Statistics on operations at the Department of Urology, School of Medicine, Tokai University (January, 1982 to March, 1984)

A total of 794 operations were performed at the Department of Urology, Tokai University Hospital between January, 1982 and March, 1984, including 5 operations on the adrenal gland, 64 operations on the kidney, 48 operations on the ureter, 93 operations on the urinary bladder, 124 operations on the prostate, 25 operations on the urethra, 124 operations on the penis, 190 operations on the scrotum and 19 operations on other organs.     

Treatment of large echinococcal cysts of the lungs

An analysis of 177 operations for pulmonary echinococcosis performed in 160 patients has been made (17 patient were operated twice because of bilateral localization of the cysts). For patients with large and giant cysts the author prefers organ-preserving operations, the A. A. Vishnevski method being considered the best. There were 115 such operations. Among other organ-preserving operations there were: 12 operations by the method of Bobrov - Spasokukotski , 16 operations of different variants of capitonage , 15 combinations of organ-preserving operations, 5 one-step operations on the lungs and liver and only 10 operations of various resections of lungs. In the rest 4 patients other operations were performed. Postoperative lethality was 2,2%. A stable clinical effect with a complete recovery was noted in 87 of the patients examined in a remote postoperative period. Two patients had recurrences of the disease.     

Reoperations in primary rectal cancer]

The authors studied the results of repeated radical operations performed in 73 patients who had been subjected earlier to exploratory and palliative operations. During repeated interventions radical operations were conducted on 54 (74%) patients which were of a combined character in 11 (20.4%) of them. Localized-radical palliative resections and extirpations in the presence of remote metastases were performed on 3 (4.1%) patients. Palliative operations were carried out on 16 (21.9%) patients. Postoperative mortality was 6.8%. The data provides evidence that the performance of repeated operations is expedient and justified because they make it possible to raise the resectability index among patients with rectal carcinoma.     

Simultaneous operations--the nomenclature and the definition]

304 operations with simultaneous herniotomy were performed on 282 patients for different associated diseases. Most frequent combinations of the diseases coexistent with ventral hernias, specific features and immediate results of the operations are described. The opinions of different scientists on the name, definition and essence of simultaneous operations are analyzed. The authors propose their personal definition of the simultaneous operations.     

Rural hospitals and volume standards in surgery

BACKGROUND: We sought to understand the potential impact of volume-based referral policy on rural hospitals by estimating the proportion of low-volume operations occurring in rural versus urban hospitals. METHODS: We performed an observational study using the national Medicare population who underwent one of 12 high-risk operations from 1999-2001. Low-volume hospitals were considered those in the 2 lowest quintiles for each procedure. Hospitals were assigned to 1 of 3 types of geographic locations on the basis of Rural-Urban Commuting Area Codes: urban areas, rural large towns, or rural small towns. For each of the 12 operations, we estimated the proportion of patients undergoing operation in low-volume hospitals within each type of geographic area. RESULTS: For all 12 operations, the majority of surgical cases were performed in urban areas (ranging from a low of 76% for colectomy to 96% for heart valve operations). Evaluation of only operations performed in low-volume hospitals showed that the majority of surgical cases were still located in urban areas (varying from a low of 55% for colectomy to a high of 94% for heart valve operations). Operations with a stronger effect of volume on outcome (eg, pancreatic and esophageal resection) were more concentrated in urban areas, compared with operations with a weaker effect (eg, colectomy). CONCLUSIONS: Most low-volume operations take place in urban hospitals. Efforts to direct patients to high-volume hospitals can exempt rural hospitals and still realize most of the potential benefits.     

Cause of failure in the surgery of renovascular hypertension]

The experience of 193 operations on 172 patients with affected renal arteries is described. The causes of failure in the surgery are analyzed. Organ-preserving operations with reconstruction of 189 renal arteries were performed on 136 patients. Primary nephrectomies were performed on 36 patients. During recent 3 years nephrectomies were made in 8% of 70 operations. Postoperative mortality was about 7%, mainly due to atherosclerotic patients. The main causes of uneffective operations are as follows: technical errors in revascularization of the kidney, pyelonephritis and neuroangiosclerosis non-diagnosed preoperatively, progressing lesions of the vessels in atherosclerosis and panarteritis.     

Surgical strategy for combined esophagogastroduodenal bleedings in liver cirrhosis patients with portal hypertension

Under analysis were results of treatment of 83 patients with bleedings resulting from portal hypertension against the background of liver cirrhosis combined with ulcer disease of the stomach and/or duodenum. In 49.4% of the patients the sources of bleedings were varicose veins of the esophagus and stomach, in 37.3%--ulcers, in 13%--a combination of ulcer and erosion of the varicose veins. Emergency operations were made on 33.8% of patients, urgent--on 22.1%, planned operations on 45.1%. Recurrences were noted in 15.4% of urgent and emergency operations, lethality--10.3%. After planned operations lethality was 0%.     

Reconstructive surgery for acute disease of the arterial circulation in the extremities

On 40 operated patients 41 operations were performed for acute arterial obstruction and arterial lesions. The reconstructive operations were most frequently performed on the femoral-popliteal zone (23 operations). Positive results were obtained in 36 cases. Amputations were performed in 2 patients. 3 patients died.     

Statistics on operations in the Department of Urology, Kobe University School of Medicine (January, 1976 to December, 1980)

Statistical observations on operations performed in our department from 1976 to 1980 were reviewed, especially in comparison with the statistics for the preceding 10 years. Operations on the kidney were the most frequent, as they were in the preceding 10 years, but operations on the bladder have increased remarkably, in 1980 accounting for more than those on the kidney. During this period, operations for benign diseases such as lithotomy of the upper urinary tract and prostatectomy tended to decrease. On the other hand, operations for malignant diseases of kidney, bladder and scrotal contents steadily increased. Transurethral operations are still increasing, especially for bladder tumors. It has been established that bladder tumors should be treated by either TUR-BT or total cystectomy and not by partial cystectomy. As to urinary diversion, ileal conduit was the main procedure used during this 5-year period instead of cutaneous ureterostomy.     

Operations during a 5-year period (1982-1986) at our department

The statistics of urological operations performed at our department between Jan., 1, 1982 and Dec., 31, 1986 were reviewed. During the 5 year period, 2331 patients were admitted to our hospital and 2192 urological operations were performed on 1834 patients. These statistics were compared with earlier statistics for two periods (1972-1976 and 1977-1981) and the recent trend of urological operations was investigated. With regard to operated organ, operations on the kidney were the most frequent followed by those on the urinary bladder. Operations on the ureter decreased during the recent 5 year period and they were the fourth most frequent following those on the scrotum, scrotal contents and penis. Operations on the adrenal gland, retroperitoneal space and parathyroid gland have gradually increased. As in the former report, transurethral resection of bladder tumor (TUR-Bt) was the most frequent and nephrectomy, TUR of prostate (TUR-P) and renal allotransplantation have followed. TUR-Bt and TUR-P have increased more and more and due to the introduction of percutaneous nephrolithotripsy and transureteral lithotripsy, open surgery for urolithiasis has greatly decreased. Endourological operations will still be on the increase.     

Adequate Vascular Training Opportunities can be Provided Without Compromising Patient Care

OBJECTIVES: to review the results of index operations in vascular surgery and to evaluate the impact of a specialist vascular training programme on patient outcome. METHODS: we undertook a 5-year (January 1995-December 1999) review of the weekly-collected mortality and morbidity data. The total number, 30-day mortality and stroke rate of all index operations i.e. AAA repairs (ruptured and elective), carotid operations and infra-inguinal bypasses (above and below knee, elective and emergency) was recorded. The number of operations performed by trainees under supervision was recorded. RESULTS: in the 5-year period 991 index operation were done of which 738 (74%) were done by trainees. Operations done by trainees were supervised by a consultant in 82% of cases with no significant effect on death or stroke rates. Overall vascular trainees performed 75% of the index operations of which 82% were supervised. CONCLUSIONS: trainees under supervision performed three out of four index operations. The mortality and morbidity of index operations in our unit compared well with accepted best mortality and morbidity figures. Our unit provides good training opportunities for vascular trainees whilst maintaining satisfactory standards of patient care.     

One-stage combined operations on the organs of the abdominal cavity in compression stenosis of the celiac trunk

The authors made an analysis of 511 operations for chronic abdominal ischemia caused by stenosis of the celiac trunk performed during 20 years. In addition to decompression of the celiac trunk, one-stage combined operations on the organs of the abdominal cavity were made in 167 out of 511 patients for concomitant diseases. It was shown that adequately fulfilled operations on organs of the abdominal cavity with stenoses of the celiac trunk improved the results of operations for the stenosed vessel.     

Specific features of surgical strategy in gastroduodenal ulcer bleedings in elderly and senile patients

An analysis of results of surgical treatment of 107 elderly and senile patients with gastroduodenal ulcer bleedings was made. Emergency operations were fulfilled on 47 patients, urgent operations on 56 patients and planned operations--on 4 patients. Ulcers of large size prevailed. Most of the patients had complications of ulcer disease. Palliative interventions were performed on 27 patients: suturing the vessel--in 20, ablation of the ulcer--in 7. Lethality was 33.3%. Radical operations were performed on 80 patients: resection of the stomach--in 75, vagotomy--in 5. Lethality was 16.3%.     

Combined operations in abdominal surgery]

Out of 20,890 operations on the organs of abdominal cavity 405 operations were combined. 146 patients underwent elective surgery and 259 were operated urgently. In 88 patients who underwent elective operations the extent of surgical intervention was determined beforehand, in 58 patients it was unexpected. Simultaneous stage of the operation usually does not influence the course of post-operative period.     

Reconstructive surgery on the vertebral artery

Summary In the last nine years 32 reconstructive operations were performed on the vertebral artery. In proportion to the 1032 operations on the carotid artery, is not the number of vertebral operations, at 3.1% unusually small? Is vertebro-basilar insufficiency too rarely recognized?Dedicated to Professor Dr. K. J. Zülch on the occasion of his 70th birthday.     

Experience with 303 operations in nonspecific aorto-arteritis (Takayasu syndrome)

From analysis of his personal 25-year experience the author suggests a classification of aorto-arteritis and discusses the incidence of various clinical syndromes. Among the 303 operations only 14 were nephrectomies, the remaining were reconstructive vascular operations. Most interventions were conducted on the branches of the aortic arch (115 operations), renal (112 operations) and visceral (73 operations) arteries. In reconstruction of the branches of the aortic arch, preference is given to extrathoracic shunting (64 operations), in the absence of the necessary conditions a bifurcation carotid or carotid-subclavian shunt from the ascending aorta is carried out (42 operations). In reconstruction of the thoracoabdominal aorta preference is given to a thoracophrenolumbotomy approach suggested by the author and the method of transaortic endarterectomy. The author describes a new method for the management of inflammation in patients with aortitis by means of cyclophosphamide and methylprednisolone. The good late-term results occur due to arrest of the inflammation. The results of the surgical methods are much more effective than those of nonoperative therapy alone.     

Surgical tactics in gastroduodenal hemorrhages caused by peptic ulcer

Among patients operated upon during the recent 10 years for gastroduodenal bleedings of ulcerous etiology emergency operations were performed at the height of bleeding on 12.6% of patients, urgent operations in the early interval on 42.3% of the patients. In the group of patients operated upon at the height of bleeding, the immediate postoperative lethality was high and made up 15.8%. After operations in the early interval 6.3% of patients died. General lethality among patients operated on for emergency and urgent indications made up 8.5%. After operations fulfilled during the late interval lethality was 2.8%.     

Tourniquet use and its complications in Norway

Over a two-year period, 265 Norwegian orthopaedic surgeons working at 71 institutions performed 63,484 operations under a tourniquet. Their replies to a questionnaire revealed that they mostly followed modern guidelines in their use of the tourniquet. Most felt that the tourniquet could be left on for two hours, and that it could be re-applied after 15 minutes. A total of 26 complications (one in 2442 operations) that might have been due to the tourniquet were reported, of which 15 were neurological. Three were in the upper limb (one in 6155 operations) and 12 in the lower limb (one in 3752 operations). Two were permanent (one in 31,742 operations), but the remainder resolved within six months. One permanent and one transient complication occurred after tourniquet times of three hours. The incidence of tourniquet complications is still at least as high as that estimated in the 1970s.     

Assessment of effectiveness of gastroduodenal anastomosis in the surgery of gastric cancer

An analysis of results of surgical treatment was made on the basis of experiences of performing 260 operations with gastroduodenal anastomosis for distal gastric cancer under conditions of the same hospital for 20 years. Postoperative lethality was 2.69%. Different complications after surgery were noted in 34.2% of the patients. Dumping syndrome after Billroth-1 operations developed in 12.3%. The 5 and 10 year survival after operations among 215 followed-up patients was 65.1% and 24.7% respectively. Original methods of operations were developed and introduced into practice for the improvement of immediate and long-term functional results of the surgery on the stomach.     

Statistics on operations at the Hara Genitourinary Hospital (1971-1986)

Statistical analysis of the inpatients and operations in our department from April, 1971 to December, 1986 revealed a total of 4,984 operations. Operations on the prostate were the most frequent (1,088 cases), followed by operations on the bladder (991 cases), on the ureter (816 cases), and kidney (719 cases). Among the operations, the percentage of endourological surgery and that of open surgery was 20.5% and 79.5% during the three years from 1975 to 1977, but in the recent three years from 1984 to 1986, these percentages were 62.6% and 37.4%, respectively, the rates being completely inverted. This shows that new endourological surgery, such as PNL, TUL, is progressing rapidly these years.