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At least 685 records · Page 38Linked to original sources

PubMed1991

Esophageal perforation during surgery on the cervical spine.

Esophageal perforation during surgery for cervical disc herniation is a rare complication. Differences in the time of diagnosis of this complication in three patients--no delay and delays of 6 hours and 4 days, respectively--resulted in different symptoms and outcomes. Early detection of the perforation allows prompt treatment. In the early stage, primary suture and, if necessary, interposition of vital tissue are sufficient to complete healing. In later stages, only drainage procedures, sometimes with a diversion of the salivary leakage, are indicated. In the reported patients, the outcome was favorable. On the other hand as an ongoing infection may cause mediastinitis, awareness of this complication and urgent surgical treatment may be lifesaving.

Adult↗

PubMed1988

Recovery times and side effects after propofol infusion and after isoflurane during ear surgery with additional infiltration anaesthesia.

Two anaesthetic procedures that did not include nitrous oxide were compared in a randomised study of 50 patients for tympanoplasty and tympanoscopy: propofol given for induction and maintenance, and thiopentone-isoflurane given for induction and maintenance, respectively. Induction in the first group was with a bolus injection of propofol and the same agent was given for the duration of anaesthesia by continuous intravenous administration. Thiopentone was given until loss of the eyelash reflex and anaesthesia maintained with isoflurane 0.4-2.0%. Analgesia was achieved in both groups by fentanyl given intravenously and by local injection of mepivacaine with ornipressin. The two patient groups were analysed for age, sex and weight as well as for side effects during the induction, maintenance and recovery periods, such as coughing, vomiting, venous pain, spontaneous movements, singultus, headaches, dysrhythmias and psychic disorders possibly due to anaesthesia. Side effects were moderate in both groups. Recovery time was statistically significantly shorter in the propofol group and the patients in this group appeared to be much more aware after recovery than those in the thiopentone-isoflurane group.

Adolescent↗

PubMed1996

Aspergilloma in the paracavernous region--two case reports.

A 30-year-old male and a 40-year-old female presented with Aspergillus fungal granuloma in the cerebral locations involving the gasserian-ganglion and its divisions in one case and was densely adherent to the lateral dural wall of the cavernous sinus in the other. Both patients were otherwise healthy with no evidence of immuno-suppression. The lesions resembled benign tumor on preoperative imaging and intraoperative consistency and vascularity. The lesions were successfully and completely resected. Both patients developed major cerebral arterial territory infarcts in the postoperative phase, remote from the site of operation, leading to crippling neurological deficits in one patient and death in the other. The unusual location and the unusual and similar clinical course suggests that awareness of the possibility of ischemic complications after surgical resection of intracranial aspergillomas is necessary.

Adult↗

PubMed1998

Ocular explosion during cataract surgery: a clinical, histopathological, experimental, and biophysical study.

INTRODUCTION: An increasing number of cases are being recognized in which a peribulbar anesthetic for cataract surgery has been inadvertently injected directly into the globe under high pressure until the globe ruptures or explodes. We reviewed the records of 6 such cases (one of which was reported previously by us), and one additional case has been reported in the literature. Surprisingly, 2 of these 7 cases went unrecognized at the time, and the surgeons proceeded with the cataract operation; all of the patients ultimately developed severe visual loss and/or loss of the eye. OBJECTIVES: To reproduce this eye explosion in a live anesthetized rabbit model and to perform a clinical, histopathological, experimental, biophysical, and mathematical analysis of this injury. METHODS: Eyes of live anesthetized rabbits were ruptured by means of the injection of saline directly into the globe under high pressure. The clinical and pathological findings of the ruptured human and animal eyes were documented photographically and/or histopathologically. An experimental, biophysical, and mathematical analysis of the pressures and forces required to rupture the globe via direct injection using human cadavers, human eye-bank eyes, and classic physics and ophthalmic formulas was performed. The laws of Bernoulli, LaPlace, Friedenwald, and Pascal were applied to the theoretical and experimental models of this phenomenon. RESULTS: The clinical and pathological findings of scleral rupture, retinal detachment, vitreous hemorrhage, and lens extrusion were observed. In the exploded human and rabbit eyes, the scleral ruptures appeared at the equator, the limbal area, or the posterior pole. In 2 of the 7 human eyes, the anterior segments appeared entirely normal despite the rupture, and cataract surgery was completed; surgery was canceled in the other 4 cases. In 4 of the 5 injected and ruptured rabbit eyes, the anterior segments appeared essentially normal. The experiments with human eye-bank eyes and the theoretical analyses of this entity show that the pressure required to produce such an injury is much more easily obtained with a 3- or 5-mL syringe than with a syringe 10 mL or larger. CONCLUSIONS: Explosion of an eyeball during the injection of anesthesia for ocular surgery is a devastating injury that may go unrecognized. The probability of an ocular explosion can be minimized by careful use of a syringe 10 mL or larger with a blunt needle, by discontinuing the injection if resistance is met, and by inspecting the globe prior to ocular massage or placement of a Honan balloon. When ocular explosion occurs, immediate referral to and intervention by a vitreoretinal surgeon is optimal. Practicing ophthalmologists should be aware of this blinding but preventable complication of ocular surgery.

Aged↗

PubMed1982

Systemic reactions following intraocular acetylcholine instillation.

An 83-year-old patient undergoing intracapsular cataract extraction under local anesthesia experienced systemic reactions to intraocular acetylcholine chloride instillation. Immediately following the injection into the anterior chamber, severe bradycardia, hypotension, flushing, sweating, and difficulty in breathing were observed. The ophthalmic surgeon must be aware of such side effects and be prepared to treat them. Constant monitoring of the vital signs of the patient is suggested in all cases of intraocular surgery.

Acetylcholine↗

PubMed2001

The Frank Stinchfield Award: Morphologic features of the acetabulum and femur: anteversion angle and implant positioning.

Morphologic features of the hips, in particular those features germane to determination of acetabular and femoral anteversion angles and femoral head offset, were studied in 50 male and 50 female human skeletons with bilateral normal joints. Four distinct configurations were identified relative to the anterior acetabular ridge. The majority (121, 60.5%) were curved; 51 (25.5%) were angular; 19 (9.5%) were irregular; and nine (4.5%) were straight. The acetabular anteversion angle measured 19.9 degrees +/- 6.6 degrees (range, 7 degrees-42 degrees) and was significantly larger in females (21.3 degrees +/- 7.1 degrees) versus males (18.5 degrees +/- 5.8 degrees). The notch acetabular angle, which can be identified easily intraoperatively, was defined as the angle created at the intersection of a line from the sciatic notch along the posterior acetabular ridge and a line from the posterior to the anterior acetabular wall. This angle is almost perpendicular (89.0 degrees +/- 3.5 degrees) and, therefore, may provide an accurate estimate of acetabular anteversion during cup placement. Awareness of the anatomic differences between genders for acetabular anteversion angle, anterolateral bowing of the femur, and neck shaft angle may help reduce the relatively higher incidence of dislocation in females and may lead to different implant designs for male and female patients.

Acetabulum↗

PubMed1982

[Echinococcoses of the human. Diagnosis and therapy].

The clinical symptoms of hydatid disease result from the suppression and damage of the parenchyma of liver or lung. They resemble those of neoplastic diseases but show comparatively slower progression. For the diagnosis of cysts serological procedures, sonography, CT-scan and laparoscopy are discussed. One should be aware that exploratory puncture might be dangerous because of the possibility of generalized spread. Among 17 patients referred to Erlangen University Hospital with echinococcus cysticus the correct diagnosis was made in only 9 patients whereas the diagnosis on admission was correct in 8 out of 13 patients with echinococcus alveolaris. The treatment of choice is intraoperative sterilization of the cystic fluid with 0,5% silver nitrate followed by radical surgery.

Diagnosis, Differential↗

PubMed1999

Catheter entrapment by atrial suture during minimally invasive port-access cardiac surgery.

PURPOSE: The port-access approach allows surgeons to perform heart operations through small intercostal openings, or "ports". This technique requires new skills for anesthesiologists. A pulmonary artery venting (PAV) catheter and, in some cases, a coronary sinus catheter (for administration of retrograde cardioplegia) are positioned with the aid of fluoroscopy and transesophageal echography (TEE). Both catheters have a wider diameter than the more commonly used conventional PA catheter and present distinctive features. We report a case in which a pulmonary artery venting catheter was entrapped by a suture during a port-access procedure. CLINICAL FEATURES: A 35-yr-old man with severe mitral valve insufficiency was scheduled for valve repair. After a successful bypass procedure, resistance was felt while attempting to withdraw the PAV catheter. On fluoroscopy, fixation of the catheter at the heart level was established and perforation by suture was confirmed after injection of a contrast agent. Because of the risk of cardiac wall rupture and tamponade, the thorax was reopened. After release of some atrial sutures, the catheter could be withdrawn easily. Transfixion by a suture was confirmed by visual examination. CONCLUSION: The more frequent use of a PAV catheter in minimally invasive cardiac surgery with the port-access technique should remind the anesthesiologist of the higher risk of entrapment by surgical sutures. Surgeons should be aware of the risk of accidentally transfixing this catheter during closure of the atriotomy via the port.

Adult↗

PubMed1998

Common bile duct injuries during laparoscopic cholecystectomy that result in litigation.

BACKGROUND: Iatrogenic common bile duct injury is the worst complication of laparoscopic cholecystectomy. The goal of this study is to increase awareness of the problem and educate surgeons about the consequences of these injuries. METHODS: A total of 46 bile duct injuries were analyzed by review of medical records, cholangiograms, videotapes, and surgeon statements. All cases were involved in malpractice litigation. RESULTS: All types of injuries were represented. There were 15 transections, 11 excisions, 6 lacerations, 8 clip impingements, 3 burns, 2 bile leaks, and 1 cystic duct leak. In all, 72% of these injuries occurred in elective cases in which there was no acute inflammation. Cholangiograms were performed in 16 cases, but they were misinterpreted in 11 of them. Injury type and severity was similar in patients with and without cholangiography. A total of 80% of these injuries were not detected at the initial surgery. The average delay in diagnosis was 10 days. Complications were worse in patients with delayed diagnosis. Primary surgeons had less successful outcomes from repairs than referral surgeons (27% versus 79%). In 86% of cases, litigation was resolved in favor of plaintiffs by settlement or verdicts. The average award was $214,000. CONCLUSIONS: Factors that predispose to lawsuits include treatment failures in immediately recognized injuries, complications that result from delays in diagnosis, and misinterpretation of abnormal cholangiograms. Injury prevention can be improved by increased awareness of common mistakes,. Improved cholangiographic technique and interpretation should decrease injury severity, delays in diagnosis, and subsequent morbidity.

Adult↗

PubMed2004

Appendicitis in incarcerated femoral hernia.

BACKGROUND: Femoral hernia can rarely present with the content of appendicitis. We report on an elderly female who was admitted to our emergency department with a painful groin mass. METHODS: An 85-year-old woman presented with a 7-day history of right groin pain and swelling. She also had complaints of nausea, vomiting, and right lower quadrant abdominal pain. Physical examination revealed a right groin mass in the femoral region, which was painful on examination. Abdominal examination ended with normal findings except bilateral lower quadrant tenderness. Ultrasonographic examination revealed a hernia sac containing suspected aperistaltic bowel segment with edematous wall. RESULTS: The patient underwent surgery. During exploration of the right groin region, a strangulated femoral hernia sac containing appendicitis was detected. CONCLUSION: Surgeons should be aware of the existence of this kind of atypical presentation of appendicitis.

Abdominal Pain↗

PubMed1995

Compliance with an incident report scheme in anaesthesia.

Voluntary anonymous reporting of incidents which occur during anaesthesia is a mechanism for obtaining information about such problems. Our objective was to estimate with reporting such incidents. For 3 months, alongside the incident report form, another form, which had to be completed for every patient, was used. This form listed a series of defined events which could occur intra-operatively. Compliance with the incident reports was estimated by comparing the data obtained from the two sets of forms. Overall compliance was only about 30%. There were differences in compliance for different events. Compliance was high with more serious events and poor in the case of common events, or when successful recovery had occurred. In order to improve compliance, incident report forms should be available on each anaesthetic machine and staff should be made more aware of the fact that reportable incidents are not limited to events which harmed the patient, but also include those which could have affected patient safety.

Anesthesia↗

PubMed1992

[Compression of the graft during the corrective surgery for scoliosis in a patient who has undergone a Rastelli's operation: a case study].

A 14 year-old male who had undergone Rastelli's operation for the tetralogy of Fallot had general anesthesia for the corrective spinal instrumentation and posterior fusion. The patient also suffered from the complication of Klippel-Feil syndrome. During the operation, right ventricular pressure gradually increased from 34 mmHg to 60 mmHg and systolic blood pressure decreased from 110 mg to 80 mmHg when the maneuver to correct spinal deformity was done. The hemodynamics returned to its former level after the maneuver was resumed. This change was presumably attributed to the fact that the external conduit was compressed by the sternum and vertebral bodies. In order to prevent this hazardous incidence, it is crucial to understand both the three-dimensional configuration of the thoracic structure and the influence of spinal correction on it. In the prone positioned patients with scoliosis, especially lordoscoliosis, compression or dysfunction of the artificial valve might occur and we have to be aware of the possibility of the compression during general anesthesia and after corrective surgery.

Adolescent↗

PubMed1996

Major vascular injury as a complication of laparoscopic surgery: a report of three cases and review of the literature.

We retrospectively reviewed all 2201 laparoscopic procedures performed at our community teaching hospital in the 3-year period between 1992 and 1995. There were three major vascular injuries, for an incidence of 0.14 per cent. Vessels injured were the left common iliac vein, the right common iliac artery, and the left internal iliac artery. Two of the injuries were believed to involve the 10 mm trocar, whereas the third involved the Veress needle. Two of the injuries were All injuries were successfully repaired primarily. We believe such major vascular injuries can be avoided by strict use of proper techniques of needle and trocar insertion, and by using the open technique to create a pneumoperitoneum in patients with previous abdominal operations. Laparoscopic surgeons should be aware of the potential for injury to major vascular structures and constantly be prepared to identify and treat this potentially life-threatening complication.

Adult↗

PubMed2003

Symptomatic spinal epidural varices presenting with nerve impingement: report of two cases and review of the literature.

STUDY DESIGN: Two cases of symptomatic epidural varices are presented and the literature was reviewed on this entity. OBJECTIVE: To raise awareness of this rare condition in the interpretation of preoperative magnetic resonance imaging scans and to assess the results of surgical treatment. BACKGROUND: Symptomatic epidural varices presenting with radiculopathy are extremely rare, and the diagnosis is often missed in the preoperative evaluation. This condition commonly masquerades as a herniated nucleus pulposus. Diagnosis is often only made intraoperatively. MATERIALS AND METHODS: Case 1 is a 40-year-old man presenting with acute exacerbation of lower back pain associated with radiculopathy down his right lower limb. Magnetic resonance imaging showed a paracentral disc prolapse. At operation, a congested epidural vein impinging on the L5 nerve root was noted with no intervertebral foramens stenosis. Excision of the vein was performed. The second case, a 50-year-old man with previous spinal instrumentation, was admitted for acute onset of radiculopathy down his left lower limb. At operation, an epidural varix compressing on the L4 nerve root was noted. Retrospectively, features of epidural varices were noted in the preoperative magnetic resonance imaging scans. Both patients reported resolution of symptoms after surgery. RESULTS: Excision was done for the first patient, and coagulative ablation was done in the second patient. Both patients had symptomatic relief and neurologic recovery on follow-up. CONCLUSION: Our experience and the literature demonstrated that a favorable outcome with resolution of neurologic symptoms can often be achieved after excision or ablation of the epidural varices.

Adult↗

PubMed1987

Radial keratotomy complications.

In a new surgical procedure, adverse reactions or complications may surface without most ophthalmic surgeons experiencing them or being aware of them. Even those with a large series of cases may never see certain problems. Through a collaborative effort with over 200 radial keratotomy surgeons totaling 63,000 cases nearly every significant complication has been documented. This study of radial keratotomy complications includes the number of patients and percentage of the total of the following: intraoperative occurrences which generally do not affect vision, which include microperforations and macroperforations; postoperative changes which do not affect vision: limbal "peeking" and star pattern with light; transient occurrences which tend to resolve with time: ptosis, recurrent erosions, corneal ulcer, microwound abscess, delayed wound healing, inferior rectus palsy, glare or fluctuating vision after six months, iritis, and stromal keratitis; postoperative changes which can affect vision (correctible): overcorrection more than 1.5 diopters, marked undercorrection more than -2.00 diopters, irregular astigmatism, neovascularization after soft-contact-lens wear, and best-corrected acuity decreased usually only one line; and postoperative changes which can affect vision (uncorrectible): retrobulbar hemorrhage and endophthalmitis, loss of the eye, herpes keratitis, and cataract formation.

Follow-Up Studies↗

PubMed1997

A comparison of blood pressure changes in phacoemulsification cataract surgery with topical and retrobulbar block local anesthesia.

BACKGROUND: Changes are observed in blood pressure (BP) levels during cataract surgery, although BPs are considered to remain stable under local anesthesia. We evaluated the daily, pre- and postoperative BPs of 2270 patients after cataract surgery performed under either topical anesthesia or retrobulbar block. METHODS: All operations were performed by the same surgeon using the same method of phacoemulsification and aspiration with posterior chamber intraocular lens implantation under local anesthesia. RESULTS: The mean daily BP was 99.3 +/- 14.2 mm Hg; the mean preoperative BPs increased and then the postoperative BPs decreased. The postoperative BPs of the retrobulbar injection group decreased significantly more than those of the topical application group. In 833 cases, the systolic BP changed by more than 20 mm Hg. Even when the patients were hypertensive, the preoperative and postoperative BPs decreased in the same manner. CONCLUSION: The present study shows that, following surgery with retrobulbar block anesthesia, BP decreases to a greater extent than with topical anesthesia. Physicians should be aware of the high proportion of cases in which the systolic BP changes by more than 20 mm Hg.

Administration, Topical↗

PubMed1993

Hyperkalaemia: a complication of warm heart surgery.

A case is presented of hyperkalaemia (13.6 mEq.L-1) occurring during cardiopulmonary bypass using warm blood cardioplegia (K+ 40-60 mEq.L-1). Treatment with epinephrine, calcium chloride, sodium bicarbonate, and furosemide reduced K+ to 6.5 mEq.L-1 within 30 min and myocardial performance was enhanced with amrinone and cardiac rhythm was controlled with A-V segmental pacing. It is believed that the hyperkalaemia resulted from a combination of the surgical procedure (mitral valve replacement) and the use of warm cardioplegia. The purpose of this report is to increase the awareness of the possibility of hyperkalaemia with warm cardioplegia and to describe a successful therapeutic regimen.

Anesthesia, Intravenous↗

PubMed1983

Nonrecurrent inferior laryngeal nerves and their association with a recurrent branch.

Seven cases of nonrecurrent inferior laryngeal nerves have been presented from a review of 1,000 consecutive thyroidectomies over a 20 year period. In two of these seven cases, both a nonrecurrent nerve and an additional recurrent branch were present on the right side. This double nerve presentation has not been described before. Unless one is aware of this possibility, one might inadvertently injure the major nonrecurrent trunk, having identified only a small recurrent branch. We emphasize the need for a complete nerve identification technique.

Humans↗