[Ambulatory cataract surgery].
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The purpose of this study is to show the result of outpatient cataract surgery and its differences or advantages with inpatient cataract surgery.The retrospective study concern 722 consecutives patients collected from June 1995 till May 1997; 388 underwent outpatient cataract surgery and 384 underwent inpatient cataract surgery.There were non significant difference between the two groups in type of cataract surgery. Immediate postoperative complications and final visual acuity did not show any significant difference in both groups.This analysis shows the great advantages of this simple surgical procedure such an increase in cataract operation leading to a decrease of patients in waiting list.Keywords:
Outpatient surgery
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The purpose of this study is to show the result of outpatient cataract surgery and its differences or advantages with inpatient cataract surgery.The retrospective study concern 722 consecutives patients collected from June 1995 till May 1997; 388 underwent outpatient cataract surgery and 384 underwent inpatient cataract surgery.There were non significant difference between the two groups in type of cataract surgery. Immediate postoperative complications and final visual acuity did not show any significant difference in both groups.This analysis shows the great advantages of this simple surgical procedure such an increase in cataract operation leading to a decrease of patients in waiting list.
Outpatient surgery
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Retrospective analysis of 31 cases of cervical spondylotic myelopathy treated by four-level subaxial cervical corpectomy.To determine whether extremes of anterior decompression and fusion have inordinate or unique levels of morbidity.There is a paucity of data on experience with four-level corpectomy. However, counsel against such surgery can be found.The records and studies of 31 consecutive cases of cervical spondylotic myelopathy, treated by four-level corpectomy, were retrospectively analyzed. Patients in 26 cases were observed longer than 2 years. No hardware was used in the procedures. External orthosis, worn for 6 months, was a Philadelphia-type collar in 25 patients and a halo vest in 6.Three patients died within 3 weeks of surgery (9.7%). Delayed radiculopathy occurred in four patients after surgery, three had acute graft complications, and one had pseudomeningocele, for a morbidity rate of 25.8%. There was no infection or worsened myelopathy.No unique morbidity is associated with extremes of subaxial decompression when compared with surgery of lesser extent.
Corpectomy
Pseudomeningocele
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From 1983 to 1990, 42 clinical N0, N1 patients with invasive squamous cell carcinoma of the vulva underwent surgery for the primary cancer, followed by nonrandomized assignment to either surgery or radiation therapy for nodal management. This is a retrospective analysis reviewing treatment outcome and complications of inguinofemoral dissection versus photon irradiation. Group I (N = 24) underwent either bilateral or unilateral inguinofemoral dissection; Group II (N = 18) underwent bilateral groin irradiation. The 3-year disease-free survival was 84.5% and 79.7% for Group I and II (p = 0.74). The nodal failure rate at 3 years was not significantly different. The postoperative complications in the surgically treated nodes were: 17% seromas, 46% wound infection, and 71% wound separation. Of those patients developing either an infection or wound separation, 41% required daily wound care for more than 2 weeks by a visiting nurse after discharge. Only 1 of 18 (6%) irradiated patients developed a clinically significant skin reaction. The median time for complete skin/wound healing was 8 weeks (range 4-24 weeks) in Group I and 2 weeks (range 2-6 weeks) in Group II. Late postoperative complications in the surgically treated patients included meralgia paresthetica (8%) and lymphedema (12%); 1 (6%) Group II patient developed lymphedema. Based on this limited retrospective review, we conclude that inguinofemoral radiation achieves reasonable local control and may represent an alternative to surgery in selected patients. The acute and delayed morbidity of lymphadenectomy exceeds that of irradiation.
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Intravenous sedation
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Study Design. A retrospective analysis. Objective. The aim of this study was to clarify the postoperative improvement of walking ability and prognostic factors in nonambulatory patients with cervical myelopathy. Summary of Background Data. Many researchers have reported the surgical outcome in compressive cervical myelopathy. However, regarding severe gait disturbance,, it has not been clarified yet how much improvement can be expected. Methods. One hundred thirty-one nonambulatory patients with cervical myelopathy were treated surgically and followed for an average of 3 years. Walking ability was graded according to the lower-extremity function subscore (L/E subscore) in Japanese Orthopedic Association score. We divided patients based on preoperative L/E subscores: group A, L/E subscore of 1 point (71 patients); and group B, 0 or 0.5 point (60 patients). The postoperative walking ability was graded by L/E subscore: excellent, ≥2 points; good, 1.5 points; fair, 1 point; and poor, 0.5 or 0 points. We compared preoperative and postoperative scores. The cutoff value of disease duration providing excellent improvement was investigated. Results. Overall, 50 patients were graded as excellent (38.2%), and 21 patients were graded as good (16.0%). In group B, 17 patients (28.3%) were graded as excellent. Seventeen patients who were graded as excellent had shorter durations of myelopathic symptoms and/or gait disturbance (7.9 and 3.8 months respectively) than the others (29.5 and 8.9 months, respectively) ( P < 0.05). Receiver-operating characteristic curve showed that the optimal cutoff values of the duration of myelopathic symptoms and gait disturbance providing excellent improvement were 3 and 2 months, respectively. Conclusion. Even if the patients were nonambulatory, 28.3% of them became able to walk without support after operation. If a patient becomes nonambulatory within 3 months from the onset of myelopathy or 2 months from the onset of gait disturbance, surgical treatment should be performed immediately to raise the possibility to improve stable gait. Level of Evidence: 3
Cervical spondylosis
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The purpose of this study was to compare patient factors and outcomes in conservatively and surgically treated patients with spinal epidural abscess (SEA). This was a single-center retrospective review of adult patients treated for SEA of the lumbar spine. Primary treatment outcome was readmission for recurrent abscess. Sixty-one patients met inclusion criteria: 59% male, mean age 56.9 years, and body mass index 30.8 kg/m2. Initially 47.5% of patients were treated with conservative measures and 52.5% were treated with surgery. In the conservative group, 31.0% failed treatment and underwent delayed surgery; 26.2% of the overall cohort was readmitted for SEA. Readmitted patients had a greater incidence of history of methicillin-resistant Staphylococcus aureus (p = .048), recurrent infections (p = .008), and recent sepsis and bacteremia (p = .005). Nearly one-third of patients failed initial conservative treatment and needed delayed surgery; however, no significant differences were found between the two treatment groups. Patients with a past history of infections may require more aggressive treatment and closer follow-up, because they are at higher risk for recurrence and readmission. (Journal of Surgical Orthopaedic Advances 28(3):224-231, 2019).
Epidural abscess
Bacteremia
Conservative Treatment
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Outpatient surgery
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Objective To retrospectively study the perioperative complications and postoperative function recovery of 93 patients treated with simultaneous bilateral total hip arthroplasty (THA). Methods A total of 93 patients (186 hips) undergone simultaneous bilateral THA from January 1999 to January 2009 in our hospital were involved in this study. There were 70 males and 23 females (at age range of 25-65 years, average 41. 8 years). The preoperative diagnosis included bilateral avascular necrosis of femoral head in 48 patients, rheumatoid arthritis in 11, developmental dysplasia of the hip in 26 and ankylosing spondylitis in 8. The intraoperative blood loss, Harris scores before operation and at final followup as well as perioperative complications were analyzed. Results All the patients were followed up for average 65 months (12-118 months), which showed femur fracture in one patient and infection six months after discharge in one patient. The Harris score was increased from (36.7 ±6.1) points preoperatively to (91.2±6.2) points at the final follow-up. Hip pain disappeared in 92 patients after operation and radiograph showed no loosening. Actebular loosening occurred in one patient 49 months after operation and was revised accordingly. Conclusion Under strict control of operation indications, suitable choice and implantation of the prosthesis and emphasis on perioperative management and postoperative rehabilitation, simultaneous bilateral THA is a safe and effective choice for bilateral hip diseases.
Key words:
Arthoplasty, replacement, hip; Hip joint; Retrospective analysis
Avascular Necrosis
Harris Hip Score
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Seventy-nine consecutive children with cerebral palsy who underwent osteotomies about the hip for subluxation or dislocation were studied retrospectively to determine risk factors that would correlate with postoperative complications of death, fracture, or decubitus ulcer. Except for the three patients who died, all of the children had > or = 1 year of follow-up. Twenty (25%) patients had at least one complication. Three children died; one at 1 week, one at 2 weeks, and one at 5 months after surgery. Sixteen patients sustained 25 fractures. All were managed with cast or splint immobilization in the clinic. Five patients developed decubitus ulcers requiring > or = 2 weeks of local care, but none required skin grafts or flaps. Complications occurred in 13 (68%) of 19 children with gastrostomies or tracheostomies but in only seven (12%) of the remaining 60 children. Only one (8%) of 13 ambulatory patients had a complication compared with 19 (29%) of 66 nonambulatory patients. In conclusion, ambulatory function correlates well with the risk of complications after osteotomies. A nonambulatory patient with a gastrostomy or tracheostomy is at even greater risk. Fortunately the fractures and ulcers observed in this series healed uneventfully with no operative intervention.
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