Abstract:
BACKGROUND:Because the abdominal insufflation and desufflation associated with laparoscopic procedures may adversely effect a compromised myocardium, patients with significant cardiopulmonary disease should be closely monitored during these procedures. The utility of intraoperative pulmonary artery catheter (PAC) and transesophageal echocardiography (TEE) monitoring was studied in 10 patients with moderate to severe cardiopulmonary disease to identify patients at greatest risk for cardiovascular complications during laparoscopic cholecystectomy. METHODS:Ten patients were enrolled in this prospective study; 7 had suffered a previous myocardial infarction, 6 had undergone coronary artery bypass grafting, and 9 had disease classified as Goldman's class II or greater. The heart was monitored by TEE throughout the laparoscopic cholecystectomy by using real-time, two-dimensional mode to study the wall thickness and motion. Several PAC measurements were taken directly: cardiac output, systemic vascular resistance, pulmonary artery wedge pressure, and central venous pressure. Heart rate and blood pressure were also obtained at corresponding intervals. Cardiac index, stroke volume, and left and right ventricular stroke work were then calculated. RESULTS:TEE demonstrated no significant changes in ventricular wall motion throughout laparoscopy. In patients who had postoperative cardiovascular complications, significant changes in cardiac index, left ventricular stroke work, and stroke volume were seen after pneumoperitoneum release. Compared to that of patients who did not develop complications, the cardiac index in those with complications dropped 42% (3.10 +/- 0.72 versus 1.80 +/- 0.10 L/min per m2, respectively; P < 0.01); left ventricular stroke work dropped 64% (139.00 +/- 11.36 versus 50.38 +/- 10.55 g x min/beat, respectively; P < 0.01); and stroke volume dropped 51% (86.90 +/- 12.68 versus 42.50 +/- 5.08 mL/beat, respectively; P < 0.01). CONCLUSIONS:PCA monitoring in patients with compromised cardiac function is useful in identifying patients who may not tolerate hemodynamic changes after pneumoperitoneum release. Normalization of hemodynamic changes secondary to abdominal insufflation and desufflation in patients with compromised hearts may not occur in patients with compromised hearts may not occur for hours postoperatively. Abnormal hemodynamic changes occur within the first hour after desufflation in patients who later develop cardiovascular complications, which are heralded by significant drops in left ventricular stroke work, cardiac index, and stroke volume. TEE did not prove to be useful for intraoperative monitoring.
journal_name
Am J Surgjournal_title
American journal of surgeryauthors
Portera CA,Compton RP,Walters DN,Browder IWdoi
10.1016/s0002-9610(99)80137-8subject
Has Abstractpub_date
1995-02-01 00:00:00pages
202-6; discussion 206-7issue
2eissn
0002-9610issn
1879-1883pii
S0002961099801378journal_volume
169pub_type
杂志文章abstract::Although few trauma patients sustain fatal pulmonary embolism, a large population is at risk from nonfatal embolism due to unrecognized deep vein thrombosis (DVT). Thirty-eight of 39 immobilized trauma patients at bed rest for 10 days or longer had venographic study of their lower extremities to evaluate for the prese...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(89)90182-7
更新日期:1989-12-01 00:00:00
abstract:BACKGROUND:For female breast cancer (BC) patients undergoing mastectomy, post-mastectomy breast reconstruction (PMBR) confers significant psychosocial benefits and improved cosmetic outcomes. The objective of this study is to explore whether the utilization of PMBR varies by race, marital status, and geographical locat...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2019.07.025
更新日期:2019-10-01 00:00:00
abstract::The success of parathyroid surgery is based on accurate localization of normal and abnormal parathyroid glands, knowledge of the pathologic conditions, and meticulous dissection during removal of the abnormal glands. Although parathyroid localization is essential in cases requiring re-exploration, there is considerabl...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(05)80976-6
更新日期:1993-09-01 00:00:00
abstract::A technique is described for salvage of looped forearm polytetrafluoroethylene (PTFE) vascular access grafts that fail because of thrombosis due to cephalic vein outflow obstruction. It entails reversal of blood flow direction through the graft and construction of a new venous outflow in the medial upper arm. This pro...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(91)91119-4
更新日期:1991-04-01 00:00:00
abstract::Increased strength of healing incisions infected with E coli was demonstrated in this experiment. Efforts to measure respiratory gas tensions and pH in these incisions were unsuccessful. Therefore, these moieties were measured in normal and infected wound fluid contained in implanted wire cylinders. The wound fluid fr...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(76)90292-0
更新日期:1976-07-01 00:00:00
abstract:BACKGROUND:Considering the surgical safety and perioperative complications, simultaneous resection after neoadjuvant therapy is not commonly recommended. METHODS:A total of 253 patients were included in study. Comparison of the short-term outcomes was performed after propensity score adjustment in Group A (n = 96) and...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2018.09.019
更新日期:2019-11-01 00:00:00
abstract::A seven day old dehydrated male infant was found to have acute ischemia of the leg due to acute thrombotic occlusion of an external iliac, common and superficial femoral, and popliteal arteries. Early thrombectomy and arterioplasty resulted in complete remission of ischemia. Our success with direct vascular surgery pr...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(75)90254-8
更新日期:1975-03-01 00:00:00
abstract:BACKGROUND:The ideal treatment algorithm for suspected choledocholithiasis is not yet well defined. Imaging options include magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), and intraoperative cholangiogram (IOC). MRCP is diagnostic, while the other two modalitie...
journal_title:American journal of surgery
pub_type: 杂志文章,评审
doi:10.1016/j.amjsurg.2016.10.025
更新日期:2017-08-01 00:00:00
abstract:BACKGROUND:Pancreatoduodenectomy is the only effective treatment for cancers of the periampullary region. Because surgeons usually grasp tumors during pancreatoduodenectomy, this procedure may increase the risk of squeezing and shedding the cancer cells into the portal vein, retroperitoneum, and/or peritoneal cavity. I...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2008.06.035
更新日期:2010-05-01 00:00:00
abstract::Our experience from 1960 to 1976 with total infrarenal aortic thrombosis (Leriche syndrome) was reviewed. Sixteen heavy smokers (14 men and 2 women) with an average age of fifty-four years underwent thrombectomy with aortoiliac (12 patients) or aortofemoral (4) Dacron bypasses. The last ten patients were hydrated for ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(77)90331-2
更新日期:1977-12-01 00:00:00
abstract::The results of the present study emphasize the importance of minimizing the time delay between a significant elevation in CEA and a second-look operation. Equally important are the frequency of serial determinations, a thorough understanding of the limitations of the assay, and careful evaluation of the clinical condi...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(79)90137-5
更新日期:1979-02-01 00:00:00
abstract:BACKGROUND:We proposed to develop a novel virtual reality (VR) team training system. The objective of this study was to determine the feasibility of creating a VR operating room to simulate a surgical crisis scenario and evaluate the simulator for construct and face validity. METHODS:We modified ICE STORM (Integrated ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2015.01.024
更新日期:2015-09-01 00:00:00
abstract::Careful intraoperative surgical staging should be considered routine for all patients undergoing thoracotomy for lung cancer. In addition, conservative resection is indicated for T1N0 lesions. Surgical adjuvant immunotherapy has not proved as effective as originally hoped. However, the advent of more effective combina...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(82)90037-x
更新日期:1982-06-01 00:00:00
abstract:BACKGROUND:We hypothesized that the increasing body mass index of the population has affected general surgery malpractice claims. METHODS:We queried the Physician Insurers Association of America database from 1990 to 1999 (ie, period 1) and 2000 to 2009 (ie, period 2) for claims associated with obesity and morbid obes...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2012.10.023
更新日期:2013-03-01 00:00:00
abstract:BACKGROUND:For locally advanced Siewert type II and III tumors we have performed total gastrectomy including resection of the distal 2/3 of the esophagus, through separate abdominal and right chest incisions (THX-ABD). The procedure involves wide lymphadenectomy in the abdomen/chest and a Roux-en-Y jejunostomy to the l...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2018.11.049
更新日期:2019-08-01 00:00:00
abstract::In a prospective randomized clinical trial, whole gut lavage was evaluated against conventional mechanical cleansing for colonic operations. The lavage took less time to perform, was better tolerated by patients, and resulted in more satisfactory preparation as judged by frequency of collapsed intestines. There was no...
journal_title:American journal of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-9610(79)90014-x
更新日期:1979-01-01 00:00:00
abstract:BACKGROUND:Trastuzumab has been found to have potent antiproliferative effects in human epidermal growth factor receptor 2 (HER-2)-overexpressing human breast tumors. Inhibition of vascular endothelial growth factor receptor (VEGFR), a protein often overexpressed in breast carcinoma, has been shown to induce apoptosis....
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2008.10.009
更新日期:2009-03-01 00:00:00
abstract::It is important that physicians participate in the debate and planning process that will ultimately guide how we reform the way health care is financed and delivered in the United States. Herein is offered a perspective on the problem, one which is not necessarily appreciated by health planners. While we deliver the b...
journal_title:American journal of surgery
pub_type: 杂志文章,评审
doi:10.1016/0002-9610(94)90081-7
更新日期:1994-02-01 00:00:00
abstract::Abdominal angina that is characterized by postprandial pain, and often associated with weight loss, is a well-recognized symptom complex of mesenteric artery insufficiency (mesenteric territory symptoms). In the past 5 years, we have observed six patients with atypical symptoms who had mesenteric artery occlusion comb...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(05)81061-x
更新日期:1993-08-01 00:00:00
abstract:BACKGROUND:Aging of the population necessitates consideration of the increasing number of older adults requiring emergency care. The objective of this study was to compare outcomes and presentation of octogenarian and/or nonagenarian emergency general surgery (EGS) patients with younger adults. METHODS:Based on a stan...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2016.01.021
更新日期:2016-08-01 00:00:00
abstract::A new way to stabilize nasogastric tubes is presented, aimed at preventing decubitus ulcerations of the mucosa of the nose and pharynx. ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(75)90467-5
更新日期:1975-07-01 00:00:00
abstract::Gastric restrictive surgery has evolved over the past decade as the treatment of choice for morbid obesity. We reviewed our experience with 289 patients who underwent gastric surgery for morbid obesity. Comorbid diseases included respiratory insufficiency in 19 percent of the patients, hypertension in 36 percent, diab...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(89)90438-8
更新日期:1989-01-01 00:00:00
abstract:BACKGROUND:Because of the increase in the geriatric population, an increasing number of elderly patients are being treated for colorectal cancer. The purpose of this study was to evaluate perioperative morbidity and mortality in this population. METHODS:A retrospective chart review was performed for patients 80 years ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2007.12.022
更新日期:2008-03-01 00:00:00
abstract::When dense hemiparesis has developed appropriate to the operated vessel after carotid surgery, the patient has been immediately returned to the operating room for reexploration of the vessel and thrombectomy. Over a 5-year period, we identified four patients who developed dense hemiparesis in the recovery room postope...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(05)81262-0
更新日期:1990-05-01 00:00:00
abstract::Hemasite is a new device incorporated in a graft that is used for hemodialysis. A technique of thrombectomizing this device incorporated graft is described. ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(84)90145-4
更新日期:1984-05-01 00:00:00
abstract::Primary non-Hodgkin's lymphomas of the gastrointestinal tract are rare in children, and few of these lymphomas are located in the sigmoid colon. The preoperative diagnosis rate is low. Complete resection is indicated if it can be done safely. Combination chemotherapy after resection is indicated. ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2007.12.063
更新日期:2009-01-01 00:00:00
abstract:BACKGROUND:Thyroglossal duct cysts (TGDCs) are common in children but also present in adults. This study evaluates the preoperative management and postoperative outcomes in patients with a resected TGDC. METHODS:A retrospective analysis was performed on patients with a surgically treated TGDC. Clinicopathologic variab...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2013.06.018
更新日期:2014-06-01 00:00:00
abstract::A retrospective study of 316 patients with a diagnosis of intestinal obstruction admitted to the University of Benin Teaching Hospital over a 5 year period is presented. The overall mortality was 10.6 percent. Attention is called to the unacceptably high morbidity and mortality associated with volvulus in this and oth...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(80)90300-1
更新日期:1980-03-01 00:00:00
abstract::A patient with the classic manifestations of the glucagonoma syndrome and hepatic metastases is presented. Clinical improvement occurred after removal of the primary tumor by distal pancreatectomy and splenectomy. No further antitumor therapy has been needed over a 15 month postoperative follow-up despite metastatic d...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(80)90306-2
更新日期:1980-03-01 00:00:00
abstract:BACKGROUND:To identify trends in total and subtotal gastrectomy for middle and distal third gastric adenocarcinoma in the U.S. METHODS:NCDB was queried for patients with stage 0-III middle or distal gastric adenocarcinoma treated with total or subtotal gastrectomy. Statistical analysis including cox proportional hazar...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2019.04.012
更新日期:2020-04-01 00:00:00