The results of direct access day surgery for minor operations

Direct access surgery (DAS) is a method of patient management which eliminates many of the common delays in providing treatment. It relies on accurate correspondence from general practitioners and a degree of confidence in these referrals so that preoperative assessment is made on the day of surgery and postoperative wound management performed in the community. This is a retrospective study of 5776 patients treated over 5 yr for minor surgical procedures under the care of one consultant at Kingston NHS Hospital Trust. Half of these patients, mostly with skin lesions, were dealt with using the direct access approach. No clinical problems were experienced in those patients treated by DAS and a very significant reduction in waiting time for more serious conditions was achieved in the outpatient department. It is concluded that DAS is the method of choice for minor skin lesions and that the technique should be used in the future for more complex procedures.     

An advanced clinical trial with laser acupuncture anesthesia for minor operations in the oro-maxillofacial region

For the purpose of improving acupuncture and acupressure anesthesia, laser acupuncture as a new type of controlled anesthetic method has been used since 1979. A beam from a 2.8-6 mW helium-neon laser apparatus (Model CW-12, Chengdu Thermometer Factory) was delivered and focused to a red spot on the selected skin point of the patient. The laser was used instead of the routine acupuncture and acupressure anesthesia. This paper reports the clinical laser trial of 610 cases (562 cases of difficult exodontia and 48 cases of various minor operations in the oro-maxillofacial region). The effect of analgesia was satisfactory. No sedatives or analgesics were administered before or during operations. The helium-neon laser apparatus, selection of laser irradiating acupuncture points, distance, and duration of irradiation and clinical observations are described.     

Prediction of risk in noncardiac operations after cardiac operations

To determine the preoperative variables affecting the mortality rate and the development of severe complications in patients who have had myocardial revascularization or a valve replacement and who then undergo a noncardiac operation, we retrospectively studied data from 120 such patients over the 5 years from 1982 through 1986. Thirty-six percent of patients had a noncardiac operation during the first month after the cardiac operation. The mortality rate was 11%, and the morbidity rate was 56%. The statistical comparison of the predictive accuracy of postoperative complications of three simple, widely used classifications (American Society of Anesthesiologists physical status, New York Heart Association classification, Massachusetts General Hospital cardiac risk index) demonstrated the superiority of the simplified three-class cardiac risk index (Massachusetts General Hospital-cardiac risk index; predictive accuracy of 84%). In a multivariate discriminant analysis of 21 variables in this population, five variables (myocardial infarction in previous 6 months, S3 gallop or jugular vein distention, arrhythmia on last preoperative electrocardiogram, emergency operation, delay between cardiac and noncardiac operation) were identified as being the most predictive of a postoperative complication. When these variables were used in the function (DF3) obtained by linear discriminant analysis, the prediction accuracy of a postoperative complication reached 83%. Performance of the new models in a prospective validation population remained satisfactory (75% for Massachusetts General Hospital-cardiac risk index three-class index and 72% for DF3). Extensive statistical analysis of our data tested by a validation study provided simple predictive models based on clinical variables easily available even in emergency situations.     

自体输血在骨科手术中的应用

我院自1999年3月开展自体血回输技术,明显减少了异体输血用量,未出现明显不良反应,现报告如下. 1 临床资料 本组275例,男176例,女99例;年龄17～82岁,平均68岁.     

多次手术与腹股沟疝术后血清肿关系的临床分析

目的探讨血清肿的发生与手术创伤的关系。方法选取腹股沟疝手术患者93例,所有患者均完整剥除疝囊,分成3组。A组:应用普里灵疝修补装置的无张力修补术38例;B组:复发疝2次手术组,第1次手术采用前入路传统疝修补术而复发,第2次采用前入路采用普里灵疝修补装置,共30例;C组:复发疝3次手术,第1次及第2次手术采用前入路传统疝修补术而复发,本次采用前入路手术应用普里灵疝修补装置的无张力修补术,共25例;以手术次数代表手术创伤大小,观察与血清肿发生率的关系。结果A组无血清肿发生,B组血清肿发生率为26.7%,C组血清肿发生率为40%。结论手术次数增加导致的腹股沟解剖结构紊乱使手术创伤增加,并与血清肿的发生有关。