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PubMedDate not supplied

[A case of intestinal occlusion caused by endometriosis of the cecum].

The purpose of this study is to heighten awareness of intestinal endometriosis, a disease that may mimic other abdominal pathologies (bowel carcinoma, intestinal inflammatory disease, diverticulitis), sometimes found in the emergency setting. The Authors report a case of acute bowel obstruction due to coecal endometriosis with appendix mucocele, peritoneal pseudomyxoma and ovarian endometrioma. The patient was operated on in the emergency setting, a right colectomy was performed and she then received pharmacological suppressive treatment with Gn-RH analogues and danatrol. We remark that preoperative diagnosis is very difficult in those cases that do not have a past history of pelvic endometriosis. An accurate anamnesis regarding the chronology of pain onset (typically only during the menstruation at first), but especially intraoperative histopathologic examination are useful for diagnosis. An increased awareness of intestinal endometriosis in reproductive age women with acute bowel obstruction, associated with an accurate anamnesis of menstrual history may allow pre- or intraoperative diagnosis, which is the clue to a less aggressive operation. Postoperative follow up and hormonal therapy are mandatory.

Adult↗
PubMed1997

Absence of memory for intraoperative information during surgery under adequate general anaesthesia.

Using the isolated forearm technique (IFT), we wished to determine if patients known to be unresponsive to commands during general anaesthesia with nitrous oxide, halothane and neuromuscular blocking agents had any evidence of explicit or implicit recall. Two groups of women, studied in a single-blind sequential block design, heard different tapes, either a command and information tape (n = 34) or radio static (n = 34), throughout surgery. Four women (two radio static, two command) had unequivocal evidence of explicit recall for a period near the beginning or end of the procedure, at a time when the IFT was not being used. With or without hypnosis, category generation, serial position of category exemplars and word association tests did not reveal evidence of priming. We conclude that during light general anaesthesia with nitrous oxide, halothane and atracurium, patients had neither explicit nor implicit memory for information presented during a period when they are known to be unresponsive to commands.

Adolescent↗
PubMed1986

Postoperative neurological deficits may occur despite unchanged intraoperative somatosensory evoked potentials.

We describe 6 patients who demonstrated postoperative neurological deficits despite unchanged somatosensory evoked potentials during intraoperative monitoring. Although there is both experimental and clinical evidence that somatosensory evoked potentials are sensitive to some types of intraoperative mishap, the technique should be employed with an awareness of its possible limitations.

Adolescent↗
PubMed2002

Dural lesions mimicking meningiomas.

Recently, a number of neoplastic and nonneoplastic entities have been reported that radiographically and clinically mimic meningiomas. Because these lesions occur infrequently and may resemble a meningioma during intraoperative analysis, they may not be considered in the differential diagnosis. This review (and case illustrations) considers some of the newly recognized and notable lesions that can mimic meningiomas, including solitary fibrous tumors, gliosarcomas, leiomyosarcomas, hemangiopericytomas, melanocytomas, Hodgkin's disease, plasmacytomas, inflammatory pseudotumors, neurosarcoidosis, plasma cell granulomas, Rosai-Dorfman disease, Castleman's disease, xanthomas, rheumatoid nodules, and tuberculomas. Awareness that these lesions involve the dura may facilitate intraoperative recognition and, in some cases, preclude unnecessary additional surgery.

Adolescent↗
PubMed1997

Donor biliary variations: an overlooked problem?

Documented causes of biliary complications following orthotopic liver transplantation have been related to technical imperfections or insufficient arterial supply. Although anatomical variations of the extrahepatic biliary system are not infrequent, neither their incidence, surgical management nor possible association with complications have been reported in liver transplantation. At our institution, the global incidence of biliary complications following 357 consecutive liver transplants performed in 324 patients over a 2-yr period was 15.4% (55/357). Anomalous donor extrahepatic ducts were verified in 10 cases (2.8%) and they were recognized intraoperatively, prior to biliary reconstruction, in 7 cases. Technical complications occurred in 1 of these 7 and in 3 other cases where the anomalous ducts were not identified until later in the postoperative period when serious clinical problems ensued. We herein present a description of these 10 cases, with reference to the techniques employed to manage the anatomical anomalies and to treat complications. As in any hepatobiliary procedure, awareness of possible variations of the extrahepatic biliary system, intraoperative identification of the anomalous ducts and appropriate tailoring of the surgical technique are advisable in order to avoid serious postoperative complications in liver transplantation.

Adult↗
PubMed1997

Intraoperative autologous transfusion during elective infrarenal aortic reconstruction: a decision analysis model.

PURPOSE: The use of intraoperative autologous transfusion devices expanded during the last decade as a result of the increased awareness of transfusion-associated complications. This study was designed to determine whether routine use of an intraoperative autologous transfusion device (Haemonetics Cell Saver [CS]) during elective infrarenal aortic reconstructions is cost-effective ($50,000/QALYs threshold). METHODS: A decision analysis tree was constructed to model all of the complications that are associated with red blood cell replacement during aortic reconstructions for both abdominal aortic aneurysm (AAA) and aortoiliac occlusive disease (AIOD). It was assumed that a unit of CS return (CSR; 250 ml/unit) equaled a unit of packed red blood cells (PRBCs) and that all CS transfusions were necessary. Transfusion requirements (AAA:PRBC = 2.8 +/- 3.2 units, CSB = 3.7 +/- 3.2 units; AIOD:PRBC = 3.1 +/- 3.0 units, CSR = 2.1 +/- 1.7 units) were determined from retrospective review of all elective aortic reconstructions (AAA, N = 63; AIOD, N = 75) from Jan. 1991 to June 1995 in which the CS was used (82.1% of all reconstructions). Risk of allogenic transfusion-related complications (transfusion reaction, hepatitis B, hepatitis C, human immunodeficiency virus, human T-cell lymphotropic virus types I and II) and their associated treatment costs (expressed in dollars and quality-adjusted life years (QALYs) were obtained from the medical literature, institutional audit, and a consensus of physicians. RESULTS: Routine use of the CS during elective infrarenal aortic reconstructions was not cost-effective in our practice. Use during reconstructions for AAA repairs cost $263.75 but added only 0.00218 QALYs, for a rate of $120,794/QALY. Use during reconstructions for AIOD was even more costly at $356.68 and provided even less benefit at 0.00062 QALYs, for a rate of $578,275/QALY. The sensitivity analyses determined that the routine use of the CS would be cost-effective in our practice only for AAA repairs if the incidence of hepatitis C were tenfold greater than the baseline assumption. The model determined that CS was cost-effective if the CSR exceed 5 units during reconstructions for AAA and 6 units during reconstructions for AIOD. CONCLUSIONS: The routine use of the CS during elective infrarenal aortic reconstructions is not cost-effective. The use of the device should be reserved for a select group of aortic reconstructions, including those in which cost-effective salvage volumes are anticipated. Alternatively, the CS should be used as a reservoir and activated as a salvage device if significant bleeding is encountered.

Aged↗
PubMed1979

Awareness, muscle relaxants and balanced anaesthesia.

The incidence of awareness during insufficient anaesthesia is reported to be one per cent. It is usually due to the use of muscle relaxants, a balanced technique and the lightest possible depth of anaesthesia. Increased incidences were noted in open-heart surgery, during intubation-endoscopy procedures and in caesarean delivery patients. Experiences of awareness are disturbing to patients, who are usually benefited by a sympathetic and forthright explanation of the event. Fourteen representative cases of the problem are reported. Since no adequate sign or test exists for detection of awareness during very light anaesthesia or with associated paralysis, more meticulous attention is required in using relaxants or the balanced technique. Greater anaesthetic supplementation and reduction in the use of relaxants are recommended to halt the recurrence of this most serious anaesthetic problem.

Adult↗
PubMed1990

Lower oesophageal contractility and detection of awareness during anaesthesia.

We have investigated the value of lower oesophageal contractility (LOC) in detecting awareness during anaesthesia in 20 human volunteer patients. LOC was measured either with subjects awake or after induction with propofol, during induction with propofol, and then as consciousness returned. Statistically significant changes were observed in the frequency of spontaneous contractions, peak and mean amplitude of spontaneous and provoked contractions, and the oesophageal contractility index as subjects lost consciousness and also as it was regained. The differences in LOC which occurred when subjects were conscious and unconscious support the view that LOC is related to the depth of anaesthesia, but its unreliability at the interface between consciousness and unconsciousness prevents selective detection of awareness, although the response in the presence of painful stimuli has not been tested.

Anesthesia, General↗
PubMed2003

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Anesthesia, General↗
PubMed2004

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Anesthesia, General↗