Integrating Endovascular and Operative Intervention in Trauma

2021 ◽  
Vol 267 ◽  
pp. 82-90
Author(s):  
Melike Harfouche ◽  
Hossam Abdou ◽  
Sakib M Adnan ◽  
Anna N Romagnoli ◽  
James R Martinson ◽  
...  
Keyword(s):  
Operative Intervention

Results after Endoscopical Synovectomy Compared to Total Bursectomy in Chronical Bursitis Olecrani

Swiss Surgery ◽  
2000 ◽  
Vol 6 (6) ◽  
pp. 323-327 ◽  
Author(s):  
Schulze ◽  
Czaja ◽  
Linder
Keyword(s):  
Operative Intervention

Die chronische Bursitis olecrani wird primär konservativ therapiert. Bei Therapieversagen ist eine operative Intervention erforderlich. Fragestellung: Vergleich der Ergebnisse nach endoskopischer Synovektomie mit den Resultaten der offenen Bursektomie. Methodik: Nachuntersuchung von neun endoskopisch operierten Patienten und einer konventionell operierten Kontrollgruppe des gleichen Jahres, die nach Alter und Anzahl der Voroperationen übereinstimmen. Zusammenfassung der objektiven und subjektiven Parameter mit dem Score nach Morrey et al. Statistischer Vergleich mit dem Mann-Whitney-U-Test für nicht parametrische Stichproben und dem chi2-Test für Häufigkeitsverteilungen. Diskussion: Beide Patientengruppen zeigten einen hohen postoperativen Zufriedenheitsgrad. Im Score nach Morrey et al. gibt es keinen signifikanten Unterschied (Endoskopiegruppe: 97.11 Punkte vs. Kontrollgruppe: 95.33 Punkte; p = 0.564). Die endoskopisch operierten Patienten erreichen ihre volle Arbeitsfähigkeit signifikant früher (10 d vs.18 d, p = 0.041). Schlussfolgerung: Die endoskopische Synovektomie bei Bursitis olecrani ist eine einfache und sichere Operationsmethode, die zu sehr guten Ergebnissen führt.

Hallux valgus

2019 ◽  
Vol 39 (03) ◽  
pp. 183-187
Author(s):  
Annette Heinze
Keyword(s):  
Hallux Valgus ◽  
Konservative Therapie ◽  
Operative Intervention ◽  
Postoperative Nachbehandlung

ZUSAMMENFASSUNGAufgrund der hohen Prävalenz und der vielschichtigen Ätiologie ist der Hallux valgus ein vieldiskutiertes Thema mit vielen verschiedenen Therapieoptionen. Ziel sowohl operativer als auch konservativer Therapien ist die schmerzfreie Mobilität des Patienten, um eine Verbesserung der Lebensqualität zu erreichen. Eine gute Kommunikation zwischen orthopädietechnischer und ärztlicher Betreuung ist eine Grundvoraussetzung sowohl für die konservative Therapie als auch für die postoperative Nachbehandlung. Bei symptomatischem Hallux valgus ist eine Progression der Fehlstellung ohne operative Intervention zu erwarten. Die konservative Therapie bietet keine ursachenorientierte Therapie, es kann jedoch eine Beschwerdebesserung erreicht werden.

Die konservative Therapie der Arthrosis deformans

2007 ◽  
Vol 27 (04) ◽  
pp. 201-208 ◽  
Author(s):  
Harald Lehnert ◽  
Stefan Rehart ◽  
Michael Walter
Keyword(s):  
Konservative Therapie ◽  
Operative Intervention ◽  
Arthrosis Deformans

ZusammenfassungDieArthrose als schmerzhafte ein Gelenk deformierende Erkrankung ist nicht heilbar. Das Fortschreiten dieser Erkrankung kann durch eine Vielzahl konservativer Behandlungsmethoden herausgezögert werden, bevor endgültig eine operative Intervention, gelenkerhaltend oder als Gelenkersatz, erforderlich wird. Die zur Verfügung stehenden konservativen Behandlungsmethoden, veranlasst durch den Arzt unter Hinzuziehung von Physiotherapeuten oder Orthopädietechnikern werden vorgestellt.

Dringlichkeit von operativen Eingriffen in der Rheumatologie

2012 ◽  
Vol 32 (05) ◽  
pp. 275-283 ◽  
Author(s):  
E. Schenzer-Hoffmann ◽  
L. Gerdesmeyer ◽  
M. Fuerst
Keyword(s):  
Medikamentöse Therapie ◽  
Operative Intervention ◽  
Zervikale Myelopathie

ZusammenfassungDie Planung von Operationen bei Patienten mit entzündlich rheumatischen Erkrankungen stellt eine große Herausforderung dar. Neben den unterschiedlichen zugrundeliegenden rheumatischen Erkrankungen, deren Aktivität und Befallsmuster und nicht zuletzt deren begleitende medikamentöse Therapie, muss großen Wert auf die richtige Terminierung der Operation gelegt werden. Bei Weitem nicht alle rheumaorthopädischen Eingriffe sind als elektive Eingriffe einzustufen. Die Schwierigkeit der richtigen Terminierung besteht auch darin, dass aus einem bestehendem Funktionsdefizit oder einer Schmerz situation nur sehr eingeschränkt auf die Dringlichkeit der anstehenden Operation zu schließen ist: Eine zervikale Myelopathie muss nicht zwingend mit einer fulminanten klinischen Symptomatik einhergehen, die grobe Endoprothesenlockerung an Hüft- und Kniegelenk ist nicht selten schmerzarm, aber mit fatalen Folgen bei zu später operativer Intervention. Dieser Beitrag soll einen Überblick über die Krankheitsbilder beim Rheumapatienten geben, die eine rasche operative Intervention erfordern.

Validation of the Surgical Intervention for Traumatic Injury scale in the pediatric population

2020 ◽  
Vol 26 (1) ◽  
pp. 92-97
Author(s):  
David Dornbos ◽  
Christy Monson ◽  
Andrew Look ◽  
Kristin Huntoon ◽  
Luke G. F. Smith ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Pediatric Population ◽  
Traumatic Injury ◽  
Pediatric Trauma ◽  
Current Method ◽  
Clinical Findings ◽  
Surgical Decompression ◽  
Operative Intervention ◽  
Admission Diagnosis ◽  
Communication Tool

OBJECTIVEWhile the Glasgow Coma Scale (GCS) has been effective in describing severity in traumatic brain injury (TBI), there is no current method for communicating the possible need for surgical intervention. This study utilizes a recently developed scoring system, the Surgical Intervention for Traumatic Injury (SITI) scale, which was developed to efficiently communicate the potential need for surgical decompression in adult patients with TBI. The objective of this study was to apply the SITI scale to a pediatric population to provide a tool to increase communication of possible surgical urgency.METHODSThe SITI scale uses both radiographic and clinical findings, including the GCS score on presentation, pupillary examination, and CT findings. To examine the scale in pediatric TBI, a neurotrauma database at a level 1 pediatric trauma center was retrospectively evaluated, and the SITI score for all patients with an admission diagnosis of TBI between 2010 and 2015 was calculated. The primary endpoint was operative intervention, defined as a craniotomy or craniectomy for decompression, performed within the first 24 hours of admission.RESULTSA total of 1524 patients met inclusion criteria for the study during the 5-year span: 1469 (96.4%) were managed nonoperatively and 55 (3.6%) patients underwent emergent operative intervention. The mean SITI score was 4.98 ± 0.31 for patients undergoing surgical intervention and 0.41 ± 0.02 for patients treated nonoperatively (p < 0.0001). The area under the receiver operating characteristic (AUROC) curve was used to examine the diagnostic accuracy of the SITI scale in this pediatric population and was found to be 0.98. Further evaluation of patients presenting with moderate to severe TBI revealed a mean SITI score of 5.51 ± 0.31 in 40 (15.3%) operative patients and 1.55 ± 0.02 in 221 (84.7%) nonoperative patients, with an AUROC curve of 0.95.CONCLUSIONSThe SITI scale was designed to be a simple, objective communication tool regarding the potential need for surgical decompression after TBI. Application of this scale to a pediatric population reveals that the score correlated with the perceived need for emergent surgical intervention, further suggesting its potential utility in clinical practice.

Reliability of the radiopharmaceutical shunt flow study for the detection of a CSF shunt malfunction in the presence of stable ventricular size

2020 ◽  
Vol 26 (4) ◽  
pp. 364-370
Author(s):  
Jeffrey J. Quezada ◽  
J. Gordon McComb
Keyword(s):  
Ct Scan ◽  
Operative Intervention ◽  
Shunt Malfunction ◽  
Shunt Revision ◽  
Csf Shunt ◽  
Technical Failure ◽  
Ventricular Size ◽  
Shunt Flow ◽  
Programmable Valve ◽  
Flow Study

OBJECTIVEThe authors sought to determine the reliability of a radiopharmaceutical (RP) shunt flow study for the detection of a CSF-diverting shunt malfunction in the presence of stable ventricular size.METHODSAfter the authors obtained IRB approval, all CSF RP shunt flow studies done between January 1, 2014, and January 1, 2019, in pediatric patients at Children’s Hospital Los Angeles were identified. Included in the study were only those patients in whom an MRI or CT scan was done during the hospital admission for shunt malfunction and showed no increase in ventricular size compared with the most recent prior MRI or CT scan when the patient was asymptomatic. Data recorded for analysis were patient age and sex, etiology of the hydrocephalus, shunt distal site, nonprogrammable versus programmable valve, operative findings if the shunt was revised, and follow-up findings for a minimum of 90 days after admission. The RP shunt flow study consisted of tapping the reservoir and injecting technetium-99m DTPA according to a set protocol.RESULTSThe authors identified 146 RP flow studies performed in 119 patients meeting the above criteria. Four of the 146 RP studies (3%) were nondiagnostic secondary to technical failure and were excluded from statistical analysis. Of the 112 normal flow studies, operative intervention was not undertaken in 102 (91%). The 10 (9%) remaining normal studies were performed in patients who underwent operative intervention, in which 8 patients had a proximal obstruction, 1 had a distal obstruction, and 1 patient had no obstruction. Of the 30 patients with abnormal flow studies, symptoms of shunt malfunction subsided in 9 (30%) patients and these patients did not undergo operative intervention. Of the 21 (70%) operated patients, obstruction was proximal in 9 patients and distal in 5, and for 7 patients the shunt tubing was either fractured or disconnected. Regression analysis indicated a significant association between the flow study interpretation and the odds for shunt revision (OR 27, 95% CI 10–75, p < 0.0001). No other clinical variables were significant. The sensitivity of a shunt flow study alone for detection of shunt malfunction in cases with stable ventricular size was the same as a shunt flow study plus an MRI or CT (70% vs 70%), but performing a shunt flow in addition to MRI or CT did increase the specificity from 92% to 100% and the accuracy from 87% to 94%.CONCLUSIONSRP shunt flow studies were of definite value in deciding whether to operatively intervene in patients with symptoms of shunt malfunction in whom no change in ventricular size was detected on current MRI or CT scans compared to scans obtained when the patients were asymptomatic.

scholarly journals Profile and outcome of pediatric intussusception: a 5-year experience in a tertiary care center

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Aqeela J. Madan ◽  
Fayza Haider ◽  
Saeed Alhindi
Keyword(s):  
Seasonal Variation ◽  
Success Rate ◽  
Pediatric Population ◽  
Care Center ◽  
Tertiary Care ◽  
Operative Intervention ◽  
Secondary Outcome ◽  
Lead Point ◽  
Pneumatic Reduction ◽  
Tertiary Center

Abstract Background Intussusception is the most frequent cause of bowel obstruction in infants and toddlers; idiopathic intussusception occurs predominantly under the age of 3 and is rare after the age of 6 years; the highest incidence occurs in infants between 4 and 9 months; the gold standard for treatment of intussusception is non-operative reduction. This research will tackle the problem of pediatric intussusception in our center which is the largest tertiary center in our region. The primary outcome is to study the profile of intussusception; the secondary outcome is to assess the success rate of pneumatic reduction in the center’s pediatric population as well as to study the seasonal variation if present. Results During the study period, eighty-six (N=86) cases were identified, from which 10 cases were recurrent intussusception. Seventy-six (N=76) cases were included from the study period. N=68 (89%) were less than 3 years of age, and only N=2 (3%) were above 6 years. Seasonal variation was not significant; N=69 (91%) patients had successful pneumatic reduction under fluoroscopy while thirteen patients N=13 (17%) needed operative intervention. Conclusion Ileocolic intussusception is one of the most common pediatric surgical emergencies that can be successfully managed non-operatively in our institute; 89% of the cases were below 3 years of age, and no seasonal variation was demonstrated. Operative intervention was required in 13 cases with the main reason being lead point. The fact that the pediatric surgeon performs the reduction might have contributed to a high success rate reaching 91% in our center. This study provides a valuable opportunity for future regional data comparisons and pooled data analyses.

scholarly journals Posterior Cloacal Variant with Clitorolabial Transposition and a Rectoperineal Fistula

2021 ◽  
Vol 09 (01) ◽  
pp. e46-e49
Author(s):  
Niveshni Maistry ◽  
Giulia Brisighelli ◽  
Chris Westgarth-Taylor
Keyword(s):  
Operative Intervention ◽  
Posterior Sagittal Anorectoplasty ◽  
Surgical Team ◽  
Ureteric Reimplantation ◽  
Long Term Follow Up

AbstractWe present a case and discuss the management of a posterior cloacal variant not as yet described in the literature. A 5-week-old infant presented to our institution with a posterior cloacal variant and transposition of the clitoris and labia. After initial radiological investigations, staged operative intervention was performed over a 1-year period. This included an initial laparotomy (with drainage of hydrocolpos and formation of a colostomy), a left ureteric reimplantation and a posterior sagittal anorectoplasty due to a rectoperineal fistula. The child is under continued long-term follow-up by our specialist pediatric surgical team.

Saving private W. H.: The surgical experiences of Dugald Blair Brown (1847–1896): Lieutenant-Colonel, FRCS, Edin., AMD

2021 ◽  
pp. 096777202199517
Author(s):  
Charles DePaolo
Keyword(s):  
Case Studies ◽  
Early Development ◽  
Royal College ◽  
Gunshot Wounds ◽  
Operative Intervention ◽  
Boer War ◽  
Conservative Method ◽  
Military Surgeon ◽  
Preserve Function ◽  
Natural Healing

Dugald Blair Brown, a military surgeon and Fellow of the Royal College of Surgeons, Edinburgh, published twelve papers containing 77 case studies of gunshot wounds that he had treated in the Anglo-Zulu War of 1879 and in the First Anglo-Boer War of 1880–1881. Brown devised a “conservative” method of surgery, the early development of which had been influenced by Thomas Longmore (1816–1895), Joseph Lister (1827–1912), F. J. von Esmarch (1823–1912), and Carl von Reyher (1846–1890). During these conflicts, Brown reacted to surgical practices unsuited to the battlefield and not in the interest of the wounded. One such practice was “expectant” surgery, the practitioners of which dangerously substituted natural healing for immediate wound resection. Brown also criticized “operative” surgeons who, when faced with gunshot wounds of the extremities, expeditiously amputated limbs. Viewing each case as diagnostically unique, Brown tried to salvage limbs, to preserve function, and to accelerate recovery. To achieve these objectives, he used debridement, antisepsis, drainage, nutrition, and limited post-operative intervention.

Sign in / Sign up

Export Citation Format

Share Document