Surgical treatment of intracranial meningiomas in geriatric patients

We studied retrospectively a series of 36 patients who underwent the surgical removal of an intracranial meningioma between April, 1982 and April, 1997. Their ages ranged from 65 to 78 years (mean age: 70.2 years); 27 patients were female, and 9 were male. Thirteen (36.1%) were located at the convexity, 6(16.7%) at the falx/parasagittal area, and 16(44.4%) at the skull base, tentorium, and posterior fossa. Operative mortality was 11.1%, but the rate was increased to 16.7% at 3 months follow-up. It was significantly higher than the younger age group (p < 0.05). Postoperative complications were manifested in 17 of 36 patients (47.2%). The postoperative morbidity rate was significantly higher in patients with class III of ASA physical status (American Society of Anesthesiology classification). Twenty-three (63.9%) patients had good postoperative outcome (Karnofsky rating scale of 80 or more). Various prognostic factors were evaluated, the most important of which were preoperative general health condition and neurological status. Age per se is not a contraindication to the surgery of intracranial meningiomas in the elderly patient.     

Surgical treatment of postop abdominal hernia in elderly and geriatric patients

The results were summarized on surgical treatment of 56 patients, ageing 60-85 years, for femoral hernia using two methods--according to Bassini and original one stipulated for femoral ring strengthening using implant made of poliuretane in hernial sac tunic fixed without tension to inguinal and public ligaments. Recurrence of hernia in the late follow-up period have occurred in 13.6% of patients operated on according to Bassini and was never observed after operation performed using original method.     

Surgical treatment of non-osteoarthritic femoropatellar diseases

Patellar instability, associated with varying degrees of pain, is the major symptom of non-osteoarthritic femoropatellar diseases. This patellar instability is due to either mechanical (femoropatellar "derailment") or pain (due to chondropathy) disruption of quadriceps function. The result of surgical treatment of painful femoropatellar instability, regardless of its type, is governed by the same postoperative factors. A good result can only be obtained when the postoperative TA-GT lies within a certain range of the ideal value which varies according to the trochlear angle; the quality of the result essentially depends on the postoperative height of the patella. Preoperative radiological measurement of the trochlear angle on femoropatellar views in 30 degrees of flexion, of the TA-GT angle in 30 degrees of flexion and the height of the patella is therefore necessary to select and modulate the therapeutic procedures designed to treat non-osteoarthritic femoropatellar diseases.     

Low-level laser therapy in osteoarticular diseases in geriatric patients]

The formation of the antibody variable domain binding unit (Fv) is the net result of three competing assembly reactions. The affinities of concurrent homologous interactions of heavy and light chain variable domains limits the heterologous interaction leading to productive formation of the Fv. To address the possible role of light chain dimerization in this phenomenon, the Gln38 residue at the dimer interface of an immunoglobulin light chain variable domain (VL) was replaced by charged amino acids. The effects of these mutations on VL homodimer formation were monitored by small-zone size exclusion HPLC and the affinities of interaction were determined by computer simulation. Reduced VL homodimerization was observed in three of the four mutants, Q38R, Q38D and Q38K. The association constants for the Q38R and Q38D homodimers were 1.2 x 10(4) and 3.2 x 10(3) M(-1), respectively. This corresponded to a 20-75-fold reduction in the homodimer association constant relative to the wild-type VL, which had an association constant of 2.4 x 10(5) M(-1). Surprisingly, the fourth charge mutant, Q38E, had a higher association constant than the wild-type VL. The potential for charged residues to facilitate heterodimeric assembly of immunoglobulin domains was also tested. Heterodimerization was observed between the Q38D and Q38R V(L)s, but with an association constant of 4.7 x 10(4) M(-1), approximately fivefold lower than that obtained for homodimerization of the native V(L). In addition, replacement of the neutral, solvent-accessible Gln38 residue with either Asp or Arg was found to be significantly destabilizing. These results suggest that charged residues could be introduced at immunoglobulin domain interfaces to guide heterodimer formation and to minimize unfavorable competing homologous associations. Nonetheless, these apparently simple modifications may also result in unintended consequences that are likely to depend upon structural features of particular variable domains.     

Surgical treatment of well-differentiated thyroid carcinoma with laryngotracheal invasion

We reviewed 141 cases of well-differentiated thyroid carcinoma with laryngotracheal invasion surgically treated from 1957 through 1984. Of the 141 cases, 68 had the tumor adhesive to the larynx or/and trachea, 66, the tumor invading the cartilage of airway, and 7, the tumor invading into the lumen of airway. 82 cases (33 with microscopically residual tumor, and 26 with grossly residual tumor) underwent total resection. Postoperative radiotherapy was added to the last two groups. The 10-year survival rate was 84.45%, but in Group I, II and III it was 93.94%, 90.68%, and 53.91% respectively. Radiotherapy which was added postoperatively was a positive prognostic factor in improving the survival.     

Surgical treatment of diseases of the operated stomach]

The experience of treatment of 303 patients with the operated stomach diseases (OSD) is summarized. It was established that to reduce the frequency of their occurrence it is necessary: to perform vagotomy especially selective proximal (SPV) thoroughly for complete acid producing zone denervation achievement; to examine gastric cardia and pyloroduodenal zone before and intraoperatively thoroughly to select an optimal method of its drainage; to conduct conservative therapy of ulcer disease after vagotomy conduction up to the ulcer defect healing according to endoscopic control data.     

Surgical treatment outcome of hemorrhoidal in 475 patients

OBJECTIVE: The process of aneurysm formation after laser welding is described. SUMMARY BACKGROUND DATA: The mechanism of aneurysm formation after laser-assisted microarterial anastomosis is presently unclear. METHODS: A series of 830-nm diode-laser-assisted longitudinal aortorrhophy with a condition of 400 to 500 J/mm2 for 1 cm length of anastomosis versus conventional manual anastomoses were performed in 90 Wistar rats. To compare this technique with normal media process, a histologic examination of aneurysm formation was conducted. RESULTS AND CONCLUSIONS: The results show that there are two important factors that cause aneurysm formation after laser-assisted anastomosis: 1) the vessel wall is damaged by laser heating; 2) proliferation of collagen fiber at the adventitia is absent during media reconstruction.     

Surgical management of patients with persistent or recurrent medullary thyroid cancer

OBJECTIVE: To compare estimates based on vaccination cards, parental recall, and medical records of the percentages of children up-to-date on vaccinations for diphtheria, tetanus, and pertussis; polio; and measles, mumps, and rubella. METHOD: The authors analyzed parent interview and medical records data from the Baltimore Immunization Study for 525 2-year-olds born from August 1988 through March 1989 to mothers living in low-income Census tracts of the city of Baltimore. RESULTS: Only one-third of children had vaccination cards; based on medical records, these children had higher up-to-date coverage at 24 months of age than did children without cards. For individual vaccines, only two-thirds of parents could provide information to calculate coverage rates; however, almost all provided enough information to estimate coverage for the primary series. For each vaccine and the series, parental recall estimates were at least 17 percentage points higher than estimates from medical records. For children without vaccination cards whose parents could not provide coverage information, up-to-date rates based on medical records were consistently lower than for children with cards or with parents who provided coverage information. CONCLUSIONS: Population-based vaccine coverage surveys that rely on vaccination cards or parental recall or both may overestimate vaccination coverage.     

Thyroid gland and thyroid status in patients with chronic liver diseases

We have conducted a prospective study aimed to analyse contraceptive use among women seeking for legal abortion in the State University Hospital "Ma?chin dom"--Sofia. Our date demonstrate that the patients were well informed about the existing contraceptive methods. On the contrary the percentage of women-using contraception and especially those, using highly effective ones is relatively low. The patients claim the possible side effects of the high effective contraception as a reason against use.     

Auto-immunity in certain thyroid diseases

In the years 1971-74, 88 patients were admitted to the Department of Otorhinolaryngology of the Finsen Institute because of thyroid disease. In 37 of these patients, who had also been tested for antibodies against the thyroid, the diagnosis was confirmed histologically. The existence of circulating antibodies against thyroid tissue was found to reflect the degree of lymphocyte infiltration in the thyroid gland, and is thus of significance in the evaluation of the patients' prognosis and potential risk at surgery.     

Surgical treatment of combined valvular disease in 680 patients

Between 1982 and May 1993, we operated on 680 patients with combined valvular disease. Previous operations were including closed mitral commissurotomy in 87, and bioprosthetic valve replacement in mitral position in 15. The types of combined valve disease included mitral valve disease combined with functional tricuspid regurgitation (FTR) (245), with organic tricuspid disease (OTD) (10); mitral and aortic disease (258), combined with FTR (128), and with OTD (39). The early mortality was 4.7% in total 2.4% and 6.1% respectively in MVR or DVR plus tricuspid procedures. The main cause of early death was low cardiac output syndrome. The late mortality was 2.6% pt-yr, congestive heart failure and coagulant-related hemorrhage were the predominant causes of late death. We considered that FTR is the outcome of right ventricle decompensation, while tricuspid valve must be actively inspected intraoperatively, and must be corrected completely. OTD can be successfully repaired in most patients. Myocardial protection should be emphasized, and continuous perfusion of cold blood cardioplegia and controlled reperfusion of warm blood contained mannitol have marked effect.     

Surgical treatment of patients with open tibial fractures

Open tibial fractures are true surgical emergencies because of the risk of extensive infection to bone and devitalized soft tissue. The most serious consequence of open tibial fractures is osteomyelitis, which usually can be prevented by prompt surgical intervention within six to eight hours after injuries occur. Open tibial fractures often are the result of trauma from motor vehicle collisions, farm accidents, falls from heights, or gunshot wounds. Initial management of patients with multiple trauma injuries focuses on their life-threatening injuries before or during orthopedic surgical intervention for open tibial fractures. Orthopedic surgeons often work in collaboration with general, vascular, and plastic surgeons and perform multiple surgical procedures (eg, fasciotomy procedures for compartment syndromes, irrigation and debridement of wounds, application of external fixation devices, placement of intramedullary nails, possible limb amputations). The type and extent of open tibial fractures and soft tissue injuries determine the best treatment options for patients. Perioperative nurses should help patients focus on treatment choices for their open tibial fractures that ensure optimal surgical outcomes and maintain their quality of life.     

Molecular biology of thyroid diseases

Recent developments in molecular biology and the accessibility of techniques for clinical research have led to a better understanding of the background of common thyroid diseases. The cloning and sequencing of the thyroid stimulating hormone receptor, thyroid peroxidase and thyroglobulin, and the characterization of the protein-DNA interaction during thyroid hormone action, as well as the discovery of intracellular signal transduction pathways were the most important steps which resulted in new diagnostic and therapeutic approaches. New explanations of thyroid autoimmune processes are being investigated.