Postoperative Clinical Assessment Research Articles

Resurfacing of atrophic facial acne scars with a high-energy, pulsed carbon dioxide laser.

Treatment of atrophic acne scars has been limited to the use of such traditional treatments as dermabrasion and chemical peels for many years. Recently, the addition of high-energy, pulsed carbon dioxide (CO2) lasers to the treatment armentarium has created renewed enthusiasm for cutaneous resurfacing due to their ability to create specific thermal injury with limited side effects. To determine the effectiveness of a high-energy, pulsed CO2 laser in eliminating atrophic facial scars and to observe for side effects. Fifty patients with skin phototypes I-V and moderate to severe atrophic facial acne scars were included in the study. Each patient received one high-energy, pulsed CO2 laser treatment using identical laser parameters by the same experienced laser surgeon. Baseline and 1-, 4-, 8-, 12-, and 24-week postoperative photographs and clinical assessments were obtained in all patients. Textural analysis of skin before and after laser irradiation were obtained in 10 patients to confirm clinical impressions. Clinical evaluations were conducted independently by two blinded assessors. There was an 81.4% average clinical improvement observed in acne scars following laser treatment. Skin texture measurements of laser-irradiated scars were comparable to those obtained in normal adjacent skin. Side effects were limited to transient hyperpigmentation lasting an average of 3 months in 36% of patients. Prolonged erythema (2 months average) was usual and considered to be a normal healing response. No hypertrophic scarring was observed following laser treatment. High-energy, pulsed CO2 laser treatment can safely and effectively improve or even eliminate atrophic facial scars and provides many benefits over traditional treatment methods.

The modified Pereyra (Raz) procedure for genuine stress incontinence—A useful option in the elderly or frail patient?

This is a prospective uncontrolled observational study to assess the modified Pereyra procedure for the treatment of genuine stress incontinence in women over the age of 65. Fifty women with proven genuine stress incontinence had pre- and postoperative clinical and urodynamic assessment with a follow-up for up to 2 years. At 2 months there was a subjective cure rate of 64% and an objective cure rate of 46%. The 2-year objective cure rate was 46%. The operation produced no voiding difficulties. Results were poorer in those who had had previous surgery, had preoperative detrusor instability, or were nulliparous. We conclude that the modified Pereyra may be recommended for parous patients without previous bladder neck surgery. Other patients may be more appropriately dealt with by a colposuspension, sling or periurethral collagen.

Computer assisted CT-guided stereotactic transplantation of foetal ventral mesencephalon to the caudate nucleus and putamen in Parkinson's disease.

We report our preliminary results related to CT-guided stereotactic transplantation of foetal ventral mesencephalic cell suspension into the striatum of five patients with idiopathic Parkinson's disease. The mean age was 51 years, the evolution time of the disease ranged from 7 to 14 years, and all of them had motor complications associated with chronic L-dopa therapy. The patients were evaluated according to the Core Assessment Program for Intracerebral Transplantations (CAPIT) for one year before and three months after surgery. The postoperative clinical assessment demonstrated significant improvement of neurological symptoms and reduction of daily L-dopa dosage.

Value of gait analysis in the assessment of surgery in cerebral palsy.

Twenty-three ambulatory children with cerebral palsy were assessed preoperatively by a detailed clinical examination and by gait analysis using a video-based gait analysis system (VICON). Surgery was then performed based on either the clinical assessment alone or a combination of clinical evaluation and gait analysis. About one year after surgery, a postoperative clinical and gait analysis assessment was performed. Sixteen children had improved and seven children had not improved after surgery. Most of the children who had not improved were found to have had operations that differed from those recommended by gait analysis. Dynamic EMG studies were found to be useful in preoperative planning but did not show any consistent improvement even in the children with good results. The combination of a careful clinical assessment and gait analysis can produce better results in surgery for children with cerebral palsy.

Aetiological factors in stress urinary incontinence in nulliparous women

SummaryThe causes of stress urinary incontinence due to urethral sphincter incompetence, other than parity, were studied in a group of 26 nulliparous women undergoing colposuspension, and compared with a group of age-matched parous women also undergoing colposuspension. Pre-and postoperative clinical and urodynamic assessment was performed. Of the paired groups, 10 were premenopausal and 16 postmenopausal. There was a higher incidence of obesity in premenopausal nulliparous patients compared with the parous patients. There were no differences in the other factors causing raised intra-abdominal pressure, such as chronic cough and constipation, between the two groups. These factors are usually thought to contribute to the aetiology of stress incontinence.

Management of neurovascular complications in extended skull base surgery.

Combined oncologic approaches to the skull base now permit resection of extensive basicranial neoplasms. Despite advances in microsurgical techniques, disabling or life-threatening complications are still encountered in such surgery. Successful management of these sequelae is dependent upon meticulous intraoperative care and compulsive postoperative clinical assessment. Perioperative neurovascular complications were recorded in 154 consecutive skull base procedures. The most frequent severe complication was cerebral edema, which occasionally required surgical intervention. Dysphagia was the most common complication noted in the late postoperative period. Based upon this review, the management and methods found to minimize the incidence of various perioperative neurovascular complications related to extended skull base surgery are described.

Symptomatic and urodynamic evaluation of patients undergoing prostatectomy.

FORTY patients with clinical evidence of bladder outflow obstruction requiring prostatectomy were followed prospectively with preoperative and post-operative clinical and urodynamic assessment. Thirty-five patients were cured or significantly improved by surgery. Of the five remaining patients, three developed strictures and two had continuing symptoms of detrusor instability. Cystometry did not predict the patients who had continuing symptoms of detrusor instability. A high urinary flow rate in the presence of symptoms of detrusor instability predicted a poorer outcome. It is suggested that patients with symptoms of detrusor instability should have urinary flow rates measured before preceding to prostatectomy.

Assessment of spinal cord injury by counting corticospinal and rubrospinal neurons

This paper describes an objective, quantifiable technique for assaying the degree of severity of spinal cord injury. Twenty-one rats underwent a C 7-T 1 laminectomy: 12 received a C 8 spinal cord clip compression injury with forces of either 2.3, 16.9 or 53.0 g; 4 had cord transection at C 8, and 5 had no cord lesion. Postoperative clinical neurological assessment was performed by the inclined plane method. At 4 weeks, the spinal cord-injured rats underwent a T 10 transection and insertion of a Gelfoam pledget impregnated with horseradish peroxidase (HRP). HRP was similarly administered to 9 normal rats. Longitudinal sections of the spinal cord encompassing the injury site were stained with Luxol fast blue, and coronal sections from the cerebrum and midbrain were processed for HRP reactivity with tetramethylbenzidine. Labelled corticospinal and rubrospinal neurons were counted in every 6th section to derive a cortical score (CS) and a red nucleus score (RNS) for each animal. The CS reflected the extent of the pathological changes at the site of cord injury and the In CS decreased linearly with increasing injury severity (P < 0.0001). In contrast, the RNS was only reduced in animals with severe (53.0 g) cord injuries (P < 0.0006). The degree of preservation of the dorsal columns including the corticospinal tracts at the injury site correlated with the CS, whereas the RNS was related to the degree of preservation of the lateral columns. Counts of rubrospinal neurons, but not corticospinal neurons, correlated closely (r = 0.96, P < 0.001) with the inclined plane results, suggesting the importance of non-pyramidal tracts in controlling gross motor function. Thus, counting corticospinal and rubrospinal neurons is an objective, reliable test of the severity of experimental spinal cord injury.

Diverticular disease (adenomyomatosis) of the gallbladder: a radiological-pathological survey.

Seventy consecutive gallbladders removed at surgery were examined radiologically and pathologically. Fifteen (21%) of the operative specimens showed naked-eye changes of adenomyomatosis. The main conclusions drawn from this study are that this abnormality is present in a much higher proportion of gallbladders removed at surgery than is generally realised, and that the pathogenesis is primarily an abnormality of muscle contractions, with a strong similarity to diverticular disease of the colon. Diverticular disease of the gallbladder might well be the most appropriate name for this condition. The results of a post-operative clinical assessment of patients with diverticular disease are also presented. But this represents a small number of patients and larger, perhaps multicentre, surveys would be required in order to assess the clinical significance of this interesting abnormality.

Long term results of radical hypophysectomy for Cushing's disease.

Sixteen consecutive cases of Cushing's disease were treated by radical transphenoidal hypophysectomy. Surgical removal was not possible in two cases. Of the other 14, there was total clinical and biochemical remission of the disease in 13 and partial remission in one. Some form of replacement therapy has been necessary in 11 out of the 14 cases. During a long period of postoperative clinical and biochemical assessment extending over 5-14 years (average 8 years) there have been no recurrences.

Dorsal Spinal Cord Stimulation in the Treatment of Multiple Sclerosis

Previously published work indicated significant improvement in the symptoms of multiple sclerosis with dorsal spinal cord stimulation. In this study 23 patients with multiple sclerosis documented by history, examination, laboratory studies, and clinical course were treated with dorsal spinal cord stimulation and followed for 19 to 45 months (mean, 32 months). Pre- and postoperative clinical assessment was carried out using the Kurtzke Scale. Walking velocity, upper limb coordination, sphincter function, and sensory function were also evaluated quantitatively. No statistically significant objective improvement in any of these measures was demonstrated. Fifty per cent of the patients initially reported subjective symptomatic improvement, but this declined to 30% at last follow-up. Fifteen of 23 patients experienced complications related mainly to the hardware used and required a total of 21 subsequent operative procedures for correction of these complications. These results do not support the continued clinical use of dorsal spinal cord stimulation in the symptomatic treatment of multiple sclerosis.

Detrusor instability following surgery for genuine stress incontinence.

Nnety-two female patients with genuine stress incontinence, and with otherwise normal bladder function, were treated by a colposuspension operation. Pre-operative and post-operative clinical and urodynamic assessments were performed on all patients. Following surgery 17 of them were found to have detrusor instability.

Late postoperative clinical and hemodynamic assessment of the early cloth-covered Starr-Edwards mitral valve prosthesis

Despite large gradients at rest and exercise across the Model 6300 Starr-Edwards valve, patients in whom it has been inserted have generally had an improvement in functional class and a decrease in heart size; in addition, the heart usually has been successfully maintained in sinus rhythm. The clinical improvement observed in patients with mitral stenosis most probably is a result of an increase in orifice area to above the critically obstructive range, producing a rise in cardiac output. In patients with mitral insufficiency a relatively competent valve is provided; this also may engender an increase in cardiac output. Nevertheless, the calculated orifice area of this prosthetic valve indicates that it may produce a moderate-to-severe degree of obstruction to blood flow. Therefore, in significantly symptomatic patients, replacement of this less than ideal prosthesis should be considered.

Isolated hypertrophic obstruction to right ventricular outflow: Clinical, hemodynamic, and angiographic findings before and after operative treatment

A child is described in whom the familial form of idiopathic hypertrophic cardiomyopathy caused isolated and severe obstruction to right ventricular outflow, accompanied by progressive angina pectoris. The obstruction, which resulted from massive hypertrophy of the crista supraventricularis and interventricular septum, was treated by resection and prosthetic enlargement of the right ventricular outflow tract. The results of pre- and postoperative clinical, hemodynamic, and angiographic assessments are summarized.

A LATE EVALUATION OF FLEXIBLE TEFLON PROSTHESES UTILIZED FOR TOTAL AORTIC VALVE REPLACEMENT: Postoperative Clinical, Hemodynamic, and Pathological Assessments

SUMMARY Postoperative clinical and hemodynamic assessments of valve function were carried out in 23 patients surviving total replacement of the aortic valve with flexible Teflon fabric prostheses. Satisfactory valve function’ was indicated in 21 of 23 patients by left heart catheterizations performed 1 to 7 months after operation; only trivial systolic gradients and normal arterial diastolic pressures were recorded. Subsequently, severe aortic regurgitation developed in 13 patients, leading to death or necessitating reoperation. Examinations of the Teflon valves removed at operation or autopsy revealed stiffening and calcification of the fabric, and regurgitation resulted from tearing of the leaflets and/or disruption of their lines of attachment. Since failure of the Teflon aortic prostheses resulted from unsatisfactory material, rather than from improper design, continuing study of this aspect of flexible valves appears indicated.