Experiences with a new EEG spectral analyzer in carotid surgery

Spectral analysis with the compressed spectral array display (CSA) and calculation of spectral edge frequency (SEF) was performed in 43 cases undergoing endarterectomy of the carotid bifurcation. New neurologic deficit appeared in 2 patients (= 4.6%). One of them died postoperatively (= 2.3%), the other suffered from permanent paralysis of the hand. Another 9 patients showed loss of high frequency activity (= decrease in SEF) without a new deficit in the postoperative period. A significant EEG event was defined as a decrease in SEF after carotid cross clamping for at least 5 min. Fisher's exact probability test revealed a close correlation between these EEG events and neurologic outcome. The sensitivity of the test, which was calculated on true positive and false negative events, was 100%, the specificity, based on true negative and false positive events, was 76%. The predictability of the test, based on all EEG events, was 18%; respectively 40% when calculated on significant events.     

Stress incontinence surgery for patients presenting with mixed incontinence and a normal cystometrogram

OBJECTIVE: To evaluate the outcome of surgery for stress urinary incontinence (SUI) in patients presenting with a combination of stress and sensory urge UI. PATIENTS AND METHODS: The study comprised 75 women presenting with mixed incontinence; the most important inclusion criterion was a negative cystometrogram for detrusor overactivity. Based on random selection, a third of the patients received a 6-month course of anticholinergic treatment (group 1) and 50 (group 2) had surgery for SUI. The surgical procedure depended on the Valsalva leak-point pressure (VLPP); those with a VLPP of > or = 90 cmH2O underwent Burch retropubic bladder neck suspension (group 2a, 24 patients) while 26 (group 2b) with a VLPP of < 90 cmH2O had pubovaginal sling (PVS) surgery. A further group of 20 patients with pure SUI (no urge UI) underwent surgery (PVS in 12 and Burch in eight) as a control group (group 3). After at least 6 months of follow-up (mean 9.3, sd 1.7), 68 patients were evaluable; they were assessed subjectively and objectively for dryness, and by a urodynamic evaluation and quantitative assessment using the SEAPI scoring system. RESULTS: In group 1 none of the patients became completely dry; there was persistent stress with and without urge UI in nine (43%) and 12 (57%) of the available 21 patients, respectively. Only three of those who had persistent SUI with no urge in the whole study group were satisfied and chose to continue anticholinergic therapy despite SUI. In this group the mean (sd) improvement in the subjective and objective SEAPI score was 3.4 (1.0) and 2.3 (3.8), respectively. In group 2a, 20 of the available 23 patients (87%) became completely dry (both stress and urge continent). The mean improvement in the SEAPI scores was 7.8 (0.9) and 7.8 (1.3), respectively. In group 2b, 20 of the 24 patients (83%) became completely dry, with mean improvements in SEAPI scores of 8.2 (0.4) and 7.9 (0.3), respectively. The improvement was statistically significant after surgery, vs anticholinergic therapy, for all variables (P < 0.05). The incidence of persistent urge UI was highest in group 1 (43%), being 13% in group 2 (13% and 12% in 2a and b, respectively). In group 3 there was de novo urge UI in four of the 20 patients, and not significantly different from that in group 2. CONCLUSION: Most patients with mixed stress and urge UI and a normal cystometrogram were cured of both symptoms by surgery. The incidence of residual urge in such patients was no higher than that of de novo urge after surgery in patients with genuine SUI.     

Experiences with clindamycin in orthopedic surgery and traumatology]

60 cases of orthopedic surgery and traumatology were treated 64 times altogether with an average dose of clindamycin of 3 X 300 mg/day. 40 patients were given clindamycin as preventive treatment. 12 patients were treated for acute infections of the locomotor system and other 8 patients 12 times for chronic osteitis. In the group having received preventive trqatment, infection occurred bu 1 out of 40 patients. As to the 12 cases of acute infections, 10 recovered, 1 improved and 1 patient got worse. Concerning the 12 treatments of 8 patients with chronic osteitis, in 1 case the inactivation of the infection was obtained. 9 cases showed significant improvement whereas in 2 cases an aggravation was noticed. In 5 patients the following side effects occurred: 2 cases of allergic exanthema, 2 cases of mild diarrhoe and 1 case of pyrosis. This study shows that clindamycin is an antibiotic with a broad field of application in orthopedic surgery.     

Experiences with shorter surgery

Through the introduction of new computer-based forms of organisation, the hospital stay for both general and visceral surgery has been significantly reduced. A short stay ward with 15 beds and a dedicated functional unit was established in 1994 where approximately 1,000 operations take place each year with a 2.3 day average hospital stay. At this center laparoscopic cholecystectomy, laparoscopic herniorrhaphy, arthroscopy and perforating vein surgery are performed on ASA-I- and ASA-II-patients. Experience indicates that patients satisfaction has dramatically increased. This is due to a shorter waiting period, a guaranteed operation in accordance with the time scheduled, a comfortable hotel-like-atmosphere and minimal hospital stay without an increase of the perioperative risk. In this way hospitals can maximize their profits using special payment arrangements (all-inclusive prices). Even after introduction of the new DRG-systems short stay surgery will be attractive considering economic aspects.     

A new method for correction of urinary stress incontinence in women

Twenty-two patients with urinary stress incontinence confirmed by urodynamic recordings were operated on by using absorbable Dexon sutures combined with a two-component fibrin sealant, which induced fibrosis, for the fixation of the urethrovesical junction to the retropubic periostium. The postoperative observation period ranged from 12 to 30 months, and so far no relapses or complications have been observed.     

Reconstructive surgery for urinary incontinence

The clinical urologist often is faced with the referral of a patient with urinary incontinence refractory to conservative measures. Given the broad spectrum of causes of urinary incontinence, the clinician must base evaluation and therapeutic management on current principles of urinary tract pathophysiology. This article organizes the pertinent diagnostic considerations that must be addressed in guiding the clinician to the appropriate surgical treatment option.