Operative Results In Patients Research Articles

Development and Efficacy of Gasless Reduced-Port Laparoscopic Surgery for Gynecological Diseases.

To evaluate the efficacy of gasless reduced-port laparoscopic surgery (GRP-LS) using a subcutaneous abdominal wall lifting method for gynecological diseases. This study included gasless laparoscopic surgeries performed at our hospital between September 1, 1993 and December 31, 2016. The new GRP-LS technique was compared with the conventional gasless three-port laparoscopic surgery (G3P-LS), based on patient background, operative results in patients treated for laparoscopic myomectomy (LM), laparoscopic ovarian cystectomy (LC), and laparoscopic salpingectomy (LT). Surgeons of the two techniques were categorized by the number of surgeries they had performed, and the number of surgeons and surgeries for each technique were compared. GRP-LS was used in 2,338 cases and G3P-LS in 2,473 cases. GRP-LS was used in 980 LM cases, 804 LC cases, 240 LT cases, and 314 cases for other conditions. The operative time required for GRP-LS was significantly less for LM, LC, LT, and the procedure also had less blood loss for LM and LC than G3P-LS. G3P-LS required a transition to open surgery in 0.69% of cases, whereas GRP-LS showed a very low rate of 0.09%. Sixty-seven of the 78 GRP-LS surgeons (85.9%) had performed fewer than 50 GRP-LSs, and these surgeons performed about half of all surgeries. Eighty-three of the 93 GRP-LS surgeons (89.2%) had performed fewer than 50 G3P-LSs, and these surgeons performed 38.9% of all surgeries. GRP-LS is an effective surgery with few complications and less cosmetic damage and can be easily introduced to novice or inexperienced laparoscopic surgeons.

P-054 Impact of age and correction timing on the progression of testicular dysfunction in patients with grade 3 varicocele

Abstract Study question Does varicocele lead to progressive testicular dysfunction If not corrected and Can patients with long history of varicocele benefit from varicocelectomy? Summary answer Varicocele in older patients have more pronounced effect. Correction at a younger age leads to more significant improvement in testicular function and semen parameters. What is known already Varicocele is present in up to 20% of the general adult male population and is more prevalent in men with primary (40%) or secondary infertility (80%). This clinical condition is mostly asymptomatic but can present with persistent scrotal pain in about 10% of cases. More importantly, varicocele has detrimental effect on testicular function due to several pathophysiologic mechanisms including hyperthermia, tissue ischemia, oxidative stress, and reflux of adrenal metabolites. Microsurgical varicocelectomy is considered the gold standard technique with least side effects compared to other modalities. Varicocelectomy is directly associated with improvements in pain and semen parameters and fertility potential. Study design, size, duration This retrospective study was approved by the ethics committee at Hamad Medical Corporation, Doha, Qatar, and has obtained a waiver of informed consent. Records of 1500 patients undergoing microsurgical subinguinal varicocelectomy between January 2017 and July 2020 were collected. Participants/materials, setting, methods The inclusion criteria were infertile patients who presented with a clinical grade 3 varicocele. Patients who were azoospermic or severe oligozoospermic, had genetic abnormalities or received prior infertility medical treatment were excluded. Also, patients with prior history of varicocelectomy, orchidopexy or exposure to gonadotoxins were also excluded. Patients were divided in 2 groups according to age, <40years and > =40years. The preoperative semen analysis and hormonal profile pre-surgery and 6 months post-surgery were collected. Main results and the role of chance 265 patients met the inclusion criteria and were therefore enrolled for data analysis. 210 patients were <40 years and 55 patients >/=40 years at the time of varicocelectomy. The patients' mean age was 33.8±8 years. Older age was found to be significantly correlated with count (-1.42), total motility (-0.166), progressive motility (-0.193), normal morphology (-0.035), FSH (-0.255) and testosterone (-0.204). Comparing the preoperative results between the groups, older patients (>/=40years) showed significantly lower values of total motility (39% vs 48.5% P = 0.04), progressive motility (7%vs 20% P = 0.0004), FSH (4 vs 3 P = 0.005) and testosterone (14.1 vs 17.1 P = 0.002) compared with younger patients. Compared with pre operative parameters, the post operative results in patients <40years showed significant improvement in sperm concentration (33 vs 26.9 p = 0.009), total motility (55% vs 48.5% p < 0.001) and progressive motility (23.5% vs 20% p = 0.022). However, in patients >/=40years, only progressive motility improved significantly (17% vs 7% p = 0.044). By comparing the post-operative results between the groups, the improvement was significantly better in patients <40years regarding total motility (p = 0.01), progressive motility (p = 0.02) and FSH (p = 0.002). Limitations, reasons for caution Retrospective nature Limited number if cases Wider implications of the findings Varicocele will lead to progressive testicular dysfunction if not corrected at younger age Trial registration number not applicable

Correlation between depressive state and post operative results in patients with cervical laminoplasty using Self-Rating Questionnaire for Depression (SRQ-D)

Correlation between depressive state and post operative results in patients with cervical laminoplasty using Self-Rating Questionnaire for Depression (SRQ-D)

Factors influencing the operative results of displaced intra-articular calcaneal fracture

Objective To determine the factors influencing the results of open reduction and internal fixation for displaced intra-articular calcaneal fracture (DIACF). Methods From May 2009 to June 2013, 80 patients with DIACF involving in 91 feet were treated by open reduction and internal fixation. Mean age was 38.7 years (range, 18-72 years). Patients were grouped according to the possible factors related to the operative results, including the Sanders classification of fracture, quality of fracture reduction, postoperative Bohler angle, width of postoperative calcaneus, and time to surgery after injury. Clinical result was evaluated and compared within each group. Results Mean duration of follow-up was 18.3 months (range, 14-26 months). The clinical results were excellent for 67 feet (74%), good for 12 feet (13%), fair for 7 feet (8%) and poor for 5 feet (5%), which yielded 87% good to excellent results. Good to excellent results in Sanders Ⅱ, Ⅲ and Ⅳ groups reached 94%, 85% and 53% respectively, in quality of fracture reduction≤2 mm and >2 mm groups reached 93% and 30% respectively, in postoperative Bohler angle 14 days groups reached 91% and 43% respectively, in age ≤60 years old and >60 years old groups reached 85% and 88% respectively. Except for the age group, the clinical result differed significantly within group (P<0.05). Conclusions Fracture type, reduction quality, postoperative Bohler angle, width of postoperative calcaneus, time to surgery after injury are the factors influencing on the operative results of patients with displaced intra-articular calcaneal fracture. Thereupon the unfavorable influences should be avoided to improve the operative results. Key words: Calcaneus; Fractures, bone; Treatment outcome; Influential factors

What has changed in surgical treatment of severe aortic stenosis with the advent of percutaneous intervention?

Introduction and ObjectiveTranscatheter aortic valve implantation (TAVI) is an alternative therapeutic approach to patients not considered suitable for surgical aortic valve replacement (SAVR) due to their high operative risk. We sought to assess the impact of TAVI on the profile and operative results of patients with severe aortic stenosis undergoing SAVR. MethodsA total of 214 patients were included, of whom 103 consecutive patients underwent isolated SAVR in 2005 and 111 in 2009. Patients’ demographic and operative data were collected retrospectively. Operative and one-year mortality and morbidity were analyzed. ResultsPatients’ mean age was 70 years, and 56% were female. Following the introduction of a TAVI program, patients undergoing conventional surgery were older, with more comorbidities. Overall 30-day and one-year mortality were 2.8% and 7.0%, respectively. After the introduction of TAVI, the observed mortality rate for SAVR decreased, but not significantly (operative mortality: 3.9% before TAVI vs. 1.8% after TAVI, p=NS; one-year mortality: 10% vs. 4.5%, p=NS). Striking differences were observed in morbidity (operative morbidity: 23.3% before TAVI vs. 13.5% after TAVI, p=0.047, and one-year morbidity: 20.4% vs. 9.9%, p=0.032). ConclusionsSince the introduction of a TAVI program at our center, the number of patients undergoing SAVR has increased, with a slight rise in surgical risk, but without worsening the final operative results. The implementation of a TAVI program has thus had a positive impact on the volume of procedures, patient selection and outcomes in SAVR.

Cirurgia cardíaca na estenose aórtica severa: o que mudou com o advento do tratamento percutâneo?

Introduction and objectiveTranscatheter aortic valve implantation (TAVI) is an alternative therapeutic approach to patients not considered suitable for surgical aortic valve replacement (SAVR) due to their high operative risk. We sought to assess the impact of TAVI on the profile and operative results of patients with severe aortic stenosis undergoing SAVR. MethodsA total of 214 patients were included, of whom 103 consecutive patients underwent isolated SAVR in 2005 and 111 in 2009. Patients’ demographic and operative data were collected retrospectively. Operative and one-year mortality and morbidity were analyzed. ResultsPatients’ mean age was 70 years, and 56% were female. Following the introduction of a TAVI program, patients undergoing conventional surgery were older, with more comorbidities. Overall 30-day and one-year mortality were 2.8% and 7.0%, respectively. After the introduction of TAVI, the observed mortality rate for SAVR decreased, but not significantly (operative mortality: 3.9% before TAVI vs. 1.8% after TAVI, p=NS; one-year mortality: 10% vs. 4.5%, p=NS). Striking differences were observed in morbidity (operative morbidity: 23.3% before TAVI vs. 13.5% after TAVI, p=0.047, and one-year morbidity: 20.4% vs. 9.9%, p=0.032). ConclusionsSince the introduction of a TAVI program at our center, the number of patients undergoing SAVR has increased, with a slight rise in surgical risk, but without worsening the final operative results. The implementation of a TAVI program has thus had a positive impact on the volume of procedures, patient selection and outcomes in SAVR.

Lost in calculation: the Clinical SYNTAX score goes logistic

This editorial refers to ‘Combined anatomical and clinical factors for the long-term risk stratification of patients undergoing percutaneous coronary intervention: the Logistic Clinical SYNTAX score’, by V. Farooq et al., doi:10.1093/eurheartj/ehs295 Cardiothoracic surgery pioneered the use of risk models in the reporting of operative results of patients referred to myocardial revascularization. Recently, interventional cardiology has rekindled its interest in constructing specific scores for long-term risk prediction of percutaneous coronary intervention (PCI). One of them, dubbed the SYNTAX score, is a successful model with website dissemination and extensive validation, in which the final score is calculated after coronary angiography by summing the scorings assigned to each individual lesion.1 Inherent limitations of the SYNTAX score, such as the lack of clinical or ischaemia information, have lately prompted its integration into more sophisticated algorithms with increased prognostic accuracy.2 There are two ways in which a prognostic model may be useful in clinical decision-making. First, it may be collapsed by tertiles or arbitrary cut-offs to classify patients into risk categories. This knowledge assists in defining the threshold for a procedure and contributes to better resource allocation. Secondly, it can be used to estimate the prognosis of individual patients. These methods may be perceived as two ways to look at the same information, but they differ significantly. For instance, consider a category-based score (i.e. the SYNTAX score) which predicts that 19.2% of patients in the high-risk group will be deceased at 5 years from complex PCI. This model implies that among a large population of patients undergoing complex PCI, ∼19% of those categorized in the high-risk group will be dead after 5 years. Owing to the typical stochastic and time-dependent nature of prognostic models, classification into risk strata is frequently …

Results of one-hundred and seventy patients after elective Bentall operation

The aim of this study was to evaluate the short and long-term operative results of patients who underwent a Bentall procedure in a 12-year period. We retrospectively analyzed the data of 170 patients who underwent an elective Bentall procedure between January 1998 and July 2010. All pre- and perioperative variable were entered into a multivariate regression model to identify significant predictors of early and late mortality. The early mortality rate was 11.2% (19/170 patients). Multivariate logistic regression analysis identified prior cardiac operation and cardiopulmonary bypass time as independent risk factors for early mortality, with odds ratios of 5.75 (95% confidence interval: 1.850-17.874; p=0.003) and 1.011 (95% confidence interval: 1.003-1.019; p=0.008), respectively. The Kaplan-Meier curve shows an overall survival of 78%±4% at 5 years and 66%±10% at 10 years. Cox regression analysis revealed no independent risk factors for late mortality. The Bentall procedure is still the procedure of choice for aortic root replacement. Improvements in perioperative management in recent years has improved the early outcome, and in our experience, the late results of this technique were satisfactory.

Duration of sciatica for contained and noncontained lumbar disc herniation: a retrospective study

The objective of this study is to examine the relationship between the duration of sciatica and morphological difference of disc, and to determine the effect of these two factors on the operative results in patients with lumbar disc herniation. Thirty-two patients who were followed for more than 1 year after nucleotomy for lumbar disc herniation at our hospital constituted the base of this study. Patients were divided into three groups by the duration between onset of symptoms and operation. Group A: patients receiving operation within 3 months of onset of symptoms; Group B: from 4 to 11 months after symptom onset; Group C: more than 12 months after symptom onset. Severity of symptoms and operative results were evaluated using JOA scores. JOA scores were not different significantly among three groups at one-year follow-up. However, rate of patients with contained disc was higher in these with longer preoperative duration. In the subsegment analysis, these of 32 patients were divided into two groups, 13 patients with contained disc and 19 patients with noncontained disc. JOA scores before operation were more severe in the noncontained group than in the contained group; however, JOA scores were not different between the groups one-year after operation. In conclusion, it seems that the duration of symptoms is unlikely to influence operative results. Patients with non-contained disc generally had more severe symptoms and thus received operation earlier than patients with contained disc, however, operative results showed no significant difference between patients with contained disc and noncontained disc.

Cardiac function before operation affects operative results in patients with hip fractures

Cardiac function before operation affects operative results in patients with hip fractures

Invited Commentary

The selection of patients aged older than 80 years as candidates for cardiac operations remains a multifactorial issue. Not only are there the obvious cardiac pathology factors that dictate the technical feasibility of the operation, there are also numerous studies that have identified important comorbidities that contribute to operative mortality and postoperative morbidity. The increased mortality and morbidity for octogenarians, plus their limited life expectancy, has created an important third factor to be considered before offering cardiac procedures to someone older than 80, namely, the presence of symptoms. The diminished life expectancy of octogenarians makes prolongation of life relatively less important and improvement in quality of life relatively more important than it is in younger patients. Unfortunately, the study by Rohde and colleagues [1Rohde S.L. Baker R.A. Tully P.J. Graham S. Cullen H. Knight J.L. Preoperative and intraoperative factors associated with long-term survival in octogenarian cardiac surgery patients.Ann Thorac Surg. 2010; 89: 105-111Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar] mentions nothing about the indications for operation, nor do they describe the quality of life for those who survived. Survival should not be the only benchmark used to assess operative results in patients over 80 years of age. In addition, there is no actual documentation of operative survival. A patient first needs to be a short-term survivor to become a long-term survivor. Their study was directed at determining the effect of comorbid conditions and intraoperative factors on long-term survival, which they found lacking in previous studies. The authors were able to confirm important comorbidities identified in other studies, including increasing age, hypercholesterolemia, impaired left ventricular ejection fraction, and elevated creatinine. Only prolonged cardiopulmonary bypass time proved to be an intraoperative predictor, but the authors were missing important intraoperative data during the early years of the study. Even if other intraoperative variables had been identified as predictors of poorer long-term survival, how can a surgeon use that information prospectively (ie, preoperatively) to assess operative risk and thus influence patient selection? Identifying intraoperative risk factors that one could alter might influence subsequent operative risk, but it would seem to be of limited value in preoperative patient selection. As cardiac surgeons join the effort to define and improve quality of care, cardiac operations in octogenarians remain a fruitful field of investigation because the increased mortality and morbidity make the evaluation of new approaches easier to assess with smaller numbers of patients. Given the relatively higher expense for limited years of improved survival and quality of life, this cohort will certainly be a focus of attention in the growing debate to limit health care costs. Preoperative and Intraoperative Factors Associated With Long-Term Survival in Octogenarian Cardiac Surgery PatientsThe Annals of Thoracic SurgeryVol. 89Issue 1PreviewThe proportion of octogenarians undergoing cardiac surgery is increasing though few studies have examined the simultaneous impact of preoperative and intraoperative factors on long-term survival in this age group. This study aimed to describe the preoperative clinical and demographic characteristics associated with long-term mortality risk and determine whether intraoperative factors related to surgical and cardiopulmonary bypass techniques impacted upon these. Full-Text PDF

Laparoscopic surgery in rectal cancer: a retrospective analysis

Laparoscopic resection for the cure of rectal cancer is still a matter of debate. Laparoscopic approach is more complex and with a long learning curve, which may results in an increase in morbidity and mortality. This study aimed to retrospectively analyze the impact of laparoscopic resection for rectal cancer on operative outcome of a hospital in a developing country. All patients presenting with rectal cancer surgically managed by laparoscopic approach were enrolled. Exclusion criteria were total coloproctectomy, palliative procedures, and metastatic disease. The following parameters were accessed: general characteristics, technical details, mortality, and the outcome. From January 2000 to January 2008, 60 patients with histologically proven rectal cancer were enrolled, and 43 were excluded. Mean age, 58.5 +/- 15.9 years. A 76.6% of patients had cancer-advanced stages. There were 20 anterior resections, 31 abdomino-perineal resections, and nine pull-through procedures. Conversion rate was 3.3%, and there had 3.3% of operative complications. No procedure-related death. With the mean follow-up of 33 months, 77.8% patients are alive and disease-free, 5.6% are alive with disease: distant metastasis in 2.8%, and local recurrence in 2.8%. About 16.7% have died from cancer-related causes. No port site or wound metastasis have occurred. This study showed the favorable short-term operative results in patients who underwent laparoscopic resection for rectal cancer. The low conversion rate of 3.3%, 3.3% complication rate, and 0% of a 30-day mortality attributed to confirm the feasibility of laparoscopic approach in the surgical treatment of rectal cancer.

LONG-TERM RESULTS OF MICROSURGICAL TREATMENT OF LUMBAR SPINAL STENOSIS BY UNILATERAL LAMINOTOMY FOR BILATERAL DECOMPRESSION

Laminectomy and bilateral laminotomy are the standard procedures for decompression of lumbar spinal stenosis (LSS). With the aim of less invasiveness and better preservation of spinal stability, the technique of unilateral laminotomy for bilateral decompression (ULBD) was developed. However, limited follow-up data exist to determine the efficiency and outcome of ULBD. Therefore, the authors present their 10-year experience with ULBD and postoperative long-term results. One hundred thirty-three consecutive patients (73 men and 60 women; mean age, 63 yr) meeting clinical and radiographic criteria for LSS who underwent first-time ULBD between 1994 and 1999 entered the study. The study parameters were set to ensure a follow-up period of at least 4 years. All patients were available for short-term follow-up re-evaluation within 3 months, and 102 (77%) of the 133 patients were available for long-term examination after a mean duration of 5.6 years. The scale of Finneson and Cooper was used for evaluation of the clinical results. One hundred thirty patients (97.7%) improved immediately after surgery. Ninety-four (92.2%) of the 102 patients available for long-term follow-up examination remained improved, and 85.3% had an excellent-to-fair operative result. The incidence of complications was 9.8%. Resurgery for complication was necessary in three patients, for restenosis in seven patients, and for spinal instability in two patients, accounting for a reoperation rate of 11.8%. ULBD allows achievement of good and long-lasting operative results in patients with LSS. Postoperative deterioration, recurrences, and spinal instability are infrequent. For the authors, ULBD is the preferred technique to treat symptomatic LSS.

Outcome after Lateral Pancreaticojejunostomy in Patients with Chronic Pancreatitis Associated with Pancreas Divisum

In order to evaluate surgical outcome after lateral pancreaticojejunostomy (LPJ) in patients with pancreas divisum (PD), we compared the operative results in patients who underwent LPJ for PD with those who underwent LPJ for other causes of chronic pancreatitis. The records of 129 patients who underwent LPJ for chronic pain associated with chronic pancreatitis from 1995 through 2001 were retrospectively reviewed and analyzed. There were 21 patients (11 men, 10 women, mean age 40 years) who had PD as a cause of chronic pancreatitis. The remaining 108 patients (58 men, 50 women, mean age 48 years) had chronic pancreatitis of other etiologies. The two groups had a similar stage of disease progress measured by incidence of pancreatic duct strictures, terminal biliary stenosis, pseudocysts, insulin dependency, need for pancreatic enzymes, and symptom duration. There was no difference in operative time (200 +/- 13.3 vs. 206 +/- 6.1 minutes) or intraoperative blood loss (200 vs. 300 mL) comparing the PD to the other group. The overall postoperative morbidity (14% vs. 23%) and mortality (0% vs. 2%) were not significantly different in PD versus other group comparison. Hospital length of stay was similar in both groups (7.0 +/- 2.4 vs. 8.0 +/- 1.3 days). In the PD group 10 per cent required reoperation with pancreatic resection for failure of LPJ to improve chronic pain versus 9 per cent in the other group. Comparison of patients who undergo LPJ for PD with those who undergo LPJ for other etiologies showed no significant difference in failure rates as measured by the need for reoperation. Postoperative morbidity and mortality were similar in both groups. Failure of LPJ in patients with PD may be related to factors associated with failure of LPJ in management of chronic pancreatitis of other causes. This includes inadequate drainage of the head of gland, failure to drain small ducts, and perineural inflammation.

高齢者頚部脊髄症に対する脊柱管拡大術の検討

We studied elderly patients over 70 years old who underwent laminoplasty for cervical spondylotic myelopathy. Operations were performed on 21 patients over 70 years old at the time of operation from 1995 at the Kumamoto City Hospital. These patients were reviewed and compared with patients below 69 years old in this study. Clinical results were evaluated by the Japanese Orthopaedic Association scoring system. The operative results of patients over 70 were not significantly different from those of patients below 69. But we found that the recovery of the lower motor function of elderly patients was apparently worse than that of younger patients statistically.

Retrospective analysis of long-term surgical results in acromegaly: preoperative and postoperative factors predicting outcome.

Sixty-one of 83 patients with acromegaly treated between 1969 and 1993 were analysed retrospectively to clarify which early postoperative factors were significant predictors of a successful long-term outcome and which preoperative factors significantly influenced the early postoperative results. Of the 61 patients, 30 were operated on before 1987 and 31 afterwards. A successful long-term surgical outcome was defined as a long-term mean basal GH level < 6 mU/l (comparable to < 3 micrograms/l), a normal IGF-I level, and normal GH dynamics. Overall, 59% of patients (37% before 1987 and 81% after) had an early postoperative mean basal GH level < 6 mU/l, and 56% (29% before 1987 and 77% after) met all three of the specified criteria for a successful long-term surgical outcome. Statistical analysis confirmed that GH dynamics and postoperative mean basal GH level < 6 mU/l were significant predictors of the long-term surgical outcome, whereas the postoperative IGF-I level alone was not. On the other hand, abnormal preoperative GH dynamics were normalized in all patients with a postoperative mean basal level < 6 mU/l. In addition, there were no patients showing an unsuccessful long-term outcome in those associated with both the early postoperative mean basal GH level < 6 mU/l and normalization of the IGF-I level. Therefore, measurement of the early postoperative mean basal GH level and the IGF-I level may be an economical and simple guide to predict the long-term surgical outcome. Moreover, multivariate analysis indicated that cavernous sinus invasion was an independent significant factor influencing the early postoperative outcome. Successful long-term surgical outcome may be predicted if early postoperative mean basal GH level is reduced to < 6 mU/l (< 3 micrograms/l) and IGF-I level becomes normal. This study also confirms that early diagnosis and treatment by an experienced endocrinologist and neurosurgeon can improve the operative results in patients with acromegaly.

破裂脳動脈瘤症例の治療成績

破裂脳動脈瘤症例の治療成績

Radical Pancreatectomy for Pancreatic Cancer in the Elderly

Surgical resection provides the only potential cure for pancreatic cancer, yet resection in patients 70 years of age and older remains controversial because of presumed increased morbidity and mortality. Our aim was to determine the operative results in patients 70 years of age or older undergoing potentially curative radical pancreatic resection for pancreatic cancer from 1982 through 1987. Of 206 consecutive patients explored for potential resection, 42 patients (mean age, 75 years) had potentially curative procedures, including radical pancreaticoduodenectomy in 23 patients, total pancreatectomy in 8 patients, and distal pancreatectomy in 11 patients. Ductal adenocarcinoma was the most frequently encountered neoplasm (69%), but cystadenocarcinoma and islet cell carcinoma accounted for 12% and 7%, respectively. The overall operative mortality rate was 9%, while surgical morbidity was 28%, and medical morbidity was 12%. Overall median survival was 19 months, and 5-year survival was 4%. Despite the low overall incidence of resectability and postoperative cure rate for pancreatic carcinoma, exploration for potential curative resection should not necessarily be withheld for healthy, selected patients who are older than 70 years. Morbidity and mortality rates, although slightly greater than for patients who are older than 70 years, are acceptable.

高齢者の頚椎疾患に対する手術療法の検討

The operative results in patients with cervical disorders were assessed retrospectively in a sample of 89 patients over 65 years old. Anterior body fusion was performed in 43 patients, cervical enlargement in 22 patients and laminectomy in 20 patients. Most of them had suffered from myelopathy due to cervical spondylosis, O. P. L. L, and upper cervical disorders.Results of anterior body fusion and cervical enlargement were better than those of laminectomy. But patients managed by laminectomy were worse in condition of cervical myelopathey preoperatively.Almost all patients improved. There were nomortalities.There were coexisting medical problems such as hypertension, ischemic heart disease, etc. We could control them well. Neurological symptoms in thoracic and lumbar spine and osteoarthritis of the knee and hip joint often coexisted. In some cases. Who had laminectomy of thoracic or lumbar spine, TKR and THR were performed.Halo-vests were applied to all patients to start early sitting, walking and rehabilitation.Proper patient selection for surgery and proper operative methods for treatment are mandatory with recognition of all risk factors during and after operation.

Operative Results in Patients with Pseudotruncus Arteriosus

Total repair was carried out in 18 patients with pseudotruncus arteriosus. Age at the time of operation ranged from 1 to 25 years and averaged 9 years. Operative methods were transannular patch reconstruction for the relief of pulmonary atresia in 4 patients (no deaths) and reconstruction with a valved external conduit from the right ventricle to the pulmonary arteries in 14 patients (5 deaths). The overall operative mortality was 28%. An average cross-sectional area of the right and left pulmonary arteries ( ▪ area) was calculated using angiograms and compared with the cross-sectional area of the normal right pulmonary artery (N-rPA area) in all patients. The ▪ area ranged from 0.06 to 2.60 cm 2 and averaged 1.02 cm 2; the ▪ area/N-rPA area ratio ranged from 0.03 to 1.05, with an average of 0.54. Three patients who died of hypoplastic right and left pulmonary arteries had a ▪ area/N-rPA area ratio less than 0.20. These patients had a right-to-left ventricular peak systolic pressure ratio (pRV/LV) greater than 1.0 after total repair. Fifteen patients had a ▪ area/N-rPA area ratio greater than 0.20, and 13 survived corrective procedures. One patient died of lung edema, which was due to failure to ligate the large bronchial collateral artery properly, and the other died of pulmonary vascular obstructive disease. Our results show that a ▪ area/N-rPA area ratio greater than 0.20 is a necessity in performing total repair of pseudotruncus arteriosus.