties were compared among groups. Mean overall surgical time in NOTES (25.7±6.8 minutes and SPLA (23.1±4.0 minutes groups were shorter than in the OPEN group (34.0±6.4 minutes (P<0.05. The intraoperative stage that required the longest time was the approach to the uterine body in the NOTES group and abdominal and cutaneous sutures in the OPEN group. There was no difference regarding the rates of complications. Major complications included postoperative bleeding requiring reoperation in a bitch in the OPEN group, while minor complications included mild vaginal discharge in four patients in the NOTES group and seroma in three bitches in the SPLA group. In conclusion, total-NOTES and SPLA OVH were less time-consuming then conventional OVH in bitches. All techniques presented complications, which were properly managed.

  15. [Congenital penile curvature (chordee without hypospadias): surgical treatment for correction of penile curvature and/or buccal mucosal graft urethroplasty].

    Science.gov (United States)

    Kolar, Ivan

    2004-01-01

    Presented are the cases of 19 boys with ventral penile curvature without hypospadias. The cases were categorised into three groups according to the severity of the anomaly. In group I were 7 boys with ventral penile curvature affecting the shortening of the frenulum with skin tethering. The anomaly was corrected by fraenulotomy and, in 4 boys, by ventral "V" and "Y" penile skinplasty with excellent cosmetic results. In group II were 10 boys with an evident chordee. In 4 boys, the chordee was of type III according to Devin-Horton. A chordectomy was done with a "V" and "Y" skinplasty with very good result. The remaining 6 cases were chordee type II according to D-H. The same treatment was undertaken here, but with an additional Nesbit's dorsal tunica albuginea plication in 4 boys and a 50% success (3 of 6). In group III were 5 boys, 3 previously failed chordectomy from group II and 2 with "skin urethra" type chordee I according to D-H. All boys in this group were treated for urethroplasty with autologous buccal mucosal graft. Good results were obtained in 3 of 5 (60%). Successful outcome was achieved in both cases with "skin urethra" not previously treated. The results of our urethroplasty with buccal mucosa agree with those in literature. In the treatment of chordee without hypospadias, where it was necessary to reconstruct the urethra there was a constant problem of the shortage of local tissue, so we believe that buccal mucosa is a good choice.

  16. Efficacy of xenogeneic bone grafting with guided tissue regeneration in the management of bone defects after surgical endodontics.

    Science.gov (United States)

    Taschieri, Silvio; Del Fabbro, Massimo; Testori, Tiziano; Weinstein, Roberto

    2007-06-01

    The purpose of this prospective clinical trial was to monitor the outcomes of periradicular surgery in large periapical lesions with or without guided tissue regeneration (GTR) and anorganic bovine bone. All teeth in the study revealed a periradicular lesion measuring at least 10 mm. A total of 63 teeth in 44 patients were included according to specific selection criteria. In the test group, after root end filling was completed, the defect was filled with anorganic bovine bone and was covered with a resorbable collagen membrane. In the control group, neither graft nor membrane was used. A total of 59 teeth in 41 patients were evaluable at 1-year follow-up. Of these, 24 teeth belonged to the test group and 35 to the control group. Overall, 46 teeth (78%) had successfully healed, 10 (16.9%) demonstrated uncertain healing, and 3 exhibited treatment failure. Investigators found no statistically significant differences in outcome between test and control groups. The present study showed that the use of GTR in association with anorganic bovine bone in the treatment of patients with large periradicular lesions of strictly endodontic origin has no beneficial effect on outcome.

  17. Sudden Cardiac Death in Patients With Ischemic Heart Failure Undergoing Coronary Artery Bypass Grafting: Results From the STICH Randomized Clinical Trial (Surgical Treatment for Ischemic Heart Failure).

    Science.gov (United States)

    Rao, Meena P; Al-Khatib, Sana M; Pokorney, Sean D; She, Lilin; Romanov, Alexander; Nicolau, Jose C; Lee, Kerry L; Carson, Peter; Selzman, Craig H; Stepinska, Janina; Cleland, John G F; Tungsubutra, Wiwun; Desvigne-Nickens, Patrice M; Sueta, Carla A; Siepe, Matthias; Lang, Irene; Feldman, Arthur M; Yii, Michael; Rouleau, Jean L; Velazquez, Eric J

    2017-03-21

    The risk of sudden cardiac death (SCD) in patients with heart failure after coronary artery bypass graft surgery (CABG) has not been examined in a contemporary clinical trial of surgical revascularization. This analysis describes the incidence, timing, and clinical predictors of SCD after CABG. Patients enrolled in the STICH trial (Surgical Treatment of Ischemic Heart Failure) who underwent CABG with or without surgical ventricular reconstruction were included. We excluded patients with prior implantable cardioverter-defibrillator and those randomized only to medical therapy. The primary outcome was SCD as adjudicated by a blinded committee. A Cox model was used to examine and identify predictors of SCD. The Fine and Gray method was used to estimate the incidence of SCD accounting for the competing risk of other deaths. Over a median follow-up of 46 months, 113 of 1411 patients who received CABG without (n = 934) or with (n = 477) surgical ventricular reconstruction had SCD; 311 died of other causes. The mean left ventricular ejection fraction at enrollment was 28±9%. The 5-year cumulative incidence of SCD was 8.5%. Patients who had SCD and those who did not die were younger and had fewer comorbid conditions than did those who died of causes other than SCD. In the first 30 days after CABG, SCD (n=5) accounted for 7% of all deaths. The numerically greatest monthly rate of SCD was in the 31- to 90-day time period. In a multivariable analysis including baseline demographics, risk factors, coronary anatomy, and left ventricular function, end-systolic volume index and B-type natriuretic peptide were most strongly associated with SCD. The monthly risk of SCD shortly after CABG among patients with a low left ventricular ejection fraction is highest between the first and third months, suggesting that risk stratification for SCD should occur early in the postoperative period, particularly in patients with increased preoperative end-systolic volume index or B

  18. Tension-free Polypropylene Mesh-related Surgical Repair for Pelvic Organ Prolapse has a Good Anatomic Success Rate but a High Risk of Complications

    Institute of Scientific and Technical Information of China (English)

    Lei Zhang; Lan Zhu; Juan Chen; Tao Xu; Jing-He Lang

    2015-01-01

    Background:Food and Drug Administration announcements have highlighted the standard rate of mesh-related complications.We aimed to report the short-term results and complications of tension-free polypropylene mesh (PROSIMATM) surgical repair of pelvic organ prolapse (POP) using the standard category (C),timing (T),and site (S) classification system.Methods:A prospective cohort study of 48 patients who underwent PROSIMATM mesh kit-related surgical repairs were followed for two years at Peking Union Medical College Hospital.Recurrence was defined as symptomatic POP quantification (POP-Q) Stage Ⅱ or higher (leading edge ≥-1 cm).The Patient Global Impression of Change Questionnaire,the Chinese version of the Pelvic Floor Impact Questionnaire short-form-7 and POP/Urinary Incontinence Sexual Questionnaire short-form-12 were used to evaluate the self-perception and sexual function of each patient.Mesh-related complications conformed to the International Urogynecological Association/International Continence Society joint terminology.The paired-sample t-test,one-way analysis of variance,Fisher's exact test,Kaplan-Meier survival analysis and log-rank test were used to analyze data.Results:All patients were followed up for≥1 2 months; 30 (62.5%) patients completed the 24 months study.We observed a 93.8% (45/48) positive anatomical outcome rate at 12 months and 90.0% (27/30) at 24 months.Recurrence most frequently involved the anterior compartment (P < 0.05).Pelvic symptoms improved significantly from baseline (P < 0.05),although the patients' impressions of change and sexual function were not satisfying.Vaginal complication was the main complication observed (35.4%,17/48).The survival analysis did not identify any relationship between vaginal complication and anatomical recurrent prolapse (POP-Q ≥ Stage Ⅱ) (P =0.653).Conclusions:Tension-free polypropylene mesh (PROSIMATM)-related surgical repair of POP has better short-term anatomical outcomes at the

  19. Thyromental height test for prediction of difficult laryngoscopy in patients undergoing coronary artery bypass graft surgical procedure.

    Science.gov (United States)

    Jain, Nilesh; Das, Sucharita; Kanchi, Muralidhar

    2017-01-01

    Patients undergoing coronary artery bypass graft (CABG) procedures have higher incidence of difficult laryngoscopy and intubation than general surgery population. Accurate prediction of difficult laryngoscopy in CABG patients is desirable to reduce the hemodynamic response and myocardial oxygen requirements. Recently, thyromental height test (TMHT) has been proposed as one of the highly sensitive and specific bedside tests to predict difficult airway. We, in our prospective observational study, evaluated the accuracy of the TMHT in predicting difficult laryngoscopy. A total of 345 patients undergoing CABG of either sex, in the age group of 35-80 years, American Society of Anesthesiologists 111, undergoing CABG, were studied. Airway assessment was performed with modified Mallampati test with the addition of thyromental distance, sternomental distance, and TMHT. Intraoperatively, direct laryngoscopy was done in accordance with Cormack and Lehane grade of laryngoscopy. The preoperative data and laryngoscopic findings were used together to evaluate the accuracy of TMHT. The sensitivity, specificity, positive and negative predictive values of other three tests were calculated according to standard formula. A total of 345 patients were in the group with mean age of study population at 56.7 (standard deviation 9.1) years (35-80 years). This study showed that almost all tests had good specificity, but sensitivity was poor. However, sensitivity of TMHT was 75% with accuracy of 95%. Receiver operating characteristic curve analysis of TMHT-derived cutoff was 52.17 which increased sensitivity to 81.25% and specificity to 92.3%. TMHT had a higher sensitivity compared to other tests along with good positive and negative predictive value and a very high specificity.

  20. Thyromental height test for prediction of difficult laryngoscopy in patients undergoing coronary artery bypass graft surgical procedure

    Directory of Open Access Journals (Sweden)

    Nilesh Jain

    2017-01-01

    Full Text Available Background: Patients undergoing coronary artery bypass graft (CABG procedures have higher incidence of difficult laryngoscopy and intubation than general surgery population. Accurate prediction of difficult laryngoscopy in CABG patients is desirable to reduce the hemodynamic response and myocardial oxygen requirements. Recently, thyromental height test (TMHT has been proposed as one of the highly sensitive and specific bedside tests to predict difficult airway. We, in our prospective observational study, evaluated the accuracy of the TMHT in predicting difficult laryngoscopy. Methodology: A total of 345 patients undergoing CABG of either sex, in the age group of 35–80 years, American Society of Anesthesiologists 111, undergoing CABG, were studied. Airway assessment was performed with modified Mallampati test with the addition of thyromental distance, sternomental distance, and TMHT. Intraoperatively, direct laryngoscopy was done in accordance with Cormack and Lehane grade of laryngoscopy. The preoperative data and laryngoscopic findings were used together to evaluate the accuracy of TMHT. The sensitivity, specificity, positive and negative predictive values of other three tests were calculated according to standard formula. Results: A total of 345 patients were in the group with mean age of study population at 56.7 (standard deviation 9.1 years (35–80 years. This study showed that almost all tests had good specificity, but sensitivity was poor. However, sensitivity of TMHT was 75% with accuracy of 95%. Receiver operating characteristic curve analysis of TMHT-derived cutoff was 52.17 which increased sensitivity to 81.25% and specificity to 92.3%. Conclusion: TMHT had a higher sensitivity compared to other tests along with good positive and negative predictive value and a very high specificity.

  1. 颈椎前路手术20例并发症治疗分析%Treatment for Surgical Complications of Anterior Cervical Spine

    Institute of Scientific and Technical Information of China (English)

    郑军; 杨效宁; 曹雷

    2011-01-01

    Objective To investigate the reasons of and prevention for surgical complications of anterior cervical spine. Methods The clinical data of 20 patients with surgical complications in 201 patients who underwent anterior cervical surgery from May 2000 to May 2009 were analyzed retrospectively. Results The patients with complications were followed up for 3 months to 10 years with an average of 5. 5 years. The rate of 11 patients with short-term complications was 15%, and the rate of nine patients with long-term complications was 4. 48%. Conclusion The key of a successful surgery for anterior cervical spine inludes full realization of type of cervical spinal cord injury, careful evaluation of the patient's general condition, skilled operation, and good post-operative care.%目的 探讨颈椎手术并发症原因及预防措施,以提高手术成功率.方法 对2000年5月-2009年5月实施颈椎前路手术的脊髓型颈椎病患者201例中20例发生并发症患者的临床资料及随访情况进行回顾性分析.结果 20例并发症患者获得随访时间3个月~10年,平均5.5年.近期并发症11例,发生率5.47%;远期并发症9例,发生率4.48%.结果 充分认识脊髓的损伤类型,仔细评估患者的全身情况,熟练的手术操作,良好的术后护理是手术成功的关键.

  2. Surgical safety checklist is associated with improved operating room safety culture, reduced wound complications, and unplanned readmissions in a pilot study in neurosurgery.

    Science.gov (United States)

    Lepänluoma, M; Takala, R; Kotkansalo, A; Rahi, M; Ikonen, T S

    2014-03-01

    The World Health Organization's surgical safety checklist is designed to improve adherence to operating room safety standards, and its use has been shown to reduce complications among surgical patients. The objective of our study was to assess the impact of the implementation of the checklist on safety-related issues in the operating room and on postoperative adverse events in neurosurgery. From structured questionnaires delivered to operating room personnel, answers were analyzed to evaluate communication and safety-related issues during 89 and 73 neurosurgical operations before and after the checklist implementation, respectively. From the analyzed operations, 83 and 67 patients, respectively, were included in a retrospective analysis of electronic patient records to compare the length of hospital stay, reported adverse events, and readmissions. In addition, the consistency of operating room documentation and patient records was assessed. Communication between the surgeon and the anesthesiologist was enhanced, and safety-related issues were better covered when the checklist was used. Unplanned readmissions fell from 25% to 10% after the checklist implementation (p = 0.02). Wound complications decreased from 19% to 8% (p = 0.04). The consistency of documentation of the diagnosis and the procedure improved. The use of the checklist improved safety-related performance and, contemporarily, reduced numbers of wound complications, and readmissions were observed.

  3. Accuracy and complications of computer-designed selective laser sintering surgical guides for flapless dental implant placement and immediate definitive prosthesis installation.

    Science.gov (United States)

    Di Giacomo, Giovanni A; da Silva, Jorge V; da Silva, Airton M; Paschoal, Gustavo H; Cury, Patricia R; Szarf, Gilberto

    2012-04-01

    Computer-aided dental implant placement seems to be useful for placing implants by using a flapless approach. However, evidence supporting such applications is scarce. The aim of this study is to evaluate the accuracy of and complications that arise from the use of selective laser sintering surgical guides for flapless dental implant placement and immediate definitive prosthesis installation. Sixty implants and 12 prostheses were installed in 12 patients (four males and eight females; age range: 41 to 71 years). Lateral (coronal and apical) and angular deviations between virtually planned and placed implants were measured. The patients were followed up for 30 months, and surgical and prosthetic complications were documented. The mean ± SD angular, coronal, and apical deviations were 6.53° ± 4.31°, 1.35 ± 0.65 mm, and 1.79 ± 1.01 mm, respectively. Coronal and apical deviations of prosthesis, and prosthesis fracture. The cumulative survival rates for implants and prostheses were 98.33% and 91.66%, respectively. The mean lateral deviation was 2 mm. The complication rate was 34.4%. Hence, computer-aided dental implant surgery still requires improvement and should be considered as in the developmental stage.

  4. Unilateral otitis media with effusion caused by retained surgical gauze as an unintended iatrogenic complication of orthognathic surgery: case report.

    Science.gov (United States)

    Park, Chang Mook; Choi, Kang Young; Heo, Sung Jae; Kim, Jung-Soo

    2014-09-01

    Inadvertent retention of surgical gauze during an operation can have disastrous consequences for both the patient and the surgeon. Several cases have been reported, particularly after abdominal surgery. However, it has never to our knowledge been reported as a leading cause of dysfunction of the Eustachian tube after orthognathic surgery. We recently encountered a patient in whom it presented with unilateral otitis media with an effusion after orthognathic surgery. All surgeons involved with orthognathic surgery should be aware that remnants of surgical gauze after orthognathic surgery can compromise the Eustachian tube and cause otitis media with an effusion.

  5. Reconstruction of mandibular defects using nonvascularized autogenous bone graft in Nigerians

    Directory of Open Access Journals (Sweden)

    Kizito Chioma Ndukwe

    2014-01-01

    Full Text Available Objectives: The aim of this study is to evaluate the success rate and complications of mandibular reconstruction with nonvascularized bone graft in Ile-Ife, Nigeria. Patients and Methods: A total of 25 patients who underwent reconstruction of mandibular discontinuity defects between January 2003 and February 2012, at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife constituted the study sample. Relevant information was retrieved from the patients′ records. This information include patients′ demographics (age and sex as well as the type of mandibular defect, cause of the defect, type of mandibular resection done, source of the bone graft used, and the method of graft immobilization. Morbidity associated with the graft procedures were assessed by retrieving information on graft failures, length of hospital stay following surgery, rehabilitation device used and associated graft donor and recipient site complications. Result: There were 12 males and 13 females with a male:female ratio was 1:1.1. The age of the patients ranged from 13 to 73 years with a mean age for males 32.7 ± standard deviation (SD 12.9 and for females 35.0 ± SD 17.1. Jaw defect was caused by resection for tumours and other jaw pathologies in 92% of cases. Complete symphyseal involvement defect was the most common defect recorded 11 (44%. Reconstruction with nonvascularized rib graft accounted for 68% of cases while iliac crest graft was used in 32% of the patients. Successful take of the grafts was recorded in 22 patients while three cases failed. Wound dehiscence (two patients and postoperative wound infection (eight patients were the most common complications recorded. Conclusion: The use of nonvascularized graft is still relevant in the reconstruction of large mandibular defects caused by surgical ablation of benign conditions in Nigerians. Precise surgical planning and execution, extended antibiotic therapy, and meticulous postoperative care

  6. A new complication of retained surgical gauze: development of malignant fibrous histiocytoma – report of a case with a literature review

    Directory of Open Access Journals (Sweden)

    Kaplan Mehmet

    2012-07-01

    Full Text Available Abstract Background Primary visceral malignant fibrous histiocytoma (MFH is a rare disease, and few cases have been reported in the English literature. However, retained foreign bodies in the abdomen after surgical procedures are important causes of intra-abdominal infections. For legal and ethical reasons, there are few publications in the literature. In this article, we describe for the first time a case of malign abdominal fibrous histiocytoma associated with a surgical sponge forgotten in the abdominal cavity a long time ago. Case presentation A 64-year-old male presented to our surgical department with cachexia, abdominal pain, distention and pyrexia of unknown origin. He had a medical history of abdominal surgery for peptic ulcer perforation 32 years ago. Clinical examination revealed fever with a distended and painful abdominal wall. Radiological imaging of the abdomen showed multiple heterogeneous masses in one large cystic cavityalmost completely filling the abdomen. The patient underwent a laparotomy, and interestingly, opening the cyst revealed retained surgical gauze (RSG. The origin of the tumor was the visceral peritoneum, and it was excised totally. Conclusions Primary intra-abdominal MFH can present as a complication of long-lasting RSG. Therefore, clinicians must remember this while establishing the differential diagnosis for patients with a history of previous abdominal surgery and presenting with symptoms associated with both the tumor and systemic inflammatory response.

  7. Emergency surgical treatment of complicated acute pancreatitis after kidney transplantation with acute rejection: Case report and literature review

    Directory of Open Access Journals (Sweden)

    Dušan Klos

    2016-06-01

    Conclusions: With regard to the patient's comorbidities, early surgical therapy was indicated – drainage and closed lavage and immunosuppressive medication as a suspected tobe ethiological factor was discontinued. This course of treatment led to a complete recovery with preservation of good function of the cadaverous kidney.

  8. Comprehensive review of post-liver resection surgical complications and a new universal classification and grading system

    Institute of Scientific and Technical Information of China (English)

    Masayuki; Ishii; Toru; Mizuguchi; Kohei; Harada; Shigenori; Ota; Makoto; Meguro; Tomomi; Ueki; Toshihiko; Nishidate; Kenji; Okita; Koichi; Hirata

    2014-01-01

    Liver resection is the gold standard treatment for certain liver tumors such as hepatocellular carcinoma and metastatic liver tumors. Some patients with such tumors already have reduced liver function due to chronic hepatitis, liver cirrhosis, or chemotherapy-associated steatohepatitis before surgery. Therefore, complications due to poor liver function are inevitable after liver resection. Although the mortality rate of liver resection has been reduced to a few percent in recent case series, its overall morbidity rate is reported to range from 4.1% to 47.7%. The large degree of variation in the post-liver resection morbidity rates reported in previous studies might be due to the lack of consen-sus regarding the definitions and classification of postliver resection complications. The Clavien-Dindo(CD) classification of post-operative complications is widely accepted internationally. However, it is hard to apply to some major post-liver resection complications because the consensus definitions and grading systems for posthepatectomy liver failure and bile leakage established by the International Study Group of Liver Surgery are incompatible with the CD classification. Therefore, a unified classification of post-liver resection complications has to be established to allow comparisons between academic reports.

  9. Hysterectomy for benign conditions: Complications relative to surgical approach and other variables that lead to post-operative readmission within 90 days of surgery.

    Science.gov (United States)

    Lonky, Neal M; Mohan, Yasmina; Chiu, Vicki Y; Park, Jeanna; Kivnick, Seth; Hong, Christina; Hudson, Sharon M

    2017-08-01

    To examine variables associated with hysterectomy-related complications, relative to surgical approach and other variables, that lead to readmission within 90 days of surgery. We conducted an observational cohort study for which data were extracted from electronic health records. Data were extracted of all patients (n = 3106) who underwent hysterectomies at 10 Kaiser Permanente Southern California medical centers between June 2010 and September 2011. Patients who were pregnant or had a cancer diagnosis were excluded from the study. To identify univariate associations between examined variables and procedure type, chi-square tests for categorical variables and t-tests or analysis of variance for continuous variables were used. Generalized estimating equations methods were used to test associations between independent variables and primary outcomes of interest. Statistical significance was determined using a p-value variables associated with an increased risk for readmission included high estimated blood loss (201-300 mL and 301+ mL, relative to 0-50 mL; odds ratio = 2.28, confidence interval = 1.24-4.18 and odds ratio = 2.63, confidence interval = 1.67-4.14) and long length of stay of 3 days or more (relative to 0 days; odds ratio = 2.93, confidence interval = 1.28-6.69). Pelvic specimen weight in the 151-300 g and 501+ g ranges appeared protective (odds ratio = 0.40, confidence interval = 0.25-0.64 and odds ratio = 0.54, confidence interval = 0.33-0.90). In a sub-analysis of 1294 patients, 74 hospital operative complications directly related to hysterectomy were identified among 59 patients. The most common hospital operative complications were excessive bleeding associated with surgery or injury to nearby structures. Among the sub-sample of 1294 patients, those with hospital operative complications were more likely to experience post-operative complications that lead to readmission (odds ratio = 3

  10. Influence of Previous Comorbidities and Common Complications on Motor Function after Early Surgical Treatment of Patients with Traumatic Spinal Cord Injury.

    Science.gov (United States)

    Kreinest, Michael; Ludes, Lisa; Biglari, Bahram; Küffer, Maike; Türk, Ansgar; Grützner, Paul A; Matschke, Stefan

    2016-12-15

    The influence of complications and comorbidities on the outcome of patients with traumatic spinal cord injury after early surgery is unclear. The aim of the current study was to analyze the influence of previous comorbidities and common complications on motor function outcome of patients with traumatic spinal cord injury if early surgery was performed. All patients with a traumatic spinal cord injury who were initially surgically treated in our hospital in the period from January 2008 to December 2013 were included in this study. Epidemiological data and previous comorbidities (cardiovascular, pulmonary, metabolic, spinal) were documented. A neurological assessment was performed using the American Spinal Injury Association (ASIA) score. Retrospectively, patients' personal data (age, gender, comorbidities) and clinical data (complications, ASIA score, motor function) were analyzed statistically. A total of 133 patients met the inclusion criteria. The level of spinal cord injury ranged from C3 to L4. Motor function was improved from 51.5 ± 24.8 to 60.1 ± 25.0 (improvement: 25.7%). The most common complications were urinary tract infection and pneumonia. There is a significant relationship between a lack of previous spinal comorbidities and a better outcome in terms of motor function. No other comorbidities or complications showed any effect on motor function outcome. The current study shows that motor function was able to be improved in patients who were given early surgery after a traumatic spinal cord injury. Common complications as well as previous cardiovascular, pulmonary, and metabolic comorbidities do not impair motor function outcome. The final motor function score is reduced if patients have previous spinal comorbidities.

  11. OPEN VERSUS ROBOTIC-ASSISTED PARTIAL NEPHRECTOMY: MULTICENTER COMPARATIVE STUDY OF SURGICAL RESULTS AND COMPLICATIONS (AGILE GROUP)

    OpenAIRE

    Minervini, A.; Vittori, G.; Antonelli, A.; Celia, A; Crivellaro, S.; Dente, D.; Di Santo, V.; B. Frea; Gacci, M; A. Gritti; L. Masieri; A. Morlacco; A. Porreca; B. Rocco; Parma, P.

    2012-01-01

    Aim of the study To compare surgical and perioperative outcomes of open partial ne- phrectomy (OPN) with those of robotic assisted partial nephrectomy (RAPN). Materials and methods This is 2-year multicentric study derived from a prospective da- tabase promoted by AGILE group, who included all patients treated awith OPN or RAPN for renal cell carcinoma between January 2010 and December 2011 at six Italian urologic centers. All clinical vari- ables, including tumor nephrometry (PADUA ...

  12. Effect of Complications After Minimally Invasive Surgical Repair of Acute Achilles Tendon Ruptures Report on 211 Cases

    NARCIS (Netherlands)

    Metz, Roderik; van der Heijden, Geert J. M. G.; Verleisdonk, Egbert-Jan M. M.; Kolfschoten, Nicky; Verhofstad, Michiel H. J.; van der Werken, Christiaan

    2011-01-01

    Background: Complications of acute Achilles tendon rupture treatment are considered to negatively influence outcome, but the relevance of these effects is largely unknown. Purpose: The Achilles Tendon Total Rupture Score (ATRS) was used to determine level of disability in patients with minimally inv

  13. Effect of Complications After Minimally Invasive Surgical Repair of Acute Achilles Tendon Ruptures Report on 211 Cases

    NARCIS (Netherlands)

    Metz, Roderik; van der Heijden, Geert J. M. G.; Verleisdonk, Egbert-Jan M. M.; Kolfschoten, Nicky; Verhofstad, Michiel H. J.; van der Werken, Christiaan

    2011-01-01

    Background: Complications of acute Achilles tendon rupture treatment are considered to negatively influence outcome, but the relevance of these effects is largely unknown. Purpose: The Achilles Tendon Total Rupture Score (ATRS) was used to determine level of disability in patients with minimally inv

  14. [Chylothorax--a rare complication of surgical ligation of patent ductus arteriosus in a premature infant-a case report].

    Science.gov (United States)

    Stempniewicz, Krzysztof; Walas, Wojciech

    2007-01-01

    A case of left sided chylothorax in preterm infant is reported. The chylothorax was a complication of ligation of patent ductus arteriosus. Treatment consisted of parenteral nutrition, pleural taps, drainage of pleural cavity, mechanical ventilation and replacement of immunoprotein losses. When the lymph effusion reduced, enteral nutrition was started with a formula containing medium chain triglycerides. Treatment of this patient was successful.

  15. Split liver transplantation: Report of right and left graft outcomes from a multicenter Argentinean group.

    Science.gov (United States)

    Halac, Esteban; Dip, Marcelo; Quiñonez, Emilio; Alvarez, Fernando; Espinoza, Johana Leiva; Romero, Pablo; Nievas, Franco; Maurette, Rafael; Luque, Carlos; Matus, Daniel; Surraco, Paz; Fauda, Martin; McCormack, Lucas; Mattera, Francisco J; Gondolesi, Gabriel; Imventarza, Oscar

    2016-01-01

    Grafts from split livers (SLs) constitute an accepted approach to expand the donor pool. Over the last 5 years, most Argentinean centers have shown significant interest in increasing the use of this technique. The purpose of this article is to describe and analyze the outcomes of right-side grafts (RSGs) and left-side grafts (LSGs) from a multicenter study. The multicenter retrospective study included data from 111 recipients of SL grafts from between January 1, 2009 and December 31, 2013. Incidence of surgical complications, patient and graft survival, and factors that affected RSG and LSG survival were analyzed. Grafts types were 57 LSG and 54 RSG. Median follow-up times for LSG and RSG were 46 and 42 months, respectively. The 36-month patient and graft survivals for LSG were 83% and 79%, respectively, and for RSG were 78% and 69%, respectively. Retransplantation rates for LSG and RSG were 3.5% and 11%, respectively. Arterial complications were the most common cause of early retransplantation (less than 12 months). Cold ischemia time (CIT) longer than 10 hours and the use of high-risk donors (age ≥ 40 years or body mass index ≥ 30 kg/m2 or ≥ 5 days intensive care unit stay) were independent factors for diminished graft survival in RSG. None of the analyzed variables were associated with worse graft survival in LSG. Biliary complications were the most frequent complications in both groups (57% in LSG and 33% in RSG). Partial grafts obtained from liver splitting are an excellent option for patients in need of liver transplantation and have the potential to alleviate the organ shortage. Adequate donor selection and reducing CIT are crucial for optimizing results.

  16. Clinical Features of Primary Vein Grafts in Free Tissue Transfers

    Directory of Open Access Journals (Sweden)

    Mitsuru Nemoto

    2015-01-01

    Full Text Available The outcomes of free tissue transfers combined with vein grafts have been inconsistent, and discussions continue regarding their appropriate use. Of the 142 free tissue transfers that we performed from January 2004 to December 2011, we retrospectively analyzed 15 consecutive patients who underwent free tissue transfers in combination with vein grafts. Etiologies included trauma (8 patients, infection (4, and tumor (3. Types of free tissue transfers were fibula (4, anterolateral thigh (3, groin (3, jejunum (3, latissimus dorsi (1, and dorsal pedis (1. Vein grafts were used for the artery (6, vein (2, or both (7. The donor veins were the saphenous vein (12 and the external jugular vein (3. The mean length of the grafted veins was 10.8 cm (range: 4–18 cm. Even though complications of congestion occurred in 2 patients, these flaps survived by reexploration. The flap success rate was 15 of 15 (100% of vein grafted free flaps versus 124 of 127 (97.6% of free flaps not requiring vein grafts. To improve the success rate of free tissue transfers combined with vein grafts, securing healthy recipient vessels, meticulous surgical handling, a reliable vascular anastomosis technique, and strict postoperative monitoring are crucial.

  17. "Squid-capture" modified in situ stent-graft fenestration technique for aortic arch aneurysm repair.

    Science.gov (United States)

    Hongo, Norio; Miyamoto, Shinji; Shuto, Rieko; Wada, Tomoyuki; Kamei, Noritaka; Sato, Aiko; Matsumoto, Shunro; Kiyosue, Hiro; Mori, Hiromu

    2014-08-01

    An 83-year-old female was found to have an fusiform aneurysm in the aortic arch. She was deemed to be a high surgical risk; therefore, endovascular stent-graft placement followed by revascularization of the brachiocephalic trunk using in situ stent-graft fenestration was considered. However, the safe application of fenestration was deemed difficult due to the tortuosity of the brachiocephalic artery. The patient was successfully treated with the aid of the "squid-capture" technique, which consists of deployment of the stent-graft in a snare wire loop that was advanced from the brachiocephalic artery and fenestration of the stent-graft with the support of the loop. A follow-up exam revealed complete sealing of the aneurysm without any complications. The squid-capture technique allows for the safe and secure puncture of the graft.

  18. Comparison of Alloderm and mucosal graft in mandibular vestibuloplasty

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    Mahmoodhashemi H.

    2009-12-01

    Full Text Available "nBackground and Aim: The usage of free gingival grafts for vestibuloplasty is a routine procedure. The free gingival procedure requires harvesting the graft from a donor site which increases morbidity and the risk of surgical complications. In addition, adequate amount of donor tissue may not be available. Acceptable results of Alloderm application as a substitute for autogenous soft tissue grafts are: Not exposing the patient to an additional surgery, no donor site morbidity, unlimited availability, decreasing the bleeding during the surgery, decreasing the surgical complications, and better color match. The aim of this study was to evaluate the maintenance of the vestibular depth in vestibuloplasty with mucosal graft and Alloderm."nMaterials and Methods: Both methods of anterior mandibular vestibuloplasty by Clark, utilizing Alloderm and mucosal grafts, were employed in ten clinical cases. During the surgeries, half the prepared recipient sites received Alloderm, while the remaining half received autografts in a randomized fashion. Immediately, 1, 3, and 6 months postoperatively, the variables of graft rejection, depth of vestibule and the degree of relapse were evaluated. SPSS software was used for analysis of the data and the methods used for "statistical tests" were as follows: Friedman Method, Paired sample t-test, Smirnov-kolmogrove Method. (The statistical significance level was established at P-value<0.05."nResults: The mean difference of the relapse measurements in both methods throughout the survey did not have significant predictive value (P>0.05. Similar results were achieved for the mean difference of depth of the vestibule."nConclusion: In patients undergoing Vestibuloplasty, Alloderm could be material of choice to be utilized as autogenic soft tissue grafts in pre-prosthesis procedures.

  19. Marginal grafts increase early mortality in liver transplantation

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    Telesforo Bacchella

    Full Text Available CONTEXT AND OBJECTIVE: Expanded donor criteria (marginal grafts are an important solution for organ shortage. Nevertheless, they raise an ethical dilemma because they may increase the risk of transplant failure. This study compares the outcomes from marginal and non-marginal graft transplantation in 103 cases of liver transplantation due to chronic hepatic failure. DESIGN AND SETTING: One hundred and three consecutive liver transplantations to treat chronic liver disease performed in the Liver Transplantation Service of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo between January 2001 and March 2006 were retrospectively analyzed. METHODS: We estimated graft quality according to a validated scoring system. We assessed the pre-transplantation liver disease category using the Model for End-Stage Liver Disease (MELD, as low MELD ( 20. The parameters for marginal and non-marginal graft comparison were the one-week, one-month and one-year recipient survival rates, serum liver enzyme peak, post-transplantation hospital stay and incidence of surgical complications and retransplantation. The significance level was 0.05. RESULTS: There were no differences between the groups regarding post-transplantation hospital stay, serum liver enzyme levels and surgical complications. In contrast, marginal grafts decreased overall recipient survival one month after transplantation. Furthermore, low-MELD recipients of non-marginal grafts showed better one-week and one-month survival than did high-MELD recipients of marginal livers. After the first month, patient survival was comparable in all groups up to one year. CONCLUSION: The use of marginal graft increases early mortality in liver transplantation, particularly among high-MELD recipients.

  20. Surgical exposure and crown lengthening for management of complicated fractures of maxillary anterior teeth. A case report.

    Science.gov (United States)

    Anand, Pradeep S; Ashok, Sukumaran; Nandakumar, K; Varghese, N O; Kamath, Kavitha P

    2013-11-01

    When a tooth fracture occurs, the fracture line can extend in a variety of directions, and the direction of the fracture line often dictates the treatment plan. In cases where fracture lines extend apical to the gingival margin, exposure of fractured margins becomes necessary. And management of such tooth fractures often requires an interdisciplinary approach involving endodontic, periodontic and restorative procedures. This article describes a case in which severely traumatized maxillary anterior teeth were managed by a combined approach involving surgical exposure and crown lengthening, endodontic and restorative procedures.

  1. Implication of Right Ventricular Dysfunction on Long-term Outcome in Patients with Ischemic Cardiomyopathy Undergoing Coronary Artery Bypass Grafting with or without Surgical Ventricular Reconstruction

    Science.gov (United States)

    Kukulski, Tomasz; She, Lilin; Racine, Normand; Gradinac, Sinisa; Panza, Julio A.; Velazquez, Eric J.; Chan, Kwan; Petrie, Mark C.; Lee, Kerry L.; Pellikka, Patricia A.; Romanov, Alexander; Biernat, Jolanta; Rouleau, Jean L.; Batlle, Carmen; Rogowski, Jan; Ferrazzi, Paolo; Zembala, Marian; Oh, Jae K.

    2014-01-01

    Background Whether right ventricular (RV) dysfunction affects clinical outcome after CABG with or without SVR is still unknown. Thus, the aim of the study was to assess the impact of RV dysfunction on clinical outcome in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting (CABG) with or without surgical ventricular reconstruction (SVR). Methods and Results Of 1,000 STICH patients with coronary artery disease (CAD), left ventricular (LV) ejection fraction (EF) ≤35% and anterior dysfunction randomized to undergo CABG or CABG + SVR, baseline RV function could be assessed by echocardiography in 866 patients. Patients were followed for a median of 48 months. All-cause mortality or cardiovascular hospitalization was the primary endpoint, and all-cause mortality alone was a secondary endpoint. RV dysfunction was mild in 102 (12%) patients and moderate or severe in 78 (9%) patients. Moderate to severe RV dysfunction was associated with larger LV, lower EF, more severe mitral regurgitation, higher filling pressure, and higher pulmonary artery systolic pressure (all p<0.0001) compared to normal or mildly reduced RV function. A significant interaction between RV dysfunction and treatment allocation was observed. Patients with moderate or severe RV dysfunction who received CABG + SVR had significantly worse outcomes compared to patients who received CABG alone on both the primary (HR=1.86; CI=1.06–3.26; p=0.028) and the secondary endpoint (HR=3.37; CI=1.36–8.37; p=0.005). After adjusting for all other prognostic clinical factors, the interaction remained significant with respect to all-cause mortality (p=0.022). Conclusion Adding SVR to CABG may worsen long-term survival in ischemic cardiomyopathy patients with moderate to severe RV dysfunction, which reflects advanced LV remodeling. PMID:25451487

  2. Quality-of-Life Outcomes in Surgical Treatment of Ischemic Heart Failure Quality-of-Life Outcomes With Coronary Artery Bypass Graft Surgery in Ischemic Left Ventricular Dysfunction

    Science.gov (United States)

    Mark, Daniel B.; Knight, J. David; Velazquez, Eric J.; Wasilewski, Jaroslaw; Howlett, Jonathan G.; Smith, Peter K.; Spertus, John A.; Rajda, Miroslaw; Yadav, Rakesh; Hamman, Baron L.; Malinowski, Marcin; Naik, Ajay; Rankin, Gena; Harding, Tina M.; Drew, Laura A.; Desvigne-Nickens, Patrice; Anstrom, Kevin J.

    2014-01-01

    Background: The STICH (Surgical Treatment for Ischemic Heart Failure) trial compared a strategy of routine coronary artery bypass grafting (CABG) with guideline-based medical therapy for patients with ischemic left ventricular dysfunction. Objective: To describe treatment-related quality-of-life (QOL) outcomes, a major prespecified secondary end point in the STICH trial. Design: Randomized trial. (ClinicalTrials.gov: NCT00023595) Setting: 99 clinical sites in 22 countries. Patients: 1212 patients with a left ventricular ejection fraction of 0.35 or less and coronary artery disease. Intervention: Random assignment to medical therapy alone (602 patients) or medical therapy plus CABG (610 patients). Measurements: A battery of QOL instruments at baseline (98.9% complete) and 4, 12, 24, and 36 months after randomization (collection rates were 80% to 89% of those eligible). The principal prespecified QOL measure was the Kansas City Cardiomyopathy Questionnaire, which assesses the effect of heart failure on patients’ symptoms, physical function, social limitations, and QOL. Results: The Kansas City Cardiomyopathy Questionnaire overall summary score was consistently higher (more favorable) in the CABG group than in the medical therapy group by 4.4 points (95% CI, 1.8 to 7.0 points) at 4 months, 5.8 points (CI, 3.1 to 8.6 points) at 12 months, 4.1 points (CI, 1.2 to 7.1 points) at 24 months, and 3.2 points (CI, 0.2 to 6.3 points) at 36 months. Sensitivity analyses to account for the effect of mortality on follow-up QOL measurement were consistent with the primary findings. Limitation: Therapy was not masked. Conclusion: In this cohort of symptomatic high-risk patients with ischemic left ventricular dysfunction and multivessel coronary artery disease, CABG plus medical therapy produced clinically important improvements in several health status domains compared with medical therapy alone over 36 months. Primary Funding Source: National Heart, Lung, and Blood Institute. PMID

  3. Investigation of clustering events of surgical site infections in patients undergoing coronary artery bypass grafting%冠状动脉搭桥术患者手术部位感染聚集性调查研究

    Institute of Scientific and Technical Information of China (English)

    程丽峰; 阿依古丽; 朱敏; 卢辉; 魏育涛

    2015-01-01

    OBJECTIVE To investigate the high risk factors for clustering events of surgical site infections in wards of cardiothoracic surgery department so as to provide guidance for prevention and control of nosocomial infections . METHODS The epidemiological survey was conducted for the patients with suspected surgical site infections who were treated in the cardiothoracic surgery department from Jul to Aug ,2012 ,the high risk factors were analyzed , and the comprehensive interventions were taken to avoid the spread of nosocomial infections .RESULTS The surgical site infections occurred in 4 of 8 patients who underwent the coronary artery bypass grafting in the cardiothoracic surgery department ,with the infection rate of 50 .00% .All the 4 cases were complicated with se‐vere underlying diseases ,and 3 cases were complicated with diabetic mellitus ;the surgical procedures were com‐plex ,the operation duration was long ,and the symptoms of surgical incision infections were the same ,all the ca‐ses had the redness ,swelling ,heat ,and bloody discharge ,accompanied by incision dehiscence ,and the culture of wound secretions showed that there was no growth of bacteria .The hand hygiene of the health care workers and the cleaning of object surfaces were unqualified ,the environmental hygiene surveillance indicated that the Staphy‐lococcus aureus have been isolated , the outbreak of the surgical site infections could not completely excluded , which was defined as the clustering events of surgical site infections ,and the 4 patients were cured and discharged successively after the active treatment .CONCLUSION It is an effective way to intensify the consciousness of control of the nosocomial infections and take targeted prevention measures so as to control the clustering events of nosoco‐mial infections .%目的:调查医院心胸外科病房手术部位感染聚集性事件发生的高危因素,为预防与控制医院感染提供参考依据。方法对2012年7

  4. Post-transplant urological and vascular complications

    Directory of Open Access Journals (Sweden)

    Safa Javid

    2009-01-01

    Full Text Available To determine the prevalence of urological and vascular complications in renal trans-plant recipients (RTx at Tabriz Renal Transplant Center, we studied 55 recipients of renal allo-grafts (25 male and 29 female patients with a mean age of 38.3 ± 13.4 years from October 2005 to November 2006. The surgical complications in our study included hematomas: 20.4%, renal artery stenosis: 20.4%, calculi: 7.4%, hydronephrosis or ureteral stricture: 5.6%, urinary leakage: 5.6%, lymphoceles: 1.9%, and renal vein thrombosis: 1.9%. We conclude that the most common urologic complications in our center were ureteric strictures and urine leaks, and the most common vascular complication was renal artery stenosis.

  5. Prognostic factors for perioperative myocardial infarction and immediate mortality in patients who underwent coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Mirtha López Ramírez

    2016-03-01

    Conclusions: Older age and higher body mass index were protective prognostic factors for perioperative acute myocardial infarction events. Prolonged surgical time and complications were independently associated with perioperative infarction and mortality after coronary artery bypass graft surgery. Low preoperative glomerular filtration rate was also associated with mortality.

  6. Balloon Tamponade Treatment of a Stent-graft Related Rupture with a Splenic Artery Pseudoaneurysm: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, See Hyung; Kim, Young Hwan [Dongsan Medical Center, Keimyung University College of Medicine, Daegu (Korea, Republic of)

    2009-09-15

    An arterial rupture resulting from stent-graft placement of a splenic artery pseudoaneurysm is a life-threatening complication and immediate endovascular or surgical treatment is indicated. We report a case of a stentgraft related splenic artery rupture treated solely with a prolonged balloon catheter tamponade, which resulted in preservation of vessel patency

  7. Extreme lateral lumbar interbody fusion. Surgical technique, outcomes and complications after a minimum of one year follow-up.

    Science.gov (United States)

    Domínguez, I; Luque, R; Noriega, M; Rey, J; Alia, J; Marco-Martínez, F

    «Minimally invasive» techniques have been recently been developed in order to achieve good clinical results with a low incidence of complications. The extralateral interbody fusion or direct transpsoas is a minimally invasive anterior arthrodesis. A total of 97 patients with 138 segments received surgery between May 2012 and May 2015. The follow-up was from 12-44 months. The mean age was 68 years (41-86). The most common cause of intervention was the adjacent segment (30%), deformity (22%), and lumbar disc disease (21%). The interbody cage was implanted as: Single (stand-alone) in 33%, and additional fixation was used in the others: Screws, percutaneous unilateral (11%), bilateral (27%), or with a lateral plate (62%). The mean stay was 3.2 days (2-6). The score on a lumbar visual analogue scale decreased from 9 to 4.1, and dropped to 3 after one year. The improvement in disc height was from 8.4mm to 13.8mm, and a larger increase in the foramen diameter from 10.5 to 13.1mm, which were statistically significant. The early major complications recorded were, three motor femoral nerve injuries and retroperitoneal haematoma (4%), and the early minor were: two fractures (2%). As major late complications there was an abdominal hernia, a mobilization of 10mm and three radiculopathy (5%), and as minor late, three fracture, two mobilisations greater than 10mm, four mobilisations of less than 10mm, and one mobilisation of a screw plate (10%). The extralateral interbody fusion technique is a safe and reliable when performing a lumbar fusion by an alternative minimally invasive route.

  8. Successful Treatment of Primary Cutaneous Mucormycosis Complicating Anti-TNF Therapy with a Combination of Surgical Debridement and Oral Posaconazole.

    Science.gov (United States)

    Camargo, Jose F; Yakoub, Danny; Cho-Vega, Jeong Hee

    2015-10-01

    Lipid formulations of amphotericin B remain the first-line antifungal therapy for invasive mucormycosis. Posaconazole is an alternative for salvage therapy, but its use as primary therapy is not recommended due to the paucity of clinical data. Here we describe the case of a 57-year-old diabetic woman receiving etanercept and prednisone for the treatment of psoriatic arthritis who developed primary cutaneous mucormycosis after a minor gardening injury. Infection was successfully treated with aggressive surgical debridement followed by a 6-week course of the new delayed-release tablet formulation of posaconazole and temporary withholding of anti-TNF treatment. Primary antifungal therapy with posaconazole can be considered in selected cases of cutaneous mucormycosis.

  9. Retention mucocele of distal viable remnant tip of appendix: An unusually rare late surgical complication following incomplete appendectomy

    Institute of Scientific and Technical Information of China (English)

    Maria Antony Johnson; Damodaran Jyotibasu; Palaniappan Ravichandran; Satyanesan Jeswanth; Devy Gounder Kannan; Rajagopal Surendran

    2006-01-01

    A 67-year old man was presented with e 6-mo history of recurrent right lower quadrant abdominal pain. On physical examination, a vague mass was palpable in the right lumbar region. His routine laboratory tests were normal. Ultrasonography showed a hypoechoic lesion in the right lumbar region anterior to the right kidney with internal echoes and fluid components.Abdominal contrast-enhanced computed tomography(CECT) showed a well-defined hypodense cystic mass lesion lateral to the ascending colon/caecum, not communicating with the lumen of colon/caecum. After complete open excision of the cystic mass lesion, gross pathologic examination revealed a turgid cystic dilatation of appendiceal remnant filled with the mucinous material. On histopathological examination, mucinous cyst adenoma of appendix was confirmed. We report this rare unusual late complication of mucocele formation in the distal viable appendiceal remnant, which was leftover following incomplete retrograde appendectomy. This unusual complication is not described in the literature and we report it in order to highlight the fact that a high index of clinical and radiological suspicion is essential for the diagnosis of mucocele arising from a distal viable appendiceal remnant in a patient who has already undergone appendectomy presenting with recurrent abdominal pain.

  10. Retention mucocele of distal viable remnant tip of appendix: An unusually rare late surgical complication following incomplete appendectomy

    Science.gov (United States)

    Johnson, Maria Antony; Jyotibasu, Damodaran; Ravichandran, Palaniappan; Jeswanth, Satyanesan; Kannan, Devy Gounder; Surendran, Rajagopal

    2006-01-01

    A 67-year old man was presented with a 6-mo history of recurrent right lower quadrant abdominal pain. On physical examination, a vague mass was palpable in the right lumbar region. His routine laboratory tests were normal. Ultrasonography showed a hypoechoic lesion in the right lumbar region anterior to the right kidney with internal echoes and fluid components. Abdominal contrast-enhanced computed tomography (CECT) showed a well-defined hypodense cystic mass lesion lateral to the ascending colon/caecum, not communicating with the lumen of colon/caecum. After complete open excision of the cystic mass lesion, gross pathologic examination revealed a turgid cystic dilatation of appendiceal remnant filled with the mucinous material. On histopathological examination, mucinous cyst adenoma of appendix was confirmed. We report this rare unusual late complication of mucocele formation in the distal viable appendiceal remnant, which was leftover following incomplete retrograde appendectomy. This unusual complication is not described in the literature and we report it in order to highlight the fact that a high index of clinical and radiological suspicion is essential for the diagnosis of mucocele arising from a distal viable appendiceal remnant in a patient who has already undergone appendectomy presenting with recurrent abdominal pain. PMID:16489657

  11. An unusual case of corneal perforation secondary to Pseudomonas keratitis complicating a patient's surgical/trauma intensive care unit stay.

    Science.gov (United States)

    Johnson, J L; Sagraves, S G; Feild, C J; Block, E F; Cheatham, M L

    2000-10-01

    We report a case of corneal perforation secondary to bacterial keratitis caused by Pseudomonas aeruginosa in a trauma patient in our intensive care unit. A 43-year-old man was involved in a motorcycle crash and suffered multiple injuries necessitating a prolonged intensive care unit (ICU) stay. Subsequently P. aeruginosa was cultured from his sputum, blood, and open abdomen. He developed a bacterial keratitis in his right eye, which also grew P. aeruginosa. This infection rapidly progressed to corneal perforation requiring a Gunderson conjunctival flap and lateral tarsorrhaphy in addition to aggressive antibiotic treatment. At the time of discharge from the hospital the patient had the return of vision to light only in his right eye. Corneal perforation is an unusual event in the ICU. Prevention or early detection of bacterial keratitis with aggressive antibiotic treatment is needed to prevent such complications. Pseudomonas is one of the more virulent organisms that can infect the cornea and early identification is paramount for a good outcome. Management of this complicated case is discussed and the limited amount of literature on nosocomial bacterial keratitis in the ICU is reviewed.

  12. Endovascular stent-graft management of thoracic aortic diseases

    Energy Technology Data Exchange (ETDEWEB)

    Dake, Michael D. E-mail: mddake@stanford.edu

    2001-07-01

    The traditional standard therapy for descending thoracic aortic aneurysm (TAA) is open operative repair with graft replacement of the diseased aortic segment. Despite important advances in surgical techniques, anesthetic management, and post-operative care over the last 30 years, the mortality and morbidity of surgery remains considerable, especially in patients at high risk for thoracotomy because of coexisting severe cardiopulmonary abnormalities or other medical diseases. The advent of endovascular stent-graft technology provides an alternative to open surgery for selected patients with TAA. The initial experience suggests that stent-graft therapy potentially may reduce the operative risk, hospital stay and procedural expenses of TAA repair. These potential benefits are especially attractive for patients at high risk for open TAA repair. Current results of endovascular TAA therapy document operative mortalities of between 0 and 4%, aneurysm thrombosis in 90 and 100% of cases, and paraplegia as a complication in 0 and 1.6% of patients. The early success of stent-graft repair of TAA has fostered the application of these devices for the management of a wide variety of thoracic aortic pathologies, including acute and chronic dissection, intramural hematoma, penetrating ulcer, traumatic injuries, and other diseases. The results of prospective controlled trials that compare the outcomes of stent-graft therapy with those of surgical treatment in patients with specific types of aortic disease are anxiously awaited before recommendations regarding the general use of these new devices can be made with confidence.

  13. 老年脊柱外科手术并发症%Complications following spinal surgical operation in the elderly

    Institute of Scientific and Technical Information of China (English)

    伍骥; 马金超; 黄蓉蓉

    2012-01-01

    随着社会的发展和进步,人口老龄化的加快和寿命的延长,老年脊柱疾病患者和手术日渐增多.由于老年人的自然条件、代谢能力和机体的储备能力都在不断下降,并且大多合并有其他疾病,在手术中和手术后容易出现各种并发症和意外,严重影响手术治疗的效果及生活质量.因此,老年脊柱外科手术并发症越来越受到人们的关注.众多学者开始研究老年脊柱手术并发症的病因、预防措施和治疗手段,本文就此予以综述.%As the society develops, people's life expectancy has increased dramatically and the whole population is aging. As a result, spinal diseases and their surgeries have become part of life for more and more aged people. Due to their naturally declining metabolic capability and body's reserve capacity, the aged people are subject to perioperative and postoperative complications, and other accidents, which often leads to reversal operative effects and damage people's life quality. Therefore, scholars are increasingly interested in exploring the causes, precautionary measures and treatment measures for such complications. This paper reviewed the related researches.

  14. The Articulated Alar Rim Graft: Reengineering the Conventional Alar Rim Graft for Improved Contour and Support.

    Science.gov (United States)

    Ballin, Annelyse C; Kim, Haena; Chance, Elizabeth; Davis, Richard E

    2016-08-01

    Surgical refinement of the wide nasal tip is challenging. Achieving an attractive, slender, and functional tip complex without destabilizing the lower nasal sidewall or deforming the contracture-prone alar rim is a formidable task. Excisional refinement techniques that rely upon incremental weakening of wide lower lateral cartilages (LLC) often destabilize the tip complex and distort tip contour. Initial destabilization of the LLC is usually further exacerbated by "shrink-wrap" contracture, which often leads to progressive cephalic retraction of the alar margin. The result is a misshapen tip complex accentuated by a conspicuous and highly objectionable nostril deformity that is often very difficult to treat. The "articulated" alar rim graft (AARG) is a modification of the conventional rim graft that improves treatment of secondary alar rim deformities, including postsurgical alar retraction (PSAR). Unlike the conventional alar rim graft, the AARG is sutured to the underlying tip complex to provide direct stationary support to the alar margin, thereby enhancing graft efficacy. When used in conjunction with a well-designed septal extension graft (SEG) to stabilize the central tip complex, lateral crural tensioning (LCT) to tighten the lower nasal sidewalls and minimize soft-tissue laxity, and lysis of scar adhesions to unfurl the retracted and scarred nasal lining, the AARG can eliminate PSAR in a majority of patients. The AARG is also highly effective for prophylaxis against alar retraction and in the treatment of most other contour abnormalities involving the alar margin. Moreover, the AARG requires comparatively little graft material, and complications are rare. We present a retrospective series of 47 consecutive patients treated with the triad of AARG, SEG, and LCT for prophylaxis and/or treatment of alar rim deformities. Outcomes were favorable in nearly all patients, and no complications were observed. We conclude the AARG is a simple and effective method for

  15. [Complications of DMEKeratoplasty: Avoid, Recognize and Treat].

    Science.gov (United States)

    Bachmann, Björn O; Schrittenlocher, Silvia A; Schaub, Friederike; Siebelmann, Sebastian; Matthaei, Mario; Cursiefen, Claus

    2017-07-31

    Descemet membrane endothelial keratoplasty (DMEK) has evolved into a routine surgical procedure for posterior lamellar keratoplasty. After its introduction more than 10 years ago, several modifications in grafting technique and postoperative treatment regimen helped to improve its safety and reproducibility. Although DMEK offers faster and better improvements in visual acuity, as well as less graft rejections when compared to Descemet's stripping (automated) endothelial keratoplasty (DS[A]EK), difficulties when implementing this technique hamper the widespread use in many areas. However, different strategies help to reduce the rate of intra- and postoperative complications, making DMEK the method of choice for most patients with corneal endothelial diseases. Certain techniques help to reduce the endothelial damage during graft preparation; correct matching of donor age and recipient's anterior chamber depth eases intracameral unfolding of the DMEK graft, the use of SF6 gas for anterior chamber tamponade reduces the need for additional rebubblings, and the correct frequency and duration of postoperative topical steroid treatment helps to reduce the development of cystoid macular edema and graft rejections. Further standardization, but also individualization, of DMEK helps to offer this treatment option to patients with more complex anterior segment situations like anterior synechia, larger iris defects and glaucoma drainage devices. Georg Thieme Verlag KG Stuttgart · New York.

  16. Use of a Javid™ shunt in the management of axillary artery injury as a complication of fracture of the surgical neck of the humerus: a case report

    Directory of Open Access Journals (Sweden)

    Suttie Stuart A

    2008-08-01

    Full Text Available Abstract Introduction Axillary artery injury is a rare but severe complication of fractures of the surgical neck of the humerus. Case presentation We present a case of axillary artery pseudoaneurysm secondary to such a fracture, in a 82-year-old white woman, presenting 10 weeks after the initial injury, successfully treated with subclavian to brachial reversed vein bypass together with simultaneous open reduction and internal fixation of the fracture. We discuss the use of a Javid™ shunt during combined upper limb revascularisation and open reduction and internal fixation of the fractured humerus. Conclusion This case highlights the usefulness of a Javid™ shunt, over other forms of vascular shunts, in prompt restoration of blood flow to effect limb salvage. It can be considered as a temporary measure whilst awaiting definitive revascularisation which can be performed following fracture fixation.

  17. Three-dimensional virtual operations can facilitate complicated surgical planning for the treatment of patients with jaw deformities associated with facial asymmetry:a case report

    Institute of Scientific and Technical Information of China (English)

    Shingo Hara; Masaharu Mitsugi; Takahiro Kanno; Akihiko Nomachi; Takehiko Wajima; Yukihiro Tatemoto

    2013-01-01

    This article describes a case we experienced in which good postsurgical facial profiles were obtained for a patient with jaw deformities associated with facial asymmetry, by implementing surgical planning with SimPlant OMS. Using this method, we conducted LF1 osteotomy, intraoral vertical ramus osteotomy (IVRO), sagittal split ramus osteotomy (SSRO), mandibular constriction and mandibular border genioplasty. Not only did we obtain a class I occlusal relationship, but the complicated surgery also improved the asymmetry of the frontal view, as well as of the profile view, of the patient. The virtual operation using three-dimensional computed tomography (3D-CT) could be especially useful for the treatment of patients with jaw deformities associated with facial asymmetry.

  18. Radical cystectomy for bladder cancer: сomparison of early surgical complications during laparoscopic, open-access, and video-assisted surgery

    Directory of Open Access Journals (Sweden)

    A. K. Nosov

    2015-01-01

    Full Text Available Objectives. To evaluate peri- and postoperative morbidity and functional results of LRC in a single-site cohort of patients, comparing it with standard open approach (ORC and laparoscopic cystectomy with open urinary diversion (HALRC.Subjects and methods. A prospective analysis was performed in 51 muscle-invasive and locally advanced BCa patients who underwent RC between February 2012 and March 2014 in N. N. Petrov Research Institute of Oncology, Saint-Petersburg. The final cohort included 21 ORC, 21 LRC and 9 HALRC patients. Mean patients age was 64 (38–81 years old and did not differ in all groups. Pathological stage were similar in all groups. Multivariable logistic and median regression was performed to evaluate operating time, perioperative and postoperative complications (30-d and 90-d, readmission rates, length of stay (LOS – totally and in ICU.Results. Operating time during LRC and HALRC was longer than that of ORC (398 min vs 468 min vs 243 min, respectively. Despite that, there was no statistically significant influence of type of surgery on intraoperative complications – 14.3 % in ORC group, 11.1 % in HALRC and 4.7 % in LRC patients. Major complication rates (Clavien grade  3; 23.8 % vs 33.3 % vs 19.4 % were similar between all groups. However, LRC had 4,0 times lower rate of minor complications (Clavien grade 1–2 compared to ORC (4.7 % vs 19.0 %. LRC had a significantly shorter LOS (27.8 d vs 32.6 d vs 22.6 d in ORC, HALRC and LRC groups, respectively, but no significant differences in ICU stay existed (5.1 d vs 3.1 d vs 2.1 d. Morbidity were present by one patient in each group (medium rate 5,8 %. The common transfusion rate during and after surgical intervention was 19.6 % and was higher in ORC group (33.3 % vs 4.7 % in LRC; as well, intraoperative bleeding was lower in minimally invasive techniques – the average volume of blood loss was 285 ml in LRC and did not differ between HALRC and ORC groups – 468

  19. Clinical evaluation of regenerative potential of type I collagen membrane along with xenogenic bone graft in the treatment of periodontal intrabony defects assessed with surgical re-entry and radiographic linear and densitometric analysis

    Directory of Open Access Journals (Sweden)

    Sowmya N

    2010-01-01

    Full Text Available Background and Objectives: The primary goal of periodontal therapy is to restore the tooth supporting tissues lost due to periodontal disease. The aim of the present study was to compare the efficacy of combination of type I collagen (GTR membrane and xenogenic bone graft with open flap debridement (OFD in treatment of periodontal intrabony defects. Materials and Methods: Twenty paired intrabony defects were surgically treated using split mouth design. The defects were randomly assigned to treatment with OFD + collagen membrane + bone graft (Test or OFD alone (Control. The clinical efficacy of two treatment modalities was evaluated at 9 month postoperatively by clinical, radiographical, and intrasurgical (re-entry parameters. The measurements included probing pocket depth (PD, clinical attachment level (CAL, gingival recession (GR, bone fill (BF, bone density (BD and intra bony component (INTRA. Results: The mean reduction in PD at 0-9 month was 3.3±0.82 mm and CAL gain of 3.40±1.51 mm occurred in the collagen membrane + bone graft (Test group; corresponding values for OFD (Control were 2.20±0.63 mm and 1.90±0.57 mm. Similar pattern of improvement was observed when radiographical and intra-surgical (re-entry post operative evaluation was made. All improvement in different parameters was statistically significant (P< 0.01. Interpretation and Conclusion: Treatment with a combination of collagen membrane and bone graft led to a significantly more favorable clinical outcome in intrabony defects as compared to OFD alone.

  20. Surgical repair of true left ventricular aneurysm in an infant: a rare complication after unsuccessful perventricular VSD closure.

    Science.gov (United States)

    Ozyilmaz, Isa; Saygi, Murat; Yildiz, Okan; Erek, Ersin; Guzeltas, Alper

    2014-10-01

    A 2.5-month-old female patient presented for closure of a ventricular septal defect (VSD). Transthoracic echocardiography showed a large muscular ventricular septal defect. After perventricular closure of the defect was performed with an Amplatzer muscular VSD occluder, peroperative transesophageal echocardiography revealed that the device had been implanted in the wrong area of the ventricular septum. The device was retrieved and a large mid-muscular defect with extension to the outlet septum was closed with a patch of Dacron which was secured with 5-0 sutures. A perforation in the ventricular septum due to attempted perventricular device delivery was seen, and it was repaired primarily. In the eighth month of follow-up, transthoracic echocardiography revealed an aneurysm in the posterior wall of the left ventricle. The patient's electrocardiogram showed pathological Q waves and ST-segment elevation in leads DII, DIII, and aVF consistent with subacute inferior myocardial infarction. At subsequent surgery, this was found to be a true aneurysm, located in area of distribution of the obtuse marginal branch of the left circumflex coronary artery in the posterior wall of the left ventricle. The aneurysm was closed off using a Dacron patch, and the sac was resected. Development of a true aneurysm is a rare but important complication of attempted perventricular VSD closure.

  1. Surgical treatment of tracheoesophageal fistula in a patient with severe acute respiratory syndrome complicated with extensive pulmonary fibrosis.

    Science.gov (United States)

    Lee, Jang-Ming; Lee, Pei-Lin; Kuo, Shuenn-Wen; Hwang, Juey-Jen; Lee, Yung-Chie

    2004-12-01

    Tracheoesophageal fistula is an uncommon complication usually associated with chronic usage of ventilator and pressure necrosis of the tracheoesophageal wall. A 56-year-old female patient with severe acute respiratory syndrome (SARS) with tracheoesophageal fistula is reported. She was intubated for ventilatory support 3 days after admission because of progressive respiratory distress. Methylprednisolone pulse therapy followed by a maintenance dosage was given due to persistence of bilateral pulmonary fibrosis. Thirty three days after admission, she underwent tracheostomy because of difficulty in weaning from the ventilator. Ten days after tracheostomy, she developed tracheoesophageal fistula, which was confirmed by bronchoscopy and panendoscopy. Tracheal resection and primary repair for the esophageal defect was performed via a cervical incision combined with partial sternotomy. She was weaned from the ventilator soon after the surgery and discharged 34 days after the operation. In SARS patients with persistent pulmonary fibrosis and under prolonged corticosteroid treatment, special care should be given to avoid intubation-related tracheal injury during the period of ventilatory support. The tracheoesophageal fistula, once developed, can be repaired in a single stage after improvement of the nutritional status.

  2. Comparison of Treatment Outcomes of Surgical Repair in Inguinal Hernia with Classic versus Preperitoneal Methods on Reduction of Postoperative Complications

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    Hormoz Mahmoudvand

    2017-01-01

    Full Text Available Background. This study aims to evaluate and compare the results of inguinal herniorrhaphy with mesh in classic and preperitoneal method. Methods. Our study community includes 150 candidate patients for inguinal herniorrhaphy with mesh. Totally, 150 candidate patients for inguinal herniorrhaphy were randomly divided into two groups: (1 classic group in which the floor of the canal was repaired and the mesh was located on the floor of the canal and (2 preperitoneal group in which the mesh was installed under the canal and then the floor was repaired. Results. The frequency of recurrence was 10 (13.3% and 2 (2.66% in the classic and preperitoneal group, respectively. The frequency of postsurgical pain was 21 (28% in the classic group and 9 (12% in the preperitoneal group. The postsurgical hematoma was observed in 7 (9.3% and 9 (12% in the classic and preperitoneal group, respectively. Also, the frequency of postsurgical seroma was 8 (10.7% and 1 (1.3% in the patients treated with the classic and preperitoneal method, respectively. Conclusion. The findings of the present study demonstrated that the preperitoneal method is a more suitable method for inguinal herniorrhaphy than the classic one because of fewer complications, according to the findings of this study.

  3. Ten-Year Outcomes After Coronary Artery Bypass Grafting According to Age in Patients With Heart Failure and Left Ventricular Systolic Dysfunction: An Analysis of the Extended Follow-Up of the STICH Trial (Surgical Treatment for Ischemic Heart Failure).

    Science.gov (United States)

    Petrie, Mark C; Jhund, Pardeep S; She, Lilin; Adlbrecht, Christopher; Doenst, Torsten; Panza, Julio A; Hill, James A; Lee, Kerry L; Rouleau, Jean L; Prior, David L; Ali, Imtiaz S; Maddury, Jyotsna; Golba, Krzysztof S; White, Harvey D; Carson, Peter; Chrzanowski, Lukasz; Romanov, Alexander; Miller, Alan B; Velazquez, Eric J

    2016-11-01

    Advancing age is associated with a greater prevalence of coronary artery disease in heart failure with reduced ejection fraction and with a higher risk of complications after coronary artery bypass grafting (CABG). Whether the efficacy of CABG compared with medical therapy (MED) in patients with heart failure caused by ischemic cardiomyopathy is the same in patients of different ages is unknown. A total of 1212 patients (median follow-up, 9.8 years) with ejection fraction ≤35% and coronary disease amenable to CABG were randomized to CABG or MED in the STICH trial (Surgical Treatment for Ischemic Heart Failure). Mean age at trial entry was 60 years; 12% were women; 36% were nonwhite; and the baseline ejection fraction was 28%. For the present analyses, patients were categorized by age quartiles: quartile 1, ≤54 years; quartile, 2 >54 and ≤60 years; quartile 3, >60 and ≤67 years; and quartile 4, >67 years. Older versus younger patients had more comorbidities. All-cause mortality was higher in older compared with younger patients assigned to MED (79% versus 60% for quartiles 4 and 1, respectively; log-rank P=0.005) and CABG (68% versus 48% for quartiles 4 and 1, respectively; log-rank P<0.001). In contrast, cardiovascular mortality was not statistically significantly different across the spectrum of age in the MED group (53% versus 49% for quartiles 4 and 1, respectively; log-rank P=0.388) or CABG group (39% versus 35% for quartiles 4 and 1, respectively; log-rank P=0.103). Cardiovascular deaths accounted for a greater proportion of deaths in the youngest versus oldest quartile (79% versus 62%). The effect of CABG versus MED on all-cause mortality tended to diminish with increasing age (Pinteraction=0.062), whereas the benefit of CABG on cardiovascular mortality was consistent over all ages (Pinteraction=0.307). There was a greater reduction in all-cause mortality or cardiovascular hospitalization with CABG versus MED in younger compared with older patients

  4. Damaged anal canal as a cause of fecal incontinence after surgical repair for Hirschsprung disease - a preventable and under-reported complication.

    Science.gov (United States)

    Bischoff, Andrea; Frischer, Jason; Knod, Jennifer Leslie; Dickie, Belinda; Levitt, Marc A; Holder, Monica; Jackson, Lyndsey; Peña, Alberto

    2017-04-01

    Fecal incontinence after the surgical repair of Hirschsprung disease is a potentially preventable complication that carries a negative impact on patient's quality of life. Patients that were previously operated for Hirschsprung disease and presented to our bowel management clinic with the complaint of fecal incontinence were retrospectively reviewed. All patients underwent a rectal examination under anesthesia looking for anatomic explanations for their incontinence. One hundred three patients were identified. 54 patients had a damaged anal canal. 22 patients also had a patulous anus. The operative reports mentioned the pectinate line in 32 patients, in 12 it was not mentioned, and in 10 patients the operative report was not available. All patients with a damaged anal canal suffered from true fecal incontinence; 45 of them are on daily enemas (41 are clean and 4 are still having "accidents"), 7 are not doing bowel management due to noncompliance and 2 patients have a permanent ileostomy. 49 patients did not have a damaged anal canal, 25 of those responded to changes in diet and medication and are having voluntary bowel movements. Fecal incontinence may occur after an operation for Hirschsprung disease. When the anal canal is damaged, incontinence is always present, severe, and probably permanent. The preservation of the anal canal may avoid this complication. Copyright © 2017. Published by Elsevier Inc.

  5. Mistakes and complications in the surgical treatment of ambulatory equino planovalgus foot deformities in patients with cerebral palsy using extra-articular subtalar arthrodesis

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    Валерий Владимирович Умнов

    2016-06-01

    Full Text Available Aim.To evaluate the results of a modified technique for extra-articular arthrodesis of the subtalar joint for patients with cerebral palsy with an ambulatory form of equine-planovalgus deformity of the foot. The mistakes and complications that occurred during treatment with this technique are discussed.Materials and methods.Between 2005 and 2015, this surgical method for performing arthrodesis of the subtalar joint, was performed on 544 patients (989 feet between 4 and 15 years old. Correction of equinus contracture was performed using Achilles tendon plasty or dissection of the tendon of the gastrocnemius muscle. Abnormal muscle tone was reduced either by administering Dysport® in the calf muscle or by selective neurotomy of the tibial nerve.Results. Good results were achieved for 72% of cases, satisfactory for 23% of cases, and unsatisfactory for 5% of cases. Unsatisfactory results of treatment were associated with overvaluation of the degree of mobility of the deformity and with a number of technical and tactical mistakes.Conclusion.This analysis of mistakes and complications of extra-articular arthrodesis of the subtalar joint will allow surgeons to avoid these issues in the future and improve the quality of treatment for similar patients.

  6. Neuroma sintomático do nervo sural uma complicação rara após a retirada do nervo: relato de caso Symptomatic neuroma of the sural nerve a rare complication of the harvesting of the nerve for grafting: case report

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    Roberto S. Martins

    2002-09-01

    Full Text Available A retirada do nervo sural para utilização como enxerto autólogo em cirurgias de nervos em geral produz sintomas de repercussão clínica pouco intensa e de duração fugaz. Raramente este procedimento leva a formação de neuroma sintomático no coto proximal. Os sintomas deste tipo de complicação frequentemente cessam após o tratamento clínico e o tratamento cirúrgico é reservado para os raros casos nos quais houve falha terapêutica. Neste estudo, apresentamos o caso de um paciente que foi submetido a tratamento cirúrgico desta patologia, com a utilização de uma variação da anastomose centro-central, descrita para o tratamento de neuromas de cotos de amputação. A utilização deste tratamento resultou na remissão da sintomatologia dolorosa. São discutidas as diversas opções de tratamento cirúrgico para essa rara entidade.The harvesting of the sural nerve for autologous grafting usually produces symptoms of low intensity and short duration. In rare occasions that procedure may lead to the formation of a symptomatic neuroma in the proximal stump. The symptons of this complication are usually controlled by clinical treatment and the surgical procedure is left for the therapeutic failures. In this paper we present the case of a patient with a sural nerve neuroma submitted to surgical treatment by a variant of the centro-central anastomosis technique, developed for the treatment of amputation neuromas, that resulted in remission of the painful symptomatology. The different options of surgical treatment for this rare entity are discussed.

  7. Postoperative Complications, In-Hospital Mortality and 5-Year Survival After Surgical Resection for Patients with a Pancreatic Neuroendocrine Tumor: A Systematic Review.

    Science.gov (United States)

    Jilesen, Anneke P J; van Eijck, Casper H J; in't Hof, K H; van Dieren, S; Gouma, Dirk J; van Dijkum, Els J M Nieveen

    2016-03-01

    Studies on postoperative complications and survival in patients with pancreatic neuroendocrine tumors (pNET) are sparse and randomized controlled trials are not available. We reviewed all studies on postoperative complications and survival after resection of pNET. A systematic search was performed in the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE from 2000-2013. Inclusion criteria were studies of resected pNET, which described postoperative complications separately for each surgical procedure and/or 5-year survival after resection. Prospective and retrospective studies were pooled separately and overall pooled if heterogeneity was below 75%. The random-effect model was used. Overall, 2643 studies were identified and after full-text analysis 62 studies were included. Pancreatic fistula (PF) rate of the prospective studies after tumor enucleation was 45%; PF-rates after distal pancreatectomy, pancreatoduodenectomy, or central pancreatectomy were, respectively, 14-14-58%. Delayed gastric emptying rates were, respectively, 5-5-18-16%. Postoperative hemorrhage rates were, respectively, 6-1-7-4%. In-hospital mortality rates were, respectively, 3-4-6-4%. The 5-year overall survival (OS) and disease-specific survival (DSS) of resected pNET without synchronous resected liver metastases were, respectively, 85-93%. Heterogeneity between included studies on 5-year OS in patients with synchronous resected liver metastases was too high to pool all studies. The 5-year DSS in patients with liver metastases was 80%. Morbidity after pancreatic resection for pNET was mainly caused by PF. Liver resection in patients with liver metastases seems to have a positive effect on DSS. To reduce heterogeneity, ISGPS criteria and uniform patient groups should be used in the analysis of postoperative outcome and survival.

  8. EXPERIENCE ON SURGICAL MANAGEMENT OF RUPTURE OF ABDOMINAL AORTIC ANEURYSM

    Institute of Scientific and Technical Information of China (English)

    管珩; 郑月宏; 李拥军; 刘昌伟; 刘暴; 叶炜

    2003-01-01

    Objective. To describe our surgical experience on rupture of abdominal aortic aneurysm .Methods. Two cases of ruptured aortic aneurysms with severe complication were analyzed. Aorta re-construction procedures were performed using bifurcated e-PTFE grafts during emergency operation. Diag-nosis, preoperative resuscitation, emergency surgical intervention, and postoperative complications of thesepatients were summarized and discussed.Results. Rupture of aortic aneurysm in both patients presented as a huge retroperitoneum haematomaby computed tomography scan. They were successfully saved by prompt body fluid compensation, emer-gency procedure, intraoperative resuscitation, and postoperative intensive care.Conclusions. Correct diagnosis, prompt surgical management, immediate intraoperative proximal aortaclamping during procedure, and effective management of postoperative complications were the key pointsto successful treatment of ruptured aortic aneurysm.

  9. Perioperative complications in revision hip surgery.

    Science.gov (United States)

    Thomasson, E; Guingand, O; Terracher, R; Mazel, C

    2001-01-01

    Revision hip surgery now constitutes 10-30% of all joint procedures. The morbidity and associated with this demanding operation are not well established. The goal of this paper is to determine these rates and to identify some predictive factors. The complication rate ranges from 31,5 to more than 77% in the literature. Life threatening complications represent 1,8 to 8% of these, leading to death in about 1,6%. ASA score and age above 75 appear to be correlated with medical complications. The injection rate varies from 1 to 5,8%, and may be as high as 14% in cases with a past history of infection. Heterotopic ossification occurred in 13 to 65%, reaching severity in 3,3 to 8,3%. Surgical complications include dislocation and femoral injuries. Dislocations occur in almost 10%, leading to revision in1-4,2%. Age and the number of previous surgical operations appear to be significant risk factors. Femoral injuries (perforations or femoral fractures) occur in 6-37%, especially in impaction grafting technique and when uncemented implants are used. Age over 75 years and femoral defects appear to be significant risk factors for femoral fractures. The rate of complications in revision hip surgery continues to be high, but successful clinical outcome can be attained even in elderly patients. Attentive preoperative exams, good prevention of technical pitfalls, the experience of the surgeon and the use of specific tools may decrease these complications and make this demanding procedure safer.

  10. 冠状动脉搭桥术患者并发精神障碍的影响因素分析%Analysis on Affecting Factors of Complicated Mental Disorder among the Patients after Coronary Artery Bypass Grafting

    Institute of Scientific and Technical Information of China (English)

    刘萍

    2014-01-01

    目的:探讨冠状动脉搭桥术后患者并发精神障碍的影响因素。方法收集自2012年1月至2013年1月于本科室行冠状动脉搭桥术的患者资料,按术后有无发生精神障碍分为两组,结果用SPSS 19.0软件进行t检验,χ2检验。结果冠状动脉搭桥术后精神障碍发生率为16.67%,主要表现为抑郁、意识障碍、认知障碍。结论冠状动脉搭桥术后发生精神障碍是多种因素共同作用的结果,医护人员应采取综合护理措施,以改善疾病预后。%Objective To explore the affecting factors of complicated mental disorder among the patients after coronary artery bypass grafting .Methods Collecting the data of patients undergoing coronary artery bypass grafting from Jan .2012 to Jan .2013 in Xinhua hospital .The patients were divided into two groups according to the presence or absence of mental disorder .And the data was analyzed by SPSS 19 .0 .Results After coronary artery bypass grafting , the mental disorder occurrence rate is 16 .67%.Mainly appearance is depression , disturbance of consciousness , cognitive impairment .Conclusion After coronary artery bypass grafting mental disorder is the re-sult of interaction of multiple factors , Medical workers should take comprehensive nursing measures , in order to im-prove the prognosis of the disease .

  11. Pseudocyclops: two cases of ACL graft partial tears mimicking cyclops lesions on MRI

    Energy Technology Data Exchange (ETDEWEB)

    Simpfendorfer, Claus; Subhas, Naveen; Winalski, Carl S.; Ilaslan, Hakan [Cleveland Clinic, Department of Radiology, Cleveland, OH (United States); Miniaci, Anthony [Cleveland Clinic, Department of Orthopedics, Cleveland, OH (United States)

    2015-08-15

    Arthroscopic reconstruction of the anterior cruciate ligament (ACL) using autografts or allografts is a common surgical procedure, particularly in young athletes. Although the procedure has excellent success rates, complications such as mechanical impingement, graft rupture, and arthrofibrosis can occur, often necessitating additional surgery. Magnetic resonance (MR) imaging has become a valuable tool in evaluating complications after ACL reconstruction. We report two cases of ACL reconstruction complicated by arthroscopically proven partial graft tears. In both cases the torn anterior graft fibers were flipped into the intercondylar notch, mimicking anterior arthrofibrosis, i.e., a ''cyclops lesion,'' on MR imaging. Careful review of the direction of graft fibers on MR imaging in the ''pseudocyclops'' lesions can help differentiate these partial tears from the fibrosis of a true cyclops. The ''pseudocyclops'' lesion is a previously undescribed MR imaging sign of partial ACL graft tear. Larger studies are required to determine the sensitivity and specificity of the sign, as well as the clinical importance of these partial graft tears. (orig.)

  12. Use of free tissue transfer in head and neck cancer surgery and risk of overall and serious complication(s): An American College of Surgeons-National Surgical Quality Improvement Project analysis of free tissue transfer to the head and neck.

    Science.gov (United States)

    Cannady, Steven B; Hatten, Kyle M; Bur, Andres M; Brant, Jason; Fischer, John P; Newman, Jason G; Chalian, Ara A

    2017-04-01

    The purpose of this article was to assess the rates of head and neck free tissue transfer and variables available in the American College of Surgeons - National Surgical Quality Improvement Project (ACS-NSQIP) dataset to predict overall and serious complications. We conducted a data analysis from 2005 to 2014 on free tissue cases in the head and neck with descriptive and cross-sectional analysis to examine correlation of NSQIP variables with complications (p < .05). Of 1643 flaps, 906 complications occurred, such as blood transfusion, return to the operating room, extended ventilator support, pneumonia, and superficial surgical site infection. Insulin-dependent diabetes, operative time, age, white blood cell (WBC) count, and smoking correlated with overall complications. Five hundred one patients experienced 859 serious complications: return to the operating room, pneumonia, deep surgical site infection, sepsis, and unplanned intubation. Operative time, clean contaminated wound status, dirty wound classification, and history of congestive heart failure were predictive. Identification of risks for complications is an opportunity for improvement. Extended operative time consistently predicts for both overall and serious complications, suggesting long surgery within contaminated sites risks complication. © 2016 Wiley Periodicals, Inc. Head Neck 39: 702-707, 2017. © 2016 Wiley Periodicals, Inc.

  13. [da Vinci surgical system].

    Science.gov (United States)

    Watanabe, Gou; Ishikawa, Norihiro

    2014-07-01

    The da Vinci surgical system was developed by Intuitive Surgical Inc. in the United States as an endoscopic surgical device to assist remote control surgeries. In 1998, the Da Vinci system was first used for cardiothoracic procedures. Currently a combination of robot-assisted internal thoracic artery harvest together with coronary artery bypass grafting (CABG) through a mini-incision (ThoraCAB) or totally endoscopic procedures including anastomoses under robotic assistance (TECAB) are being conducted for the treatment of coronary artery diseases. With the recent advances in catheter interventions, hybrid procedures combining catheter intervention with ThoraCAB or TECAB are anticipated in the future.On the other hand, with the decrease in number of coronary artery bypass surgeries, the share of valvular surgeries is expected to increase in the future. Among them, mitral valvuloplasty for mitral regurgitation is anticipated to be conducted mainly by low-invasive procedures, represented by minimally invasive cardiac surgery( MICS) and robot-assisted surgery. Apart from the intrinsic good surgical view, robotic-assisted systems offer additional advantages of the availability of an amplified view and the easy to observe the mitral valve in the physiological position. Thus, robotic surgical surgeries that make complicated procedures easier are expected to accomplish further developments in the future. Furthermore, while the number of surgeries for atrial septal defects has decreased dramatically following the widespread use of Amplatzer septal occluder, robotic surgery may become a good indication for cases in which the Amplatzer device is not indicated. In Japan, clinical trial of the da Vinci robotic system for heart surgeries has been completed. Statutory approval of the da Vinci system for mitral regurgitation and atrial septal defects is anticipated in the next few years.

  14. 关节镜下自体肌腱移植重建前交叉韧带术后并发症的研究进展%Research progress on the postoperative complications of arthroscopic anterior cruciate ligament reconstruction using autogenous tendon grafts

    Institute of Scientific and Technical Information of China (English)

    赵阳; 张春礼

    2015-01-01

    As an important therapy for anterior cruciate ligament ( ACL ) ruptures,ACL reconstruction using autogenous tendon grafts has been gradually accepted by the majority of doctors and patients,but there is a lack of an intensive study on the postoperative complications.Deep vein thrombosis ( DVT ),peripheral neuropathy and muscle weakness may be caused by the use of tourniquets.The joint infection rate after arthroscopic ACL reconstruction is about 0.3%-1.7%.The pollution of surgical tools and grafts is the main cause of postoperative knee infections.The infection chance will be increased due to soft tissue injuries in harvesting tendons and the use of internal fixation.Erythrocyte sedimentation rate ( ESR ) and C-reactive protein ( CRP ) are considered to be the effective laboratory indexes in early diagnosis of infections after ACL reconstruction.The application of sensitive antibiotics,repeated arthrocentesis and arthroscopic debridment are important and effective in the treatment of knee joint infections.Injuries of the infrapatellar branch of the saphenous nerve and the lateral sural cutaneous nerve may lead to sensory disability in the anterior region and the distal end of the affected knee.The choice of incision location and fixed position of the affected limb are related to nerve injuries.The incidence of cysts after ACL reconstruction is not high,and tibial tunnel cyst and cruciate ligament cyst are relatively common.The symptoms can be alleviated with the treatment of arthroscopic cystectomy.The incidence of postoperative fibrosis of the knee joint is 4%-35%,which is mainly associated with tunnel positioning,combined soft tissue injuries and postoperative rehabilitation exercise.

  15. Breast reconstruction following conservative mastectomies: predictors of complications and outcomes

    Science.gov (United States)

    Voineskos, Sophocles H.; Frank, Simon G.

    2015-01-01

    Breast reconstruction can be performed using a variety of techniques, most commonly categorized into an alloplastic approach or an autologous tissue method. Both strategies have certain risk factors that influence reconstructive outcomes and complication rates. In alloplastic breast reconstruction, surgical outcomes and complication rates are negatively impacted by radiation, smoking, increased body mass index (BMI), hypertension, and prior breast conserving therapy. Surgical factors such as the type of implant material, undergoing immediate breast reconstruction, and the use of fat grafting can improve patient satisfaction and aesthetic outcomes. In autologous breast reconstruction, radiation, increased BMI, certain previous abdominal surgery, smoking, and delayed reconstruction are associated with higher complication rates. Though a pedicled transverse rectus abdominis myocutaneous (TRAM) flap is the most common type of flap used for autologous breast reconstruction, pedicled TRAMs are more likely to be associated with fat necrosis than a free TRAM or deep inferior epigastric perforator (DIEP) flap. Fat grafting can also be used to improve aesthetic outcomes in autologous reconstruction. This article focuses on factors, both patient and surgical, that are predictors of complications and outcomes in breast reconstruction. PMID:26645003

  16. Surgical and perioperative management techniques for simultaneous pancreas-kidney transplantation with insulin systemic circulation reflux and enteric drainage

    Directory of Open Access Journals (Sweden)

    Ming CAI

    2011-12-01

    Full Text Available Objective The present paper aims to summarize the surgical and perioperative management techniques for simultaneous pancreas-kidney transplantation(SPKT with insulin systemic circulation reflux and enteric drainage to reduce surgical risks and complications and improve the long-term survival of transplanted organs.Methods The present paper retrospectively analyzes the clinical data,surgical techniques,and prevention of surgery-related complications from five cases that received SPKT with insulin systemic circulation reflux and enteric drainage.These five patients suffered from Type 1 diabetes mellitus and diabetic nephropathy resulting in uremia.They were admitted to the Organ Transplant Center of the 309th Hospital of PLA from 2003 to 2010.Results Of the five successful SPKT cases,three patients had normally functioning graft pancreas and kidneys and were able to stop their insulin and hypoglycemic drug medications and dialysis.Two cases had delayed kidney graft functions.One suffered perioperative death due to infection and multiple organ failure,and the other received graft pancreas resection due to a leaky gut caused by donor duodenal segment necrosis.The graft kidney,however,retained normal function.The insulin medication was stopped after an average time of 15 days,and blood creatinine returned to its normal level after 10 days.The graft survival was checked after 12 months to 96 months(by July of 2011,and the graft procedure was found to be successful.Conclusions SPKT with insulin systemic circulation reflux and enteric drainage is the preferred surgical technique for pancreas transplantation.Enhanced surgical skills and effective perioperative management can help reduce,and even eliminate,postoperative complications and improve graft survival.

  17. Free Nipple Graft Technique to Correct Nipple and Areola Malposition after Breast Procedures

    Directory of Open Access Journals (Sweden)

    Mario Rietjens, MD

    2013-11-01

    Full Text Available Summary: Secondary correction of nipple areola complex (NAC malposition represents a major concern after breast reconstructive procedures. It is frequently requested by patients complaining about asymmetric areolas impairing the whole reconstructive procedure and asking for improved cosmetic outcomes. Several methods have been described to achieve a good symmetry between the 2 areolas, either natural or reconstructed. We describe our correction technique with free NAC graft. A total of 16 patients were treated with free NAC grafts between April 2010 and April 2013 at the European Institute of Oncology, Milan, Italy. This series focused on the surgical technique and its postoperative outcomes. Three cases of partial graft loss (18% were observed in the postoperative period. No total NAC necrosis occurred. No infection was observed. All the complications were managed with a conservative treatment, not requiring any further surgery. NAC malposition following breast reconstructive procedures can be corrected using the technique of free NAC graft with reliable and satisfactory results.

  18. Repair of a bowel-containing, scrotal hernia with incarceration contributed by femorofemoral bypass graft

    Science.gov (United States)

    Sharma, Gaurav; Schouten, Jonathan A.; Itani, Kamal M. F.

    2017-01-01

    The rising use of endovascular techniques utilizing femoral artery access may increase the frequency with which surgeons face the challenge of hernia repair in reoperative groins—which may or may not include a vascular graft. We present a case where a vascular graft contributed to an acute presentation and complicated dissection, and review the literature. A 67-year-old man who had undergone prior endovascular aneurysm repair via open bilateral femoral artery access and concomitant prosthetic femorofemoral bypass, presented with an incarcerated, scrotal inguinal hernia. The graft with its associated fibrosis contributed to the incarceration by compressing the inguinal ring. Repair was undertaken via an open, anterior approach with tension-free, Lichtenstein herniorraphy after releasing graft-associated fibrosis. Repair of groin hernias in this complex setting requires careful surgical planning, preparation for potential vascular reconstruction and meticulous technique to avoid bowel injury in the face of a vascular conduit and mesh. PMID:28069880

  19. Parenchyma-wise technique for the harvest and implantation of hepatic segment 2-3 grafts: Anatomic basis and surgical steps.

    Science.gov (United States)

    El Gharbawy, Ramadan M; Skandalakis, Lee J; Heffron, Thomas G; Skandalakis, John E

    2011-09-01

    We propose a technique for pediatric liver transplantation that does not waste the donor's parenchyma. Organ shortage has extended criteria for donor acceptance, such that even individuals with livers of suboptimal volume can donate their segment 2-3. By incorporating wise use of parenchyma, our proposed technique for harvesting segment 2-3 for implantation in a pediatric recipient benefits these and other donors, and it might increase donations. This is especially important in countries in which procurement of organs from the deceased is not allowed. Our technique also aims to solve the problem of the large-for-size syndrome for neonates and extremely small infants and to allow for primary closure of the abdomen. This technique enables harvest of the following four grafts: (1) complete segment 2-3; (2) reduced segment 2-3; (3) complete segment 3; and (4) reduced segment 3. The surgeon will select the type that has suitable graft-to-recipient weight ratio and that suits the donor's liver anatomy and volume. These four types benefit the donor by preserving the parenchyma of segment 4 and the left part of the caudate lobe. The three graft types other than the complete segment 2-3 graft will also preserve varying fractions of the parenchyma of segment 2-3. The technique for complete segment 2-3 graft can be put into practice immediately; the techniques for the other three grafts need an imaging modality to preoperatively delineate the donor's fourth-order bile ducts. We expect to correct this deficiency in the near future by developing the requisite imaging technique.

  20. Prevention strategies for surgical complications of sphenoid wing meningiomas%蝶骨嵴脑膜瘤手术并发症的防治

    Institute of Scientific and Technical Information of China (English)

    迁荣军; 张佳栋; 李治晓; 史锡文

    2016-01-01

    Objective To explore the prevention strategies for surgical complications of sphenoid wing meningiomas.Methods A total of 76 cases of sphenoid wing meningiomas were included from The People's Hospital of Henan Province from 2011 to 2014.Based on the preoperative imaging data, the patients were divided into 28 cases of lateral type, 16 cases of middle type and 32 cases of medial type.According to the different characteristics of different types of sphenoid wing meningiomas, appropriate preoperative, intraoperative and postoperative measures to prevent complications were carried out.Results A total of 2 cases of facial nerve injury occurred in 28 cases with lateral type;1 case of intraoperative subarachnoid hemorrhage and brain swelling occurred in 16 cases with middle type;3 cases of oculomotor nerve damage, 1 case of optic nerve injury and 4 cases of vascular injury occurred in 32 cases with the medial type.The total incidence of complications was 14.5% (11/76).Conclusion Detailed preoperative planning according to the characteristics of different types of sphenoid wing meningiomas, intraoperative use of microsurgery and Cavitron Ultrasonic Surgical Aspirator (CUSA), following the principle of in situ removal, controlling the extent of resection of tumor adhering to cavernous sinus and the great vessels, the severe surgery complications of sphenoid wing meningiomas can be reduced.%目的 探讨蝶骨嵴脑膜瘤手术并发症的防治对策.方法 对象为河南省人民医院2010至2014年收治蝶骨嵴脑膜瘤患者76例,根据术前影像资料分为外侧型28例,中间型16例,内侧型32例,依据不同分型的不同特点,分别采取相应的术前、术中、术后措施预防并发症.结果 28例外侧型患者中出现面神经损伤2例;16例中间型患者中出现术中蛛网膜下腔出血并脑肿胀1例;32例内侧型患者中出现动眼神经损伤3例,视神经损伤1例,血管性损伤4例.并发症总发生率为14.5%(11/76).结论

  1. The Preliminary Study on Procurement Biliary Convergence from Donors with Complicated Bile Duct Variant in Emergency Right Lobe Living Donor Liver Transplantation.

    Science.gov (United States)

    Ye, Sheng; Dong, Jia-Hong; Duan, Wei-Dong; Ji, Wen-Bing; Liang, Yu-Rong

    2017-03-01

    The incidence of biliary complications after living donor adult liver transplantation (LDALT) is still high due to the bile duct variation and necessity reconstruction of multiple small bile ducts. The current surgical management of the biliary variants is unsatisfactory. We evaluated the role of a new surgical approach in a complicated hilar bile duct variant (Nakamura type IV and Nakamura type II) under emergent right lobe LDALT for high model for end-stage liver disease score patients. The common hepatic duct (CHD) and the left hepatic duct (LHD) of the donor were transected in a right-graft including short common trunks with right posterior and anterior bile ducts, whereas the LHD of the donor was anastomosed to the CHD and the common trunks of a right-graft bile duct and the recipient CHD was end-to-end anastomosed. Ten of 13 grafts (Nakamura types II, III, and IV) had two or more biliary orifices after right graft lobectomy; seven patients had biliary complications (53.8%). Later, the surgical innovation was carried out in five donors with variant bile duct (four Nakamura type IV and one type II), and, consequently, no biliary or other complications were observed in donors and recipients during 47-53 months of follow-up; significant differences (P right hepatic ducts in a complicated donor bile duct variant may facilitate biliary reconstruction and reduce long-term biliary complications.

  2. Assessment of Surgical Complications in Morbid Obese Patients, The Candidates for 2 Methods of Laparoscopic Bariatric Surgery (Laparoscopic Gastric Bypass, Laparoscopic Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    Pazouki

    2015-11-01

    Full Text Available Background In 2005, obesity rate was declared 396 million worldwide, which has been doubled in the last 20 years (compared with 1985. Obesity has a strong correlation with a pool of comorbidities and consequences. Although many modules, including behavioural approach and medications have presented particular short-term unreliable methods to reduce and control the body weight in morbid obesity, only 5 - 10% of weight loss was achieved, which is usually regained overtime, compared with 50 - 75% success rate in bariatric surgery. Objectives This retrospective study tried to monitor weight loss after LRYGB and LSG in morbid obese patients referred to a known center in Tehran through a one-year follow up. Materials and Methods Participants were selected regarding the U.S. National Institute of Health (NIH guidelines, which indicates BMI > 40 kg/m2 alone, or BMI > 35 kg/m2 in addition to comorbidities and failure of non-surgical attempts to control their weight. They were visited at points of one, three, six, and 12 months postoperatively to collect information about weight loss, BMI, and complications in addition to percent excess weight loss (EWL%. The percentage of failure was computed to the proportion of patients who had EWL% < 25 to the total number of operated patients in a year. Results Significant decrease in BMI and weight were achieved in all postoperative visits (for all of them, P value < 0.0001, while no significant difference was found in which the parameters between two studied procedures were in this regard. Conclusions To sum up, LRYGB and LSG deserve an overall preference not only in current study, but also in the majority of performances up to now. Nevertheless it is urgent the relevant studies to confirm the preference or improve this kind of bariatric surgery in order to diminish complications as far as possible.

  3. Reconstruction of the Upper Eyelid with Flaps and Free Grafts after Excision of Basal Cell Carcinoma

    Directory of Open Access Journals (Sweden)

    Alessandro Guido Actis

    2011-11-01

    Full Text Available Purpose: To describe a reconstructive technique of the superior eyelid with flaps and free grafts after excision of a basal cell carcinoma. Methods: Single case report of a 79-year-old woman who presented to our hospital with a basal cell carcinoma of the upper eyelid margin with initial erosion. Results: A large and full-thickness excision of the carcinoma was performed. The reconstruction technique should be customized to the individual patient. In this case, the use of a full-thickness tarsal graft from the contralateral upper eyelid, followed by an ipsilateral bipedicled flap and finally by a skin graft, was an effective surgical procedure, performed in one stage, without complications, and with good functional and esthetic results. Conclusions: Malignant neoplasms represent the leading cause of plastic reconstruction in the orbital region. Surgical techniques must be individualized for each patient and for each type of carcinoma. Reconstructive techniques with free grafts and flaps yield excellent results in the orbital region, particularly when some advice and a few fundamental rules are followed, namely accurate hemostasis of the receiving graft bed by moderate use of diathermy, careful suturing of the edges, and application of a compressive dressing for at least 4 days. Postoperative complications are very rare.

  4. Chronic acromioclavicular joint dislocations treated by the GraftRope device.

    Science.gov (United States)

    Nordin, Jonas S; Aagaard, Knut E; Lunsjö, Karl

    2015-04-01

    Surgical treatment of chronic acromioclavicular joint dislocations is challenging, and no single procedure can be considered to be the gold standard. In 2010, the GraftRope method (Arthrex Inc., Naples, FL) was introduced in a case series of 10 patients, showing good clinical results and no complications. We wanted to evaluate the GraftRope method in a prospective consecutive series. 8 patients with chronic Rockwood type III-V acromioclavicular joint dislocations were treated surgically using the GraftRope method. The patients were clinically evaluated and a CT scan was performed to assess the integrity of the repair. In 4 of the 8 patients, loss of reduction was seen within the first 6 weeks postoperatively. A coracoid fracture was the reason in 3 cases and graft failure was the reason in 1 case. In 3 of the 4 patients with intact repairs, the results were excellent with no subjective shoulder disability 12 months postoperatively. It was our intention to include 30 patients in this prospective treatment series, but due to the high rate of complications the study was discontinued prematurely. Based on our results and other recent reports, we cannot recommend the GraftRope method as a treatment option for chronic acromioclavicular joint dislocations.

  5. Autologous smashed dermal graft with epidermal re-closure: Modified technique for acne scars

    Directory of Open Access Journals (Sweden)

    Umashankar Nagaraju

    2016-01-01

    Full Text Available Conventional technique of dermal grafting for acne scars where the source of filler material used is the patient′s own dermis requires longer surgical time, recovery period and can result in unsightly scars at the donor area. Hence, it is not suitable for treating a larger number of scars. Furthermore, these dermal grafts are firm and cannot be contoured to fit all types of acne scars. Occurrence of epidermal cyst and secondary infection is another complication if epidermis is not completely removed. Enzymatic techniques need trypsinisation which is expensive and requires laboratory facilities.

  6. Causes and countermeasures of complications of one-stage surgical management for spinal tuberculosis%脊柱结核一期手术治疗的并发症分析及对策

    Institute of Scientific and Technical Information of China (English)

    叶伟; 李春海; 梁安靖; 彭焰; 黄东生; 刘尚礼

    2010-01-01

    Objective To analyze the causes of the complications of one-stage surgical management for spinal tuberculosis and its countermeasures.Methods From May 1997 to December 2008,116 patients with spinal tuberculosis underwent operations.Among them,6 were in cervical vertebra,3 in cervicothoracie vertebra,29 in thoracic vertebra,37 in thoracolumbar vertebra.29 in lumbar vertebra and 12 in hmbrosacrum vertebra.All cases underwent the anterior and/or radical debridement,decompression,autogenous bone grafting or radical debridement,decompression,autogenous bone grafting and internal fixation.The causes of the complications of surgical management and the countermeasures were analyzed.Results One hundred and ehven cases were followed upfor an average of(3.86±2.16)years(range 6 months to 12 years).The rate of complication was 13.5%(15/111).Recurrent spinal tuberculosis occarred in 5 cases,internal fixation loosened in 1 case,rupture of the external iliac vein occurred in 2 cases,lateral ventral syndrome in 1 case,venous embolism of the lower extremity in 1 csse,reactional psychosis in 2 cases,pneumatothorax in 2 cases and femoral nerve irritating syndrome in 1 case.Among the recurrent cages,2cases with anterior debridement and 2 cases with posterior debridement underwent anterior operation again andgot good results, 1 case with anterior debridement gave up the reoperafion.Other cases relieved after conservative therapy.Conclusions Standardized anti-tuberculosis thempy is fundamental for preventing the recurrence of tuberculosis.Correct approach for the operation and thorough radical debddement are the key points for preventing the recurrence of tuberculosis.Good and effective therapy surround the operation is helpful for preventing the recurrence of tuberculosis.%目的 分析脊柱结核一期手术治疗所发生并发症的原因并探讨其相应对策.方法 1997年5月至2008年12月采用一期手术治疗脊柱结核116例.其中颈椎结核6例,颈胸椎结核3

  7. Treatment of oroantral fistula with autologous bone graft and application of a non-reabsorbable membrane

    Directory of Open Access Journals (Sweden)

    Adele Scattarella, Andrea Ballini, Felice Roberto Grassi, Andrea Carbonara, Francesco Ciccolella, Angela Dituri, Gianna Maria Nardi, Stefania Cantore, Francesco Pettini

    2010-01-01

    Full Text Available Aim: The aim of the current report is to illustrate an alternative technique for the treatment of oroantral fistula (OAF, using an autologous bone graft integrated by xenologous particulate bone graft.Background: Acute and chronic oroantral communications (OAC, OAF can occur as a result of inadequate treatment. In fact surgical procedures into the maxillary posterior area can lead to inadvertent communication with the maxillary sinus. Spontaneous healing can occur in defects smaller than 3 mm while larger communications should be treated without delay, in order to avoid sinusitis. The most used techniques for the treatment of OAF involve buccal flap, palatal rotation - advancement flap, Bichat fat pad. All these surgical procedures are connected with a significant risk of morbidity of the donor site, infections, avascular flap necrosis, impossibility to repeat the surgical technique after clinical failure, and patient discomfort.Case presentation: We report a 65-years-old female patient who came to our attention for the presence of an OAF and was treated using an autologous bone graft integrated by xenologous particulate bone graft. An expanded polytetrafluoroethylene titanium-reinforced membrane (Gore-Tex ® was used in order to obtain an optimal reconstruction of soft tissues and to assure the preservation of the bone graft from epithelial connection.Conclusions: This surgical procedure showed a good stability of the bone grafts, with a complete resolution of the OAF, optimal management of complications, including patient discomfort, and good regeneration of soft tissues.Clinical significance: The principal advantage of the use of autologous bone graft with an expanded polytetrafluoroethylene titanium-reinforced membrane (Gore-Tex ® to guide the bone regeneration is that it assures a predictable healing and allows a possible following implant-prosthetic rehabilitation.

  8. Surgical Treatment of Acoustic Neuromas and Its Common Complications%听神经瘤的手术切除及常见并发症分析

    Institute of Scientific and Technical Information of China (English)

    王诚; 卓治平; 周焜; 梁郸; 乔志立

    2011-01-01

    Objective: To study the postoperative complications and related factors of acoustic neuroma resection via suboccipital retrosigmoid approach. Methods: Thirty-six patients with acoustic neuroma were analyzed retrospectively. Results: Total removal was achieved in 28 cases, while subtotal resection was performed in 8 cases. Hearing loss occurred in 31 cases, and other complications were facial nerve dysfunction in 18 cases, lower cranial nerve injury in 4 cases, cerebrospinal fluid leakage in 3 cases, hydrocephalus or aggravated hydrocephalus in 2 cases, intracranial infection in 1 case, and intracranial bleeding in 1 cases. Only one case died. Conclusion: The high incidence of hearing loss and facial nerve dysfunction was found after acoustic neuroma resection, and the incidence of complications were related to the tumor size, cystic changes, and micro-surgical proficiency.%目的:分析枕下乙状窦后入路切除听神经瘤术后常见并发症及相关因素.方法:对36例听神经瘤患者术后出现的并发症进行回顾性分析.结果:36例听神经瘤全切除28例,次全切除8例.术后出现听力丧失31例,面神经功能障碍18例,后组颅神经损伤4例,脑脊液漏3例,出现脑积水或原有脑积水加重2例,颅内感染1例,颅内出血1例,死亡l例.结论:听神经瘤术后听力丧失和面神经功能障碍发生率高,并发症的发生率与肿瘤的大小、囊性变及术者显微手术熟练程度相关.

  9. Endovascular stent graft treatment of acute thoracic aortic transections due to blunt force trauma.

    LENUS (Irish Health Repository)

    Bjurlin, Marc A

    2012-02-01

    Endovascular stent graft treatment of acute thoracic aortic transections is an encouraging minimally invasive alternative to open surgical repair. Between 2006 and 2008, 16 patients with acute thoracic aortic transections underwent evaluation at our institution. Seven patients who were treated with an endovascular stent graft were reviewed. The mean Glasgow Coma Score was 13.0, probability of survival was .89, and median injury severity score was 32. The mean number of intensive care unit days was 7.7, mean number of ventilator support days was 5.4, and hospital length of stay was 10 days. Mean blood loss was 285 mL, and operative time was 143 minutes. Overall mortality was 14%. Procedure complications were a bleeding arteriotomy site and an endoleak. Endovascular treatment of traumatic thoracic aortic transections appears to demonstrate superior results with respect to mortality, blood loss, operative time, paraplegia, and procedure-related complications when compared with open surgical repair literature.

  10. The arterial supply of the cervical and thoracic spinal muscles and overlying skin: Anatomical study with implications for surgical wound complications.

    Science.gov (United States)

    Yue, Brian Yin Ting; le Roux, Cara Michelle; Corlett, Russell; De La Harpe, David; Richardson, Martin; Ashton, Mark

    2013-07-01

    Postoperative spinal wound dehiscence is a significant complication following the posterior midline approach. It is postulated that this approach disrupts the vasculature supplying the paraspinal muscles and overlying skin. Although the spinal vasculature has been investigated previously, the smaller arterioles have not been described in the context of the posterior midline approach. Eight cadaveric neck and posterior torso specimens were dissected after injection with a radio-opaque lead oxide mixture and subsequent radiographs taken were analyzed. The deep cervical, vertebral, superficial cervical, and occipital arteries consistently supplied the cervical paraspinal muscles. The latter two arteries also vascularized the overlying skin. The deep cervical arteries were found to be located lateral to the C3 to C6 vertebrae, vulnerable to damage with the posterior approach. In the thoracic region, the superior and posterior intercostal arteries consistently supplied the spinal muscles. In all specimens, two small anastomotic vessels posterior to the laminae were found connecting the intercostal artery perforators. Both the arterial perforators and their anastomotic channels were situated in the surgical field and susceptible to damage with the posterior approach. It is likely that the disruption in spinal vasculature contributes to the multifactorial problem of wound dehiscence with the posterior midline approach. Copyright © 2012 Wiley Periodicals, Inc.

  11. 齿状突合并周围性骨折的手术治疗策略%Surgical Treatment Strategies of Fascia Dentata Complicated with Peripheral Fractures

    Institute of Scientific and Technical Information of China (English)

    姚波; 黄象望; 刘向阳; 肖晟

    2011-01-01

    [Objective]To explore the individualized surgical treatment of fascia dentata complicated with peripheral fracture. [Methods] Thirty six cases(26 males and 10 females) of fascia dentata complicated with peripheral fracture admitted in our hospital from Jan. 2002 to Dec. 2008 were enrolled in the study. After admission, X-ray, CT and MRI were performed for the diagnosis of fascia dentata complicated with peripheral fracture. According to the individuation, Apofix, dentate axon screws, occipitocervical fusion and C1~2 pedicle nail internal fixation were applied. All patients got successful treatment. [Results]Among 36 patients, 41 places were diagnosed as fascia dentata complicated with peripheral fracture before operation. Five places of peripheral fracture were found in 5 patients during operation. There were 46 places of fractures. All 36 patients were operated smoothly. The patients were followed up from 3 months to 3 years. All fractures were already osseous healing and no internal fixation was loose. JOA rating showed that 14 patients were moderate and 22 patients were mild. After operation, JOA score increased 3~ 5 points, and the average improvement rate of postoperative JAO score was 84.2%. The efficacy of 32 patients was excellent or good. [Conclusion]Individualized method for the treatment of fascia dentata complicated with peripheral fracture has good clinical efficacy.%[目的]探讨齿状突合并周围性骨折的个性化手术治疗方法及其疗效.[方法]本院2002年1月至2008年12月共收治36例齿状突合并周围性骨折患者,其中男26例,女10例.入院后行X线片,CT或MRI检查,诊断齿状突合并周围骨折,根据个性化分别采用Apofix,齿状突螺钉,枕颈融合术,C1~2椎弓根钉内固定术治疗.[结果]36例患者术前诊断齿状突合并周围骨折41处,术中发现周围骨折5例5处,共46处骨折,术中36例患者手术顺利,术后随访3个月至3年,骨折均已骨性愈合,内固

  12. Complicações tromboembólicas no paciente cirúrgico e sua profilaxia Thromboembolic complications in surgical patients and its prophylaxis

    Directory of Open Access Journals (Sweden)

    Eric Rassam

    2009-03-01

    of Rudolf Virchow which includes vascular endothelial injury, hypercoagulability and venous stasis. This article aims to review, demonstrating the importance of understanding the thromboembolic complications in surgical patients in order to avoid them. METHODS: Information on the subject at Medline/PubMed, which showed that thromboprofylaxis is the most effective strategy to reduce morbidity and mortality in surgical patients by VTE. The incidence of proximal DVT without prophylaxis is around 25% to 32% and, with prophylaxis of 10% to 18%. CONCLUSION: Knowing risks of DVT may increase the focus on the problems of PTE in hospitalized patients and form the basis of strategies for prophylaxis.

  13. Primary renal graft thrombosis

    NARCIS (Netherlands)

    Bakir, N; Sluiter, WJ; Ploeg, RJ; van Son, WJ; Tegzess, Adam

    1996-01-01

    Background. Renal allograft thrombosis is a serious complication of kidney transplantation that ultimately leads to graft loss. Its association with acute and hyperacute rejection is well documented; however, in a large proportion of patients the precise cause remains obscure. The exact incidence an

  14. Screw in the aorta: minimally invasive graft replacement for chronic aortic erosion by spinal instrument.

    Science.gov (United States)

    Fukuda, Wakako; Aoki, Chikashi; Daitoku, Kazuyuki; Taniguchi, Satoshi; Fukuda, Ikuo

    2013-01-01

    Intra-and early post-operative aortic injury by pedicle screw is not a rare complication in orthopedic surgery, but aortic penetration by a screw head over a long time period is considered as an uncommon case. There are various surgical management options for thoracic aortic injury caused by malpositioned spinal instruments. We report a case of a patient who underwent minimally invasive graft replacement of the descending thoracic artery for pedicle screw penetration.

  15. Endovascular treatment of abdominal aortic aneurysms--6 years of experience with Ella stent-graft system

    Energy Technology Data Exchange (ETDEWEB)

    Koecher, Martin E-mail: martin.kocher@seznam.cz; Utikal, Petr; Koutna, Jirina; Bachleda, Petr; Buriankova, Eva; Herman, Miroslav; Bucil, Jiri; Benysek, Vladimir; Cerna, Marie; Kojecky, Zdenek

    2004-08-01

    Purpose: Evaluation of 6-year results of abdominal aortic aneurysm (AAA) treatment by Ella stent-grafts with regard to safety and effectivity in relation to morphology of the aneurysm. Methods: From a group of 172 patients with AAA, in whom elective endovascular treatment was considered, 120 of them (69.8%) were found to be suitable for this type of therapy. The bifurcated type of stent-graft was implanted in 97 patients, uniiliacal type in 19 patients and only four patients were found to be suitable for tubular type of stent-graft. Additional necessary procedures (internal iliac artery occlusion or contralateral common iliac artery occlusion in a group of patients with uniiliacal type of stent-graft) were performed surgically during the stent-graft implantation. CT and US controls were performed at 3, 6 and 12 months after implantation, later every 12 months. Results: Primary technical success was achieved in 109 of the 120 patients (91%). Primary endoleak was recorded in 11 patients (primary endoleak type Ia in seven patients, type Ib in three patients and type IIIa in one patient). Assisted technical success after reintervention or spontaneous seal was 98.3%. Surgical conversion was indicated in two patients (1.7%). Perioperative mortality rate was 3.3%. Total average follow-up period was 20.7 months (range from 2 to 60 months). In nine patients (7.5%) secondary endoleak type II was found at control CT or US, in three patients partial thrombosis of the stent-graft was found. There was no aneurysm rupture during follow-up. Conclusion: Treatment of AAA with Ella stent-graft system is effective and safe. Bifurcated stent-graft is the most frequently used type. Uniiliacal type of stent-graft is used by us only in cases of complicated morphology.

  16. Buccal mucosa is a promising graft in Peyronie’s disease surgery. Our experience and a brief literature review on autologous grafting materials

    Directory of Open Access Journals (Sweden)

    Andrea Fabiani

    2016-07-01

    Full Text Available Aim: Peyronie’s Disease (PD is an under reported acquired benign condition that, at the moment, is not curable with medical therapy. Surgery represent the gold standard of treatment. Surgical approaches are several and they consist in “plication techniques” or plaque incision/excision with grafting of resulting albuginea defect. Among grafting procedures, albuginea defect substitution with autologous materials demonstrated over the years not inferior results respect to heterologous grafts. Buccal mucosa graft (BMG is not usually emphasized in many review articles and clinical series are yet limited. Methods: We present our experience with seventeen plaque incision procedures and BMG in surgical correction of complex penile curvatures due to PD performed in a period of 30 months. Our analyses was focused on buccal mucosa graft characteristics as major determinant of the surgical success. We also conducted a brief literature review on autologous grafting materials used in reconstructive penile surgery for PD. Results: Our cosmetics and functional results consists in a 100% of functional penile straightening with no relapses and 5,8% of de novo erectile dysfunction. Mean age was 56.4 years, mean follow-up of 22.5 (6-36 months. No complications graft related were observed. Operative time was 115.3 minutes in mean. Over 94% of patients referred they were “really much better” and “much better” satisfied based on PGI-I questionnaire administrated at the last follow- up visit. Conclusion: BMG is revealing as an optimal choice for reconstructive surgery in PD. Anatomical characteristics consisting in the great elasticity, the quick integration time and the easy harvesting technique lead to high cosmetics and functional success rate, without omitting economical and invasiveness aspects.

  17. [Complications of operative hysteroscopy].

    Science.gov (United States)

    Agostini, A; Bretelle, F; Cravello, L; Ronda, I; Roger, V; Blanc, B

    2003-05-24

    Assess the prevalence and severity of the various complications of operative hysteroscopy, the context in which they occur and the treatments proposed. A single-center observational study from 1/1/90 to 1/1/99 including 2,116 surgical hysteroscopies (resection of a fibroma (782) or polyp (422), section of a septate uterus (199), synechia uteri (90) and endometrectomy (623)). There were 74 complications (3.5%). The most frequent was uterine perforation (34 cases (1.61%)). There were 13 cases of haemorrhage (0.61%), 16 cases of post-surgical fever (0.76%) and 11 metabolic complications (0.47%). Synechia uteri was the surgical intervention with the greatest risk of complications. The complications of surgical hysteroscopy are rare and relatively benign. Uterine perforation appears to predominate. In our study, the risk of complication was enhanced in the case of synechia uteri.

  18. Surgical results of complicated ocular trauma with cyclodialysis%复杂眼外伤伴睫状体离断的手术疗效

    Institute of Scientific and Technical Information of China (English)

    于滨; 董晓光; 王金艳

    2010-01-01

    目的 观察复杂眼外伤致睫状体离断并伴有眼前后节损伤患者的手术治疗效果.方法 B型超声及超声生物显微镜(UBM)检查确诊存在不同程度睫状体离断伴眼前后节损伤,需行玻璃体切割手术治疗的复杂眼外伤患者55例55只眼纳入本研究.其中,眼球钝挫伤35例,眼球破裂伤20例.视力无光感~0.15,不能矫正.眼压1~10 mm Hg(1 mm Hg=0.133 kPa),睫状体离断范围1~12个钟点.所有患者均行经扁平部玻璃体切割联合睫状体离断复位术.对于睫状体离断范围≤3个钟点者,冷冻封闭睫状体离断口;睫状体离断范围>3个钟点者,缝合离断的睫状体与相应巩膜.手术后就外伤愈合、视力、眼压、眼内出血、睫状体以及视网膜的复位情况进行随访.结果 手术后1个月,UBM检查显示,54例患者睫状体复位良好,1例患者前房角镜检查仍见针尖大小离断口,第2次手术缝合后复位成功.手术后3个月,55例患者眼外伤愈合良好,视力无光感~0.15,最佳矫正视力为0.8.视网膜在位,睫状体复位良好.52例患者眼压恢复至正常范围,另外3例眼压仍低于10 mm Hg.3例发生继发性青光眼,手术后15 d行抗青光眼手术,眼压得以控制.结论 经扁平部玻璃体切割联合睫状体冷冻或缝合复位手术治疗复杂眼外伤致睫状体离断并伴有眼前后节损伤患者安全有效,避免了分期手术的痛苦,手术后眼压恢复良好,部分患者恢复了有用的视力.%Objective To explore the surgical techniques, efficacy and the management of complicated ocular trauma with anterior-posterior segment complications such as cyclodialysis. Methods Fifty-five patients (55 eyes) with complicated ocular trauma were enrolled in this study. Among them, there were 35 cases with eyeball contusion and 20 cases of eyeball rupture. Preoperative visual acuity was from no light perception to 0. 15, intraocular pressure (IOP) ranged from one to 10 mm Hg (1 mm

  19. Importance of stent-graft design for aortic arch aneurysm repair

    Directory of Open Access Journals (Sweden)

    C Singh

    2017-02-01

    Full Text Available Aneurysm of the aorta is currently treated by open surgical repair or endovascular repair. However, when the aneurysm occurs in regions between the aortic arch and proximal descending aorta, it can be a complex pathology to treat due to its intricate geometry. When complex aortic aneurysms are treated with the conventional procedures, some of the patients present with significant post-operative complications and high mortality rate. Consequently, a clinically driven hybrid innovation known as the frozen elephant trunk procedure was introduced to treat complex aortic aneurysms. Although this procedure significantly reduces mortality rate and operating time, it is still associated with complications such as endoleaks, spinal cord ischemia, renal failure and stroke. Some of these complications are consequences of a mismatch in the biomechanical behaviour of the stent-graft device and the aorta. Research on complex aneurysm repair tended to focus more on the surgical procedure than the stent-graft design. Current stent-graft devices are suitable for straight vessels. However, when used to treat aortic aneurysm with complex geometry, these devices are ineffective in restoring the normal biological and biomechanical function of the aorta. A stent-graft device with mechanical properties that are comparable with the aorta and aortic arch could possibly lead to fewer post-operative complications, thus, better outcome for patients with complex aneurysm conditions. This review highlights the influence stent-graft design has on the biomechanical properties of the aorta which in turn can contribute to complications of complex aneurysm repair. Design attributes critical for minimising postoperative biomechanical mismatch are also discussed.

  20. 髂骨块状骨植骨术修复恒牙列牙槽突裂的短期临床观察%Alveolar bulk bone grafting:A new surgical approach for alveolar cleft

    Institute of Scientific and Technical Information of China (English)

    唐燕驰; 杜一飞; 李盛; 袁华; 江宏兵; 万林忠

    2016-01-01

    目的:探讨牙槽突裂髂骨块状骨植骨术的临床可行性和可靠性。方法回顾分析15例行“牙槽突裂髂骨块状骨植骨术”的恒牙列牙槽突裂患者,随访6个月以上,收集临床资料,并进行影像学分析。结果所有患者均能定期复诊,术后13例患者创口愈合良好,2例因创口裂开导致植骨失败。影像学资料显示术后6个月植骨区间隙消失,骨桥形成,且植骨区无明显吸收。已有2例患者完成正畸及种植治疗。术后3个月所有患者均可正常行走,无明显行动障碍。结论牙槽突裂髂骨块状骨植骨术短期临床效果满意,移植骨吸收少,长期效果还需进一步研究。%Objective To investigate the feasibility and reliability of alveolar bulk bone grafting in clinical practice. Methods 15 cases of alveolar cleft treated with alveolar bulk bone grafting were analyzed retrospectively, and were followed up for over 6 months. Clinical materials were collected to carry out the radiological analysis. Results The clinical over 6-month follow⁃up of 15 cases was finished. 13 patients showed satisfactory recovery of wounds. 2 cases failed due to the dehiscence. The radiological materials showed that after 6 months the bone graft clearances disappeared, bone bridge formed and bone graft area had no obvious absorption.2 patients fin⁃ished the orthodontic treatment and dental implantation. All the patients could walk normally after 3 months and had no obvious action barriers. Conclusions Alveolar bulk bone grafting, a new surgical approach for alveolar cleft, has satisfactory short⁃term clinical effects, and the long⁃term clinical effects need more further studies.

  1. Complicações pós-operatórias das anastomoses colorretais Post-surgical complications of the colorectal anastomosis

    Directory of Open Access Journals (Sweden)

    Júlio César Monteiro Santos Jr

    2011-03-01

    are frequently severe. With morbid variable extensions, they extend the period of hospital, considerablyincrease the treatment cost, perpetuate functional sequels, and contribute to undesirable high rate mortality. The most frightening complication is the anastomosis dehiscence, whose definition, incidence, etiology, and factors of risks are targets of controversial opinions, causing difficulty to prepare preventive universal schemes. The most severe consequence of the anastomosis leakage is the generalized peritonitis, culminating in the sepsis that is the primary cause of surgically related mortality. The least and less frequent complications are the anastomotic hemorrhage, stenosis, and fistula. The anastomotic hemorrhage, fistula and stenosis most times, can be treated as a nonsurgical form. This manuscript was intended by to provide a general view of these complications, their causes, evolutions, diagnoses, and treatments.

  2. Retrograde ascending aortic dissection during or after thoracic aortic stent graft placement: insight from the European registry on endovascular aortic repair complications

    DEFF Research Database (Denmark)

    Eggebrecht, Holger; Thompson, Matt; Rousseau, Hervé

    2009-01-01

    BACKGROUND: Single-center reports have identified retrograde ascending aortic dissection (rAAD) as a potentially lethal complication of thoracic endovascular aortic repair (TEVAR). METHODS AND RESULTS: Between 1995 and 2008, 28 centers participating in the European Registry on Endovascular Aortic...

  3. Transabdominal sacrocolpopexy with autologous rectus fascia graft.

    Science.gov (United States)

    Abraham, Nitya; Quirouet, Adrienne; Goldman, Howard B

    2016-08-01

    Extrusion and infection are potential postoperative complications when using synthetic mesh for abdominal sacrocolpopexy. Long-term follow-up in the Colpopexy and Urinary Reduction Efforts (CARE) trial revealed an estimated 9.9 % risk of mesh extrusion. There are 26 reports of spondylodiscitis after sacrocolpopexy with synthetic mesh. These surgical risks may be decreased by using autologous fascia. To date, there have been no reports of extrusion or spondylodiscitis after using autologous fascia for sacrocolpopexy. This video demonstrates transabdominal sacrocolpopexy with an autologous rectus fascia graft. A 76-year-old woman with symptomatic stage 3 prolapse also had a history of diverticulitis and sigmoid abscess requiring sigmoid colectomy with end colostomy and incidental left ureteral transection with subsequent left nephrostomy tube placement. She presented for colostomy reversal, ureteral reimplantation, and prolapse repair. Given the need for concomitant colon and ureteral reconstruction, the risk of infection was potentially higher if synthetic mesh were used. The patient therefore underwent transabdominal sacrocolpopexy with autologous rectus fascia graft. At 4 months' follow-up the patient reported resolution of her symptoms and on examination she had no pelvic organ prolapse. Transabdominal sacrocolpopexy using autologous rectus fascia graft is a feasible option, especially in cases in which infection and synthetic mesh extrusion risks are potentially higher.

  4. Incidence, Predictors, and Postoperative Complications of Blood Transfusion in Thoracic and Lumbar Fusion Surgery: An Analysis of 13,695 Patients from the American College of Surgeons National Surgical Quality Improvement Program Database.

    Science.gov (United States)

    Aoude, Ahmed; Nooh, Anas; Fortin, Maryse; Aldebeyan, Sultan; Jarzem, Peter; Ouellet, Jean; Weber, Michael H

    2016-12-01

    Study Design Retrospective cohort study. Objective To identify predictive factors for blood transfusion and associated complications in lumbar and thoracic fusion surgeries. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients who underwent lumbar or thoracic fusion from 2010 to 2013. Multivariate analysis was used to determine predictive factors and postoperative complications associated with transfusion. Results Out of 13,695 patients, 13,170 had lumbar fusion and 525 had thoracic fusion. The prevalence of transfusion was 31.8% for thoracic and 17.0% for lumbar fusion. The multivariate analysis showed that age between 50 and 60, age between 61 and 70, age > 70, dyspnea, American Society of Anesthesiologists class 3, bleeding disease, multilevel surgery, extended surgical time, return to operation room, and higher preoperative blood urea nitrogen (BUN) were predictors of blood transfusion for lumbar fusion. Multilevel surgery, preoperative BUN, and extended surgical time were predictors of transfusion for thoracic fusion. Patients receiving transfusions who underwent lumbar fusion were more likely to develop wound infection, venous thromboembolism, pulmonary embolism, and myocardial infarction and had longer hospital stay. Patients receiving transfusions who underwent thoracic fusion were more likely to have extended hospital stay. Conclusion This study characterizes incidence, predictors, and postoperative complications associated with blood transfusion in thoracic and lumbar fusion. Pre- and postoperative planning for patients deemed to be at high risk of requiring blood transfusion might reduce postoperative complications in this population.

  5. Bone Grafting: Sourcing, Timing, Strategies, and Alternatives.

    Science.gov (United States)

    Egol, Kenneth A; Nauth, Aaron; Lee, Mark; Pape, Hans-Christoph; Watson, J Tracy; Borrelli, Joseph

    2015-12-01

    Acute fractures, nonunions, and nonunions with bone defects or osteomyelitis often need bone graft to facilitate union. There are several factors to consider when it is determined that a bone graft is needed. These factors include the source of the bone graft (autograft vs. allograft), proper timing for placement of the bone graft, strategies to avoid further complications (particularly in the setting of osteomyelitis), and with the development of a variety of bone graft substitutes, whether alternatives to autograft are available and appropriate for the task at hand. Autograft bone has commonly been referred to as the "gold standard" of bone grafts, against which the efficacy of other grafts has been measured. The best timing for when to place a bone graft or substitute is also somewhat controversial, particularly after an open fracture or a potentially contaminated bed. The treatment of infected nonunions, particularly those that require a graft to facilitate healing, can be quite challenging. Typically, the infection is completely eradicated before placement of a bone graft, but achieving a sterile bed and the timing of a bone graft require strategic thinking and planning. This review outlines the benefits of autografts, the most suitable sites for harvesting bone grafts, the timing of bone graft procedures, the potential risks and benefits of grafting in the face of infection, and the currently available bone graft extenders.

  6. A guided surgical approach and novel fixation method for arthroscopic Latarjet.

    Science.gov (United States)

    Boileau, Pascal; Gendre, Patrick; Baba, Mohammed; Thélu, Charles-Édouard; Baring, Toby; Gonzalez, Jean-François; Trojani, Christophe

    2016-01-01

    Most of the complications of the Latarjet procedure are related to the bone block positioning and use of screws. The purpose of this study was to evaluate if an arthroscopic Latarjet guiding system improves accuracy of bone block positioning and if suture button fixation could be an alternative to screw fixation in allowing bone block healing and avoiding complications. Seventy-six patients (mean age, 27 years) underwent an arthroscopic Latarjet procedure with a guided surgical approach and suture button fixation. Bone graft union and positioning accuracy were assessed by postoperative computed tomography imaging. Clinical examinations were performed at each visit. At a mean of 14 months (range, 6-24 months) postoperatively, 75 of 76 patients had a stable shoulder. No neurologic complications were observed; no patients have required further surgery. The coracoid graft was positioned strictly tangential to the glenoid surface in 96% of the cases and below the equator in 93%. The coracoid graft healed in 69 patients (91%). A guided surgical approach optimizes graft positioning accuracy. Suture button fixation can be an alternative to screw fixation, obtaining an excellent rate of bone union. Neurologic and hardware complications, classically reported with screw fixation, have not been observed with this guided technique and novel fixation method. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  7. [Chickenpox, burns and grafts].

    Science.gov (United States)

    Rojas Zegers, J; Fidel Avendaño, L

    1979-01-01

    An outbreak of chickenpox that occurred at the Burns Repair Surgery Unit, Department of Children's Surgery, Hospital R. del Río, between June and November, 1975, is reported. 27 cases of burned children were studied, including analysis of correlations of the stages and outcome of the disease (varicela), the trauma (burns) and the graft (repair surgery). As a result, the authors emphasize the following findings: 1. Burns and their repair are not aggravating factors for varicella. In a small number of cases the exanthema looked more confluent in the graft surgical areas and in the first degree burns healing spontaneously. 2. Usually there was an uneventful outcome of graft repair surgery on a varicella patient, either during the incubation period, the acme or the convalescence. 3. The fact that the outmost intensity of secondary viremia of varicella occurs before the onset of exanthemia, that is, during the late incubation period, is confirmed.

  8. [Use of the calvarium for bone grafting in cranio-maxillo-facial surgery].

    Science.gov (United States)

    Raulo, Y; Baruch, J

    1990-01-01

    Bone grafts's traditional donor sites in cranio-maxillo-facial surgery have been for many years and are still in some occasions the ribs, iliac crest and tibia. Bone grafts taken from the calvaria have been used by some surgeons in the past but its wide acceptance was only achieved after Paul Tessier had reported his own experience. The calvaria is composed of inner and outer tables that encloses a layer of cancellous bone called the diploe. A high degree of variability exist with respect to skull thickness. Nevertheless parietal bones is the preferable site for the harvesting of the graft. The embryonic origin of the cranium should be responsible for greater survival of the graft. Membranous bone would maintain its volume to a greater extent than endochondral bone when autografted in the cranio-facial region. However this remains controversial. Two techniques can be used for the harvesting of a calvarial bone grafts. A split thickness calvarial graft involves removal of the outer table while leaving the inner layer in place. Its main disadvantage is the relatively thinness of the bone transferred. A full thickness segment of skull involves the cranium cavity be entered. A half of the graft can be split along the diploe space and returned to fill the donor site. The other half is used for reconstruction. It is a more complicated procedure. Cranial grafts have been used in the following cases. Correction of contour defect of the forehead and zygomatic bones, orbital floor reconstruction, restoration of the nasal bridge, bone grafting of the maxilla and mandibule. The advantages are the following: the donor and recipient sites are in adjacent surgical fields, the donor site scar is hidden in the scalp, morbidity associated with removing the graft is almost inexistent. (ABSTRACT TRUNCATED AT 250 WORDS)

  9. Técnica modificada de injerto de tejido conectivo interposicionado y sobrepuesto en implantología y rehabilitación oral. Reporte de dos casos clínicos Description of two clinical cases showing surgical possibilities of correction or ridges reconstruction, using connective tissue graft and gingival sculping

    OpenAIRE

    ME Javer; CC Godoy; VC López

    2010-01-01

    Se describen dos reportes de casos clínicos mostrando posibilidades quirúrgicas de corrección o reconstrucción para rebordes usando tejido conectivo y posterior modelado gingival.Description of two clinical cases showing surgical possibilities of correction or ridges reconstruction, using connective tissue graft and gingival sculping.

  10. Técnica modificada de injerto de tejido conectivo interposicionado y sobrepuesto en implantología y rehabilitación oral. Reporte de dos casos clínicos Description of two clinical cases showing surgical possibilities of correction or ridges reconstruction, using connective tissue graft and gingival sculping

    OpenAIRE

    ME Javer; CC Godoy; VC López

    2010-01-01

    Se describen dos reportes de casos clínicos mostrando posibilidades quirúrgicas de corrección o reconstrucción para rebordes usando tejido conectivo y posterior modelado gingival.Description of two clinical cases showing surgical possibilities of correction or ridges reconstruction, using connective tissue graft and gingival sculping.

  11. Técnica modificada de injerto de tejido conectivo interposicionado y sobrepuesto en implantología y rehabilitación oral. Reporte de dos casos clínicos Description of two clinical cases showing surgical possibilities of correction or ridges reconstruction, using connective tissue graft and gingival sculping

    Directory of Open Access Journals (Sweden)

    ME Javer

    2010-04-01

    Full Text Available Se describen dos reportes de casos clínicos mostrando posibilidades quirúrgicas de corrección o reconstrucción para rebordes usando tejido conectivo y posterior modelado gingival.Description of two clinical cases showing surgical possibilities of correction or ridges reconstruction, using connective tissue graft and gingival sculping.

  12. Surgical Management of Cicatricial Ectropion in Pityriasis Rubra Pilaris.

    Science.gov (United States)

    Haridas, Anjana S; Sullivan, Timothy J

    2016-01-01

    Pityriasis rubra pilaris is an idiopathic, papulosquamous dermatological disease. It is clinically and histologically distinct from, but may resemble, psoriasis. Pityriasis rubra pilaris can be self-limiting but may also run a protracted, relapsing course. Medical treatment may involve topical emollients, systemic retinoids, methotrexate, and/or tumor necrosis factor antagonists. Ocular complications include cicatricial ectropion. The authors describe the surgical management of 3 patients with cicatricial ectropion secondary to pityriasis rubra pilaris. All patients had procedures involving skin grafts; 1 patient required multiple operations. The management principles are discussed, including the role and timing of surgery, within the context of emerging treatments for pityriasis rubra pilaris. Patients with pityriasis rubra pilaris and cicatricial ectropion should be closely managed by both ophthalmologist and dermatologist. The eyelid position may improve with conservative or surgical measures. If surgery is required, the limitations of skin grafting under these circumstances should be anticipated and patients counseled appropriately.

  13. Quantitation of mandibular ramus volume as a source of bone grafting.

    Science.gov (United States)

    Verdugo, Fernando; Simonian, Krikor; Smith McDonald, Roberto; Nowzari, Hessam

    2009-10-01

    When alveolar atrophy impairs dental implant placement, ridge augmentation using mandibular ramus graft may be considered. In live patients, however, an accurate calculation of the amount of bone that can be safely harvested from the ramus has not been reported. The use of a software program to perform these calculations can aid in preventing surgical complications. The aim of the present study was to intra-surgically quantify the volume of the ramus bone graft that can be safely harvested in live patients, and compare it to presurgical computerized tomographic calculations. The AutoCAD software program quantified ramus bone graft in 40 consecutive patients from computerized tomographies. Direct intra-surgical measurements were recorded thereafter and compared to software data (n = 10). In these 10 patients, the bone volume was also measured at the recipient sites 6 months post-sinus augmentation. The mandibular second and third molar areas provided the thickest cortical graft averaging 2.8 +/- 0.6 mm. The thinnest bone was immediately posterior to the third molar (1.9 +/- 0.3 mm). The volume of ramus bone graft measured by AutoCAD averaged 0.8 mL (standard deviation [SD] 0.2 mL, range: 0.4-1.2 mL). The volume of bone graft measured intra-surgically averaged 2.5 mL (SD 0.4 mL, range: 1.8-3.0 mL). The difference between the two measurement methods was significant (p AutoCAD software program did not overestimate the volume of bone that can be safely harvested from the mandibular ramus.

  14. Meta-analysis of complications following autologous iliac crest bone graft from donor site%自体髂骨植骨供骨区并发症的Meta分析**★

    Institute of Scientific and Technical Information of China (English)

    邹沙沙; 陈婷婷; 田汝辉; 常燕燕; 王亚楠; 李铮; 胡洪亮

    2013-01-01

      背景:目前,自体髂骨移植被广泛认为是治疗骨缺损的“金标准”;然而,髂嵴供骨区常出现并发症,限制了其在临床上的推广使用。目的:采用循证医学研究方法,对已发表相关文献进行汇总分析,总结自体髂骨植骨后供骨区并发症的种类及发生率。方法:检索 PubMed Medline、Ovid Medline、Cochrane Database、Embase Database 等数据库,检索时间范围:2002年1月至2011年12月,以“Iliac crest bone graft”或“autologous bone graft”或“bone graft donor site”或“complication”或“Morbidity”为检索词,共检索到174篇文献。根据检索条件及评价标准,最终筛选出30篇临床研究报道进行 Meta 分析,共计2476例患者。采用 SPSS 13.0和 R 软件及其 Meta 程序包对检索结果进行统计分析。结果与结论:自体髂骨植骨后供骨区主要并发症包括供骨区≥6个月长期疼痛(发生率=7.88%,95%可信区间4.76%-12.79%)、供骨区感染(发生率=4.26%,95%可信区间2.95%-6.12%)、血肿及血清肿(发生率=6.55%,95%可信区间4.90%-8.70%)、神经损伤(发生率=5.85%,95%可信区间3.46%-9.71%)、感觉障碍(发生率=10.1%,95%可信区间6.07%-16.23%)。可见髂骨取骨后并发症发生率较高,临床医师应予以重视。%BACKGROUND: Recently, autologous iliac crest bone graft is considered to be the “gold standard” therapeutic method for bone defects. However, there are some complications in iliae crest bone donor site, and the clinical application is limited. OBJECTIVE: To compiled analyze the published articles and evaluate the types of complications and morbidity fol owing autologous iliac crest bone graft by employing evidence-based medicine method. METHODS: A computer-based online search in PubMed Medline database, Ovid Medline database, Cochrane database and Embase database was performed using key words of “Iliac crest bone graft”,“autologous bone

  15. Preserved scleral patch graft for unexpected extreme scleral thinning found at the scleral buckling procedure: A case report

    Directory of Open Access Journals (Sweden)

    Spela Stunf

    2011-01-01

    Full Text Available Pre-existing scleral pathology is an important risk factor for globe rupture during scleral buckling procedures. We report here, the surgical management of an unexpected scleral pathology found at the scleral buckling procedure in a retinal detachment patient. A 77-year-old white female with retinal detachment underwent a scleral buckling procedure. The surgery was converted into a scleral graft procedure, as extreme scleral thinning was found intraoperatively. An alcohol-preserved donor sclera graft was used. The second surgery for definitive retinal alignment was performed two weeks later. The presented case of an unexpected scleral pathology in a retinal detachment patient was managed with a combination of scleral grafting and pars plana vitrectomy, without any major complications. The anatomical outcome was excellent and the scleral rupture was prevented; the visual outcome was satisfactory. A conversion of the scleral buckling procedure into a scleral graft procedure has proved to be safe and effective for unexpected scleral pathology.

  16. Clinical testing of Belarusian aortic stent graft system

    Directory of Open Access Journals (Sweden)

    А. П. Шкет

    2016-12-01

    Full Text Available Aim. The study looks at the results of clinical testing of the first Belarusian aortic stent graft system developed and manufactured by a team of specialists from RSPC "Cardiology", Minsk, Belarus, and Belarusian Technical University.Methods. The original system of aortic stent graft includes a delivery system and an aortic stent graft itself. It is used in surgical treatment of complicated and common aneurysms of the thoracic aorta, as well as in cases of concomitant thoracic aneurysms and heart pathology to be treated under cardiopulmonary bypass. Clinical testing of the stent graft was carried out according to the requirements of Ministry of Health of the Republic of Belarus on the basis of three different cardiac hospitals of the country. Results. All the three hospitals treated one patient each. The first patient underwent implantation of the stent graft into the descending thoracic aorta, with the thoracic aorta aneurysm isolated and the aortic valve replaced with bioprosthesis. The second patient underwent ascending aorta and aortic valve replacement with a conduit and implantation of aortic stent graft into the descending thoracic aorta. In the third patient the domestic aortic stent graft was implanted into the descending thoracic aorta with isolation of the thoracic aneurysm; aortic valve and ascending aorta were replaced with ‘MedEng' conduit and the aortic arch was also replaced, with the brachiocephalic arteries re-implanted in place. All the patients were followed-up for both early and long-term outcomes for more than 1 year and were examined by using CT angiography in the early postoperative period and after 1 year. Uncomplicated postoperative course was observed in all the patients. There were no complications in the long-term follow-up as well. CT angiography data confirmed good positioning of the stent graft and good isolation of the aneurysm lumen. Preoperative and postoperative СТ data of one patient are presented in the

  17. Collagen hydrogels strengthened by biodegradable meshes are a basis for dermo-epidermal skin grafts intended to reconstitute human skin in a one-step surgical intervention.

    Science.gov (United States)

    Hartmann-Fritsch, Fabienne; Biedermann, Thomas; Braziulis, Erik; Luginbühl, Joachim; Pontiggia, Luca; Böttcher-Haberzeth, Sophie; van Kuppevelt, Toin H; Faraj, Kaeuis A; Schiestl, Clemens; Meuli, Martin; Reichmann, Ernst

    2016-01-01

    Extensive full-thickness skin loss, associated with deep burns or other traumata, represents a major clinical problem that is far from being solved. A promising approach to treat large skin defects is the use of tissue-engineered full-thickness skin analogues with nearly normal anatomy and function. In addition to excellent biological properties, such skin substitutes should exhibit optimal structural and mechanical features. This study aimed to test novel dermo-epidermal skin substitutes based on collagen type I hydrogels, physically strengthened by two types of polymeric net-like meshes. One mesh has already been used in clinical trials for treating inguinal hernia; the second one is new but consists of a FDA-approved polymer. Both meshes were integrated into collagen type I hydrogels and dermo-epidermal skin substitutes were generated. Skin substitutes were transplanted onto immuno-incompetent rats and analyzed after distinct time periods. The skin substitutes homogeneously developed into a well-stratified epidermis over the entire surface of the grafts. The epidermis deposited a continuous basement membrane and dermo-epidermal junction, displayed a well-defined basal cell layer, about 10 suprabasal strata and a stratum corneum. Additionally, the dermal component of the grafts was well vascularized. Copyright © 2012 John Wiley & Sons, Ltd.

  18. Penile prosthesis implant with bi-triangular excision and graft for surgical therapy of Peyronie’s disease: A case report

    Directory of Open Access Journals (Sweden)

    Alexandre de Freitas Miranda

    2016-01-01

    Full Text Available We present a case of a 65-year-old man, who presented with moderate erectile dysfunction and a dorsal penile deviation of 60° caused by Peyronie’s disease. The patient underwent bi-triangularshaped plaque excision, followed by grafting and implantation of inflatable penile prosthesis. Complete penile straightening, without mechanical or geometric abnormalities, was achieved using bi-triangular excision and grafting. Postoperatively, the patient reported high satisfaction with the results and could perform sexual intercourse naturally. This novel technique corrects any degree of penile curvature, permits malleable and semi-rigid penile prosthesis implantation, avoids penile length loss, and eliminates additional incisions. To our knowledge, this case is the first in the literature in which the bi-triangular technique was successfully used for penile prosthesis implantation secondary to Peyronie’s disease. This new technique appears to be a good solution to correct penile curvature during penile prosthesis implantation for the treatment of Peyronie’s disease associated with erectile dysfunction.

  19. [Rehabilitation of facial paralysis using autogenous fascia lata graft. Stable results over time].

    Science.gov (United States)

    Graillon, N; Colson, T; Bardot, J

    2015-10-01

    Dynamic facial reanimation with free muscle or nerve transfers represents the mainstay of facial paralysis treatments particularly for perioral area and smile. These techniques are not always feasible, in such cases we perform a perioral suspension with fascia lata graft. However many teams blame this technique for short-term recurrence of the deformity. We describe in this paper details of our surgical technique, to improve the aesthetic result and stability over time, and the results and complications encountered. Fascia lata graft was sutured beyond the midline to the contralateral healthy lips, after tunneling through upper and lower orbicularis oris. Fascia lata graft was then tunneled through the buccal fat pad, then under the zygomatic arch to the temporal region, where the temporal aponeurosis was incised to make way for the fascia lata graft, which was fixed to the outer face of the temporal aponeurosis, applying slight overcorrection to the oral commissure. From 2003 to 2012, we performed this procedure on 8 patients. Results showed an immediate aesthetic improvement, stable over time. Perioral suspension with fascia lata graft is a surgical alternative when dynamic reanimation is not feasible.

  20. Early Non-Immunological Post Transplant complications: A Single Center Experience

    Directory of Open Access Journals (Sweden)

    Jabur Wael

    2008-01-01

    Full Text Available To assess non-immunological complications affecting renal transplant patients in the first six months after transplantation in Al-Karama hospital, Baghdad, Iraq, we studied 68 patients (49 males, 19 females attending the clinic during the year 2006. Forty six (67% patients received kidneys from related and 22 (33% from unrelated donors. The patients revealed the following complications: post transplant hypertension in 28 (41% patient, infection (mostly bacterial in 27 (37%, new onset diabetes in 11 (16%, calcineurin inhibitor toxicity in 10 (14%, anemia in 8 (12%, surgical complications in 7 (10%, slow graft recovery in 4 (6%, cardiovascular complications in 3 (4%, and Kaposi sarcoma in 2 (2.9%.Transient hyperglycemia, hypertension, infection and diabetes mel-litus were the commonest early complications of renal transplantation. The incidence of complications is comparable to the average reported in the literature, especially in this region of the world.

  1. Retrospective review of grafting techniques utilized in conjunction with endosseous implant placement.

    Science.gov (United States)

    Meraw, S J; Eckert, S E; Yacyshyn, C E; Wollan, P C

    1999-01-01

    Bone resorptive patterns may prevent the ideal placement of endosseous implants. Numerous techniques have been described to create a more favorable surgical site for implant placement. This retrospective review was conducted to determine the frequency of need for implant site preparation in an outpatient clinical setting. In addition, different techniques of surgical site preparation were evaluated to determine their frequency of use and surgical outcome. A history review was conducted of all consecutively treated partially edentulous patients between January 1993 and December 1997. This review evaluated the number of implants placed, the age and gender of patient, the type of graft used, and the status of the implant. In all, 542 patients were seen in this time interval, with a total of 1,313 implants placed. Implant site preparation was needed in 4.4% of the patients, with the requirement for grafts occurring more frequently in the maxilla. Implant site preparation is a relatively infrequent requirement in the general population. Grafts are required more frequently in the maxilla than in the mandible. Complications following grafting were relatively infrequent and were not severe.

  2. Grafting the alar rim: application as anatomical graft.

    Science.gov (United States)

    Gruber, Ronald P; Fox, Paige; Peled, Anne; Belek, Kyle A

    2014-12-01

    Alar rim contour and alar rim grafts have become essential components of rhinoplasty. Ideally, grafts of the nose should be anatomical in shape. So doing might make grafts of the alar rim more robust. The authors considered doing that by applying the graft as a continuous extension of the lateral crus. Twelve patients (two men and 10 women) constituted the study group (seven primary and five secondary cases). Of those, there were five concave rims, two concave rims with rim retraction, two boxy tips, and three cephalically oriented lateral crura. Surgical technique included the following: (1) an open approach was used; (2) a marginal incision that ignored the caudal margin of the lateral crus (the incision went straight posteriorly to a point 5 to 6 mm from the rim margin) was used; (3) a triangular graft was made to cover the exposed vestibular skin; (4) it was secured end to end to the caudal border of the lateral crus; and (5) the poster end was allowed to sit in a small subcutaneous pocket. Follow-up was 11 to 19 months. All 12 patients exhibited good rims as judged by a blinded panel. Rim retraction was not fully corrected in one patient, but no further treatment was required. One patient did require a secondary small rim graft for residual rim concavity. The concept of grafting the alar rim is strongly supported by the authors' results. The modifications the authors applied by designing the graft to be anatomical in shape has been a technical help.

  3. Surgical Treatment of Winged Scapula

    National Research Council Canada - National Science Library

    Galano, Gregory J; Bigliani, Louis U; Ahmad, Christopher S; Levine, William N

    2008-01-01

    .... Although nonoperative treatment is successful in some patients, failures have led to the evolution of surgical techniques involving various combinations of fascial graft and/or transfer of adjacent muscles...

  4. Aneurysmal bone cyst of the mandible managed by conservative surgical therapy with preoperative embolization

    Energy Technology Data Exchange (ETDEWEB)

    An, Seo Young [School of Dentistry, Kyungpook National University, Daegu (Korea, Republic of)

    2012-03-15

    A 9-year-old girl visited our hospital, complaining of a rapid-growing and rigid swelling on the left posterior mandibular area. Panoramic radiograph showed a moderately defined multilocular honeycomb appearance involving the left mandibular body. CT scan revealed an expansile, multilocular osteolytic lesion and multiple fluid levels within cystic spaces. Bone scan demonstrated increased radiotracer uptake and angiography showed a highly vascularized lesion. The lesion was suspected as aneurysmal bone cyst (ABC) and preoperative embolization was performed, which minimize the extent of operation and the surgical complication. The lesion was treated by surgical curettage and lateral decortication with repositioning. No additional treatment such as a surgical reconstruction or bone graft was needed. Early diagnosis of ABC is very important and appropriate treatment should be performed considering several factors such as age, surgical complication, and possibility of recurrence.

  5. Corporoplasty using bovine pericardium grafts in complex penile prosthesis implantation surgery

    Directory of Open Access Journals (Sweden)

    Eduardo J. A. Lopes

    2009-02-01

    Full Text Available Purpose: This paper is the first, to our knowledge, to propose the use of a bovine pericardium graft in corporoplasty for penile prosthesis implantation. The advantages of bovine pericardium graft have been demonstrated by its use in cardiac surgery, including low cost, biocompatibility, impermeability, resistance to dilatation, flexibility, low likelihood of retraction, absence of antigenic reaction and natural absorption of the tissue. In this paper, we propose the use of this heterologous material graft in corporoplasty for penile prosthesis implantation. Materials and Methods: Five patients with a history of erosion, infection and fibrosis, mean time of follow-up 32 months (range 9-48 months. Bovine pericardium was used to cover large areas of implanted penile prostheses when use of the tunica albuginea was unfeasible. Results: The surgical procedure resulted in no complications in all patients. Conclusions: Bovine pericardium may substitute synthetic and autologous material with the additional advantages of lower cost and greater availability.

  6. [Anesthesic management of thoracic aortic stent graft deployment using rapid ventricular pacing].

    Science.gov (United States)

    Yamagishi, Akio; Kunisawa, Takayuki; Katsumi, Norifumi; Nagashima, Michio; Takahata, Osamu; Iwasaki, Hiroshi

    2008-08-01

    Controlled hypotension is useful for accurate deployment of an aortic endograft. We describe the use of rapid ventricular pacing during thoracic aortic stent graft deployment. Anesthesia was induced and maintained with intravenous propofol and remifentanil. A pulmonary artery catheter with pacing function was introduced, and rapid ventricular pacing was started before stent graft deployment. Pacing mode was VVI and pacing rate was 120-160 beats min(-1). Aortic pressure and flow decreased immediately and were maintained at low levels during surgical manipulation. After stopping rapid ventricular pacing, heart rate and aortic pressure recovered immediately. Rapid ventricular pacing was performed 4 times, and there were no complications such as entailed arrhythmia. With rapid ventricular pacing maneuver, which is thought to cause a rapid change in cardiac output, continuous cardiac output measurement can be a useful monitor. This procedure has advantages over pharmacologic or other methods of aortic pressure reduction. Rapid ventricular pacing is safe and effective during stent graft positioning and deployment.

  7. Tibial tunnel and pretibial cysts following ACL graft reconstruction: MR imaging diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Ghazikhanian, Varand [Brigham and Women' s Hospital, Musculoskeletal Imaging and Intervention, Department of Radiology, Boston, MA (United States); Beltran, Javier [Maimonides Medical Center, Brooklyn, NY (United States); Nikac, Violeta [Maimonides Medical Center, Department of Radiology, Brooklyn, NY (United States); Bencardino, Jenny T. [NYU Hospital for Joint Diseases, New York, NY (United States); Feldman, Marina

    2012-11-15

    Tunnel cyst formation is a rare complication after anterior cruciate ligament reconstruction, usually occurring 1-5 years post-operatively, which may occasionally be symptomatic. There are multiple proposed theories regarding the etiology of tunnel cysts. Theories include necrosis, foreign-body reaction, lack of complete graft osteo-integration, and intravasation of articular fluid. It is important to know if the tunnel cysts are communicating or not communicating with the joint, as surgical management may be different. Imaging characteristics on magnetic resonance images (MRI) include tibial tunnel widening, multilocular or unilocular cyst formation in the graft or tibial tunnel, with possible extension into the pretibial space, intercondylar notch, and/or popliteal fossa. The MR imaging differential diagnosis of tibial tunnel cysts includes infection, foreign-body granuloma, or tibial screw extrusion. Importantly, to the best of our knowledge, graft failure or instability has not been reported in association with tibial tunnel cysts. (orig.)

  8. Procedure, applications, and outcomes of autologous fat grafting.

    Science.gov (United States)

    Simonacci, Francesco; Bertozzi, Nicolò; Grieco, Michele Pio; Grignaffini, Eugenio; Raposio, Edoardo

    2017-08-01

    To systematically review the procedure, applications, and outcomes of autologous fat grafting, a promising technique with various clinical applications. Literature review of publications concerning autologous fat grafting. Since its introduction, lipofilling has become increasingly popular; however, its results are variable and unpredictable. Several modifications have been made to the procedures of fat harvesting, processing, and injecting. Surgical excision and low negative-pressure aspiration with large-bore cannulas minimize adipocyte damage during fat harvesting. The "wet" method of fat harvesting involves fluid injection at the donor site and facilitates lipoaspiration while minimizing pain and ecchymosis. For fat processing, centrifugation at a low speed is preferable to high-speed centrifugation, gravity separation or filtration. Fat injection at the recipient site should be performed using small-gauge cannulas in a fanning out pattern over multiple sessions, rather than a single session. Fat grafts exhibit not only dermal filler properties but also regenerative potential owing to the presence of stem cells in fat tissue. Thus, the clinical applications of autologous fat grafting include correction of secondary contour defects after breast reconstruction, release of painful scar contractures, and treatment of burn scars and radiodermatitis. Lipofilling is also used in aesthetic surgery, such as facial and hand rejuvenation, augmentation rhinoplasty, and breast and gluteal augmentation. The complications of lipofilling are minimal and include bruising, swelling, pain, infection, necrosis, and calcification. Lipofilling is a low-risk procedure that can be used to correct soft-tissue defects in the face, trunk, and extremities, with minimal discomfort for patients.

  9. Endovascular repair of early rupture of Dacron aortic graft--two case reports.

    LENUS (Irish Health Repository)

    Sultan, Sherif

    2005-01-01

    Complications after open aortic surgery pose a challenge both to the vascular surgeon and the patient because of aging population, widespread use of cardiac revascularization, and improved survival after aortic surgery. The perioperative mortality rate for redo elective aortic surgery ranges from 5% to 29% and increases to 70-100% in emergency situation. Endovascular treatment of the postaortic open surgery (PAOS) patient has fewer complications and a lower mortality rate in comparison with redo open surgical repair. Two cases of ruptured abdominal aortic aneurysm (AAA) were managed with the conventional open surgical repair. Subsequently, spiral contrast computer tomography scans showed reperfusion of the AAA sac remnant mimicking a type III endoleak. These graft-related complications presented as vascular emergencies, and in both cases endovascular aneurysm repair (EVAR) procedure was performed successfully by aortouniiliac (AUI) stent graft and femorofemoral crossover bypass. These 2 patients add further merit to the cases reported in the English literature. This highlights the crucial importance of endovascular grafts in the management of such complex vascular problems.

  10. Graft nephrectomy: The SGPGI experience

    Directory of Open Access Journals (Sweden)

    Nand Kishore Arvind

    2002-01-01

    Full Text Available Background: Graft nephrectomy is often considered a hazardous procedure with high morbidity and occasional mortality, and this may pose a technical challenge. The aim of this study was to evaluate the indications, etiology and complications following graft nephrectomy. Materials and Methods: From 1988 to 2001, among total of 1,019 live related renal transplants carried at our center, 46 underwent graft nephrectomy. Patients were divided into 2 groups depending on timing of graft re-moval. The early group included 27 patients (within 2 months of transplantation while in late group (graft re-moval after 2 months of transplantation there were 19 patients. The 2 groups were compared in terms of indica-tion, etiology and complications. Results: In early group the indications for graft removal were acute rejection, thrombosis/infarction and hyper-acute rejection, while in late group the indications were pain, hematuria, fever, hypertension and infection along with chronic failure. Overall, the external iliac artery in-jury occurred in I and 4 patients in early and late group respectively. Major blood loss occurred in I and 6 pa-tients in early and late graft removal respectively. There were 2 deaths in early group due to ftdminant pneumoni-tis that progressed to sepsis and disseminated intravascu-lar coagulation. There were 9 major wound infections all in early group except in 2 patients of late group. Respira-tory infections occurred in 14 patients in early group and 1 in late group. In early group patients had CNS compli-cations in form of seizures, clinical depression and delusional psychosis in 12 patients. Conclusions: Our experience highlights the risk in-volved in graft nephrectomies. Severe acute rejection and thrombosis lead to early graft nephrectomies. Pain, hematuria, infection and hypertension in setting of chronic rejection are predominant causes for the delayed graft ne- phrectomies. Early graft nephrectomy, though technically easy, is

  11. Giant saphenous vein graft pseudoaneurysm to right posterior descending artery presenting with superior vena cava syndrome

    Institute of Scientific and Technical Information of China (English)

    Andres; Vargas-Estrada; Dianna; Edwards; Mohammad; Bashir; James; Rossen; Firas; Zahr

    2015-01-01

    Saphenous vein grafts(SVG) pseudoaneurysms,especially giant ones,are rare and occur as a late complication of coronary artery bypass grafting. This condition affects both genders and typically occurs within the sixth decade of life. The clinical presentation ranges from an asymptomatic incidental finding on imaging studies to new onset angina,dyspnea,myocardial infarction or symptoms related to compression of neighboring structures. An 82-year-old woman presented with acute onset back pain,dyspnea and was noted to have significantly engorged neck veins. In the emergency department,a chest computed tomographic angiogram with intravenous contrast revealed a ruptured giant bilobed SVG pseudoaneurysm to the right posterior descending artery(RPDA). This imaging modality also demonstrated compression of the superior vena cava(SVC) by the SVG pseudoaneurysm. Coronary angiogram with bypass study was performed to establish the patency of this graft. Endovascular coiling and embolization of the SVG to RPDA was initially considered but disfavored after the coronary angiogram revealed preserved flow from the graft to this arterial branch. After reviewing the angiogram films,a surgical strategy was favored over a percutaneous intervention with a Nitinol self-expanding stent since the latter would have not addressed the superior vena cava compression caused by the giant pseudoaneurysm. Intraoperative transesophageal echocardiogram demonstrated SVCcompression by the giant pseudoaneurysm cranial lobe. Our patient underwent surgical ligation and excision of the giant pseudoaneurysm and the RPDA was regrafted successfully. In summary,saphenous vein grafts pseudoaneurysms can be life-threatening and its therapy should be guided based on the presence of mechanical complications,the patency of the affected vein graft and the involved myocardial territory viability.

  12. Surgical therapy by sandwich transplantation using a dermal collagen-elastin matrix and full thickness split grafts and gait rehabilitation with individualized orthesis

    Directory of Open Access Journals (Sweden)

    Uwe Wollina

    2012-01-01

    Full Text Available Painful callosities of the feet (PCOF are a rare complaint in children with severe impairment of mobility and quality of life. There is no medical treatment available.We investigated the usefulness of a recently developed combined transplant technique-the sandwich transplantation with dermal collagen-elastin template in this rare condition. A 14-year-old boy suffered from PCOF for several years without any improvement by topical therapy, dermabrasion, and oral retinoids. He was unable to walk normally and suffered from severe pain. We performed a complete deep excision of the hyperkeratotic plantar tissue in general anaesthesia in combination with sandwich transplantation in the same setting. Dry sheets of collagen-elastin matrix (1 mm thickness were placed on the soft tissue defects and covered by full-thickness mesh graft transplants from the upper leg. An individualized orthosis was produced for gait rehabilitation. Two weeks after surgery the gait-related pain was reduced remarkably. Using the orthosis, the boy was able to walk pain-free even on staircase. Surgery of PCOF with sandwich transplantation and gait rehabilitation appears to be a promising strategy for this rare condition.

  13. Difference in the Surgical Outcome of Unilateral Cleft Lip and Palate Patients with and without Pre-Alveolar Bone Graft Orthodontic Treatment

    Science.gov (United States)

    Chang, Chun-Shin; Wallace, Christopher Glenn; Hsiao, Yen-Chang; Chiu, Yu-Ting; Pai, Betty Chien-Jung; Chen, I.-Ju; Liao, Yu-Fang; Liou, Eric Jen-Wein; Chen, Philip Kuo-Ting; Chen, Jyh-Ping; Noordhoff, M. Samuel

    2016-04-01

    Presurgical orthodontic treatment before secondary alveolar bone grafting (SABG) is widely performed for cleft lip/palate patients. However, no randomized controlled trial has been published comparing SABG outcomes in patients with, and without, presurgical orthodontic treatment. This randomized, prospective, single-blinded trial was conducted between January 2012 and April 2015 to compare ABG volumes 6 months postoperatively between patients with and without presurgical orthodontic treatment. Twenty-four patients were enrolled and randomized and 22 patients completed follow-up. Patients who had presurgical orthodontics before SABG had significantly improved inclination (p < 0.001) and rotation (p < 0.001) of the central incisor adjacent to the defect, significantly improved ABG fill volume (0.81 ± 0.26 cm3 at 6 months compared to 0.59 ± 0.22 cm3 p < 0.05) and less residual alveolar bone defect (0.31 ± 0.08 cm3 at 6 months compared to s 0.55 ± 0.14 cm3 p < 0.001) compared to patients who did not have presurgical orthodontic treatment. In conclusion, orthodontic treatment combined with SABG results in superior bone volume when compared with conventional SABG alone.

  14. Experience with surgical salvage in pulmonary tuberculosis: application to general thoracic surgery.

    Science.gov (United States)

    Delarue, N C; Pearson, F G; Henderson, R D; Cooper, J D; Nelems, J M; Gale, G

    1975-11-01

    The diminishing incidence of pulmonary tuberculosis and the increasing effectiveness of drug therapy have resulted in an almost complete disappearance of surgical problems in the management of patients with this disease. However, the lessons learned from the management of such problems should not be forgotten, for they are equally applicable to the management of disabling and life-endangering problems in general thoracic surgical practice. "Salvage" situations develop when therapeutic requirements for control of disease are combined with factors affecting a patient's health so as to increase the surgical risk beyond the range usually considered acceptable. Attempts to salvage patients are indicated when treatment has failed to arrest disease, when life expectancy is threatened, or when return to normal activity is imperiled. Risk may be increased because of age, inadequate cardiopulmonary reserve, or chronic toxemia; in tuberculosis, risk may be increased because of positive sputum culture or resistance of organisms. Experience with 146 tuberculous patients has provided a basis for evaluation of the indications for resection, prophylactic and therapeutic thoracoplasty, and closure of bronchopleural fistulas in general thoracic surgical salvage. Both infection in residual spaces and bronchopleural fistulas are serious complications that can be controlled by thoracoplasty and pedicled muscle grafts. Prophylactic use of osteoplastic thoracoplasty and intercostal muscle grafts warrant more serious consideration. In established complications a "tailored" thoracoplasty can also be combined with an intercostal muscle graft.

  15. Lymphocele – urological complication after renal transplantation

    Directory of Open Access Journals (Sweden)

    Wojciech Krajewski

    2013-04-01

    Full Text Available Renal transplantation is the best renal replacement treatment. It provides longer survival and a better quality of life. The outcome of renal transplantation is influenced by the occurrence of various complications, including urological. One of the most frequently occurring complicationsis lymphocele. Most cases of lymphocele develop during a period of several weeks after the procedure of transplantation. However, there are some literature reports concerning lymphocele diagnosis in the later period, even after several years. Most cases of lymphocele are asymptomatic and are diagnosed accidentally. Nevertheless, a large lymphocele may press the kidney, ureter, urinary bladder or neighbouring blood vessels, causing deterioration of renal function, leg oedema and thrombosis of iliac vessels. Among other complications there are infections. The cause of lymphocele is collection of the lymph drained from damaged lymph vessels surrounding iliac blood vessels and/or lymph vessels of the graft. Important factors predisposing to lymphocele are immunosuppressive treatment, including mTOR inhibitors, mycophenolic acid derivatives and high doses of glucosteroids. Factors favouring occurrence of lymphocele comprise obesity, diabetes, elderly age of recipient, long time of warm ischaemia, acute rejection episodes and delayed graft function. The authors describe presently available treatment methods including aspiration and percutaneous drainage, with or without sclerotisation, drainage using the Tenckhoff catheter and laparoscopic or open fenestration. At present, laparoscopic fenestration is considered to be the most efficient and the safest method. However, there are clinical cases where open surgical treatment is necessary.

  16. Unusual complication of percutaneous nephrostomy in a renal transplant recipient

    Directory of Open Access Journals (Sweden)

    Martina Paetzel

    2010-11-01

    Full Text Available Context: Ureteral obstruction, resulting in impaired graft function, is a well-known problem following renal transplantation. Management of ureteral complications includes percutaneous nephrostomy, which is considered to be a safe and effective measure. Case Report: Here, we demonstrate a case of a 35-year old renal allograft recipient with primary graft function but stagnating serum creatinine following extraction of the double-J catheter. Ureteral stenosis was suspected by ultrasound imaging and magnetic resonance tomography, and urinary flow was preserved with a percutaneous nephrostomy. However, early displacement of the percutaneous nephrostomy catheter resulted in distinct clinical discomfort. CT imaging suggested an intra-abdominal position of the catheter’s tip, requiring immediate surgical action. Conclusion: The present case demonstrates that performing PCN following renal transplantation may have unexpected risks.

  17. Surgical technique for allogeneic uterus transplantation in macaques

    Science.gov (United States)

    Obara, Hideaki; Kisu, Iori; Kato, Yojiro; Yamada, Yohei; Matsubara