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PubMed2004

High frequency jet ventilation in exploration of tracheostomy--a case report.

Exploration of tracheostomy is not uncommon, however, in case a patient with a facial reconstruction flap, trouble may arise because of difficulty in intubation. We hereby report a patient who had a fresh facial reconstruction flap after radical resection of buccal carcinoma, sustained bleeding around the tracheostomy and was scheduled for exploration of tracheostomy. Fiberoptic oral intubation was failed because of profuse secretion and edematous oral mucosa; high frequency jet ventilation (HFJV) was thus applied and made possible with a suction catheter put through the tracheostomy tube. Exploration was performed following withdrawal of the tracheostomy tube. The tracheostomy tube was reinserted under the guidance of the in-place suction tube after uneventful exploration. The probable concomitant complications and contraindications of using HFJV are discussed here. With thorough preparation and careful monitoring, and under the supervision of experienced physicians, transtracheal HFJV can substitute fiberoptic intubation for ventilation in case of exploration of tracheostomy.

High-Frequency Jet Ventilation↗

PubMed2004

[Nerve exploration and decompression for traumatic recurrent laryngeal nerve injuries induced by thyroid gland surgery].

OBJECTIVE: To show the findings of recurrent laryngeal nerve injury exploration and find out therapeutic effects, indications and timing of nerve decompression for traumatic recurrent laryngeal nerve injury induced by thyroid gland surgery. METHODS: In this study there were 87 patients with recurrent laryngeal nerve injury, including 65 for nerve exploration and 22 for nonsurgical treatment. During nerve exploration, the types, severity of laryngeal nerve injuries and laryngeal muscular mass were studied. Nerve decompression was performed in these 14 patients whose compressing sutures or compression due to cicatricial hypertrophy were received nerve decompression. RESULTS: Injuries caused by thyroid gland operations mostly are of suture ligation (43%) and nerve severance (48%); simple scar compression was found only in 6 cases (9%). Atrophy of the laryngeal muscles was not very serious in patients with a course less than 6 months. In 10 patients with a course less than three months, nerve decompression restored normal functional abductor and abductor motion of the vocal cord in 9 patients and had no effects in one. Although functional motion of vocal cord was not seen in one case with a course less than 3 months and 4 cases between 3 and 5 months, the mass and tension of the reinnervated vocal cord became much the same as the contralateral normal vocal cord, thus resuming symmetric vibration of the vocal cords and physiological phonation. Although nonsurgical treatment improved severe hoarseness, it didn't restore normal functional motion of the vocal cord and normal voice. CONCLUSIONS: Nerve exploration showed a primary rule for recurrent laryngeal nerve injury induced by thyroid gland surgery. Early and mid-stage recurrent laryngeal nerve exploration and decompression may restore normal motion of the glottis, and it suggested laryngeal delayed reinnervation may help patients with a course more than 6 months.

Adult↗

PubMed2005

CT angiography in penetrating neck trauma reduces the need for operative neck exploration.

The evaluation of penetrating neck injury has evolved dramatically from mandatory operative exploration of Zone II injuries that penetrate the platysma to selective management based on physical examination and adjunctive studies. More recently, CT angiography has emerged as an efficient, noninvasive method of evaluating penetrating neck injury. We retrospectively reviewed our experience over 10 years with the management of penetrating neck injury. One hundred thirty cases were reviewed with 34 undergoing CT angiogram (Group CTA) and 96 with no CT angiogram (Group nCTA). Group CTA had significantly fewer neck explorations, 1 (3%) versus 32 (33%), P < 0.001. Negative explorations were significantly higher in nCTA as well, with a rate of 22 per cent versus 0 in CTA (P < 0.01). The use of angiogram and esophagram was also significantly lower in CTA versus nCTA (P = 0.02 and P = 0.04). Of the 34 patients in CTA, 4 (12%) also underwent angiography and 4 (12%) received a contrast esophagram. Of the 64 patients in nCTA who did not undergo a neck exploration, 19 (29%) underwent angiography, and 17 (26%) received a contrast esophagram. The use of CT angiogram increased over time with a concomitant decrease in the rate of neck explorations.

Adolescent↗

PubMed2006

Laparoscopic exploration of the common bile duct: 10-year experience of 174 patients from a single centre.

OBJECTIVES: To evaluate the role of laparoscopic exploration of the common bile duct in the management of common bile duct stones. DESIGN: Retrospective study. SETTING: Regional minimal access surgery training centre in Hong Kong. PATIENTS: Patients undergoing laparoscopic exploration of the common bile duct from 1995 to 2005. MAIN OUTCOME MEASURES: Demographic information, reasons for failed endoscopic retrograde cholangiopancreatography and open conversions, and operative morbidity and mortality. RESULTS: A total of 174 laparoscopic explorations of the common bile duct were performed. Indications for surgery (some overlapping) included: concomitant gallstones and common bile duct stones (n=68, 39%) in young persons (<60 years), previously failed endoscopic extraction (n=59, 34%), large (>2 cm) or multiple common bile duct stones (n=40, 23%), and need for laparoscopic bypass to improve bile drainage (n=34, 20%). Mean patient age was 63 (standard deviation, 16) years and 103 were female. Altogether 156 choledochotomies and 18 transcystic duct explorations were performed, with 12 (7%) open conversions. The mean operating time was 129 (standard deviation, 57) minutes. Additional procedures included: 54 laparoscopic operative cholangiographies, 34 laparoscopic biliary bypasses, and 31 instances of adhesiolysis in patients with a history of open upper gastro-intestinal surgery. Complete stone clearance was achieved in 160 (92%) patients. Non-lethal complications occurred in 34 (20%) patients and one died of sepsis after a major bile leak. The mean postoperative stay was 9 (standard deviation, 9) days. Stone recurrence ensued in seven (4%) patients after a mean follow-up of 37 (standard deviation, 29) months. CONCLUSIONS: Laparoscopic exploration of the common bile duct is highly successful and can achieve satisfactory ductal clearance even after unsuccessful endoscopic extraction and previous upper gastro-intestinal surgery. In skilled hands, for selected patients laparoscopic bypass can also achieve improved bile drainage.

Cholangiopancreatography, Endoscopic Retrograde↗

PubMed2005

[Breast cancer. current use of the extra-pleural exploration of the internal mammary chain].

The interest to know the Internal Mammary Chain (IMC) Involvement , is that it is a lymphatic filter as primary as the axilla. Anatomic-surgical fundaments, were presented for their exploration. Fifty (50) pectus-sternal, analizing the number of nodes (average 9,7 per specimen), located preferably in the three first intercostal spaces, were studied. In the second phase IMC with a staging criterion and extrapleural way, resecting 1 or 2 costal cartilages, were explored. In 78 patients, pathological-anatomy correlation between IMC and the axilla, we observed 6% positive IMC with negative axilla. More recently in the era of the setinel node, we have explored IMC in 44 patients through intercostal spaces and without cartilages resection. In 28 patients we performed through radioisotopic way and gamma probe and in the remaining 16, through anatomic search if the tumor was either upper mid or lower. The most frequent spaces explored were in the 2nd and 3rd; 2,27 nodes average per patient. The pathological-anatomy between IMC and the axilla revealed the following results: axilla (-) IM (-): 59%; axilla (+) MI (-): 25%; axilla (+) IM (+): 11% and axilla (-)IM (+): 5%. We concluded that this is a non-aggressive method, with an excellent tolerance that allows the evaluation of another filter as primary as the axilla and that together they represent the best systemic disease prognostics. We believe that its exploration is justified in those cases in which the histological result , correlated with the axilla, allows a therapeutic approach change.

Axilla↗

PubMed2006

Hypocalcemia after neck exploration for untreated primary hyperparathyroidism.

Hypocalcemia after neck exploration for hyperparathyroidism is an important postoperative management issue. With increasing acceptance of less invasive surgical approaches, hypocalcemia is less frequent. This study was conducted to evaluate postoperative hypocalcemia after current surgical exploration techniques in patients with untreated primary hyperparathyroidism. From the University of Louisville parathyroid database, charts of patients undergoing surgery for untreated primary hyperparathyroidism from May 1, 1998 to May 30, 2004 were reviewed. Data was analyzed based on age, sex, preoperative calcium and parathyroid hormone levels, preexisting diseases, and extent of neck exploration. One hundred sixty-nine patients were identified with adequate data for analysis. Transient postoperative hypocalcemia occurred in 21 per cent (36/169) for the total group, in 18 per cent (22/125) after minimally invasive radio-guided parathyroidectomy, and in 32 per cent (14/44) after bilateral neck exploration. Patients with postoperative hypocalcemia had a statistically significant association with older age and pre-existing hypertension. Patients with postoperative hypocalcemia were more likely to have undergone longer surgical procedures and were more likely to have had pre-existing diabetes and mental disorders. These findings were not statistically significant and were considered trends. The frequency of osteoporosis in the hypocalcemia group was increased but was not significant. Transient hypocalcemia occurred in 21 per cent of patients after parathyroid surgery. It was more likely after bilateral neck exploration, a longer duration of surgery, and with hypertension, diabetes, and mental disorders.

Age Factors↗

PubMed1991

Transduodenal exploration of the common bile duct in patients with nondilated ducts.

Exploration of the small common bile duct can be technically difficult and is associated with a significant risk of ductal injury or late stricture, or both. Transduodenal common duct exploration after sphincteroplasty (TCDE/S) is an alternative method of duct exploration that avoids choledochotomy. Cholecystectomy followed by TCDE/S was performed upon 28 patients with nondilated ducts and suspected choledocholithiasis. Common duct stones were retrieved in 17 patients. Failure to retrieve stones in the remaining 11 patients was attributed to either false-positive results of cholangiography, forceful passage of stones into the duodenum during the initial insertion of a Fogarty catheter through the cystic duct or a false-negative finding at duct exploration. There was no perioperative mortality. Two patients had asymptomatic postoperative hyperamylasemia. One patient had postoperative pancreatitis, hyperbilirubinemia and cholangitis that resolved with antibiotic therapy by the eighth postoperative day. Other complications included wound infection, delayed gastric emptying, pneumonia and otitis media. The over-all morbidity rate was 28.6 per cent. Long term follow-up was obtained in all 28 patients. All patients in the follow-up group are free of recurrent biliary tract disease. TCDE/S appears to be a safe and effective method of exploring the nondilated common bile duct.

Adult↗

PubMed1990

The role of emergent exploration in free-tissue transfer: a review of 150 consecutive cases.

One-hundred and fifty consecutive free-tissue transfers were reviewed to evaluate the role of emergent exploration in flap survival. Eleven flaps exhibited signs of circulatory failure between 1 hour and 6 days postoperatively and required return to the operating room. In eight patients the preoperative diagnosis was venous thrombosis, and in three patients it was arterial thrombosis. The average time from the first abnormal examination to exploration was 1.5 hours. There were no false-positive explorations. All 11 flaps were salvaged following correction of the cause of circulatory compromise. In eight patients this was due to inflow or outflow obstruction in the recipient vessels proximal to the anastomosis, in two patients it was due to extrinsic compression of the flap from a tight wound closure, and in one patient it was due to obstruction of the recipient vein by a drain. Primary anastomotic thrombosis was not encountered as the cause of circulatory compromise in any patient. An aggressive approach to exploration was responsible for an increase in flap survival in the entire series from 90 to 98 percent. The results of this study demonstrate the efficacy of clinical monitoring, the role of early exploration, and the durability of microvascular anastomoses.

Adolescent↗

PubMed1989

Efficacy of routine postpartum uterine exploration and manual sponge curettage.

Many physicians feel that manual exploration and sponge curettage of the uterus should be a routine part of all vaginal deliveries. Three hundred twenty uncomplicated routine vaginal deliveries (185 with exploration and sponge curettage, 135 without) were prospectively analyzed for differences in outcome with regard to postpartum hemorrhage, postpartum infection, and the patient's perception of pain. Results revealed there to be no clinically or statistically significant difference between these two groups in postpartum bleeding, postpartum white blood cell counts, and postpartum fever during the three-day postdelivery hospitalization. All patients were followed for six weeks. Five of 185 patients (2.7 percent) in the explored group returned for postpartum bleeding complications, one requiring hospital admission. Three of 135 (2.2 percent) returned for postpartum bleeding in the unexplored group, none requiring hospital admission. No patients in either group had complications with postpartum endometritis in the follow-up period. The patient's perception of pain was significantly higher in the explored and curettaged group as opposed to the unexplored group (P less than .0002). This study reveals that routine elective postpartum manual exploration and sponge curettage of the uterus is a painful procedure that is not clinically indicated for reducing the potential risk of postpartum hemorrhage or endometritis and is unnecessary following routine vaginal delivery.

Adult↗

PubMed1986

Timing of automatic contralateral groin exploration in male infants with unilateral hernias.

The effect of using 6 months as the cutoff age for automatic exploration of the asymptomatic contralateral side in male infants undergoing inguinal herniorrhaphy was studied by evaluating the operative findings and follow-up of 300 consecutive male infants admitted for symptomatic unilateral groin hernias. Males under the age of 6 months were automatically explored on the contralateral asymptomatic side. Those between 6 and 24 months underwent repair of only the symptomatic presenting side. The negative exploration rate in the 121 infants less than 6 months was 38 per cent. The return rate for contralateral exploration in children between 6 months and 2 years was 1 per cent. Follow-up ranged from 1 to 5 years. This data suggests that lowering the age for automatic exploration of the male contralateral groin to 6 months does not increase the rate of positive findings on the asymptomatic side. Nor does it appreciably increase the rate of later required contralateral operations.

Follow-Up Studies↗

PubMed1979

Exploration and play in retarded and nonretarded preschool children: effects of object complexity and age.

Three-dimensional random polygon objects ranging in complexity between 4 and 40 turns were presented to 12, 30-month-old and 12, 42-month-old moderately retarded and nonretarded children. Time spent in exploration and in play was measured over three successive exposure-time blocks. Exploration time for the combined sample of retarded and nonretarded younger children did not vary with object complexity. The older retarded children explored objects of low complexity more than did either the combined sample of younger children or the older nonretarded children. Nonretarded older children explored complex objects more than did the combined sample of younger children. Exploration time decreased linearly with exposure-time blocks. Play time increased linearly with successive exposure-time blocks and decreased linearly with increasing complexity.

Age Factors↗

PubMed1981

Common bile duct exploration: indications and results.

To ascertain the best diagnostic indicators of choledocholithiasis and to decrease the incidence of retained stones in the common bile duct after exploration, the authors carried out a retrospective review of 110 consecutive patients who underwent common bile duct exploration for calculous biliary tract disease. Conditions that were most often associated with choledocholithiasis were cholangitis and clinically obvious jaundice. The serum bilirubin level was helpful in identifying patients with stones in the common bile duct only when the value was greater than 6 mg/dl (103 mumol/l), and alkaline phosphatase only when the value was more than 250 IU (normal 110 IU). When stones are felt in the duct at operation, the diagnosis of choledocholithiasis is certain; positive operative cholangiograms are highly reliable and the coexistence of small gallstones and a dilated cystic duct is suggestive. The retention of stones is best prevented by careful exploration followed by high-quality T-tube cholangiography performed at operation after the exploration is complete. Any missed stones found in this way should be removed by re-exploration at the time of the original operation. Stones left in the common bile duct are best extracted nonoperatively under radiologic control. This technique, while effective and safe, is associated with considerable morbidity.

Cholangiography↗

PubMed1993

[Experiences of unilateral exploration of parathyroid adenoma].

In a series of 135 cases of primary hyperparathyroidism encountered in PUMC Hospital. Unilateral exploration was performed in 55 cases including 49 cases single adenoma, 1 double adenomas, 3 cases hyperplasia, 2 carcinoma and one MEN-I case. All the 3 cases of hyperplasia and 1 double adenomas were reoperations. There was only one case failed due to misguided by imaging diagnosis. The overall success rate of unilateral exploration was 98%. The reason of unilateral exploration is that about 80%-85% cases of hyperparathyroidism were caused by single adenoma. For single adenoma, unilateral exploration is enough and reasonable. The authors considered that once the diagnosis was made and preoperative localization has positive findings in experienced surgeon's hand the successful rate was very high, 2% of failure is acceptable. Technique point was discussed for unilateral exploration.

Adenoma↗

PubMed1994

[Explorations of the common bile duct in the era of laparoscopic surgery].

The advent of laparoscopic surgical procedures has infatuated both patients and surgeons. Potential beneficiaries in France could number 50,000 per year for gall stone surgery alone. The affect this type of procedure could have on exploration of the common bile duct has led to a certain degree of controversy in the literature. From 10 to 15% of the patients who undergo cholecystectomy have a stone in the common duct and require specific treatment. The clinician thus must propose an exploration of the common duct and decide on whether it should be performed before, during or after cholecystectomy. The choice of the exploration technique is directly related to the planned surgical approach. Most surgeons have abandoned the dogma of systematic per-operative cholangiography. The risk of missing a stone in the common bile duct in patients with no suggestive clinical or laboratory signs has been evaluated at 0 to 2%, suggesting that per-operative exploration is needed only in symptomatic cases. Transcutaneous echography cannot be considered as the reference technique since its sensitivity in no greater than 80%, similar to intravenous cholangiography. Reliable exploration currently relies on two techniques: endoscopic retrograde cholangiography which gives the diagnosis in 95% of the cases and echoendoscopy which has the advantage of a lower rate of complications. Other new improvements including miniaturization of the endoscopes are currently being tested. The correct approach must take into account the planned surgical procedure, the age and clinical situation of the patient and the experience of the operators with each technique.

Cholangiopancreatography, Endoscopic Retrograde↗

PubMed1993

[Exploration of the efferent system in man: basic and clinical results].

Since 1989, the exploration of the medial efferent system has been possible in human by using a non-invasive technique consisting in the association of the contralateral acoustic stimulation and the evoked otoacoustic emissions (EOAEs). This exploration presents a great interest for fundamental auditory research because it is the sole means of exploring in human these cochlear efferent neurons synapsing at the base of the outer hair cells. The function of this system is still unknown. The interest of such an exploration in clinical research is now becoming obvious such that it would be not only useful but also necessary to establish a precise diagnosis in particular pathologies. The aim of the present paper is to expose basic results obtained on the medial efferent system in normal subjects and above all to present findings for pathological ears, among which figure in particular: retrocochlear pathologies, hyperacousia, noise-induced hearing loss, tinnitus. In addition to the diagnostic interest of the exploration of the medial efferent system, a knowledge of its functioning will probably allow its role in audition to be determined.

Acoustic Stimulation↗

PubMed1996

Altered inhibition of dentate granule cells during spatial learning in an exploration task.

To investigate the extent to which inhibitory interneurons control impulse flow through the dentate gyrus during spatial learning in an exploration task, dentate field potentials were recorded in response to paired stimulation of the perforant path while rats rested or explored. Recurrent inhibition of the granule cells was measured as the reduction of the second waveform when a population spike was present in the first. Both the population spike and the field EPSP (fEPSP) were suppressed at interstimulus intervals shorter than approximately 40 msec. Consistent differences were observed between potentials recorded at equivalent brain temperature in the exploration and resting (reference) conditions. During exploration, the fEPSP of the second (test) waveform was reduced further compared with reference potentials with a similar response to the first (conditioning) stimulus. This reduction was observed only when the first pulse elicited a population spike. The population spike of the second waveform was facilitated compared with reference potentials with similar fEPSP slopes. These observations suggest that exploration is coupled to increased inhibition on the perforant-path terminals or the dendrites of the granule cells, whereas the inhibition on the somata is decreased. The two phenomena were not correlated and followed different time courses. The suppression of the fEPSP decayed gradually, although it was still present at 15 min, whereas the facilitation of the population spike was stable. Together, these changes, which likely involve different populations of interneurons, may focus and amplify incoming signals from the entorhinal cortex.

Animals↗

PubMed1995

Adolescent identity exploration: a test of Erikson's theory of transitional crisis.

This research investigated Erikson's theory that adolescent identity exploration is associated with a variety of symptoms, such as fluctuations in ego strength, mood swings, rebelliousness, and heightened physical complaints. A sample of 82 high school students completed the Minnesota Multiphasic Personality Inventory (MMPI) and the Ego-Identity Interview. Identity exploration was correlated with 23 major clinical scales and the 14 Frequently Scored Scales of the MMPI. A factor analysis revealed seven scales loading on a single factor, which accounted for 39% of the variance in exploration. The items in the factor suggested a pattern consistent with Erikson's theory of adolescent crisis, and was labeled the Identity Exploration Crisis (IEC) factor. Adolescents who were actively engaged in identity exploration were more likely to produce a personality pattern characterized by self-doubt, confusion, disturbed thinking impulsivity, conflicts with parents and other authority figures, reduced ego strength, and increased physical symptoms.

Adolescent↗

PubMed1998

Initial cervical exploration for parathyroidectomy is not benefited by preoperative localization studies.

Published data is controversial as to the ability of preoperative localization studies (PLS) to enhance the outcome of initial cervical exploration in patients with primary hyperparathyroidism (PHPT). One surgeon's experience was reviewed to compare surgical success, operative time, and morbidity of initial cervical exploration for PHPT in patients who had undergone PLS versus those who had not. From August 1991 to September 1997, 95 patients who had not undergone prior central cervical exploration presented for surgical management of PHPT. Sixty-seven patients underwent initial cervical exploration without any PLS having been performed (Group A). Twenty-eight patients underwent PLS, either alone or in combination, before surgical intervention (Group B). Analysis of intergroup variability was conducted upon the data available using a two-tailed t test for independent samples. In addition, the sensitivities and positive predictive values of the PLS were calculated using study reports and operative and histologic findings. There was no statistically significant difference in surgical success between those patients who had PLS and those that did not undergo PLS. Sixty-four of 67 patients (95.5%) not having PLS were cured with initial surgery, while 27 of 28 patients (96.4%) who had PLS were surgically cured. Mean postoperative calcium and intact parathormone levels were similar between the two groups, and the mean operative time did not differ. Permanent hypocalcemia occurred in one patient, and five patients had transient hoarseness. Thirty-six total PLS were obtained at an average cost of $752.68/patient, and seven patients underwent multiple tests. Overall, sestamibi scan had the highest positive predictive value (81%). For adenomatous disease alone, sestamibi scan was the most sensitive (83%). Our study shows that for matched groups limited to age, sex, and clinical diagnosis, the use of PLS did not shorten operative time, decrease complication frequency, nor alter the success of the operation as measured by postoperative calcium and parathormone levels. Therefore, routine use of preoperative localization studies before initial cervical exploration for PHPT cannot be recommended.

Adenoma↗