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At least 667 records · Page 37Linked to original sources

PubMed1990

Surgical asepsis revisited.

Basic principles, rituals, and surgical conscience are essential components of surgical asepsis. Surgical asepsis has become too complicated. Protective asepsis describes principles of good hygiene, sanitation, and impeccable aseptic technique; the term has received renewed interest in the advent and increased awareness of bloodborne diseases. Rituals may actually enhance learning and efficiency in the operating room even though they may or may not directly affect nosocomial infection rates.

Asepsis↗

PubMed1987

Safety of Hyskon for routine gynecologic surgery. A case report.

Hyskon is widely used to prevent postoperative adhesions in infertility surgery. Occasionally its use leads to serious complications, some of which may have a delayed onset. An awareness of these complications will enable practitioners to lessen morbidity through appropriate patient selection for procedures involving Hyskon and through appropriate postoperative management.

Adult↗

PubMed1994

[Pneumothorax during laparoscopic cholecystectomy].

One patient developed pneumothorax during laparoscopic cholecystectomy. The pneumothorax was immediately drained with an intercostal canula. A diaphragmatic lesion caused by the electrocoagulator was identified and closed, surgery was completed, and the patient was not seriously affected by the complication. Laparoscopic cholecystectomy has gained enormous popularity. Pneumothorax is a rare, but potentially fatal complication. Immediate treatment is essential and easy. This report should make anaesthetists and surgeons aware of the possibility of gas insufflated during laparoscopy producing a pneumothorax, particularly with the increased use of the technique for major upper abdominal procedures.

Cholecystectomy, Laparoscopic↗

PubMed1996

[Recent changes in breast cancer surgery].

After former radical extensions the breast cancer surgery now tends to accept the necessary minimum principle. There are surveys which rated the local recurrence to the width of the intact margin around the tumour; they are aware of the decisive role of extensive intraductal component to have an influence on the local recurrence. Leaving out irradiation in selected groups is a part of the less aggressive tendency of breast cancer treatment. The omitment of the routine use of axillary dissection is under further consideration as well. The intraoperative mapping of lymph nodes looks promising in assessing their tumorous involvement. The prognostic role of dissection can be replaced by the immunoreactive hepatocyte growth factor. Timing of the operation adjusted to the menstrual phase seems to improve the survival in case of those patients who were operated on in the luteal phase.

Breast Neoplasms↗

PubMed2001

Latex allergy: an update for the otolaryngologist.

OBJECTIVE: To describe the clinical manifestations of latex allergy in otolaryngology patients. DESIGN: Descriptive case series. SETTING: Tertiary academic otolaryngology practice. PATIENTS: Otolaryngology patients with documented allergic reactions to latex during surgery and confirmatory laboratory test results for latex allergy. MAIN OUTCOME MEASURES: Clinical description of latex reactions; identification of risk factors for latex allergy. RESULTS: We describe 3 patients, 2 children and 1 young adult, with severe latex allergy manifested by intraoperative cardiorespiratory changes and confirmed by positive latex-specific IgE test results. A 9-year-old boy with a tracheotomy and a history of multiple procedures for laryngeal stenosis developed a rash and unexplained bronchospasm during an open laryngeal procedure. Surgery was aborted, and subsequent surgery was performed uneventfully 4 weeks later using a latex-safe environment. A 13-year-old boy with recurrent respiratory papillomatosis and a ventriculoperitoneal shunt had sudden unexplained arterial oxygen desaturation and a rash during laser endoscopy. He was then treated successfully using latex-safe protocols. A 23-year-old man with a parotid malignancy developed unexplained hypotension and ventilatory difficulties in the operating room during preparation for surgery. He responded to medical treatment for anaphylaxis. CONCLUSION: The otolaryngologist should share in the increased awareness of latex allergy. Our patients who have had multiple surgical procedures or who are exposed to latex on a long-term basis may be at increased risk. Latex allergy should be considered when unexplained cardiorespiratory compromise occurs during surgery.

Adolescent↗

PubMed2005

[What is the influence of the approach to intraoperative measurement of the knee joint on total knee arthroplasty? A navigation-controlled study on a cadaver knee].

Correct postoperative leg alignment and stability of the total knee prosthesis over the full range of movement is one critical factor for successful TKA. The anatomic approach is still the subject of controversy. The aim of our study was to elucidate the influence of the surgical approach on the ligament balancing and the anterioposterior limb axis.On five cadaver knees we studied the influence of the subvastus, midvastus, medial parapatellar, rectus snip, and tuberosity osteotomy approaches on the anterioposterior leg axis in extension and the rotation of the femoral component in flexion. Measurements were performed and documented by CT-free Ci-Navigation-System. Ligament tension was measured with a tensor device. We found that the subvastus approach leads to less widening of the medial compartment than all other approaches in extension. In 90 degrees flexion we found a similar influence. The consecutive release from subvastus to midvastus to medial parapatellar approach leads to a further opening of 0.5-1 degrees valgus in extension as well as in flexion. An everted patella amplifies this influence. The surgeon has to be aware of the impact on the ligament situation in regard to the anatomic approach when ligament balancing and soft tissue releases are carried out. Patella eversion should be avoided when managing soft tissues.

Arthroplasty, Replacement, Knee↗

PubMed1998

Gallbladder duplication and laparoscopic management.

Gallbladder duplication can present a significant challenge to the laparoscopic surgeon, primarily due to difficulties with diagnosis and recognition. Previous reports of attempted laparoscopic cholecystectomy in patients with gallbladder duplication resulted in incomplete or staged multiple procedures. The case report of a 35-year-old woman with successful laparoscopic management of symptomatic gallbladder duplication is described, emphasizing several important considerations. Preoperatively when evaluating radiologic studies a high index of suspicion is necessary in interpreting atypical findings. To further evaluate these abnormalities, liberal use of preoperative ERCP is helpful, and specific endoscopic techniques may be necessary as well. Intraoperatively, the findings may be confusing, and cholangiography can help clarify ductular anomalies, especially if the gallbladder duplication is contained within a common serosal coat. Missing a second gallbladder can result in persistent symptoms postoperatively necessitating further surgery. Laparoscopic cholecystectomy in the management of gallbladder duplication can be safely done and an awareness is necessary to avoid complications or multiple procedures.

Adult↗

PubMedDate not supplied

Intraocular drugs used in cataract surgery and their effect on the corneal endothelium.

Cataract surgery has evolved dramatically over the last 20 years largely because of developments in intraocular drugs and solutions, as well as intraocular mechanical devices used for removing cataracts. These include viscoelastic materials, intraocular miotics, intraocular irrigating solutions, and intraoperative mydriatics. It also involves attention to subtle details which may cause idiopathic postoperative corneal edema such as the avoidance of using surfactant cleaners or soaps on instruments that are used in the eye. The following discussion briefly outlines some of the intraocular drug issues of which cataract surgeons need to be aware.

Cataract Extraction↗

PubMed2005

Heterogeneity of subvesical ducts or the ducts of Luschka: a study using drip-infusion cholangiography-computed tomography in patients and cadaver specimens.

The objective of this study was to examine the heterogeneity of the subvesical duct or the ducts of Luschka as well as the reliability of drip-infusion cholangiography with computed tomography (DIC-CT) for their identification. DIC-CT was used in 277 consecutive patients (135 men, 142 women) and for the dissection and histologic study of 10 cadaver livers. We found 32 subvesical ducts in 28 (10.1%) of 277 patients. Irrespective of whether the terminals were extra- or intraparenchymal, the subvesical ducts often (17/32 ducts, 15/28 patients) drained into a subsegmental duct of S5 or S4. Notably, some displayed an "intermediate" course along the gallbladder fossa with an intraparenchymal origin and terminated at S5. Such ducts tended to be seen in the elderly. Another 15 ducts drained into a thick, centrally located duct, such as the right sectorial or hepatic duct. The anatomic study demonstrated that the subvesical duct likely included the cystic vein-concomitant duct. A major type of subvesical duct, characterized by an intermediate course along its bed, appeared to result from degenerative exposure of a peripheral duct with aging. The subvesical duct draining into the thick duct included both a "daughter branch," such as seen in the lung, and the so-called anomaly. Such ducts can be demonstrated with DIC-CT, but the incidence might be limited. However, the cystic vein/concomitant duct was difficult to identify radiologically. Consequently, although presurgical radiology is useful for avoiding bile leakage after laparoscopic cholecystectomy, surgeons should be aware of its limitations.

Adolescent↗

PubMed2006

How to manage splenic rupture during major liver resection?

Spontaneous splenic rupture is a rare but life threatening complication of major liver resection with only five reported cases during major liver resection under hepatic vascular occlusion. We report two cases of splenic rupture during liver resection including the first case during portal triad clamping. In both patients, the hemorrhage was stopped by removing the vascular clamp. A splenectomy was performed in both patients and liver resection was completed under vascular clamping without complications. Although very rare, physicians should be aware of the possibility of splenic rupture during liver resection because instead of increasing vascular occlusion, clamp removal usually stops the hemorrhage.

Aged↗

PubMed2003

Study of some "intrinsic risk factors" that can enhance an iatrogenic injury of the external branch of the superior laryngeal nerve.

OBJECTIVE: This study evaluates some "intrinsic risk factors" for a surgical injury of the external branch of superior laryngeal nerve (EBSLN) based on its anatomic relationship with the thyroid gland. STUDY DESIGN AND SETTING: Seventy-two neck dissections were performed in 36 fresh human adult cadavers. Every EBSLN was dissected and categorized using Cernea's classification. All data regarding gender, ethnicity, stature, side of the neck, and volume of hemi thyroid were collected and statistically analyzed by the chi(2)-test and analysis of variance. RESULTS: Although no statistical differences were observed between genders (P = 0.3770), ethnicities (P = 0.9780) or sides of the neck (P = 0.2523), statistical significance was reached regarding the nerve type when the groups were divided by stature (P = 0.0006) and glandular volume (P = 0.0007). CONCLUSION: Individual stature and volume of the hemi thyroid gland are probably involved in risk of the surgical EBSLN injury. SIGNIFICANCE: Surgeons should be aware of these anatomic findings in order to obtain a good voice-related outcome in the thyroidectomies.

Adult↗

PubMed1996

Depression of excitatory effects of propofol induction by fentanyl.

Propofol is an intravenous anesthetic drug commonly used in outpatient anesthesia for its rapid and smooth onset of action, short recovery period and its minimal perioperative side effects. However, propofol like other intravenous anesthetic drugs can produce excitatory signs during induction without signs of epilepsy on EEG. We studied 64 patients scheduled for various outpatient procedures. The patients were allocated to 2 groups: Group A (n = 32) received on induction xylocaine 1 mg.Kg-1 followed by propofol 2 mg.Kg-1 over 20 seconds, Group B (n = 32) received xylocaine 1 mg.Kg-1 and fentanyl 1.5 ug.Kg-1 followed by propofol 2 mg.Kg-1 over 20 seconds. The incidence of excitatory movements (cough, hiccup, hypertonus, twitching or tremors) was in group A (13) significantly higher than that in group B (1), there was no significant difference between the two groups in the time of stay in the post anesthesia care unit. Fentanyl 1.5 ug.Kg-1 used in outpatient anesthesia with propofol 2 mg.Kg-1 provides cardio-vascular stability, deepens the anesthesia level, decrease the awareness and decrease the excitatory effects or propofol.

Adjuvants, Anesthesia↗

PubMed1995

Unexpected Mirizzi anatomy: a major hazard to the common bile duct during laparoscopic cholecystectomy.

Mirizzi's syndrome is described as an impaction of gallstone(s) in the infundibulum, Hartmann's pouch, or cystic duct in close proximity to the common hepatic duct, causing secondary inflammation, hepatic duct obstruction, and jaundice. This anatomical configuration can unexpectedly present itself during laparoscopic cholecystectomy without the associated clinical syndrome. Identification of the gallbladder-cystic duct junction may become impossible, leading to dangerous exposure of the common duct. The case presented here demonstrates the dangers and difficulties encountered with such anatomy. Increased awareness of this rare and unusual configuration may help in avoiding injuries to the biliary tree during laparoscopic cholecystectomy.

Adult↗

PubMed2004

Strategies for minimizing blood loss in orthopedic surgery.

Several major orthopedic surgical procedures including hip arthroplasty, femoral osteotomy, and spinal fusion may result in significant blood loss and the need for allogeneic blood transfusions. Due to the heightened awareness of the potential deleterious effects of allogeneic blood product administration, several techniques have been evaluated to determine their efficacy in limiting perioperative blood loss. The following article will discuss the options to limit the need for allogeneic blood product administration during orthopedic surgical procedures. These techniques include: general considerations, autologous transfusion therapy, intraoperative and postoperative blood salvage, pharmacologic manipulation of the coagulation cascade, and controlled hypotension. Undoubtedly, many of these techniques are effective alone; however, the goal of performing major orthopedic surgical procedures without the use of allogeneic blood products can only be accomplished by combining several of these techniques.

Aminocaproic Acid↗

PubMed2003

Endoscopic strip craniectomy: a minimally invasive treatment for early correction of craniosynostosis.

Traditionally, surgical correction of craniosynostosis involves calvarial remodeling, large blood losses necessitating transfusions, hospital stays of several days, and less-than-satisfactory results. In this study, outcomes from a minimally invasive technique called endoscopic strip craniectomy, along with a postoperative molding helmet, to correct craniosynostosis in young infants were evaluated. The endoscopic strip craniectomy was performed on 185 patients with clinical signs of craniosynostosis, with the following distribution: 107 sagittal, 42 coronal, 37 metopic, and 7 lambdoid, for a total of 198 sutures. The mean blood loss was 29.4 cc, and only two patients underwent intraoperative blood transfusion. Fourteen patients underwent postoperative blood transfusion; none was life-threatening. There were no deaths, complications, neurological injuries, or infections. All but six patients were discharged on the first postoperative day. A majority of the patients achieved or approached normocephaly, and there were no complications. Neuroscience nurses need to be aware of this technique when they discuss treatment options with the families of infants with craniosynostosis.

Craniosynostoses↗

PubMed2006

Metaplastic squamous epithelial downgrowth after clear corneal cataract surgery.

PURPOSE: To report a case of metaplastic squamous epithelial downgrowth after cataract surgery. DESIGN: Interventional case report. METHODS: Clinical, laboratory, and histologic findings are presented. Our study is in compliance with institutional review board guidelines. RESULTS: A 76-year-old man developed anterior chamber inflammation five months after uncomplicated clear corneal cataract surgery. Despite antimicrobial and anti-inflammatory therapies, the inflammation persisted. An extensive examination failed to demonstrate an infectious etiology or lymphoma. Subsequently, the patient developed an incipient limbal lesion and iris mass. Immunostaining of a biopsy specimen from the iris mass indicated an epithelial-derived tumor. The prephthisical and painful eye was enucleated; histopathology of the globe revealed a contiguous lesion extending from the limbal mass to the iris tumor through the surgical incision site, a finding consistent with metaplastic squamous epithelial downgrowth. Systemic evaluation was negative. CONCLUSIONS: After intraocular surgery, metaplastic epithelial downgrowth may occur as a consequence of occult ocular surface squamous neoplasia and masquerade as chronic inflammation; clinicians should be aware of this rare complication.

Aged↗

PubMed1987

Cardiac transplantation. Organ procurement to patient discharge.

The care of the cardiac transplant patient is complex, yet rewarding. During the hospital stay, the patients, families, and nurses develop close-knit relationships that last after discharge. The cardiac transplant patients at Hershey Medical Center have formed a support group. To promote organ donation, they wear T-shirts, hats, and coats with the logo, "I got my heart at HMC," (Hershey Medical Center). This not only increases awareness of the need for organ donation, but also gives Hershey Medical Center recognition for its cardiac transplantation program.

Cardiomyopathies↗

PubMed1979

Massive unifocal cyst of the liver in a drug abuser: case report and review of the literature.

A 20-year-old white male presented, complaining of abdominal fullness. His previous history was unremarkable except for the use of intravenous illicit drugs. Physical examination disclosed a mass filling the upper and lower right quadrants. We evaluated this mass through the use of barium contrast x-ray, sonography and angiography, and made the preoperative diagnosis of hepatic cystic disease. On operative exploration, a large thin-walled cyst was found on the right lobe of the liver and was shown to be free of communication with the biliary tree; 3,000 cc of chocolate colored fluid were aspirated from the cyst. Total removal of the cyst was achieved with careful dissection. The cavity was filled with omentum and closed with drainage. After a benign immediate postoperative course, the patient remains asymptomatic one year later. Although most reports from the literature describe unexpected intraoperative findings, we stress that symptomatic patients can and should be diagnosed prior to laparotomy, and that a thorough search be made for concomitant polycystic disease. Total extirpation of the cyst is the most desirable of the discussed treatments, when tempered by the age and physical condition of the patient. Thorough preoperative evaluation and awareness of different modalities of therapy allow for the correct choice of treatment.

Adult↗