Prediction Of Surgical Outcome Research Articles

Differential effects of advanced age on neurologic and cardiac risks of coronary artery operations

Two thousand patients undergoing coronary artery bypass grafting with cardiopulmonary bypass were prospectively studied to compare the influence of age on the incidence of neurologic, cardiac, and other complications. Postoperative neurologic events were found in 56 (2.8%) patients, with an incidence in patients > or = 75 years (8.9%) more than twice that of patients 65 to 74 (3.6%) and nine times larger than in patients < 65 (0.9%). Cardiac complications did not differ between age groups except for low cardiac output state, which occurred 1.7 times more frequently in patients > or = 75 years compared with those < 65. Patients with postoperative neurologic events had a ninefold increase in mortality--35.7% versus 4.0%. Logistic regression analysis demonstrate the most important predictors of a postoperative neurologic event to be age, preoperative neurologic abnormality, recent myocardial infarction, and duration of cardiopulmonary bypass. The risk of neurologic complications increases disproportionately to the risk of cardiac complications in the elderly undergoing coronary artery bypass grafting with cardiopulmonary bypass. Despite neurologic improvement (32 of 56 patients), a postoperative neurologic event was second only to low cardiac output state as the postoperative complication most highly associated with in-hospital death. These results are important for decisions regarding selection of candidates for coronary artery bypass grafting and for prediction of surgical outcome.

Prolactin Dynamics and Tumour Size in the Prediction of Surgical Outcome for Prolactinoma

Each of 62 females were studied for a period of between two and 72 months (mean 36 months) following the removal of a prolactinoma by transsphenoidal pituitary surgery. Our aims were to define the relationships between pre- and post-operative features, the operative findings and the functional outcome. Pre-operative serum prolactin (PRL) concentrations correlated with tumour diameter (r = 0.55, p less than 0.001). Following surgery two groups of patients were identified: Group 1, 46 spontaneously and regularly menstruating patients and Group 2, 16 patients with persistent amenorrhoea. The patients in Group 1 had significantly lower pre-operative and post-operative serum (PRL) concentrations (p less than 0.02 and p less than 0.001 respectively) and significantly greater PRL responses to thyrotrophin releasing hormone (TRH) and metoclopramide stimulation after surgery (p less than 0.001). There was not a significant difference in tumour size between the groups. Forty-four (96 per cent) of the patients in Group 1 had normal post-operative serum PRL concentrations within one week of surgery. By comparison (p less than 0.001) only 42 and 20 per cent respectively of Group 1 patients who were tested had normal TRH and metoclopramide evoked PRL secretion following surgery. Return of regular menstruation was associated with cessation of galactorrhoea in 44 patients (96 per cent) and ovulation occurred in 37 of 38 menstruating patients for whom data are available. All patients with normal TRH and metoclopramide stimulation tests menstruated spontaneously. Nevertheless most patients who menstruated did so in spite of retaining suppressed PRL responses. Of 46 patients followed to date whose serum PRL was normal one week after surgery, seven later were found to have an elevation of serum PRL outside the normal range but in only two has this been persistent. We suggest that a single measurement of serum PRL one week following transsphenoidal pituitary surgery for prolactinoma provides a good basis for deciding about the future management of patients who desire menstruation and pregnancy.

Diagnosis of "renal" hypertension and prediction of surgical outcome. Application of supplementary renal tests to confirm a positive screening survey.

THIS SUBJECT has created intense interest and diverse opinions recently among those who treat patients having hypertension and disorders. Part of the interest may be attributed to rapid advances in diagnostic and surgical procedures. This is especially true of renal-vascular lesions responsible for the stimulus of hypertension. When the proper method of investigation is carried out, a higher incidence of arterial lesions is found than formerly thought. These lesions include atherosclerotic plaques, thrombosis, aneurysm, fibrosis, and arteriovenous fistula. The parenchymal lesions of unilateral pyelonephritis, infarct, cyst, tumor, and hydronephrosis continue to account for 2% of the causes of remedial hypertension. Many investigators place great emphasis upon 1 or 2 diagnostic tests for the evaluation of renal hypertension. Their application may be advocated out of proportion to actual value. Thus many equally valuable diagnostic procedures may receive inadequate attention. With our incomplete knowledge of the etiology of