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At least 613 records · Page 34Linked to original sources

PubMedDate not supplied

Saphenous nerve injury. An unusual arthroscopic complication.

The surgeon should use strict technical vigilance to prevent intraoperative arthroscopic complications. An expert understanding of the anatomy, along with visualization of all instruments during surgery, should prevent inadvertent injury to neighboring structures. This case report represents one unusual complication associated with arthroscopic knee surgery and should serve to heighten the surgeon's awareness that arthroscopy is not a benign procedure.

Adult↗

PubMed2001

Echographic evaluation of a patient with diabetes and dense vitreous hemorrhage: an avulsed retinal vessel may mimic a tractional retinal detachment.

PURPOSE: To report that an avulsed retinal vessel may appear as a tractional retinal detachment on echographic evaluation. METHODS: Case report. RESULTS: A 57-year-old diabetic woman presented with a nonclearing vitreous hemorrhage of 2 months duration in the left eye. Echography was consistent with a localized tractional retinal detachment on longitudinal sections; transverse sections demonstrated a pinpoint opacity in the vitreous cavity. Intraoperatively, an avulsed retinal vessel was noted in the area of echographic abnormality. CONCLUSION: An avulsed retinal vessel may mimic tractional retinal detachment on echography. Although trained ophthalmic echographers routinely perform both longitudinal and transverse sections during an echographic evaluation, less skilled observers must be aware of the importance of performing both longitudinal and transverse sections for accurate echographic diagnosis.

Diabetes Mellitus, Type 1↗

PubMed2003

Psychosocial management of the foot and ankle surgery patient.

Currently, many patients undergo surgery when they and their families are not prepared or resilient enough to recover fully, predisposing them to poor outcomes. These poor outcomes lead to missed work, patient depression, chronic pain, litigation, and surgeon frustration. Sometimes these individuals require the surgeon's oversight and are more likely to improve with rapid vocational therapy, physical therapy, and aggressive, continuous chronic-pain management. The foot and ankle surgeon who takes a biopsychosocial multidisciplinary perspective will prescreen his or her patients for positive risk factors and expand his or her intervention long before and after surgery. This strategy of triaging medical cases to differential treatment is not a new concept in medicine. What is novel is the necessity of triaging and prioritizing patients on the basis of the most significant factors that determine successful surgical outcome: psychologic, social, environmental, and historical medical factors . Robert Sternberg of Yale University suggested that three psychologic problem-solving strategies are available: (1) I can try to change myself, (2) I can try to change others, or (3) I can try to change the situation. Naturally, the authors of this article encourage applying all three: (1) the caring surgeon is attentive to these issues; (2) the medical community prepares the patient, themselves, and the patient's family; and (3) the environment into which the patient is released is altered to support their rehabilitation. The ABLE Presurgical Assessment Tool and related treatment strategies provide foot and ankle surgeons with an easy-to-use, research-based application to better screen and manage their surgical patients. The goal of this review and assessment tool is not to determine a quantitative level of risk. Instead, the authors hope to facilitate a surgeon's awareness of critical preoperative risk factors and provide a tool to efficiently identify these factors and arrange appropriate treatment as needed.

Ankle↗

PubMed1999

Anesthetic management of a patient with laryngeal amyloidosis.

A 73-year-old woman who suffered from progressive hoarseness for 6 years and dysphagia without pain for 1 year presented with a soft tissue deposition on the posterior region of the vocal cords and narrowing in the subglottic area. Biopsy of this soft tissue and histological examination revealed laryngeal amyloidosis. A tracheostomy and partial removal of the amyloid were performed with general anesthesia. The airway was secured with a smaller diameter endotracheal tube, which was inserted atraumatically with Magill's forceps. The larynx is a rare site for amyloidosis. Laryngeal amyloidosis is fragile and hemorrhagic. Therefore, massive bleeding may occur during intubation. Anesthetists should take care in intubating the tracheas of these patients and be aware of other systemic diseases in laryngeal amyloidosis.

Aged↗

PubMed1998

Superior oblique damage from the traction suture at cataract surgery.

A 41-year-old woman underwent uneventful phacoemulsification and posterior chamber lens implantation in the right eye. Approximately a month later similar surgery was performed in the left eye. The surgery was performed with the patient under retro-bulbar anesthesia with a combination of bupivacaine (Marcaine) 0.75% and lidocaine (Xylocaine) 4% administered through a lower lid injection. Immediately after the patch was removed, the patient was aware of constant vertical diplopia. Over the ensuing 6 months the symptom worsened. Orbital computed tomography showed no abnormalities.

Adult↗

PubMed1996

Double-blind, randomized trial of cessation of smoking after audiotape suggestion during anaesthesia.

We studied the use of intraoperative tape suggestion to improve the rate of cessation of smoking in 363 smokers who wanted to stop smoking. They were allocated randomly to hear a taped message encouraging them to stop smoking or to a blank tape, played during general anaesthesia. Overall 56 patients (15.4%, 95% confidence interval (CI) 11.7-19.1%) had claimed to have stopped smoking at 2 months and 29 patients (8.0%, 95% CI 5.9-10.1%) were confirmed to have stopped smoking at 6 months. There was no significant difference between the groups at either 2 or 6 months (risk ratios 1.06 and 1.09, respectively, P = 0.78). A preoperative:postoperative ratio of a visual analogue scale measuring the patient's motivation to stop smoking was not significantly different (control group 1.13 vs message group 1.10, P = 0.55). This study does not support the hypothesis that intraoperative tape suggestion can change smoking behaviour.

Adolescent↗

PubMed1999

The changes of ventilatory parameters in laparoscopic colecystectomy.

We investigated the ventilatory changes in healthy patients without cardiopulmonary pathology during elective laparoscopic cholecystectomy in the head-up position. During surgery, intraabdominal pressure was maintained at 15 mmHg by a CO2 insufflator, and minute ventilation was controlled with a constant tidal volume and fixed respiratory rate. PETCO2 was monitored continuously and recorded every minute. Basic hemodynamic and ventilatory parameters were measured before anesthesia; after induction of anesthesia; at 5 min, 10 min and 30 min after peritoneal insufflation; and 5 min and 10 min after exsufflation. Arterial blood samples were obtained 3 times to calculate D(a-A)CO2, VD/VT, and Vco2. The latent period of PETCO2 change was 2.9 min, the ascending period was 12.6 min, and the descending period was 12.2 min. During the 71.5 min of pneumoperitoneum, V(I), VE, peak and plateau Paw increased, while Cdyn decreased significantly. Peritoneal insufflation or exsufflation also resulted in a significant change of D(a-A)CO2, D(a-A)O2, and Vco2. The anesthesiologist must be aware of both hemodynamic and ventilatory changes and must be ready to respond promptly and adequately.

Adolescent↗

PubMed2002

Computed tomography of traumatic abdominal wall hernia and associated deceleration injuries.

We retrospectively reviewed the computed tomographic (CT) examinations of 15 cases of abdominal wall hernia due to abdominal trauma; 13 patients had been injured in motor vehicle accidents (11 of those were belted in). All hernias were correctly identified on CT and confirmed intraoperatively. Traumatic abdominal wall hernia proved an important indicator of associated visceral injury, especially to the bowel (n = 6) and mesentery (n = 10). Careful review of the bowel and mesentery should thus be undertaken when disruption of the abdominal wall is documented. Radiologists should be aware, however, that CT findings may correlate poorly with severity of injury in these areas. In these instances, close clinical correlation and, sometimes, rescanning may be necessary.

Abdominal Injuries↗

PubMed2003

[A case of latex anaphylactoid reaction starting with respiratory symptoms].

We report a case of latex anaphylactoid reaction in a 39-year-old man with aortitis. He was scheduled to undergo stent-graft implantation. When the operation progressed into his abdomen, respiratory symptoms, wheezing and high airway pressure, occurred. However, he did not show any dermal symptoms. Thirty-five minutes after the start of respiratory symptoms, his face suddenly showed flush, and intravenous epinephrine worked successfully against anaphylactoid reactions. There are anaphylactoid reactions which occurred with respiratory symptoms, and we should be aware of these cases.

Adult↗

PubMed2006

BIS monitoring in a patient with history of awareness and a difficult airway.

We describe a case where bispectral index (BIS) monitoring was used successfully to guide an inhaled induction technique for a difficult airway. The patient was a 34 years old male who had a previous history of awareness during anaesthesia. He was also morbidly obese with a Mallampatti score of III on preoperative examination.

Adult↗

PubMed1991

Photic maculopathy in young males with intraocular foreign body.

A young male with intraocular foreign body (IOFB) and clear media had successful removal of the IOFB but sustained macular damage and permanent loss of vision secondary to operating microscope phototoxicity. Light damage to the eye can be thermal, mechanical, or photochemical and is dependent on source and wavelength of light, filters, and host factors. Removal of IOFB is important, but surgeons must be aware of potential light damage to the macula in lengthy surgical procedures and take appropriate precautions.

Adult↗

PubMed1990

[Anesthetic management of patients with cardiomyopathies].

Anesthetic management of patients with cardiomyopathy was studied. In the past 8 years, we experienced 24 surgical procedures for 16 patients complicated with cardiomyopathy of whom 6 cases with hypertrophic type (HCM) and 10 cases with dilated type (DCM). In HCM there was no correlation between the incidence of intraoperative complication and preoperative evaluation by New York Heart Association. In HCM cases who revealed atrial fibrillation, conduction disturbance on ECG and hypokinesis on echocardiogram resulted in high incidence of cardiac complication during anesthesia. Induction of anesthesia is extremely risky if the anesthesiologist is not aware of the presence of cardiomyopathies. In DCM, preoperative episode of heart failure, arrhythmias and conduction disturbance on ECG were considered as anesthetic risk factors. Both in HCM and DCM, there were no statistical significance in complication between general anesthesia and epidural anesthesia. The authors recommend epidural technique as a method of choice for HCM patient.

Adult↗

PubMed1992

[Pitfalls in cortical localization by intraoperative recording of cortical somatosensory evoked potentials].

Cortical somatosensory evoked potential (SEP) recordings were made in 11 patients who had lesions located in or near the somatosensory or motor gyri to localize the central sulcus and sensorimotor cortex during neurosurgical operations. Cortical localization was successful in 7 of the 11 patients by recording phase reversal waveforms of N20 and P20 at electrode sites in the hand area on opposite sides of the central sulcus. There were 4 cases in which the cortical localization failed. Locations of craniotomy were far distant from the central sulcus retrospectively in 2 of the 4 patients. Cortical SEPs couldn't be recorded despite probable exposure of the hand area and apparently adequate stimulation and recording conditions in 2 patients who had showed no or low amplitude scalp SEP preoperatively. In one of these 2 patients only low amplitude negative waves were recorded at the cortex which was thought far field potentials originated from subcortical structures. In 2 patients cortical SEP was monitored during the removal of the tumors and was useful to estimate the effects of the operative procedures on the sensorimotor cortex. It is concluded that the localization of cortical functions using cortical SEP is useful for reducing risk associated with intracranial surgery. However, we must be aware that there are some pitfalls in this method.

Adolescent↗

PubMed2003

Propofol and sufentanil titration with the bispectral index to provide anesthesia for coronary artery surgery.

BACKGROUND: To provide anesthesia for cardiac surgery, hypnotics and opioids are frequently titrated on variables such as mean arterial pressure and heart rate. In this study conducted in patients scheduled to undergo coronary artery bypass grafting, propofol and sufentanil, both administered by computer-controlled infusion, were titrated on the Bispectral Index (BIS) values using a predefined algorithm. METHODS: After written informed consent, 110 patients, 95 men and 15 women aged 61 (9) yr [mean (SD)], were randomly allocated to receive predicted sufentanil effect site concentrations (Ce) of 0.5, 0.75, 1, 1.25, and 1.5 ng/ml, decreased by a third after sternotomy (groups 1-5). Target induction propofol concentration was 1.5 microg/ml and subsequently adjusted on BIS values. The following parameters were recorded: BIS values, predicted propofol Ce, the number of changes of propofol target, mean arterial pressure, heart rate, the number of bolus injection and doses of vasoconstrictor and vasodilator drugs, time to tracheal extubation, postoperative awareness and satisfaction scores, and cumulative morphine doses for the first postoperative day. RESULTS: One patient randomized to group 1 required 0.75 ng/ml sufentanil Ce instead of 0.5 ng/ml for increased BIS values on tracheal intubation. BIS values were similar in the five groups. The predicted propofol Ce values were different (P < 0.05; analysis of variance) among the five groups: 1.59 (0.47) to 1.23 (0.25) microg/ml in group 1 and group 4, respectively. Significantly fewer changes of propofol target were required in group 4 as compared to group 1. There were no differences among the five groups for mean arterial pressure, heart rate, time to tracheal extubation, awareness, satisfaction scores, and morphine requirements. CONCLUSION: These results suggest the BIS, as part of an algorithm that uses both the absolute BIS value and its increase following tracheal intubation, can be used to effectively titrate both propofol and sufentanil. A predicted sufentanil Ce of 1.25 ng/ml before and 0.8 ng/ml after sternotomy was associated with the lowest predicted propofol Ce and fewer changes of propofol target. Lower sufentanil concentrations required higher propofol concentrations and more frequent changes of the target propofol concentration and were associated with similar hemodynamic tolerance.

Adolescent↗

PubMed1976

Ruptured submucosal gastric artery microaneurysm.

A patient with massive upper gastrointestinal hemorrhage from a ruptured submucosal gastric artery microaneurysm is described. Intraoperative diagnosis was made and wedge resection of the lesion resulted in survival of the patient. Forty-two cases in this entity have been reported in the literature, with nonoperative therapy being uniformly fatal; there were only four cases of successful surgical management. An increased awareness of this entity in cases of unexplained gastrointestinal hemorrhage is the key to diagnosis and successful management.

Aged↗

PubMed2005

[Non palpable lesions of the breast: the Mammotome-biopsy in the preoperative management of breast cancer].

BACKGROUND: Breast tumour takes first place for frequency in women in Western Countries and is in constant increase. The diagnosis of the so-called non palpable lesions is increased remarkably above all due to the diffusion of mammographic screening and to a greater awareness of the problem. Furthermore it is helped by an important development of mininvasive diagnostic methods: the traditonal cytology with fine needle is supported by various trans-skin bioptic procedures (micro-histological examination). This methods almost always replaces the surgical excisional biopsy and frozen intraoperative examination, still used but reserved for particular cases. PATIENTS AND METHODS: In our Department of General and Mininvasive Surgery, from December 1999 to September 2004, we carried out 214 biopsies, with the collaboration of the radiological Service, under echographic guidance using vacuum--assisted biopsy (Mammotome) with 11-Gauge needle. The results are examined and discussed here in this report with regard to diagnostic accuracy, quantity and quality of information, significant for subsequent surgical management. RESULTS: Of 214 biopsies carried out with Mammotome technique, 89.3% of the cases are clinically non palpable lesions, with a average diameter of 8 mm. The average age of patients was 57.6 years (range 31-88). There are 90 cases of positive malignant pathology (42%). In the atypical ductal iperplasia and radial scar cases (6%) surgical removal of lesion was carried out which confirmed the previous bioptic diagnosis in 100% of cases. The 19% of patients submitted to a Mammotome biopsy was subject previously to cytology with fine needle. Comparing the results of both methods the diagnostic reliability of Mammotome was significantly superior (p < 0.05) as also the amount of information obtained (histotype, invasivity, grading, estrogen receptor, etc.); discomfort linked to the procedure, valued as pain (VAS), resulted inferior to the discomfort of biopsy with fine needle. The only complication of Mammotome biopsy is represented by haematoma in the biopsy site (8% of cases). The number of false negatives was one case due to incorrect targeting. CONCLUSION: In the present situation, the choice of method is conditioned by the degree of radiological suspicion, taking into account the information obtained thereby, in order to ensure the appropriate surgise management. Mammotome biopsy of non palpable lesions of the breast, in our experience, is preferable if suspicion of malignancy is high. In this way a correct preoperative strategy can be prepared. Including the sentinel lymphnode method. Consequently a decision regarding the type of surgery can be taken (generally conservative), as well as making easier the intraoperative localisation of lesion by positioning the metallic clips during biopsy.

Adult↗

PubMed1997

[Organ preservation in the treatment of malignant solid tumors in children].

Organ preservation is one of the requirements for maintaining the high quality of life after the treatment of malignant solid tumors in children. We analyze our recent results of renal preservation in the abdominal neuroblastoma and describe 3 cases of successful organ preservation in pelvic malignancy. Between 1982 and 1996, 29 patients with adrenal or retroperitoneal neuroblastoma, that extended into the surrounding tissues and organs and/or to the contralateral side, underwent delayed primary excision. Before 1982, 9 patients were treated and only one ipsilateral kidney was preserved. On the other hand, 13 of 20 kidneys were preserved after 1987. Adoption of cis-platinum deepened our awareness of preserving the kidney. Furthermore, we have altered our strategy since 1987 to continuing preoperative chemotherapy until the size of the tumor becomes as small as it is estimated completely resectable by our own index, which is derived from computed tomography. Kidneys are shielded during intraoperative irradiation, and the tumor relapsed from the shielded area of retroperitoneum in one patient. Four of 14 preserved kidneys became atrophic and lost their function. The bladder and the rectum were left intact at tumor resection after intensive chemotherapy in two patients with pelvic (one retroperitoneal and one vaginal) rhabdomyosarcoma. A yolk sac tumor of the vagina responded completely to chemotherapy with cis-platinum, etoposide and bleomycin. The patient has survived 7.5 years without any local and distant relapse in spite of the fact that surgery, aside from several diagnostic biopsies, was not undertaken.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2004

[Iatrogenic perforations of the esophagus and hypopharynx--5 year experience at the Center for Esophageal Surgery].

Iatrogenic perforations of the esophagus and hypopharynx are important problem, due to diagnostic difficulties, controversies about adequate treatment, and high morbidity and mortality rate. Incidence of iatrogenic perforations is from 50 to 75% of all perforations. In the period from April 1999. to April 2004, 15 patients with iatrogenic perforation of the esophagus and hypopharynx were treated at the Department of esophageal surgery, First University Surgical Hospital in Belgrade. In majority of patients iatrogenic perforation occured during endoscopic interventional procedure (endoscopic removal of ingested foreign body--10 pts, endotracheal intubation--2 pts, intraoperative iatrogenic perforation--2 pts, pneumatic dilatation--1 pt). Surgical treatment was performed in 12 (80%) pts and 3 (20%) pts were treated conservatively. Surgical approach was cervicoabdominal, thoracoabdominal and cervicothoracoabdominal in 9.1 and 2 pts, respectively. Among 12 operated pts, primary repair of the esophagus was performed in 5 pts, and esophageal resection or exclusion in 7 pts. Overall mortality rate was 13.3% (2 pts), in surgical group 8.3% (1 pt) and in conservatively treated group 33.3% (1 pt). Iatrogenic perforations of the esophagus and hypopharynx are diagnostic and therapeutic problem. Awareness of the possibility of esophageal perforation during instrumental manipulations and early diagnosis is essential for successful, individually adapted, and in most cases surgical, treatment.

Adult↗