PubMed Health⌕ Search

Biomedical subjects

D Hiyama

Publications and source records attributed to D Hiyama.

5 recordsLinked to original sources
PubMed2001

Scrotal abscess following appendectomy.

Postoperative infectious complications in children following perforated appendicitis present in diverse ways. We present two unusual complications of appendectomy for perforated appendicitis: an acute scrotum after open and laparoscopic appendectomy. A retrospective review of two cases of scrotal abscess following appendectomy at our hospital as well as a MEDLINE search was performed to review the clinical presentation, etiology, type of treatment, and outcome of these patients. Although scrotal inflammation occurring postoperatively in a patient with perforated appendicitis may be due to an incarcerated hernia, it is much more likely to be due to a scrotal abscess. Patients without a patent processus vaginalis or inguinal hernia at initial presentation of peritonitis must be carefully followed in the postoperative period and explored early if testicular or scrotal pain becomes manifest.

Abscess↗
PubMed2000

Surgery in the nineties.

The population of the United States is aging, and by 2020 it is estimated that 16 per cent of U.S. citizens will be over 65 years of age. Little has been published about the results of surgery in nonagenarians but mortality rates of 45 per cent are reported. Given recent improvements in perioperative care we reviewed the experience with major general surgical operative procedures in nonagenarians. We reviewed the charts of patients greater than or equal to 90 years of age who underwent general surgical procedures at UCLA Medical Center since 1986. No patients were excluded. Thirty-two patients were identified. Most (87.5%) patients had significant premorbid conditions. The most common diagnoses were cancer (12), incarcerated hernia (seven), trauma (three), colonic volvulus (two), and cholecystitis (two). Overall perioperative mortality was 9.4 per cent (3 of 32). Twenty-two surgeries (69%) were performed on an emergency basis, and all three deaths were in this group (13.6%). Overall morbidity rate was 57 per cent. Mean intensive care unit stay was 4.8 days. Most patients were discharged home. Our findings support the perioperative safety of elective general surgery in nonagenarians (0% mortality and 20% morbidity). We also found an acceptable risk (13.6% mortality and 68% morbidity) for emergency procedures despite significant comorbid conditions. Most of the patients had acceptable functional outcomes.

Aged↗
PubMed1997

Preemptive analgesia in patients undergoing appendectomy.

OBJECTIVE: To evaluate the use of preemptive analgesia in patients who were undergoing an operation for acute appendicitis. DESIGN: Double-blind, randomized control trial. SETTING: Public hospital. PATIENTS: Patients who presented with presumed appendicitis. INTERVENTION: Patients received 1 of the following treatments: group 1, preemptive analgesia with a combination of lidocaine hydrochloride and bupivacaine hydrochloride; group 2, preemptive analgesia with saline solution; or group 3, nothing. MAIN OUTCOME MEASURES: The Wong-Baker FACES Pain Rating Scale, analgesic requirements, number of analgesic doses required, and length of hospital stay. RESULTS: No differences were noted in postoperative pain, the total number of analgesic doses per day, the quantity of narcotic medication administered, and the length of hospital stay. CONCLUSIONS: Compared with healthy control subjects, preemptive analgesia did not reduce postoperative pain, reduce analgesic requirements, or shorten the length of hospital stay in patients who underwent an appendectomy. Premptive analgesia may be applicable only for patients without preoperative pain.

Acute Disease↗
PubMed1990

Right common carotid artery ligation for extracorporeal membrane oxygenation: cerebral blood flow velocity measurement with Doppler duplex US.

Duplex Doppler ultrasound (US) provides a noninvasive method of monitoring cerebral blood flow velocity in newborns. The authors observed the changes in cerebral blood flow velocity in the right middle cerebral artery (RMCA) in 15 neonates during right common carotid artery (RCCA) ligation for extracorporeal membrane oxygenation. Antegrade flow in the RMCA continued uninterrupted in all patients at the moment of ligation. Peak systolic velocity decreased initially and then increased to 70% of baseline levels in the following 3-5 minutes. End diastolic velocity remained relatively unchanged at the time of ligation and rose slightly above baseline during the following 3-5 minutes. This study demonstrates that at the time of RCCA ligation, collateral flow is immediately established in the RMCA distribution and is further augmented within minutes.

Blood Flow Velocity↗