Articles: surgery.
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J. Cardiovasc. Pharmacol. Ther. · Jul 1998
Significance of Supraventricular Tachyarrhythmias After Coronary Artery Bypass Graft Surgery and Their Prevention by Low-Dose Sotalol: A Prospective Double-Blind Randomized Placebo-Controlled Study.
The single most frequent complication after coronary artery bypass graft surgery is the occurrence of supraventricular tachyarrhythmias leading to a prolonged hospital stay. Although several drugs have been used to treat these arrhythmias, effective prevention was only possible with beta-blocking drugs in selected patients. It was, therefore, the aim of the present study to evaluate the significance of supraventricular tachyarrhythmias in presence of today's cardioprotective management in a broad spectrum of patients and to assess the possible preventive effect and safety of low-dose sotalol after coronary artery bypass graft surgery. METHODS AND ⋯ These data show that without antiarrhythmic therapy the incidence of supraventricular arrhythmias after coronary artery bypass graft surgery is high (43%) and that supraventricular arrhythmias were associated with a prolonged hospital stay (+/-2 days). Prophylactic treatment with low-dose sotalol reduced the incidence of supraventricular arrhythmias significantly (by 40%), thereby reducing overall hospital stay in treated patients. Because more than 90% of all supraventricular arrhythmic episodes occurred within 10 days after surgery and considering the small proarrhythmic effect of sotalol late after surgery, prophylactic treatment with sotalol may be recommended for the first 10 postoperative days to safely reduce supraventricular tachyarrhythmias.
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A firm head dressing is usually applied after otoplasty. Some surgeons recommend that the patient should wear the bandage for up to 10 days after surgery. However, these bandages are frequently displaced or come off. ⋯ A case series of 52 patients undergoing bilateral otoplasty who had a head bandage on for only 24 hours was audited prospectively. Minor complications occurred in two patients. A head bandage does not need to remain on for more than 24 hours after otoplasty.
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The purpose of this study was to evaluate the diagnostic accuracy of transvaginal sonography for first trimester spontaneous abortions, thought to be incomplete or complete, in patients with postabortion bleeding or uterine cramping within 5 days of abortion. In a prospective study, 78 patients underwent transvaginal sonography to evaluate the maximum anteroposterior diameter of the uterine cavity on the long axis view and echo pattern of the retained products of conception. Patients were divided into three groups: those with a normal uterine cavity or a uterine cavity with fluid collection without echogenic foci (n = 13, group A), those with a uterine cavity containing fluid mixed with solid components (n = 38, group B), and those with a uterine cavity containing solid components (n = 27, group C). ⋯ In group C, all patients with a diameter of the uterine cavity 8 mm or greater underwent elective curettage. The overall complication and patient satisfaction rates were approximately 14% and 88%, respectively. Transvaginal sonographic findings can be used as a decision factor in the management of patients with first trimester spontaneous abortion to reduce the need for an elective curettage by approximately 58%.
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We retrospectively analyzed 48 patients with pathological T3 (PT3) and/or margin positive disease who had undetectable or unknown postoperative serum prostate specific antigen (PSA) following radical prostatectomy. Twenty-nine patients received postoperative adjuvant radiotherapy (RT) while 19 did not. Follow-up ranged from 0.5 to 6.9 years with a median of 3.4 years for the irradiated group and 2.9 years for the surgery alone group. ⋯ Actuarial overall survival was 92% for the entire group and showed no difference between the irradiated and non-irradiated groups. However, the 5-year actuarial disease free survival including freedom from PSA failure was statistically better in those treated with adjuvant RT than that in the surgery alone group (88% vs 46%, p=0.0035). The morbidity of adjuvant RT was acceptable with only 2 patients developing Grade 3 genitourinary complication.
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Resection of intramedullary spinal cord tumors carries a high risk for surgical damage to the motor pathways. This surgery is therefore optimal for testing the performance of intraoperative motor evoked potential (MEP) monitoring. This report attempts to provide evidence for the accurate representation of patients' pre- and postoperative motor status by combined epidural and muscle MEP monitoring during intramedullary surgery. ⋯ There was no instance in which a patient with stable MEPs developed a motor deficit postoperatively. Intraoperative MEPs adequately represented the motor status of patients undergoing surgery for intramedullary tumors. Because deterioration of the motor status was transient in all cases, it can be considered that impairment of the functional integrity of the motor pathways was detected before permanent deficits occurred.