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At least 703 records · Page 39Linked to original sources

PubMed2005

Myogenic transcranial motor evoked potentials monitoring cannot always predict neurologic outcome after spinal cord ischemia in rats.

OBJECTIVES: A day after undergoing an operation of the thoracic aorta, a patient showed signs of spastic paraplegia, but on myogenic transcranial motor evoked potential monitoring, the myogenic transcranial motor evoked potentials recorded from the left anterior tibial muscle appeared normal. We sought to confirm these observations by using a rat spinal ischemia model to define the possibility of false-negative results in myogenic transcranial motor evoked potential monitoring by motor function behavior and spinal histopathology. METHODS: Spinal ischemia was induced for 6 minutes (group A, n = 6) or 10 minutes (group B, n = 6) with an intra-aortic balloon. After ischemia, motor function was assessed periodically by using the motor deficit index (0, complete recovery; 6, complete paraplegia). Myogenic transcranial motor evoked potentials were recorded from the right soleus muscle before ischemia, 2 and 6 minutes after the start of spinal ischemia, and at 30 minutes, 24 hours, and 72 hours of reperfusion. RESULTS: All group A rats showed normal motor function at 72 hours of reperfusion, whereas all group B rats displayed complete spastic paraplegia (motor deficit index = 6) at 72 hours of reperfusion. However, transcranial motor evoked potential was preserved in both group B and group A. Histopathologic analysis in group B revealed the presence of extensive necrotic changes of the gray matter distributed between laminae V through VII in the L3 to L5 segments but normal appearance of alpha motor neurons. CONCLUSION: According to our data, in using myogenic transcranial motor evoked potential monitoring during thoracic or thoracoabdominal aneurysm repair, we should be aware that transcranial motor evoked potentials cannot always be used to predict neurologic outcome after the operation.

Animals↗

PubMed2002

Delayed retrograde aortic dissection after endovascular stenting of the descending thoracic aorta.

A 66-year-old patient underwent emergency endovascular repair of a descending thoracic aneurysm because of suspected aortic rupture. Two weeks later, a small saccular aneurysm of the aortic arch was treated with open surgery. An unexpected intraoperative finding was retrograde dissection of the aortic arch and of the ascending aorta that was not seen on the postprocedural computed tomographic scans after endografting. The ascending aorta, the aortic arch, and the proximal part of the descending thoracic aorta were successfully replaced with a Dacron graft with deep hypothermia, circulatory arrest, and retrograde cerebral perfusion. Awareness that this life-threatening complication that necessitates extensive cardiovascular surgery can occur not only during or immediately after endovascular stenting of the thoracic aorta but also as much as several days or perhaps even weeks after the procedure is important.

Aged↗

PubMed1999

AANA Journal course: update for nurse anesthetists--utilizing the Ohmeda draw-over vaporizer in the operating room.

The draw-over anesthesia system (DOAS) is a portable, lightweight, safe system for administering anesthesia in a remote or disaster situation. Unfortunately, the DOAS (which has many models worldwide) cannot be used in a modern operating room because it lacks safety monitors that are required by the Joint Commission on Accreditation of Healthcare Organizations and Harvard standards. Therefore, this article examines modifications to the DOAS to permit staff familiarization with it in a modern operating room. All anesthesia providers who have an interest or obligation in assisting in civil defense, humanitarian missions, or volunteer healthcare organizations should be aware of this anesthesia delivery system, its unique characteristics, and this suggested method of familiarization.

Adult↗

PubMed2005

Pseudoexfoliation syndrome and cataract surgery by phacoemulsification.

Pseudoexfoliation syndrome is a systemic age-related disease in which abnormal extracellular material is produced and accumulates in many ocular tissues. Its ocular manifestations involve all of the structures of the anterior segment as well as conjunctiva and orbital structures. The presence of pseudoexfoliation should alert the physicians to the increased risks associated during and after cataract surgery. Increasing awareness of this condition are important in the detection and preoperative determination of patients inclined to be at greater risk for complications during surgery. Data regarding the rate of complications during phacoemulsification suggest a lower complication rate than with exstracapsular extraction but still greater than in eyes without pseudoexfoliation. Despite the existence of a higher number of intraoperative and postoperative complications, experience with the phacoemulsification technique together with the improvement of the apparatus and instruments used enable similar results to obtained in eyes with pseudoexfoliation syndrome as in eyes without this pathology.

Cataract↗

PubMed1997

Adhesions: pathogenesis and prevention-panel discussion and summary.

This article summarizes the discussions of the faculty and chairpersons on four major topics on postsurgical adhesions examined at the symposium, "Adhesions: Pathogenesis and Prevention". These topics are: 1) clinical significance; 2) pathogenesis; 3) research status and directions; and 4) recommendations for reduction or prevention. Abdominal postsurgical adhesions develop following trauma to the mesothelium, which is damaged often by surgical handling and instrument contact, foreign materials such as sutures and glove dusting powder, desiccation, and overheating. Postoperative adhesions occur after most surgical procedures and can result in serious complications, including intestinal obstruction, infertility, and pain. A long-term and unpredictable problem, postoperative adhesions impact the surgical workload and hospital resources, resulting in considerable health care expenditures. Although understanding of the pathogenesis of adhesions has improved recently, the molecular mechanisms involved continue to be delineated. Adhesions result from the normal peritoneal wound healing response and develop in the first five to seven days after injury. Adhesion formation and adhesion-free re-epithelialization are alternative pathways, both of which begin with coagulation which initiates a cascade of events resulting in the buildup of fibrin gel matrix. If not removed, the fibrin gel matrix serves as the progenitor to adhesions by forming a band or bridge when two peritoneal surfaces coated with it are apposed. The band or bridge becomes the basis for the organization of an adhesion. Protective fibrinolytic enzyme systems of the peritoneum, such as the plasmin system, can remove the fibrin gel matrix. However, surgery dramatically diminishes fibrinolytic activity. The pivotal events determining whether the pathway taken is adhesion formation or re-epithelialization are therefore the apposition of two damaged surfaces and the extent of fibrinolysis. Research in postsurgical adhesion formation and prevention abounds in a variety of avenues of investigation, including: 1) identification on a molecular level of the components involved in adhesiogenesis and their interactions; 2) clarification of the role of fibrin and fibrinolysis in adhesion formation; 3) standardization of design in preclinical and clinical studies of adhesion formation and prevention; 4) delineation of the relationship between adhesion formation and adhesive complications; and 5) elucidation of efficient, site-specific methods of prophylactic drug delivery. Currently, it seems logical to focus preventive research on development of barriers, fibrinolytic drugs, and selected agents such as phospholipids. The major strategies for adhesion prevention or reduction are adjusting surgical practice and applying adjuvants. Surgeons should adjust their major practices by: 1) becoming aware of the potential adhesive complications of a procedure; 2) minimizing the invasiveness of surgery; and 3) minimizing surgical trauma, ischemia, exposure to intestinal contents, introduction of foreign material into the body, and the use of talc- or starch-containing gloves. Available adjuvants include a newly developed by hyaluronic acid-phosphate-buffered saline solution applied intraoperatively to protect peritoneal surfaces from indirect surgical trauma and three mechanical barriers. One of these, a bioresorbable membrane consisting of hyaluronic acid and carboxymethylcellulose, has demonstrated efficacy and safety in both general and gynecological surgery. The other two barriers, one made of expanded polytetrafluoroethylene and one developed from oxidized regenerated cellulose, are indicated only for use in gynecological surgery.

Humans↗

PubMed1987

Cardiac arrest in ambulatory surgery. The management perspective.

Preventing cardiac arrests requires constant vigilance on the part of the entire perioperative team. In the preoperative phase, physicians must make careful patient selections based on the patients' risk factors, and cancel the cases or admit the patients if problems are found. In the intraoperative phase, the anesthesia personnel must carefully monitor vital signs, observe tissue perfusion, replace fluids, position the patient to maximize vital functions, and carefully select the anesthetic agents. In the postoperative phase, nurses must carefully observe and monitor the patient, especially high-risk patients, and take any necessary precautions. They must also explain instructions to the patient regarding complications after discharge. Although a manager may establish careful patient selection criteria, the day may come when the staff members must respond to a cardiac arrest in the ambulatory surgery unit. When it does, management of the patient must be the first priority. The staff members must correctly diagnose the problem, send for assistance, perform CPR, mobilize equipment, oxygen, and medications, control traffic, document interventions, and record patient responses. In an ambulatory setting, there is a high probability that family members or friends will be with the patient. A nurse should be delegated to take them to a quiet area away from the immediate crisis, and provide information and emotional support. Frequent reports will help them cope with the crisis. Public awareness and knowledge about CPR has greatly increased since it was first used in 1960. By 1977, some 12 million Americans had been CPR-trained and some 53 million more were awaiting training.(ABSTRACT TRUNCATED AT 250 WORDS)

Administrative Personnel↗

PubMed1993

Surgical management of pulmonary infections in chronic granulomatous disease of childhood.

Chronic granulomatous disease of childhood is an inheritable disorder of phagocytic cell respiratory burst resulting in recurrent, life-threatening, catalase-positive infections. The lung is the most common site of infection, and pulmonary disease is the primary cause of death in greater than 50% of children with chronic granulomatous disease. Still, the role of surgery in management of this disease remains undefined. Between 1974 and 1990, 19 patients with chronic granulomatous disease required 31 thoracic interventions at our institution. Patients ranged in age from 2.5 to 27 years (mean age, 15 years). Seventeen of 19 patients (89%) had had previous pulmonary infections. Patients presented as toxic (temperature > 38.5 degrees C, chest pain, and cough) in 22 instances before the 31 procedures. Aggressive surgical intervention for diagnosis and extirpation of localized infections was undertaken with lobectomy/pneumonectomy with or without other procedures (5), bisegmentectomy (2), segmentectomy with or without other procedures (5), or wedge with or without other procedures (13). In five instances, an empyema was drained; a chest tube for a sterile collection was placed in one instance. There was one intraoperative death, and 3 patients died 22 to 600 days postoperatively with overwhelming sepsis. The mean hospitalization was 101 days (range, 24 to 600 days). Wound complications occurred in 5 patients, requiring 17 separate anesthetic debridements. A change in therapy was dictated by the results of the procedure in 23 of 31 instances (74%). Thoracic surgeons must be aware of this rare cause of immunosuppression in these children and, due to the unusual nature of the pulmonary infections, should follow an aggressive approach in their diagnosis and management.

Adolescent↗

PubMed1999

Illicit drugs and anesthesia.

Substance abuse is the nation's number one health problem. With illicit drug use so prevalent, the anesthesia care team undoubtedly sees more people under the influence of illicit drugs. Cocaine, heroin, and marijuana are the drugs that are commonly used. Cocaine acts as an intense stimulant, heroin has profound sedative effects, and marijuana may cause various respiratory problems. Many times when drug users present for anesthesia, they will not admit to using illicit drugs, leaving the anesthetist to treat complications intraoperatively. This article discusses the history, street practices, pharmacodynamics, and anesthetic management of people using cocaine, heroin, and marijuana. This knowledge of how to treat patients abusing drugs will undoubtedly improve anesthetic outcomes. There are many illicit drugs used by people that anesthetists do not see frequently in the care of their patients, but the anesthetist should be aware of the common street drugs in use.

Anesthesia↗

PubMed2003

Major reconstructive surgery for pelvic organ prolapse in elderly women, including the medically compromised.

OBJECTIVE: To demonstrate the safety of performing extensive pelvic surgery for benign disease in elderly patients, many with significant chronic medical conditions. STUDY DESIGN: Thirty-four consecutive women over the age of 65 and many with significant chronic medical illnesses underwent extensive pelvic reconstructive surgery in a major teaching hospital. The same attending surgeon, in conjunction with several different chief residents in obstetrics and gynecology, performed all the procedures between November 1998 and December 2001. A variety of procedures for the correction of significant, symptomatic pelvic organ prolapse were utilized. Intra-operative, postoperative, immediate and, when possible, extended outcomes were analyzed. RESULTS: There were no instances of intraoperative or postoperative mortality or of major intraoperative morbidity. Major postoperative morbidity was uncommon and totally correctable. The vast majority of patients achieved immediate and long-term satisfactory relief of their symptoms. CONCLUSION: Extensive pelvic reconstructive surgery is safe and effective in the elderly, regardless of concomitant medical conditions. It is important that patients, primary care physicians and, in some cases, gynecologists be made aware of this fact so that this ever-expanding segment of the population not be denied treatment for the very distressing and often debilitating symptoms of pelvic organ prolapse.

Age Factors↗

PubMed1990

Nonspecific inflammatory pseudotumour of the caecum unrelated to the vermiform appendix.

A case of nonspecific inflammatory pseudotumour of the caecum unrelated to the appendix is reported. Symptomatology, radiological findings, and intraoperative findings suggested a caecal carcinoma. A right hemicolectomy was carried out. Histologic examination revealed an inflammatory mass with abundant fibroblastproliferation and collagen formation infiltrating the muscularis and adjacent pericolic adipose tissue. The caecal mucosa was entirely intact and normal. Histology suggested sclerosing mesenteritis. A correct preoperative diagnosis of nonspecific inflammatory pseudotumours of the caecum is difficult, but awareness of its existence might prevent too radical surgical resections. The differential diagnosis is discussed.

Aged↗

PubMedDate not supplied

The neurosurgical treatment of epilepsy.

Despite the new advancements in antiepileptic drug development, thousands of people with epilepsy will remain intractable to medication. For a considerable proportion of these people, epilepsy surgery is a consideration for better control of their seizures. Resective surgery is now standard practice for patients with medication-refractory epilepsy. Temporal lobectomy continues to be the most common surgery performed. Once patients fail 2 to 3 optimal trials of antiepileptic medication, further drug therapy offers a minimal number of patients freedom from seizures. In contrast, temporal lobectomy in carefully selected patients may result in seizure-free outcomes in more than 70% to 90% of patients with intractable seizures. As technology and drug availability increases in the new millennium, it is important for the primary care physician to be aware of epilepsy surgery as a means to treat patients with antiepileptic drug-refractory epilepsy. Arch Fam Med. 2000;9:1142-1147

Brain↗

PubMed2006

Is phenytoin administration safe in a hypothermic child?

A male neonate with a Chiari malformation and a leaking myelomeningocoele underwent ventriculoperitoneal shunt insertion followed by repair of myelomeningocoele. During anaesthesia and surgery, he inadvertently became moderately hypothermic. Intravenous phenytoin was administered during the later part of the surgery for seizure prophylaxis. Following phenytoin administration, the patient developed acute severe bradycardia, refractory to atropine and adrenaline. The cardiac depressant actions of phenytoin and hypothermia can be additive. Administration of phenytoin in the presence of hypothermia may lead to an adverse cardiac event in children. As phenytoin is a commonly used drug, clinicians need to be aware of this interaction.

Anti-Arrhythmia Agents↗

PubMedDate not supplied

Endovascular rescue of a maldeployed aortic stent-graft causing renal artery occlusion: technical considerations.

The technical success of an endovascular abdominal aortic aneurysm repair depends on the endograft exclusion of the aneurysm along with preservation of flow to major aortic branches, such as the renal or hypogastric artery. A proximally malpositioned aortic endograft may result in inadvertent renal artery occlusion, which may lead to renal infarction with irreversible loss of the renal function. In this report, the authors describe an endovascular rescue technique to salvage a proximally maldeployed aortic endograft that inadvertently covered the renal artery orifice. Physicians performing endovascular aneurysm procedures should be aware of such a salvage maneuver in the event an aortic endograft is proximally maldeployed and occludes the renal artery orifice.

Aged↗

PubMed1998

[Carbon monoxide in the expiratory gas during laparoscopic surgery].

One of the complications of laparoscopic surgery is carbon monoxide (CO) production under the use of electrocautery. We experienced a case in which high levels of CO were detected in the expiratory gas. An 80-year old, 33 kg female was scheduled for laparoscopic nephrectomy. Anesthesia was induced with thiopental and vecuronium and maintained with nitrous oxide 60% in oxygen and isoflurane. The concentrations of CO in the anesthetic circuit were examined with CO sensor (XC-341, Shinkosumosudenshi, Tokyo). The CO concentrations were not detected at the start of operation. About 140 minutes after carbon dioxide pneumoperitoneum, the CO concentration increased up to 170 ppm accompanying a high Paco level. The high concentrations, however, decreased immediately after ending of pneumoperitoneum. The HbCO levels were unchanged. Subcutaneous emphysema was noted at the end of surgery. This is because CO is more absorbable in the subcutaneous tissue than in the peritoneal cavity. We consider that CO was absorbed in subcutaneous emohysema during pneumoperitoneum and exhausted in the expiratory gas. When subcutaneous emphysema occurred during laparoscopic surgery, we should be aware of absorption of CO.

Aged↗

PubMed2005

The accuracy of frozen section (intraoperative consultation) in the diagnosis of ovarian masses.

OBJECTIVE: Frozen section is an important and helpful adjunct in the intraoperative diagnosis of ovarian tumors. This retrospective study was undertaken to determine the accuracy of frozen section diagnosis of ovarian masses and the reasons of discordance. METHODS: From January 1995 to December 2003, 1494 ovarian specimens were received for histopathological evaluation, and 617 of them were submitted for frozen section examination. RESULTS.: The final paraffin section diagnoses of these 617 cases were a nonneoplastic lesion in 18.3% of the cases, benign tumor in 56.1%, borderline tumor in 6.2%, and malignant tumor in 19.4%. The overall accuracy was 97%. Twenty-one cases were incorrectly diagnosed by frozen section. All of them were false negatives. There were no deferred cases. The majority of the cases of disagreement were mucinous and borderline tumors. The sensitivity for benign, borderline, and malignant tumors were 100%, 87%, and 87%, respectively. The specificity for benign tumors was 97%; for borderline tumors 98%; and for malignant tumors 100%. CONCLUSION: Our data confirm that frozen section diagnosis is a reliable method for the surgical management of patients with an ovarian mass. However, diagnostic problems can occur in mucinous and borderline tumors during frozen section examination. The clinicians and pathologists must be aware of the pitfalls of this method; therefore, a good communication established between them is necessary to obtain more accurate results and to minimize the number of deferred cases.

Adolescent↗

PubMed2005

Image-guided surgery: what is the accuracy?

PURPOSE OF REVIEW: Use of image-guided surgery (IGS) systems in otolaryngology, particularly rhinology, has grown exponentially in recent years. Central to their use is the understanding of the accuracy of each system. The purpose of this review is to discuss the error inherent in all IGS systems. A standardized technique (currently used in the engineering literature) for understanding and reporting error in IGS systems is reviewed. Using this technique, the error of commercially available IGS systems is reviewed. RECENT FINDINGS: The most commonly used IGS systems depend on the conformation of the skin, as opposed to relying on bone-implanted devices. For these systems, mean accuracies 2 mm or less are routinely reported. This finding is independent of fiducial markers (eg, proprietary headsets, skin-affixed markers, or laser scanning of skin surfaces). Techniques of fiducial localization and registration of CT scans to intraoperative anatomy are proprietary to each company. As such, there is great variability in reporting system specifications-particularly error of IGS systems. This lack of standardization makes comparison of one system to another difficult if not impossible. SUMMARY: Image-guided surgery systems commonly used in rhinology report mean accuracies of 2 mm or less. Surgeons must be aware that this value represents a mean of a distribution of errors. As such, 95% of the time error can be expected to be less than approximately 1.7 times its mean value. However, outliers (errors much larger and much smaller than the mean) may exist for each IGS intervention. As noted, IGS systems function to complement-not replace-knowledge of surgical anatomy.

Humans↗

PubMed2006

Endovascular embolization of iatrogenic vertebral artery injury during anterior cervical spine surgery: report of two cases and review of the literature.

STUDY DESIGN: Case description. OBJECTIVES: To report 2 cases of vertebral artery injury (VAI) during anterior cervical decompression surgery and review the pertinent medical literature. SUMMARY OF BACKGROUND DATA: The incidence of VAI during an anterior surgical approach to the cervical spine is rare but potentially lethal. The spine surgeon should be aware of the detailed surgical anatomy and be prepared to manage an inadvertent injury to the vertebral artery. METHODS: In the first case presented, infection was the cause of VAI. During aggressive irrigation and pus drainage, massive bleeding was encountered. For the second case, the vertebral artery was injured during decompression of cervical spondylosis while drilling the neural foramen. Intraoperative direct packing with hemostatic agents provided effective control of hemorrhage. RESULTS: Ten days after surgery, sudden neck swelling and mental deterioration occurred because of rebleeding from a pseudoaneurysm in the first case. In the second case, a pseudoaneurysm was detected by angiography, obtained 4 days after surgery. Both pseudoaneurysms were successfully occluded by an endovascular technique without any neurologic sequelae. CONCLUSIONS: In case of bleeding control by hemostatic packing, there remains a risk of delayed hemorrhage from pseudoaneurysm. Postoperative vertebral angiography is helpful to avoid life-threatening complications. Endovascular treatment can be a good alternative in the treatment of VAI.

Aneurysm, False↗

PubMed2005

The falcine trigeminocardiac reflex: case report and review of the literature.

BACKGROUND: Trigeminocardiac reflex (TCR), the reproducible hypotension and bradycardia upon stimulation of the trigeminal nerve, has been reported during craniofacial surgery and during surgery within the cerebellopontine angle, petrosal sinus, orbit, and trigeminal ganglion. Whereas the falx cerebri is known to be innervated by the nervus tentorii, a recurrent branch of V1, there have been no reports to date of this response upon mechanical stimulation of the falx. CASE DESCRIPTION: We report a case of immediate, reproducible, and reflexive response of asystole upon stimulation of the falx cerebri during operative resection of a parafalcine meningioma in a 53-year-old woman. Upon recognition of the reproducible relationship between falcine stimulation and increased vagal tone, the patient was given glycopyrrolate in an effort to block cholinergic hyperactivity. After glycopyrrolate was given, no further dysrhythmias occurred. CONCLUSION: In this patient, mechanical stimulation of the falx likely resulted in the hyperactivity of the trigeminal ganglion, thereby triggering TCR. The dorsal region of the spinal trigeminal tract includes neurons from hypoglossal and vagus nerves, and projections have been seen between the vagus and trigeminal nuclei. The vagus provides parasympathetic innervation to the heart, vascular smooth muscle, and abdominal viscera. Vagal stimulation via these connections after trigeminal nerve activation likely accounts for the reflexive response of asystole seen in this patient. This is confirmed by the observation that the reflex was inhibited by the anticholinergic effects of glycopyrrolate. Awareness of TCR allows for early detection and appropriate treatment.

Blood Pressure↗