Surgical treatment of patients with complicated forms of cholelithiasis

An analysis of surgical treatment of 124 patients with "difficult" gallbladder has shown that in most cases (59.7%) the causes impeding surgical procedures were massive commissural processes in the gallbladder zone and stony infiltrates of the hepato-duodenal ligament with shrunken or sclerosed gallbladder as well as earlier operations on the gallbladder, a combination of echinococcosis and liver cirrhosis with acute calculous cholecystitis, cholecystodigestive fistulas, Mirizzi syndrome and intrahepatic location of the gallbladder. Videolaparoscopic operations in such cases are extremely difficult, so open laparotomic operations should be preferred.     

非气腹腹腔镜技术的临床应用

目的研究非气腹腹腔镜手术的设计及安全性与可行性. 方法应用非气腹装置(gassless laparoscopic device,GLD)在腹腔镜下行胆总管切开取石T管引流术124例,胆总管切开取石一期缝合术56例,胆总管囊肿切除肝管空肠吻合术1例,改良非气腹腹腔镜胆总管空肠吻合术15例,手助腹腔镜脾切除联合门奇静脉断流术1例,非气腹装置辅助腹腔镜脾切除术1例. 结果手术均获成功,无严重手术并发症.129例胆道手术者随访1～9年,1例复发;2例脾脏手术者随访3～12个月,无复发. 结论所开展的非气腹腹腔镜手术达到了微创外科手术效果,安全可行.     

Intraoperative use of fibrin sealant in pulmonary surgery. A prospective study on a series of 124 procedures

Following lung resection, there is often important air leakage. Application of fibrin sealant on the parenchymal sutures or sites stripped of visceral pleura improves airtightness. The author reports a prospective series of 124 operations complicated by important air leakage, which was treated by application of fibrin sealant. This group is compared to another similar group of patients in which fibrin sealant was not used. All operations were done by the same surgeon. The time of post-operative thoracic drainage is markedly reduced (mean two days), and the post-operative hospital stay time is also reduced. It seems that intra-operative use of fibrin sealant helps to improve the post-operative course in the surgical unit.     

Comprehensive treatment of calculous cholecystitis associated with surgery-requiring diseases of other organs

Experience of performance of concurrent operations in 124 patients with chronic and acute calculous cholecistitis (CC) in presence of concurrent surgical diseases was summarized. Application of oblique minilaparotomic access in right subcostal region without m. rectus abdomini intersection had permitted after the cholecystectomy performance to broaden the indications for the concordant operative interventions performance using other surgical accesses. Inexpediency of doing of surgical interventions on stomach, n. vagi in CC and noncomplicated gastroduodenal ulcer disease in favor of medicinal therapy were substantiated.     

A ten-year experience with reduction mammoplasty and abdominoplasty. What is happening in our part of the world?

The authors update their experience with 124 reduction mammoplasties (including mastopexy) and 67 abdominoplasties and discuss their applications of these procedures in Turkey. In almost all cases the Str?mbeck procedure for mammoplasty and the Grazer and Pitanguy procedures for abdominoplasty were used. They present problems encountered in performing such operations and their solutions.     

Update: malaria, U.S. Armed Forces, 2011

U.S. service members are at risk of malaria when they are assigned to endemic areas (e.g., Korea), participate in operations in endemic areas (e.g., Afghanistan, Africa) and visit malarious areas during personal travel. In 2011, 124 service members were reported with malaria. Nearly three-fourths of cases were presumably acquired in Afghanistan (n=91) and one-fifth were considered acquired in Africa (n=24). One-quarter of cases were caused by P. vivax and one-fifth by P. falciparum (including 6 Afghanistan-acquired infections); most cases were reported as "unspecified" malaria. Malaria was diagnosed/reported from 51 different medical facilities in the United States, Afghanistan, Kyrgyzstan, Iraq, Germany and Korea. Providers of care to military members should be knowledgeable regarding and vigilant for clinical presentations of malaria outside of endemic areas.     

Substantiation of wound retractors choice for median approach in various abdominal trauma

Clinical and morphological experimental examination for assessment of advisability of the use of wound retractor by Sigal-Kabanov in median celiotomy has been carried out. The results of anatomical experiments in 28 cadavers of adult persons and the application of wound retractors for surgical operations in 124 patients with injuries of abdominal organs have evidenced the advantages of proposed version for retraction of the wound over the other methods.     

Study of cardiothoracic wound infection at St. Thomas' Hospital

Wound infection occurred after 14.3 per cent of 433 open heart operations. In 309, saphenous veins were harvested for coronary artery bypass grafting (CABG) and 8.7 per cent of sternal wounds and 12.9 per cent of leg wounds were infected. Only 1.6 per cent of the remaining 124 patients who had open heart operations without leg surgery suffered sternal wound infections. In the CABG group sternal infection was theatre-related and significantly associated with length of pre-operative stay, diabetes and re-operation. Similar organisms were isolated from both leg and sternal wounds which suggest that organisms were transferred from legs to sternum with the veins. No clinically relevant cross infection was demonstrated. Skin disinfection and surgical technique seem more important than antibiotic prophylaxis in the control of these infections.     

Choice of approach trajectories in stereotaxic surgery in patients with intracerebral tumors

An analysis of factors was made which influence the choice of approach trajectories in preoperative planning the diagnostic and medical stereotaxic interventions in patients with intracerebral tumors. Stereotaxic operations were planned and fulfilled on 124 patients with glial tumors of different supratentorial localizations. In planning trajectories with using MRI the passage of stereotaxic cannula through the pial folds and functionally significant zones of the brain were avoided. At the postoperative period no parenchymatous hemorrhages were noted in the approach zone, even with great number of trajectories. It was also noted that in passing the stereotaxic instrument through the lateral venticles of the brain the risk of complications was minimal.     

Resident perceptions of the impact of paging on intraoperative education

Our purpose was to evaluate the impact of paging on perceptions of intraoperative learning. Intraoperative logs of pager interruptions were kept by surgical residents at a university hospital over a 30-day period. The postgraduate year, number of pages, category of caller, reason for call, and level of urgency were recorded during each operation. At the conclusion of each operation, residents also completed a two-item survey with responses on a 5-point scale (1 = strongly disagree to 5 = strongly agree), querying if interruptions negatively impacted the intraoperative experience and if a message taken by a third party was effective in limiting interruptions. Logs were completed for 124 of 204 operations. Fifty-five per cent of operations were interrupted at least once with 49 per cent interrupted two to five times and 6 per cent were interrupted six or more times. Junior residents had 69 per cent of their operations interrupted compared with 39 per cent of senior residents (P = 0.001). Ninety-two per cent of pages were nonurgent. Residents did not perceive pager interruptions negatively impacted their educational experience (mean 2.3) but were neutral with respect if messages taken by a third party decreased interruptions (mean 3.8). Although our hypothesis was that pager interruptions were frequent and disrupt resident education, our data demonstrate the opposite.     

Effects of preoperative parathyroid localisation studies on the cost of operations for persistent hyperparathyroidism.

OBJECTIVE: To find out whether preoperative parathyroid localisation studies are cost-effective in patients with persistent hyperparathyroidism (HPT). DESIGN: Retrospective study. SETTING: University hospital, Sweden. PATIENTS: 29 consecutive patients with persistent HPT who were reoperated on with or without localisation studies. 15 other patients had initial operations for HPT without localisation studies. INTERVENTIONS: Initial or repeat operation for HPT, localisation studies with 99mTc sestamibi scintigraphy, and catheterisation of large cervical and mediastinal veins with measurements of serum concentrations of parathyroid hormone. MAIN OUTCOME MEASURES: Operative time. Cost of operations, frozen section biopsy and localisation studies. RESULTS: The mean durations of reoperation with localisation studies and for the initial operation without them, were 124 and 135 minutes, respectively, while it was 269 minutes for reoperation without studies. For patients who had localisation studies the mean total cost of the investigations, operating time, and frozen section biopsy was 28% less than for patients who were reoperated on without such studies. CONCLUSION: Preoperative localisation studies before repeat operations for HPT were cost-effective. Even if it has not been shown in this series, the reduction in operating time and the extent of dissection by localisation studies has the potential to decrease morbidity.     

Results of corrective surgery of hydronephrosis]

The analysis of 120 cases of hydronephrosis and 124 of corrective operations of hydronephrosis (4 bilaterally) from the Urological Clinic in Belgrade, with 81.5% very good and good results, showed the endresult which is dependent from the correctness of the indication for surgical corrective treatment, adequacy of the performed type of the corrective operation, the correctness of its performance, lack of complications and its abolishment even more from anatomical resp. functional state of the kidney before the operation. Less damaged kidneys precede well, and developed damage has a bad prognosis of the corrective operation.     

Late results following extra-anatomic bypass procedures for chronic aortoiliac occlusive disease

During the period from 1970 to 1983 150 extra-anatomic bypass operations were carried out on 129 high risk patients revascularizing 157 extremities. There were 124 axillofemoral and 26 femorofemoral bypass grafts. In elective operations the mortality ranged from 4.9% for the axillofemoral bypass and 3.7% for the femorofemoral bypass. A five year postoperative follow-up showed a cumulative patency rate (according to life table method) of 80.21% for the femorofemoral bypass, 79.90% for the axillobifemoral bypass (Type IV) and 45.77% for the unilateral axillofemoral bypass (Type I and II). Considering the low operative mortality, the short operating time, the late results and the high late mortality independent of the surgical procedure, the femorofemoral bypass and in many ways also the axillobifemoral bypass represent suitable and effective methods of operation for high risk patients, whereas unilateral and bilateral axillofemoral grafts showed a high rate of graft thrombosis and poor long term results (Type I and III).     

Significance of intraoperative ultrasonography in anterior spinal operation

Intraoperative spinal ultrasonography (IOSU) was performed during anterior spinal operations in 124 patients. The IOSU proved very useful in ascertaining whether the bone-removing width was sufficient for the spinal transverse diameter. It was also possible to check intraoperatively for unremoved material that was still compressing the cord (in particular, posterior lateral osteophytes and hernial prolapse). When the insufficient width of bone removal or remaining compression factor was found, an additional technique could be performed immediately, and the IOSU was helpful for prevention of cervical reoperation and improvement of surgical results. The degree of spinal pulsations observed in IOSU was of great value in the prediction of the prognosis for spinal cord postoperatively.     

Value of non-reperitonization for preventing lymphocele after extended lymphadeno-colpo-hysterectomy. Our experience in a comparative retrospective series of 124 cases

Pelvic lymphadenectomy for genital cancer can lead to numerous complications, particularly lymphoceles. Two types of drainage were compared in a series of 124 patients treated by extended lymphadeno-colpo-hysterectomy. In the first group (n = 83), hermetic peritonization with aspiration drainage was performed, and in the second group (n = 41), non-peritonization combined with omentoplasty was performed. Lymphoceles developed in 20% of patients in the first group (17 cases), requiring 7% of repeat operations (5 cases). Lymphoceles occurred in only one patient in the second group. The combined use of the reabsorption qualities of peritoneum and omentum avoids lymphoceles complications, particularly in patients previously treated by external radiotherapy.     

Open-Heart Experience in Infants Using Normothermia and Deep Hypothermia

During the 9-year period from 1967 through 1975, 124 open-heart operations were performed on infants less than 1 year of age with 35 operative deaths (28%). Ninety-seven of these procedures used continuous cardiopulmonary bypass with normothermia or mild hypothermia, and 27 were done under deep hypothermia and circulatory arrest. Mortality and morbidity were similar regardless of the operative technique, although deep hypothermia facilitated the repair of complex lesions. The highest mortality occurred in infants less than 3 months of age. Respiratory insufficiency, usually requiring prolonged ventilatory support, occurred only among infants who had pulmonary overcirculation or congestion prior to operation. Adequacy of intraoperative repair and postoperative care were the major determinants of survival.     

Off-pump coronary operations can be safely taught to cardiothoracic trainees

BACKGROUND: Off-pump coronary artery bypass (OPCAB) operations are evolving rapidly and becoming established in many cardiothoracic centers. For the technique to be widely applicable, teaching methods must be developed for surgical trainees. Early and midterm clinical outcomes of OPCAB performed at our institution by trainees as first operators under supervision were compared to those obtained in patients operated on by consultants. METHODS: Analysis was undertaken on data prospectively inserted in the Patient Analysis & Tracking System. Of the 559 OPCAB operations performed between January 1997 and May 2000, 124 (22%) were carried out by a supervised trainee and 435 (78%) by a consultant. RESULTS: There was no difference in age, sex, angina class, New York Heart Association functional class, or operative priority and extent of coronary artery disease in the two groups. More patients operated on by consultants had a history of congestive heart failure requiring medical therapy, significantly lower ejection fraction, and higher Parsonnet score compared with patients operated on by trainees. Early and midterm clinical results, in terms of morbidity and mortality, were similar in patients operated on by trainees or by consultants. CONCLUSIONS: Our data show no differences in early and midterm clinical outcome for patients undergoing OPCAB operations performed either by consultants or by trainees under supervision. The improvements in exposure and stabilization techniques, as well as the use of intracoronary shunts, have made it possible and safe to teach trainees off-pump multivessel coronary artery revascularization.     

Clinical statistics on operations for inpatients at Department of Urology, Tokai University Hospital 1975-1989]

Operations on inpatients during the 15-year period from 1975 to 1989 were analyzed statistically. A total of 3,791 operations were performed at our Department of Urology, including 717 operations on the kidney, 316 operations on the ureter, 583 operations on the bladder, 811 operations on the prostate, 136 operations on the urethra, 1,097 operations on the scrotum, 43 operations on the adrenal gland, 19 operations on the retroperitoneal space and 69 operations on other organs.     

Mortality after nonemergent major surgery performed on Friday versus Monday through Wednesday

OBJECTIVE: To determine whether nonemergent major surgery leads to higher mortality when performed on Friday versus early weekdays. SUMMARY BACKGROUND DATA: Adults admitted emergently to acute-care hospitals on weekends experience higher mortality than those admitted on weekdays. METHODS: Cohort study of 188,212 patients undergoing nonemergent major surgery at 124 Veterans Affairs hospitals from 2000 to 2004. Risk-adjusted 30-day mortality was compared for operations performed on Fridays versus Mondays through Wednesdays. Data were derived from the Veterans Affairs' National Surgical Quality Improvement Program database. Patients were divided into 3 groups: floor (admitted postoperatively to regular floor), ICU (admitted postoperatively to intensive care unit), and outpatient (not admitted postoperatively). A stepwise logistic regression analysis was used to test the effect of day of surgery (Friday vs. Monday-through-Wednesday) on 30-day mortality in the presence of characteristics that were significant in bivariate analysis. RESULTS: In the floor group (n = 89,786), operations performed on Fridays were associated with a higher 30-day mortality rate than those performed on Mondays through Wednesdays (2.94% vs. 2.18%; odds ratio, 1.36; 95% confidence interval, 1.24-1.49; P < 0.001). After adjusting for patient characteristics, odds ratio of 30-day mortality for operations on Fridays, when compared with Mondays through Wednesdays, was 1.17 (95% confidence interval, 1.05-1.26; P = 0.003). Within the ICU (n = 14,271) and outpatient (n = 84,155) groups, nonsignificant differences in 30-day mortality were observed for operations on Fridays versus Mondays through Wednesdays. CONCLUSIONS: For patients admitted to regular hospital floors after nonemergent major surgery, mortality is increased if surgery is performed on Friday versus Monday through Wednesday.     

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.