Early Postoperative Examination Research Articles

Appearance of Absorbable Gelatin Compressed Sponge on Early Post-Thyroidectomy Neck Sonography

Absorbable gelatin compressed sponge (Gelfoam; Pfizer Inc, New York, NY), a biodegradable agent prepared from purified porcine skin gelatin, is frequently used for intraoperative hemostasis. Its appearance on sonography may mimic tumor or residual thyroid when placed in the resection bed after thyroidectomy. The purpose of this study was to describe the appearance of Gelfoam on early post-thyroidectomy sonography so that an erroneous diagnosis of locally recurrent or residual tumor can be avoided. We reviewed the early postoperative sonographic examinations of 6 patients after thyroidectomy in which Gelfoam was used for hemostasis. Screening cervical sonography was performed to identify possible lateral compartment adenopathy before completion of thyroidectomy or ablation. Sonographic examinations were performed up to 50 days after resection. Surgical reports confirmed the use of Gelfoam in each patient. In all cases, uniform elongated echogenicity was shown within the lobectomy bed. In 1 patient, sonographically guided fine-needle aspiration of lobectomy bed echogenicity yielded scant red blood cells, multinucleated giant cells, and macrophages. Follow-up sonography performed in 1 patient 14 months after thyroidectomy confirmed complete Gelfoam absorption. Gelfoam may mimic residual or recurrent thyroid carcinoma on early surveillance sonography performed after thyroidectomy. Recognition of its characteristic appearance should prompt a search for an appropriate surgical history and, when placed in the appropriate clinical context, should prevent an errant diagnosis of tumor.

Basal cusp enlargement for repair of aortic valve insufficiency

Objective The aim of this study was to evaluate the clinical and echocardiographic results after aortic valve reconstruction with a novel surgical technique consisting of basal cusp enlargement with an autologous pericardial patch. Methods Between December 2005 and June 2008, a total of 106 consecutive patients underwent elective valve-sparing aortic root repair at Cardiovascular Clinic, Bad Neustadt, Germany. Fifty-nine patients required additional procedures on the aortic cusps; among them, in 10 cases basal cusp enlargement was used for restoration of coaptation area. All these patients had an ascending aortic aneurysm combined with aortic insufficiency, which was severe (4+) in 2 cases and moderate to severe (3+) in 4. The root repair was performed with valve reimplantation (David technique) in 1 case and the author's own single-patch technique in the other 9. Partial and total arch replacements were performed in 3 and 1 cases, respectively. Results The postoperative echocardiography at discharge showed no aortic regurgitation in 7 cases and trivial regurgitation in 3. The average coaptation height of the leaflets was 9.9 ± 0.6 mm, and the mean gradient across the valve was 5.4 ± 1.9 mm Hg. At follow-up as late as 31 months, all patients were alive with echocardiographic findings unchanged from the early postoperative examinations. Conclusions The technique presented here allows an individualized reconstruction of the aortic cusps, leading to considerable improvement in coaptation area, in patients who have aortic leaflet prolapse or restriction caused by complex aortic root and valve disease.

Synchronous Colorectal Cancer

Purpose: Synchronous colorectal cancer is clinically significant because there is a chance to miss concurrent lesions. The aim of this study is to investigate the clinical features of synchronous colorectal cancer. Methods: Retrospectively, the records of 4,494 colorectal cancer patients who underwent a potentially curative resection for colorectal cancer from September 1994 to December 2005 were reviewed. Synchronous colorectal cancer was defined according to the following two criteria: 1) two or more colorectal cancers had to be found simultaneously in the same patient and 2) each of the tumors had to be distinctly separated by an intact bowel wall. Results: Synchronous colorectal cancer was diagnosed in 114 patients (2.5%). Synchronous colorectal cancer shows different features compared with single colorectal cancer. Synchronous colorectal cancer occurs at a older age, occurs more frequently in the colon, has a bigger size, and has more polyps. There was no difference of stage based on survival rate between synchronous and single colorectal cancer patients. The preoperative diagnosis rate of synchronous colorectal cancer was 74.6%. Eleven (9.6%) synchronous colorectal cancer patients underwent a total colectomy, and there were no significant differences in survival or complications compared with the other group. Conclusion: Synchronous colorectal cancer is difficult to diagnose preoperatively. Early postoperative examination for synchronous colorectal cancer is required, especially in patients who did not have a complete preoperative evaluation.

Compression anastomosis clip for gastrointestinal anastomosis

To investigate the feasibility of compression anastomosis clip (CAC) for gastrointestinal anastomosis proximal to the ileocecal junction. Sixty-six patients undergoing gastrointestinal anastomosis proximal to the ileocecal junction were randomized into two groups according to the anastomotic method, CAC or stapler. The postoperative recovery of patients in CAC and stapled anastomosis groups was similar. No postoperative complication related to the anastomotic method was found in either group. Both upper gastrointestinal contrast radiography at the early postoperative course and endoscopic examination after a 6-mo follow-up showed a better healing at the compression anastomosis. CAC can be used not only in colonic surgery but also in gastrointestinal anastomosis. Our result strongly suggests that CAC anastomosis is safe in various complication circumstances. However, it should be further confirmed with a larger patient sample.

Progression of mitral regurgitation following ischemic mitral valve repair

Durability of mitral valve repair for ischemic mitral regurgitation remains questionable. The aim of our study was to reveal predictors of recurrent mitral regurgitation following ischemic mitral valve repair. The study population consisted of 136 patients with ischemic heart disease and ischemic mitral regurgitation. Mitral valve repair was performed at the Kaunas University of Medicine Hospital in 2000-2004. Preoperative echocardiographic examinations were performed two days before surgery, early postoperative examinations 5-10 days after mitral valve repair, late postoperative examinations at 1.89+/-0.15 years after operation. Mitral regurgitation increased from 0.78+/-0.77 at early period to 1.46+/-0.81 at late postoperative period (P<0.001). At late follow-up mitral regurgitation increased in 13 (9.5%) patients in comparison with preoperative mitral regurgitation and in 69 (50.7%) patients in comparison with early postoperative mitral regurgitation. Left ventricular end-diastolic diameter decreased significantly from 56.44+/-6.29 mm at early period to 54.44+/-5.98 mm at late period (P<0.004). Left ventricular ejection fraction increased from 35+/-10% at early period to 38+/-10% at late period (P<0.047). Left atrial diameter decreased from 46.12+/-6.35 mm at early period to 43.95+/-6.94 mm at late period (P<0.034). Multivariate analysis revealed predictors of late postoperative mitral regurgitation: preoperative left ventricular end-systolic diameter index (P=0.037), left ventricular wall motion score index (P=0.042), mitral regurgitation (P=0.013), and systolic pulmonary artery pressure (P=0.04). It is possible to predict the progression of mitral regurgitation following ischemic mitral valve repair. Late postoperative mitral regurgitation depends on these preoperative echocardiographic variables: left ventricular end-systolic diameter index, left ventricular wall motion score index, mitral regurgitation, and systolic pulmonary artery pressure.

Six months post-operative clinical and 24 hour post-operative MRI examinations after nucleoplasty with radiofrequency energy

Minimally invasive techniques are gaining popularity for the treatment of discogenic low-back pain. Nucleoplasty is a relatively new procedure that uses radiofrequency energy to disintegrate and evacuate the disc material. The purpose of this study is to examine the early post-operative radiological changes after lumbar nucleoplasty and to assess the short-term effects of this procedure on discogenic lower back pain and leg pain. Twenty nine patients between the ages of 32 and 59 years (mean 44.14, SD 7.11 years) were included in the study. Visual Analogue Scale (VAS) scores of the patients were recorded in the pre-operative period and 24 hours, 3 months and 6 months after the procedure. Additionally, pre-operative and post-operative lumbar magnetic resonance imaging (MRI) examinations of these patients were compared. The mean pre-operative VAS score was 6.95 (range 3.0-10.0, SD 1.87) and the mean post-operative VAS scores at 24 hours, 3 months and 6 months were 2.46 (range 0-8.0, SD 2.07), 4.0 (range 0-10.0, SD 3.09) and 4.53 (range 0-10.0, SD 3.6), respectively. There were statistically significant reductions (p < 0.001) in VAS scores for all post-operative time points when compared to pre-operative values. Nucleoplasty did not produce obvious changes at least on the early post-operative MRI examination. Although, nucleoplasty appeared to be a safe minimally invasive procedure, the value of this new technique for the treatment of discogenic low-back pain remains as yet unproven. Further randomised placebo-controlled studies with longer follow-up are needed to elucidate the effects of nucleoplasty on discogenic low back and leg pain.

Reduction of myocardial hypertrophy after aortic valve replacement

Aortic valve disease - stenosis and regurgitation are the cause of increased homodynamic stress of the left ventricle (LV) which then develops an adaptive mechanism of cardiac muscle hypertrophy. The aim of this study was to establish if aortic valve replacement procedure (AVR) reduces myocardial hypertrophy and if it does in what period of time. Eighty-six patients who had been operated for AVR in the Clinical Centre of Serbia were included in this investigation. In the every patient the aortic valve had been replaced with a mechanical valve prosthesis. Transthoracic echocardiography examination (TTE) was performed in all of the patients before, and one week after the operation, while 22 patients were followed-up on a long-term basis. The LV mass was determined with the formula according to the Pen convention. In the tested group there was significantly more male than female individuals (n = 57-66.3%, 29-337%). Twelve patients (14%) were operated for isolated aortic stenosis, 22 patients (25.6%) for aortic regurgitation, 48 patients (55.8%) for combined aortic valve disease, while 4 patients (4.7%0/) for endocarditis. Student t test did not show any significant difference in diastolic septal thickness before and after the operation (p = 0.88), while it did show that the difference in the LV mass before and after the operation was highly significant (p = 0.000). This test also showed that, taking the mass of 240 g as the border value for hypertrophy of LV, the reduction of LV mass between preoperative and early postoperative finding was not significant (p = 0.5), while the reduction in LV mass between late and early postoperative examination was statistically significant (p = 0.000). In 19 of 22 patients who were followed-up postoperatively over a long period (84 months after the operation) significant reduction of LV mass was registered. The mean time of the reduction was 27.5 months. This study showed the presence of a significant reduction in the LV mass after AVR, and that the mean time required for this process was more than two years.

Amaurosis After Lower Eyelid Laser Blepharoplasty

The transconjunctival CO(2) laser approach to lower eyelid blepharoplasty was used to treat a 66-year-old man presenting with bilateral lower eyelid herniated fat without excess skin. Early postoperative examination revealed left eye blindness. This report presents clinical circumstances of this rare complication and further discusses the most likely causative factors.

Does Using the Bispectral Index (BIS) During Craniotomy Affect the Quality of Recovery?

One of the aims of neuroanesthesia is to provide early postoperative recovery and neurologic examination in patients undergoing supratentorial surgery. Our aim was to investigate the role of using the bispectral index (BIS) in recovery from anesthesia and altering drug administration in patients undergoing craniotomy. Fifty American Society of Anesthesiologists' (ASA) physical status I-II patients undergoing craniotomy were included in the study. The patients were randomly divided into two groups, and all patients received standard induction drugs, and 0.8%-1.5% sevoflurane was used for maintenance of anesthesia. In the BIS-guided group, the concentration of sevoflurane was titrated to maintain BIS at 40-60. In the control group, the anesthesiologist was blind to BIS, and the concentration of sevoflurane was changed according to the patients' hemodynamic changes. The hemodynamic data, BIS values, and sevoflurane concentrations were recorded every 15 minutes. In addition, the BIS value was recorded by the primary anesthetist in the BIS-guided group and by another independent anesthetist in the control group. At the end of the study, recovery criteria and Aldrete recovery scores were recorded every 15 minutes. Neurologic assessments were performed when the Aldrete score was 9-10. BIS values were higher, and sevoflurane concentrations (P < 0.05) and total doses of fentanyl (P < 0.01) were lower, in the BIS-guided group. Times to first spontaneous breathing, eye opening, and extubation (P = 0.035, P = 0.001, and P = 0.0001, respectively) were significantly shorter in the BIS-guided group. Time to an Aldrete score of 9-10 and adequate neurologic assessment were similar between the groups. In conclusion, BIS monitoring by supratentorial craniotomy under general anesthesia reduced the maintenance anesthetic concentration and narcotic drug usage and lowered the recovery times from general anesthesia.

Valve-Sparing Aortic Root Repair With Patch Technique

In the valve-sparing aortic root repair technique presented, each pathologic sinus is replaced with a teardrop-shaped patch. In this study, the clinical and echocardiographic results after the first 20 procedures are evaluated. Between September 2000 and May 2004, 20 patients underwent aortic root repair using a patch technique. Eight patients had an acute type A aortic dissection and 12 patients had an aneurysm of the ascending aorta. In 12 cases, the aortic root was reconstructed with three patches, in 1 case with two patches, and in 7 cases with one patch. The postoperative echocardiography at discharge showed no aortic regurgitation in 15 cases and trivial regurgitation in 5 cases. Three patients with aortic dissection as an initial pathologic diagnosis died during a median follow-up period of 14.5 months (range, 0.5 to 32 months). At the time of follow-up, the echocardiographic findings in all 17 survivors remained unchanged from the early postoperative examinations. Median peak and mean transvalvular gradients were 8 mm Hg (range, 3.2 to 14 mm Hg) and 4 mm Hg (range, 1.7 to 6 mm Hg), respectively. The technique presented allows an individualized reconstruction of the sinuses of Valsalva, a simplified sizing of the vascular graft, and the creation of a new sinotubular junction resulting in good hemodynamic conditions. The technique is especially advantageous in patients in whom replacement of all sinuses is not necessary.

Late ultrasonographic findings in cases operated for hydatid cyst of the liver

Purpose: The aim of this study was to evaluate and present the images due to surgical intervention and to recurrences in patients who had been operated for hydatid cyst of the liver at least 12 months prior to the imaging process. Material and methods: A total of 77 patients (46 females, 31 males) with a mean age of 38 years (10–60 years) who had undergone surgical intervention for hydatid cyst of the liver were included in this study. The type and the number of operations were determined by reviewing previous medical records of the patients. Recurrence findings and postoperative images were examined by ultrasonography in all patients. Results: Of the 77 patients, 68 had undergone surgical operation for hydatid cyst of the liver for once, six cases for twice, one patient for three and another patient for four times. Ultrasonographic examination was considered normal in 9 (11.6%) patients. The most frequent finding in the remaining patients was hypoechoic ( n = 6) and anechoic ( n = 14) images with a hyperechoic periphery within the operation area. While a coarse heterogenous area was visualized in 12 cases (15.5%), a sole hypoechoic image was present in 10 patients. Recurrence was detected in 9 (11.6%) patients of whom 7 were asymptomatic. While daughter cysts were detected in two recurrent cases; the remaining were unilocular cysts. An omentum image extending to the operation area was detected in 11 patients. Calcification was present in 14 patients, whereas four cases had less common findings of anechoic tubular structures adjacent to the operation area. Conclusion: While the liver may seem normal by ultrasonography in the late postoperative period in patients, who had been operated for hydatid cyst of the liver, various images may also be present. These images may be misinterpreted as recurrence or other pathologies. Thus, the radiologist should be familiar with the postoperative ultrasonographic findings of hydatid cyst and should not misinterpret the image of anechoic fluid as recurrence. When in doubt, ultrasonographic follow-up is essential. An early postoperative ultrasonographic examination may be the key point in precluding a misdiagnosis.

Regarding “High embolic rate early after carotid endarterectomy is associated with early cerebrovascular complications, especially in women”

Abstract Purpose: The aim of this study was to evaluate the relationship between the rate of emboli (ER), as detected with transcranial Doppler scan (TCD) monitoring during and shortly after carotid endarterectomy (CEA), and early cerebrovascular complications (CVC). Materials and Methods: One-hunderd eighty-five consecutive patients underwent 203 CEAs with general anesthesia at the Sint Lucas Andreas Hospital. Inclusion criteria included adequate TCD monitoring during the operation and for at least 10 minutes in the recovery room. Fifteen patients were excluded because of inadequate TCD monitoring. To prevent statistical bias, only data from the first operation of those patients who underwent bilateral CEA were included. The study group thus consisted of 170 patients (113 men, 57 women) with a mean age of 67 years (range, 45 to 83 years). The monitored TCD signals were stored on tape for offline analysis. ERs during dissection, wound closure, and the postoperative period shortly after arrival in the recovery room were studied. Preoperative and early postoperative neurologic examination, including grading with the modified Rankin scale, was performed by the same board-certified neurologist. Results: A CVC occurred in 10 patients (5.9%). Five minor strokes (2.9%) and three major strokes (1.8%) occurred, one with a fatal outcome (0.6%). Two patients (1.2%) had transient ischemic attacks. Median ERs for the three periods studied were significantly different (postoperative period, 0.3/min; dissection, 0.03/min; wound closure: 0/min; Friedman, P P = .0003) and the postoperative period ( P P P P Conclusion: Especially during the postoperative period, high ER is associated with early CVC. Women have a higher ER than men in this period. If the ER is 0.9/min or more during the postoperative period, there appears to be at least a nearly four-fold increased risk of CVC. (J Vasc Surg 2002;36:278-84.)

High embolic rate early after carotid endarterectomy is associated with early cerebrovascular complications, especially in women

Purpose: The aim of this study was to evaluate the relationship between the rate of emboli (ER), as detected with transcranial Doppler scan (TCD) monitoring during and shortly after carotid endarterectomy (CEA), and early cerebrovascular complications (CVC). Materials and Methods: One-hunderd eighty-five consecutive patients underwent 203 CEAs with general anesthesia at the Sint Lucas Andreas Hospital. Inclusion criteria included adequate TCD monitoring during the operation and for at least 10 minutes in the recovery room. Fifteen patients were excluded because of inadequate TCD monitoring. To prevent statistical bias, only data from the first operation of those patients who underwent bilateral CEA were included. The study group thus consisted of 170 patients (113 men, 57 women) with a mean age of 67 years (range, 45 to 83 years). The monitored TCD signals were stored on tape for offline analysis. ERs during dissection, wound closure, and the postoperative period shortly after arrival in the recovery room were studied. Preoperative and early postoperative neurologic examination, including grading with the modified Rankin scale, was performed by the same board-certified neurologist. Results: A CVC occurred in 10 patients (5.9%). Five minor strokes (2.9%) and three major strokes (1.8%) occurred, one with a fatal outcome (0.6%). Two patients (1.2%) had transient ischemic attacks. Median ERs for the three periods studied were significantly different (postoperative period, 0.3/min; dissection, 0.03/min; wound closure: 0/min; Friedman, P < .005). ERs were significantly higher in the CVC group but only during wound closure ( P = .0003) and the postoperative period ( P < .0001). Women had significantly more CVCs than men (14% versus 2.7%; P < .02) and, during the postoperative period, had a significantly higher median ER (0.70/min) than men (0.25/min) ( P < .002). High ERs during dissection in two men were associated with CVC. An ER of 0.9/min or more during the postoperative period was significantly correlated with CVC ( P < .0001; odds ratio, 64.6; 95% CI, 3.7 to 1128). Conclusion: Especially during the postoperative period, high ER is associated with early CVC. Women have a higher ER than men in this period. If the ER is 0.9/min or more during the postoperative period, there appears to be at least a nearly four-fold increased risk of CVC. (J Vasc Surg 2002;36:278-84.)

Screening for carotid disease and surveillance for carotid restenosis.

Duplex scanning is being used now to screen patients with suspected carotid artery disease, as the sole diagnostic test before carotid endarterectomy, and for follow-up surveillance after carotid surgery. Although the role of screening in patients with neurologic symptoms generally is accepted, noninvasive screening of asymptomatic patients remains controversial. The basic rationale for screening is to detect disease that can be treated to improve the patient's outcome. Although debate over the value of endarterectomy for asymptomatic carotid stenosis will continue, there is abundant evidence from natural history studies and clinical trials indicating that patients with asymptomatic high-grade (80% to 99% by duplex) stenoses can benefit from surgery if it can be performed with an acceptably low perioperative complication rate. Therefore, screening appears to be justified in patients with asymptomatic neck bruits and patients being evaluated for peripheral arterial or coronary artery disease. Those who are found to have moderate stenoses (50% to 79%) should be followed up at 6-month intervals to detect disease progression that may require surgery. Patients with less than 50% carotid stenoses can be followed up annually. Early restenosis is relatively common after carotid endarterectomy, occurring in about 20% of patients followed up with serial duplex scans, but it appears to have a benign natural history in the majority of patients. Reoperation is indicated only for symptomatic recurrent lesions and selected high-grade asymptomatic restenoses. An early postoperative surveillance examination is justified to provide a baseline study. The frequency of subsequent follow-up examinations will be determined by the status of the contralateral nonoperated carotid artery or the development of neurologic symptoms.

Peripheral nerve injuries during cardiac surgery: risk factors, diagnosis, prognosis, and prevention.

Neuropathies involving the brachial plexus, phrenic, recurrent laryngeal, and saphenous nerves, as well as the sympathetic chain are complications of cardiac surgery. The reported frequency of nerve injuries varies from 1.5% to 24% for the brachial plexus and 10% to 60",,6 for the phrenic nerve (1-5). Neuropathies of the recurrent laryngeal, lower limb (saphenous) nerves, and the sympathetic chain are less frequent.

Dega's transiliac osteotomy in the treatment of spastic hip subluxation and dislocation in cerebral palsy.

The study presents the long-term results of operative treatment of spastic subluxation and dislocation of hip joints in cerebral palsy children with open reduction and pelvic transiliac osteotomy by Dega. The subjects were 25 patients (30 hips) and the follow-up lasted from 3 to 25 years (average 12 years). Final examinations were carried out after the end of body growth. Detailed analysis covered a patient's function, occurrence and intensity of pain in the hip joint, value of radiological parameters such as angle of centre-edge of the roof after Wiberg (CE), acetabular index (AI), neck-shaft angle (NS) and migration percentage (MP). The final evaluation of radiological results was carried out in accordance with Severin's classification. The clinical and radiological results obtained showed gradual deteriorations in comparison with the early postoperative results (dating from 12 months after surgery). In the final examination, in one patient a recurrent dislocation of the hip joint was diagnosed and subluxation was diagnosed in six patients (23%). Only the values of the CE angle went up (from -16 degrees in the early postoperative examination to 20 degrees in the final assessment), which we consider to be due to the change of sphericity of the head of femur. The remaining radiological parameters did not change significantly: AI from 22 degrees to 23 degrees, MP from 11% to 23%, NS from 133 degrees to 140 degrees. The surgical method presented is currently applied in a modified form, with a wider release within the soft tissues, more radical varusderotation osteotomy and greater shortening of the femur.

Laser in situ keratomileusis for high myopia with the VISX Star laser

Purpose To evaluate the results of laser in situ keratomileusis (LASIK) for spherical and spherocylindrical myopia (range, 9–22 diopters [D]) with the VISX Star laser, (VISX Inc., Santa Clara, CA). Design Non-comparative, single-surgeon interventional case series. Participants Two hundred ninety eyes of 175 patients. Methods Consecutive patients who underwent LASIK in the study range with the VISX Star laser were evaluated for early (approximately 1 month) and late (after 9 months) outcomes. Both single procedure outcomes and results after reoperation for refractive enhancement were included. Main outcome measures Outcome measures included uncorrected visual acuity, manifest refraction, refractive predictability, refractive stability, best spectacle-corrected visual acuity (BSCVA), results of reoperations, and complications. Results At the early postoperative examination, approximately 1 month after surgery, 285 of 290 eyes (98.3%) were examined. Uncorrected visual acuity of 20/40 or better occurred in 209 of 285 (73.3%) eyes, and 198 of 285 (69.5%) eyes had a manifest spheroequivalent between ±1.00 D. Subsequently, 60 eyes (20.7%) underwent reoperation for refractive enhancement. Late results, beyond 8 months from the initial surgery and including reoperations, were available in 195 of 290 eyes (67.2%). Uncorrected visual acuity results of 20/40 or better were found in 166 of 195 eyes (85.1%) and of 20/25 or better in 99 of 195 eyes (50.8%). Manifest spheroequivalent results were ±2.00 D in 187 of 195 eyes (95.9%) and ±1.00 D in 148 of 195 eyes (75.9%). In a paired-cohort analysis of 131 single-procedure eyes seen at both intervals, refractive stability (change in manifest refractive spheroequivalent of less than 1.00 D) was present in 101 of 131 eyes (77.1%) between the two observation intervals. Overall, approximately 3.6% eyes lost 2 lines or more of BSCVA, and other complications (flap wrinkling and epithelial ingrowth) were reported in 2% of eyes. Improvement in BSCVA of 1 line or more occurred in 5.6% eyes. Conclusions Laser in situ keratomileusis for high myopia with the VISX Star laser provided satisfactory refractive and visual results that compare well with other reports in the literature. Subjective results and other measures of visual function need further evaluation.

The use of intravenous contrast in postoperative mr imaging of pituitary macroadenomas

In this study we reviewed 23 postoperative magnetic resonance (MR) imaging examinations of patients with pituitary macroadenomas to determine if intravenous contrast is of value in this setting. The addition of contrast enhanced images to noncontrast T1-weighted images changed the radiologist’s assessment in 4/5 early postoperative examinations and in 0/18 late postoperative examinations. Intravenous contrast is of value in distinguishing residual tumor from packing material on early postoperative MR examinations but is less useful in later postoperative examinations.

Prognostic factors in long-term intraocular pressure control following combined phacoemulsification and trabeculectomy.

We studied 36 consecutive patients who underwent combined phacoemulsification and trabeculectomy to determine prognostic factors associated with intraocular pressure control one year postoperatively. In patients who were either easier (intraocular pressure < 16 mmHg, n = 19) or more difficult (> or = 16 mmHg, n = 17) to control, the mean intraocular pressure increased up to the fourth week postoperatively. In the more difficult to control group, however, the intraocular pressure continued to increase and a statistical difference between groups was noted by the second month postoperatively (P < 0.05). The peak intraocular pressure within the first month postoperatively was lower in patients easier to control long-term (P < 0.005). No statistical difference between groups in the filtering bleb or anterior chamber appearance, or postoperative complications, was noted (P > 0.05). This study suggests combined trabeculectomy and phacoemulsification is safe and effective in controlling intraocular pressure postoperatively. Determining from the early postoperative examination the long-term pressure control, however, is difficult.

Testicular fate after incarcerated hernia repair and/or orchiopexy performed in patients under 6 months of age

This study assessed testicular viability after 476 inguinal procedures performed in 338 infants under 6 months of age, between 1974 and 1993. One hundred twenty-one elective hernia repairs (contralateral explorations) were compared with 355 hernia repairs complicated by incarceration and/or orchiopexy. Clinical examination of 323 testes in the early postoperative period showed 20 atrophic testes. Since January 1994, 71 of the 338 patients have had testicular measurements obtained through ultrasonography (US). An additional 13 atrophic testes were found during US examination. Of these, nine were believed to be normal during early postoperative examination. Assuming that US examination will confirm atrophy in the 20 atrophic testes noted early in the postoperative clinical evaluation, and that all other testes not yet scanned are found to be normal, the minimal atrophy rate (MAR) would be 9.3% (33 of 355). Neither operative nor early postoperative testicular assessment correlates with ultimate testicular survival. Testicular pathology may become more evident after puberty, and the real incidence of atrophy may increase.