RESUMEN
OBJECTIVES: To investigate whether patency of a thin walled 8 mm fluoropassivated Dacron graft was similar to that of a standard 8mm PTFE graft for femorofemoral crossover bypass surgery. DESIGN: A randomised multicentre clinical trial comparing two vascular grafts with participation of 10 departments of vascular surgery in Denmark, Sweden and Norway. PATIENTS AND METHODS: 198 patients were randomised to PTFE (n=107) or fluoropolymer-coated Dacron grafts (n=91), 63% underwent surgery for claudication, 27% for ischaemic rest pain and 10% for tissue loss. The median follow-up time was 24 months (IQR 19-26 months). RESULTS: The primary patency rate of the two grafts was similar (log rank test: p=0.35). The primary patency rates (95% CI) for coated Dacron and PTFE grafts were 92% (86-98) and 94% (89-99) at 12 months and 87% (74-95) and 93% (87-99) at 24 months, respectively. CONCLUSION: In patients with unilateral iliac artery disease not amenable to angioplasty, the femoral-femoral bypass is durable and effective. No difference in patency was found between the two graft materials (fluoropolymer coated Dacron and PTFE).
Asunto(s)
Implantación de Prótesis Vascular , Prótesis Vascular , Materiales Biocompatibles Revestidos , Arteria Femoral/cirugía , Polímeros de Fluorocarbono , Tereftalatos Polietilenos , Politetrafluoroetileno , Anciano , Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/efectos adversos , Femenino , Oclusión de Injerto Vascular/etiología , Humanos , Claudicación Intermitente/cirugía , Isquemia/cirugía , Pierna/irrigación sanguínea , Masculino , Complicaciones Posoperatorias , Factores de Riesgo , Grado de Desobstrucción VascularRESUMEN
OBJECTIVE: This investigation was performed to evaluate the prognostic role of high age as to survival after transurethral prostatic resection (TURP). MATERIAL AND METHODS: The study was retrospective, considering all men over the age of 80 years consecutively treated for lower urinary tract symptoms (LUTS). The material consisted of 249 patients who had TURP, 30 patients who were considered too ill for surgery and 18 who did not want treatment. Survival was compared to the background population. RESULTS: A significantly higher mortality was found initially if patients treated with TURP were compared to the age-matched background population. Twelve patients died within 30 days after operation. These patients suffered from severe preoperative comorbidity. Ninety-seven patients had chronic retention while only 17 had a catheter at discharge from the hospital. CONCLUSION: In conclusion, even very old men benefit significantly from a TURP provided they have been carefully selected.
Asunto(s)
Envejecimiento/patología , Prostatectomía/mortalidad , Anciano , Anciano de 80 o más Años , Cateterismo , Humanos , Masculino , Complicaciones Posoperatorias/mortalidad , Pronóstico , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Information was retrieved from the national patient register (Landspatientregisteret), that contains information on all admissions to Danish hospitals 1977-1993. The number of admissions during which a diagnosis of occlusive arterial disease (OAD) of the lower extremities was made and an amputation performed increased from 1290 in 1977 to a maximum of 1609 in 1983 (p < 0.001). From 1987 on the number decreased almost 30% to 1111 in 1993 (p < 0.001). During the period the number of admissions during which arterial reconstruction for OAD were performed increased steadily from 963 in 1977 to 2637 in 1993 (p < 0.001). The result may indicate that vascular surgery is effective on a national scale in preventing amputations for OAD.
Asunto(s)
Amputación Quirúrgica/estadística & datos numéricos , Arteriopatías Oclusivas/cirugía , Pierna/cirugía , Adulto , Anciano , Arteriopatías Oclusivas/diagnóstico , Arteriopatías Oclusivas/fisiopatología , Dinamarca/epidemiología , Femenino , Humanos , Isquemia/diagnóstico , Isquemia/fisiopatología , Isquemia/cirugía , Pierna/irrigación sanguínea , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
An extremely rare case of progressive perineal clostridial myonecrosis secondary to Thiersch's operation for rectal prolapse illustrates the need for early recognition of the initial clinical findings to maximize the chances for survival. Management of these infections include prompt administration of shock therapy, a broad spectrum of antibiotics, and thorough surgical debridement of all involved tissue. Prophylactic systemic antibiotic therapy must be considered, especially in high risk patients.