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Sample records for day case surgery

  1. Is day case surgery the key to basic surgical training?

    PubMed

    Weale, A R; Lear, P A; Mitchell, D C

    2002-11-01

    The logbooks of 5 senior house officers (SHOs) were audited to determine progression of surgical skills on a single vascular firm. Total surgical experience and, in particular, experience in varicose vein and arterio-venous fistula surgery, performed in the day-case unit (DCU), were examined. Trainees were divided into those undertaking their first surgical SHO post (group 1, n = 2) and those who had had previous surgical exposure (group 2, n = 3) on the basic surgical training rotation. SHOs were exposed to a mean of 273 (+/- 41 SD) operative cases in 6 months. Emergency work comprised 15% (+/- 7%) of workload. Day cases accounted for 35% (+/- 3%) of elective workload. A mean of 66 (+/- 5) varicose vein and AVF cases were undertaken in the DCU. This represented 82% (+/- 6%) of day-case operative experience for the firm. SHOs undertook 12 (+/- 6) VV/AVF cases unassisted, 35 (+/- 5) cases with senior assistance, and 20 (+/- 11) as first assistance in the DCU. All SHOs progressed to being able to perform arterial bypass and amputation (with senior assistance) during their time on the firm. There was no significant difference in experience or progression to major vascular surgery between group 1 and group 2 in this study except in lower limb amputation procedures. It is concluded that vascular surgical firms can provide a good introduction to surgical skills. Most experience as first operator was gained in the DCU and we suggest that those undergoing basic surgical training might benefit from an attachment to the DCU early in their rotations.

  2. 'Diprifusor' for general and day-case surgery.

    PubMed

    Coates, D

    1998-04-01

    Total intravenous anaesthesia may be most beneficial for day-case surgery with regard to quality of recovery, lack of complications and the ability to sustain an efficient throughput of patients. However, the technique can be applied to all forms of surgery and, with a little practice, consistent results will be achieved. Computerised infusion pumps can be programmed to provide a target blood concentration that can be easily varied to alter the anaesthetic state. The commercially available 'Diprifusor', a target controlled infusion system for propofol, can facilitate the more widespread use of total intravenous techniques and allow their potential benefits to be applied and appreciated more widely. This review outlines some practical considerations that should enable a more confident approach to total intravenous techniques by anaesthetists who are unfamiliar with them.

  3. 'Diprifusor' for general and day-case surgery.

    PubMed

    Coates, D

    1998-04-01

    Total intravenous anaesthesia may be most beneficial for day-case surgery with regard to quality of recovery, lack of complications and the ability to sustain an efficient throughput of patients. However, the technique can be applied to all forms of surgery and, with a little practice, consistent results will be achieved. Computerised infusion pumps can be programmed to provide a target blood concentration that can be easily varied to alter the anaesthetic state. The commercially available 'Diprifusor', a target controlled infusion system for propofol, can facilitate the more widespread use of total intravenous techniques and allow their potential benefits to be applied and appreciated more widely. This review outlines some practical considerations that should enable a more confident approach to total intravenous techniques by anaesthetists who are unfamiliar with them. PMID:9640115

  4. Audit of patient acceptance of nasal surgery as a day case procedure.

    PubMed

    Tierney, P A; Samuel, D; Patel, K S; Thomas, D M

    1996-01-01

    A greater emphasis on day case surgery within the health service is seen as a method of improving efficiency and reducing expenditure. We interviewed 90 consecutive patients undergoing nasal surgery who had been preoperatively assessed as being fit for day case surgery. They were randomised into three groups regarding the duration of postoperative nasal packing. All patients stayed overnight following surgery and were interviewed prior to discharge. Some 52% of the overall sample would be happy to have nasal surgery performed as a day case. If the nasal pack was removed after two hours, this figure rose to 67%. This difference in patient acceptance did not attain statistical significance overall, but there was a significant difference in those undergoing submucosal resection. There was no difference in the age, sex distribution or type of surgery performed between each group. The audit commission quotes patient satisfaction with day case surgery at 80%. Nasal surgery was not examined in their report, but was included as one of a set of procedures suitable for consideration. Although day case nasal surgery may be safe, further research regarding patient acceptance is required.

  5. Ear, Nose and Throat Day-Case Surgery at a District General Hospital

    PubMed Central

    Pézier, T; Stimpson, P; Kanegaonkar, RG; Bowdler, DA

    2009-01-01

    INTRODUCTION In 2000, The NHS Plan in the UK set a target of 75% for all surgical activity to be performed as day-cases. We aim to assess day-case turnover for ENT procedures and, in particular, day-case rates for adult and paediatric otological procedures together with re-admissions within 72 h as a proxy measure of safety. PATIENTS AND METHODS Retrospective collection of data (procedure and length of stay) from the computerised theatre system (Galaxy) and Patient Information Management System (PIMS) of all elective patients operated over one calendar year. The setting was a district general hospital ENT department in South East England. All ENT operations are performed with the exception of oncological head and neck procedures and complex skull-base surgery. RESULTS Overall, 2538 elective operations were performed during the study period. A total of 1535 elective adult procedures were performed with 74% (1137 of 1535) performed as day-cases. Of 1003 paediatric operations, 73% (730 of 1003) were day-cases. Concerning otological procedures, 93.4% (311 of 333) of paediatric procedures were day-cases. For adults, we divided the procedures into major and minor, achieving day-case rates of 88% (93 of 101) and 91% (85 of 93), respectively. The overall day-case rate for otological procedures was 91% (528 of 580). Re-admission rates overall were 0.7% (11 of 1535) for adults and 0.9% (9 of 1003) for paediatric procedures. The most common procedure for re-admission was tonsillectomy accounting for 56% of all adult re-admissions and 78% of paediatric re-admissions. The were no deaths following day-case procedures. DISCUSSION ENT surgery is well-suited to a day-case approach. UK Government targets are attainable when considering routine ENT surgery. Day-case rates for otology in excess of targets are possible even when considering major ear surgery. PMID:19102826

  6. Late periorbital haemorrhage following functional endoscopic sinus surgery: a caution for potential day case surgery

    PubMed Central

    Arya, Arvind Kumar; Machin, David; Al-Jassim, Hadi

    2006-01-01

    Background Orbital complications following functional endoscopic sinus surgery (FESS) are fortunately rare. They are usually easily and rapidly recognizable. Case presentation We present an unusual case of a forty-five year old woman who underwent routine FESS and was not packed nasally after the procedure. Six hours later she started bleeding and nasal packs were inserted. She soon developed unilateral periorbital bruising and within hours her condition had worsened so much that the viability of the eye was thrown into question. She underwent medial and lateral canthotomies and made an uneventful post-operative recovery. Conclusion This rare case demonstrates that late, brisk post-operative bleeding can occur after FESS with potentially catastrophic consequences. Clinicians should be aware that discharging patients after FESS too early may lead to medico-legal problems. PMID:16734910

  7. [Laparoscopic surgery in day surgery].

    PubMed

    Micali, S; Bitelli, M; Torelli, F; Valitutti, M; Micali, F

    1998-06-01

    Since ten years laparoscopic techniques have been employed as alternatives of many established open procedures in gynecologic, abdominal and finally urologic surgery. Laparoscopic techniques show significant advantages compared to open surgery, such as less hospitalization, reduced need of analgesic drugs, quick return to daily activities and far a better cosmetic results. Laparoscopic surgery has been advocated for urologic, uro-gynecologic and andrologic diseases. Since 1983 one-day surgery was proposed for only a few gynecologic and abdominal procedures and only recently for laparoscopic renal biopsy and abdominal testis evaluation. In these preliminary experiences the conditions for a correct management of laparoscopic one-day surgery have been clearly pointed out: 1. correct surgical indication; 2. through knowledge of surgical technique; 3. duration of the procedure less than 90 minutes; 4. correct anesthesia. Technique of anesthesia must be adapted to the surgical procedure required, its duration and the physical features of the patient. General anesthesia is usually preferred for either longer and more complex procedures or when a higher abdominal insufflation pressure is needed. Spinal or local anesthesia are preferred for simpler procedures or when only one trocar is required. At date only few urologic procedures seem to be suitable to one-day laparoscopic surgery. 1) Varicocele: although laparoscopic varicocelectomy in one-day surgery has never been reported previously, it can be performed in a short time, only 3 trocars are needed and insufflation pressure can be maintained within 15 mm Hg. 2) Renal biopsy and marsupialization of renal cysts. These are usually managed percutaneously but in some particular indications procedures under direct vision should be preferable. Both are short-lasting and only superficial general anesthesia is required; as surgical access is retroperitoneal only two trocars are sufficient; at date only renal biopsies have

  8. A comparison of diagnosis related groups and ambulatory visit groups in day-case surgery.

    PubMed

    Parkin, D; Hutchinson, A; Philips, P; Coates, J

    1993-01-01

    Case-mix measurement is a basic requirement of clinical and resource management systems within health care organisations, and offers a potentially useful tool for the setting and monitoring of contracts. Ambulatory care has particular problems in the construction of appropriate case-mix measures, and day-case surgery provides an opportunity to test two existing measures, one inpatient (Diagnosis Related Groups) and one ambulatory (Ambulatory Visit Groups). These grouping systems were applied to the same data to compare the case-mix patterns that they produce. The findings show that Ambulatory Visit Groups appear to have advantages over the Diagnosis Related Groups with respect to their underlying assumptions and labelling of the groups; in particular, they assign greater weight to procedures. However, Diagnosis Related Groups are more developed, easier to use, more familiar and allow direct comparisons with inpatient care. Nevertheless, a proper evaluation of these issues requires further data collection and analysis, together with a fundamental examination of the uses of ambulatory case-mix. PMID:10171758

  9. A comparison of diagnosis related groups and ambulatory visit groups in day-case surgery.

    PubMed

    Parkin, D; Hutchinson, A; Philips, P; Coates, J

    1993-01-01

    Case-mix measurement is a basic requirement of clinical and resource management systems within health care organisations, and offers a potentially useful tool for the setting and monitoring of contracts. Ambulatory care has particular problems in the construction of appropriate case-mix measures, and day-case surgery provides an opportunity to test two existing measures, one inpatient (Diagnostic Related Groups) and one ambulatory (Ambulatory Visit Groups). These grouping systems were applies to the same data to compare the case-mix patterns that they produce. The findings show that the ambulatory visit group appear to have advantages over the diagnostic group with respect to their underlying assumptions and labelling of the groups; in particular, they assign greater weight to procedures. However, diagnostic groups are more developed, easier to use, more familiar and allow direct comparisons with inpatient care. Nevertheless, a proper evaluation of these issues requires further data collection and analysis, together with a fundamental examination of the uses of ambulatory case-mix. PMID:10171429

  10. Variations in lengths of stay and rates of day case surgery: implications for the efficiency of surgical management.

    PubMed Central

    Morgan, M; Beech, R

    1990-01-01

    Variability in lengths of acute hospital stay and rates of day case surgery is shown to be a continuing pattern which occurs both between and within countries. A model of the determinants of health service activity is presented and the contribution of different factors to the observed variations is assessed. Differences in methods of funding health services are identified as a major determinant of the between country variations, while the within country variations largely reflect the influence of local differences in facilities and services and the organisation of care at a hospital level, as well as the independent effects of differences in clinical practice style. The main rationale for advocating a reduction in length of stay and increased use of day surgery is to increase efficiency by reducing costs per case while maintaining the quality of care. These criteria of costs, clinical outcomes and patient acceptability are examined in relation to day case surgery for an intermediate surgical procedure (inguinal hernia repair) and short stay surgery for cholecystectomy. The precise cost savings are shown to depend on the methods of costing, assumptions made and facilities employed, while factors influencing the outcomes achieved include the criteria of patient selection, the surgical techniques employed, and the adequacy of preoperative communication. Barriers to the more widespread adoption of short stay and day case surgery include practical and organisational constraints on clinical practice at a hospital level, lack of awareness among clinicians as to how far their practices differ from current norms, and clinical barriers raised by surgeons who do not see short stay policies as advantageous. Mechanisms to promote changes in clinical practice styles include independent professional audit, peer review, and involvement of clinicians in budgeting and resource allocation. Assessing quality requires that attention is given to patient acceptability and satisfaction as

  11. [Day surgery for anal disease].

    PubMed

    Takano, M

    2000-10-01

    Historically, patients with anal diseases treated on a day surgery basis had inadequate cure rates and a high complication rate. After World War II, modern treatment methods were learned from the UK and USA and improved in Japan. However, the improved radical methods were so complex that approximately 2 weeks' hospitalization was needed. Recently, day surgery for various diseases including hemorrhoids has been recommended by the Japanese ministry of Health and Welfare. However, the characteristics of anal anatomy and physiology make the smooth healing of wounds difficult and tend to cause postoperative pain, bleeding, infection, prolonged healing time, etc. To prevent such difficulties, care must be well planned following the critical path of informed consent, careful surgery, postoperative observation, and management at home. However, hospital staff in charge of such surgery are under so much stress that only patients with less severe anal disease without local or systemic complications should be selected for day surgery.

  12. ["Day surgery, for an efficient patient pathway"].

    PubMed

    Burkhardt, Céline; Michon, Florence

    2015-05-01

    Working in day surgery requires teams to harmonise their practices and coordinate with each other at all times.We interview Céline Burkhardt, a healthcare manager who oversaw the deployment of a day surgery unit in her hospital.

  13. Applying a managerial approach to day surgery.

    PubMed

    Onetti, Alberto

    2008-01-01

    The present article explores the day surgery topic assuming a managerial perspective. If we assume such a perspective, day surgery can be considered as a business model decision care and not just a surgical procedure alternative to the traditional ones requiring patient hospitalization. In this article we highlight the main steps required to develop a strategic approach [Cotta Ramusino E, Onetti A. Strategia d'Impresa. Milano; Il Sole 24 Ore; Second Edition, 2007] at hospital level (Onetti A, Greulich A. Strategic management in hospitals: the balanced scorecard approach. Milano: Giuffé; 2003) and to make day surgery part of it. It means understanding: - how and when day surgery can improve the health care providers' overall performance both in terms of clinical effectiveness and financial results, and, - how to organize and integrate it with the other hospital activities in order to make it work. Approaching day surgery as a business model decision requires to address in advance a list of potential issues and necessitates of continued audit to verify the results. If it does happen, day surgery can be both safe and cost effective and impact positively on surgical patient satisfaction. We propose a sort of "check-up list" useful to hospital managers and doctors that are evaluating the option of introducing day surgery or are trying to optimize it. PMID:19131286

  14. Absorbable or non-absorbable sutures? A prospective, randomised evaluation of aesthetic outcomes in patients undergoing elective day-case hand and wrist surgery

    PubMed Central

    Kundra, RK; Newman, S; Saithna, A; Lewis, AC; Srinivasan, S; Srinivasan, K

    2010-01-01

    INTRODUCTION We prospectively evaluated aesthetic outcomes in a group of randomised patients who underwent elective day-case hand and wrist surgery using either absorbable or non-absorbable sutures. PATIENTS AND METHODS A cohort of 100 adult patients were randomised using sealed envelopes to receive either absorbable or non-absorbable sutures for their wound closure. Clinical review was carried out at 6 weeks. A postal questionnaire was sent to all patients 3 months following surgery comprising a visual analogue scale (VAS) for wound satisfaction, a validated 6-point patient scar assessment tool and the shortened version of the disabilities of the arm, shoulder and hand questionnaire (QuickDASH). RESULTS From the postal questionnaire, 70 responses were received. There was no statistically significant difference between the two groups in terms of VAS, patient scar assessment tool and quick DASH. CONCLUSIONS For elective day-case hand and wrist surgery, either suture material can be used confidently with respect to overall aesthetic appearance in such patients. PMID:20659358

  15. [Day surgery: recommendations, tools and feedback].

    PubMed

    Bontemps, Gilles

    2015-05-01

    The ANAP (French agency for supporting medical institutions' performance) has the legal responsibility to provide tools and recommendations and to support institutions in improving their organisational performance. In the context of the public authorities' push for day surgery, the ANAP has specifically addressed this issue, gathering feedback from French and European health institutions. PMID:26126379

  16. Surgical treatment of early breast cancer in day surgery.

    PubMed

    Marrazzo, Antonio; Taormina, Pietra; David, Massimo; Riili, Ignazio; Lo Gerfo, Domenico; Casà, Luigi; Noto, Antonio; Mercadante, Sebastiano

    2007-01-01

    Quadrantectomy and associated sentinel lymph node biopsy (SLNB) is currently employed in most breast surgery centres as the gold standard in the treatment of early breast cancer. This approach has a modest morbidity and can usually be performed in a day-surgery regimen, leading to best acceptance by the patients. This reports outlines the experience of our Breast Unit with quadrantectomy and SLNB in day surgery for early breast cancer. One hundred patients presenting to our institution with primary invasive breast cancer measuring less than 3 cm and clinically negative axillary nodes underwent quadrantectomy and SLNB in day surgery. For 60 women with breast cancer the sentinel node was negative, so the only definitive surgical treatment was performed in the day-surgery regimen; 40 patients with positive sentinel nodes were hospitalised a second time for axillary dissection. In these patients that needed clearance of the axilla, SLNB was performed on the only positive node in 22 cases (55%). None of the patients admitted for quadrantectomy and SLNB in day surgery required re-hospitalisation after discharge. All patients proved to be fully satisfied with early discharge from hospital when questioned on the occasion of subsequent monitoring. Short-stay surgical programs in early invasive breast cancer treatment are feasible today owing to the availability of less invasive approaches such as quadrantectomy and SLNB. There are two main pointers to a distinct advantage for this kind of approach, i.e. recovery and psychological adjustment. Recovery from surgery is faster and the patient tends to play down the seriousness of the operation and to have a better mental attitude to neoplastic disease. Moreover, when performing quadrantectomy with SLNB in day surgery fewer than 50% of breast cancer patients (40% in our experience) require another surgical treatment, concluding the surgery in a single session. PMID:18019641

  17. The day of your surgery - adult

    MedlinePlus

    ... your surgery. Answer any of your questions. Bring paper and pen to write down notes. Ask about ... and anesthesia. You will need to sign admission papers and consent forms for surgery and anesthesia. Bring ...

  18. Prevalence of Post-tonsillectomy Bleeding as Day-case Surgery with Combination Method; Cold Dissection Tonsillectomy and Bipolar Diathermy Hemostasis

    PubMed Central

    Faramarzi, Abolahassan; Heydari, Seyed Taghi

    2010-01-01

    Objective Post-tonsillectomy hemorrhage remains an important factor in determining the safety of performing tonsillectomy as a day case procedure. The aim of this study was to determine the safety of day case tonsillectomy by using combination method, cold dissection tonsillectomy and bipolar diathermy hemostasis. Methods A prospective randomized clinical study conducted on the patients who had undergone day case tonsillectomy (DCT). There were two groups (DCT and control group) each group consisting of 150 cases. Tonsillectomy was performed by using combination method; cold dissection and hemostasis was achieved by ligation of vessels with bipolar electerocautery. Findings We found 3 cases of post-tonsillectomy bleeding in DCT group and 4 cases in the control group. There was no statistically significant difference in the rate of post-operative hemorrhage between the two groups. Conclusion The findings suggest the safety of the combination of cold dissection tonsillectomy and bipolar diathermy hemostasis as day case tonsillectomy. PMID:23056702

  19. The day of surgery for your child

    MedlinePlus

    Waking up from anesthesia: After surgery, your child goes to the recovery room. There, the doctors and nurses ... nurse will come get you. Know that children waking up from anesthesia can cry a lot and be ...

  20. [Trazodone versus flunitrazepam in premedication in day-care surgery].

    PubMed

    Bonazzi, M; Riva, A; Marsicano, M; Prampolini, F; Speranza, R; Andriolli, A; Laveneziana, D

    1994-03-01

    A prospective single-blind study was conducted to compare flunitrazepam vs trazodone in the premedication of patients undergoing day-case surgery for termination of pregnancy, with particular regard to the degree of preoperative sedation, intraoperative analgesia and postoperative recovery. 86 patients were randomly allocated to receive orally 45 minutes before the surgical procedure either flunitrazepam 2 mg (group F) or trazodone 50 mg (group T). In both groups anaesthesia was achieved by i.v. fentanyl 2.5 micrograms/kg and ketamina 250 micrograms/kg. Patients in group F showed a deeper degree of preoperative sedation. There were no significant differences in intraoperative analgesia and in the immediate arousal time. In the postoperative period, the incidences of emetic symptoms and dizziness were similar in both groups; the incidence of drowsiness was significantly higher in group F at 120 minutes but not at 180 minutes of observation. Psychomotor performance was assessed preoperatively two days before the surgical procedure and 60, 120 and 180 minutes after surgery, using the Toulouse-Pieron test and the reaction time to a luminous stimulus with the aid of a computerized analogic tachystoscope (Neurometer). Trazodone allowed a more rapid recovery of psychomotor performance and it can represent a valid alternative to the use of benzodiazepines in the premedication of day-case surgical patients.

  1. Propofol as sole agent for paediatric day-case dental surgery. A randomised study comparing an intravenous propofol infusion with 100% inspired oxygen versus a nitrous oxide/oxygen/halothane maintenance technique.

    PubMed

    Moore, W J; Underwood, S

    1994-09-01

    After intravenous induction of anaesthesia with propofol (4 mg.kg-1) 80 unpremedicated children admitted for day-case dental extractions were randomly allocated to receive either an intravenous propofol infusion whilst breathing 100% oxygen, or inhalational nitrous oxide, oxygen and halothane for maintenance of anaesthesia. In both groups, the quality of anaesthesia was acceptable to both anaesthetist and surgeon. Recovery times and postoperative analgesia requirements did not differ significantly between the two groups. No child vomited. Propofol appears to be suitable for use as a sole agent in paediatric day case dental surgery.

  2. Propofol as sole agent for paediatric day-case dental surgery. A randomised study comparing an intravenous propofol infusion with 100% inspired oxygen versus a nitrous oxide/oxygen/halothane maintenance technique.

    PubMed

    Moore, W J; Underwood, S

    1994-09-01

    After intravenous induction of anaesthesia with propofol (4 mg.kg-1) 80 unpremedicated children admitted for day-case dental extractions were randomly allocated to receive either an intravenous propofol infusion whilst breathing 100% oxygen, or inhalational nitrous oxide, oxygen and halothane for maintenance of anaesthesia. In both groups, the quality of anaesthesia was acceptable to both anaesthetist and surgeon. Recovery times and postoperative analgesia requirements did not differ significantly between the two groups. No child vomited. Propofol appears to be suitable for use as a sole agent in paediatric day case dental surgery. PMID:7978143

  3. Dissecting the myths of day surgery: the anaesthetist's view.

    PubMed

    Smith, Ian

    2006-05-01

    Although day surgery is now well established, its practice varies enormously between various parts of the country and even between different practitioners (Audit Commission 2001). Some of these differences may be explained by a number of lingering myths which persist from the earlier, pioneering days of day surgery. The purpose of this short review is to discuss some of these myths from an anaesthetist's perspective and to try to dispel them using the available evidence.

  4. Spread patterns and effectiveness for surgery after ultrasound-guided rectus sheath block in adult day-case patients scheduled for umbilical hernia repair

    PubMed Central

    Manassero, Alberto; Bossolasco, Matteo; Meineri, Maurizio; Ugues, Susanna; Liarou, Chrysoula; Bertolaccini, Luca

    2015-01-01

    Background and Aims: We conducted a prospective study to examine the local anesthetic (LA) spread and the effectiveness for surgical anesthesia of ultrasound (US)-guided rectus sheath block (RSB) in adult patients undergoing umbilical hernia repair. Material and Methods: Thirty patients received at T-10 level a bilateral US-guided injection of 20 mL levobupivacaine 0.375% + epinephrine 5 μg/mL behind the rectus muscle to detach it from its sheath. Anesthetic spread into the rectus sheath was evaluated ultrasonographically at T-9 and T-11 levels and scored from 0 to 4. The RSB was defined effective for surgical anesthesia if it was able to guarantee an anesthetic level sufficient for surgery without any mepivacaine supplementation. Results: Overall, the block was effective for surgical anesthesia in 53.3% of patients (95% confidence interval, ±17.8). In the remaining patients, anesthesia supplementation was needed at cutaneous incision, whereas manipulation of the muscle and fascial planes was painless. No patients required general anesthesia. LA spreads as advocated (to T-9 and to T-11 bilaterally = spread score 4) in 8/30 patients (26.6%); in these cases, the block was 75% effective for surgery. The anesthetic spread was most negatively influenced by increased body mass index. Postoperative analgesia was excellent in 97% of patients. Conclusion: Use of RSB as an anesthetic management of umbilical herniorrhaphy is recommended only with anesthetic supplementation at the incision site. PMID:26330714

  5. 30-day Mortality after Bariatric Surgery: Independently Adjudicated Causes of Death in the Longitudinal Assessment of Bariatric Surgery

    PubMed Central

    Smith, Mark D.; Patterson, Emma; Wahed, Abdus S.; Belle, Steven H.; Berk, Paul D.; Courcoulas, Anita P.; Dakin, Gregory F.; Flum, David R.; Machado, Laura; Mitchell, James E.; Pender, John; Pomp, Alfons; Pories, Walter; Ramanathan, Ramesh; Schrope, Beth; Staten, Myrlene; Ude, Akuezunkpa; Wolfe, Bruce M.

    2011-01-01

    Purpose Mortality following bariatric surgery is a rare event in contemporary series, making it difficult for any single center to draw meaningful conclusions as to cause of death. Nevertheless, much of the published mortality data come from single center case series and reviews of administrative databases. These sources tend to produce lower mortality estimates than those obtained from controlled clinical trials. Furthermore, information about the causes of death and how they were determined is not always available. The aim of the present report is to describe in detail all deaths occurring within 30-days of surgery in the Longitudinal Assessment of Bariatric Surgery (LABS). Methods LABS is a 10-center observational cohort study of bariatric surgical outcomes. Data were collected prospectively for bariatric surgeries performed between March 2005 and April 2009. All deaths occurring within 30-days of surgery were identified, and cause of death assigned by an independent Adjudication Subcommittee, blinded to operating surgeon and site. Results 6118 patients underwent primary bariatric surgery. 18 deaths (0.3%) occurred within 30-days of surgery. The most common cause of death was sepsis (33% of deaths), followed by cardiac causes (28%) and pulmonary embolism (17%). For one patient cause of death could not be determined despite examination of all available information. Conclusions This study confirms the low 30-day mortality rate following bariatric surgery. The recognized complications of anastomotic leak, cardiac events, and pulmonary emboli accounted for the majority of 30-day deaths. PMID:21866378

  6. [Day surgery: the role and training needs of nurses].

    PubMed

    Agozzino, Erminia; Naddei, Maria; Schiavone, Beniamino

    2014-01-01

    Medicine and health care are increasingly directed towards the achievement of high quality standards and of costs reduction. It is in this framework that same-day surgery finds its role, being able to satisfy both of the above needs. Despite its recognized benefits, in Italy this efficient model of hospitalization still meets several obstacles and the ratio of services provided in day hospital with respect to ordinary hospital admission is about 1 to 3. Day Surgery services depend on team work and the nurse's role is of utmost importance and responsibility since it involves both clinical care and managerial activities. Through a careful analysis of the skills required of a day surgery nurse, the authors discuss aspects of nurses' training in view of the pre- and post-graduate courses currently offered, including on-the-job training.

  7. Prevalence and Predictors of Quality of Recovery at Home After Day Surgery

    PubMed Central

    Stessel, Björn; Fiddelers, Audrey A.; Joosten, Elbert A.; Hoofwijk, Daisy M.N.; Gramke, Hans-Fritz; Buhre, Wolfgang F.F.A.

    2015-01-01

    Abstract Traditionally, major complications and unanticipated admission/readmission rates were used to assess outcome after day surgery. However, in view of the relative absence of major complications the quality of recovery (QOR) should be considered one of the principal endpoints after day surgery. In our study, the level of QOR is defined by a combination of the Global Surgical Recovery (GSR) Index and the Quality of Life (QOL). The aim of this study was to analyze prevalence and predictors of QOR after day surgery on the fourth postoperative day. Elective patients scheduled for day surgery from November 2008 to April 2010 were enrolled in a prospective cohort study. Outcome parameters were measured by using questionnaire packages at 2 time points: 1 week preoperatively and 4 days postoperatively. Primary outcome parameter is the QOR and is defined as good if the GSR index >80% as well as the postoperative QOL is unchanged or improved as compared with baseline. QOR is defined as poor if both the GSR index ≤80% and if the postoperative QOL is decreased as compared with baseline. QOR is defined as intermediate in all other cases. Three logistic regression analyses were performed to determine predictors for poor QOR after day surgery. A total of 1118 patients were included. A good QOR was noted in 17.3% of patients, an intermediate QOR in 34.8%, and a poor QOR in 47.8% 4 days after day surgery. The best predictor for poor QOR after day surgery was type of surgery. Other predictors were younger age, work status, and longer duration of surgery. A history of previous surgery, expected pain (by the patient) and high long-term surgical fear were significant predictors of poor QOR in only 1 of 3 prediction models. The QOR at home 4 days after day surgery was poor in the majority of patients and showed a significant procedure-specific variation. Patients at risk for poor QOR can be identified during the preoperative period based on type of surgery, age, work status, and

  8. [Calling patients on the eve of their day surgery procedure].

    PubMed

    Boule, Marie; Darribère, Véronique; Derouard, Nathalie; Goyenetche, Maryline; Peyroulet, Christel; Coquet, Marie-Monique

    2015-01-01

    In day surgery, the call on the eve of the procedure is a key stage in the patient's care pathway. Systematically carried out by the nurse, it helps to establish a relationship of trust with the nursing team. Through this exchange, the nurse ensures various aspects of the patient management are taken care of and optimises the organisation of the following day's programme. A team from Pau shares its practice. PMID:26145999

  9. [Calling patients on the eve of their day surgery procedure].

    PubMed

    Boule, Marie; Darribère, Véronique; Derouard, Nathalie; Goyenetche, Maryline; Peyroulet, Christel; Coquet, Marie-Monique

    2015-01-01

    In day surgery, the call on the eve of the procedure is a key stage in the patient's care pathway. Systematically carried out by the nurse, it helps to establish a relationship of trust with the nursing team. Through this exchange, the nurse ensures various aspects of the patient management are taken care of and optimises the organisation of the following day's programme. A team from Pau shares its practice.

  10. Initial experience using a femtosecond laser cataract surgery system at a UK National Health Service cataract surgery day care centre

    PubMed Central

    Dhallu, Sandeep K; Maurino, Vincenzo; Wilkins, Mark R

    2016-01-01

    Objectives To describe the initial outcomes following installation of a cataract surgery laser system. Setting National Health Service cataract surgery day care unit in North London, UK. Participants 158 eyes of 150 patients undergoing laser-assisted cataract surgery. Interventions Laser cataract surgery using the AMO Catalys femtosecond laser platform. Primary and secondary outcome measures Primary outcome measure: intraoperative complications including anterior and posterior capsule tears. Secondary outcome measures: docking to the laser platform, successful treatment delivery, postoperative visual acuities. Results Mean case age was 67.7±10.8 years (range 29–88 years). Docking was successful in 94% (148/158 cases), and in 4% (6/148 cases) of these, the laser delivery was aborted part way during delivery due to patient movement. A total of 32 surgeons, of grades from junior trainee to consultant, performed the surgeries. Median case number per surgeon was 3 (range from 1–20). The anterior capsulotomy was complete in 99.3% of cases, there were no anterior capsule tears (0%). There were 3 cases with posterior capsule rupture requiring anterior vitrectomy, and 1 with zonular dialysis requiring anterior vitrectomy (4/148 eyes, 2.7%). These 4 cases were performed by trainee surgeons, and were either their first laser cataract surgery (2 surgeons) or their first and second laser cataract surgeries (1 surgeon). Conclusions Despite the learning curve, docking and laser delivery were successfully performed in almost all cases, and surgical complication rates and visual outcomes were similar to those expected based on national data. Complications were predominately confined to trainee surgeons, and with the exception of intraoperative pupil constriction appeared unrelated to the laser-performed steps. PMID:27466243

  11. Extent of Surgery Does Not Influence 30-Day Mortality in Surgery for Metastatic Bone Disease

    PubMed Central

    Sørensen, Michala Skovlund; Hindsø, Klaus; Hovgaard, Thea Bechmann; Petersen, Michael Mørk

    2016-01-01

    Abstract Estimating patient survival has hitherto been the main focus when treating metastatic bone disease (MBD) in the appendicular skeleton. This has been done in an attempt to allocate the patient to a surgical procedure that outlives them. No questions have been addressed as to whether the extent of the surgery and thus the surgical trauma reduces survival in this patient group. We wanted to evaluate if perioperative parameters such as blood loss, extent of bone resection, and duration of surgery were risk factors for 30-day mortality in patients having surgery due to MBD in the appendicular skeleton. We retrospectively identified 270 consecutive patients who underwent joint replacement surgery or intercalary spacing for skeletal metastases in the appendicular skeleton from January 1, 2003 to December 31, 2013. We collected intraoperative (duration of surgery, extent of bone resection, and blood loss), demographic (age, gender, American Society of Anesthesiologist score [ASA score], and Karnofsky score), and disease-specific (primary cancer) variables. An association with 30-day mortality was addressed using univariate and multivariable analyses and calculation of odds ratio (OR). All patients were included in the analysis. ASA score 3 + 4 (OR 4.16 [95% confidence interval, CI, 1.80–10.85], P = 0.002) and Karnofsky performance status below 70 (OR 7.34 [95% CI 3.16–19.20], P < 0.001) were associated with increased 30-day mortality in univariate analysis. This did not change in multivariable analysis. No parameters describing the extent of the surgical trauma were found to be associated with 30-day mortality. The 30-day mortality in patients undergoing surgery for MBD is highly dependent on the general health status of the patients as measured by the ASA score and the Karnofsky performance status. The extent of surgery, measured as duration of surgery, blood loss, and degree of bone resection were not associated with 30-day mortality. PMID:27082592

  12. Perioperative tranexamic acid in day-case paediatric tonsillectomy

    PubMed Central

    Thorning, G

    2014-01-01

    Introduction Tranexamic acid has been used for many years to minimise blood loss during surgery and, more recently, to reduce morbidity after major trauma. While small studies have confirmed reduction in blood loss during tonsillectomy with its use, the rate of primary haemorrhage following tonsillectomy has not been reported. In the UK, less than 50% of children having a tonsillectomy are managed as day cases, partly because of concerns about bleeding during the initial 24 hours following surgery. Methods A retrospective review of clinical records between January 2007 and January 2013 produced 476 children between the ages of 3 and 16 years who underwent Coblation™ tonsillectomy, with or without adenoidectomy and/or insertion of ventilation tubes. All children were ASA (American Society of Anesthesiologists) grade 1 or 2 and anaesthetised using a standard day surgery protocol. Following induction of anaesthesia, all received intravenous tranexamic acid at a dose of 10–15mg/kg. Results Two children (0.4%) had minor bleeding within two hours of surgery. Both returned to theatre for haemostasis and were discharged home later the same day with no further complications. The expected rate for primary haemorrhage in the UK using this technique for tonsillectomy is 1%. Conclusions Perioperative tranexamic acid in a single, parenteral dose might reduce the incidence of primary haemorrhage following paediatric tonsillectomy, facilitating discharge on the day of surgery. The results from this observational study indicate a potential benefit and need for a large, prospective, multicentre, randomised controlled trial. PMID:24780670

  13. Surgery of the head and 70-day brain surgeons.

    PubMed

    Hanigan, William C

    2003-09-01

    In 1917, the Sugeon General of the United States Army, William Gorgas, learned that almost 15% of the casualties on the Western Front sustained intracranial injuries. Soon after the United States declared war in April 1917, the Council of National Defense established a General Medical Board and attached a brain surgery subsection to its Committee of Ophthalmology. Postcards were sent to experts around the country, asking for the names of individuals who had specialty training or practice in brain surgery. In August, Gorgas assumed control of this subsection and created a Division of Surgery of the Head in the American Army Medical Department, with additional sections for plastic surgery, ophthalmology, and otolaryngology. He needed almost 300 brain surgeons; he received 50 names. As Harvey Cushing, Gilbert Horrax, and others went to France, neurosurgeons at home trained student officers. Schools were established in Philadelphia (Charles Frazier), Chicago (Dean Lewis), New York City (Charles Elsberg), St. Louis (Ernest Sachs), and Camp Greenleaf in Georgia (Claude Coleman), with 10-week intensive courses for selected candidates. Basic science and x-ray classes and operative clinics addressed most aspects of neurosurgical care. An army manual outlined clinical diagnoses and surgical techniques. Lewis H. Weed established a laboratory at Johns Hopkins Hospital, staffed by volunteers such as K.D. Blackfan and W.E. Dandy, to investigate infections of the central nervous system. By the time of the armistice, Gorgas had his complement of brain surgeons. The newly trained brain surgeons and their mentors gradually made their way to the Western Front during the summer of 1918. Plans for a neurosurgical school in France were quickly discarded as the American Army Medical Department changed the specialized assignments to front-line general surgical care. Some of the 190 brain surgeons in the American Expeditionary Forces, notably Gilbert Horrax, Charles E. Dowman, and Charles

  14. Surgery of the head and 70-day brain surgeons.

    PubMed

    Hanigan, William C

    2003-09-01

    In 1917, the Sugeon General of the United States Army, William Gorgas, learned that almost 15% of the casualties on the Western Front sustained intracranial injuries. Soon after the United States declared war in April 1917, the Council of National Defense established a General Medical Board and attached a brain surgery subsection to its Committee of Ophthalmology. Postcards were sent to experts around the country, asking for the names of individuals who had specialty training or practice in brain surgery. In August, Gorgas assumed control of this subsection and created a Division of Surgery of the Head in the American Army Medical Department, with additional sections for plastic surgery, ophthalmology, and otolaryngology. He needed almost 300 brain surgeons; he received 50 names. As Harvey Cushing, Gilbert Horrax, and others went to France, neurosurgeons at home trained student officers. Schools were established in Philadelphia (Charles Frazier), Chicago (Dean Lewis), New York City (Charles Elsberg), St. Louis (Ernest Sachs), and Camp Greenleaf in Georgia (Claude Coleman), with 10-week intensive courses for selected candidates. Basic science and x-ray classes and operative clinics addressed most aspects of neurosurgical care. An army manual outlined clinical diagnoses and surgical techniques. Lewis H. Weed established a laboratory at Johns Hopkins Hospital, staffed by volunteers such as K.D. Blackfan and W.E. Dandy, to investigate infections of the central nervous system. By the time of the armistice, Gorgas had his complement of brain surgeons. The newly trained brain surgeons and their mentors gradually made their way to the Western Front during the summer of 1918. Plans for a neurosurgical school in France were quickly discarded as the American Army Medical Department changed the specialized assignments to front-line general surgical care. Some of the 190 brain surgeons in the American Expeditionary Forces, notably Gilbert Horrax, Charles E. Dowman, and Charles

  15. Transient Thyroiditis after Surgery for Tertiary Hyperparathyroidism: A Case Report

    PubMed Central

    Hakami, Yasser Ali

    2015-01-01

    Parathyroid (PTH) exploration surgery carries the risk of developing post-operative thyroiditis due to vigorous manual manipulation of the thyroid gland during surgery. Post-operative thyroiditis has a wide spectrum of clinical manifestations. However, it remains underreported. Here, we describe a case of post-operative transient thyroiditis in a 33-year-old male who developed 3 days after parathyroidectomy for PTH hyperplasia. We review the limited literature regarding this interesting entity. PMID:26347710

  16. Day care percutaneous renal surgery--is this viable?

    PubMed

    Chong, W L; Murali, S; Sahabudin, R M; Khairullah, A

    2002-03-01

    Pros and cons of Percutaneous Nephrolithotripsy (PCNL) versus Extracorporeal Shockwave Lithotripsy (ESWL) have often been highlighted when one discusses on the management of renal stones. An oft quoted point is that PCNL entails a prolonged hospital stay whereas ESWL sessions are day surgical in nature. However, PCNL has superior stone clearance rate as compared to ESWL especially for lower pole stones. In addition, PCNL is more suitable for large bulk stones and when ancillary procedures are required e.g. endopyelotomy. The first 50 cases of successful tubeless PCNL were reported by Bellman et al in 1997. The remarkable recovery of patients in their series encouraged them to employ this technique as their technique of choice for the majority of their cases. A similar technique was employed on endopyelotomy by Liang et al and they concluded that this was a safe, less morbid and effective technique. We report our first case of tubeless PCNL.

  17. [Plastic surgery in day hospital conditions: comparison between two hospital models].

    PubMed

    Faga, A; Carminati, M; Falconi, D; Gatti, S; Rottino, A

    2003-12-01

    Personal experience of plastic surgery carried out in Day Hospital conditions is reported. The experience took place within the hospital structure through two different organisational models called here transversal and divisional organisation models: characteristic of the former is that it uses a dedicated interdivisional structure within the hospital involving the centralization of all day-surgery activities, whereas the latter organizes Day Surgery activities within the operating unit whose structures it shares. On the basis of a comparison between the two models we were able to note advantages and disadvantages. We can review our experience in brief by stating that our own preference went to the transversal model which presents the indubitable advantage of being a logistic structure which is hinged on daytime activity and is ready therefore to satisfy on the one hand the needs of this type of patient and, on the other, the needs of the structure itself in efficiency terms. We propose to correct the disadvantages of the transversal model which can be outlined in its lack of homogeneity in the pathology treated and in the subtraction of the criterion of clinical priority in waiting lists through the attainment of a critical dimensional threshold such as to permit programmable sessions with patients with homogeneous pathology (i.e. belonging to the same hospital unit) and through the maintenance of a certain number of Day Hospital beds (around 25%) reserved for new emergency clinical cases.

  18. Day care cataract surgery in Central and Southern Italy: a multicentric survey

    PubMed Central

    Cillino, Salvatore; Casuccio, Alessandra; Di Pace, Francesco; Pillitteri, Francesco; Cillino, Giovanni; Lodato, Gaetano

    2007-01-01

    Background Cataract day surgery has rapidly gained worldwide acceptance, because the new surgical techniques and costs are generally lower than those involved in ordinary hospitalization. Cataract surgery serves as a proxy indicator of the trend towards day surgery hospitalization in Italy and, therefore, of regional variability in health-care delivery and cost. The aim of this study was to update the diffusion of cataract day surgery through various surgical ophthalmological centers in central and southern Italy during 2005. Methods A two-stage stratified cluster sampling method was used to draw a sample of Cataract Surgery Unit from Ophthalmic Units of central and southern Italy. A questionnaire was sent to 25 cataract surgery centers in nine health districts that represented the range of establishments (public, private, accredited or otherwise) in which cataract surgery is performed. Data were collected on numbers of procedures performed in 2005, hospital admission type, time from the onset of cataract day surgery, surgical procedure, and presence of other surgical centers. Results The response rate was 42% (10 surveys), resulting in at least one completed questionnaire for each of these 9 districts. There is a positive trend towards day surgery hospitalization in all surgical centers. The percentage of patients treated as outpatients during 2005 varied from 50–60% (Avellino, Naples, Campobasso), to 80–90% (Rome, Bari), up to 90–100% (Catania, Palermo, Siracusa and Trapani), with an increasing trend in all the centers studied. Few differences were found in surgical procedures, and these were statistically insignificant. Conclusion Our results confirm a positive trend towards day surgery in place of hospital inpatient admission for cataract surgery. This trend is expected to close the existing regional gap in Italy. Increased efficiency is an overriding need for the National Health Service in order to improve the rationalization of resources. PMID:17270040

  19. Patients' experiences and perceived causes of persisting discomfort following day surgery

    PubMed Central

    2010-01-01

    Background The aim of this study was to describe patients' experiences and perceived causes of persisting discomfort following day surgery. Earlier research has mainly covered symptoms and signs during a recovery period of up to one month, and not dealt with patients' perceptions of what causes persisting, longer-term discomfort. Methods This study is a part from a study carried out during the period May 2006 to May 2007 with a total of 298 day surgery patients. Answers were completed by 118 patients at 48 hours, 110 at seven days and 46 at three months to one open-ended question related to discomfort after day surgery constructed as follows: If you are still experiencing discomfort related to the surgery, what is the reason, in your opinion? Data was processed, quantitatively and qualitatively. Descriptive, inferential, correlation and content analyses were performed. Results The results suggest that patients suffer from remaining discomfort e.g. pain and wound problem, with effects on daily life following day surgery up to three months. Among patients' perceptions of factors leading to discomfort may be wrongful or suboptimal treatment, type of surgery or insufficient access to provider/information. Conclusions The results have important implications for preventing and managing discomfort at home following day surgery, and for nursing interventions to help patients handle the recovery period better. PMID:20979624

  20. Postoperative Morbidity by Procedure and Patient Factors Influencing Major Complications Within 30 Days Following Shoulder Surgery

    PubMed Central

    Shields, Edward; Iannuzzi, James C.; Thorsness, Robert; Noyes, Katia; Voloshin, Ilya

    2014-01-01

    Background: Little data are available to prioritize quality improvement initiatives in shoulder surgery. Purpose: To stratify the risk for 30-day postoperative morbidity in commonly performed surgical procedures about the shoulder completed in a hospital setting and to determine patient factors associated with major complications. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective study utilized the National Surgical Quality Improvement Program (NSQIP) database from the years 2005 to 2010. Using Current Procedural Terminology codes, the database was queried for shoulder cases that were divided into 7 groups: arthroscopy without repair; arthroscopy with repair; arthroplasty; clavicle/acromioclavicular joint (AC) open reduction and internal fixation (ORIF)/repair; ORIF of proximal humeral fracture; open tendon release/repair; and open shoulder stabilization. The primary end point was any major complication, with secondary end points of incisional infection, return to the operating room, and venothromboembolism (VTE), all within 30 days of surgery. Results: Overall, 11,086 cases were analyzed. The overall major complication rate was 2.1% (n = 234). Factors associated with major complications on multivariate analysis included: procedure performed (P < .001), emergency case (P < .001), pulmonary comorbidity (P < .001), preoperative blood transfusion (P = .033), transfer from an outside institution (P = .03), American Society of Anesthesiologists (ASA) score (P = .006), wound class (P < .001), dependent functional status (P = .027), and age older than 60 years (P = .01). After risk adjustment, open shoulder stabilization was associated with the greatest risk of major complications relative to arthroscopy without repair (odds ratio [OR], 5.56; P = .001), followed by ORIF of proximal humerus fracture (OR, 4.90; P < .001) and arthroplasty (OR, 4.40; P < .001). These 3 groups generated over 60% of all major complications. Open shoulder

  1. De-hospitalization of the pediatric day surgery by means of a freestanding surgery center: pilot study in the lazio region

    PubMed Central

    2012-01-01

    Background Day surgery should take place in appropriate organizational settings. In the presence of high volumes, the organizational models of the Lazio Region are represented by either Day Surgery Units within continuous-cycle hospitals or day-cycle Day Surgery Centers. This pilot study presents the regional volumes provided in 2010 and the additional volumes that could be provided based on the best performance criterion with a view to suggesting the setting up of a regional Freestanding Center of Pediatric Day Surgery. Methods This is an observational retrospective study. The activity volumes have been assessed by means of a DRG (Diagnosis Related Group)-specific indicator that measures the ratio of outpatients to the total number of treated patients (freestanding indicator, FI). The included DRGs had an FI exceeding the 3rd quartile present in at least a health-care facility and a volume exceeding 0.5% of the total patients of the pediatric surgery and urology facilities of the Lazio Region. The relevant data have been provided by the Public Health Agency and relate to 2010. The best performance FI has been used to calculate the theoretical volume of transferability of the remaining facilities into freestanding surgery centers. Patients under six months of age and DRGs common to other disciplines have been excluded. The Chi Square test has been used to compare the FI of the health-care facilities and the FI of the places of origin of the patients. Results The DRG provided in 2010 amounted to a total of 5768 belonging to 121 types of procedures. The application of the criteria of inclusion have led to the selection of seven final DRG categories of minor surgery amounting to 3522 cases. Out of this total number, there were 2828 outpatients and 694 inpatients. The recourse of the best performance determines a potential transfer of 497 cases. The total outpatient volume is 57%. The Chi Square test has pointed to a statistically significant difference of the

  2. Day care surgery in a metropolitan government hospital setting--Indian scenario.

    PubMed

    Dorairajan, Natarajan; Andappan, Anandi; Arun, B; Siddharth, Dorairajan; Meena, M

    2010-01-01

    Day care surgery has generated a lot of interest, among both surgeons and the common people. This study aims to explore the management and advantages, including the cost benefits and cost effectiveness, of day care surgery in a government hospital setting. A prospective, single-center, single-unit study was carried out over 1 year from August 2006 to January 2008. The total number of patients studied was 327. Surgeries for hernia, hydrocele, fibroadenoma, fissure in ano, and phimosis were included. Patients were admitted on the day of surgery and were discharged the same day or evening. Patients were analyzed with respect to failure to discharge, wound infection, duration of stay in the ward, cost benefits, cost effectiveness, and postoperative pain. A total of 157 patients were treated for hernia, 61 for hydrocele, 52 for fibroadenoma, 34 for fissure in ano, and 23 for phimosis. Day care surgery is a fast growing and well accepted way of providing care to patients. Most of the patients studied had a favorable impression of the day care surgical procedure compared with inpatient care. In a country like India, in spite of problems of financial constraints and insufficient grants for health care, we are able to enjoy all the advantages of day care surgery, even in a government hospital setting.

  3. The use of local area networks in the day surgery department.

    PubMed

    Meikle, S M; Dresen, S D

    1994-08-01

    As patient care moves from inpatient to outpatient status, there is an increased demand for specially developed software applications in the Day Surgery Department. Although a stand-alone computer initially could handle routine tasks performed by surgical staff, it is becoming increasingly apparent that a need exists for a more inclusive system that can manage the vast amounts of information necessary for effective resource management in today's Day Surgery Department environment. Local area networks (LANs) provide the necessary flexibility, expandability, and usability requisite of such a system. This article will discuss the benefits of using LANs in the Day Surgery Department. Specifically, an operating room scheduling and resource management software program is used to illustrate the advantages of LANs in the Day Surgery Department.

  4. Pediatric Day Case Surgical Practice at a Tertiary Hospital in Lagos: How Have We Faired?

    PubMed Central

    Elebute, OA; Ademuyiwa, AO; Bode, CO; Idiodi-Thomas, HOI

    2014-01-01

    Background: There has been a gradual increase in the number of patients treated as a day case surgery in our center. This study has been conducted to audit pediatric day case surgery practice at the Lagos University Teaching Hospital. Aims: The aim of the following study is to determine the morbidity and mortality from day case surgery in our center. Subjects and Methods: The type of study was a prospective study over a 2½ year period at the Lagos University Teaching Hospital. The patients scheduled for surgeries were assessed in the pediatric outpatient clinic and information obtained for each of the patients included age, sex, diagnosis and operation planned. Additional information collected included the (1) type of anesthesia (2) post-operative complications and the cadre of the surgeon. The data was analyzed using SPSS version 19 (IBM Corp. Released 2010. IBM SPSS Statistics for Windows, Version 19.0. Armonk, NY: IBM Corp, USA). Result: A total of 381 patients were operated during the study period. The age range of patients was 2 weeks to 15 years and the mean age was 2.9 years (3.0). There were 338 male patients (88.7%;338/381) and 43 females (11.3%;43/381). Inguinal hernias and hydroceles constituted almost half of the cases treated while 16.0% of cases were undescended testis. There were four morbidities and no mortality. Conclusion: Day case surgery is associated with a low morbidity and no mortality in our center. PMID:25221704

  5. Visual loss after spine surgery: Case report.

    PubMed

    Cobar-Bustamante, Andrés E; Cahueque, Mario A; Caldera, Gustavo

    2016-12-01

    The presence of postoperative visual loss is a well-known complication, and described in various reports, its low incidence (0.028-0.2%) makes it extremely rare. Two main causes have been determined: Posterior Ischemic Optic Neuropathy and central Retinal Artery Oclusion. The following is a case report of a 52-year-old patient that presented visual loss after elective spine surgery that had no complications that could initially explain this complication. Studies were performed and evaluations by ophthalmologists determined that the cause of Posterior Ischemic Optic Neuropathy due to multiple risk factors that the patient had previously and during the surgery. After 3 year follow-up the patient still has total visual loss and no other complications were reported.

  6. Opioid use among same-day surgery patients: Prevalence, management and outcomes

    PubMed Central

    Wilson, Jennifer LC; Poulin, Patricia A; Sikorski, Robert; Nathan, Howard J; Taljaard, Monica; Smyth, Catherine

    2015-01-01

    OBJECTIVES: To determine whether the prevalence of opioid use among patients requiring elective same-day admission (SDA) surgery is greater than the 2.5% prevalence found in the general population. Secondary objectives were to assess compliance with expert recommendations on acute pain management in opioid-tolerant patients and to examine clinical outcomes. METHODS: A retrospective review of 812 systematically sampled adult SDA surgical cases between April 1, 2008 and March 31, 2009 was conducted. RESULTS: Among 798 eligible patients, 148 (18.5% [95% CI 15.9% to 21.2%]) were prescribed opioids, with 4.4% prescribed long-acting opioids (95% CI 3.0% to 5.8%). Use of opioids was most prevalent among orthopedic and neurosurgery patients. Among the 35 patients on long-acting opioids who had a high likelihood of being tolerant, anesthesiologists correctly identified 33, but only 13 (37%) took their usual opioid preoperatively while 22 (63%) had opioids continued postoperatively. Acetaminophen, nonsteroidal anti-inflammatory drugs and pregabalin were ordered preoperatively in 18 (51%), 15 (43%) and 18 (51%) cases, respectively, while ketamine was used in 15 (43%) patients intraoperatively. Acetaminophen, nonsteroidal anti-inflammatory drugs and pregabalin were ordered postoperatively in 31 (89%), 15 (43%) and 17 (49%) of the cases, respectively. No differences in length of stay, readmissions and emergency room visits were found between opioid-tolerant and opioid-naïve patients. CONCLUSION: Opioid use is more common in SDA surgical patients than in the general population and is most prevalent within orthopedic and neurosurgery patients. Uptake of expert opinion on the management of acute pain in the opioid tolerant patient population is lacking. PMID:26357683

  7. Improved Surgery Planning Using 3-D Printing: a Case Study.

    PubMed

    Singhal, A J; Shetty, V; Bhagavan, K R; Ragothaman, Ananthan; Shetty, V; Koneru, Ganesh; Agarwala, M

    2016-04-01

    The role of 3-D printing is presented for improved patient-specific surgery planning. Key benefits are time saved and surgery outcome. Two hard-tissue surgery models were 3-D printed, for orthopedic, pelvic surgery, and craniofacial surgery. We discuss software data conversion in computed tomography (CT)/magnetic resonance (MR) medical image for 3-D printing. 3-D printed models save time in surgery planning and help visualize complex pre-operative anatomy. Time saved in surgery planning can be as much as two thirds. In addition to improved surgery accuracy, 3-D printing presents opportunity in materials research. Other hard-tissue and soft-tissue cases in maxillofacial, abdominal, thoracic, cardiac, orthodontics, and neurosurgery are considered. We recommend using 3-D printing as standard protocol for surgery planning and for teaching surgery practices. A quick turnaround time of a 3-D printed surgery model, in improved accuracy in surgery planning, is helpful for the surgery team. It is recommended that these costs be within 20 % of the total surgery budget. PMID:27303117

  8. First 101 Robotic General Surgery Cases in a Community Hospital

    PubMed Central

    Robertson, Jarrod C.; Alrajhi, Sharifah

    2016-01-01

    Background and Objectives: The general surgeon's robotic learning curve may improve if the experience is classified into categories based on the complexity of the procedures in a small community hospital. The intraoperative time should decrease and the incidence of complications should be comparable to conventional laparoscopy. The learning curve of a single robotic general surgeon in a small community hospital using the da Vinci S platform was analyzed. Methods: Measured parameters were operative time, console time, conversion rates, complications, surgical site infections (SSIs), surgical site occurrences (SSOs), length of stay, and patient demographics. Results: Between March 2014 and August 2015, 101 robotic general surgery cases were performed by a single surgeon in a 266-bed community hospital, including laparoscopic cholecystectomies, inguinal hernia repairs; ventral, incisional, and umbilical hernia repairs; and colorectal, foregut, bariatric, and miscellaneous procedures. Ninety-nine of the cases were completed robotically. Seven patients were readmitted within 30 days. There were 8 complications (7.92%). There were no mortalities and all complications were resolved with good outcomes. The mean operative time was 233.0 minutes. The mean console operative time was 117.6 minutes. Conclusion: A robotic general surgery program can be safely implemented in a small community hospital with extensive training of the surgical team through basic robotic skills courses as well as supplemental educational experiences. Although the use of the robotic platform in general surgery could be limited to complex procedures such as foregut and colorectal surgery, it can also be safely used in a large variety of operations with results similar to those of conventional laparoscopy. PMID:27667913

  9. Risk Factors for 30-Day Hospital Readmission among General Surgery Patients

    PubMed Central

    Kassin, Michael T; Owen, Rachel M; Perez, Sebastian; Leeds, Ira; Cox, James C; Schnier, Kurt; Sadiraj, Vjollca; Sweeney, John F

    2012-01-01

    Background Hospital readmission within 30-days of an index hospitalization is receiving increased scrutiny as a marker of poor quality patient care. This study identifies factors associated with 30-day readmission following General Surgery procedures. Study Design Using standard National Surgical Quality Improvement Project (NSQIP) protocol, preoperative, intraoperative, and postoperative outcomes were collected on patients undergoing inpatient General Surgery procedures at a single academic center between 2009 and 2011. Data were merged with our institutional clinical data warehouse to identify unplanned 30-day readmissions. Demographics, comorbidities, type of procedure, postoperative complications, and ICD-9 coding data were reviewed for patients who were readmitted. Univariate and multivariate analysis was utilized to identify risk factors associated with 30-day readmission. Results 1442 General Surgery patients were reviewed. 163 (11.3%) were readmitted within 30 days of discharge. The most common reasons for readmission were gastrointestinal complaint/complication (27.6%), surgical infection (22.1%), and failure to thrive/malnutrition (10.4%). Comorbidities associated with risk of readmission included disseminated cancer, dyspnea, and preoperative open wound (p<0.05 for all variables). Surgical procedures associated with higher rates of readmission included pancreatectomy, colectomy, and liver resection. Postoperative occurrences leading to increased risk of readmission were blood transfusion, postoperative pulmonary complication, wound complication, sepsis/shock, urinary tract infection, and vascular complications. Multivariable analysis demonstrates that the most significant independent risk factor for readmission is the occurrence of any postoperative complication (OR 4.20, 95% CI 2.89–6.13). Conclusions Risk factors for readmission after General Surgery procedures are multi-factorial; however, postoperative complications appear to drive readmissions in

  10. Virtual help for real surgery: the case of awake surgery.

    PubMed

    Albani, Giovanni; Cipresso, Pietro; Gaggioli, Andrea; Serino, Silvia; Vigna, Cinzia; Priano, Lorenzo; Mauro, Alessandro; Franzini, Angelo; Riva, Giuseppe

    2012-01-01

    Awake surgery can be highly stressful for patients. In fact, being awake, patients could perceive that the environmental demands are taxing or exceed their adaptive abilities. We proposed the use of Virtual Reality as a functional and effective tool for a new class of clinical applications aimed at helping patients to cope with these specific stressful situations. Using coping skills that have been learnt during the virtual experience, patients can reduce their psychological stress and improve their collaboration and - in general - the outcome of the intervention.

  11. Computer Simulation Shows the Effect of Communication on Day of Surgery Patient Flow.

    PubMed

    Taaffe, Kevin; Fredendall, Lawrence; Huynh, Nathan; Franklin, Jennifer

    2015-07-01

    To improve patient flow in a surgical environment, practitioners and academicians often use process mapping and simulation as tools to evaluate and recommend changes. We used simulations to help staff visualize the effect of communication and coordination delays that occur on the day of surgery. Perioperative services staff participated in tabletop exercises in which they chose the delays that were most important to eliminate. Using a day-of-surgery computer simulation model, the elimination of delays was tested and the results were shared with the group. This exercise, repeated for multiple groups of staff, provided an understanding of not only the dynamic events taking place, but also how small communication delays can contribute to a significant loss in efficiency and the ability to provide timely care. Survey results confirmed these understandings.

  12. Cost-effectiveness of different regimens of anesthesia for day surgery in China

    PubMed Central

    Shen, Liang; Luo, Yan; Lu, Zhijun; Hu, Xiang; Ding, Wen; Yu, Buwei

    2014-01-01

    Objectives: To compare the cost-effectiveness of inhalation of sevoflurane, target-controlled infusion (TCI) of propofol, intravenous (IV) propofol for induction-inhalation of sevoflurane, and IV propofol for induction-inhalation of desoflurane for anesthesia maintenance in day surgery. Methods: 240 patients, scheduled for elective day surgery, were randomly divided into 4 groups (n = 60 each): inhalation of sevoflurane anesthesia group (group S); TCI of propofol anesthesia (group P); and intravenous propofol for induction of anesthesia-inhalation of sevoflurane for maintenance of anesthesia group (group PS); and intravenous propofol for induction of anesthesia-inhalation of desoflurane for maintenance of anesthesia group (group PD). Results: Group S was associated with less time to loss of consciousness, as well as the other three groups were associated with less time to recovery (P < 0.05). Group P was associated with a higher anesthetic agents cost than other 3 groups (P < 0.05), and group S was associated with a higher anesthetic agents costs than group PS and PD (P < 0.05). Conclusion: Induction with intravenous injection of propofol and maintenance with inhalation of desoflurane is the most cost-effective method of anesthesia for day surgery. PMID:25664101

  13. Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis.

    PubMed

    Karhade, Aditya V; Vasudeva, Viren S; Dasenbrock, Hormuzdiyar H; Lu, Yi; Gormley, William B; Groff, Michael W; Chi, John H; Smith, Timothy R

    2016-08-01

    OBJECTIVE The goal of this study was to use a large national registry to evaluate the 30-day cumulative incidence and predictors of adverse events, readmissions, and reoperations after surgery for primary and secondary spinal tumors. METHODS Data from adult patients who underwent surgery for spinal tumors (2011-2014) were extracted from the prospective National Surgical Quality Improvement Program (NSQIP) registry. Multivariable logistic regression was used to evaluate predictors of reoperation, readmission, and major complications (death, neurological, cardiopulmonary, venous thromboembolism [VTE], surgical site infection [SSI], and sepsis). Variables screened included patient age, sex, tumor location, American Society of Anesthesiologists (ASA) physical classification, preoperative functional status, comorbidities, preoperative laboratory values, case urgency, and operative time. Additional variables that were evaluated when analyzing readmission included complications during the surgical hospitalization, hospital length of stay (LOS), and discharge disposition. RESULTS Among the 2207 patients evaluated, 51.4% had extradural tumors, 36.4% had intradural extramedullary tumors, and 12.3% had intramedullary tumors. By spinal level, 20.7% were cervical lesions, 47.4% were thoracic lesions, 29.1% were lumbar lesions, and 2.8% were sacral lesions. Readmission occurred in 10.2% of patients at a median of 18 days (interquartile range [IQR] 12-23 days); the most common reasons for readmission were SSIs (23.7%), systemic infections (17.8%), VTE (12.7%), and CNS complications (11.9%). Predictors of readmission were comorbidities (dyspnea, hypertension, and anemia), disseminated cancer, preoperative steroid use, and an extended hospitalization. Reoperation occurred in 5.3% of patients at a median of 13 days (IQR 8-20 days) postoperatively and was associated with preoperative steroid use and ASA Class 4-5 designation. Major complications occurred in 14.4% of patients: the

  14. The constraints on day-case total knee arthroplasty: the fastest fast track.

    PubMed

    Thienpont, E; Lavand'homme, P; Kehlet, H

    2015-10-01

    Total knee arthroplasty (TKA) is a major orthopaedic intervention. The length of a patient's stay has been progressively reduced with the introduction of enhanced recovery protocols: day-case surgery has become the ultimate challenge. This narrative review shows the potential limitations of day-case TKA. These constraints may be social, linked to patient's comorbidities, or due to surgery-related adverse events (e.g. pain, post-operative nausea and vomiting, etc.). Using patient stratification, tailored surgical techniques and multimodal opioid-sparing analgesia, day-case TKA might be achievable in a limited group of patients. The younger, male patient without comorbidities and with an excellent social network around him might be a candidate. Demographic changes, effective recovery programmes and less invasive surgical techniques such as unicondylar knee arthroplasty, may increase the size of the group of potential day-case patients. The cost reduction achieved by day-case TKA needs to be balanced against any increase in morbidity and mortality and the cost of advanced follow-up at a distance with new technology. These factors need to be evaluated before adopting this ultimate 'fast-track' approach. PMID:26430085

  15. Thirty-day readmission rates in spine surgery: systematic review and meta-analysis.

    PubMed

    Bernatz, James T; Anderson, Paul A

    2015-10-01

    OBJECT The rate of 30-day readmissions is rapidly gaining significance as a quality metric and is increasingly used to evaluate performance. An analysis of the present 30-day readmission rate in the spine literature is needed to aid the development of policies to decrease the frequency of readmissions. The authors examine 2 questions: 1) What is the 30-day readmission rate as reported in the spine literature? 2) What study factors impact the rate of 30-day readmissions? METHODS This study was registered with Prospera (CRD42014015319), and 4 electronic databases (PubMed, Cochrane Library, Web of Science, and Google Scholar) were searched for articles. A systematic review and meta-analysis was performed to assess the current 30-day readmission rate in spine surgery. Thirteen studies met inclusion criteria. The readmission rate as well as data source, time from enrollment, sample size, demographics, procedure type and spine level, risk factors for readmission, and causes of readmission were extrapolated from each study. RESULTS The pooled 30-day readmission rate was 5.5% (95% CI 4.2%-7.4%). Studies from single institutions reported the highest 30-day readmission rate at 6.6% (95% CI 3.8%-11.1%), while multicenter studies reported the lowest at 4.7% (95% CI 2.3%-9.7%). Time from enrollment had no statistically significant effect on the 30-day readmission rate. Studies including all spinal levels had a higher 30-day readmission rate (6.1%, 95% CI 4.1%-8.9%) than exclusively lumbar studies (4.6%, 95% CI 2.5%-8.2%); however, the difference between the 2 rates was not statistically significant (p = 0.43). The most frequently reported risk factors associated with an increased odds of 30-day readmission on multivariate analysis were an American Society of Anesthesiology score of 4+, operative duration, and Medicare/Medicaid insurance. The most common cause of readmission was wound complication (39.3%). CONCLUSIONS The 30-day readmission rate following spinal surgery is

  16. Perceived quality in Day Surgery Units Proposal of an enquiry postoperative questionnaire.

    PubMed

    Palumbo, Piergaspare; Perotti, Bruno; Amatucci, Chiara; Pangrazi, Maria Pia; Leuzzi, Barbara; Vietri, Francesco; Illuminati, Giulio

    2016-01-01

    La soddisfazione dei pazienti assume particolare importanza nell’attività chirurgica in Day Surgery, al fine di mantenere ed incrementare la domanda di prestazioni da parte dell’utenza ed inoltre di valutare le abilità e le competenze dello staff clinico dedicato. Sono stati valutati i risultati di un questionario somministrato dal 2007 al 2012, divisi in due gruppi, alla dimissione e a 30 giorni dall’intervento. Tali risultati hanno permesso di valutare i principali vantaggi e limiti del questionario in termini di comprensibilità, di corretto timing di somministrazione, e di utilità per lo staff clinico.

  17. Extent of Surgery Does Not Influence 30-Day Mortality in Surgery for Metastatic Bone Disease: An Observational Study of a Historical Cohort.

    PubMed

    Sørensen, Michala Skovlund; Hindsø, Klaus; Hovgaard, Thea Bechmann; Petersen, Michael Mørk

    2016-04-01

    Estimating patient survival has hitherto been the main focus when treating metastatic bone disease (MBD) in the appendicular skeleton. This has been done in an attempt to allocate the patient to a surgical procedure that outlives them. No questions have been addressed as to whether the extent of the surgery and thus the surgical trauma reduces survival in this patient group. We wanted to evaluate if perioperative parameters such as blood loss, extent of bone resection, and duration of surgery were risk factors for 30-day mortality in patients having surgery due to MBD in the appendicular skeleton. We retrospectively identified 270 consecutive patients who underwent joint replacement surgery or intercalary spacing for skeletal metastases in the appendicular skeleton from January 1, 2003 to December 31, 2013. We collected intraoperative (duration of surgery, extent of bone resection, and blood loss), demographic (age, gender, American Society of Anesthesiologist score [ASA score], and Karnofsky score), and disease-specific (primary cancer) variables. An association with 30-day mortality was addressed using univariate and multivariable analyses and calculation of odds ratio (OR). All patients were included in the analysis. ASA score 3 + 4 (OR 4.16 [95% confidence interval, CI, 1.80-10.85], P = 0.002) and Karnofsky performance status below 70 (OR 7.34 [95% CI 3.16-19.20], P < 0.001) were associated with increased 30-day mortality in univariate analysis. This did not change in multivariable analysis. No parameters describing the extent of the surgical trauma were found to be associated with 30-day mortality. The 30-day mortality in patients undergoing surgery for MBD is highly dependent on the general health status of the patients as measured by the ASA score and the Karnofsky performance status. The extent of surgery, measured as duration of surgery, blood loss, and degree of bone resection were not associated with 30-day mortality.

  18. [Laparoscopic surgery of varicocele. Role of total endovenous anesthesia in same-day discharge].

    PubMed

    Donà, B; Cantele, P; Pianalto, S; Funes, M; Gagliardi, G; Cappi, F

    2000-10-01

    The success of out-patients laparoscopic surgery depends on a careful selection of patients and the ability of anesthetic technique to ensure a rapid emergence from anesthesia, with a satisfactory control of postoperative pain and the absence of side effects. This study was undertaken to investigate the influence of a total intravenous anesthetic management on the recovery process after laparoscopic varicocelectomy. Fifty-three ASA 1 patients aged 12-41 yrs (mean 26.02) scheduled to undergo laparoscopic varicocelectomy as day surgery procedure were included in this study. Propofol was used as inductor agent and in variable-rate infusion (170-100 mcg/Kg/min) to maintain anesthesia supplemented with Fentanyl (FNT) before endotracheal intubation, incision surgery and if the patient manifested clinical signs of inadequate analgesia. Local anesthesia was infiltrated into the skin before incision. Tramadol 100 mg and Ketorolac 30 mg were administered before the end of surgery to delay the onset of the postoperative pain. Pain was evaluated using a self-rating visual analoque scale (VAS) ranging from 0 to 10 at 0-0.5 hrs postoperatively and every 2 hrs until discharge. At the same time nausea was clinically evaluated using a scale ranging from 0 to 3. Postoperative pain and nausea (PONV) treatment were standardized. Patients were discharged by Post-Anesthesia Discharge Scoring System (PADS). Mean operating time was 34.2 min and mean estubation time was 11.6 min. At time 0 all patients had VAS pain score < 3, on the same time 2 of patients was treated for mild PONV; mean time to first request for postoperative analgesia treatment in 89% of patients was more than 6 hrs, 5 patients required pain treatment before discharge in a mean time 216' +/- 156'. Using the PADS system, 64% of patients were discharged at 4 hrs and 89% at 6 hrs after surgery. One patient was admitted to hospital for an overnight stay for walking dizziness; another was readmitted for surgical complications

  19. Increased intraocular pressure on the first postoperative day following resident-performed cataract surgery

    PubMed Central

    Kim, J Y; Jo, M-W; Brauner, S C; Ferrufino-Ponce, Z; Ali, R; Cremers, S L; An Henderson, B

    2011-01-01

    Purpose The aim of this study was to investigate the incidence of intraocular pressure (IOP) elevation after resident-performed cataract surgery and to determine variables, which influence postoperative day 1 (POD1) IOP. Methods In all, 1111 consecutive cataract surgeries performed only by training residents between 1 July 2001 and 30 June 2006 were included. Elevated IOP was defined as ≥23 mm Hg. Surgeries were classified according to the presence of POD1-IOP elevation. Fisher's exact test and Student t-test were used to compare both groups. Multivariate analyses using generalized estimating equations were performed to investigate predictor variables associated with POD1-IOP elevation. Results The average preoperative IOP was 16.0±3.2 mm Hg and the average POD1-IOP was 19.3±7.1 mm Hg, reflecting a significant increase in IOP (P<0.001, paired t-test). The incidence of POD1-IOP elevation ≥23 mm Hg was 22.0% (244/1111). Presence of glaucoma and ocular hypertension, higher preoperative IOP, and longer axial length were frequently encountered variables in the POD1-IOP elevation group (all P<0.05). Using a multivariate analysis, presence of glaucoma (P=0.004, OR=2.38; 95% confidence interval (95% CI)=1.31–4.30), presence of ocular hypertension (P=0.003, OR=6.09; 95% CI=1.81–20.47), higher preoperative IOP (P<0.001, OR=3.73; 95% CI=1.92–7.25), and longer axial length (P=0.01, OR=1.15; 95% CI=1.03–1.29) were significant predictive factors for POD1-IOP elevation. Conclusions IOP elevation on the first postoperative day following resident-performed cataract surgery occurred frequently (22.0%). Increased early postoperative IOP was associated with presence of glaucoma and ocular hypertension, higher preoperative IOP, and longer axial length. PMID:21527959

  20. Paediatric day-case neurosurgery in a resource challenged setting: Pattern and practice

    PubMed Central

    Owojuyigbe, Afolabi Muyiwa; Komolafe, Edward O.; Adenekan, Anthony T.; Dada, Muyiwa A.; Onyia, Chiazor U.; Ogunbameru, Ibironke O.; Owagbemi, Oluwafemi F.; Talabi, Ademola O.; Faponle, Fola A.

    2016-01-01

    Background: It has been generally observed that children achieve better convalescence in the home environment especially if discharged same day after surgery. This is probably due to the fact that children generally tend to feel more at ease in the home environment than in the hospital setting. Only few tertiary health institutions provide routine day-case surgery for paediatric neurosurgical patients in our sub-region. Objective: To review the pattern and practice of paediatric neurosurgical day-cases at our hospital. Patients and Methods: A prospective study of all paediatric day-case neurosurgeries carried out between June 2011 and June 2014. Results: A total of 53 patients (34 males and 19 females) with age ranging from 2 days to 14 years were seen. Majority of the patients (77.4%) presented with congenital lesions, and the most common procedure carried out was spina bifida repair (32%) followed by ventriculoperitoneal shunt insertion (26.4%) for hydrocephalus. Sixty-eight percentage belonged to the American Society of Anesthesiologists physical status class 2, whereas the rest (32%) belonged to class 1. General anaesthesia was employed in 83% of cases. Parenteral paracetamol was used for intra-operative analgesia for most of the patients. Two patients had post-operative nausea and vomiting and were successfully managed. There was no case of emergency re-operation, unplanned admission, cancellation or mortality. Conclusion: Paediatric day-case neurosurgery is feasible in our environment. With careful patient selection and adequate pre-operative preparation, good outcome can be achieved. PMID:27251657

  1. Incidence And Risk Factors For 30-Day Readmissions After Hip Fracture Surgery

    PubMed Central

    Martin, Christopher T; Gao, Yubo; Pugely, Andrew J.

    2016-01-01

    Background Unplanned hospital readmission following orthopedic procedures results in significant expenditures for the Medicare population. In order to reduce expenditures, hospital readmission has become an important quality metric for Medicare patients. The purpose of the present study is to determine the incidence and risk factors for 30-day readmissions after hip fracture surgery. Methods Patients over the age of 18 years who underwent hip fracture surgery, including open reduction internal fixation (ORIF), intramedullary nailing, hemi-arthroplasty, or total hip arthroplasty, between the years 2012 and 2013 were identified from the American College of Surgeons National Surgical Quality improvement Program (NSQIP) database. Overall, 17,765 patients were identified. Univariate and multivariate analyses were performed in order to determine patient and surgical factors associated with 30-day readmission. Results There were 1503 patients (8.4%) readmitted within 30-days of their index procedure. Of the patients with a reason listed for readmission, 27.4% were for procedurally related reasons, including wound complications (16%), peri-prosthetic fractures (4.5%) and prosthetic dislocations (6%). 72.6% of readmissions were for medical reasons, including sepsis (7%), pneumonia (14%), urinary tract infection (6.3%), myocardial infarction (2.7%), renal failure (2.7%), and stroke (2.3%). In the subsequent multivariate analysis, pre-operative dyspnea, COPD, hypertension, disseminated cancer, a bleeding disorder, pre-operative hematocrit of <36, pre-operative creatinine of >1.2, an ASA class of 3 or 4, and the operative procedure type were each independently associated with readmissions risk (p<0.05 for each). Conclusions The overall rate of readmission following hip fracture surgery was moderate. Surgeons should consider discharge optimization in the at risk cohorts identified here, particularly patients with multiple medical comorbidities or an elevated ASA class, and

  2. Risk Factors and Indications for 30-Day Readmission After Primary Surgery for Epithelial Ovarian Cancer

    PubMed Central

    AlHilli, Mariam; Langstraat, Carrie; Tran, Christine; Martin, Janice; Weaver, Amy; McGree, Michaela; Mariani, Andrea; Cliby, William; Bakkum-Gamez, Jamie

    2015-01-01

    Background To identify patients at risk for postoperative morbidities, we evaluated indications and factors associated with 30-day readmission after epithelial ovarian cancer surgery. Methods Patients undergoing primary surgery for epithelial ovarian cancer between January 2, 2003, and December 29, 2008, were evaluated. Univariable and multivariable logistic regression models were fit to identify factors associated with 30-day readmission. A parsimonious multivariable model was identified using backward and stepwise variable selection. Results In total, 324 (60.2%) patients were stage III and 91 (16.9%) were stage IV. Of all 538 eligible patients, 104 (19.3%) were readmitted within 30 days. Cytoreduction to no residual disease was achieved in 300 (55.8%) patients, and 167 (31.0%) had measurable disease (≤1 cm residual disease). The most common indications for readmission were surgical site infection (SSI; 21.2%), pleural effusion/ascites management (14.4%), and thromboembolic events (12.5%). Multivariate analysis identified American Society of Anesthesiologists score of 3 or higher (odds ratio, 1.85; 95% confidence interval, 1.18–2.89; P = 0.007), ascites [1.76 (1.11–2.81); P = 0.02], and postoperative complications during initial admission [grade 3–5 vs none, 2.47 (1.19–5.16); grade 1 vs none, 2.19 (0.98–4.85); grade 2 vs none, 1.28 (0.74–2.21); P = 0.048] to be independently associated with 30-day readmission (c-index = 0.625). Chronic obstructive pulmonary disease was the sole predictor of readmission for SSI (odds ratio, 3.92; 95% confidence interval, 1.07–4.33; P = 0.04). Conclusions Clinically significant risk factors for 30-day readmission include American Society of Anesthesiologists score of 3 or higher, ascites and postoperative complications at initial admission. The SSI and pleural effusions/ascites are common indications for readmission. Systems can be developed to predict patients needing outpatient management, improve care, and reduce

  3. Benign paroxysmal positional vertigo after nonotologic surgery: case series.

    PubMed

    Kansu, Leyla; Aydin, Erdinc; Gulsahi, Kamran

    2015-03-01

    Benign paroxysmal positional vertigo is one of the most common types of vertigo caused by peripheral vestibular dysfunction. Although head trauma, migraine, long-term bed rest, Ménière disease, viral labyrinthitis, and upper respiratory tract infections are believed to be predisposing factors, most cases of benign paroxysmal positional vertigo are idiopathic. Ear surgery is another cause, but after non-otologic surgery, attacks of benign paroxysmal positional vertigo are rare. We describe three cases of benign paroxysmal positional vertigo attacks after non-otologic surgery (one patient after a nasal septoplasty and two patients after dental endodontic treatment) and discuss the pathophysiological mechanism of benign paroxysmal positional vertigo seen after non-otologic surgery, its diagnosis and treatment.

  4. [Hospital day-surgery: comparative evaluation of 3 general anesthesia techniques].

    PubMed

    Rossi, A E; Lo Sapio, D; Oliva, O; Vitale, O; Ebano, A

    1995-06-01

    For the voluntary interruption of pregnancy, three anaesthetic techniques have been compared being a random assigned to three groups of 40 patients. Induction of anaesthesia was based on fentanyl 0.005 mg/kg+midazolam 0.2 mg/kg or fentanyl 0.005 mg/kg = propofol 2.5 mg/kg or ketamina 0.5 mg/kg+propofol 2.0 mg/kg. Anaesthesia was maintained delivering in spontaneous-assisted ventilation N2O 70% in O2. In addition to the intraoperative conditions, quality and rapidity of some neurofunctional aspects of the recovery have been evaluated using the Steward Score and the Coin Counting Test respectively. Our data suggest fentanyl-propofol association as the safest one as regards the needs of one-day surgery.

  5. [Four cases of double bypass surgery involving choledochojejunostomy and gastrojejunostomy for inoperable peripancreatic head cancer].

    PubMed

    Tsujie, Masanori; Isono, Sayuri; Sato, Katsuaki; Kawai, Kenji; Ikeda, Mitsunori; Hara, Johji; Kitani, Kotaro; Nakayama, Tsuyoshi; Fujiwara, Yoshinori; Yukawa, Masao; Watatani, Masahiro; Inoue, Masatoshi

    2013-11-01

    Peripancreatic head cancer often causes obstructive jaundice and duodenal obstruction, which reduces the quality of life and hinders the administration of anti-cancer drugs. Here, we report 4 cases of double bypass surgery( biliary and gastric) for the treatment of inoperable peripancreatic head cancer. The patients' ages ranged from 64 to 72 years. Two patients had pancreatic head cancer and 2 had ampullary cancer. No postoperative morbidity was observed and all 4 patients resumed oral intake within 5 days after surgery and began receiving chemotherapy within 1 month after surgery. There was immediate relief of biliary obstruction in all 3 patients with obstructive jaundice. None of the patients experienced recurrence of obstructive jaundice requiring biliary drainage. Two patients who died of cancer were able to consume food orally just before they died. Although bypass surgery is more invasive than endoscopic stenting, it may be safe and useful not only for palliation, but also for induction or continuation of chemotherapy.

  6. Aphonia after shoulder surgery: case report.

    PubMed

    Moreno, Carlos Alberto da Silva Soares; Fonseca, Sara

    2016-01-01

    In this case report we highlight the uniqueness of aphonia as, to the best of our knowledge, cases of aphonia related to interscalene brachial plexus block (IBPB) are not described in the literature. Although hoarseness is a common complication of IBPB, aphonia is not. Therefore, we think it is important to publicize the first case of aphonia after IBPB, which may have arisen only because of a recurrent laryngeal nerve chronic injury contralateral to the IBPB site. PMID:27108832

  7. A rare case of Wunderlich syndrome five days after left hemicolectomy for colorectal cancer

    PubMed Central

    Grassia, Michele; Romano, Angela; Esposito, Giuseppe; Braccio, Bartolomeo; Pezzella, Modestino; Rossetti, Amalia Rosaria Rita; Torelli, Francesco; Izzo, Giuseppe; Alfano, Roberto; Di Martino, Natale

    2015-01-01

    Introduction Wunderlich syndrome (WS) is a surgical emergency characterized by spontaneous, non-traumatic retroperitoneal hemorrhage. Angiomyolipoma (AML), a benign mesenchymal tumor, is the most frequent cause of WS. We present a case of WS, appearance five days after a left hemicolectomy for cancer. Presentation of case A 66 years-old man with a sigmoid adenocarcinoma and a small left AML (3.4 cm) was undergone to left hemicolectomy. He was subjected to bridging therapy with high doses of low-molecular-weight heparin for prosthetic replacement of heart valve secondary to endocarditis and atrial fibrillation. Five days after surgery he presents retroperitoneal hemorrhage due to rupture of AML diagnosed by a CT scan and scintigraphy with labeled red blood cells. Total left nephrectomy was performed as the patient became unstable. Discussion Rupture of a renal AML is the main cause of WS. This risk increases with the size of the tumor (>4 cm) and during pregnancy. CT scan is the best imaging modalities for diagnosis. The bridging therapy increases the perioperative bleeding risk. These patients are conservative treated with selective transarterial embolization. Nephrectomy is limited for the patients hemodynamically unstable or in case of failed embolization. Conclusion This is a unusual case of WS after surgery in patients with small AML and treated with high dose of anticoagulant for cardiac disease. There are no other similar cases in literature. PMID:26410804

  8. Same day discharge following inter-scalene block administration for arthroscopic shoulder surgery: implementing a change in practice.

    PubMed

    Lane, Suzanne; Blundell, Clare; Mills, Simon; Charalambous, C P

    2014-10-01

    Patients who had arthroscopic shoulder surgery with the provision of an inter-scalene nerve block (ISB) at Blackpool Teaching Hospitals, were previously required to remain in hospital overnight. We introduced a new protocol that allowed same day discharge following arthroscopic shoulder surgery under general anaesthesia and ISB. The aim of this study was to review the outcome of this change in practice. Our results indicated that providing a discharge protocol for patients having arthroscopic shoulder surgery with the inclusion of ISB can avoid unnecessary overnight stay and enable significant cost savings, without detriment to patient safety or satisfaction.

  9. Parents' perceptions of pediatric day surgery risks: unforeseeable complications, or avoidable mistakes?

    PubMed

    Sobo, Elisa J

    2005-05-01

    A decline in people's trust of the US health care system has been documented. But do parents of pediatric patients have specific safety worries? If so, what are they? And what cultural factors inform them? To help answer these questions, in San Diego 35 English- and Spanish-speaking parents' (or guardians') self-reports of perceptions of their child's risk for experiencing a medical error during day surgery were collected using open-ended rapid assessment interviews, and analyzed using qualitative content analysis methods. (The innovative data collection and analysis protocol is described so as to be easily replicable in other settings for other types of highly focused quality improvement initiatives that rely on the inclusion of parent or patient perspectives and entail limited time and resources). Twelve key themes were identified. Anthropological discourse analysis techniques (modified for rapid use with rapidly collected interview data) were then applied to the transcripts in order to generate ideas regarding cultural factors underlying the themes. Discursive patterns of risk rationalization or refutation related to cultural expectations for parenting, children's bodies, and health care consumerism were found. Neither the (careful, loving, good) parent nor the (wisely chosen or well-reputed) care team was to blame for medical errors. Errors were cast as the inevitable results of latent, unanticipatable vulnerabilities inherent in the (defenseless) children undergoing surgery. The anxiety-generating potential of the surgical consent process also was noted. The implications of the findings for action as well as for theories of risk and vulnerability and of childhood and parenthood are discussed.

  10. The active management of surgical waiting lists: a urological surgery case study.

    PubMed

    Briggs, Russell J; Smith, Katrina M; Dejager, Ebony M; Callahan, John T; Abernethy, Jennifer A; Dunn, Eddie J; Hunter-Smith, David J

    2011-11-01

    Elective surgery waiting list management is a major public healthcare issue. This case study describes an integrated multifaceted approach to waiting list management at Peninsula Health, a public health service in Victoria, Australia. At the commencement of this study it was recognised that several issues associated with the urological surgical service constituted potential clinical risk. These included: recall mechanisms for multiple surveillance procedures; significant resource deficits; and long surgery waiting times. Responding to these issues a multifaceted approach to wait list management was implemented including: audit; direct lines of communication between clinical and administrative staff; urgent caseload management; utilisation of the Elective Surgery Access Scheme; financial and resource analysis justifying the appointment of a full-time urologist, and the establishment of a urology service from a satellite campus; implementation of a recall database; development of an outpatient service; and commencement of a day surgery initiative. This approach yielded results that included a 67% reduction in the number of 'ready for care' patients and a 78% reduction in the number of patients classified as 'overdue for surgery'. Average wait time for semi-urgent and non-urgent patients reduced from 248 days to 180 days in the 10-month period. PMID:22126940

  11. Guillain-Barré Syndrome after Coronary Artery Bypass Graft Surgery: a Case Report.

    PubMed

    Hekmat, Manouchehr; Ghaderi, Hamid; Foroughi, Mahnoosh; Mirjafari, S Adeleh

    2016-01-01

    Guillain-Barre syndrome is a neurologic disorder that may appear after infection or major surgery. Guillain-Barré syndrome following cardiac surgery is rare and only based on case reports, and we review all of the published cases. A 52-year-old man after 5 months suffering from chest pain was referred to our hospital and underwent coronary artery bypass graft for 3 vessel disease. The patient was discharged without complication on the 5th postoperative day. He presented Guillain-Barré syndrome after 12 months. He has not completely recovered weakness of upper extremities grade 4/5 with atrophy of both upper extremities remains after 18 months. This disorder is similar to classic GBS. It is important to be alert to de novo autoimmune neurological disorders after cardiac surgery. These disorders are similar to classic autoimmune disease and treated with standard therapies.

  12. Biodentine pulpotomy several days after pulp exposure: Four case reports.

    PubMed

    Borkar, Swati A; Ataide, Ida

    2015-01-01

    Conventionally, few-days-old pulp exposures have been treated with root canal treatment. We report four cases of traumatized, fully matured, maxillary permanent central incisors, which have been treated by Biodentine pulpotomy several days after traumatic pulp exposure. Biodentine pulpotomy consisted of pulp tissue removal to a depth of 2 mm, then capping the pulpal wound with Biodentine, followed by immediate restoration. The teeth were assessed clinically through pulpal sensitivity tests and radiographically for periapical healing. At each recall (24 hours, 1 week, 30 days, 3, 6, 12, and 18 months), no spontaneous pain was observed; the pulp showed signs of vitality and absence of periapical radiolucency after 18 months. Biodentine pulpotomy is recommended as a treatment option for cases of vital pulp exposure in permanent incisors due to trauma.

  13. Biodentine pulpotomy several days after pulp exposure: Four case reports

    PubMed Central

    Borkar, Swati A.; Ataide, Ida

    2015-01-01

    Conventionally, few-days-old pulp exposures have been treated with root canal treatment. We report four cases of traumatized, fully matured, maxillary permanent central incisors, which have been treated by Biodentine pulpotomy several days after traumatic pulp exposure. Biodentine pulpotomy consisted of pulp tissue removal to a depth of 2 mm, then capping the pulpal wound with Biodentine, followed by immediate restoration. The teeth were assessed clinically through pulpal sensitivity tests and radiographically for periapical healing. At each recall (24 hours, 1 week, 30 days, 3, 6, 12, and 18 months), no spontaneous pain was observed; the pulp showed signs of vitality and absence of periapical radiolucency after 18 months. Biodentine pulpotomy is recommended as a treatment option for cases of vital pulp exposure in permanent incisors due to trauma. PMID:25657533

  14. An electronic surgical order, undertaking patient education, and obtaining informed consent for regional analgesia before the day of surgery reduce block-related delays

    PubMed Central

    Brooks, Brandon S; Barman, Joydip; Ponce, Brent A; Sides, Alisa; Vetter, Thomas R

    2016-01-01

    Background Obtaining patient informed consent for a regional analgesia block on the day of surgery can result in surgical case delays. We hypothesized that implementing a preoperative electronic surgical order, undertaking patient education, and obtaining informed consent for a regional block in our preoperative assessment clinic prior to the day of surgery would reduce surgical case delays attributed to our regional anesthesia pain service and increase the percentage of patients for whom our regional anesthesia pain service was requested to provide a block. Methods A prospective two-group time-series design, with a nonrandomized, pre- and post-intervention data collection strategy, was applied. Based upon the surgeons’ newly implemented preoperative electronic outpatient orders, patients were identified by our preoperative assessment clinic staff to receive educational materials. The attending anesthesiologist in the preoperative assessment clinic then obtained written informed consent. Block-related delay and utilization data were analyzed with conventional inferential statistics. Results We observed a 14.8% (95% CI: 9.4%, 20.1%; P<0.001) decrease in surgical case delays, attributed to the regional nerve block, in the post- vs pre-intervention group. In addition, there was a 9.9% (95% CI: 4.7%, 15.1%); P<0.001) increase in the proportion of patients for whom a regional nerve block was ordered by our three high-volume orthopedic surgeons in the post- vs pre-intervention time periods. Conclusion When performed before the day of surgery, a surgeon’s electronic order, patient education, and informed consent for regional postoperative analgesia can improve patient throughput, thereby reducing block-related operating room delays. The preoperative assessment clinic can serve as a venue to achieve this goal, thereby adding value by decreasing downstream delays on the day of surgery. PMID:27785096

  15. [Considerations in a case of refractive surgery].

    PubMed

    Muşat, Ovidiu; Gheorghe, Andreea; Mahdi, Labib; Cernat, Corina; Toma, Oana; Asandi, Radu; Burcea, Marian

    2014-01-01

    We present a case report of a 38 year old patient, with medium myopia LASIK --operated, with rhegmatogenous retinal detachment. We present the seriated surgical interventions (posterior vitrectomy with silicone oil, followed by the extrusion of the silicone oil and the extraction of complicated cataract with IOL-CP implantation).

  16. Music Benefits on Postoperative Distress and Pain in Pediatric Day Care Surgery

    PubMed Central

    Calcaterra, Valeria; Ostuni, Selene; Bonomelli, Irene; Mencherini, Simonetta; Brunero, Marco; Zambaiti, Elisa; Mannarino, Savina; Larizza, Daniela; Albertini, Riccardo; Tinelli, Carmine; Pelizzo, Gloria

    2014-01-01

    Postoperative effect of music listening has not been established in pediatric age. Response on postoperative distress and pain in pediatric day care surgery has been evaluated. Forty-two children were enrolled. Patients were randomly assigned to the music-group (music intervention during awakening period) or the non-music group (standard postoperative care). Slow and fast classical music and pauses were recorded and played via ambient speakers. Heart rate, blood pressure, oxygen saturation, glucose and cortisol levels, faces pain scale and Face, Legs, Activity, Cry, Consolability (FLACC) Pain Scale were considered as indicators of response to stress and pain experience. Music during awakening induced lower increase of systolic and diastolic blood pressure levels. The non-music group showed progressive increasing values of glycemia; in music-group the curve of glycemia presented a plateau pattern (P<0.001). Positive impact on reactions to pain was noted using the FLACC scale. Music improves cardiovascular parameters, stress-induced hyperglycemia. Amelioration on pain perception is more evident in older children. Positive effects seems to be achieved by the alternation of fast, slow rhythms and pauses even in pediatric age. PMID:25635217

  17. Music benefits on postoperative distress and pain in pediatric day care surgery.

    PubMed

    Calcaterra, Valeria; Ostuni, Selene; Bonomelli, Irene; Mencherini, Simonetta; Brunero, Marco; Zambaiti, Elisa; Mannarino, Savina; Larizza, Daniela; Albertini, Riccardo; Tinelli, Carmine; Pelizzo, Gloria

    2014-08-12

    Postoperative effect of music listening has not been established in pediatric age. Response on postoperative distress and pain in pediatric day care surgery has been evaluated. Forty-two children were enrolled. Patients were randomly assigned to the music-group (music intervention during awakening period) or the non-music group (standard postoperative care). Slow and fast classical music and pauses were recorded and played via ambient speakers. Heart rate, blood pressure, oxygen saturation, glucose and cortisol levels, faces pain scale and Face, Legs, Activity, Cry, Consolability (FLACC) Pain Scale were considered as indicators of response to stress and pain experience. Music during awakening induced lower increase of systolic and diastolic blood pressure levels. The non-music group showed progressive increasing values of glycemia; in music-group the curve of glycemia presented a plateau pattern (P<0.001). Positive impact on reactions to pain was noted using the FLACC scale. Music improves cardiovascular parameters, stress-induced hyperglycemia. Amelioration on pain perception is more evident in older children. Positive effects seems to be achieved by the alternation of fast, slow rhythms and pauses even in pediatric age. PMID:25635217

  18. General or Local Anaesthesia in One-Day Thyroid Surgery-Does It Matter?

    PubMed Central

    Belitova, Maya; Pandev, Rumen; Karadimov, Dimitar

    2012-01-01

    Objective: We aimed to determine the safety and feasibility of general anaesthesia (GA) compared with local anaesthesia + Monitored Anaesthesia Care (LA+MAC) for One-Day Thyroid Surgery (ODTS); to assess patient and operator satisfaction with either of the anesthetic approaches. Material and Methods: We reviewed prospectively 130 patients who underwent ODTS from 2008 to 2011. 64 patients were operated on under GA and 62 - under LA+MAC. All variables of patient demographic characteristics, duration and type of operation, postoperative complications, difficulty in airway management and postoperative opiate consumption were recorded and analyzed. Results: There is no difference in respect to length of stay, discharge time and major/minor complications rate between two groups, but in the LA+MAC group, pain appears earlier and is more severe (56min; VAS 6, 5) than in GA patients (223 min; VAS 1, 5; p<0.001). Patient satisfaction was similar but the operator preference was greater for GA. Conclusion: In experienced hands LA with MAC for Thyroidectomy is a safe and wise choice, but GA is even more so! PMID:25206980

  19. Dementia after DBS Surgery: A Case Report and Literature Review

    PubMed Central

    Rektorova, I.; Hummelova, Z.; Balaz, M.

    2011-01-01

    We report the case history of a 75-year-old woman with Parkinson's disease who developed severe cognitive problems after deep brain stimulation (DBS) of the bilateral subthalamic nuclei (STN). After a brief cognitive improvement, the patient gradually deteriorated until she developed full-blown dementia. We discuss the case with respect to the cognitive effects of STN DBS and the possible risk factors of dementia after STN DBS surgery. PMID:22191066

  20. Narcotic addiction following gastric bypass surgery--a case study.

    PubMed

    Wendling, Andrea; Wudyka, Andrea

    2011-05-01

    Addictive behavior following gastric bypass surgery is widely discussed in the lay press, but published reports provide conflicting evidence regarding the prevalence of postoperative substance abuse among bariatric surgery patients. We present a case report of a Roux-en-Y gastric bypass patient who presented with recurrent and various pain and nausea complaints postoperatively. These symptoms resulted in multiple radiological and operative procedures before her narcotic addiction was identified. Physicians caring for bariatric surgical patients postoperatively need to be aware of this risk and need to be able to identify early signs of potential postoperative addictions. PMID:20473721

  1. One hundred consecutive cases of video-assisted thoracoscopic surgery for primary spontaneous pneumothorax.

    PubMed

    Yim, A P; Ho, J K

    1995-03-01

    We reviewed our experience on video-assisted thoracoscopic surgery (VATS) from our first 100 cases of primary spontaneous pneumothorax (PSP) performed at our institution from September 1992 to January 1994. Apical bullae were identified in 87% of cases. Mechanical pleurodesis with Marlex mesh was performed on all patients. Excision with endoscopic staple cutter was performed in 69 cases; an endoloop was used in five cases; ablation with an argon beam coagulator (ABC) was done in six cases; excision with endoscopic suturing occurred in seven cases; and mechanical pleurodesis alone was used in 13 cases. The overall median postoperative chest tube duration was 2 days (range 1-25 days) and hospital stay 4 days (range 1-30 days). Complications occurred in 8 cases (8%): 1 wound infection; 1 chest wall bleeding; and 6 persistent air leaks which lasted for more than 10 days (one of which eventually required an axillary thoracotomy for control). Procedure failure with recurrence occurred in three cases (3%) at a mean follow-up of 17 months (range 8-24 months). The ABC group alone was responsible for one recurrence and two persistent leaks. We conclude that with the VATS approach in the treatment of PSP, staple resection of apical bullae is quick and most reliable but costly. Endoloop and hand suturing are applicable to selected patients with small and localized bullae and should be further studied, while our limited experience does not favor ABC as the primary treatment modality.

  2. Glaucoma Surgery in Pregnancy: A Case Series and Literature Review

    PubMed Central

    Razeghinejad, Mohammad Reza; Masoumpour, Masoumeh; Eghbal, Mohammad Hossein; Myers, Jonathan S.; Moster, Marlene R.

    2016-01-01

    Glaucoma management in pregnant patients is a real challenge, especially when the glaucoma is not controlled with medications. We report the results of 6 incisional glaucoma surgeries for the management of medically uncontrolled glaucoma patients during pregnancy. This retrospective, case series was conducted on the 6 eyes of 3pregnant patients with uncontrolled glaucoma using maximum tolerable medications. Details of the glaucoma surgical management of these patients as well as their postoperative care and pregnancy and clinical outcomes on longitudinal follow-up are discussed. All 3 patients had juvenile open-angle glaucoma and were on various anti-glaucoma medications, including oral acetazolamide. The first case described underwent trabeculectomy without antimetabolites in both eyes because of uncontrolled intraocular pressure with topical medications. The surgery was done with topical lidocaine jelly and subconjunctival lidocaine during the second and third trimesters. The second patient had an Ahmed valve implantation in both eyes during the second and third trimesters because of uncontrolled IOP with topical medications and no response to selective laser trabeculoplasty. Surgery was done with topical tetracaine and subconjunctival and sub-Tenon’s lidocaine. The third case had a Baerveldt valve implantation under general anesthesia in the second trimester. In selected pregnant glaucoma patients with medically uncontrolled intraocular pressure threatening vision, incisional surgery may lead to good outcomes for the patient with no risk for the fetus. PMID:27582594

  3. Glaucoma Surgery in Pregnancy: A Case Series and Literature Review.

    PubMed

    Razeghinejad, Mohammad Reza; Masoumpour, Masoumeh; Eghbal, Mohammad Hossein; Myers, Jonathan S; Moster, Marlene R

    2016-09-01

    Glaucoma management in pregnant patients is a real challenge, especially when the glaucoma is not controlled with medications. We report the results of 6 incisional glaucoma surgeries for the management of medically uncontrolled glaucoma patients during pregnancy. This retrospective, case series was conducted on the 6 eyes of 3pregnant patients with uncontrolled glaucoma using maximum tolerable medications. Details of the glaucoma surgical management of these patients as well as their postoperative care and pregnancy and clinical outcomes on longitudinal follow-up are discussed. All 3 patients had juvenile open-angle glaucoma and were on various anti-glaucoma medications, including oral acetazolamide. The first case described underwent trabeculectomy without antimetabolites in both eyes because of uncontrolled intraocular pressure with topical medications. The surgery was done with topical lidocaine jelly and subconjunctival lidocaine during the second and third trimesters. The second patient had an Ahmed valve implantation in both eyes during the second and third trimesters because of uncontrolled IOP with topical medications and no response to selective laser trabeculoplasty. Surgery was done with topical tetracaine and subconjunctival and sub-Tenon's lidocaine. The third case had a Baerveldt valve implantation under general anesthesia in the second trimester. In selected pregnant glaucoma patients with medically uncontrolled intraocular pressure threatening vision, incisional surgery may lead to good outcomes for the patient with no risk for the fetus. PMID:27582594

  4. Evaluation of the safety and efficacy of same-day discharge following outpatient surgery in a US hospital.

    PubMed

    Singletary, De'Ana

    2016-07-01

    In the US, safe and effective same-day discharge of patients, following uncomplicated, ambulatory surgery, also referred to as outpatient surgery, significantly reduces the nursing hours spent caring for patients who do not require hospital admission. Data from the last three decades show that same-day discharge for patients who undergo approved outpatient surgical procedures carries no higher risk of complications than for those who stay for 24-hour observation. This article describes a service development project which evaluated patients' perceived preparedness for same-day discharge. Results suggest that a standardised approach to managing potential complicating factors, such as pain and patients' expectations, can increase the number of successful same-day discharges. The terms outpatient and ambulatory are used interchangeably in the article, and refer to surgical procedures for which inpatient admission is not considered necessary by patients' insurance providers. PMID:27369726

  5. A case of retroperitoneal bronchogenic cyst treated by laparoscopic surgery.

    PubMed

    Minei, Sadatsugu; Igarashi, Tomohiro; Hirano, Daisaku

    2007-03-01

    We describe herein a rare case of a retroperitoneal bronchogenic cyst successfully treated by laparoscopic surgery. A 39-year-old man with low-grade fever was referred to our hospital because of suspicion of an adrenal tumor. Abdominal computerized tomography (CT) and ultrasonography revealed a homogenous solid mass, 35 x 30 mm in diameter, in the left suprarenal region. Laboratory studies showed that the levels of adrenal hormones were normal except for the white blood cell count of 9,700/microL and C-reactive protein of 1.7 mg/dl. We diagnosed it as a non-functioning adrenocortical adenoma or an adrenal cyst. However, one year later he underwent laparoscopic surgery because the mass had gradually increased by 10 mm and the low-grade fever persisted. Pathological evaluation of the surgical specimens established the diagnosis of retroperitoneal bronchogenic cyst. The low-grade fever disappeared after the surgery.

  6. A case of anaphylaxis apparently induced by sugammadex and rocuronium in successive surgeries.

    PubMed

    Yamada, Yuko; Yamamoto, Takuji; Tanabe, Kumiko; Fukuoka, Naokazu; Takenaka, Motoyasu; Iida, Hiroki

    2016-08-01

    Rocuronium is the agent most frequently involved in perioperative anaphylaxis, and sugammadex has also been known to induce anaphylactic reactions. We describe a case of successive anaphylactic episodes that seemed to be induced by clinical doses of rocuronium and sugammadex. The patient was a 19-year-old woman who had a medical history of asthma, but no history of surgery. She had been injured in a fall, and several surgeries were scheduled for multiple bone fractures. At the first surgery under general anesthesia, she developed anaphylaxis 5 min after sugammadex administration. A second general anesthesia for treatment of calcaneal fracture was induced uneventfully without neuromuscular blockade after 10 days. A third general anesthesia was scheduled to reinforce the spinal column 12 days after the first surgery. She developed anaphylaxis 8 min after rocuronium administration. The level of plasma histamine was elevated, but serum tryptase level remained normal. This surgery was canceled and rescheduled without use of a neuromuscular blockade. Skin tests were performed in a later investigation. The patient showed positive results on intradermal tests for sugammadex and rocuronium, supporting a diagnosis of allergic reactions to both drugs. Clinicians must be aware that anaphylactic reactions can be induced by both sugammadex and rocuronium. PMID:27290941

  7. Concurrent upper and lower urinary tract robotic surgery: A case series

    PubMed Central

    Pisipati, Sailaja; Bach, Christian; Daneshwar, Datesh; Rowe, Edward W.; Koupparis, Anthony J.

    2014-01-01

    The da Vinci Surgical System (Intuitive Surgical Inc.) continues to develop as a platform in urological surgery. Synchronous upper and lower urinary tract tumours requiring extirpative surgery are not uncommon. We report the first case robotic series of combined complex upper and lower urinary tract surgery. Six high-risk anaesthetic patients with a median age of 71 years and apparent synchronous upper and lower urinary tract pathologies underwent concurrent robotic surgery. Five underwent robotic nephroureterectomy and robotic-assisted radical cystectomy (RARC); 1 had combined robotic nephroureterectomy and robotic-assisted radical prostatectomy (RALP). The mean length of stay was 10 days, with an average blood loss of 416.7 mL. The median console time for nephroureterectomy, RALP and RARC was 90, 90 and 210 minutes, respectively. Four patients had intra-corporeal ileal conduit urinary diversion. There were no Clavien grade 3, 4, or 5 complications. In all patients, 30- and 90-day mortality was nil. Margins were clear in the entire cohort. We concluded that combined upper and lower urinary tract robotic surgery is safe and technically feasible with acceptable complications and oncological outcomes. PMID:25485015

  8. [Recurrent hyperperfusion after revascularization surgery for adult moyamoya disease: a case report].

    PubMed

    Hayashi, Tomohide; Kashiwazaki, Daina; Akioka, Naoki; Kuwayama, Naoya; Kuroda, Satoshi

    2014-07-01

    Direct bypass surgery for moyamoya disease is quite useful for rapidly improving cerebral hemodynamics and resolving ischemic attacks but may induce hyperperfusion syndrome. In this report, we present a rare case of recurrent hyperperfusion after surgery for moyamoya disease. A 47-year-old woman developed left homonymous hemianopsia and was admitted to our hospital. Magnetic resonance(MR)imaging/angiography revealed definitive moyamoya disease presenting with acute cerebral infarction in the right temporoparietal lobe. She was treated with anti-hypertensive agents because she had severe hypertension. She successfully underwent right superficial temporal artery-middle cerebral artery double anastomosis and indirect bypass. A cerebral blood flow study just after surgery demonstrated marked hyperperfusion in the operated hemisphere. A repeat study 2 days later revealed that the hyperperfusion was dramatically improved. Subsequently, however, she developed a severe ipsilateral headache and focal seizure regardless of the blood pressure control. She complained of the headache for >2 weeks. Follow-up MRI showed a small subcortical hemorrhage in the right frontal lobe. Single-photon emission computed tomography revealed that the hyperperfusion relapsed 9 days after surgery and then gradually disappeared. This study shows that preoperative severe hypertension may induce uncontrollable hyperperfusion after direct bypass surgery for moyamoya disease. PMID:25006102

  9. Surgery of intracranial aneurysms at Yonsei University: 780 cases.

    PubMed

    Lee, K C

    1991-03-01

    Seven hundred and eighty patients with intracranial aneurysm, which were surgically treated by the author since 1976, were analyzed. Strategies important for intracranial aneurysm surgery were the timing of surgery, preoperative preparation and intraoperative management. The best management outcome could be achieved by early operation, removal of subarachnoid blood clot, maintenance of circulating blood volume, administration of nimodipine, and meticulous surgical tactics to avoid pitfalls. Indications for aneurysm surgery in the acute phase were determined by intracerebral hematoma, angiographic findings, clinical grade, general physical status and readiness of the surgical team. Important goals to be considered during the operation were obtaining a slack brain, preparation of proximal control, protection of the brain, awareness of microsurgical anatomy, and complete dissection of the sac. The morbidity and mortality were 2.7% and 4.0%, respectively. The mortality was attributed to intracranial causes in 20 cases (poor grade, delayed ischemic deficits, rebleeding, postoperative infarction, and postoperative epidural hematoma), extracranial causes in 7 cases (pulmonary embolism, heparin induced intracerebral hemorrhage, hepatic failure, myocardial infarction, and gastrointestinal bleeding), and unknown problems in 5 cases. The postoperative intracerebral hemorrhage occurred in 16 cases and seemed to be caused by one or more of the following events: cerebral infarction developed during the preoperative period, occlusion of the cerebral veins during the Sylvian dissection, cerebral retraction and/or sudden change of intracranial hemodynamics. Hydrocephalus, almost always a communicating type as confirmed by isotope cisternography, was managed by lumboperitoneal shunt.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2046205

  10. Prediction of glycated hemoglobin levels at 3 months after metabolic surgery based on the 7-day plasma metabolic profile.

    PubMed

    Kwon, Hyuk Nam; Lee, Yeon Ji; Kang, Ju-Hee; Choi, Ji-Ho; An, Yong Jin; Kang, Sunmi; Lee, Dae Hyun; Suh, Young Ju; Heo, Yoonseok; Park, Sunghyouk

    2014-01-01

    Metabolic surgery has been shown to provide better glycemic control for type 2 diabetes than conventional therapies. Still, the outcomes of the surgery are variable, and prognostic markers reflecting the metabolic changes by the surgery are yet to be established. NMR-based plasma metabolomics followed by multivariate regression was used to test the correlation between the metabolomic profile at 7-days after surgery and glycated hemoglobin (HbA1c) levels at 3-months (and up to 12 months with less patients), and to identify the relevant markers. Metabolomic profiles at 7-days could differentiate the patients according to the HbA1c improvement status at 3-months. The HbA1c values were predicted based on the metabolomics profile with partial least square regression, and found to be correlated with the observed values. Metabolite analysis suggested that 3-Hydroxybutyrate (3-HB) and glucose contributes to this prediction, and the [3-HB]/[glucose] exhibited a modest to good correlation with the HbA1c level at 3-months. The prediction of 3-month HbA1c using 7-day metabolomic profile and the suggested new criterion [3-HB]/[glucose] could augment current prognostic modalities and help clinicians decide if drug therapy is necessary.

  11. Prediction of Glycated Hemoglobin Levels at 3 Months after Metabolic Surgery Based on the 7-Day Plasma Metabolic Profile

    PubMed Central

    Choi, Ji-ho; An, Yong Jin; Kang, Sunmi; Lee, Dae Hyun; Suh, Young Ju; Heo, Yoonseok; Park, Sunghyouk

    2014-01-01

    Metabolic surgery has been shown to provide better glycemic control for type 2 diabetes than conventional therapies. Still, the outcomes of the surgery are variable, and prognostic markers reflecting the metabolic changes by the surgery are yet to be established. NMR-based plasma metabolomics followed by multivariate regression was used to test the correlation between the metabolomic profile at 7-days after surgery and glycated hemoglobin (HbA1c) levels at 3-months (and up to 12 months with less patients), and to identify the relevant markers. Metabolomic profiles at 7-days could differentiate the patients according to the HbA1c improvement status at 3-months. The HbA1c values were predicted based on the metabolomics profile with partial least square regression, and found to be correlated with the observed values. Metabolite analysis suggested that 3-Hydroxybutyrate (3-HB) and glucose contributes to this prediction, and the [3-HB]/[glucose] exhibited a modest to good correlation with the HbA1c level at 3-months. The prediction of 3-month HbA1c using 7-day metabolomic profile and the suggested new criterion [3-HB]/[glucose] could augment current prognostic modalities and help clinicians decide if drug therapy is necessary. PMID:25384027

  12. Echo-Guided Differential Popliteal Block in an Obese Patient With Intractable Painful Leg Ulcer for Early Discharge in Day Surgery.

    PubMed

    Zampi, Maddalena; Iacovazzo, Carmine; Pagano, Tommaso; Buonanno, Pasquale; Carlomagno, Mariella; Cianciulli, Flavia; Servillo, Giuseppe

    2016-06-01

    Pain management is extremely important in day surgery, and it is one of the limiting factors for this type of procedures. Locoregional anesthesia is strongly recommended for day surgery; nevertheless, it could be very difficult to localize nerve position especially in obese patients. Furthermore, a complete nerve blockade could result in a delayed discharge. We present a case of analgesic ultrasound-guided block of tibial and common peroneal nerves in the popliteal fossa without any motor function involvement in an obese patient undergoing debridement of an infected lower limb ulcer; all previous attempts of surgical debridement in day surgery with topical anesthetics had failed because of discomfort due to pain. Our aim was to ensure an optimal degree of analgesia and, at the same time, to save motor function in order to make early discharge possible. We used 15 mL ropivacaine 0.375% to obtain a differential block, taking advantage of sensitive fibers selectivity of ropivacaine. Surgical debridement was performed successfully. Our peripheral blockade was able to provide significantly prolonged analgesia without motor block that guaranteed a safe and early discharge according to the Post Anesthetic Discharge Scoring System. The satisfaction expressed by the patient and her comfort during the procedure support the choice of this approach for intractable painful ulcers of lower limb.

  13. Impact of preoperative serum albumin on 30-day mortality following surgery for colorectal cancer: a population-based cohort study

    PubMed Central

    Montomoli, Jonathan; Erichsen, Rune; Antonsen, Sussie; Nilsson, Tove; Sørensen, Henrik Toft

    2015-01-01

    Objective Surgery is the only potentially curable treatment for colorectal cancer (CRC), but it is hampered by high mortality. Human serum albumin (HSA) below 35 g/L is associated with poor overall prognosis in patients with CRC, but evidence regarding the impact on postoperative mortality is sparse. Methods We performed a population-based cohort study including patients undergoing CRC surgery in North and Central Denmark (1997–2011). We categorised patients according to HSA concentration measured 1–30 days prior to surgery date. We used the Kaplan-Meier method to compute 30-day mortality and Cox regression model to compute HRs as measures of the relative risk of death, controlling for potential confounders. We further stratified patients by preoperative conditions, including cancer stage, comorbidity level, and C reactive protein concentration. Results Of the 9339 patients undergoing first-time CRC surgery with preoperative HSA measurement, 26.4% (n=2464) had HSA below 35 g/L. 30-day mortality increased from 4.9% among patients with HSA 36–40 g/L to 26.9% among patients with HSA equal to or below 25 g/L, compared with 2.0% among patients with HSA above 40 g/L. The corresponding adjusted HRs increased from 1.75 (95% CI 1.25 to 2.45) among patients with HSA 36–40 g/L to 7.59 (95% CI 4.95 to 11.64) among patients with HSA equal to or below 25 g/L, compared with patients with HSA above 40 g/L. The negative impact associated with a decrement of HSA was found in all subgroups. Conclusions A decrement in preoperative HSA concentration was associated with substantial concentration-dependent increased 30-day mortality following CRC surgery. PMID:26462287

  14. Forensic evaluation of medical liability cases in general surgery.

    PubMed

    Moreira, H; Magalhães, T; Dinis-Oliveira, Rj; Taveira-Gomes, A

    2014-10-01

    Although medical liability (disciplinary, civil and criminal) is increasingly becoming an issue, few studies exist, particularly from the perspective of forensic science, which demonstrate the extent to which medical malpractice occurs, or when it does, the reasons for it. Our aims were to evaluate the current situation concerning medical liability in general surgery (GS) in Portugal, the reasons for claims, and the forensic evaluations and conclusions, as well as the association between these issues and the judicial outcomes. We analysed the Medico-Legal Council (CML) reports of the National Institute of Legal Medicine and Forensic Sciences of Portugal related to GS during 2001-2010. The judicial outcomes of each case were requested from the Public Prosecutor Office (PPO) and the court. Alleged cases of medical liability in GS represented 11.2% of the total cases analysed by the CML. We estimated that in Portugal, 4:100,000 surgeries are subject to litigation. The majority of complaints were due to the patient's death (75.4%), with laparoscopic cholecystectomy surgeries representing 55.2% of cases. In 76.1% of the cases, the CML believed that there was no violation of legesartis and in 55.2% of cases, no causal nexus was found between the medical practice and the alleged harm. The PPO prosecuted physicians in 6.4% of the cases and resulted in one conviction. Finally, the importance of the CML reports as a relevant technical-scientific tool for judicial decision was evident because these reports significantly (p < 0.05) influenced the prosecutor's decision, whether to prosecute or not.

  15. Retroperitoneal laparoscopic management of a lymphocele after abdominal aortic surgery: a case report.

    PubMed

    Uchinami, Masaru; Morioka, Koichi; Doi, Koji; Nakamura, Tomoaki; Yoshida, Makoto; Tanaka, Kuniyoshi

    2005-09-01

    A retroperitoneal lymphocele is a rare complication of abdominal aortic surgery. We present a case of 77-year-old man who developed a retroperitoneal lymphocele 14 days after undergoing graft replacement for an abdominal aortic aneurysm. Paracentesis showed a white and turbid fluid that was determined to be chyle. Conservative therapy, including percutaneous drainage, fasting, and total parenteral nutrition, was unsuccessful. Retroperitoneal laparoscopic ligation of the leaking lymphatics was performed on postoperative day 33. The postoperative course was satisfactory. The laparoscopic approach to retroperitoneal lymphocele treatment after abdominal aortic repair is a safe and minimally invasive therapeutic method.

  16. Hurricane Katrina: impact on cardiac surgery case volume and outcomes.

    PubMed

    Bakaeen, Faisal G; Huh, Joseph; Chu, Danny; Coselli, Joseph S; LeMaire, Scott A; Mattox, Kenneth L; Wall, Matthew J; Wang, Xing Li; Shenaq, Salwa A; Atluri, Prasad V; Awad, Samir S; Berger, David H

    2008-01-01

    Hurricane Katrina produced a surge of patient referrals to our facility for cardiac surgery. We sought to determine the impact of this abrupt volume change on operative outcomes. Using our cardiac surgery database, which is part of the Department of Veterans Affairs' Continuous Improvement in Cardiac Surgery Program, we compared procedural outcomes for all cardiac operations that were performed in the year before the hurricane (Year A, 29 August 2004-28 August 2005) and the year after (Year B, 30 August 2005-29 August 2006). Mortality was examined as unadjusted rates and as risk-adjusted observed-to-expected ratios. We identified 433 cardiac surgery cases: 143 (33%) from Year A and 290 (67%) from Year B. The operative mortality rate was 2.8% during Year A (observed-to-expected ratio, 0.4) and 2.8% during Year B (observed-to-expected ratio, 0.6) (P = 0.9). We identified several factors that enabled our institution to accommodate the increase in surgical volume during the study period. We conclude that, although Hurricane Katrina caused a sudden, dramatic increase in the number of cardiac operations that were performed at our facility, good surgical outcomes were maintained.

  17. Hip salvage surgery in cerebral palsy cases: a systematic review.

    PubMed

    de Souza, Rafael Carboni; Mansano, Marcelo Valentim; Bovo, Miguel; Yamada, Helder Henzo; Rancan, Daniela Regina; Fucs, Patricia Maria de Moraes Barros; Svartman, Celso; de Assumpção, Rodrigo Montezuma César

    2015-01-01

    Imbalance and muscle spasticity, in association with coxa valga and persistent femoral anteversion, compromises hip development in cases of cerebral palsy and may result in chronic pain and even dislocation. Some of these hips undergo salvage surgery because of the severe impact of their abnormalities in these patients' quality of life. We conducted a systematic review of the literature to compare the results from the main hip salvage techniques applied to these individuals. The literature search focused on studies that evaluated results from hip salvage surgery in cases of cerebral palsy, published from 1970 to 2011, which are present in the Embase, Medline, PubMed, Cochrane Library and SciELO databases. Although the results were not statistically comparable, this systematic review demonstrates that hip salvage surgery should be indicated after individual evaluation on each patient, due to the wide spectrum of presentations of cerebral palsy. Therefore, it seems that no surgical technique is superior to any other. Rather, there are different indications.

  18. Dax's case redux: when comes the end of the day?

    PubMed

    Hurst, Ashley R; Mahanes, Dea; Marshall, Mary Faith

    2014-01-01

    Forty years after Dax Cowart fought to have his voice heard regarding his medical treatment, patient autonomy and rights are at the heart of patient care today. Yet, despite its centrality in patient care, the tension between a severely burned patient's right to stop treatment and the physician's role in saving a life has not abated. As this case study explores, barriers remain to hearing and respecting a patient's treatment decisions. Dismantling these barriers involves dispelling the myths that burn patients must grin and bear intense pain to recover and that a patient's choice to discontinue treatment equals physician failure. Moreover, in these situations, sustained, direct engagement between physician and patient can reduce the moral distress of all involved and enable physicians to hear and better accept when a patient is calling for the end of the day. PMID:25130357

  19. Application of ultrasound in bone surgery: two case reports.

    PubMed

    Escoda-Francolí, Jaume; Rodríguez-Rodríguez, Araceli; Berini-Aytés, Leonardo; Gay-Escoda, Cosme

    2010-11-01

    The present study describes some of the applications of ultrasound in bone surgery, based on the presentation of two clinical cases. The Piezosurgery® ultrasound device was used (Tecnología Mectron Medical, Carasco, Italy). In one case the instrument was used to harvest a chin bone graft for placement in a bone defect at level 1.2, while in the other case a bony window osteotomy was made in the external wall of the maxillary sinus, in the context of a sinus membrane lift procedure. The Piezosurgery® device produces specific ultrasound frequency modulation (25-29 kHz), and has been designed to secure increased precision in application to bone surgery. This instrument produces selective sectioning of the mineralized bone structures, and causes less intra- and postoperative bleeding. One of the advantages of the Piezosurgery® device is that it can be used for maxillary sinus lift procedures in dental implant placement. In this context it considerably lessens the risk of sinus mucosa laceration by preparing the bony window in the external wall of the upper maxilla, and can be used to complete the lifting maneuver. The use of ultrasound in application to hard tissues can be regarded as a slow technique compared with the conventional rotary instruments, since it requires special surgical skill and involves a certain learning curve.

  20. Four Cases of Chylous Ascites following Robotic Gynecologic Oncological Surgery

    PubMed Central

    Göçmen, Ahmet; Avcı, Muhittin Eftal; Şanlıkan, Fatih; Uçar, Mustafa Gazi

    2014-01-01

    Chylous ascites is an uncommon form of ascites characterized by milky-appearing fluid caused by blocked or disrupted lymph flow through chyle-transporting vessels. The most common causes of chylous ascites are therapeutic interventions and trauma. In this report, we present four cases of chylous ascites following robot-assisted surgery for endometrial staging and the treatment strategies that we used. After retroperitoneal lymph node dissection, leaving a drain is very useful in diagnosing chylous ascites and observing its resolution; furthermore, the use of octreotide in conjunction with TPN appears to be an efficient treatment modality for chylous ascites and should be considered before any invasive intervention. PMID:24716036

  1. Asystole during posterior fossa surgery: Report of two cases

    PubMed Central

    Goyal, Keshav; Philip, Frenny Ann; Rath, Girija Prasad; Mahajan, Charu; Sujatha, M.; Bharti, Sachidanand Jee; Gupta, Nidhi

    2012-01-01

    Asystole during posterior fossa neurosurgical procedures is not uncommon. Various causes have been implicated, especially when surgical manipulation is carried out in the vicinity of the brain stem. The trigemino-cardiac reflex has been attributed as one of the causes. Here, we report two cases who suffered asystole during the resection of posterior fossa tumors. The vago-glossopharyngeal reflex and the direct stimulation of the brainstem were hypothesized as the causes of asytole. These episodes resolved spontaneously following withdrawal of the surgical stimulus emphasizing the importance of anticipation and vigilance during critical moments of tumor dissection during posterior fossa surgery. PMID:22870159

  2. [PERIOPERATIVE VISUAL LOSS AFTER SPINE SURGERY: A CASE REPORT].

    PubMed

    Talmasse, M; Franssen, C; Martin, D; Georges, A; Brichant, J-f

    2016-04-01

    Perioperative visual loss is a rare but devastating complication that may follow spine surgery in the prone position. So far, the incidence, mechanisms and risk factors have not been clearly established. Most commonly, the visual loss results from an ischemic optic neuropathy. We describe the case of a 68 year-old woman who underwent a lumbar laminectomy in the prone position. Upon recovery from anesthesia, the patient complained of total left blindness. This visual loss was, slowly and only partially, recovered after 72 hours. We discuss the most common causes of postoperative visual loss, the risk factors and preventive strategy. PMID:27295895

  3. [A bridge to surgery for colon cancer obstruction in a very elderly patient - a case report].

    PubMed

    Kagawa, Yoshinori; Kato, Takeshi; Sakisaka, Hideki; Sato, Yasufumi; Morimoto, Yoshihiro; Kusama, Hiroki; Hashimoto, Tadayoshi; Kawashima, Hiroshi; Kimura, Kei; Mukai, Yosuke; Katsura, Yoshiteru; Takeno, Jun; Nakahira, Shin; Taniguchi, Hirokazu; Takeda, Yutaka; Tamura, Shigeyuki

    2014-11-01

    A 94-year-old woman with a distended abdomen was transferred to our hospital.Based on the enhanced abdominal computed tomographic (CT) finding, she was diagnosed with colonic obstruction due to sigmoid cancer. Colonoscopy was performed to make definitive and qualitative diagnoses, and to release the stenosis using a self-expanding metallic stent (SEMS). The SEMS was inserted without complication.On the fifth day after the decompression, the patient underwent laparoscope-assisted sigmoidectomy with lymph node resection.Despite the colon obstruction, a primary anastomosis was performed.The operation time was 163 min, and 3 mL of blood was lost.The patient was discharged without complications. We describe the case of a bridge to surgery in a very elderly patient. A bridge to surgery can be an effective option for the treatment of colon obstruction in non-elderly and very elderly patients.

  4. A Historic Case of Cardiac Surgery in Pregnancy

    PubMed Central

    Labib, Smael; Harandou, Mustapha

    2016-01-01

    Background. Heart disease is the leading cause of nonobstetric mortality in pregnant women. Because of high risk, medical management represents the first line of treatment. However, when medical treatment fails, cardiac surgery becomes necessary. Case Presentation. A 27-year-old female who underwent successfully cardiac surgery three times within 3 years. At the first time, she had an aortic valve replacement at 25 weeks of gestation after an infectious endocarditis complicated with an ischemic stroke. At 39 weeks of gestation, she had delivered, vaginally, a healthy baby boy weighing 2800 g. In the second time, pregnant again at 30 weeks of gestation, she had a mitral valve replacement with an aortic prosthesis reinforcement after a paraprosthetic regurgitation and a mitral vegetation. A fetal death in utero had occurred; the extraction of the fetus by cesarean section with a tubal ligation was performed after stabilization of the mother. In the third time, she underwent successfully a mitral prosthesis replacement with Bentall's procedure after a mitral prosthesis disinsertion with an abscess of aortic annulus due to new episode of infectious endocarditis. Conclusion. Our patient has assembled almost all poor prognosis factors, which makes her a real historic case, probably never described in the literature. PMID:27803828

  5. [A significant increase in intraoperative flash visual evoked potential amplitude during craniopharyngioma surgery-case report].

    PubMed

    Kawaguchi, Tomohiro; Ogawa, Yoshikazu; Fujiwara, Satoru; Tominaga, Teiji

    2015-04-01

    The flash visual evoked potential (VEP) is a useful diagnostic modality for visual preservation during surgery. Decreased VEP amplitude is recognized to indicate visual deterioration;however, whether intraoperative VEP can detect visual improvement remains unclear. We describe a craniopharyngioma case with a significant increase in VEP amplitude during surgery. A 67-year-old woman presented with progressive gait disturbance and impaired consciousness. Head magnetic resonance imaging demonstrated a sellar-suprasellar tumor compressing the optic chiasm upward with significant ventricular dilation. Her Glasgow Coma Scale was E3V3M5. Visual fields and acuity could not be examined because of impaired consciousness, and she could not see/recognize objects on a table. Preoperative VEP showed reproducible waveforms. Tumor removal by the extended transsphenoidal approach was performed with VEP monitoring. Increased VEP amplitude was observed after dural incision and persisted until the surgery ended. Postoperative VEP waveforms were also reproducible, but visual fields/acuity could not be examined because of cognitive dysfunction. Useful visual function was restored, and she became independent in daily life. The histological diagnosis was craniopharyngioma. The patient underwent ventriculo-peritoneal shunting for hydrocephalus 16 days after tumor removal. The postoperative course was uneventful and she was transferred to another hospital for rehabilitation. Intraoperative VEP may indicate visual improvement during surgery, which is a useful objective assessment for visual function in patients with impaired consciousness and cognitive dysfunction.

  6. [A significant increase in intraoperative flash visual evoked potential amplitude during craniopharyngioma surgery-case report].

    PubMed

    Kawaguchi, Tomohiro; Ogawa, Yoshikazu; Fujiwara, Satoru; Tominaga, Teiji

    2015-04-01

    The flash visual evoked potential (VEP) is a useful diagnostic modality for visual preservation during surgery. Decreased VEP amplitude is recognized to indicate visual deterioration;however, whether intraoperative VEP can detect visual improvement remains unclear. We describe a craniopharyngioma case with a significant increase in VEP amplitude during surgery. A 67-year-old woman presented with progressive gait disturbance and impaired consciousness. Head magnetic resonance imaging demonstrated a sellar-suprasellar tumor compressing the optic chiasm upward with significant ventricular dilation. Her Glasgow Coma Scale was E3V3M5. Visual fields and acuity could not be examined because of impaired consciousness, and she could not see/recognize objects on a table. Preoperative VEP showed reproducible waveforms. Tumor removal by the extended transsphenoidal approach was performed with VEP monitoring. Increased VEP amplitude was observed after dural incision and persisted until the surgery ended. Postoperative VEP waveforms were also reproducible, but visual fields/acuity could not be examined because of cognitive dysfunction. Useful visual function was restored, and she became independent in daily life. The histological diagnosis was craniopharyngioma. The patient underwent ventriculo-peritoneal shunting for hydrocephalus 16 days after tumor removal. The postoperative course was uneventful and she was transferred to another hospital for rehabilitation. Intraoperative VEP may indicate visual improvement during surgery, which is a useful objective assessment for visual function in patients with impaired consciousness and cognitive dysfunction. PMID:25838303

  7. Two Cases of Single-Stage Closure of a Bronchopleural Fistula Using Latissimus Dorsi Musculocutaneous Flaps after Lung Surgery

    PubMed Central

    Akiyama, Hirohiko; Kinoshita, Hiroyasu; Inoue, Takuya; Hamahata, Atsumori; Uramoto, Hidetaka

    2015-01-01

    Two cases of successful primary closure of a bronchopleural fistula with favorable infection control using latissimus dorsi musculocutaneous flaps are reported. Case 1 was a 70-year-old man who underwent resection of the right lower pulmonary lobe due to right lung metastasis of sigmoid colon cancer. A bronchopleural fistula was found on day 28 after surgery. Infection was controlled by antibiotic administration and tube drainage. Closure of the bronchopleural stump, thoracoplasty and plombage of latissimus dorsi muscles were performed for single-stage closure without open treatment, based on a negative pleural effusion culture. Case 2 was a 64-year-old man who underwent right lower pulmonary lobe resection due to right lung cancer. A bronchopleural fistula was found on day 14 after surgery. In single-stage closure, thoracoplasty and plombage of latissimus dorsi muscles were performed due to infection control and a negative pleural effusion culture. Both cases had a good postoperative course. PMID:26004108

  8. How creation of a parent satisfaction questionnaire improved multidisciplinary service delivery in a paediatric day surgery unit.

    PubMed

    Bradley, Alison

    2013-01-01

    Auditing patient satisfaction has become a keystone of quality patient centred healthcare. A plethora of patient satisfaction studies exist but only a few studies have been evaluated for their validity, reliability, specificity or psychometric properties. And the majority focus on adult health care. However, if validated tools are not utilised, then inaccurate results could stymie service improvement. The level of satisfaction with the paediatric day surgery service at Tayside Children's Hospital was unknown. Our objective was to measure parent satisfaction with the paediatric day surgery by creating a parent satisfaction questionnaire which has undergone satisfactory testing for validity, reliability, specificity and psychometric properties. A Likert-style questionnaire was constructed through literature review and focus group meetings with professionals, parents and patient groups to establish content validity. Statements worded in positive phrasing were re-worded in negative phrasing to ensure intra-rater reliability. A pilot study was conducted and responses analysed for construct validity and inter-rater agreement. Internal reliability was established using Chronbach's alpha analysis, which produced scores for each part of the questionnaire between 0.7 and 0.9. Overall parent satisfaction was high. 95.48% either strongly agreed or agreed with positively worded statements regarding pre-operative clinic service. In particular 100% satisfaction was reported with the pre-operative phone call which only 70% of participants received. 96.60% strongly agreed or agreed with positive statements regarding service provided on the ward and 87.50% strongly agreed or agreed with positive statements regarding the discharge process. 5% specifically requested improved information giving. In conclusion the parent satisfaction questionnaire was found to have proven validity, reliability, specificity and psychometric properties. Overall parent satisfaction was found to be high

  9. Patient subjective experience and satisfaction during the perioperative period in the day surgery setting: a systematic review.

    PubMed

    Rhodes, Lenore; Miles, Gail; Pearson, Alan

    2006-08-01

    This systematic review used the Joanna Briggs Institute Qualitative Assessment and Review Instrument to manage, appraise, analyse and synthesize textual data in order to present the best available information in relation to how patients experience nursing interventions and care during the perioperative period in the day surgery setting. Some of the significant findings that emerged from the systematic review include the importance of pre-admission contact, provision of relevant, specific education and information, improving communication skills and maintaining patient privacy throughout their continuum of care.

  10. Lymphopenia and Elevated Blood C-Reactive Protein Levels at Four Days Postoperatively Are Useful Markers for Early Detection of Surgical Site Infection Following Posterior Lumbar Instrumentation Surgery

    PubMed Central

    Shigematsu, Hideki; Koizumi, Munehisa; Nakajima, Hiroshi; Okuda, Akinori; Morimoto, Yasuhiko; Masuda, Keisuke; Tanaka, Yasuhito

    2016-01-01

    Study Design Case-control study. Purpose To identify the characteristics of candidate indexes for early detection of surgical site infection (SSI). Overview of Literature SSI is a serious complication of spinal instrumentation surgery. Early diagnosis and treatment are crucial for the welfare of the patient postoperation. Methods We retrospectively reviewed laboratory data of patients who underwent posterior lumbar instrumentation surgery for degenerative spine disease. The sensitivity and specificity of six laboratory markers for early detection of SSI were calculated: greater elevation of the white blood cell count at day 7 than at day 4 postoperatively, greater elevation of the C-reactive protein (CRP) level at day 7 than at day 4 postoperatively, a CRP level of >10 mg/dL at 4 days postoperatively, neutrophil percentage of >75% at 4 days postoperatively, a lymphocyte percentage of <10% at 4 days postoperatively, and a lymphocyte count of <1,000/µL at 4 days postoperatively. Statistical analysis was via Fisher's exact test and a p-value of <0.05 was considered significant. Results In total, 85 patients were enrolled. Of these, five patients developed deep SSI. The sensitivity and specificity of each index were as follows: index 1, 20.0% and 77.5%; index 2, 20.0% and 83.8%; index 3, 40.0% and 97.5%; index 4, 40.0% and 86.3%; index 5, 0% and 96.3%; and index 6, 80.0% and 80.0%. A significant difference was noted for indexes 3 and 6. Conclusions A CRP level of >10 mg/dL at 4 days postoperatively would be useful for definitive diagnosis of SSI, and a lymphocyte count of <1,000/µL at 4 days postoperatively would be a useful screening test for SSI. Although laboratory markers for early detection of SSI have been frequently reported, we believe that it is important to understand the characteristics of each index for a precise diagnosis. PMID:27114760

  11. Case report of two patients having successful surgery for lung cancer after treatment for Grade 2 radiation pneumonitis

    PubMed Central

    Nakajima, Yuki; Akiyama, Hirohiko; Kinoshita, Hiroyasu; Atari, Maiko; Fukuhara, Mitsuro; Saito, Yoshihiro; Sakai, Hiroshi; Uramoto, Hidetaka

    2015-01-01

    Introduction Surgery for locally advanced lung cancer is carried out following chemoradiotherapy. However, there are no reports clarifying what the effects on the subsequent prognosis are when surgery is carried out in cases with radiation pneumonitis. In this paper, we report on 2 cases of non-small cell lung cancer with Grade 2 radiation pneumonitis after induction chemoradiotherapy, in which we were able to safely perform radical surgery subsequent to the treatment for pneumonia. Presentation of cases Case 1 was a 68-year-old male with a diagnosis of squamous cell lung cancer cT2aN2M0, Stage IIIA. Sixty days after completion of the radiotherapy, Grade 2 radiation pneumonitis was diagnosed. After administration of predonine, and upon checking that the radiation pneumonitis had improved, radical surgery was performed. Case 2 was a 63-year-old male. He was diagnosed with squamous cell lung cancer cT2bN1M0, Stage IIB. One hundred and twenty days after completion of the radiotherapy, he was diagnosed with Grade 2 radiation pneumonitis. After administration of predonine, the symptoms disappeared, and radical surgery was performed. In both cases, the postoperative course was favorable, without complications, and the patients were discharged. Conclusion Surgery for lung cancer on patients with Grade 2 radiation pneumonitis should be deferred until the patients complete steroid therapy, and the clinical pneumonitis is cured. Moreover, it is believed that it is important to remove the resolved radiation pneumonitis without leaving any residual areas and not to cut into any areas of active radiation pneumonitis as much as possible. PMID:26793310

  12. Robotic rectosigmoidectomy - pioneer case report in Brazil. Current scene in colorectal robotic surgery.

    PubMed

    Averbach, Marcelo; Popoutchi, Pedro; Marques Jr, Oswaldo Wiliam; Abdalla, Ricardo Z; Podgaec, Sérgio; Abrão, Maurício Simões

    2010-01-01

    Laparoscopic colorectal surgery is believed to be technically and oncologically feasible. Robotic surgery is an attractive mode in performing minimally-invasive surgery once it has several advantages if compared to standard laparoscopic surgery. The aim of this paper is to report the first known case of colorectal resection surgery using the robotic assisted surgical device in Brazil. A 35-year-old woman with deep infiltrating endometriosis with rectal involvement was referred for colorectal resection using da Vinci surgical system. The authors also reviewed the most current series and discussed not only the safety and feasibility but also the real benefits of robotic colorectal surgery.

  13. Robotic rectosigmoidectomy - pioneer case report in Brazil. Current scene in colorectal robotic surgery.

    PubMed

    Averbach, Marcelo; Popoutchi, Pedro; Marques Jr, Oswaldo Wiliam; Abdalla, Ricardo Z; Podgaec, Sérgio; Abrão, Maurício Simões

    2010-01-01

    Laparoscopic colorectal surgery is believed to be technically and oncologically feasible. Robotic surgery is an attractive mode in performing minimally-invasive surgery once it has several advantages if compared to standard laparoscopic surgery. The aim of this paper is to report the first known case of colorectal resection surgery using the robotic assisted surgical device in Brazil. A 35-year-old woman with deep infiltrating endometriosis with rectal involvement was referred for colorectal resection using da Vinci surgical system. The authors also reviewed the most current series and discussed not only the safety and feasibility but also the real benefits of robotic colorectal surgery. PMID:20520984

  14. Anterior esthetic crown-lengthening surgery: a case report.

    PubMed

    Lai, J Y; Silvestri, L; Girard, B

    2001-11-01

    The theoretical concepts underlying crown-lengthening surgery are reviewed, and a patient who underwent esthetic crown-lengthening surgery is described. An overview of the various indications and contraindications is presented.

  15. [A case of retroperitoneal serous cyst resected by laparoscopic surgery].

    PubMed

    Izaki, Hirofumi; Takahashi, Masayuki; Yuasa, Akihito; Fukawa, Tomoya; Koizumi, Takahiro; Yamaguchi, Kunihisa; Yamamoto, Yasuyo; Taue, Ryuichi; Nakatsuji, Hiroyoshi; Kishimoto, Tomoteru; Fukumori, Tomoharu; Kanayama, Hiro-Omi; Bando, Yoshimi; Kusuhara, Yoshito

    2009-11-01

    A 40-year-old woman was referred to our hospital because of pain extending from the left lateral abdomen to the left inferior limb. The abdominal computed tomography (CT) revealed an 8x7x12 cm retroperitoneal serous cystic mass. The serum carcinoembryogenic antigen (CEA) level was slightly elevated to 2.7 ng/ml. Therefore, we suspected it to be malignant, and we performed laparoscopic resection carefully. The retroperitoneal cyst was not adherent to the surrounding tissues and was easily dissected and removed under laparoscopy. Carbohydrale antigen (CA)19-9, CA125 and CEA levels in the fluid were elevated, but a cytology of the fluid was negative and no malignant sign was seen in the cyst wall. To our knowledge, this is the second reported case of retroperitoneal serous cyst resected by laparoscopic surgery in the Japanese literature.

  16. Surgery

    MedlinePlus

    ... there can be a risk of complications, including infection, too much bleeding, reaction to anesthesia, or accidental injury. There is almost always some pain with surgery. Agency for Healthcare Research and Quality

  17. Congenital aural cholesteatoma: results of surgery in 60 cases.

    PubMed

    Doyle, K J; Luxford, W M

    1995-03-01

    From 1978 to 1993, 59 patients (60 ears) with congenital middle ear cholesteatoma were treated at the House Ear Clinic. The median patient age at presentation was 5 years, and the period of postoperative follow-up was 4.8 years. An intact canal wall was maintained in 58 of 60 cases and a closed middle ear space in all cases. In 12 operations, lateral graft tympanoplasty eradicated the cholesteatoma in one stage; 32 patients required a second-stage surgery to rule out recurrence, and the remaining 16 cases required three or more operations to eradicate disease and reconstruct the hearing mechanism. Thirty-five (63%) of 56 patients had a postoperative air-conduction threshold pure-tone average (PTA) within 10 dB of the best bone-conduction PTA; 91% were within 20 dB. Average speech reception threshold improved from 32 dB hearing level (HL) preoperatively to 20 dB HL postoperatively. PMID:7877414

  18. Surgery-first orthognathic approach case series: Salient features and guidelines.

    PubMed

    Gandedkar, Narayan H; Chng, Chai Kiat; Tan, Winston

    2016-01-01

    Conventional orthognathic surgery treatment involves a prolonged period of orthodontic treatment (pre- and post-surgery), making the total treatment period of 3-4 years too exhaustive. Surgery-first orthognathic approach (SFOA) sees orthognathic surgery being carried out first, followed by orthodontic treatment to align the teeth and occlusion. Following orthognathic surgery, a period of rapid metabolic activity within tissues ensues is known as the regional acceleratory phenomenon (RAP). By performing surgery first, RAP can be harnessed to facilitate efficient orthodontic treatment. This phenomenon is believed to be a key factor in the notable reduction in treatment duration using SFOA. This article presents two cases treated with SFOA with emphasis on "case selection, treatment strategy, merits, and limitations" of SFOA. Further, salient features comparison of "conventional orthognathic surgery" and "SFOA" with an overview of author's SFOA treatment protocol is enumerated.

  19. Surgery-first orthognathic approach case series: Salient features and guidelines.

    PubMed

    Gandedkar, Narayan H; Chng, Chai Kiat; Tan, Winston

    2016-01-01

    Conventional orthognathic surgery treatment involves a prolonged period of orthodontic treatment (pre- and post-surgery), making the total treatment period of 3-4 years too exhaustive. Surgery-first orthognathic approach (SFOA) sees orthognathic surgery being carried out first, followed by orthodontic treatment to align the teeth and occlusion. Following orthognathic surgery, a period of rapid metabolic activity within tissues ensues is known as the regional acceleratory phenomenon (RAP). By performing surgery first, RAP can be harnessed to facilitate efficient orthodontic treatment. This phenomenon is believed to be a key factor in the notable reduction in treatment duration using SFOA. This article presents two cases treated with SFOA with emphasis on "case selection, treatment strategy, merits, and limitations" of SFOA. Further, salient features comparison of "conventional orthognathic surgery" and "SFOA" with an overview of author's SFOA treatment protocol is enumerated. PMID:26998476

  20. Influence of depression, catastrophizing, anxiety, and resilience on postoperative pain at the first day after otolaryngological surgery

    PubMed Central

    Suffeda, Alexander; Meissner, Winfried; Rosendahl, Jenny; Guntinas-Lichius, Orlando

    2016-01-01

    Abstract The aim was to assess the association between objectified preoperative psychological factors and postoperative pain at the first day after otolaryngological surgery in accordance with other predictors of postoperative pain. Eighty-two (82) patients (59% male, median age 56 years) were included between January and May 2015. The psychological assessment the day before surgery included the Patient Health Questionnaire (PHQ-9), pain catastrophizing scale (PCS), State-Trait Operation Anxiety (STOA) inventory, and the resilience scale (RS-13). On first postoperative day, patients were rated their pain using the questionnaires of the German-wide project Quality Improvement in Postoperative Pain Treatment (QUIPS) including a numeric rating scale (NRS, 0–10) for determination of patient's maximal pain. QUIPS allowed standardized assessment of patients’ characteristics, pain parameters, and outcome. The influence of preoperative and postoperative parameters on patients’ maximal postoperative pain was estimated by univariate and multivariate statistical analysis. The mean maximal pain was 3.2 ± 2.9. In univariate analysis, higher PHQ-9 score more than 4 (P = 0.010), higher STOA trait anxiety (P = 0.044), and higher STOA total score (P = 0.043) were associated to more postoperative pain. In multivariate analysis higher PHQ-9 score remained an independent predictor for severe pain (beta = 0.302; 95% confidence interval [CI]: 0.054–0.473; P = 0.014). When all parameters were included into multivariate analysis, 2 of all somatic, psychological, and treatment factors were associated with severe maximal pain: more depression (PHQ-9; beta = 0.256; 95% CI: 0.042–0.404; P = 0.017), and use of opioids in the recovery room (beta = 0.371; 95% CI: 0.108–0.481; P = 0.002). Otolaryngological surgery covers the spectrum from low to severe postoperative pain and is therefore a good model for pain management studies. A set of somatic and psychological parameters seems

  1. Sentinel node navigation surgery for gastroduodenal neuroendocrine tumors: Two case reports.

    PubMed

    Arigami, Takaaki; Uenosono, Yoshikazu; Yanagita, Shigehiro; Okubo, Keishi; Kijima, Takashi; Matsushita, Daisuke; Amatatsu, Masahiko; Hagihara, Takahiko; Haraguchi, Naoto; Mataki, Yuko; Ehi, Katsuhiko; Ishigami, Sumiya; Natsugoe, Shoji

    2016-06-01

    The percentage of gastroduodenal neuroendocrine tumors (NETs) among all gastroenteropancreatic (GEP) NETs has gradually increased worldwide. Sentinel node navigation surgery (SNNS) has been developed as a personalized approach in the surgical strategy for early gastrointestinal tract cancers. We herein report 2 cases of gastroduodenal NETs treated with SNNS. Technetium-tin colloid including indocyanine green was endoscopically injected into the submucosa around a tumor the day before surgery. Basin dissection including the sentinel nodes (SNs), which were identified by Navigator GPS and near-infrared fluorescence imaging, was performed during laparoscopic surgery. SNs were intraoperatively examined using hematoxylin-eosin (HE) staining.SNs were detected in 2 patients. Lymph node metastasis was intraoperatively identified in 1 of the 2 patients. Consequently, 1 patient with metastatic SNs underwent laparoscopic gastrectomy with lymphadenectomy. Pathological findings identified submucosal NET measuring 6.0 mm × 5.0 mm.Our results suggest that SNNS is a promising surgical tool for detecting subclinical lymph node metastasis in patients with gastroduodenal NETs. PMID:27368046

  2. Local or general anaesthetic in day case arthroscopy?

    PubMed Central

    Fairclough, J. A.; Graham, G. P.; Pemberton, D.

    1990-01-01

    A series of 66 patients who have undergone arthroscopy of the knee using three local anesthetic techniques is presented. Over a similar period of time 70 patients had knee arthroscopy performed under general anaesthesia. In the local anaesthetic group the technique was successful in 50 cases, partially successful in 12 cases and totally unsatisfactory in 4 cases. In the general anaesthetic group all the procedures were successful. Local anaesthetic techniques were found to be satisfactory for diagnostic arthroscopy but general anaesthesia was better for operative procedures and was more acceptable to the surgeon and patient. PMID:2334091

  3. Low-dose acetylsalicylic acid (100 mg/day) after aortocoronary bypass surgery: a placebo-controlled trial.

    PubMed Central

    Meister, W; von Schacky, C; Weber, M; Lorenz, R; Kotzur, J; Reichart, B; Theisen, K; Weber, P C

    1984-01-01

    The effect of low-dose acetylsalicylic acid (100 mg/day) upon bypass patency-rate and clinical course after aortocoronary bypass surgery was investigated in a randomized, placebo-controlled clinical trial. Sixty patients with 143 distal anastomoses of bypasses were randomized, 46 underwent repeat angiography after 4 months. Using the intention to treat-strategy, treatment was superior to placebo as judged by bypass patency rate and occurrence of cardiovascular complications or death. Counting the six drop-outs as failures, only nine of the 31 patients of the placebo group, but 16 of the 29 patients of the treatment group were considered successes (P less than 0.04). Eighteen patients in the placebo group and eight patients of the treatment group received beta-adrenoceptor blockers postoperatively, suggesting again a favourable effect of the treatment. Adverse drug reactions were very rare and minor. Supported by pathophysiological insights and positive trends in similar trials, the positive result justifies the recommendation of prescribing 100 mg of acetylsalicylic acid once daily to all patients without contraindications after aortocoronary bypass surgery. The positive result of this trial warrants further clinical trials of low-dose acetylsalicylic acid for other indications in arterial diseases. PMID:6378232

  4. Tonic-Clonic Seizure following Cytoreductive Surgery with Intraperitoneal Oxaliplatin: A Case Report and Review of the Literature

    PubMed Central

    Tsukamoto, Jessica Sayuri; Belotto de Oliveira, Marcos; Peixoto, Renata D'alpino

    2016-01-01

    Cytoreductive surgery (CRS) with hyperthermic intraperitoneal (IP) chemotherapy (HIPEC) is believed to improve outcomes in well-selected patients with peritoneal carcinomatosis. However, morbidity and mortality rates associated with this procedure are substantial. Here, we describe the case of a previously healthy young man who underwent CRS with hyperthermic IP oxaliplatin and developed one episode of tonic-clonic seizure on the second postoperative day. PMID:26933425

  5. Epilepsy surgery in children and adolescents: Report on 43 cases.

    PubMed

    Aberastury, Marina; Comas, Betina; García, María; Besocke, Ana; Ciraolo, Carlos; Agosta, Guillermo; Silva, Walter

    2016-10-01

    Epilepsy surgery in children with refractory epilepsy is one of the most effective methods to control seizures. The proper selection and assessment of surgery candidates is critical for surgical treatment to be adequately effective and safe. The purpose of this article is to describe our experience with 43 consecutive pediatric patients that underwent epilepsy surgery for refractory epilepsy between September 2005 and May 2014. Effectiveness, safety, and prognostic factors were analyzed. The median age was 12 years old at the time of surgery and 4.5 years old at epilepsy onset, with a latency period of up to 6 years until surgery. Since the surgery, the 43 patients have been in follow-up for a median of 5.4 years (±2.3 years). Resective surgery was performed in 32 patients and hemispherectomy, in 11 patients. To date, 62.8% of patients remain seizure-free. Abetterprognosis was observed in patients who underwent surgery with a duration of epilepsy of less than two years and in patients in whom a complete resection of the epileptogenic zone was achieved. PMID:27606645

  6. A case of bilateral visual loss after spinal cord surgery.

    PubMed

    Shifa, Jemal; Abebe, Worknehe; Bekele, Negussie; Habte, Dereje

    2016-01-01

    Visual loss is a rare but potentially devastating postoperative complication of prone spinal surgery with a reported incidence of 0.017 to 0.1 percent. We present a case of post-operative bilateral visual loss in a patient who had a laminectomy in prone position under general anesthesia. A 17-year-old male patient with large syringomyelia extending from C2 - T2 level had a surgical procedure done under general anesthesia (GA) in prone position that lasted four hours. After the surgical procedure, the patient presented to the Ophthalmology Clinic of Princess Marina Hospital, with a complaint of visual loss of the right eye followed by left, of one week duration. The patient never had a visual impairment in the past. Physical examination, fundal examination and CT scan revealed no primary cause for the visual loss. In this patient the absence of any finding in the optic disc and the retina and the normal CT scan, suggests that the most likely diagnosis is posterior ischemic optic neuropathy. The patient was treated with prednisolone tablet daily and showed mild improvement in vision. PMID:27279946

  7. A case of bilateral visual loss after spinal cord surgery

    PubMed Central

    Shifa, Jemal; Abebe, Worknehe; Bekele, Negussie; Habte, Dereje

    2016-01-01

    Visual loss is a rare but potentially devastating postoperative complication of prone spinal surgery with a reported incidence of 0.017 to 0.1 percent. We present a case of post-operative bilateral visual loss in a patient who had a laminectomy in prone position under general anesthesia. A 17-year-old male patient with large syringomyelia extending from C2 – T2 level had a surgical procedure done under general anesthesia (GA) in prone position that lasted four hours. After the surgical procedure, the patient presented to the Ophthalmology Clinic of Princess Marina Hospital, with a complaint of visual loss of the right eye followed by left, of one week duration. The patient never had a visual impairment in the past. Physical examination, fundal examination and CT scan revealed no primary cause for the visual loss. In this patient the absence of any finding in the optic disc and the retina and the normal CT scan, suggests that the most likely diagnosis is posterior ischemic optic neuropathy. The patient was treated with prednisolone tablet daily and showed mild improvement in vision. PMID:27279946

  8. Surgery-first orthognathic approach case series: Salient features and guidelines

    PubMed Central

    Gandedkar, Narayan H; Chng, Chai Kiat; Tan, Winston

    2016-01-01

    Conventional orthognathic surgery treatment involves a prolonged period of orthodontic treatment (pre- and post-surgery), making the total treatment period of 3–4 years too exhaustive. Surgery-first orthognathic approach (SFOA) sees orthognathic surgery being carried out first, followed by orthodontic treatment to align the teeth and occlusion. Following orthognathic surgery, a period of rapid metabolic activity within tissues ensues is known as the regional acceleratory phenomenon (RAP). By performing surgery first, RAP can be harnessed to facilitate efficient orthodontic treatment. This phenomenon is believed to be a key factor in the notable reduction in treatment duration using SFOA. This article presents two cases treated with SFOA with emphasis on “case selection, treatment strategy, merits, and limitations” of SFOA. Further, salient features comparison of “conventional orthognathic surgery” and “SFOA” with an overview of author's SFOA treatment protocol is enumerated. PMID:26998476

  9. Fertility sparing surgery in gestational trophoblastic neoplasia: A report of 4 cases

    PubMed Central

    Hasanzadeh, Malihe; Vahid Roodsari, Ftemeh; Ahmadi, Shahnaz; Gavedan Mehr, Masoumeh; Azadeh, Tabari

    2016-01-01

    Background: Gestational trophoblastic neoplasia (GTN) is a curable disease that involves the development of malignant tumor in the woman after a normal or molar pregnancy. The position of surgery in GTN is not properly specified and is changing due to new chemotherapy protocols. However, the role of surgery is highlighted in chemotherapy-resistant GTN. Other indications of surgery in trophoblastic diseases are drug toxicity and uterine perforation. Based on the fact that most women in certain age tend to preserve fertility, this study reported 4 cases of successful treatment after fertility sparing surgery. Case: A hospital-based case-report study was carried out to investigate the role of surgery in 4 patients with GTN. In this study, acute complications, such as intra-abdominal bleeding and liver dysfunction due to chemotherapy occurred in some patients. Surgery was performed and all cases underwent localized tumor removal while preserving the uterus. No hysterectomy surgery was performed. Conclusion: Surgery is supposed in specific cases of GTN, who desire preserving fertility. PMID:27738663

  10. Collaborating to increase access to clinical and educational resources for surgery: a case study.

    PubMed

    Tomasko, Jonathan M; Adams, Nancy E; Garritano, Frank G; Santos, Mary C; Dillon, Peter W

    2014-01-01

    A case study is described in which collaborations between a Department of Surgery, a Department of Information Technology, and an academic health sciences library resulted in the development of an electronic surgical library available at the bedside, the deployment of tablet devices for surgery residents, and implementation of a tablet-friendly user interface for the institution's electronic medical record.

  11. Cutting Edge Treatment: Pain and Surgery in the Ashley X Case

    ERIC Educational Resources Information Center

    Sobsey, Dick

    2009-01-01

    Pain and surgery are phenomena that have frequently been mentioned in the discussions of the Ashley X case. This article describes how pain and surgery have been used selectively to argue for or against the Ashley X procedures. Few if any of the many publications discussing the merits of the Ashley-X procedures can be said to strike a reasonable…

  12. Children Coping with Surgery through Drawings: A Case Study from a Parenting Class

    ERIC Educational Resources Information Center

    Broecher, Joachim

    2012-01-01

    This case study illustrates how parents can help their children cope with the fear and pain of surgery by engaging them in expressive drawing. As part of a parenting class that utilized art therapy techniques, a father shared his 6-year-old son's spontaneous drawings that had been created directly before and after surgery. Through guidance by the…

  13. A Case of Acute Fulminant Fat Embolism Syndrome after Liposuction Surgery.

    PubMed

    Byeon, Seong Wook; Ban, Tae Hyun; Rhee, Chin Kook

    2015-10-01

    Fat embolism syndrome (FES) is a clinical manifestation that consists of multiple organ dysfunction due to fat emboli. FES occurs as a complication after trauma or procedures such as surgery. The diagnostic criteria of FES have not yet been established, so clinical criteria are used for its diagnosis. The clinical course of acute fulminant FES can be rapid. Liposuction surgery, in which adipocytes are mechanically disrupted, is one cause of FES. As the number of liposuction surgeries increases, clinicians should be aware of the possibility of FES. This was the first report of a case of acute fulminant FES with severe acute respiratory distress syndrome after liposuction surgery, in Korea.

  14. A Case of Acute Fulminant Fat Embolism Syndrome after Liposuction Surgery

    PubMed Central

    Byeon, Seong Wook; Ban, Tae Hyun

    2015-01-01

    Fat embolism syndrome (FES) is a clinical manifestation that consists of multiple organ dysfunction due to fat emboli. FES occurs as a complication after trauma or procedures such as surgery. The diagnostic criteria of FES have not yet been established, so clinical criteria are used for its diagnosis. The clinical course of acute fulminant FES can be rapid. Liposuction surgery, in which adipocytes are mechanically disrupted, is one cause of FES. As the number of liposuction surgeries increases, clinicians should be aware of the possibility of FES. This was the first report of a case of acute fulminant FES with severe acute respiratory distress syndrome after liposuction surgery, in Korea. PMID:26508938

  15. [Superior Mesenteric Artery Syndrome following Scoliosis Surgery during Intravenous Patient Controlled Analgesia (IV-PCA) with Fentanyl: A Case Report].

    PubMed

    Doi, Hiroyoshi; Izumi, Kaoru; Kawasaki, Sho; Jimi, Nobuo; Sumiyoshi, Rieko; Mizuno, Keiichiro

    2016-01-01

    Compression and obstruction of the duodenum can occur after surgical correction of spinal scoliosis. We report a case of 15-year-old girl who developed superior mesenteric artery syndrome (SMAS) following scoliosis surgery. On the 4th postoperative day, the patient complained of nausea and vomiting, which was considered as side effects of opioids as she was treated with intravenous fentanyl infusion with patient-controlled analgesia (PCA) device. Nasogastric tube was placed and background infusion rate of the PCA was tapered. On the 5th postoperative day, fentanyl infusion was stopped, but she complained of persistent nausea and vomiting. Barium upper gastrointestinal series and abdominal echography revealed compression in the third portion of the duodenum between the superior mesenteric artery and aorta on the 7th postoperative day. She responded to conservative treatment (nutritional and fluid supplementation), which lasted about two weeks. She was discharged home on the 51st postoperative day. SMAS is rare but sometimes carries serious complications. Vomiting following scoliosis surgery should be examined thoroughly including the possibility of SMAS, especially during postoperative pain management with opioids (i. e., IV-PCA with fentanyl). Early diagnosis and institution of appropriate conservative therapy is essential to reduce the likelihood of future complications and avoid the need for surgery.

  16. Oral fluids prior to day surgery. The effect of shortening the pre-operative fluid fast on postoperative morbidity.

    PubMed

    Goodwin, A P; Rowe, W L; Ogg, T W; Samaan, A

    1991-12-01

    One hundred day surgical patients undergoing first trimester termination of pregnancy were randomly allocated to receive either 150 ml of clear fluid 1.5-2 hours before anaesthesia or to remain fasted from midnight the night before. Patients were anaesthetised using a total intravenous technique which consisted of propofol and alfentanil. No adverse intra-operative events were noted in either group. There were no significant differences in immediate recovery time, or pain, nausea and headache scores at 30 or 120 minutes following recovery. The fasted group had less pain (p less than 0.05) at 60 minutes after recovery than the fluid group, although the mean pain scores in both groups were low. Eighty two per cent of the patients returned questionnaires about pain, nausea and headache scores on arriving home, and at 12 and 24 hours after surgery. There were no significant differences between the two groups. In conclusion, pain, nausea and headache scores are low following total intravenous anaesthesia with propofol and alfentanil for termination of pregnancy and these were unaffected by the administration of 150 ml of clear fluid given approximately 1.5 hours pre-operatively.

  17. Staging in giant vestibular schwannoma surgery: A two consecutive day technique for complete resection in basic neurosurgical setups

    PubMed Central

    Bandlish, Deepak; Biswas, Nilay; Deb, Sumit

    2014-01-01

    Introduction: Vestibular schwannomas constitute 8% of all intracranial tumors. A majority of vestibular schwannomas are sporadic and unilateral. Giant vestibular schwannomas are seen in our country due to the late diagnosis and long duration of symptoms before diagnosis. These giant schwannomas are challenging to manage as most of the patients are having brainstem compression. Materials and Methods: Twelve cases of a giant vestibular schwannoma were operated in our department between May 2011 and December 2012. Vestibular schwannomas with a maximal diameter of more than 4 cm were defined as a giant vestibular schwannoma. All the patients had a unilateral vestibular schwannoma. Performance status of all the patients were graded as per the Karnofsky performance score. Pre-operative assessment of 5th, 7th, 8th and lower cranial nerve status was done in all cases. Ventriculoperitoneal shunting was done pre-operatively in all cases. All patients were operated through retromastoid suboccipital craniectomy and retrosigmoid approach. These patients were operated in two stages in two consecutive days with overnight elective ventilation in ICU. Ultrasonic aspirator and nerve monitoring techniques were not used. Results: Giant acoustic schwannomas can be safely resected completely by a staged resection on two consecutive days without any increased morbidity or mortality. This technique may be employed to achieve complete resection of such lesions without deterioration of facial nerve function in institutions which do not have advanced facilities like nerve monitoring or ultrasonic aspirator. PMID:25002760

  18. Instrument malfunction during robotic surgery: A case report.

    PubMed

    Singh, Shivanshu; Bora, Girdhar S; Devana, Sudheer S; Mavuduru, Ravimohan S; Singh, Shrawan K; Mandal, Arup K

    2016-01-01

    Robotic assistance is the new dimension of minimally invasive surgery. Despite being the state-of-the-art technology, newer technical problems still occur during robotic surgeries which are not addressed in the trouble shooting manual. We report one such problem being encountered with the tip cover accessory of monopolar scissors. In the current report, we discuss the technical fault and its correction. We feel that this problem needs to be registered into the trouble-shooting manual to prevent such incidents in future. PMID:27127362

  19. Malignant hyperpyrexia in oral surgery--case report and literature review.

    PubMed

    Monaghan, A; Hindle, I

    1994-06-01

    A case of malignant hyperpyrexia (MH) occurring in a patient undergoing orthognathic surgery is reported which resulted in the procedure being abandoned prior to completion. The oral surgeon's role in recognising the early clinical signs of masseteric spasm and central cyanosis is highlighted. The case shows that with proper investigation and management the MH susceptible patient was able to have a second anaesthetic with safety to complete the surgery. PMID:8068595

  20. Frontal recess surgery for diving-related frontal pain: case report.

    PubMed

    Jones, S E; Yung, M; Norris, A

    2001-03-01

    We report the case of a professional scuba diver who was unable to dive because he began experiencing severe frontal pain on descent. Following endoscopic surgery to open the frontal recess, the man was able to resume diving unrestricted by pain. We discuss the causes and treatment of this complaint, and we suggest that this might be considered a new indication for surgery in a limited number of cases.

  1. Loss of reflex tearing after maxillary orthognathic surgery: a report of two cases

    PubMed Central

    2014-01-01

    Background Few reports have described the ophthalmic complications that occur after maxillary orthognathic surgery. Since cases of decreased reflex tearing after maxillary orthognathic surgery are extremely rare, we describe 2 cases of loss of reflex tearing after maxillary orthognathic surgery. Case presentation Two Asian women, an 18-year-old and a 32-year-old, suffered from unilateral dryness and irritation caused by maxillary orthognathic surgery. In both patients, Schirmer test (II) showed reduced reflex tearing in 1 eye. Computed tomography showed that the pterygoid plate had been fractured in both patients. Conclusions The pterygopalatine ganglion and its associated fibers in the pterygopalatine fossa may be injured during Le Fort osteotomy. PMID:24673800

  2. [Neoadjuvant chemotherapy followed by radical surgery in pregnant patient with invasive cervical cancer: case report and literature review].

    PubMed

    da Fonseca, Allex Jardim; Dalla-Benetta, Anderson Cesar; Ferreira, Leonardo Pires; Martins, Cibelli Roldan Navarro; Lins, Cynthia Dantas Macedo

    2011-01-01

    The treatment options for pregnant patients with invasive cervical cancer (ICC) depend on gestational age, clinical stage and the patient's wishes. Some authors have reported cases of neoadjuvant chemotherapy followed by radical surgery in these patients. The aim of this paper was to revisit this subject and to add a new case and review the literature. We report the case of a 30 year-old woman in the 24th week of gestation. She was diagnosed with ICC (squamous cell carcinoma grade 2), stage IIB (International Federation of Gynecology and Obstetrics - FIGO). Nulliparous, the patient refused to interrupt the pregnancy. After meticulous counseling, the patient accepted treatment with neoadjuvant chemotherapy (cisplatin 75 mg/m² and vincristine 1 mg/m²) and subsequent evaluation of radical surgery concomitant to a cesarean section. Four complete cycles of chemotherapy were administered without delays or significant adverse effects. A few days before the date scheduled for surgery, the patient was admitted in advanced labor (37th week of gestation). Due to tumor clinical response, the obstetric team decided to monitor the labor, and the patient gave birth to a male newborn (2,450 g) uneventfully. Radical surgery was performed three days after birth, and histopathology analysis revealed carcinoma confined to the cervix without lymphatic involvement. Mother and son are in good general condition 12 months after delivery. Cisplatin-based chemotherapy during the second or third trimester of pregnancy appears to be a safe option for patients who do not wish to interrupt a pregnancy while awaiting fetal maturity. However, additional studies are needed to confirm the prognosis and assure the safety of newborns and patients.

  3. The surgery-first approach in orthognathic surgery: a retrospective study of 50 cases.

    PubMed

    Yu, H B; Mao, L X; Wang, X D; Fang, B; Shen, S G

    2015-12-01

    The surgery-first approach (SFA), without presurgical orthodontic treatment, has become favoured in the treatment of dentomaxillofacial deformities. This approach has been applied in our institution since 2012. The purpose of this study was to report our experience with the SFA for skeletal malocclusion. Fifty patients with skeletal malocclusions were enrolled in this study (11 bimaxillary protrusion, 27 skeletal class III malocclusion, and 12 facial asymmetry). After orthognathic-orthodontic consultation, suitability for SFA was determined and a treatment plan drawn up. Patients then underwent orthognathic surgery, which included Le Fort I maxillary osteotomy, bilateral sagittal split ramus osteotomy, subapical osteotomy, and genioplasty. Postoperative orthodontic treatment was started after a healing period of 2 weeks. The mean postoperative orthodontic treatment duration was 14.9 months, which is shorter than that of traditional joint orthognathic-orthodontic treatment. In the bimaxillary protrusion group, this was about 19 months, which was longer than for the other groups. After joint orthognathic-orthodontic treatment, a good facial profile and ideal occlusion were achieved. With the advantages of earlier improvements in patient facial aesthetics and dental function, the reduction in difficulty and treatment duration of orthodontic management, and increasing patient acceptance, SFA is regarded as an ideal and valuable alternative for this potentially complicated procedure.

  4. Influence of Arousal, Previous Experience, and Age on Surgery Preparation of Same Day of Surgery and In-Hospital Pediatric Patients.

    ERIC Educational Resources Information Center

    Faust, Jan; Melamed, Barbara G.

    1984-01-01

    Studied two pediatric surgery populations (N=66) to determine differences in retention of preparatory information. Results showed that children exposed to a hospital-relevant film retained more information than those children not prepared regardless of age, IQ, previous experience, sex, and time of film preparation. (LLL)

  5. Managing Drawbacks in Unconventional Successful Glaucoma Surgery: A Case Report of Stent Exposure

    PubMed Central

    Fea, Antonio; Cannizzo, Paola Maria Loredana; Consolandi, Giulia; Lavia, Carlo Alessandro; Pignata, Giulia; Grignolo, Federico M.

    2015-01-01

    Traditional options in managing failed trabeculectomy (bleb needling, revision, additional incisional surgery and tube surgery) have a relatively high failure and complication rate. The use of microinvasive glaucoma surgery (MIGS) has generally been reserved to mild to moderate glaucoma cases, proving good safety profiles but significant limitations in terms of efficacy. We describe a patient who underwent MIGS (XEN Aquesys subconjunctival shunt implantation) after a prior failed trabeculectomy. After the surgery, the IOP was well controlled but as the stent was close to an area of scarred conjunctiva of the previous trabeculectomy, it became partially exposed. As a complete success was achieved, we decided to remove the conjunctiva over the exposed area and replace it by an amniotic membrane transplantation and a conjunctiva autograft. Six months after surgery, the unmedicated IOP is still well controlled with complete visual acuity recovery. PMID:26294994

  6. Managing Drawbacks in Unconventional Successful Glaucoma Surgery: A Case Report of Stent Exposure.

    PubMed

    Fea, Antonio; Cannizzo, Paola Maria Loredana; Consolandi, Giulia; Lavia, Carlo Alessandro; Pignata, Giulia; Grignolo, Federico M

    2015-01-01

    Traditional options in managing failed trabeculectomy (bleb needling, revision, additional incisional surgery and tube surgery) have a relatively high failure and complication rate. The use of microinvasive glaucoma surgery (MIGS) has generally been reserved to mild to moderate glaucoma cases, proving good safety profiles but significant limitations in terms of efficacy. We describe a patient who underwent MIGS (XEN Aquesys subconjunctival shunt implantation) after a prior failed trabeculectomy. After the surgery, the IOP was well controlled but as the stent was close to an area of scarred conjunctiva of the previous trabeculectomy, it became partially exposed. As a complete success was achieved, we decided to remove the conjunctiva over the exposed area and replace it by an amniotic membrane transplantation and a conjunctiva autograft. Six months after surgery, the unmedicated IOP is still well controlled with complete visual acuity recovery.

  7. Suicidal Ideation and Behaviors among Adolescents Receiving Bariatric Surgery: A Case-Control Study

    PubMed Central

    McPhee, Jeanne; Freidl, Eve Khlyavich; Eicher, Julia; Zitsman, Jeffrey L.; Devlin, Michael J.; Hildebrandt, Tom; Sysko, Robyn

    2015-01-01

    Objective This study examined the prevalence and correlates of suicidal ideation and behavior (SI/B) among adolescents receiving bariatric surgery. Method Charts of 206 adolescents receiving bariatric surgery were reviewed. Cases with SI/B (current/lifetime reported at baseline or event occurring in the program n= 31, 15%) were case-matched on gender, age, and surgery type to 31 adolescents reporting current or past psychiatric treatment, and 31 adolescents denying lifetime SI/B or psychiatric treatment. Results Before surgery, adolescents with SI/B reported significantly lower total levels of health-related quality of life (p=0.01) and greater depressive symptoms (p=0.004) in comparison to candidates who never received psychiatric treatment. No significant differences were found between groups for the change in depressive symptoms or body mass index following surgery. Conclusions As in studies of adults, a notable subset of adolescents receiving bariatric surgery indicated pre- or post-operative SI/B. It is critical that clinicians evaluate and monitor adolescent patients undergoing bariatric surgery for risk of SI/B. PMID:26377705

  8. Axillary web syndrome following secondary breast-conserving surgery: a case report

    PubMed Central

    2013-01-01

    Background Axillary web syndrome is a cause of significant morbidity in the early postoperative period after axillary surgery. Case presentation A patient developed axillary web syndrome after secondary breast surgery and recovered in 3 weeks through physical therapy and using Aescuven Forte. Discussion The pathogenesis of axillary web syndrome is not clear. It is reported that axillary surgery is the main cause. The presented case indicates that tissue injury might be an important cause of axillary web syndrome. Though axillary web syndrome is self-limiting, special physical therapy and Aescuven Forte can shorten the natural duration. Conclusion Secondary breast surgery could cause axillary web syndrome. Physical therapy and Aescuven Forte could shorten the duration of the self-limited morbidity. PMID:23327341

  9. Transfusion-free anesthetic management for open heart surgery in a neonate -A case report-.

    PubMed

    Lee, Jung Min; Byon, Hyo-Jin; Kim, Jin-Tae; Kim, Hee-Soo; Kim, Chong Sung

    2010-12-01

    In small infants or neonates, open heart surgery without transfusion can have many risks regarding inadequate oxygen delivery and coagulopathy. However, if parents refuse blood transfusion, cardiac surgery without transfusion should be considered. We report a case of bloodless cardiac surgery in a 2.89 kg neonate with Jehovah's Witness parents. Blood conserving strategies were used. Preoperatively, erythropoietin and iron were supplemented to increase the hemoglobin level. Intraoperatively, techniques for minimizing blood loss were used, such as reducing priming volume for cardiopulmonary bypass, a blood salvage system, and modified ultrafiltration. Postoperatively, pharmacologic agents were administered and blood sampling was minimized. PMID:21286425

  10. Oncoplastic breast surgery for centrally located breast cancer: a case series

    PubMed Central

    Yoshinaka, Heiji; Shinden, Yoshiaki; Hirata, Munetsugu; Nakajo, Akihiro; Arima, Hideo; Okumura, Hiroshi; Kurahara, Hiroshi; Ishigami, Sumiya; Natsugoe, Shoji

    2014-01-01

    Oncoplastic breast surgery (OBS), which combines the concepts of oncologic and plastic surgery, is becoming more common worldwide. We herein report the results of OBS in Japanese patients with centrally located breast cancer (CLBC) and Paget’s disease. We performed OBS combining partial mastectomy and immediate volume replacement on patients with non-ptotic and/or small breasts, and volume reduction surgery for patients with ptotic breasts, as reported in Western countries. Japanese encounters are described in this report as a case series. PMID:25083497

  11. Sudden sensorineural hearing loss after varicose vein surgery under general anesthesia. Case report.

    PubMed

    Galanopoulos, G; Rapti, D; Nikolopoulos, I; Lambidis, C

    2011-01-01

    Sudden sensorineural hearing loss following non-otologic surgery, under general anesthesia, is an extremely rare complication. Furthermore, postoperative deafness has more commonly been associated with cardiac surgery. This acute dysfunction of the inner ear consists a controversial subject in terms of etiopathogenic mechanisms and treatment modalities. We present the case of a 60-year-old male patient who underwent varicose vein surgery under general anesthesia and presented immediately after the operation bilateral and profound impairment of his hearing acuity. A high index of suspicion is required to early diagnosis of this complication, although prompt treatment does not guarantee a good outcome.

  12. Panniculectomy Combined with Bariatric Surgery by Laparotomy: An Analysis of 325 Cases.

    PubMed

    Colabianchi, Vincenzo; de Bernardinis, Giancarlo; Giovannini, Matteo; Langella, Marika

    2015-01-01

    Surgical treatment of obese patients is much debated in the literature because of the significant intraoperative risks related to comorbidities presented by this type of patients. Recent literature suggests that panniculectomy should follow bariatric surgery after the patient's weight loss has been stabilized. However, when performed by laparotomy, bariatric surgery can be combined with panniculectomy. This paper presents the analysis of 325 cases of patients undergoing abdominal panniculectomy combined with bariatric surgery. The study highlights the risks, complications, and benefits of the combined procedure and describes a standardized technique for excision of a large abdominal panniculus in a short operating time.

  13. Panniculectomy Combined with Bariatric Surgery by Laparotomy: An Analysis of 325 Cases

    PubMed Central

    Colabianchi, Vincenzo; de Bernardinis, Giancarlo; Giovannini, Matteo; Langella, Marika

    2015-01-01

    Surgical treatment of obese patients is much debated in the literature because of the significant intraoperative risks related to comorbidities presented by this type of patients. Recent literature suggests that panniculectomy should follow bariatric surgery after the patient's weight loss has been stabilized. However, when performed by laparotomy, bariatric surgery can be combined with panniculectomy. This paper presents the analysis of 325 cases of patients undergoing abdominal panniculectomy combined with bariatric surgery. The study highlights the risks, complications, and benefits of the combined procedure and describes a standardized technique for excision of a large abdominal panniculus in a short operating time. PMID:26682282

  14. Extensive cytoreductive surgery in a Jehovah's Witness patient. A case report.

    PubMed

    Vallicelli, Carlo; Catena, Fausto; Ghermandi, Claudio; Amaduzzi, Annalisa; Coccolini, Federico; Cipolat, Luciano; Martignani, Matteo; Lazzareschi, Daniel; Cucchi, Michele; Schiavina, Riccardo; Di Pinna, Antonio

    2015-03-13

    Jehovah's Witnesses are a well-known patient demographic in medicine because of their religious-based refusal of blood transfusion. This case report outlines the treatment of a Jehovah's Witness patient in need of an extensive cytoreductive surgery due to a peritoneal carcinomatosis of ovarian origin. The surgeons carried out all the recommended surgical and anaesthetic measures concluding that extensive cytoreductive surgery on a Jehovah's Witness is possible and that a complete cytoreduction can be safely performed.

  15. [A case of retroperitoneal bronchogenic cyst treated by laparoscopic surgery].

    PubMed

    Kohno, Mitsuru; Namura, Kazuhiro; Fujikawa, Atsushi; Sawada, Takuto; Oota, Jun-ichi; Moriyama, Masatoshi

    2013-06-01

    A 51-year-old woman was referred to our hospital because of continuing back pain for 2 weeks. Computed tomography revealed a mass 30x40 mm in diameter adjacent to the left adrenal gland. We performed laparoscopic surgery in order to relieve the symptoms and make a diagnosis. Because there was adhesion between the mass and gastric wall, the mass was resected together with the gastric wall. Histopathological findings revealed the cyst with ciliated columunar epithelium and the final diagnosis was retroperitoneal bronchogenic cyst. There was no evidence of malignancy and the back pain disappeared.

  16. Candida glabrata prosthetic valve endocarditis treated successfully with fluconazole plus caspofungin without surgery: a case report and literature review.

    PubMed

    Lye, D C B; Hughes, A; O'Brien, D; Athan, E

    2005-11-01

    Reported here is the case of a 72-year-old man who was diagnosed with Candida glabrata prosthetic mitral valve endocarditis and treated successfully with fluconazole plus caspofungin after he refused and was determined unfit for surgery. Initial treatment with intravenous amphotericin B resulted in acute renal impairment. Despite 8 days of intravenous fluconazole therapy, he remained fungemic. Caspofungin was added to the treatment regimen with subsequent sterilisation of blood culture. The patient was treated for 34 days with caspofungin and 41 days with fluconazole. He continued oral fluconazole after hospital discharge and remained well at follow-up 11 months later. The role of fluconazole and caspofungin in the treatment of Candida endocarditis is discussed.

  17. Three cases of post-cataract surgery endophthalmitis due to Rhizobium (Agrobacterium) radiobacter.

    PubMed

    Moreau-Gaudry, Viviane; Chiquet, Christophe; Boisset, Sandrine; Croize, Jacques; Benito, Yvonne; Cornut, Pierre Loïc; Bron, Alain; Vandenesch, François; Maurin, Max

    2012-04-01

    We present three unrelated post-cataract surgery endophthalmitis cases caused by Rhizobium radiobacter, hospitalized in three different hospitals. Early diagnosis was obtained in two cases by bacterial DNA detection in vitreous samples. All patients recovered from infection, but pars plana vitrectomy was needed in two patients due to rapid clinical deterioration.

  18. Endoscopic ear surgery: A case series and first United Kingdom experience

    PubMed Central

    Kanona, Hala; Virk, Jagdeep Singh; Owa, Anthony

    2015-01-01

    AIM: To present the United Kingdom’s first case series of 70 otological cases of endoscopic and non-endoscopic ear surgeries. METHODS: Prospective case series incorporating a range of endoscopic procedures performed using a 4 mm, 18 cm rigid endoscope, performed by a single surgeon at a single centre. Primary outcome measures included mean average pre and post-operative air-bone gap hearing thresholds and duration of surgery. RESULTS: Thirty-eight patients underwent endoscopic assisted ear surgery and 32 underwent non-endoscopic assisted ear surgery. In both surgical groups, there was a significant difference between pre and post-operative mean air-bone gaps (P = 0.02). Mean operating time was comparable between both groups. Eight patients developed post-operative complications. CONCLUSION: Endoscopic ear surgery can be performed safely in a range of otological procedures. This has the potential to become a well-established surgical option for middle ear surgery in the near future. Advantages and limitations are discussed. PMID:25789304

  19. Unusual clinical case: extraluminal manifestation of a tapeworm from the eviscerated midline incision in a post-surgery patient.

    PubMed

    Dural, Ahmet Cem; Celik, Muhammet Ferhat; Temizgonul, Baha; Unsal, Mustafa Gokhan; Akarsu, Cevher; Gonenc, Murat; Kalayci, Mustafa Uygar; Alis, Halil

    2015-04-01

    Taenia saginata infestation is one of the most common cestode infestations in humans, that may cause gastrointestinal tract related complications as a result of obstruction, perforation or anastomotic leakage. A 55-year-old male patient who was receiving palliative chemotherapy for stage IV gastric cancer was admitted to the emergency department for abdominal pain. A hollow viscus organ perforation was diagnosed and an emergency surgery was performed. On postoperative day 5, the patient's midline incision eviscerated and a moving taenia emerged, with abundant particulated fluid from the incision line. The patient was admitted for abdominal surgery due to suspected bowel perforation. During the abdominal exploration, a relaxed purse stitch of the feeding tube was observed and no other bowel perforations were seen. The patient underwent two planned surgery for abdominal cavity lavage after the removal of cestode. Unfortunately, the patient died sixteen days after his admission to the intensive care unit. This is the first case describing an extraluminal manifestation of a tapeworm in a midline incision from evisceration without intestinal perforation.

  20. Unusual clinical case: extraluminal manifestation of a tapeworm from the eviscerated midline incision in a post-surgery patient.

    PubMed

    Dural, Ahmet Cem; Celik, Muhammet Ferhat; Temizgonul, Baha; Unsal, Mustafa Gokhan; Akarsu, Cevher; Gonenc, Murat; Kalayci, Mustafa Uygar; Alis, Halil

    2015-04-01

    Taenia saginata infestation is one of the most common cestode infestations in humans, that may cause gastrointestinal tract related complications as a result of obstruction, perforation or anastomotic leakage. A 55-year-old male patient who was receiving palliative chemotherapy for stage IV gastric cancer was admitted to the emergency department for abdominal pain. A hollow viscus organ perforation was diagnosed and an emergency surgery was performed. On postoperative day 5, the patient's midline incision eviscerated and a moving taenia emerged, with abundant particulated fluid from the incision line. The patient was admitted for abdominal surgery due to suspected bowel perforation. During the abdominal exploration, a relaxed purse stitch of the feeding tube was observed and no other bowel perforations were seen. The patient underwent two planned surgery for abdominal cavity lavage after the removal of cestode. Unfortunately, the patient died sixteen days after his admission to the intensive care unit. This is the first case describing an extraluminal manifestation of a tapeworm in a midline incision from evisceration without intestinal perforation. PMID:25881535

  1. Dysembryoplastic neuroepithelial tumors: report of 10 cases from a center where epilepsy surgery is not done.

    PubMed

    Tatke, M; Suri, V S; Malhotra, V; Sharma, A; Sinha, S; Kumar, S

    2001-01-01

    Dysembryoplastic neuroepithelial tumor (DNT) is a recently recognized tumor entity with distinctive clinicopathological features and an excellent long-term prognosis. We report 10 cases of DNT out of neurosurgical specimens sent for histopathological examination since 1994. Epilepsy surgery is not done at our center, and all the cases were sent with a clinical diagnosis of glioma. On histopathological examination, all the 10 cases contained the specific glioneuronal element. In 6 cases, glial nodules were noted in addition. This study therefore reports 4 cases of simple DNT and 6 cases of complex DNT. There was no nuclear atypia or mitosis in any of the cases. Proliferative index by PCNA varied from negative to <1%. It is very important to recognize this entity, as surgery cures the patient, and radiotherapy or chemotherapy is not required.

  2. Postsurgical Cystoid Macular Edema following Posterior Chamber Toric Phakic Intraocular Lens Implantation Surgery: A Case Report

    PubMed Central

    Canan, Julide; Akkan, Umurhan; Tuncer, Kemal; Elbay, Ahmet

    2015-01-01

    Purpose To describe a case of cystoid macular edema (CME) developing after posterior chamber toric phakic intraocular lens (PIOL) implantation. Methods Case report. Results A 33-year-old male underwent implantation of toric implantable collamer lenses (ICL), a new generation of PIOLs, for both eyes. Preoperative best spectacle-corrected distance visual acuity (BCVA) was 20/25 in the right eye and 20/32 in the left eye, with a manifest refraction of −9.25 −4.0 × 4° and −9.75 −4.25 × 171°, respectively. On day 1 postoperatively, the left eye had an uncorrected distance visual acuity (UDVA) of 20/60 with a refraction of +2.0 −3.5 × 11°. Despite the rotation of the PIOL, the cylindrical refractive component persisted in the left eye with a refraction of +2.0 −3.5 × 11°. Two weeks after the initial surgery, he presented with a decrease in his visual acuity in the left eye. The UDVA and BCVA were both 20/100 in the left eye with a refraction of +2.0 −4.25 × 3°. Dilated fundus examination and macular optical coherence tomography revealed a CME in the left eye. Following topical nepafenac therapy and explantation of the ICL, we observed a complete resolution of the CME at 3 months with an improvement in BCVA to 20/32 in the left eye. Conclusions To our knowledge, this is the first reported case of postsurgical CME following toric ICL implantation. In cases of phakic eyes with an intact posterior capsule, postsurgical CME can develop, thus highlighting the purpose of this report. PMID:26265909

  3. Ayurvedic management of postlumbar myelomeningocele surgery: A case study

    PubMed Central

    Butali, Savita; Patil, Annapurna R.; Arbar, Aziz; Tonne, Veena

    2014-01-01

    A 11-year-old male child presented with the complaints of urinary incontinence, passing hard stools associated with weakness in lower limbs, deformity of feet, reduced sensation below ankle joint since he was 5 years of age as noticed by parents. The clinical features were seen as postlumbar myelomeningocele surgery and child had congenital talipus equinovarus. For this, he was administered anulomana, sarvāṅga abhyaṅga (oleation / massage), saṅgraha cikitsā, avagāha sveda (sudation) and matrā basti (type of oleaginous enema). After the treatment, child was able to get control over his bladder, he started feeling sense the fullness of the bladder, there was a desire to void urine and a reduction in a number of voids in daytime and a reduced degree of wetness PMID:25737612

  4. [The principles of differentiated thyroid cancer surgery and anesthesia in pregnancy: three case reports].

    PubMed

    Bayır, Ömer; Polat, Reyhan; Saylam, Güleser; Öcal, Bülent; Çakal, Erman; Delibaşı, Tuncay; Korkmaz, Mehmet Hakan

    2015-01-01

    Development of thyroid nodule during pregnancy is rare, however the cancer rate of this nodule is high. Herein, we present medical outcomes of three pregnant women who were operated with the diagnosis of differentiated thyroid carcinoma in the light of literature. As sonographic findings of three cases showed malignant characteristics, fine needle aspiration biopsy (FNAB) was performed. Cytological examination result was reported as papillary thyroid carcinoma (PTC). Surgery was performed in the second trimester in all cases. One case underwent total thyroidectomy with neck dissection at level III and VI and two cases underwent total thyroidectomy with neck dissection at level VI. Pathological examination result was also reported as PTC. Lymph node metastases in the dissected materials were detected. During the intraoperative and early postoperative period, no complications occurred and no findings of recurrence or residues were observed during one-year follow-up following surgery. In conclusion, as the first trimester has an increased risk of congenital malformations, elective surgery should be performed at the second trimester, if applicable. In pregnants with malignant sonographic features and PTC confirmed by FNAB, surgery can be applied safely by taking precautions during pre-/peri- and postoperative period. These patients should not be given premedication for anesthesia, should be properly positioned and teratogenic agents should be avoided. After surgery, mother and fetus should be monitored closely. PMID:26572180

  5. Review of 500 single incision laparoscopic colorectal surgery cases - Lessons learned

    PubMed Central

    Keller, Deborah S; Flores-Gonzalez, Juan R; Ibarra, Sergio; Haas, Eric M

    2016-01-01

    Single incision laparoscopic surgery (SILS) is a minimally invasive platform with specific benefits over traditional multiport laparoscopic surgery. The safety and feasibility of SILS has been proven, and the applications continue to grow with experience. After 500 cases at a high-volume, single-institution, we were able to standardize instrumentation and operative steps, as well as develop adaptations in technique to help overcome technical and ergonomic challenges. These technical adaptations have allowed the successful application of SILS to technically difficult patient populations, such as pelvic cases, inflammatory bowel disease cases, and high body mass index patients. This review is a frame of reference for the application and wider integration of the single incision laparoscopic platform in colorectal surgery. PMID:26811615

  6. Traumatic arteriovenous fistula as consequence of TMJ arthroscopic surgery. A case report

    PubMed Central

    Marin-Fernandez, Ana-Belen; Monsalve-Iglesias, Fernando; Roman-Ramos, Maria; Garcia-Medina, Blas

    2016-01-01

    The ocurrence of a traumatic arteriovenous fistula after arthroscopic surgery of TMJ represents an extremely rare event. Specifically, this uncommon complication has been described only in a few case reports. In this light, the most frequent symptoms showed by this disease are thrills, bruits, pulsatile tinnitus, and an expansible vascular mass. Importantly, the severity of these symptoms is also dependent on the vessels involved. With regard to the management, is important to note that the vessel ligation with surgery as well as vessel emolization with endovascular procedures have been shown to be effective in the treatment of these cases. In view of that, the present study describes a case of superficial temporal arteriovenous fistula that arose as a postoperative complication of a bilateral arthroscopic eminoplasty of TMJ. The aim of the present report is to characterize this rare syndrome with the goal of proposing suitable treatments. Key words:Arteriovenous fistula, arthroscopic surgery, eminoplasty of TMJ, temporal vessels. PMID:27398189

  7. 42 CFR 412.82 - Payment for extended length-of-stay cases (day outliers).

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 false Payment for extended length-of-stay cases (day outliers). 412.82 Section 412.82 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Payments for Outlier Cases, Special...

  8. A Day at the Beach: A Multidisciplinary Business Law Case Study

    ERIC Educational Resources Information Center

    Rymsza, Leonard; Saunders, Kurt; Baum, Paul; Tontz, Richard

    2010-01-01

    This case study, written for use in a multidisciplinary course, exposes students to concepts in business law, economics, and statistics. The case is based upon a hypothetical scenario involving a young woman who, having spent a relaxing day at the beach, heads for home. On the drive home, a flip-flop she is wearing becomes lodged under the gas…

  9. After Surgery

    MedlinePlus

    ... side effects. There is usually some pain with surgery. There may also be swelling and soreness around ... the first few days, weeks, or months after surgery. Some other questions to ask are How long ...

  10. [Anesthesia in the pleuropulmonary complications surgery of tuberculosis: a 79 cases study].

    PubMed

    Kane, O; Diouf, E; Beye, M D; Diarra, O; Ndoye Diop, M; Diouf, M; Ndiaye, M; Ka Sall, B

    2003-01-01

    Reported is a retrospective study carried out from Aristide Le Dantec Hospital in patients who underwent pleuropulmonary surgery after tuberculosis complication, from June 1995 to June 1999. The aim of this study was to evaluate the anaesthesiology procedures and outcomes of tuberculosis pleuropulmonary complications surgery. Seventy nine patients were studied. Their mean age was 34.63 years, and the sex ratio was 3.14. They all underwent general anaesthesia procedures with barbituric, morphinics et myorelaxants drugs. The peroperative complications noted were distributed as follow: 50 cases of haemorrhage needing transfusion, 18 cases of hypotension associated to the anaesthesia. In the intensive care period, we have noticed 30 atelectasia cases associated to a spastic bronchopathy, 3 cases of pulmonary oedema and 1 case of pulmonary infarctus. In the postoperative period, 8 cases of hemodynamic instability occurred, including 5 cases of cardiovascular collapsus treated by filling, and 2 septic shocks cases. An infectious bronchopneumopathy was noticed on 11 patients with two cases of septicaemia. The mortality rate was 6.3% (5 cases of death). The pleuropulmonary surgery in tuberculosis complication is very haemorrhagic, and therefore require an adequate preoperative preparation. PMID:15776622

  11. Sperm parameters and male fertility after bariatric surgery: three case series.

    PubMed

    Sermondade, Nathalie; Massin, Nathalie; Boitrelle, Florence; Pfeffer, Jérôme; Eustache, Florence; Sifer, Christophe; Czernichow, Sébastien; Lévy, Rachel

    2012-02-01

    Recent studies have underlined the impact of obesity on sperm parameters, but very few data are available on the effect of weight loss on male fertility. This article reports the case series of three male patients who underwent rapid and major weight loss following bariatric surgery and the consequences of this surgery on semen parameters and fertility. A severe worsening of semen parameters was observed during the months after bariatric surgery, including extreme oligoasthenoteratozoospermia, but azoospermia was not observed. This effect may hypothetically be the result of two opposite mechanisms: (i) the suppression of the deleterious effects of obesity; and (ii) the negative impact of both nutritional deficiencies and the release of toxic substances. Information about potential reproductive consequences of bariatric surgery should be given to patients and sperm cryopreservation before surgery proposed. However, for one case, the alterations of spermatogenesis were reversible 2 years after the surgical procedure. Finally, intracytoplasmic sperm injection with fresh spermatozoa after male bariatric surgery can be successful, as demonstrated here, where clinical pregnancies were obtained for two out of the three couples.

  12. Laparoendoscopic single-site surgery adrenalectomy – own experience and matched case-control study with standard laparoscopic adrenalectomy

    PubMed Central

    Ürge, Tomáš; Stránský, Petr; Trávníček, Ivan; Pitra, Tomáš; Kalusová, Kristýna; Dolejšová, Olga; Petersson, Fredrik; Krčma, Michal; Chlosta, Piotr

    2014-01-01

    Introduction At our institution, laparoendoscopic single-site surgery (LESS) has been established as a technique for laparoscopic nephrectomy since 2011, and since 2012 in selected cases for adrenalectomy (AE) as well. Aim To compare LESS AE with standard laparoscopic AE (SLAE). Material and methods Between 3/2012 and 7/2014, 35 adrenalectomies were performed. In 18 (51.4%), a LESS approach was chosen. Indications were strictly non-complicated cases (body mass index (BMI) < 34 kg/m2, tumour ≤ 7 cm, non-malignant aetiology, no previous surgery). All LESS procedures were done by one surgeon. Standard equipment was a 10 mm rigid 0° camera, Triport+, one pre-bent grasper, and a sealing instrument. The approach was pararectal in all cases except one (transumbilical in a slim man). Three patients with LESS were excluded (2 partial AEs only, one adrenal cancer converted to SLAE and then to open surgery). These 15 LESS AE procedures were compared to 15 SLAEs with similar characteristics chosen among 54 SLAEs performed in the period 1/2008–2/2012. Results In 8 cases (53.3%) of LESS AE, a 3 mm port was added to elevate the liver/spleen. Mean parameters of LESS AE vs. SLAE (Wilcoxon test): maximal tumour diameter 43.7 mm vs. 36.1 mm (p = 0.28), time of surgery 63.3 min vs. 55.3 min (p = 0.22), blood loss 38.0 ml vs. 38.0 ml (p = 0.38), BMI 26.9 kg/m2 vs. 28.5 kg/m2 (p = 0.13), discharge from hospital 5.4 days vs. 3.9 days (p = 0.038). There were no complications in either group. Conclusions The LESS AE is feasible in selected cases, especially small left-sided tumours in thin patients with no history of previous abdominal operations, but requires an additional port in half of the cases. PMID:25561998

  13. Length of stay, wait time to surgery and 30-day mortality for patients with hip fractures after the opening of a dedicated orthopedic weekend trauma room

    PubMed Central

    Taylor, Michel; Hopman, Wilma; Yach, Jeff

    2016-01-01

    Background In September 2011, Kingston General Hospital (KGH) opened a dedicated orthopedic weekend trauma room. Previously, 1 weekend operating room (OR) was used by all surgical services. We assessed the impact this dedicated weekend trauma room had on hospital length of stay (LOS), time to surgery and 30-day mortality for patients with hip fractures. Methods Patients admitted between Oct. 1, 2009, and Sept. 30, 2012, were identified through our trauma registry, representing the 2 years before and 1 year after the opening of the orthopedic weekend trauma room. We documented type of fracture, mode of fixation, age, sex, American Society of Anesthesiologists (ASA) score, time to OR, LOS, discharge disposition and 30-day mortality. We excluded patients with multiple fractures, open fractures and those requiring trauma team activation. Results Our study included 609 patients (405 pre- and 204 post–trauma room opening). Mean LOS decreased from 11.6 to 9.4 days (p = 0.005) and there was a decreasing trend in mean time to OR from 31.5 to 28.5 hours (p = 0.16). There was no difference in 30-day mortality (p = 0.24). The LOS decreased by an average of 2 days following opening of the weekend trauma room (p = 0.031) and by an average of 2.2 additional days if the patient was admitted on the weekend versus during the week (p = 0.024). Conclusion The weekend trauma OR at KGH significantly decreased the LOS and appears to have decreased wait times to surgery. Further analysis is needed to assess the cost-effectiveness of the current strategy, the long-term outcome of this patient population and the impact the additional orthopedic weekend trauma room has had on other surgical services (i.e., general surgery) and their patients. PMID:27668332

  14. Moyamoya syndrome associated with γ knife surgery for cerebral arteriovenous malformation: case report.

    PubMed

    Uozumi, Yoichi; Sumitomo, Masaki; Maruwaka, Mikio; Araki, Yoshio; Izumi, Takashi; Miyachi, Shigeru; Kato, Takenori; Hasegawa, Toshinori; Kida, Yoshihisa; Okamoto, Sho; Wakabayashi, Toshihiko

    2012-01-01

    A 30-year-old female developed moyamoya syndrome after gamma knife surgery (GKS) for cerebral arteriovenous malformation (AVM), and was treated with bypass surgery. She suffered from flittering scotoma, right transient hemianopsia, and headache for 1 year. Cerebral angiography revealed a Spetzler-Martin grade III AVM located in the left occipital lobe. After staged embolization, GKS was performed with a minimum dose of 20 Gy to the periphery of the nidus at the 50% isodose level of the maximum target dose. Gradual nidus regression was achieved, and the clinical symptoms disappeared completely. However, at 30 months after GKS, the patient suffered transient ischemic attack. Cerebral angiography showed left middle cerebral artery occlusion with moyamoya vessels. The patient underwent direct and indirect bypass surgery. After surgery, the patient was free from ischemic symptoms. Chronic inflammation and long-term changes in expression of cytokines and growth factors after GKS may have triggered this case.

  15. Endotracheal tube fires during carbon dioxide laser surgery on the larynx--a case report.

    PubMed

    Kuo, C H; Tan, P H; Chen, J J; Peng, C H; Lee, C C; Chung, H C; Tseng, C K

    2001-03-01

    Endotracheal tube (ETT) fire is a catastrophic disaster that may occur during laser surgery of the upper airway. Several means are available for protection of polyvinyl chloride (PVC) tube from fire, but they are not perfect in prevention of fires caused by laser beam. The PVC tube is hazardous for carbon dioxide (CO2) laser surgery if it is not well wrapped with metallized foil tape. We report a case that a PVC ETT wrapped with aluminum foil ignited during CO2 laser surgery of the larynx. In this report, we emphasize the shaft of the PVC tube must be completely wrapped with aluminum foil to prevent exposure of any surface if it is used in CO2 laser surgery of the upper aero digestive tract. PMID:11407297

  16. Epidural anaesthesia and familial dysautonomia (the Riley Day syndrome). Three case reports.

    PubMed

    Challands, J F; Facer, E K

    1998-01-01

    Epidural anaesthesia in Familial Dysautonomia (FD) or the Riley Day syndrome has not previously been reported. Three children with FD presenting for redo Nissen fundoplication were managed with epidural anaesthesia. Cases 1 and 2 had had their original Nissen fundoplication without epidural anaesthesia. In Case 3, FD had not yet been diagnosed when she had her first operation, and it was performed with epidural anaesthesia. The anaesthetic management of these cases with and without epidural anaesthesia is described and discussed.

  17. Is spinal instrumentation a risk factor for late-onset infection in cases of distant infection or surgery? Case report.

    PubMed

    Naderi, Sait; Acar, Feridun; Mertol, Tansu

    2003-09-15

    As a cause of revision spinal surgery, spinal epidural abscess after instrumentation-assisted fusion is rare in neurosurgical practice. Postoperative infections are frequently seen in the time period soon after surgery. The authors report on the case of a 45-year-old woman who had undergone posterior instrumentation-augmented fusion for L4-5 degenerative spondylolisthesis. Ten months after the operation she presented to the neurosurgery clinic with complaints of severe low-back pain and radicular right lower-extremity pain. She had undergone laparoscopic surgery for acute cholecystitis 1 month prior to readmission. Radiological study revealed a spinal epidural abscess in communication with a right psoas abscess at L4-5. The abscess was drained percutaneously with the aid of C-arm fluoroscopic guidance, and a 6-week course of parenteral antibiotic therapy was administered. Retrograde lymphatic bacterial translocation, hematopoietic spread, and the suitable characteristics in the host may facilitate the development of infection around the implant. Thus, distant surgery and infection may be a risk factor in cases in which spinal instrumentation is placed. In such cases a prolonged antibiotic therapy for distant infection after surgery is recommended.

  18. Anesthesia for microlaryngeal surgery: the case for subglottic jet ventilation.

    PubMed

    Hunsaker, D H

    1994-08-01

    Although the techniques for surgery on the endolarynx using suspension and the operating microscope have been fully developed, the safest, and least obtrusive anesthetic technique has yet to be manifested, as evidenced by more than 200 references to anesthesia for microlaryngoscopy in the world literature. This study reviews the physiology, physics, and problems of each anesthetic technique. In light of this review, animal and human studies are reported demonstrating the utility and safety of subglottic ventilation when provided with proper monitoring using an automatic ventilator. A modified Ben-Jet tube is reported, which has a 1-mm ID channel to monitor PCO2 and tracheal pressure. This self-centering 3.0-mm tube, which extends 6 to 8 cm below the glottis, is unobtrusive for the surgeon. The subglottic tube, which is much less likely to be malaligned, is much more acceptable to the anesthesiologist. Anesthesia, by intravenous sedation, utilizes neuromuscular blockade while ventilating through the jet tube powered by an automatic ventilator with an automatic shutdown feature attached to the monitor tube to prevent inadvertent barotrauma. The third phase of this study compared fluoroplastic, used in a prototype jet ventilation tube, with 6-mm Silastic, Red Rubber, and polyvinyl chloride (PVC) tubes when struck by maximum power of CO2, Nd-YAG, and K-532 lasers. The test was performed in a closed chamber in which concentrations of oxygen and nitrogen were controlled. Although damaged by the CO2 laser beam, the fluoroplastic tubes did not continue burning when the laser was turned off in 100% oxygen, even when coated by blood. The other three tubes continued to burn in 23% oxygen. Neither the KTP nor Nd-YAG laser damaged the Teflon tube, while they ignited a sustained flame in 30% oxygen. This study supports the use of fluoroplastic for a laser safe jet ventilation tube. It also demonstrates the danger of tube fires, even in low oxygen concentrations, when using

  19. Olfactory neuroblastoma followed by emergency surgery for symptomatic intradural spinal metastasis: A case report

    PubMed Central

    Yunoki, Masatoshi; Suzuki, Kenta; Uneda, Atsuhito; Yoshino, Kimihiro

    2016-01-01

    Background: Olfactory neuroblastoma (ONB) is a rare, aggressive tumor of the nasal cavity. It may invade the paranasal cavities and anterior skull base locally but may also metastasize to the cervical lymph nodes, lungs, or distant central nervous system. Case Description: Here, we report a case of ONB in which emergency surgery was performed for intradural spinal metastasis (ISM). The patient was a 52-year-old male who underwent surgery for ONB. The tumor extended from the nasal cavity to the intracranial space and was resected completely. After radiotherapy (60 Gy), the patient was discharged without any neurological deficit except anosmia. Seven months after the surgery, he consulted our department because of progressive tetraparesis. Cervical magnetic resonance imaging demonstrated an intradural spinal mass involving C5–T2 and necessitating emergency surgery. The tumor was resected subtotally followed by 58 Gy whole-spine irradiation. The patient's neurological symptoms improved, however, paralysis of the right upper and both the lower limbs remained. During the 4 months between the spinal surgery and his death, there was no further motor deterioration in any of his four extremities. Conclusion: This case demonstrates the need to be aware of potential ISM in the follow-up of patients with ONB. The early detection of ISM by spinal MRI is crucial to ensuring good palliative care. PMID:27625887

  20. Olfactory neuroblastoma followed by emergency surgery for symptomatic intradural spinal metastasis: A case report

    PubMed Central

    Yunoki, Masatoshi; Suzuki, Kenta; Uneda, Atsuhito; Yoshino, Kimihiro

    2016-01-01

    Background: Olfactory neuroblastoma (ONB) is a rare, aggressive tumor of the nasal cavity. It may invade the paranasal cavities and anterior skull base locally but may also metastasize to the cervical lymph nodes, lungs, or distant central nervous system. Case Description: Here, we report a case of ONB in which emergency surgery was performed for intradural spinal metastasis (ISM). The patient was a 52-year-old male who underwent surgery for ONB. The tumor extended from the nasal cavity to the intracranial space and was resected completely. After radiotherapy (60 Gy), the patient was discharged without any neurological deficit except anosmia. Seven months after the surgery, he consulted our department because of progressive tetraparesis. Cervical magnetic resonance imaging demonstrated an intradural spinal mass involving C5–T2 and necessitating emergency surgery. The tumor was resected subtotally followed by 58 Gy whole-spine irradiation. The patient's neurological symptoms improved, however, paralysis of the right upper and both the lower limbs remained. During the 4 months between the spinal surgery and his death, there was no further motor deterioration in any of his four extremities. Conclusion: This case demonstrates the need to be aware of potential ISM in the follow-up of patients with ONB. The early detection of ISM by spinal MRI is crucial to ensuring good palliative care.

  1. Flapless implant surgery: A review of the literature and 3 case reports

    PubMed Central

    Romero-Ruiz, Manuel-Maria; Mosquera-Perez, Regina; Gutierrez-Perez, Jose-Luis

    2015-01-01

    Since the 1970s, modern Implantology is based on a concept of surgery with flap elevation. Gradually, several clinical trials demonstrated that a mid-crestal incision gives similar success rates compared to those obtained using the classical protocol. However, over the past decade in medicine it has been established the concept of minimally invasive surgery, consisting in taking advantage of advancements experienced in diagnostic techniques and specific surgical instruments, to perform surgical procedures infringing as less damage as possible to the patient The present work aims to produce a thorough review of the literature published on the field of Implantology with flapless surgery, to determine the current scientific evidence of the technique, along with illustrating the results with different clinical cases. After presenting the clinical cases, and the review of literature, we can say that flapless surgeries should be restricted to well-selected cases in which a proper clinical and radiological planning has been made. Patients treated with anticoagulant drugs or medically compromised equally can get benefitted by this minimal invasion technique. Key words:Flapless, minimally invasive surgery, dental implant. PMID:25810827

  2. Major thoracic surgery in Jehovah's witness: A multidisciplinary approach case report

    PubMed Central

    Rispoli, Marco; Bergaminelli, Carlo; Nespoli, Moana Rossella; Esposito, Mariana; Mattiacci, Dario Maria; Corcione, Antonio; Buono, Salvatore

    2016-01-01

    Introduction A bloodless surgery can be desirable also for non Jehovah’s witnesses patients, but requires a team approach from the very first assessment to ensure adequate planning. Presentation of the case Our patient, a Jehovah’s witnesses, was scheduled for right lower lobectomy due to pulmonary adenocarcinoma. Her firm denies to receive any kind of transfusions, forced clinicians to a bloodless management of the case. Discussion Before surgery a meticulous coagulopathy research and hemodynamic optimization are useful to prepare patient to operation. During surgery, controlled hypotension can help to obtain effective hemostasis. After surgery, clinicians monitored any possible active bleeding, using continuous noninvasive hemoglobin monitoring, limiting the blood loss due to serial in vitro testing. The optimization of cardiac index and delivery of oxygen were continued to grant a fast recovery. Conclusion Bloodless surgery is likely to gain popularity, and become standard practice for all patients. The need for transfusion should be targeted on individual case, avoiding strictly fixed limit often leading to unnecessary transfusion. PMID:27107502

  3. Scoliosis Surgery in Cystic Fibrosis: Surgical Considerations and the Multidisciplinary Approach of a Rare Case

    PubMed Central

    Fall, Andrew

    2016-01-01

    Spinal deformity in patients with cystic fibrosis (CF) is usually mild requiring no treatment. These patients are rarely considered as surgical candidates for scoliosis correction, as the pulmonary condition and other comorbidities increase the risk of general anaesthesia and recovery. This paper reviews all the literature up to date with regard to scoliosis in patients with CF and reports this unique case of a 14-year-old Caucasian girl with progressive scoliosis, who was treated surgically at the age of 17. She underwent a posterior spinal fusion T2-L3 with the use of unilateral segmental instrumentation. Preoperative workup included respiratory, cardiac, anaesthetic, endocrine, and dietician reviews, as well as bone density optimisation with zoledronic acid and prophylactic antibiotics. Surgical time was 150 minutes and intraoperative blood loss was 47% of total blood volume. Postoperative intensive care included noninvasive ventilation, antibiotic cover, pain management, chest physiotherapy, pancreatic enzyme supplementation, and nutritional support. She was discharged on day 9. At follow-up she had a good cosmetic outcome, no complaints of her back, and stable respiratory function. Multidisciplinary perioperative care and meticulous surgical technique may reduce the associated risks of major surgery in CF patients, while achieving adequate deformity correction and a good functional outcome. PMID:27413564

  4. Scoliosis Surgery in Cystic Fibrosis: Surgical Considerations and the Multidisciplinary Approach of a Rare Case.

    PubMed

    Mataliotakis, George I; Tsirikos, Athanasios I; Pearson, Karen; Urquhart, Don S; Smith, Carolyn; Fall, Andrew

    2016-01-01

    Spinal deformity in patients with cystic fibrosis (CF) is usually mild requiring no treatment. These patients are rarely considered as surgical candidates for scoliosis correction, as the pulmonary condition and other comorbidities increase the risk of general anaesthesia and recovery. This paper reviews all the literature up to date with regard to scoliosis in patients with CF and reports this unique case of a 14-year-old Caucasian girl with progressive scoliosis, who was treated surgically at the age of 17. She underwent a posterior spinal fusion T2-L3 with the use of unilateral segmental instrumentation. Preoperative workup included respiratory, cardiac, anaesthetic, endocrine, and dietician reviews, as well as bone density optimisation with zoledronic acid and prophylactic antibiotics. Surgical time was 150 minutes and intraoperative blood loss was 47% of total blood volume. Postoperative intensive care included noninvasive ventilation, antibiotic cover, pain management, chest physiotherapy, pancreatic enzyme supplementation, and nutritional support. She was discharged on day 9. At follow-up she had a good cosmetic outcome, no complaints of her back, and stable respiratory function. Multidisciplinary perioperative care and meticulous surgical technique may reduce the associated risks of major surgery in CF patients, while achieving adequate deformity correction and a good functional outcome. PMID:27413564

  5. Repair of diaphragmatic hernia following spinal surgery by laparoscopic mesh application: a case report and review of the literature

    PubMed Central

    2014-01-01

    We describe the laparoscopic management of diaphragmatic hernia (DH) caused by vertebral pedicle screw displacement. A 58-year-old woman underwent surgery for scoliosis and underwent posterior pedicle screw fixation. In the first postoperative (PO)day, she developed mild dyspnea. An anteroposterior chest radiograph revealed bilateral pleural effusion, which was more pronounced on the left side. A thoracoabdominal computed tomography (CT) scan, performed in the second PO day, revealed a solid mass in the pleural cavity that was associated with screw displacement, which had also entered into the peritoneal cavity without apparent other lesion of hollow and solid viscous. In the third PO day, after the screw was removed, explorative laparoscopy was carried out. We observed herniation of the omentum through a small diaphragmatic tear. Once the absence of visceral injury was confirmed, we reduced the omentum into the abdomen. Then, we repaired the hernia by applying a dual layer polypropylene mesh over the defect with a 3-cm overlap. The remainder of the postoperative period was uneventful. Iatrogenic DH due to a pedicle screw displacement has never been described before. In cases of pleural effusion following spinal surgery, rapid assessment and treatment are crucial. We conclude that a laparoscopic approach to iatrogenic DH could be feasible and effective in a hemodynamically stable patient with negative CT findings because it enables the completion of the diagnostic cascade and the repair of the tear, providing excellent visualization of the abdominal viscera and diaphragmatic tears. PMID:24808922

  6. Deep vein thrombosis: A rare complication in oral and maxillofacial surgery: A review of two cases.

    PubMed

    Babu, M R Ramesh; Ramesh, C; Thirumurugan, K; Prasad, G Arun

    2013-04-01

    Deep vein thrombosis (DVT) is caused by obstruction of blood flow of deep veins in upper and lower limb. One of the precipitating factors for DVT is surgery under general anesthesia exceeding 30 min. However, there are very few reports of DVT associated with surgery of oral and maxillofacial region. In this paper we report two cases of DVT involving left ilio-femoropopliteal deep vein in one patient treated for fractured left angle of mandible and left peroneal vein in the other patient treated for oral sub mucous fibrosis. Clinical and color Doppler examination were performed to diagnose the condition and were referred to vascular surgical unit of higher institute for further management. These cases illustrates any surgery of maxillofacial region is not free from risk of DVT, which can cause fatal pulmonary thromboembolism. PMID:24015017

  7. Surgery for Patients With Spontaneous Deep Supratentorial Intracerebral Hemorrhage: A Retrospective Case-Control Study Using Propensity Score Matching.

    PubMed

    Zheng, Jun; Li, Hao; Zhao, He-Xiang; Guo, Rui; Lin, Sen; Dong, Wei; Ma, Lu; Fang, Yuan; Tian, Meng; Liu, Ming; You, Chao

    2016-03-01

    Spontaneous intracerebral hemorrhage (sICH) is one of the most dangerous cerebrovascular diseases, especially when in deep brain. The treatment of spontaneous deep supratentorial intracerebral hemorrhage is still controversial. We conducted a retrospective case-control study using propensity score matching to compare the efficacy of surgery and conservative treatment for patients with deep surpatentorial hemorrhage. We observed the outcomes of consecutive patients with spontaneous deep supratentorial hemorrhage retrospectively from December 2008 to July 2013. Clinical outcomes of surgery and conservative treatments were compared in patients with deep sICH using propensity score matching method. The primary outcome was neurological function status at 6 months post ictus. The second outcomes included mortality at 30 days and 6 months, and the incidence of complications. Subgroup analyses of 6-month outcome were conducted. Sixty-three (22.66%) of the 278 patients who received surgery had a favorable neurological function status at 6 months, whereas in the conservative group, 66 of 278 (23.74%) had the same result (P = 0.763). The 30-day mortality in the surgical group was 19.06%, whereas 30.58% in the conservative group (P = 0.002). There was significant difference in the mortality at 6 months after ictus as well (23.38% vs 36.33%, P = 0.001). The subgroup analyses showed significantly better outcomes for the surgical group when hematoma was >40 mL (13.33% vs 0%, P = 0.005) or complicated with intraventricular hemorrhage (16.67% vs 7.27%, P = 0.034). For complications, the risk of pulmonary infection, gastrointestinal hemorrhage, urinary infection, pulmonary embolus, and need for tracheostomy/long term ventilation in the surgical group was higher than the conservative group (31.29% vs 15.47%, P < 0.001; 6.83% vs 3.96%, P = 0.133; 2.88% vs 1.80%, P = 0.400; 1.80% vs 1.08%, P = 0.476; 32.73% vs 23.38%, P = 0.014). Surgery could

  8. Surgery for Patients With Spontaneous Deep Supratentorial Intracerebral Hemorrhage: A Retrospective Case-Control Study Using Propensity Score Matching.

    PubMed

    Zheng, Jun; Li, Hao; Zhao, He-Xiang; Guo, Rui; Lin, Sen; Dong, Wei; Ma, Lu; Fang, Yuan; Tian, Meng; Liu, Ming; You, Chao

    2016-03-01

    Spontaneous intracerebral hemorrhage (sICH) is one of the most dangerous cerebrovascular diseases, especially when in deep brain. The treatment of spontaneous deep supratentorial intracerebral hemorrhage is still controversial. We conducted a retrospective case-control study using propensity score matching to compare the efficacy of surgery and conservative treatment for patients with deep surpatentorial hemorrhage. We observed the outcomes of consecutive patients with spontaneous deep supratentorial hemorrhage retrospectively from December 2008 to July 2013. Clinical outcomes of surgery and conservative treatments were compared in patients with deep sICH using propensity score matching method. The primary outcome was neurological function status at 6 months post ictus. The second outcomes included mortality at 30 days and 6 months, and the incidence of complications. Subgroup analyses of 6-month outcome were conducted. Sixty-three (22.66%) of the 278 patients who received surgery had a favorable neurological function status at 6 months, whereas in the conservative group, 66 of 278 (23.74%) had the same result (P = 0.763). The 30-day mortality in the surgical group was 19.06%, whereas 30.58% in the conservative group (P = 0.002). There was significant difference in the mortality at 6 months after ictus as well (23.38% vs 36.33%, P = 0.001). The subgroup analyses showed significantly better outcomes for the surgical group when hematoma was >40 mL (13.33% vs 0%, P = 0.005) or complicated with intraventricular hemorrhage (16.67% vs 7.27%, P = 0.034). For complications, the risk of pulmonary infection, gastrointestinal hemorrhage, urinary infection, pulmonary embolus, and need for tracheostomy/long term ventilation in the surgical group was higher than the conservative group (31.29% vs 15.47%, P < 0.001; 6.83% vs 3.96%, P = 0.133; 2.88% vs 1.80%, P = 0.400; 1.80% vs 1.08%, P = 0.476; 32.73% vs 23.38%, P = 0.014). Surgery could

  9. A Case for Day Care in Chicago: A Study of Families Using Not-for-Profit Day Care Centers.

    ERIC Educational Resources Information Center

    Syler, Murrell; Kemper, Patti Gregory

    This report is based on a survey undertaken by the Mayor's Office in Chicago to ascertain the effects of proposed HEW regulations for Title IV-A funds on the eligibility of families now using day care services in Chicago. The survey attempted to: (1) obtain actual profiles of the families currently using non-profit day care centers, (2) establish…

  10. Epididymitis following Cytoreductive Surgery with Intraperitoneal Oxaliplatin Chemotherapy: Two Case Reports

    PubMed Central

    Barbosa, Luiza Damian Ribeiro; Belotto, Marcos; Peixoto, Renata D'Alpino

    2016-01-01

    Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy has emerged as an aggressive treatment option with intent to either cure or extend disease-free survival of selected patients with peritoneal carcinomatosis. However, postoperative complications are common. We describe the cases of 2 men who underwent CRS with hyperthermic intraperitoneal oxaliplatin and developed scrotal pain, which was consistent with noninfectious epididymitis. PMID:27293401

  11. Two cases of Z syndrome with the Crystalens after uneventful cataract surgery.

    PubMed

    Yuen, Leonard; Trattler, William; Boxer Wachler, Brian S

    2008-11-01

    We report 2 cases of Z syndrome with the Crystalens AT50SE and AT52SE intraocular lenses (Eyeonics, Inc.) after uneventful cataract surgery. Both patients had subsequent neodymium:YAG laser capsulotomy treatment that remedied the complication. To our knowledge, these are the first reported cases of Z syndrome with the Crystalens AT50SE and AT52SE, a unique complication with this type of hinged accommodating intraocular lens. PMID:19006749

  12. Malignant vagal paraganglioma: report of a case treated with embolization and surgery.

    PubMed

    Carlsen, Camilla S; Godballe, Christian; Krogdahl, Annelise S; Edal, Anette L

    2003-12-01

    Approximately 20 cases of malignant vagal paragangliomas (MVP)have been reported in English literature. Malignancy is based on the presence of metastases. A careful preoperative evaluation is necessary to detect multicentricity and/or significant production of catecholamines. A new case of MVP treated with embolization and surgery is presented and the literature discussed. It is concluded, that preoperative embolization followed by radical surgical resection is a rational treatment of patients with unilateral MVP. PMID:14656575

  13. [Retroperitoneal lymphocele: a rarely reported complication of abdominal aortic surgery. Apropos of a case].

    PubMed

    Paule, A M; Le Dreff, P; Nonent, M; Braesco, J; Le Guyader, J; Bellet, M

    1994-01-01

    The authors present a case of a retroperitoneal lymphocele following prosthetic reconstruction of the abdominal aorta followed by a discussion about the principal differential diagnosis of a retroperitoneal collection following surgery on abdominal aorta. To date, only ten cases have been reported in this post-operative; it is probably a more frequent complication; the radiologist must play a major role both in the detection and the treatment of such collections.

  14. Symptomatic pericardial schwannoma treated with video-assisted thoracic surgery: a case report

    PubMed Central

    Yun, Po-Jen; Huang, Tsai-Wang; Li, Yao-Feng; Chang, Hung; Lee, Shih-Chun

    2016-01-01

    Intrathoracic schwannomas are neurogenic tumors derived from the Schwann cells of the nerve sheath, most often seen in the posterior mediastinum with anatomical correlations to nerves. Although they are typically benign, a malignant transformation can occur, and thoracotomy instead of video-assisted thoracoscopic surgery (VATS) is required to achieve a complete resection. Only a few cases of pericardial schwannoma have been reported so far. We present a rare case of pericardial schwannoma confirmed by video-assisted thoracoscopic resection. PMID:27162698

  15. [Cases of Obstructive Colon Cancer for Which Elective Surgery Was Performed after Colonic Stent Placement].

    PubMed

    Maruo, Hirotoshi; Nakamura, Koichi; Higashi, Yukihiro; Shoji, Tsuyoshi; Yamazaki, Masanori; Nishiyama, Raisuke; Koike, Kota; Kubota, Hiroyuki

    2015-11-01

    The present study investigated the short-term outcomes of 20 patients with obstructive colon cancer who underwent colonic stent placement as a bridge to surgery (BTS) during the 3-year period between April 2012 and March 2015. Subjects comprised 13 men and 7 women, with a mean age of 68.3 years. Placement and decompression were successfully achieved in all of the patients. Oral ingestion became possible from a mean of 2.7 days after placement. No serious complications associated with placement were encountered. Total colonoscopy was performed after placement in 17 patients (85%), and independent advanced cancer was seen in the proximal portion of the colon in 1 patient. Elective surgery was performed for all of the patients after placement. Excluding the 2 patients for whom preoperative chemotherapy or treatment of another disease was prioritized, the mean interval to surgery for the remaining 18 patients was 23.2 days. The operative procedure performed was laparoscopic surgery in 8 patients (40%). Although minor leakage (n=1) and abdominal wall abscess (n=1) were observed as postoperative complications, the patients generally had an uneventful course. Colonic stent placement for obstructive colon cancer is relatively easy and safe, and may be considered as an effective treatment method that enables favorable intestinal decompression preoperatively and one-stage resection. PMID:26805323

  16. Unilateral otitis media with effusion caused by retained surgical gauze as an unintended iatrogenic complication of orthognathic surgery: case report.

    PubMed

    Park, Chang Mook; Choi, Kang Young; Heo, Sung Jae; Kim, Jung-Soo

    2014-09-01

    Inadvertent retention of surgical gauze during an operation can have disastrous consequences for both the patient and the surgeon. Several cases have been reported, particularly after abdominal surgery. However, it has never to our knowledge been reported as a leading cause of dysfunction of the Eustachian tube after orthognathic surgery. We recently encountered a patient in whom it presented with unilateral otitis media with an effusion after orthognathic surgery. All surgeons involved with orthognathic surgery should be aware that remnants of surgical gauze after orthognathic surgery can compromise the Eustachian tube and cause otitis media with an effusion.

  17. [An original case of laryngomucocele after Tucker surgery].

    PubMed

    Ayache, S; Braccini, F; Pelissier, P; Thomassin, J M

    2001-01-01

    Although discovered since nearly 2 centuries, the cystic tumours of the laryngeal ventricle remain very badly known by otorhinolaryngologists. Air-containing or cystic, these lesions can be congenital or acquired. We present an original case of laryngomucocele, acquired after a partial laryngectomy of Tucker type for a laryngeal neoplasty. Through a review of the literature, we expose in the second time, the etiopathogenic mechanisms of these lesions. If this pathology contributes to mislay the diagnosis during the post-operative survey, small surgical details at the time of the initial intervention, can prevent the appearance of this lesion. The treatment is a surgical procedure, with an endoscopic way or a cervicotomy.

  18. A Case Study: Transitioning from a Five-Day School Week to a Four-Day School Week

    ERIC Educational Resources Information Center

    Duchscherer, Brian

    2011-01-01

    For over a century, most PK-12 schools across the United States have been using the same format of five days of school a week for approximately 9 months a year. The discussion of a four-day school week is being considered as many school districts try to balance their budgets each school year. Some schools in the past 30 years have begun changing…

  19. Case series on anesthesia for video-assisted thoracoscopic surgery for congenital diaphragmatic hernia in children

    PubMed Central

    Aggarwal, Anurag; Lohani, Rohit; Suresh, Varun

    2016-01-01

    Video-assisted thoracoscopic surgery (VATS) in the pediatric population is a challenging task for any anesthesiologist, moreover considering the high incidence of associated congenital anomalies which are individual predictors of poor prognosis. A thorough preoperative evaluation, knowledge of the physiology of one lung ventilation - pertaining to various methods of lung isolation, individualized meticulous planning, and continuous vigilance to detect any untoward event at the earliest with good communication between the anesthesiology and surgical teams contributes to a safe and successful surgery. We present a case series of anesthetic management of congenital diaphragmatic hernia with VATS. PMID:26957707

  20. A case of abdominal textiloma following gynecologic surgery at the Yaounde Central Hospital, Cameroon

    PubMed Central

    Fouelifack, Florent Ymele; Fouogue, Jovanny Tsuala; Fouedjio, Jeanne Hortence; Sando, Zacharie

    2013-01-01

    Textiloma is the inadvertent retention of a textile foreign body on the surgical site. It is a rare complication of surgery but which carries severe consequences for both patients and surgeons in terms of morbi-mortality and medico-legal procedures respectively. We herein report the case of an abdominal textiloma in a 42 year old woman who underwent a total abdominal hysterectomy for symptomatic leiomyomas. We also depict the errors that led to this mishap in a tertiary hospital in Yaounde (Cameroon). The textiloma was recognized six weeks after the causative surgery and removed by laparotomy without further complications. PMID:24876905

  1. Why carers use adult day respite: a mixed method case study

    PubMed Central

    2014-01-01

    Background We need to improve our understanding of the complex interactions between family carers’ emotional relationships with care-recipients and carers use of support services. This study assessed carer’s expectations and perceptions of adult day respite services and their commitment to using services. Methods A mixed-method case study approach was used with psychological contract providing a conceptual framework. Data collection was situated within an organisational case study, and the total population of carers from the organisation’s day respite service were approached. Fifty respondents provided quantitative and qualitative data through an interview survey. The conceptual framework was expanded to include Maslow’s hierarchy of needs during analysis. Results Carers prioritised benefits for and experiences of care-recipients when making day respite decisions. Respondents had high levels of trust in the service and perceived that the major benefits for care-recipients were around social interaction and meaningful activity with resultant improved well-being. Carers wanted day respite experiences to include all levels of Maslow’s hierarchy of needs from the provision of physiological care and safety through to the higher levels of belongingness, love and esteem. Conclusion The study suggests carers need to trust that care-recipients will have quality experiences at day respite. This study was intended as a preliminary stage for further research and while not generalizable it does highlight key considerations in carers’ use of day respite services. PMID:24906239

  2. 42 CFR 412.82 - Payment for extended length-of-stay cases (day outliers).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Payments for Outlier Cases, Special Treatment Payment for New Technology, and Payment Adjustment for... request payment for day outliers before the medical review required in paragraph (b) of this section. (b) The QIO must review and approve to the extent required by CMS— (1) The medical necessity...

  3. 42 CFR 412.82 - Payment for extended length-of-stay cases (day outliers).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Payments for Outlier Cases, Special Treatment Payment for New Technology, and Payment Adjustment for... request payment for day outliers before the medical review required in paragraph (b) of this section. (b) The QIO must review and approve to the extent required by CMS— (1) The medical necessity...

  4. 42 CFR 412.82 - Payment for extended length-of-stay cases (day outliers).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Payments for Outlier Cases, Special Treatment Payment for New Technology, and Payment Adjustment for... request payment for day outliers before the medical review required in paragraph (b) of this section. (b) The QIO must review and approve to the extent required by CMS— (1) The medical necessity...

  5. Culture and Character Education in a Jewish Day School: A Case Study of Life and Experience

    ERIC Educational Resources Information Center

    Roso, Calvin G.

    2013-01-01

    This article addresses how to teach character comprehensively by studying ways a school's concurrent curricula (the official curriculum, the operational curriculum, the extra curriculum, and the hidden curriculum) can be used to teach character to students. A single case study analyzes the curriculum at a Jewish day school by examining school…

  6. Nucleus drop during small incision cataract surgery: A report of four cases.

    PubMed

    Rotimi-Samuel, Adekunle; Onakoya, Adeola Olukorede; Aribaba, Olufisayo Temitayo; Musa, Kareem Olatubosun; Alabi, A Sunday; Akinsola, Folashade Bolanle

    2015-01-01

    Small incision cataract surgery (SICS) offers the benefits of a phacoemulsification (phaco) surgery without the attendant high cost, but it is not without certain risk such as nucleus drop into the vitreous as seen in phaco. A retrospective study of SICS and associated factors leading to nucleus drop during surgery, challenges of management and the visual outcomes. Of 793 eye surgeries performed during the study 586 were SICSs. Nucleus drop during SICS occurred in 0.68% of patients. Can-opener technique of capsulotomy, use of dispersive viscoelastic, diabetes mellitus, lack of anterior vitrectomy machine and poor access to immediate posterior vitrectomy were important problems in the management of the cases of nucleus drop in this study. The visual outcomes were poor in all the cases of nucleus drop. Careful patient selection for SICS and the use of continuous curvilinear capsulorhexis are advocated. An interior vitrectomy machine should be available to all cataract surgeons. It is good professional practice to be acquainted with the available vitreo-retina surgeons for urgent assistance in cases of nucleus drop. PMID:26776338

  7. Local infiltration of liposome bupivacaine in foot and ankle surgery: case-based reviews.

    PubMed

    Herbst, Steven A

    2014-10-01

    Foot and ankle surgical procedures, ranging from simple procedures, such as bunionectomy and correction of hammer toe, to more complex surgery, such as ankle fusion and ankle replacement, are extremely painful. Moreover, there is increasing interest in performing these procedures in an outpatient setting. Nerve blocks are extensively used in foot and ankle surgery, and commonly used techniques include sciatic nerve block with saphenous nerve augmentation; ankle block; and local, digital, or field block. Whereas more extensive blocks are associated with increased medical risk, higher cost, and delayed ambulation, more local approaches may not provide an adequate duration of effect. EXPAREL® (bupivacaine liposome injectable suspension) is an extended-release local anesthetic that can be infiltrated directly into the surgical site by the orthopedic surgeon to provide continuous and effective analgesia at the site of surgical injury for up to 72 hours. Two cases that illustrate the use of EXPAREL® in foot and ankle surgery are described. The first case involves ankle replacement in an active 58-year-old man with a 20-plus-year history of arthritis. The second case involves a young woman undergoing surgery for a talar neck fracture-dislocation with an open injury, dislocated subtalar joint, avascular talus, and considerable deformity. Both patients reported excellent control of postsurgical pain. PMID:25303454

  8. Orthodontic surgery and professional liability: the homozygote twin case.

    PubMed

    Nuzzolese, Emilio; Cirulli, Nunzio

    2012-07-01

    A professional liability lawsuit of an orthodontic case is presented through its medico-legal assessment. The patient underwent an orthodontic treatment combined with several maxillo-facial surgical interventions. Several temporomandibular joint complications followed, plus he was unhappy with aesthetic results and modifications to his facial features. He wanted to verify from a medico-legal point of view the treatment received as he believed something was not done lege artis. The result of the orthodontic assessment was that there were no indications for such surgical interventions, along with other professional negligence: no psychological support given and no indications as to the aesthetic results postsurgery. It was decided to carry out an orthodontic assessment also on his homozygote twin brother, who was discovered to have the same malocclusion. His medico-legal assessment did not substitute the evidence obtained from the deceased, but gave added weight to the final technical conclusion. PMID:22390137

  9. Laparoscopic sleeve gastrectomy at a new bariatric surgery centre in Canada: 30-day complication rates using the Clavien–Dindo classification

    PubMed Central

    Falk, Vanessa; Twells, Laurie; Gregory, Deborah; Murphy, Raleen; Smith, Chris; Boone, Darrell; Pace, David

    2016-01-01

    Background Newfoundland and Labrador (NL) has the highest rate of obesity in Canada, prompting the establishment of a bariatric surgery program at the Health Sciences Centre in NL. This retrospective study examined 30-day complication rates in more than 200 consecutive patients who underwent laparoscopic sleeve gastrectomy (LSG) between May 2011 and February 2014. Methods We performed a chart review and collected data on 30-day postoperative complications. Complications were graded and reported using the Clavien–Dindo classification. Grades I and II were defined as minor and grades III and higher were defined as major complications. Results We reviewed the charts of the first 209 patients to undergo LSG. The mean body mass index was 49.2, 81% were women and the average age was 43 years. Comorbidities included hypertension (55.0%), obstructive sleep apnea (46.4%), dyslipidemia (42.1%), diabetes (37.3%), osteoarthritis (36.4%) and cardiovascular disease with previous cardiac stents (5.3%). Furthermore, 38.3% of patients reported psychiatric diagnoses, such as depression and anxiety. The overall 30-day complication rate was 15.3%. The complication rate for minor complications was 13.4% and for major complications was 1.9% (2 leaks, 1 stricture and 1 fistula). Conclusion Our results support the feasibility of safely performing LSG surgery at bariatric centres completing fewer than 125 procedures annually. PMID:27007089

  10. Assessing Risk Factors for Hospital-Based, Acute Care Within Thirty Days of Craniosynostosis Surgery Using the Healthcare Cost and Utilization Project.

    PubMed

    Xu, Wen; Fox, Justin P; Gerety, Patrick A; Li, Jing; Wes, Ari M; Bartlett, Scott P; Taylor, Jesse A

    2016-09-01

    While in-hospital outcomes and long-term results of craniosynostosis surgery have been described, no large studies have reported on postoperative readmission and emergency department (ED) visits. The authors conducted this study to describe the incidence, associated diagnoses, and risk factors for these encounters within 30 days of craniosynostosis surgery.Using 4 state-level databases, the authors conducted a retrospective cohort study of patients <3 years of age who underwent surgery for craniosynostosis. The primary outcome was any hospital based, acute care (HBAC; ED visit or hospital readmission) within 30 days of discharge. Multivariate logistic regression modeling was used to identify factors associated with this outcome.The final sample included 1120 patients. On average, patients were ages 4.6 months with the majority being male (67.3%) and having Medicaid (52%) or private (48.0%) insurance. Ninety-nine patients (8.8%) had at least 1 HBAC encounter within 30 days and 13 patients (1.2%) had 2 or more. The majority of encounters were managed in the ED without hospital admission (56.6%). In univariate analysis, age, race, insurance status, and initial length of stay significantly differed between the HBAC and non-HBAC groups. In multivariate analysis, only African-American race (adjusted odds ratio [AOR] = 5.98 [1.49-23.94]) and Hispanic ethnicity (AOR = 5.31 [1.88-14.97]) were associated with more frequent HBAC encounters.Nearly 10% of patients with craniosynostosis require HBAC postoperatively with ED visits accounting for the majority of these encounters. Race is independently associated with HBAC, the cause of which is unknown and will be the focus of future research. PMID:27526238

  11. Cerebral oximetry monitoring during aortic arch aneurysm replacement surgery in Jehovah's Witness patient -A case report-.

    PubMed

    Kim, Seong-Hyop; Yoon, Tae-Gyoon; Kim, Tae-Yop; Kim, Hae-Kyoung; Sung, Woo-Sung

    2010-02-01

    Anesthetic management for aortic arch aneurysm (AAA) surgery employing deep hypothermic circulatory arrest in a Jehovah's Witness (JW) patient is a challenge to anesthesiologist due to its complexity of procedures and their refusal of allogeneic transfusion. Even in the strict application of intraoperative acute normovolemic hemodilution (ANH) and intraopertive cell salvage (ICS) technique, prompt timing of re-administration of salvaged blood is essential for successful operation without allogeneic transfusion or ischemic complication of major organs. Cerebral oximetery (rSO(2)) monitoring using near infrared spectroscopy is a useful modality for detecting cerebral ischemia during the AAA surgery requiring direct interruption of cerebral flow. The present case showed that rSO(2) can be used as a trigger facilitating to find a better timing for the re-administration of salvaged blood acquired during the AAA surgery for JW patient. PMID:20498799

  12. Intraoperative hypertensive crisis secondary to an undiagnosed pheochromocytoma during orthognathic surgery: a case report.

    PubMed

    Bouchard, Carl; Chiniara, Gilles; Valcourt, Annie-Claude

    2014-04-01

    Increased blood pressure (BP) during orthognathic surgery may result in excessive blood loss, poor surgical field visualization, and longer surgical time and require blood transfusion. When uncontrollable high BP is encountered in an otherwise healthy patient during orthognathic surgery, the diagnosis of pheochromocytoma should be considered. Pheochromocytomas are rare neuroendocrine tumors of the chromaffin cells of the adrenal medulla or extra-adrenal paraganglia (sympathetic ganglia) that secrete catecholamine. They are present in approximately 0.05 to 0.2% of hypertensive patients. Patients can present with hypertension, tachycardia, headaches, and diaphoresis. The clinical presentation may vary and a wide spectrum of nonspecific symptoms may be encountered. The elevated BP can be intermittent (40%) or permanent (60%). About 10% of pheochromocytomas are hereditary and they can be a feature of multiple endocrine neoplasia type 2. This report describes the case of a 29-year-old patient with a large pheochromocytoma of the right adrenal gland undiagnosed before orthognathic surgery.

  13. Bronchoscopic Nd-YAG laser surgery for tracheobronchial mucoepidermoid carcinoma--a report of two cases.

    PubMed

    Li, C H; Huang, S F; Li, H Y

    2004-10-01

    Mucoepidermoid carcinoma (MEC) of the tracheobronchial tree represents 0.2% of all lung tumours. It arises from the excretory ducts of the bronchial mucosa and is classified into low- and high-grade tumours using criteria derived from similar tumours of the major salivary glands. Low-grade MEC behaves in a benign fashion with less parenchymal and hilar lymph nodal invasion. The traditional method of treatment is by thoracotomy. The bronchoscopic approach to this lesion using lasers has rarely been reported. This article reports two cases of low-grade tracheobronchial MEC, which were both managed through bronchoscopic neodymium yttrium aluminium garnet (Nd-YAG) laser surgery. The patients were free from disease, 26 and 36 months after surgery. Bronchoscopic laser surgery promises to be an effective alternative treatment modality for tracheobronchial MEC. It is minimally invasive, results in less hospital stay and does not impair pulmonary functions.

  14. Obesity and Outcome of Crohn’s Associated Perianal Fistula Surgery: A Case-Control Study

    PubMed Central

    Manne, Ashish; Khan, Ali S.; Malik, Talha A.

    2015-01-01

    Background Evidence suggests that obesity (body mass index (BMI) > 30 kg/m2) adversely affects several outcomes in Crohn’s disease (CD). CD-associated perianal fistula (CDPF) represents a debilitating phenotype with a clinical course that may be affected by obesity. We hypothesized that obese CD patients would be more likely to have poor outcomes following CDPF surgery. Methods We designed a case-control study of CD patients who underwent surgery for CDPF between 2000 and 2013 with documented pre-operative BMI and post-operative outcome. Cases and controls were defined based on the outcome of CDPF surgery. Poor outcomes were designated as cases. Results Of the 317 patients diagnosed with CDPF, 73 patients underwent 120 surgeries for CDPF. Eighty-nine (74%) of the surgeries comprised fistulotomy with or without Seton placement, whereas 31 (26%) were mucosal flap procedures. Twenty-five (21%) cases and 95 (79%) controls were identified. Unadjusted odds ratio (OR) for the association between obesity and outcome demonstrated a trend towards a poor surgical outcome among obese patients that did not reach statistical significance (OR: 1.86; 95% confidence interval (CI): 0.58 - 5.98; P = 0.295). Multivariable logistic regression analysis demonstrated an even stronger trend towards a poor outcome among obese CD patients, albeit without reaching statistical significance (OR: 2.83; 95% CI: 0.64 - 12.49; P = 0.169). Conclusion In patients undergoing Seton placement, fistulotomy or mucosal flap procedure for CDPF, there is a trend towards poor outcomes in the obese; however, as this trend did not reach statistical significance, this association should be examined further.

  15. Successful tongue cancer surgery under general anesthesia in a 99-year-old patient in Okinawa, Japan: A case report and review of the literature

    PubMed Central

    Maruyama, Tessho; Nakasone, Toshiyuki; Matayoshi, Akira; Arasaki, Akira

    2016-01-01

    As advances in the medical field have resulted in increased life expectancy, performing surgery under general anesthesia in elderly patients has become an important issue. A 99-year-old Okinawan female was admitted to the hospital presenting with pain in the tongue. Following physical examination, a clinical diagnosis of early stage tongue cancer (T2N0Mx) was confirmed. Early stage tongue cancer is particularly easy to access for surgical resection. By contrast, later stages of tongue cancer are associated with pain, dysphagia and throat obstruction. The patient and their family agreed to surgery due to the worsening pain associated with the tumor and gave informed consent for surgery. Following consultation with a cardiologist and an anesthesiologist, the tongue tumor was surgically resected under general anesthesia. Subsequent to surgery, the patient experienced pain relief and was discharged from the hospital on day 14 post-surgery. The patient was able to maintain the same quality of life, and lived for 5 years and 2 months longer without evidence of disease, surviving to the age of 104 years old. The present case demonstrates that surgery under general anesthesia may be appropriate in patients of an advanced age, with a treatment plan that should ideally be based on careful assessment of the wishes of the patient and their family, medical risks, and benefits and economic costs of alternative treatments, in addition to consideration of the patient's culture. PMID:27588116

  16. The First Successful Case of Transoral Robotic Surgery in a Patient with Sialadenoma Papilliferum

    PubMed Central

    Koç, Arzu-Karaman; Yegin, Yakup; Çelik, Mustafa; Sar, Mehmet; Sakiz, Damlanur; Kayhan, Fatma-Tülin

    2016-01-01

    Introduction: Sialadenoma papilliferum (SP) is a rare benign tumor, which originates from the minor salivary gland. It occurs at sites that have minor salivary glands, such as the palate, retromolar pads, buccal mucosa, and lips. The most common location for tumor development is on the hard palate. A differential diagnosis consists of ruling out other salivary gland tumors. Transoral robotic surgery (TORS) is a new technology used in head and neck surgery within certain centers around the world. Case Report: Herein, we present the first successful case of SP tumor removal by TORS. Conclusion: This particular case highlights the identification of this rare tumor in an unusual location. Furthermore, it demonstrates the utilization of TORS, leveraging the superior visualization to obtain excellent local control with minimal acute and long-term morbidity, in comparison to conventional transoral surgical approaches. PMID:27738613

  17. Combined cataract surgery on a Marfan-syndrome patient (case report).

    PubMed

    Biró, Zsolt; Szabó, Ilona; Pámer, Zsuzsanna

    2014-01-01

    Combined cataract surgery of an ectopic lens was performed on a 10 years old girl with Marfan-syndrome. A Cionni capsular tension ring was implanted into the capsular bag, and the bag was pulled to its place and fixed with a scleral suture. Because of the young age of the patient a primary posterior capsulorhexis was performed, through which anterior vitrectomy was carried out and the artificial lens was implanted into the capsular bag. In the literature several surgical solutions are advised for the treatment of the ectopic lens in patients with Marfan-syndrome. We have performed a successful surgery combined with posterior capsulorhexis in our case. Because of its rarity and special surgical solution, we think this case report is interesting and can be helpful in such cases to be published.

  18. The possibility of seeding vestibular schwannomas through surgery: Limited experience with two cases

    PubMed Central

    Roser, Florian; Ebner, Florian Heinrich; Skardelly, Marco

    2016-01-01

    Background: We present two exceptional cases of possible tumor seeding in benign vestibular schwannoma (VS) patients occurring years after initial microsurgical resection. Case Description: We retrospectively analyzed the surgical management, histology and documented the growth of new tumor occurrence in close vicinity of the original schwannomas by serial magnetic resonance imaging over a period of 10 years. None of the patients had stigmata of neurofibromatosis, making it a reasonable assumption that the second tumor was due to surgical seeding during the first surgery. Moreover, in the second case, a microsurgical re-exploration showed that the recurrent tumor did not show any adhesion or contact to the caudal cranial nerves as anticipated had this been a new cranial nerve schwannoma. Conclusions: Surgical seeding of VSs is a rare complication but can occur despite benign histology and generous irrigation during surgery. PMID:27217967

  19. Gender Reassignment Surgery in Human Immunodeficiency Virus-Positive Patients: A Report of Two Cases

    PubMed Central

    Choi, Ji-An; Kim, Myung-Hoon; Kim, Min-Su; Lee, Keun-Cheol

    2015-01-01

    It is believed that surgery on human immunodeficiency virus (HIV)-positive patients is dangerous and should be avoided due to the possibility of postoperative infection of the patients or HIV occupational transmission to the medical staff. We discuss here the preparations and measures needed to conduct surgery safely on HIV-positive patients, based on our experience. We performed sex reassignment surgery on two HIV-positive patients from January 2013 to January 2015. Both of them were receiving highly active antiretroviral therapy and were asymptomatic, with a normal CD4 count (>500 cells/µL). The HIV-RNA was undetectable within the bloodstream. All the staff wore protective clothing, glasses, and three pairs of protective gloves in the operating room because of the possibility of transmission. Prophylactic antibiotics were administered to the patients, and antiviral therapy was performed during their perioperative course. Neither of the patients had postoperative complications, and none of the medical staff experienced accidental exposure. Both patients had satisfactory surgery outcomes without complications. HIV-positive patients can undergo surgery safely without increased risk of postoperative complications or HIV transmission to the staff through the proper use of antibiotics, active antiretroviral therapy, and supplemental protective measures with post-exposure prophylaxis for the staff in case of HIV exposure. PMID:26618127

  20. Gender Reassignment Surgery in Human Immunodeficiency Virus-Positive Patients: A Report of Two Cases.

    PubMed

    Kim, Seok-Kwun; Choi, Ji-An; Kim, Myung-Hoon; Kim, Min-Su; Lee, Keun-Cheol

    2015-11-01

    It is believed that surgery on human immunodeficiency virus (HIV)-positive patients is dangerous and should be avoided due to the possibility of postoperative infection of the patients or HIV occupational transmission to the medical staff. We discuss here the preparations and measures needed to conduct surgery safely on HIV-positive patients, based on our experience. We performed sex reassignment surgery on two HIV-positive patients from January 2013 to January 2015. Both of them were receiving highly active antiretroviral therapy and were asymptomatic, with a normal CD4 count (>500 cells/µL). The HIV-RNA was undetectable within the bloodstream. All the staff wore protective clothing, glasses, and three pairs of protective gloves in the operating room because of the possibility of transmission. Prophylactic antibiotics were administered to the patients, and antiviral therapy was performed during their perioperative course. Neither of the patients had postoperative complications, and none of the medical staff experienced accidental exposure. Both patients had satisfactory surgery outcomes without complications. HIV-positive patients can undergo surgery safely without increased risk of postoperative complications or HIV transmission to the staff through the proper use of antibiotics, active antiretroviral therapy, and supplemental protective measures with post-exposure prophylaxis for the staff in case of HIV exposure.

  1. Change in fracture risk and fracture pattern after bariatric surgery: nested case-control study

    PubMed Central

    Rousseau, Catherine; Jean, Sonia; Gamache, Philippe; Lebel, Stéfane; Mac-Way, Fabrice; Biertho, Laurent; Michou, Laëtitia

    2016-01-01

    Objective To investigate whether bariatric surgery increases the risk of fracture. Design Retrospective nested case-control study. Setting Patients who underwent bariatric surgery in the province of Quebec, Canada, between 2001 and 2014, selected using healthcare administrative databases. Participants 12 676 patients who underwent bariatric surgery, age and sex matched with 38 028 obese and 126 760 non-obese controls. Main outcome measures Incidence and sites of fracture in patients who had undergone bariatric surgery compared with obese and non-obese controls. Fracture risk was also compared before and after surgery (index date) within each group and by type of surgery from 2006 to 2014. Multivariate conditional Poisson regression models were adjusted for fracture history, number of comorbidities, sociomaterial deprivation, and area of residence. Results Before surgery, patients undergoing bariatric surgery (9169 (72.3%) women; mean age 42 (SD 11) years) were more likely to fracture (1326; 10.5%) than were obese (3065; 8.1%) or non-obese (8329; 6.6%) controls. A mean of 4.4 years after surgery, bariatric patients were more susceptible to fracture (514; 4.1%) than were obese (1013; 2.7%) and non-obese (3008; 2.4%) controls. Postoperative adjusted fracture risk was higher in the bariatric group than in the obese (relative risk 1.38, 95% confidence interval 1.23 to 1.55) and non-obese (1.44, 1.29 to 1.59) groups. Before surgery, the risk of distal lower limb fracture was higher, upper limb fracture risk was lower, and risk of clinical spine, hip, femur, or pelvic fractures was similar in the bariatric and obese groups compared with the non-obese group. After surgery, risk of distal lower limb fracture decreased (relative risk 0.66, 0.56 to 0.78), whereas risk of upper limb (1.64, 1.40 to 1.93), clinical spine (1.78, 1.08 to 2.93), pelvic, hip, or femur (2.52, 1.78 to 3.59) fractures increased. The increase in risk of fracture reached significance only for

  2. Effect of complications within 90 days on patient-reported outcomes 3 months and 12 months following elective surgery for lumbar degenerative disease.

    PubMed

    Chotai, Silky; Parker, Scott L; Sivaganesan, Ahilan; Sielatycki, J Alex; Asher, Anthony L; McGirt, Matthew J; Devin, Clinton J

    2015-12-01

    OBJECT There is a paradigm shift toward rewarding providers for quality rather than volume. Complications appear to occur at a fairly consistent frequency in large aggregate data sets. Understanding how complications affect long-term patient-reported outcomes (PROs) following degenerative lumbar surgery is vital. The authors hypothesized that 90-day complications would adversely affect long-term PROs. METHODS Nine hundred six consecutive patients undergoing elective surgery for degenerative lumbar disease over a period of 4 years were enrolled into a prospective longitudinal registry. The following PROs were recorded at baseline and 12-month follow-up: Oswestry Disability Index (ODI) score, numeric rating scales for back and leg pain, quality of life (EQ-5D scores), general physical and mental health (SF-12 Physical Component Summary [PCS] and Mental Component Summary [MCS] scores) and responses to the North American Spine Society (NASS) satisfaction questionnaire. Previously published minimum clinically important difference (MCID) threshold were used to define meaningful improvement. Complications were divided into major (surgicalsite infection, hardware failure, new neurological deficit, pulmonary embolism, hematoma and myocardial infarction) and minor (urinary tract infection, pneumonia, and deep venous thrombosis). RESULTS Complications developed within 90 days of surgery in 13% (118) of the patients (major in 12% [108] and minor in 8% [68]). The mean improvement in ODI scores, EQ-5D scores, SF-12 PCS scores, and satisfaction at 3 months after surgery was significantly less in the patients with complications than in those who did not have major complications (ODI: 13.5 ± 21.2 vs 21.7 ± 19, < 0.0001; EQ-5D: 0.17 ± 0.25 vs 0.23 ± 0.23, p = 0.04; SF-12 PCS: 8.6 ± 13.3 vs 13.0 ± 11.9, 0.001; and satisfaction: 76% vs 90%, p = 0.002). At 12 months after surgery, the patients with major complications had higher ODI scores than those without complications (29.1

  3. Effect of complications within 90 days on patient-reported outcomes 3 months and 12 months following elective surgery for lumbar degenerative disease.

    PubMed

    Chotai, Silky; Parker, Scott L; Sivaganesan, Ahilan; Sielatycki, J Alex; Asher, Anthony L; McGirt, Matthew J; Devin, Clinton J

    2015-12-01

    OBJECT There is a paradigm shift toward rewarding providers for quality rather than volume. Complications appear to occur at a fairly consistent frequency in large aggregate data sets. Understanding how complications affect long-term patient-reported outcomes (PROs) following degenerative lumbar surgery is vital. The authors hypothesized that 90-day complications would adversely affect long-term PROs. METHODS Nine hundred six consecutive patients undergoing elective surgery for degenerative lumbar disease over a period of 4 years were enrolled into a prospective longitudinal registry. The following PROs were recorded at baseline and 12-month follow-up: Oswestry Disability Index (ODI) score, numeric rating scales for back and leg pain, quality of life (EQ-5D scores), general physical and mental health (SF-12 Physical Component Summary [PCS] and Mental Component Summary [MCS] scores) and responses to the North American Spine Society (NASS) satisfaction questionnaire. Previously published minimum clinically important difference (MCID) threshold were used to define meaningful improvement. Complications were divided into major (surgicalsite infection, hardware failure, new neurological deficit, pulmonary embolism, hematoma and myocardial infarction) and minor (urinary tract infection, pneumonia, and deep venous thrombosis). RESULTS Complications developed within 90 days of surgery in 13% (118) of the patients (major in 12% [108] and minor in 8% [68]). The mean improvement in ODI scores, EQ-5D scores, SF-12 PCS scores, and satisfaction at 3 months after surgery was significantly less in the patients with complications than in those who did not have major complications (ODI: 13.5 ± 21.2 vs 21.7 ± 19, < 0.0001; EQ-5D: 0.17 ± 0.25 vs 0.23 ± 0.23, p = 0.04; SF-12 PCS: 8.6 ± 13.3 vs 13.0 ± 11.9, 0.001; and satisfaction: 76% vs 90%, p = 0.002). At 12 months after surgery, the patients with major complications had higher ODI scores than those without complications (29.1

  4. Study of factors for unsuitability of DSAEK in cases of corneal decompensation following cataract surgery.

    PubMed

    Sharma, Namrata; Sachdev, Ritika; Pandey, Ravindra M; Titiyal, Jeewan S; Sinha, Rajesh; Tandon, Radhika; Vajpayee, Rasik B

    2012-08-01

    To evaluate suitability of Descemet's stripping automated endothelial keratoplasty (DSAEK) in cases of corneal decompensation following cataract surgery. In this cross-sectional case series, 90 eyes of 90 patients were evaluated at a tertiary eye care centre. Cases with central corneal scarring or vascularisation, complicated aphakia with significant iris tissue defects and extensive synechaie or posterior segment pathology precluding visual recovery were classified as unsuitable for DSAEK. Of 90 eyes, 42 (46.67%) were unsuitable for DSAEK. Multivariate logistic regression analysis, revealed that patients presenting more than a year after cataract surgery had 7.5-fold odds of being unsuitable for DSAEK as compared with those who presented earlier(OR 7.5; CI 2.0-29.1). Patients with BCVA poorer than 0.06 at initial presentation had 5.0 times odds of being unsuitable for DSAEK (OR 5.0; CI 1.0-24.2). Patients who had prior non-phacoemulsification cataract surgery were 5.5 times less likely to be candidates for DSAEK as compared to those who had prior phacoemulsification (OR 5.5; CI 1.5-19.9) and those with anterior chamber IOL or aphakia were 5.0 times less likely suitable for DSAEK, in contrast to posterior chamber intraocular lenses (OR 5.0; CI 1.3-18.7). The type of cataract surgery, time to presentation and initial visual acuity play a role in determining the suitability of performing DSAEK in patients with corneal decompensation after cataract surgery.

  5. Candida famata mediastinitis. A rare complication of open heart surgery. Case report and brief review.

    PubMed

    Sanchez Betancourt, Alfredo Alonso; Sibaja Alvarez, Pablo; Camacho, Rolando Arguedas; Guevara Espinoza, Edward

    2016-01-01

    Candida mediastinitis is a rare complication of open heart surgery with high mortality and morbidity usually associated with C. albicans. We are reporting the case of a 57 year old male who after having a triple coronary artery bypass graft procedure, had mediastinitis caused by Candida famata, a yeast, that had only been reported once before as the causal agent of this condition. It is of vital importance, that future cases be reported, due to the fact that both reported cases have led to patient demise. PMID:27419075

  6. Robotic-assisted gynecologic/oncologic surgery: experience of early cases in a Saudi Arabian tertiary care facility.

    PubMed

    Al-Badawi, Ismail A; Al-Aker, Murad; Al-Subhi, Jamal; Bukhari, Ibtihal; Al-Omar, Osama; Ahmad, Sarfraz

    2012-06-01

    We report early experience of a case-mix series of robotic-assisted (RA) gynecologic/oncologic surgery in an Arabian population from a tertiary care facility, and discuss the emergence/growth of robotic surgery in the Arab world (Middle East). From December 2005 to December 2010, 60 consecutive patients [benign with complex pathology (BN, n = 34) and 26 cases with various malignancies; i.e., endometrial cancer (EC, n = 13), ovarian cancer (OC, n = 4), cervical cancer (CC, n = 1), and other cancers (OTH, n = 8), underwent RA procedures for the diagnosis/treatment/management of gynecologic/oncologic diseases at a single institution using the da Vinci(®) Surgical System. Data were analyzed for demographics, clinico-pathologic and peri/post-operative factors using intent-to-treat analysis. Despite continuous growth in the number of cases performed each year, the establishment of the robotic surgery program at our institution has been rather challenging due to patient acceptance, public awareness, and administrative resistance. The mean age of the case-mix was 43 ± 15 years (distribution: BN 39 ± 14, EC 61 ± 6, OC 36 ± 15, CC 50, OTH 41 ± 12 years). The body mass index for the case-mix was 30.3 ± 6.9 kg/m(2) (distribution: BN 29.7 ± 6.2, EC 34.0 ± 3.6, OC 20.0 ± 1.7, CC 48, OTH 30.2 ± 6.2 kg/m(2)). The histology of most EC cases was endometrioid adenocarcinoma. The mean operative time was case-mix 95 ± 43, BN 77 ± 26, EC 156 ± 30, OC 80 ± 35, CC 150, OTH 79 ± 23 min. Mean blood loss was case-mix 126, BN 129, EC 177, OC 67, CC 50, OTH 71 min. Two cases (3.3%) were converted to laparotomy (one each in EC and BN groups). Mean hospital length of stay was 2 days. Four cases (6.7%) experienced complications. Only 4/26 (15.4%) of cancer cases required adjuvant therapy. The data suggest that RA gynecologic/oncologic procedures are feasible and satisfactory to our Arabian patient population and comparable to the

  7. The development of cardiac surgery in West Africa--the case of Ghana.

    PubMed

    Edwin, Frank; Tettey, Mark; Aniteye, Ernest; Tamatey, Martin; Sereboe, Lawrence; Entsua-Mensah, Kow; Kotei, David; Baffoe-Gyan, Kofi

    2011-01-01

    West Africa is one of the poorest regions of the world. The sixteen nations listed by the United Nations in this sub-region have some of the lowest gross domestic products in the world. Health care infrastructure is deficient in most of these countries. Cardiac surgery, with its heavy financial outlay is unavailable in many West African countries. These facts notwithstanding, some West African countries have a proud history of open heart surgery not very well known even in African health care circles. Many African health care givers are under the erroneous impression that the cardiovascular surgical landscape of West Africa is blank. However, documented reports of open-heart surgery in Ghana dates as far back as 1964 when surface cooling was used by Ghanaian surgeons to close atrial septal defects. Ghana's National Cardiothoracic Center is still very active and is accredited by the West African College of Surgeons for the training of cardiothoracic surgeons. Reports from Nigeria indicate open-heart surgery taking place from 1974. Cote D'Ivoire had reported on its first 300 open-heart cases by 1983. Senegal reported open-heart surgery from 1995 and still runs an active center. Cameroon started out in 2009 with work done by an Italian group that ultimately aims to train indigenous surgeons to run the program. This review traces the development and current state of cardiothoracic surgery in West Africa with Ghana's National Cardiothoracic Center as the reference. It aims to dispel the notion that there are no major active cardiothoracic centers in the West African sub-region. PMID:22355425

  8. A case of giant ileal duplication in an adult, successfully treated with laparoscope-assisted surgery.

    PubMed

    Matsumoto, Yasunori; Tohma, Takayuki; Miyauchi, Hideaki; Suzuki, Kazufumi; Nishimori, Takanori; Ohira, Gaku; Narushima, Kazuo; Muto, Yorihiko; Maruyama, Tetsuro; Matsubara, Hisahiro

    2015-12-01

    Alimentary tract duplication is a rare congenital malformation but can occur anywhere along the digestive tract. Most patients become symptomatic in early childhood, and only a few cases of adult patients have been reported in the literature. We herein report a unique case of a giant ileal duplication in an adult, which was successfully treated with laparoscope-assisted surgery. A 60-year-old male was admitted because of abdominal pain. Imaging studies revealed a well-defined cystic mass, measuring 15 cm, in the ileocecal region. We diagnosed it as a duplicated ileum and performed laparoscope-assisted surgery. The duplication was successfully resected with attached normal ileum, and there were no major complications in the postoperative course. PMID:26943378

  9. Orthodontic-orthognathic interventions in orthognathic surgical cases: "Paper surgery" and "model surgery" concepts in surgical orthodontics.

    PubMed

    Gandedkar, Narayan H; Chng, Chai Kiat; Yeow, Vincent Kok Leng

    2016-01-01

    Thorough planning and execution is the key for successful treatment of dentofacial deformity involving surgical orthodontics. Presurgical planning (paper surgery and model surgery) are the most essential prerequisites of orthognathic surgery, and orthodontist is the one who carries out this procedure by evaluating diagnostic aids such as crucial clinical findings and radiographic assessments. However, literature pertaining to step-by-step orthognathic surgical guidelines is limited. Hence, this article makes an attempt to provide an insight and nuances involved in the planning and execution. The diagnostic information revealed from clinical findings and radiographic assessments is integrated in the "paper surgery" to establish "surgical-plan." Furthermore, the "paper surgery" is emulated in "model surgery" such that surgical bite-wafers are created, which aid surgeon to preview the final outcome and make surgical movements that are deemed essential for the desired skeletal and dental outcomes. Skeletal complexities are corrected by performing "paper surgery" and an occlusion is set up during "model surgery" for the fabrication of surgical bite-wafers. Further, orthodontics is carried out for the proper settling and finishing of occlusion. Article describes the nuances involved in the treatment of Class III skeletal deformity individuals treated with orthognathic surgical approach and illustrates orthodontic-orthognathic step-by-step procedures from "treatment planning" to "execution" for successful management of aforementioned dentofacial deformity.

  10. Orthodontic-orthognathic interventions in orthognathic surgical cases: "Paper surgery" and "model surgery" concepts in surgical orthodontics.

    PubMed

    Gandedkar, Narayan H; Chng, Chai Kiat; Yeow, Vincent Kok Leng

    2016-01-01

    Thorough planning and execution is the key for successful treatment of dentofacial deformity involving surgical orthodontics. Presurgical planning (paper surgery and model surgery) are the most essential prerequisites of orthognathic surgery, and orthodontist is the one who carries out this procedure by evaluating diagnostic aids such as crucial clinical findings and radiographic assessments. However, literature pertaining to step-by-step orthognathic surgical guidelines is limited. Hence, this article makes an attempt to provide an insight and nuances involved in the planning and execution. The diagnostic information revealed from clinical findings and radiographic assessments is integrated in the "paper surgery" to establish "surgical-plan." Furthermore, the "paper surgery" is emulated in "model surgery" such that surgical bite-wafers are created, which aid surgeon to preview the final outcome and make surgical movements that are deemed essential for the desired skeletal and dental outcomes. Skeletal complexities are corrected by performing "paper surgery" and an occlusion is set up during "model surgery" for the fabrication of surgical bite-wafers. Further, orthodontics is carried out for the proper settling and finishing of occlusion. Article describes the nuances involved in the treatment of Class III skeletal deformity individuals treated with orthognathic surgical approach and illustrates orthodontic-orthognathic step-by-step procedures from "treatment planning" to "execution" for successful management of aforementioned dentofacial deformity. PMID:27630506

  11. Anesthetic Management of a Patient with Myasthenia Gravis for Meningioma Surgery - A Case Report.

    PubMed

    Srivastava, V K; Agrawal, S; Ahmed, M; Sharma, S

    2015-01-01

    Myasthenia gravis is a disease of great challenge to the anesthesiologist, because it affects the neuromuscular junction. Anesthetic management involves either muscle relaxant or non-muscle relaxant techniques. This case report documents the safe use of fentanyl, propofol and sevoflurane combination guided by bispectral index, without the use of muscle relaxants in a patient with myasthenia gravis who presented for meningioma surgery. PMID:26620756

  12. A case of axillary web syndrome with subcutaneous nodules following axillary surgery.

    PubMed

    Reedijk, Michael; Boerner, Scott; Ghazarian, Danny; McCready, David

    2006-06-01

    Axillary web syndrome (AWS) is a cause of morbidity in the early postoperative period following axillary surgery, which is characterized by cords of subcutaneous tissue extending from the axilla into the medial arm. Few reports have been published describing this entity, which results in pain and a limitation of shoulder abduction. Here, we report a case of AWS that was accompanied with sub-cutaneous nodules mimicking recurrence of breast cancer. PMID:16257525

  13. Splenic infarction – A rare cause of acute abdominal pain following gastric surgery: A case series

    PubMed Central

    Yazici, Pinar; Kaya, Cemal; Isil, Gurhan; Bozkurt, Emre; Mihmanli, Mehmet

    2015-01-01

    Introduction The dissection of splenic hilar lymph nodes in gastric cancer surgery is indispensable for treating gastric cancers located in the proximal third of the stomach. Splenic vascular injury is a matter of debate resulting on time or delayed splenectomy. We aimed to share our experience and plausible mechanisms causing this complication in two case reports. Case presentations Two male patients with gastric cancer were diagnosed with acute splenic infarction following gastric surgery in the early postoperative period. Both underwent emergent exploratory laparotomy. Splenectomy was performed due to splenic infarction. Discussion Because we observed this rare complication in recent patients whose surgery was performed using vessel-sealing device for splenic hilar dissection, we suggested that extensive mobilization of the surrounding tissues of splenic vascular structures hilum using the vessel sealer could be the reason. Conclusion In case of acute abdominal pain radiating to left shoulder, splenic complications should be taken into consideration in gastric cancer patients performed radical gastrectomy. Meticulous dissection of splenic hilar lymph nodes should be carried out to avoid any splenic vascular injury. PMID:25818369

  14. Immediate function on the day of surgery compared with a delayed implant loading process in the mandible: a randomized clinical trial over 5 years

    PubMed Central

    Jokstad, Asbjorn; Alkumru, Hassan

    2014-01-01

    Objectives To appraise the feasibility of loading four implants with a pre-existing denture converted to a fixed dental prosthesis (FDP) on the day of implant surgery compared with waiting for 3- to 4-month healing. Methods Patients with an edentulous, fully healed mandible were recruited in a faculty clinic to partake in a blinded two-arm parallel randomized controlled trial (RCT). The participants received four parallel intraforamina mandibular implants with a moderately rough titanium surface (Brånemark System Mk III or Mk IV TiUnite; Nobel Biocare AB, Göteborg, Sweden). The implants were loaded on the same day by converting the participants' pre-existing denture in the experimental group. The implants were placed using a one-stage surgery procedure, and the participants' pre-existing denture were soft-relined in the control group. For both groups, the permanent 10- to 12-unit FDP consisting of a type-3 cast precious alloy veneered with acrylic and artificial teeth was placed 3–4 months after implant surgery. All participants have been recalled annually for 5 years for appraisal of bone loss and registration of adverse events. Results Thirty-five of the original 42 participants (83%) returned for clinical and radiological examinations at the 5-year follow-up recall. No selective dropout or specific reasons for dropout was identified in the two study arms; leaving n = 17 (Intention-to-treat group, ITT) in the experimental group, alternatively n = 13 as per protocol group (PP), and n = 18 participants in the control group (ITT = PP). At study commencement, five of the participants assigned to the experimental group did not receive their planned intervention. In the control group, one implant failed to osseointegrate and another failed due to bone loss after 5 years. The crestal bone level changes over 5 years were identical in the experimental and control groups, that is, 1.2 mm (SD = 0.7). There were no differences between the two study arms

  15. Minimally invasive surgery for superior mesenteric artery syndrome: A case report.

    PubMed

    Yao, Si-Yuan; Mikami, Ryuichi; Mikami, Sakae

    2015-12-01

    Superior mesenteric artery (SMA) syndrome is defined as a compression of the third portion of the duodenum by the abdominal aorta and the overlying SMA. SMA syndrome associated with anorexia nervosa has been recognized, mainly among young female patients. The excessive weight loss owing to the eating disorder sometimes results in a reduced aorto-mesenteric angle and causes duodenal obstruction. Conservative treatment, including psychiatric and nutritional management, is recommended as initial therapy. If conservative treatment fails, surgery is often required. Currently, traditional open bypass surgery has been replaced by laparoscopic duodenojejunostomy as a curative surgical approach. However, single incision laparoscopic approach is rarely performed. A 20-year-old female patient with a diagnosis of anorexia nervosa and SMA syndrome was prepared for surgery after failed conservative management. As the patient had body image concerns, a single incision laparoscopic duodenojejunostomy was performed to achieve minimal scarring. As a result, good perioperative outcomes and cosmetic results were achieved. We show the first case of a young patient with SMA syndrome who was successfully treated by single incision laparoscopic duodenojejunostomy. This minimal invasive surgery would be beneficial for other patients with SMA syndrome associated with anorexia nervosa, in terms of both surgical and cosmetic outcomes. PMID:26668518

  16. Case report: use caution when applying magnets to pacemakers or defibrillators for surgery.

    PubMed

    Schulman, Peter M; Rozner, Marc A

    2013-08-01

    The application of a magnet to a pacemaker (intended to cause asynchronous pacing) or implanted cardioverter defibrillator (intended to prevent shocks) during surgery without a clear understanding of actual magnet function(s) or precautions can have unexpected, untoward, or harmful consequences. In this report, we present 3 cases in which inadequate assessment of cardiac implanted electronic device (CIED) function, coupled with magnet application, contributed to or resulted in inappropriate antitachycardia pacing or shocks, CIED damage, or patient injury. Although these cases might be rare, they reinforce the need for a timely, detailed preoperative review of CIED function and programming as recommended by the American Society of Anesthesiologists and the Heart Rhythm Society.

  17. Reliable low-molecular-weight heparin reversal in a child undergoing emergency surgery: a case report.

    PubMed

    Botros, Mena M; Mahmoud, Mohamed A; Costandi, Andrew J

    2016-09-01

    Low-molecular-weight heparin neutralization using protamine alone can be unreliable, especially in cases of immediate reversal for emergency surgery. Here, we describe a unique case of a 17-month-old girl with a history of glioneuronal tumor and corresponding hydrocephalus status post debulking and ventriculoperitoneal shunt placement, who was placed on enoxaparin after the development of a sagittal sinus thrombosis. Patient presented for emergency craniectomy and evacuation of subdural bleed after a fall while on therapeutic dose of enoxaparin. Protamine and fresh frozen plasma were used in the patient's perioperative course providing a reliable reversal of enoxaparin. PMID:27555185

  18. Influence of depression, catastrophizing, anxiety, and resilience on postoperative pain at the first day after otolaryngological surgery: A prospective single center cohort observational study.

    PubMed

    Suffeda, Alexander; Meissner, Winfried; Rosendahl, Jenny; Guntinas-Lichius, Orlando

    2016-07-01

    The aim was to assess the association between objectified preoperative psychological factors and postoperative pain at the first day after otolaryngological surgery in accordance with other predictors of postoperative pain. Eighty-two (82) patients (59% male, median age 56 years) were included between January and May 2015. The psychological assessment the day before surgery included the Patient Health Questionnaire (PHQ-9), pain catastrophizing scale (PCS), State-Trait Operation Anxiety (STOA) inventory, and the resilience scale (RS-13). On first postoperative day, patients were rated their pain using the questionnaires of the German-wide project Quality Improvement in Postoperative Pain Treatment (QUIPS) including a numeric rating scale (NRS, 0-10) for determination of patient's maximal pain. QUIPS allowed standardized assessment of patients' characteristics, pain parameters, and outcome. The influence of preoperative and postoperative parameters on patients' maximal postoperative pain was estimated by univariate and multivariate statistical analysis. The mean maximal pain was 3.2 ± 2.9. In univariate analysis, higher PHQ-9 score more than 4 (P = 0.010), higher STOA trait anxiety (P = 0.044), and higher STOA total score (P = 0.043) were associated to more postoperative pain. In multivariate analysis higher PHQ-9 score remained an independent predictor for severe pain (beta = 0.302; 95% confidence interval [CI]: 0.054-0.473; P = 0.014). When all parameters were included into multivariate analysis, 2 of all somatic, psychological, and treatment factors were associated with severe maximal pain: more depression (PHQ-9; beta = 0.256; 95% CI: 0.042-0.404; P = 0.017), and use of opioids in the recovery room (beta = 0.371; 95% CI: 0.108-0.481; P = 0.002). Otolaryngological surgery covers the spectrum from low to severe postoperative pain and is therefore a good model for pain management studies. A set of somatic and psychological parameters seems to allow the

  19. 23-hour/next day discharge post-laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery is safe.

    PubMed

    Waydia, S; Gunawardene, A; Gilbert, J; Cota, A; Finlay, I G

    2014-11-01

    Laparoscopic Roux-en-Y gastric bypass (LRYGB) is well established, yet practice varies as to when patients should be discharged post operation. After noting that many LRYGB patients met our unit's discharge criteria sooner than anticipated, we implemented a policy of aiming for 23-h inpatient stay post LRYGB in January 2012. This retrospective study aimed to assess the safety of this policy. We reviewed data of all patients undergoing LRYGB at our unit from September 2010 to October 2013. We compared the lengths of inpatient stay, complication rates and re-admission rates of patients treated before and after the introduction of the 23-h length of stay policy. Of 161 LRYGB procedures, 38 patients (29 female) underwent LRYGB from September 2010 to December 2011 (pre-policy change) and 123 (107 female) underwent operation after this date (post-policy change). The two groups were similar in terms of mean age (46.5 vs. 46.7 years, p = 0.932), mean BMI (46.8 vs. 46.6 kg/m(2), p = 0.868) and median number of pre-operative comorbidities (3 vs. 3, p = 0.9). There were significant reductions in median length of inpatient stay (2 vs. 1 day, p < 0.0001), re-admission rate (21.1 to 6.5 %, p = 0.025) and complication rate (18.4 vs. 3.3 %, p = 0.004) after the policy change. There were seven complications pre-policy change: pulmonary embolus (n = 1), chest infection (n = 1), constipation and anal fissure (n = 1), umbilical hernia requiring operation (n = 2), adhesional obstruction (n = 1) and persistent food intolerance (n = 1). Post-policy changes, there were four complications: adhesional obstruction (n = 2), staple line bleeding (n = 1) and persistent dysphagia (n = 1). There were no deaths. Patients undergoing LRYGB can be safely discharged on the first post-operative day. This reduction in length of inpatient stay offers significant cost savings.

  20. What Influences Patient Participation in an Online Forum for Weight Loss Surgery? A Qualitative Case Study

    PubMed Central

    Faxvaag, Arild

    2014-01-01

    Background Many patients who undergo weight loss (bariatric) surgery seek information and social support in online discussion forums, but the vast amount of available information raises concerns about the impact of such information. A secure online discussion forum was developed and offered to bariatric surgery patients. The forum was moderated and allowed contact with peers and health care professionals. Objective The purposes of this study were to explore how individuals undergoing bariatric surgery used the moderated discussion forum and to better understand what influenced their participation in the forum. Methods The study was designed as an explorative case study. We conducted participant observation of the discussion forum over a time period of approximately six months. For further insight, we carried out in-depth semistructured interviews with seven patients who had access to the forum. We analyzed the material inductively, using content and thematic analysis. Results The patients used the forum as an arena in which to interact with peers and providers, as well as to provide and achieve informational and social support. The analysis suggests that there are three major themes that influenced participation in the online discussion forum: (1) the participant’s motivation to seek information, advice, and guidance, (2) the need for social support and networking among peers, and (3) concerns regarding self-disclosure. Conclusions The findings of this study imply that a moderated discussion forum for bariatric surgery patients has potential for use in a therapeutic context. The discussion forum fulfilled the informational and support needs of the bariatric surgery patients and was particularly useful for those who excluded themselves from the traditional program and experienced barriers to expressing their own needs. Even though our findings imply that the patients benefitted from using the forum regardless of their active or passive participation, restraining

  1. Major Surgery in A Jehovah Witness with Sickle Cell Disease: Case Presentation

    PubMed Central

    Anyaehie, Udo Ego; Nwadinigwe, Cajetan Uwatoronye; Nwosu, Arinze Duke; Ogbui, Valentine Ogochukwu

    2016-01-01

    Introduction: A Jehovah’s Witness belongs to the religious group that does not accept blood transfusion in any form, while a sickle cell disease patient has abnormal haemoglobins that do not last in circulation predisposing one to anaemia and other systemic complications. Performing a major surgery in a Jehovah’s Witness who has sickle cell disease is tasking for a surgeon. Case presentation: This case reports a 28-year-old African female with sickle cell disease who outrightly refused any form of blood transfusion as being a Jehovah’s Witness and having a complex primary hip that required total hip replacement. This work highlighted the complexity and difficulty encountered by virtue of the fact that patient had orthopaedic complications of Sickle Cell Disease and measures taken to prevent sickling crisis. Conclusion: It is possible to carry out major surgery in a sickler who has durable power of attorney not to receive blood, but optimum preparation, meticulous and fast surgery and adequate monitoring must be instituted to avert morbidity and mortality seen in this group of patients. PMID:27703935

  2. [A Case of Extrahepatic Hepatocellular Cancer Discovered during Gynecological Laparoscopic Surgery].

    PubMed

    Koga, Chikato; Murakami, Masayuki; Shimizu, Junzo; Yasuyama, Akinobu; Hitora, Toshiki; Oda, Naofumi; Kawabata, Ryohei; Hirota, Masaki; Yoshikawa, Masato; Morishima, Hirotaka; Ikenaga, Masakazu; Matsunami, Nobuki; Miwa, Hideaki; Hasegawa, Junichi

    2015-11-01

    Recently, laparoscopic surgery has become increasingly popular because of its lesser invasiveness, including smaller incisions, and fewer post-operative complications. It is also possible to observe the abdominal cavity by laparoscopy. We report a hepatocellular carcinoma arising in an accessory liver lobe detected during gynecological laparoscopic surgery. A 48-year-old woman who was undergoing laparoscopic hysterectomy for uterine fibroids was found to have a protruding, extrahepatic pedunculated tumor by intraoperative observation of the abdominal cavity during the fibroid procedure. We suspected FNH based on preoperative imaging findings, including abdominal ultrasound, computed tomographic scanning, and magnetic resonance imaging. We performed a laparoscopic partial hepatectomy. The cut surface of the tumor was similar to normal liver tissue. The pathological findings identified normal liver tissue and vessels, suggesting it was the accessory liver lobe. It also included a well-differentiated hepatocellular carcinoma. The final diagnosis was hepatocellular carcinoma arising in the accessory liver lobe. There have been no prior reports of extrahepatic liver tissue detected during gynecological surgery. This case reminded us of the importance of intra-abdominal observation during laparoscopic procedures. The opportunities to discover other cases of extrahepatic liver tissue by laparoscopy will increase. PMID:26805199

  3. Guillain-Barré syndrome (demyelinating) six weeks after bariatric surgery: A case report and literature review.

    PubMed

    Ishaque, Noman; Khealani, Bhojo A; Shariff, Amir H; Wasay, Muhammad

    2015-01-01

    Obesity is a major health problem worldwide. Bariatric surgery has been increasingly used to manage obesity. Many acute as well as chronic neurological complications have been reported after bariatric surgery including Guillain-Barré syndrome (GBS). An autoimmune process has been postulated as the underlying pathophysiology. Most of the reported cases of GBS after bariatric surgery are of the axonal variety. Here, we report a case of a demyelinating variety of GBS in a young woman who presented with acute onset of progressive weakness and paresthesia of all limbs within six weeks after bariatric surgery. She was treated with intravenous immunoglobulin (IVIG) and rehabilitation. She had complete recovery on follow-up. We believe that onset of acute inflammatory demyelinating polyradiculoneuropathy (AIDP), which is demyelinating variety of GBS, is associated with changes in immune system after bariatric surgery.

  4. Five fruit and vegetables and five praises a day: the case for a proactive approach.

    PubMed

    Sutton, Carole; Herbert, Martin

    2008-04-01

    The government has adopted the five outcomes of Every Child Matters as guiding principles for all those caring for and working with children. One of the ways in which efforts are being made to help children achieve good physical health is to encourage them to eat 'five fruit and vegetables a day'. This article sets out the case that practitioners can help children achieve good mental health by encouraging parents and those who care for children to give them at least'five praises a day'. Babies are predisposed from birth to make close social and emotional attachments with their main caregivers, and typically receive generous and loving admiration and appreciation. However, we know that some parents may not understand how infants and toddlers continue to need active nurturing attention, praise and positive messages from those who care for them as they grow. The authors seek to develop their inter-professional campaign to extend the 'five fruit and vegetables a day' maxim to include'five praises a day' for children. Health visitors are uniquely placed to help parents, to explain and encourage the contribution that praise and positive feedback make toward children's general wellbeing and sound mental health.

  5. Hand-held transendoscopic robotic manipulators: A transurethral laser prostate surgery case study

    PubMed Central

    Hendrick, Richard J.; Mitchell, Christopher R.; Herrell, S. Duke; Webster, Robert J.

    2016-01-01

    Natural orifice endoscopic surgery can enable incisionless approaches, but a major challenge is the lack of small and dexterous instrumentation. Surgical robots have the potential to meet this need yet often disrupt the clinical workflow. Hand-held robots that combine thin manipulators and endoscopes have the potential to address this by integrating seamlessly into the clinical workflow and enhancing dexterity. As a case study illustrating the potential of this approach, we describe a hand-held robotic system that passes two concentric tube manipulators through a 5 mm port in a rigid endoscope for transurethral laser prostate surgery. This system is intended to catalyze the use of a clinically superior, yet rarely attempted, procedure for benign prostatic hyperplasia. This paper describes system design and experiments to evaluate the surgeon’s functional workspace and accuracy using the robot. Phantom and cadaver experiments demonstrate successful completion of the target procedure via prostate lobe resection. PMID:27570361

  6. [The use of prosthesis material in emergency surgery. Comments on a clinical case].

    PubMed

    Pacifico, G; Landi, L; Rizzo, D; Corsi, A; Masi, C

    1998-10-01

    The authors briefly report the case of a patient in whom a double Mersilene graft was used to repair a strangulated umbilical hernia. This report is interesting for various reasons. Firstly, the fact that surgery was performed under emergency conditions and secondly, the position of the graft, which was certainly not ideal--even if obligatory owing to the circumstances under which the operation was performed--in the abdominal wall. In spite of the successful results obtained, the authors feel that graft should preferably be used in elective surgery in which additional operations are not required which may further contaminate the operating field. In particular, special attention should be paid to graft position in relation to the various layers of the abdominal wall.

  7. Sporadic gastric carcinoid tumor successfully treated by two-stage laparoscopic surgery: A case report

    PubMed Central

    Kinoshita, Takahiro; Oshiro, Takashi; Urita, Tasuku; Yoshida, Yutaka; Ooshiro, Mitsuru; Okazumi, Shinichi; Katoh, Ryoji; Sasai, Daisuke; Hiruta, Nobuyuki

    2010-01-01

    We report a case of sporadic gastric carcinoid tumor successfully treated by two-stage laparoscopic surgery. A 38-year old asymptomatic woman was referred to our hospital for evaluation of a submucosal tumor of the stomach. Endoscopic examination showed a solitary submucosal tumor without ulceration or central depression on the posterior wall of the antrum and biopsy specimens were not sufficient to determine the diagnosis. Endoscopic ultrasound revealed a tumor nearly 2 cm in diameter arising from the muscle layer and a computed tomography scan showed the tumor enhanced in the arterial phase. Laparoscopic wedge resection was performed for definitive diagnosis. Pathologically, the tumor was shown to be gastric carcinoid infiltrating the muscle layer which indicated the probability of lymph node metastasis. Serum gastrin levels were normal. As a radical treatment, laparoscopy-assisted distal gastrectomy with regional lymphadenectomy was performed 3 wk after the initial surgery. Finally, pathological examination revealed no lymph node metastasis. PMID:21160902

  8. The effects of a personal versus a factual approach videotape on the level of preoperative anxiety of same day surgery patients.

    PubMed

    Wicklin, N; Forster, J

    1994-06-01

    The literature which evaluates the effects of different health education techniques demonstrates that approaches that are more personal and relevant to the learner are more effective than traditional didactic learning methods. In particular, such findings have been found with regard to decreasing anxiety levels of hospital patients. However, not many of these studies have used the medium of videotape, and studies evaluating the effects of this medium are rare. This study compared the effects of a personal approach video with a factual approach video on the level of preoperative anxiety of same day surgery patients. It was hypothesized that those patients who viewed the personal approach video would have lower levels of preoperative anxiety than those who viewed the factual approach video. Multiple regression and analysis of variance (ANOVA) techniques indicated that gender was the most significant predictor of preoperative anxiety in this study. Recommendations for future research are offered.

  9. Surgery for spinal tuberculosis: a multi-center experience of 582 cases

    PubMed Central

    Phan, Kevin; Karim, Rezaul; Jonayed, Sharif Ahmed; Munir, Hasan Khalid Md.; Chakraborty, Shubhendu; Alam, Tashfique

    2015-01-01

    Background Tuberculosis (TB) of the spine is a common site of osseous TB, accounting for 50%-60% of cases. Spinal TB still occurs in both developed and developing countries. The diagnosis of spinal TB is difficult and it commonly presents at an advanced stage. Delays in establishing diagnosis and management result in complications such as spinal cord compression and spinal deformity. Methods A total of 582 patients with TB of the cervical, thoracic and lumbar spine with moderate to severe cord compression were studied. Variable degrees of neurological deficit with deformity were treated from January, 2003 to July, 2014. Thoracotomy along with anterolateral decompression and autogenous strut bone grafting with simultaneous fixation by screws and rods were performed in 113 cases. Posterior decompression, posterior interbody and posterolateral fusion by bone graft with stabilization by transpedicular screws and rods were done in the remaining 469 cases. Appropriate anti-TB drugs were given to all patients for 18-24 months. The follow-up period was 3 months to 10 years. Results The average age was 32.5 years. All patients survived surgery. There were 7 cases of superficial infections (1.2%) whilst there were 4 cases (0.7%) of deep infections. Revision surgery was performed in 6 patients (1.0%). Implant failure occurred in 4 cases (0.7%) whilst malposition of screws occurred in 12 cases (2.1%). Perioperative bleeding complications were reported for 4 patients (0.7%). Neurological improvement occurred in all patients except for 2 cases (0.3%). Preoperatively, the majority of patients (n=221, 38%) were classified with Class A on the American Spinal Injury Association (ASIS) neurological impairment scale. This was significantly reduced postoperatively to 0.4%. Conclusions For patients with spinal TB anterior debridement, auto graft bone fusion, anterior or posterior fixation appears to be effective in arresting disease, correcting kyphotic deformity and maintaining

  10. Laparoscopic and endoscopic cooperative surgery for duodenal neuroendocrine tumor (NET) G1: Report of a case

    PubMed Central

    Tsushimi, Takaaki; Mori, Hirohito; Harada, Takasuke; Nagase, Takashi; Iked, Yoshitaka; Ohnishi, Hiromo

    2014-01-01

    INTRODUCTION We report a case of duodenal neuroendocrine tumor (NET) G1 resected by laparoscopic and endoscopic cooperative surgery (LECS) technique. PRESENTATION OF CASE A 58-year-old woman underwent esophagastroduodenoscopy, revealing an 8-mm, gently rising tumor distal to the pylorus, on the anterior wall of the duodenal bulb. Endoscopic ultrasonography suggested the tumor might invade the submucosal layer. The tumor was pathologically diagnosed as a G1 duodenal NET, by biopsy. Endoscopic submucosal dissection was attempted, but was unsuccessful because of the difficulty of endoscopically performing an inversion operation in the narrow working space. The case was further complicated by the patient's duodenal ulcer scar. We performed a full-thickness local excision using laparoscopic and endoscopic cooperative surgery. The tumor was confirmed and endoscopically marked along the resection line. After full-thickness excision, using endoscopy and laparoscopy, interrupted full-thickness closure was performed laparoscopically. DISCUSSION Endoscopic treatment is generally recommended for G1 NETs <10 mm in diameter and extending only to the submucosal layer. However, some cases are difficult to resect endoscopically because the wall of duodenum is thinner than that of stomach, and endoscope maneuverability is limited within the narrow working space. LECS is appropriate for early duodenal G1 NETs because they are less invasive and resection of the lesion area is possible. CONCLUSION We demonstrated that LECS is a safe and feasible procedure for duodenal G1 NETs in the anterior wall of the first portion of the duodenum. PMID:25460463

  11. Single-surgeon fully endoscopic endonasal transsphenoidal surgery: outcomes in three-hundred consecutive cases.

    PubMed

    Mamelak, Adam N; Carmichael, John; Bonert, Vivien H; Cooper, Odelia; Melmed, Shlomo

    2013-09-01

    The objective of this study was to evaluate outcomes of endoscopic transsphenoidal surgery using a single-surgeon technique as an alternative to the more commonly employed two-surgeon, three-hand method. Three hundred consecutive endoscopic transsphenoidal procedures performed over a 5 year period from 2006 to 2011 were reviewed. All procedures were performed via a binasal approach utilizing a single surgeon two handed technique with a pneumatic endoscope holder. Expanded enodnansal cases were excluded. Surgical technique, biochemical and surgical outcomes, and complications were analyzed. 276 patients underwent 300 consecutive surgeries with a mean follow-up period of 37 ± 22 months. Non-functioning pituitary adenoma (NFPA) was the most common pathology (n = 152), followed by growth hormone secreting tumors (n = 41) and Rathke's cleft cysts (n = 30). Initial gross total cyst drainage based on radiologic criteria was obtained in 28 cases of Rathke's cleft cyst, with 5 recurrences. For NFPA and other pathologies (n = 173) gross total resection was obtained in 137 cases, with a 92% concordance rate between observed and expected extent of resection. For functional adenoma, remission rates were 30/41 (73%) for GH-secreting, 12/12 (100%) for ACTH-secreting, and 8/17 (47%) for prolactin-secreting tumors. Post-operative complications included transient (11%) and permanent (1.4%) diabetes insipidus, hyponatremia (13%), and new anterior pituitary hormonal deficits (1.4%). CSF leak occurred in 42 cases (15%), and four patients required surgical repair. Two carotid artery injuries occurred, both early in the series. Epistaxis and other rhinological complications were noted in 10% of patients, most of which were minor and diminished as surgical experience increased. Fully endoscopic single surgeon transsphenoidal surgery utilizing a binasal approach and a pneumatic endoscope holder yields outcomes comparable to those reported with a two-surgeon method. Endoscopic outcomes

  12. Case management vocational rehabilitation for women with breast cancer after surgery: a feasibility study incorporating a pilot randomised controlled trial

    PubMed Central

    2013-01-01

    Background There is a paucity of methodologically robust vocational rehabilitation (VR) intervention trials. This study assessed the feasibility and acceptability of a VR trial of women with breast cancer to inform the development of a larger interventional study. Methods Women were recruited in Scotland and randomised to either a case management VR service or to usual care. Data were collected on eligibility, recruitment and attrition rates to assess trial feasibility, and interviews conducted to determine trial acceptability. Sick leave days (primary outcome) were self-reported via postal questionnaire every 4 weeks during the first 6 months post-surgery and at 12 months. Secondary outcome measures were change in employment pattern, quality of life and fatigue. Results Of the 1,114 women assessed for eligibility, 163 (15%) were eligible. The main reason for ineligibility was age (>65 years, n = 637, 67%). Of those eligible, 111 (68%) received study information, of which 23 (21%) consented to participate in the study. Data for 18 (78%) women were analysed (intervention: n = 7; control: n = 11). Participants in the intervention group reported, on average, 53 fewer days of sick leave over the first 6 months post-surgery than those in the control group; however, this difference was not statistically significant (p = 0.122; 95% confidence interval −15.8, 122.0). No statistically significant differences were found for secondary outcomes. Interviews with trial participants indicated that trial procedures, including recruitment, randomisation and research instruments, were acceptable. Conclusions Conducting a pragmatic trial of effectiveness of a VR intervention among cancer survivors is both feasible and acceptable, but more research about the exact components of a VR intervention and choice of outcomes to measure effectiveness is required. VR to assist breast cancer patients in the return to work process is an important component of cancer survivorship plans. Trial

  13. Inhibition/Development of equatorial Spread F on magnetically disturbed days - A case study

    NASA Astrophysics Data System (ADS)

    Devasia, C. V.; Jyothi, N.; Pant, K. T.; Diwakar, T.; Sridharan, R.

    A case study of occurrence/ non-occurrence of Equatorial Spread F (ESF) events on several magnetically disturbed days over the magnetic equatorial location of Trivandrum (8.5°N; 77°E; dip 0.5°N) in India was conducted during March-April 1998. This study carried out under the ISTEP (Indian-STEP) program brought out some interesting aspects of the occurrence/non occurrence of ESF in relation to the nature of equatorial ionospheric response to the geomagnetic disturbance. The study indicated that the polarity and strength of the electric field disturbances which become active around noon hours on these days have an important role in modulating the development of Equatorial Ionization Anomaly (EIA). These electric field disturbances of larger timescales that are associated with ionospheric disturbance dynamo effects are shown to have a controlling effect on the F-region height rise, which in turn characterise the occurrence/ non- occurrence of ESF on different disturbed days. These aspects are discussed and presented.

  14. Bioabsorbable plates and screws in pediatric craniofacial surgery: a review of 22 cases.

    PubMed

    Kumar, A V; Staffenberg, D A; Petronio, J A; Wood, R J

    1997-03-01

    The purpose of this study was to evaluate the application of bioabsorbable fixation devices in reconstructive craniofacial procedures in the pediatric population. We reviewed 22 cases in which bioabsorbable plates and screws were used in craniofacial surgery for reconstruction. The procedures were performed in a 7-month period. The patients ranged in age from 5 to 228 months at the time of surgery (mean, 76.7 months). The postoperative clinical follow-up ranged from 2 to 16 weeks. The fixation devices were evaluated with regards to satisfactory fixation at the time of procedure. The postoperative follow-up evaluated clinical wound healing, signs of infection or local inflammation, and visibility or palpability of plates through the skin. All patients except one showed satisfactory wound healing with no sign of infection or local inflammation. The plates provided satisfactory fixation and were not visible through the skin. Two patients had plates that were palpable at the 4-month follow-up period. One patient with repair of a blow-out fracture of the orbit with resorbable mesh had redness and swelling over the wound site 2 weeks postoperatively with resolution 4 weeks postoperatively. Our early experience suggests reabsorbable fixation is an attractive option in pediatric plastic and craniofacial surgery. With further experience, this technology may represent the standard of care in reconstruction of the infant calvarium. PMID:10332274

  15. Case of Pleomorphic Dermal Sarcoma of the Eyelid Treated with Micrographic Surgery and Secondary Intention Healing

    PubMed Central

    Kim, Jung-In; Choi, Young-Jun; Seo, Hyun-Min; Kim, Han-Saem; Lim, Jae Yun; Kim, Dong-Hoon; Chae, Seoung Wan; Lee, Ga-Young

    2016-01-01

    Pleomorphic dermal sarcoma (PDS) is a rare mesenchymal neoplasm sharing histopathological features with atypical fibroxanthoma (AFX), but has additional features of deep invasion of the superficial subcutis, tumor necrosis and vascular/perineural invasion. It is not well documented in the literature because of its rarity, and its clinical course has been debated due to the lack of homogenous criteria. We describe here the case of a 91-year-old female with a 6-month history of a solitary, asymptomatic, well-defined, 3.4-cm-sized, reddish, hard, protruding mass on the lateral aspect of the right upper eyelid. On the basis of initial punch biopsy results, storiform cellular infiltrate of pleomorphic spindle and polygonal cells with frequent atypical mitoses, the lesion was identified as AFX. Following the initial biopsy, micrographic surgery was performed and a tumor-free margin was confirmed. Considering the conservation of the periocular function and the advanced age of the patient, we planned secondary intention healing rather than primary suturing. After surgery, skeletal muscle infiltration was found and the diagnosis was revised to PDS by a pathologist based on the currently accepted criteria for PDS. There has been no evidence of recurrence or periocular functional defects during a 2-year follow-up without adjuvant therapy. Although the PDS is highly malignant, complete excision under micrographic surgery can prevent recurrence without adjuvant therapy. Also, the secondary intention healing is an effective method for closure of large defects on the face. PMID:27746645

  16. Esophageal, pharyngeal and hemorrhagic complications occurring in anterior cervical surgery: Three illustrative cases

    PubMed Central

    Paradells, Víctor Rodrigo; Pérez, Juan Bosco Calatayud; Vicente, Francisco Javier Díar; Florez, Luciano Bances; de la Viuda, Marta Claramonte; Villagrasa, Francisco Javier

    2014-01-01

    Background: The number of esophageal and pharyngeal perforations occurring in anterior cervical surgeries ranges from 0.25% to 1% and 0.2% to 1.2%, respectively. Symptoms usually appear postoperatively and are attributed to: Local infection, fistula, sepsis, or mediastinitis. Acute postoperative hematoma, although very rare (<1%), is the first complication to rule out due to its life-threatening complications (e.g. acute respiratory failure). Case Description: Over a 36-year period, the author(s) described three severe esophageal/pharyngeal complications attributed to anterior cervical surgery. As these complications were appropriately recognized/treated, patients had favorable outcomes. Conclusions: Anterior cervical spine surgery is a safe approach and is associated with few major esophageal/pharyngeal complications, which most commonly include transient dysphagia and dysphonia. If symptoms persist, patients should be assessed for esophageal/pharyngeal defects utilizing appropriate imaging studies. Notably, even if the major complications listed above are adequately treated, optimal results are in no way guaranteed. PMID:24843808

  17. Surgery in extensive vertebral hemangioma: case report, literature review and a new algorithm proposal.

    PubMed

    Tarantino, Roberto; Donnarumma, Pasquale; Nigro, Lorenzo; Delfini, Roberto

    2015-07-01

    Hemangiomas are benign dysplasias or vascular tumors consisting of vascular spaces lined with endothelium. Nowadays, radiotherapy for vertebral hemangiomas (VHs) is widely accepted as primary treatment for painful lesions. Nevertheless, the role of surgery is still unclear. The purpose of this study is to propose a novel algorithm of treatment about VHs. This is a case report of an extensive VH and a review of the literature. A case of vertebral fracture during radiotherapy at a total dose of 30 Gy given in 10 fractions (treatment time 2 weeks) using a linear accelerator at 15 MV high-energy photons for extensive VH is reported. Using PubMed database, a review of the literature is done. The authors have no study funding sources. The authors have no conflicting financial interests. In the literature, good results in terms of pain and neurological deficits are reported. No cases of vertebral fractures are described. However, there is no consensus regarding the treatment for VHs. Radiotherapy is widely utilized in VHs determining pain. Surgery for VHs determining neurological deficit is also widely accepted. Perhaps, regarding the width of the lesion, no indications are given. We consider it important to make an evaluation before initiating the treatment for the risk of pathologic vertebral fracture, since in radiotherapy, there is no convention regarding structural changes determined in VHs. We propose a new algorithm of treatment. We recommend radiotherapy only for small lesions in which vertebral stability is not concerned. Kyphoplasty can be proposed for asymptomatic patients in which VHs are small and in patients affected by VHs determining pain without spinal canal invasion in which the VH is small. In patients affected by pain without spinal canal invasion but in which the VH is wide or presented with spinal canal invasion and in patients affected by neurological deficits, we propose surgery. PMID:25720346

  18. Surgery in extensive vertebral hemangioma: case report, literature review and a new algorithm proposal.

    PubMed

    Tarantino, Roberto; Donnarumma, Pasquale; Nigro, Lorenzo; Delfini, Roberto

    2015-07-01

    Hemangiomas are benign dysplasias or vascular tumors consisting of vascular spaces lined with endothelium. Nowadays, radiotherapy for vertebral hemangiomas (VHs) is widely accepted as primary treatment for painful lesions. Nevertheless, the role of surgery is still unclear. The purpose of this study is to propose a novel algorithm of treatment about VHs. This is a case report of an extensive VH and a review of the literature. A case of vertebral fracture during radiotherapy at a total dose of 30 Gy given in 10 fractions (treatment time 2 weeks) using a linear accelerator at 15 MV high-energy photons for extensive VH is reported. Using PubMed database, a review of the literature is done. The authors have no study funding sources. The authors have no conflicting financial interests. In the literature, good results in terms of pain and neurological deficits are reported. No cases of vertebral fractures are described. However, there is no consensus regarding the treatment for VHs. Radiotherapy is widely utilized in VHs determining pain. Surgery for VHs determining neurological deficit is also widely accepted. Perhaps, regarding the width of the lesion, no indications are given. We consider it important to make an evaluation before initiating the treatment for the risk of pathologic vertebral fracture, since in radiotherapy, there is no convention regarding structural changes determined in VHs. We propose a new algorithm of treatment. We recommend radiotherapy only for small lesions in which vertebral stability is not concerned. Kyphoplasty can be proposed for asymptomatic patients in which VHs are small and in patients affected by VHs determining pain without spinal canal invasion in which the VH is small. In patients affected by pain without spinal canal invasion but in which the VH is wide or presented with spinal canal invasion and in patients affected by neurological deficits, we propose surgery.

  19. Cutaneous manifestations of kwashiorkor: a case report of an adult man after abdominal surgery.

    PubMed

    Mann, Danielle; Presotto, Carolina; Queen, Stella Maria Facó; Oliveira, Elisa Fontenelle de; Gripp, Alexandre Carlos

    2011-01-01

    Kwashiorkor is a type of protein-energy malnutrition where diet protein deficit is found, in spite of appropriate caloric intake. Cutaneous manifestations include xerosis, with abnormally dry skin that has a flaking enamel paint aspect, a typical red to gray-white hair color, the "flag sign" and more evident edema in lower limbs and face, giving it a full moon appearance. This article reports a case of a male adult patient who had undergone Whipple surgery for treatment of chronic pancreatitis associated with pseudotumor of the pancreatic head that progressed to cutaneous manifestations of kwashiorkor after pulmonary tuberculosis.

  20. 1004 cases of traumatic cataract surgery with implantation of an intraocular lens.

    PubMed

    Fyodorov, S N; Egorova, E V; Zubareva, L N

    1981-04-01

    Traumatic cataracts occurring after ocular trauma were removed by phacoemulsification, cryoextraction or extracapsular cataract extraction, depending on the degree of lens absorption. All eyes received sputnik-style iridocapsular lenses. Most cases were complicated by the presence of synechiae and/or the need for iridoplasty. The surgical technique varied with the specific nature of the ocular pathology. Eyes with penetrating injuries has a higher complication rate. Anterior chamber shallowing or collapse was the most frequent intraoperative complication, and was directly related to the incidence of postoperative complications. Most postoperative complications were typical of those associated with cataract surgery in complicated situations. PMID:7263486

  1. Perioperative morbidity and outcome of esophageal surgery in dogs and cats: 72 cases (1993-2013).

    PubMed

    Sutton, Jessie S; Culp, William T N; Scotti, Katherine; Seibert, Rachel L; Lux, Cassie N; Singh, Ameet; Wormser, Chloe; Runge, Jeffrey J; Schmiedt, Chad W; Corrie, Jessica; Phillips, Heidi; Selmic, Laura E; Nucci, Daniel J; Mayhew, Philipp D; Kass, Philip H

    2016-10-01

    OBJECTIVE To evaluate perioperative morbidity and outcome in dogs and cats undergoing esophageal surgery. DESIGN Retrospective case series. ANIMALS 63 client-owned dogs and 9 client-owned cats. PROCEDURES Medical records of dogs and cats that underwent esophageal surgery were reviewed for information on signalment, history, results of preoperative diagnostic testing, condition treated, details of surgery, intraoperative complications, and postoperative complications. Long-term follow-up data were obtained via veterinarian and client telephone conversations. The relationship between complications and survival to hospital discharge was evaluated by means of regression analysis. RESULTS The most common indication for surgical intervention was an esophageal foreign body in dogs (50/63 [79%]) and esophageal stricture in cats (3/9). Complications were documented in 54% (34/63) of dogs and 3 of 9 cats. The most common immediate postoperative complications were respiratory in nature (9 dogs, 1 cat). Partial esophagectomy and resection with anastomosis were significantly associated with the development of immediate postoperative complications in dogs. The most common delayed postoperative complications were persistent regurgitation (7 dogs) and esophageal stricture formation (3 dogs, 1 cat). For dogs, a mass lesion and increasing lesion size were significantly associated with the development of delayed postoperative complications. Six dogs (10%) and 1 cat died or were euthanized prior to discharge, and pneumomediastinum and leukopenia were negative prognostic factors for dogs being discharged from the hospital. CONCLUSIONS AND CLINICAL RELEVANCE Results of this study suggested that the short-term prognosis for dogs and cats that survive surgery for treatment of esophageal lesions is favorable, with 90% of patients discharged from the hospital (57/63 dogs; 8/9 cats). However, dogs treated for more extensive esophageal lesions as well as those undergoing esophagectomy or

  2. Management of traumatic dental injury after periodontal surgery in patient with hereditary gingival fibromatosis: case report.

    PubMed

    Inagaki, Koji; Kamei, Hidehiko; Mitani, Akio; Noguchi, Toshihide

    2014-06-01

    Traumatic Dental Injury (TDI) is often caused by a bruise from a sports-related incident or fall. In individuals with maxillary protrusion, the risk for TDI may be higher. We treated a patient with Hereditary Gingival Fibromatosis (HGF), a rare genetic disorder characterized by proliferative fibrous overgrowth of gingival tissue, who subsequently received a TDI after periodontal surgery. A 13-year-old Japanese boy was referred to the Division of Periodontics at Aichi Gakuin University Dental Hospital in March 2005 with the chief complaint of generalized severe gingival overgrowth involving the maxillary and mandibular arches covering nearly all teeth. Prior to orthodontic treatment, periodontal surgery was performed under general anesthesia in consideration of mastication, dental esthetics, and development. However, soon thereafter in August 2007, the protruded maxillary anterior teeth received an injury while he was playing basketball and the maxillary central incisors showed extrusive luxation. Two weeks after being reset, the maxillary anterior teeth were splinted with wire and adhesive resin cement, and then the splint was removed following evaluations of clinical and radiographic showing signs of normal periodontium. The marginal bone height corresponded to that seen in radiographic findings after the reset and orthodontic treatment was started 1 year later. At the 6-year follow-up examination, the teeth remained asymptomatic, pulpal response to sensitivity tests was normal, and healing was shown in radiographic images. In the present HGF case, we speculated that removal of thick gingiva around the teeth, which might have functioned as a mouth guard, increased the risk for TDI while playing sports. TDI is more likely to occur in patients with exposed protruded misaligned teeth after periodontal surgery. Therefore, it is important for HGF patients with such protruded maxillary anterior teeth to use a mouth guard when participating in sports following

  3. Quality measures for total ankle replacement, 30-day readmission and reoperation rates within 1 year of surgery: a data linkage study using the NJR data set

    PubMed Central

    Zaidi, Razi; Macgregor, Alexander J; Goldberg, Andy

    2016-01-01

    Objective To report on the rate of 30-day readmission and the rate of additional or revision surgery within 12 months following total ankle replacement (TAR). Design A data-linkage study of the UK National Joint Registry (NJR) data and Hospital Episodes Statistics (HES) database. These two databases were linked in a deterministic fashion. HES episodes 12 months following the index procedure were isolated and analysed. Logistic regression was used to model predictors of reoperation and revision for primary ankle replacement. Participants All patients who underwent primary and revision ankle replacements according to the NJR between February 2008 and February 2013. Results The rate of 30-day readmission following primary and revision ankle replacement was 2.2% and 1.3%, respectively. In the 12 months following primary and revision ankle replacements, the revision rate (where implants needed to be removed) was 1.2% with increased odds in those orthopaedic units preforming <20 ankle replacements per year and patients with a preoperative fixed equinus deformity. The reoperation other than revision (where implants were not removed) in the 12 months following primary and revision TARs was 6.6% and 9.3%, respectively. Rheumatoid arthritis, cemented prosthesis and high ASA grade significantly increased the odds of reoperation. Conclusions TAR has a 30-day readmission rate of 2.2%, which is similar to that of knee replacement but lower than that of total hip replacement. 6.6% of patients undergoing primary TAR require a reoperation within 12 months of the index procedure. Early revision rates are significantly higher in low-volume centres. PMID:27217286

  4. Implementing world class manufacturing ideas: A case study at the Dalles/John Day Dams

    SciTech Connect

    Armentrout, T.B.

    1995-12-31

    The key question is can a very autocratically lead, vertically defined organization change to a horizontal, employee empowered structure where the employees have significant influence? All too often managers look to a simple and easy procedure which will bring about dramatic change, however this kind of dreaming is naive. {open_quotes}For every complex question there is a simple answer, and it is wrong!{close_quotes} This experience described in this case indicates the transformation from the autocratic extreme to the team model takes a long time and is a difficult process. To begin the transformation at The Dalles and John Day has taken concerted effort over six years to set the foundations in place. Guiding the organization to a complete restructuring will take at least several more years. Managers and organizations who are not willing to make the long term commitment need not attempt the change!

  5. All-day recordings to investigate vocabulary development: A case study of a trilingual toddler

    PubMed Central

    2010-01-01

    Major innovations are becoming available for research in language development and disorders. Among these innovations, recent tools allow naturalistic recording in children’s homes and automated analysis to facilitate representative sampling. The present study employed all-day recordings during the second year of life in a child exposed to three languages, using a fully-wearable battery-powered recorder, with automated analysis to locate appropriate time periods for coding. This method made representative sampling possible, and afforded the opportunity for a case study indicating that language spoken directly to the child had dramatically more effect on vocabulary learning than audible language not spoken to the child, as indicated by chi-square analyses of the child’s verbal output and input in each of the languages. The work provides perspective on the role of learning words by overhearing in childhood, and suggests the value of representative naturalistic sampling as a means of research on vocabulary acquisition. PMID:21037965

  6. A case of surgery for congenital esophagobronchial fistula accompanied by a destroyed lung.

    PubMed

    Ikeda, Masaki; Murata, Yoshitake; Ohnishi, Ryoko; Kato, Tatsuo; Hara, Akira; Fujinaga, Takuji

    2016-12-01

    Congenital esophagobronchial fistula (EBF) is rarely seen in adults. We report a case of EBF detected in adulthood with a destroyed lung. A 67-year-old man experienced repeated pneumonia during his childhood. Since the age of 38, he had often suffered from bloody phlegm and always had a cough and sputum during oral intake. Before cardiac surgery for atrial fibrillation and valvular disease, computed tomography (CT) detected bronchiectasis, which could cause pulmonary bleeding during heart surgery, and the patient was introduced to our hospital for lung resection. A fistula between the esophagus and the right lower lung lobe was found using CT, esophagoscopy, and esophagography. Contrast CT and angiography revealed an abnormal artery branching from the inferior phrenic artery into the lobe. As indicated by intraoperative findings, the middle and lower lobes had strongly adhered to chest wall and diaphragm, but we located the fistula easily without adhesion to the surroundings, severed it using an automatic stapler, and resected the middle and lower lobes. The symptoms disappeared immediately, and the patient was uneventfully discharged.The diagnosis of congenital EBF was established with intraoperative findings and pathological exam. The existence of pulmonary sequestration was suggested because of the long-term absence of any symptoms during his adulthood, the tract of the EBF running into the lung, not directly into the bronchus, and a septum pathologically detected in the right lower lobe. A congenital EBF should be considered for differential diagnosis in cases of limited bronchiectasis in elderly people. PMID:27612868

  7. Antiseptic phobia in a patient experiencing anesthesia awareness during cleft palate repair surgery: a case report.

    PubMed

    Fang, Jun; Prakash, Ravi

    2013-01-01

    Specific phobia is an excessive and irrational fear often triggered by a stressor. Among different types of phobias arising in medical settings, we could not find any case reported for exclusively antiseptic fluids without any medical-surgical intervention. The term "anesthesia awareness" (AA) signifies the specific surgical period of time when an individual, in spite of being under intended general anesthesia, remains aware of the sensory stimuli and the memories of which also remain available for his subsequent explicit recall in the future. According to the "American Society of Anesthesiologists Practice Advisory", it is explicit recall during general anesthesia. Its hallmark is the presence of awareness of the events going on during the surgical procedure while being under a general anesthesia. AA is a distressing condition with immediate and long-term consequences. In spite of an estimated prevalence of 0.1%-0.2% of all the surgeries, our knowledge about this condition is limited. The most commonly reported consequences of AA are acute painful flashbacks of surgical events along with the emotional turmoil and a sense of helplessness followed later by posttraumatic stress disorder. Here, we report a unique case of occurrence of "antiseptic-phobia" in a patient following the experience of anesthesia awareness during cleft palate repair surgery. PMID:23725824

  8. Perioperative stroke in a patient undergoing surgery for oral cancer: A case report

    PubMed Central

    Sukegawa, Shintaro; Kanno, Takahiro; Kanai, Kengo; Mandai, Toshiko; Shibata, Akane; Takahashi, Yuka; Hirata, Yuji; Furuki, Yoshihiko

    2016-01-01

    Carotid artery stenosis is a significant risk factor for stroke. In elderly patients with carotid atherosclerosis and stenosis, it is not unusual for oral, head and neck cancer surgery to be performed. The present study describes a case of stroke that occurred during a neck dissection for the treatment of cervical lymph node metastasis of a left maxillary gingival carcinoma. The patient was an 84-year-old female who was considered to be at high risk of a stroke based on pre-operative head and neck computed tomography scans, which detected severe carotid atherosclerosis and stenosis. There was no possible stroke prophylaxis available during the performance of the neck dissection in the present case. However, if patients are evaluated to be high-risk pre-operatively, statin agents should be administered, the surgery should be carefully performed, adequate sedation should be maintained post-operatively and the patient should be followed up, aiming to achieve the early detection of a possible stroke. PMID:27698839

  9. Piezoelectric surgery and navigation: a safe approach for complex cases of Eagle syndrome.

    PubMed

    Spalthoff, S; Zimmerer, R; Dittmann, O; Tavassol, F; Dittmann, J; Gellrich, N-C; Jehn, P

    2016-10-01

    Eagle syndrome was first described by Eagle in 1937. It is associated with an elongated styloid process and/or calcification of the stylohyoid ligament, mainly resulting in pain in the orofacial region. The treatment of Eagle syndrome includes conservative treatment with physical therapy supported by medication, or surgical removal of the styloid process. Two different surgical approaches are described in the literature: the transoral and transcervical approaches. Both have their limitations and specific intraoperative risks. A modification of the transcervical approach that adds an extra security measure to the treatment of complex cases of Eagle syndrome is presented herein. The styloid process was removed by combining piezoelectric surgery, preoperative digital planning, and surgical navigation. No complication was noted, and the patient recovered quickly after surgery. A follow-up visit 2 months later showed no remaining symptoms of Eagle syndrome on the treated side. Therefore, digital planning and surgical navigation could add valuable safety measures to the treatment of complex cases of Eagle syndrome. PMID:27261164

  10. Piezoelectric surgery and navigation: a safe approach for complex cases of Eagle syndrome.

    PubMed

    Spalthoff, S; Zimmerer, R; Dittmann, O; Tavassol, F; Dittmann, J; Gellrich, N-C; Jehn, P

    2016-10-01

    Eagle syndrome was first described by Eagle in 1937. It is associated with an elongated styloid process and/or calcification of the stylohyoid ligament, mainly resulting in pain in the orofacial region. The treatment of Eagle syndrome includes conservative treatment with physical therapy supported by medication, or surgical removal of the styloid process. Two different surgical approaches are described in the literature: the transoral and transcervical approaches. Both have their limitations and specific intraoperative risks. A modification of the transcervical approach that adds an extra security measure to the treatment of complex cases of Eagle syndrome is presented herein. The styloid process was removed by combining piezoelectric surgery, preoperative digital planning, and surgical navigation. No complication was noted, and the patient recovered quickly after surgery. A follow-up visit 2 months later showed no remaining symptoms of Eagle syndrome on the treated side. Therefore, digital planning and surgical navigation could add valuable safety measures to the treatment of complex cases of Eagle syndrome.

  11. Perioperative stroke in a patient undergoing surgery for oral cancer: A case report

    PubMed Central

    Sukegawa, Shintaro; Kanno, Takahiro; Kanai, Kengo; Mandai, Toshiko; Shibata, Akane; Takahashi, Yuka; Hirata, Yuji; Furuki, Yoshihiko

    2016-01-01

    Carotid artery stenosis is a significant risk factor for stroke. In elderly patients with carotid atherosclerosis and stenosis, it is not unusual for oral, head and neck cancer surgery to be performed. The present study describes a case of stroke that occurred during a neck dissection for the treatment of cervical lymph node metastasis of a left maxillary gingival carcinoma. The patient was an 84-year-old female who was considered to be at high risk of a stroke based on pre-operative head and neck computed tomography scans, which detected severe carotid atherosclerosis and stenosis. There was no possible stroke prophylaxis available during the performance of the neck dissection in the present case. However, if patients are evaluated to be high-risk pre-operatively, statin agents should be administered, the surgery should be carefully performed, adequate sedation should be maintained post-operatively and the patient should be followed up, aiming to achieve the early detection of a possible stroke.

  12. [An unusual case of a 35 days preterm birth of a German Holstein calf].

    PubMed

    Reinartz, Sina; Höltershinken, Martin; Distl, Ottmar

    2016-01-01

    A female calf of the breed German Holstein (GH) was spontaneously born on July 28, 2013 which was 35 days before the expected term of birth. The dam was a heifer when she got pregnant from the first insemination on November 23, 2012. Calving was without complications. The calf was fully viable and without visible anomalies. We assume that the calf was fully mature at the termination of the pregnancy. Growth rate after the second month of life was comparable to calves born in the same herd after normal length of gestation. The sire of this preterm calf was a GH-bull used for artificial insemination. This bull had already sired 151 daughters. For this bull, preterm calvings were not yet reported. The dam was a heifer, and neither external influences on this dam or in the herd could be identified that could have induced this premature calving. In the herd, no further premature calvings were observed or reasons associated with a preterm calving were found. In this exceptional case, however, gestation length was 248 days and the prematurely born calf survived without any signs of debility, organ defects and respiratory distress.

  13. [An unusual case of a 35 days preterm birth of a German Holstein calf].

    PubMed

    Reinartz, Sina; Höltershinken, Martin; Distl, Ottmar

    2016-01-01

    A female calf of the breed German Holstein (GH) was spontaneously born on July 28, 2013 which was 35 days before the expected term of birth. The dam was a heifer when she got pregnant from the first insemination on November 23, 2012. Calving was without complications. The calf was fully viable and without visible anomalies. We assume that the calf was fully mature at the termination of the pregnancy. Growth rate after the second month of life was comparable to calves born in the same herd after normal length of gestation. The sire of this preterm calf was a GH-bull used for artificial insemination. This bull had already sired 151 daughters. For this bull, preterm calvings were not yet reported. The dam was a heifer, and neither external influences on this dam or in the herd could be identified that could have induced this premature calving. In the herd, no further premature calvings were observed or reasons associated with a preterm calving were found. In this exceptional case, however, gestation length was 248 days and the prematurely born calf survived without any signs of debility, organ defects and respiratory distress. PMID:26904901

  14. Complications of mesh repair in hiatal surgery: about 3 cases and review of the literature.

    PubMed

    De Moor, Véronique; Zalcman, Marc; Delhaye, Myriam; El Nakadi, Issam

    2012-08-01

    Primary repair of large hiatal hernia is associated with high recurrence rate. The use of prosthetic mesh to reinforce the cure seems to lead to less recurrence. Unfortunately, this procedure is still controversial in regard of the possible complications that may occur. We report here 3 cases of complications related to mesh placement in hiatal hernia surgery: an esophageal perforation, an intragastric migration, and a fundic erosion. When a patient complains of epigastric pain or dysphagia with no peritoneal signs, in the postoperative course of mesh placement, an upper endoscopy should be achieved to rule out those complications. The patient must be informed about the mesh placement and he must notify the endoscopist in case of an upper gastrointestinal endoscopy.

  15. Effectiveness of neoadjuvant chemotherapy with cisplatin and irinotecan followed by surgery on small-cell carcinoma of the esophagus: A case report

    PubMed Central

    Akiyama, Yuji; Iwaya, Takeshi; Shioi, Yoshihiro; Endo, Fumitaka; Chiba, Takehiro; Otsuka, Koki; Nitta, Hiroyuki; Koeda, Keisuke; Mizuno, Masaru; Uesugi, Noriyuki; Kimura, Yusuke; Sasaki, Akira

    2015-01-01

    Introduction Small-cell carcinoma of the esophagus (SCCE) is a rare disease with aggressive progression and a poor prognosis. A standard treatment strategy for SCCE is yet to be established. Presentation of case A 40-year-old woman with dysphagia was admitted to our hospital. A clinical diagnosis of SCCE (T3N1N0 stage IIIA) was established. She was initially treated with chemotherapy using cisplatin (CDDP) and irinotecan (CPT-11). After two courses of treatment, the primary lesion in the esophagus was not detectable by esophageal endoscopy. Likewise, swelling of the right recurrent nerve lymph node present prior to treatment could not be detected. The chemotherapy resulted in a complete response. One month after the conclusion of chemotherapy, radical esophagectomy with three-field lymph node dissection was performed. Histopathological examination of the excised specimen revealed no residual tumor or lymph node metastasis. The patient was discharged from hospital 29 days after surgery with no complications. The patient is alive and has remained cancer-free for 48 months after the surgery. Discussion Systemic chemotherapy for SCCE in combination with surgery was treated after surgery in most reports. Neoadjuvant chemotherapy is advantageous from three viewpoints, namely achievement of downstaging, increasing complete resection rates, and a better completion of treatment compared with postoperative chemotherapy. Neoadjuvant chemotherapy following esophagectomy could be a useful treatment option for patients with limited disease (LD) of SCCE. Conclusion We report a case of SCCE achieving a pathologically complete response with neoadjuvant chemotherapy using CDDP and CPT-11, and long-term survival followed by surgery. PMID:26615446

  16. Death due to disruption of sternal fixation wire--a rare complication after open heart surgery through sternotomy: report of a case.

    PubMed

    Chang, H; Hung, C R

    1989-04-01

    Following sternotomy for open heart surgery, a 57-year-old man had the sternum closed in the usual manner with six No.22 gauge stainless steel wire sutures. Twenty-four days later, sternum disruption occurred with only one wire suture in place, 3 wire sutures cutting through the bone, and 2 wire sutures fractured. A lacerating injury over the anterior surface of the right ventricle was rendered by these 2 fractured wires followed by fatal outcome. To our knowledge, death induced by fractured wires has not been reported. We report in this communication what we believe to be the first case in the literature. PMID:2794943

  17. Long-term Follow-up of a Case of Gold Shunt Surgery for Refractory Silicone Oil–induced Glaucoma

    PubMed Central

    Le, Ryan; Berger, Alan R.

    2016-01-01

    Purpose: To report the first case of gold shunt surgery for treatment of silicone oil–induced refractory glaucoma in a tertiary care academic center, with 5-year follow-up. Design: The study design is a case report. Participants: The participant was a patient who underwent gold shunt surgery. Methods: Institutional Research Ethics Board approval for the study was obtained. A diabetic patient was referred for refractory glaucoma with a history of proliferative diabetic retinal detachment, and surgery with silicone oil. She was uncontrolled on maximal medical therapy and following informed consent, gold shunt surgery was performed. Ocular outcomes and number of medications were reviewed over a 5-year period. Results: Following uncomplicated surgery, intraocular pressure was reduced from 41 to 14 mm Hg, and the number of medications was reduced from 4 to 1. Glaucomatous optic neuropathy remained stable. Conclusions: Gold shunt surgery in this challenging case of silicone oil refractory glaucoma provided long-term intraocular pressure control and reduced need for medication over a 5-year period. PMID:27253968

  18. Video assisted thoracoscopic surgery cases with right-sided aortic arch aneurysm and complete vascular ring: Case report

    PubMed Central

    Nezafati, Mohammad Hassan; Nezafati, Pouya

    2014-01-01

    Introduction Right-sided aortic arch with aberrant left subclavian artery and ligamentum arteriosum, after double aortic arch, is the second most common complete vascular ring. It was traditionally treated by open surgical thoracotomy and recently video assisted thoracoscopic surgery (VATS) has been used in some cases. Presentation of case We describe the cases of two infants who presented with gastroesophageal reflux, dyspnea, dysphagia secondary to aneurysmal dilatation of the retroesophageal arch confirmed by imaging data. VATS procedure was performed through a left thoracoscopic approach. Ligamentum arteriosus compressed esophagus was clipped, sectioned and then released the esophagus in one case; also, In the second case, we clipped and sectioned aorta, distal to the origin of aberrant left subclavian artery. Discussion CT angiography and MRI are known to be the most effective available imaging methods for vascular ring detection. Also, there are several surgical approaches to vascular rings such as, thoracotomy and thoracoscopy. There is a large body of evidence confirming the safety, efficacy and convenience of VATS as a therapeutic option for congenital heart disease including right-sided aortic arch and aberrant left subclavian artery. Conclusion VATS is a less invasive and safe strategy for management of right-sided aortic arch with aberrant left subclavian artery and ligamentum arteriosum. PMID:25544489

  19. Open heart surgery

    MedlinePlus

    Heart surgery - open ... lung machine is used in most cases during open heart surgery. While the surgeon works on the ... with these procedures, the surgeon may have to open the chest to do the surgery.

  20. A Case of Nonalcoholic Steatohepatitis and Small Intestinal Bacterial Overgrowth with Peripheral Edema Caused by Intestinal Bypass Surgery and Relieved by Repair

    PubMed Central

    Sung, Young Kyung; Gwak, Geum Youn; Choi, Moon Seok; Koh, Kwang Chul; Paik, Seung Woon; Yoo, Byung Chul

    2012-01-01

    Intestinal bypass surgery, particularly jejuno-ileal bypass surgery, performed for the purpose of weight reduction may cause an unexpected exacerbation of nonalcoholic steatohepatitis (NASH). Here, we report a case of NASH caused by small intestinal bacterial overgrowth, which developed after jejuno-colic bypass surgery and resolved dramatically after surgical correction. PMID:23170161

  1. Postoperative analgesia for day-case herniorrhaphy patients. A comparison of cryoanalgesia, paravertebral blockade and oral analgesia.

    PubMed

    Wood, G J; Lloyd, J W; Bullingham, R E; Britton, B J; Finch, D R

    1981-06-01

    Patients were admitted as day-cases for inguinal herniorrhaphy under epidural anaesthesia and chlormethiazole sedation. The patients were given oral analgesia, and in addition, some were given either a paravertebral block with a dextran/bupivacaine mixture or cryoanalgesia of the ilio-inguinal nerve for postoperative pain relief. These anaesthetic and analgesic techniques are discussed in relation to day-case herniorrhaphy. PMID:7270829

  2. Surgery-triggered and non surgery-triggered Bisphosphonate-related Osteonecrosis of the Jaws (BRONJ): A retrospective analysis of 567 cases in an Italian multicenter study.

    PubMed

    Vescovi, Paolo; Campisi, Giuseppina; Fusco, Vittorio; Mergoni, Giovanni; Manfredi, Maddalena; Merigo, Elisabetta; Solazzo, Luigi; Gabriele, Mario; Gaeta, Giovanni M; Favia, Gianfranco; Peluso, Franco; Colella, Giuseppe

    2011-03-01

    Invasive local procedures are often reported in clinical history of patients suffering from Bisphosphonates-Related Osteonecrosis of the Jaws (BRONJ) but over 40% of spontaneous forms have been also described in literature. We compared age, gender, underlying bone disorders, bisphosphonate therapy, clinical features and surgical outcome of 205 cases (36.2%) of BRONJ non surgery-triggered (group 1) with 362 (63.8%) cases of surgery-triggered forms (group 2). Differences between group 1 and 2 were analysed using Mann-Whitney U and χ(2) tests. Statistical analysis was performed using STATA 8. Zoledronate was the most used type of bisphosphonate (63.4% versus 69.0%) and the mandible was the most frequently involved site (63.9% versus 63.4%) in both groups. BRONJ in group 1 was more frequently multicentric (9.3% versus 5%, p<0.05), had a lower clinical stage (45.9% versus 13.8% in stage 1, p<0.01) and had a better outcome after surgical therapy (improvement in 74.1% versus 58.6%, p<0.05). The high prevalence of non surgery-triggered forms of BRONJ should be considered by oncologists, haematologists and general physicians who are advised to inform their patients regarding the importance of preventive dental protocols to control the possible causes of osteonecrosis not related to dental invasive procedures.

  3. Factors contributing to successful interorganizational collaboration: the case of CS2day.

    PubMed

    Olson, Curtis A; Balmer, Jann T; Mejicano, George C

    2011-01-01

    Continuing medical education's transition from an emphasis on dissemination to changing clinical practice has made it increasingly necessary for CME providers to develop effective interorganizational collaborations. Although interorganizational collaboration has become commonplace in most sectors of government, business, and academia, our review of the literature and experience as practitioners and researchers suggest that the practice is less widespread in the CME field. The absence of a rich scholarly literature on establishing and maintaining interorganizational collaborations to provide continuing education to health professionals means there is little information about how guidelines and principles for effective collaboration developed in other fields might apply to continuing professional development in health care and few models of successful collaboration. The purpose of this article is to address this gap by describing a successful interorganizational CME collaboration-Cease Smoking Today (CS2day)-and summarizing what was learned from the experience, extending our knowledge by exploring and illustrating points of connection between our experience and the existing literature on successful interorganizational collaboration. In this article, we describe the collaboration and the clinical need it was organized to address, and review the evidence that led us to conclude the collaboration was successful. We then discuss, in the context of the literature on effective interorganizational collaboration, several factors we believe were major contributors to success. The CS2day collaboration provides an example of how guidelines for collaboration developed in various contexts apply to continuing medical education and a case example providing insight into the pathways that lead to a collaboration's success. PMID:22190099

  4. Stratus-Fog Formation and Dissipation: A 6-Day Case Study

    NASA Astrophysics Data System (ADS)

    Dupont, Jean-Charles; Haeffelin, Martial; Protat, Alain; Bouniol, Dominique; Boyouk, Neda; Morille, Yohann

    2012-04-01

    A suite of active and passive remote sensing instruments and in-situ sensors deployed at the SIRTA Observatory (Instrumented Site for Atmospheric Remote Sensing Research), near Paris, France, for a period of six months (October 2006-March 2007) document simultaneously radiative, microphysical and dynamic processes driving the continental-fog life cycle. The study focuses on a 6-day period between 23 and 29 December 2006 characterized by several stratus-cloud lowering and lifting events and almost 18 h of visibility below 1 km. Conceptual models and different possible scenarios are presented here to explain the formation, the development and the dissipation phases of three major stratus-fog events and to quantify the impact of each driving process. For example, slowly evolving large-scale conditions characterized by a slow continuous cloud-base lowering, followed by a rapid transient period conductive to fog formation and dissipation, are observed for cases 1 and 3. During this stable period, continuous cloud-top radiative cooling (≈ -160 Wm-2) induces a progressive and slow lowering of the cloud base: larger droplets at cloud top (cloud reflectivity approximately equals to -20 dBZ) induce slow droplet fall to and beyond cloud base (Doppler velocity ≈ -0.1 ms-1), cooling the sub-cloud layer by evaporation and lowering the saturation level to 100 m (case 1) or to the surface (cases 2 and 3). Suddenly, a significant increase in Doppler velocity magnitude ≈ -0.6 ms-1 and of turbulent kinetic energy dissipation rate around 10-3 m2s-3 occurs at cloud base (case 1). These larger cloud droplets reach the surface leading to fog formation over 1.5 h. The Doppler velocity continues to increase over the entire cloud depth with a maximum value of around -1 ms-1 due to the collection of fog droplets by the drizzle drops with high collection efficiency. As particles become larger, they fall to the ground and lead to fog dissipation. Hence, falling particles play a major

  5. Anterior cervical discectomy and fusion in the outpatient ambulatory surgery setting compared with the inpatient hospital setting: analysis of 1000 consecutive cases.

    PubMed

    Adamson, Tim; Godil, Saniya S; Mehrlich, Melissa; Mendenhall, Stephen; Asher, Anthony L; McGirt, Matthew J

    2016-06-01

    OBJECTIVE In an era of escalating health care costs and pressure to improve efficiency and cost of care, ambulatory surgery centers (ASCs) have emerged as lower-cost options for many surgical therapies. Anterior cervical discectomy and fusion (ACDF) is one of the most prevalent spine surgeries performed, and the frequency of its performance is rapidly increasing as the aging population grows. Although ASCs offer significant cost advantages over hospital-based surgical centers, concern over the safety of outpatient ACDF has slowed its adoption. The authors intended to 1) determine the safety of the first 1000 consecutive ACDF surgeries performed in their outpatient ASC, and 2) compare the safety of these outpatient ACDFs with that of consecutive ACDFs performed during the same time period in the hospital setting. METHODS A total of 1000 consecutive patients who underwent ACDF in an ACS (outpatient ACDF) and 484 consecutive patients who underwent ACDF at Vanderbilt University Hospital (inpatient ACDF) from 2006 to 2013 were included in this retrospective study of patients' medical records. Data were collected on patient demographics, comorbidities, operative details, and perioperative and 90-day morbidity. Perioperative morbidity and hospital readmission were compared between the outpatient and inpatient ACDF groups. RESULTS Of the first 1000 outpatient ACDF cases performed in the authors' ASC, 629 (62.9%) were 1-level and 365 (36.5%) were 2-level ACDFs. Mean patient age was 49.5 ± 8.6, and 484 (48.4%) were males. All patients were observed postoperatively at the ASC postanesthesia care unit (PACU) for 4 hours before being discharged home. Eight patients (0.8%) were transferred from the surgery center to the hospital postoperatively (for pain control [n = 3], chest pain and electrocardiogram changes [n = 2], intraoperative CSF leak [n = 1], postoperative hematoma [n = 1], and profound postoperative weakness and surgical reexploration [n = 1]). No perioperative

  6. Anterior cervical discectomy and fusion in the outpatient ambulatory surgery setting compared with the inpatient hospital setting: analysis of 1000 consecutive cases.

    PubMed

    Adamson, Tim; Godil, Saniya S; Mehrlich, Melissa; Mendenhall, Stephen; Asher, Anthony L; McGirt, Matthew J

    2016-06-01

    OBJECTIVE In an era of escalating health care costs and pressure to improve efficiency and cost of care, ambulatory surgery centers (ASCs) have emerged as lower-cost options for many surgical therapies. Anterior cervical discectomy and fusion (ACDF) is one of the most prevalent spine surgeries performed, and the frequency of its performance is rapidly increasing as the aging population grows. Although ASCs offer significant cost advantages over hospital-based surgical centers, concern over the safety of outpatient ACDF has slowed its adoption. The authors intended to 1) determine the safety of the first 1000 consecutive ACDF surgeries performed in their outpatient ASC, and 2) compare the safety of these outpatient ACDFs with that of consecutive ACDFs performed during the same time period in the hospital setting. METHODS A total of 1000 consecutive patients who underwent ACDF in an ACS (outpatient ACDF) and 484 consecutive patients who underwent ACDF at Vanderbilt University Hospital (inpatient ACDF) from 2006 to 2013 were included in this retrospective study of patients' medical records. Data were collected on patient demographics, comorbidities, operative details, and perioperative and 90-day morbidity. Perioperative morbidity and hospital readmission were compared between the outpatient and inpatient ACDF groups. RESULTS Of the first 1000 outpatient ACDF cases performed in the authors' ASC, 629 (62.9%) were 1-level and 365 (36.5%) were 2-level ACDFs. Mean patient age was 49.5 ± 8.6, and 484 (48.4%) were males. All patients were observed postoperatively at the ASC postanesthesia care unit (PACU) for 4 hours before being discharged home. Eight patients (0.8%) were transferred from the surgery center to the hospital postoperatively (for pain control [n = 3], chest pain and electrocardiogram changes [n = 2], intraoperative CSF leak [n = 1], postoperative hematoma [n = 1], and profound postoperative weakness and surgical reexploration [n = 1]). No perioperative

  7. Kyphotic deformity after laminectomy surgery for a gunshot wound to the spine: a case report

    PubMed Central

    Taheri, Morteza

    2016-01-01

    Spinal kyphotic deformity after spinal laminectomy or laminoplasty is more common in pediatric patients than adults. Laminectomy can lead to decreased cartilage growth, anterior wedging and posterior spinal muscle insufficiency which can result in kyphotic deformity. Herein we outline a case report of a child presenting with kyphotic deformity after receiving a spinal laminectomy to treat a penetrating spinal trauma. The 8-year-old male presented with penetrating spinal trauma following a gunshot wound and subsequently underwent L1 laminectomy and thecal sac decompression to remove the foreign body. In a follow-up examination approximately one month after surgery, imaging revealed kyphotic deformity and the patient was referred to the Rasoul-e-Akram Hospital. The patient then underwent surgical reconstruction. The postoperative computed tomography (CT) scan showed appropriate repair of sagittal balance and the patient’s symptoms gradually improved. Post-laminectomy kyphosis is a notable concern and complication in the pediatric population and can occur shortly after surgery. The following interventions can decrease the likelihood of post-laminectomy kyphosis: minimal muscle dissection and bone removal during laminectomy, avoidance of facet disruption, use of laminoplasty rather than laminectomy, postoperative immobilization/bracing and regular follow-up for early detection and treatment of any deformity.

  8. Anesthetic considerations for an adult heart transplant recipient undergoing noncardiac surgery: a case report.

    PubMed

    Valerio, Regalado; Durra, Omar; Gold, Michele E

    2014-08-01

    Approximately 3,500 Americans undergo heart transplantation each year. A portion of this patient population will possibly present later for an elective noncardiac surgery. Anesthesia professionals can be tasked to assess and provide the anesthesia management for heart transplant recipients undergoing a noncardiac surgical procedure. A 57-year-old man with a complicated cardiac history before undergoing heart transplantation was scheduled to undergo a right inguinal hernia repair. The patient underwent general anesthesia and had an uneventful course of surgery and recovery. Management of the patient with a heart transplant includes consideration of the altered physiology of a denervated heart; the perioperative anesthetic considerations specific to this patient population; and the risks of rejection, infection, and pharmacologic interactions brought about by immunosuppression. The purposes of this case report were to discuss the indications for the perioperative care of heart transplant recipients undergoing noncardiac procedures, and to discuss the evidence-based literature to provide delivery of safe and effective patient care. PMID:25167609

  9. Kyphotic deformity after laminectomy surgery for a gunshot wound to the spine: a case report.

    PubMed

    Babashahi, Ali; Taheri, Morteza

    2016-03-01

    Spinal kyphotic deformity after spinal laminectomy or laminoplasty is more common in pediatric patients than adults. Laminectomy can lead to decreased cartilage growth, anterior wedging and posterior spinal muscle insufficiency which can result in kyphotic deformity. Herein we outline a case report of a child presenting with kyphotic deformity after receiving a spinal laminectomy to treat a penetrating spinal trauma. The 8-year-old male presented with penetrating spinal trauma following a gunshot wound and subsequently underwent L1 laminectomy and thecal sac decompression to remove the foreign body. In a follow-up examination approximately one month after surgery, imaging revealed kyphotic deformity and the patient was referred to the Rasoul-e-Akram Hospital. The patient then underwent surgical reconstruction. The postoperative computed tomography (CT) scan showed appropriate repair of sagittal balance and the patient's symptoms gradually improved. Post-laminectomy kyphosis is a notable concern and complication in the pediatric population and can occur shortly after surgery. The following interventions can decrease the likelihood of post-laminectomy kyphosis: minimal muscle dissection and bone removal during laminectomy, avoidance of facet disruption, use of laminoplasty rather than laminectomy, postoperative immobilization/bracing and regular follow-up for early detection and treatment of any deformity. PMID:27683698

  10. Allergic reaction to patent blue dye in breast surgery - case report.

    PubMed

    Maranhão, Marcius Vinícius M; da Nóbrega, Dyluzia Kelly Amaral; Anunciação, Carlos Eduardo Caiado; Maia, Barbara de Alcântara Brito; Mariano, Paulo Virgílio Dantas

    2016-01-01

    We present a case of allergic reaction to patent blue in a patient who underwent excision of sentinel lymph node associated with segmental breast resection. About 20min after the dye injection, the patient developed hypotension (BP=70×30mmHg) associated with increased heart frequency. The patient was treated successfully with decreased inspired fraction of inhaled anesthetic and fluid replacement. At the end of the procedure, she presented with bluish urticarial-like plaques on the head, neck, upper limbs, and trunk; hydrocortisone was then used. The patient recovered uneventfully and was discharged from the PACU 2h after the end of surgery without skin changes, and was discharged from hospital on the morning after surgery. The incidence of allergic reactions with the use of patent blue is far superior to the hypersensitivity reactions seen with anesthetic and adjuvant drugs. Therefore, the anesthesiologist must be aware of cardiovascular instability associated with skin changes during the use of patent blue, for early diagnosis and appropriate treatment of this hypersensitivity reaction to this dye. PMID:27343798

  11. [Allergic reaction to patent blue dye in breast surgery - case report].

    PubMed

    Maranhão, Marcius Vinícius M; Nóbrega, Dyluzia Kelly Amaral da; Anunciação, Carlos Eduardo Caiado; Maia, Barbara de Alcântara Brito; Mariano, Paulo Virgílio Dantas

    2016-01-01

    We present a case of allergic reaction to patent blue in a patient who underwent excision of sentinel lymph node associated with segmental breast resection. About 20minutes after the dye injection, the patient developed hypotension (BP=70×30mmHg) associated with increased heart frequency. The patient was treated successfully with decreased inspired fraction of inhaled anesthetic and fluid replacement. At the end of the procedure, she presented with bluish urticarial - like plaques on the head, neck, upper limbs, and trunk; hydrocortisone was then used. The patient recovered uneventfully and was discharged from the PACU two hours after the end of surgery without skin changes, and was discharged from hospital on the morning after surgery. The incidence of allergic reactions with the use of patent blue is far superior to the hypersensitivity reactions seen with anesthetic and adjuvant drugs. Therefore, the anesthesiologist must be aware of cardiovascular instability associated with skin changes during the use of patent blue, for early diagnosis and appropriate treatment of this hypersensitivity reaction to this dye. PMID:25458838

  12. Treatment of a post surgery defect of the lower lip: a case report.

    PubMed

    Di Lauro, A E; Abbate, D; Dell'angelo, B; Di Lauro, F; Sammartino, G

    2010-01-01

    We present the clinical case of a patient, CT of 35 years who came to our observation for the appearance of a recurrent mucocele on the lower lip. The mucocele or retention cyst is a benign lesion of minor salivary glands characterized by swelling, which can vary from a few millimeters to several centimeters, as determined by retention of secretion due to partial or total obstruction of an excretory duct. Current thinking is that the mucocele is formed due to traumatic events or inflammatory, malformation of the excretory duct or parenchyma of the minor salivary glands. Once framed the patient from a clinical point of view we performed surgery, which provides complete enucleation of the lesion by about 7 mm. The clinical suspicion was confirmed by histological diagnosis as extraductal mucocele. After about six months after surgery, at complete healing, resulted a residual imperfections with a loss of substance in the area. To eliminate this defect, poorly tolerated by the patient, we decided to use a filler of hyaluronic acid, which, although it is an absorbable material, results in an excellent appearance and does not expose to complications like the use of inducible permanent. PMID:21217631

  13. Piezoelectric surgery in mandibular split crest technique with immediate implant placement: a case report

    PubMed Central

    BELLEGGIA, F.; POZZI, A.; ROCCI, M.; BARLATTANI, A.; GARGARI, M.

    2009-01-01

    SUMMARY Implant supported rehabilitation of thin edentulous ridges with horizontal atrophy necessitates a regenerative approach. Within the procedures for horizontal bone defects augmentation, ridge expansion techniques permit dislocation of the buccal bone plate in a labial direction and simultaneous implant insertion in single-stage surgery, abbreviating overall treatment time. The piezoelectric ridge expansion technique permits to obtain the expansion of very mineralized bone crests without excessive traumas or the risk of ridge fractures. The case reported shows an implant treatment for partial edentulous lower arch rehabilitation. A full-split thickness flap was raised. The mucoperiosteal reflection permitted to identify alveolar crest contour where osteotomies had to be performed. Split thickness dissection allowed periosteal blood supply to be mainteined on the buccal bone plate. After horizontal and vertical osteotomies were performed with OT7 piezoelectric microsaw (Piezo-surgery, Mectron), a single-bevel scalpel was used to move the buccal bone plate to the labial. Two Straumann TE 3.3/4.8 mm wide implants were inserted in the lower right premolar area, and 1 Straumann 4.8 mm Wide Neck implant was inserted to replace lower right first molar. The amount of bone expansion was equal to the cervical diameter of the placed implants (4.8 mm) and residual bone gap was packed with Bio-Oss granules (Geistlich). Healing was uneventful and 3 months later final restorations with implant-supported porcelain-fused-to-metal crowns were cemented. PMID:23285347

  14. Allergic reaction to patent blue dye in breast surgery - case report.

    PubMed

    Maranhão, Marcius Vinícius M; da Nóbrega, Dyluzia Kelly Amaral; Anunciação, Carlos Eduardo Caiado; Maia, Barbara de Alcântara Brito; Mariano, Paulo Virgílio Dantas

    2016-01-01

    We present a case of allergic reaction to patent blue in a patient who underwent excision of sentinel lymph node associated with segmental breast resection. About 20min after the dye injection, the patient developed hypotension (BP=70×30mmHg) associated with increased heart frequency. The patient was treated successfully with decreased inspired fraction of inhaled anesthetic and fluid replacement. At the end of the procedure, she presented with bluish urticarial-like plaques on the head, neck, upper limbs, and trunk; hydrocortisone was then used. The patient recovered uneventfully and was discharged from the PACU 2h after the end of surgery without skin changes, and was discharged from hospital on the morning after surgery. The incidence of allergic reactions with the use of patent blue is far superior to the hypersensitivity reactions seen with anesthetic and adjuvant drugs. Therefore, the anesthesiologist must be aware of cardiovascular instability associated with skin changes during the use of patent blue, for early diagnosis and appropriate treatment of this hypersensitivity reaction to this dye.

  15. [Allergic reaction to patent blue dye in breast surgery - case report].

    PubMed

    Maranhão, Marcius Vinícius M; Nóbrega, Dyluzia Kelly Amaral da; Anunciação, Carlos Eduardo Caiado; Maia, Barbara de Alcântara Brito; Mariano, Paulo Virgílio Dantas

    2016-01-01

    We present a case of allergic reaction to patent blue in a patient who underwent excision of sentinel lymph node associated with segmental breast resection. About 20minutes after the dye injection, the patient developed hypotension (BP=70×30mmHg) associated with increased heart frequency. The patient was treated successfully with decreased inspired fraction of inhaled anesthetic and fluid replacement. At the end of the procedure, she presented with bluish urticarial - like plaques on the head, neck, upper limbs, and trunk; hydrocortisone was then used. The patient recovered uneventfully and was discharged from the PACU two hours after the end of surgery without skin changes, and was discharged from hospital on the morning after surgery. The incidence of allergic reactions with the use of patent blue is far superior to the hypersensitivity reactions seen with anesthetic and adjuvant drugs. Therefore, the anesthesiologist must be aware of cardiovascular instability associated with skin changes during the use of patent blue, for early diagnosis and appropriate treatment of this hypersensitivity reaction to this dye.

  16. A case of petrous apex cholesterol granuloma successfully treated with endoscopic endonasal surgery.

    PubMed

    Miyamura, Sayuru; Yamaguchi, Satoshi; Tominaga, Atsushi; Kinoshita, Yasuyuki; Takeda, Masaaki; Usui, Satoshi; Morishige, Mizuki; Sugiyama, Kazuhiko; Kurisu, Kaoru

    2014-12-01

    A transcranial approach in combination with a transpetrosal setting has been the mainstream of surgical treatment of cholesterol granulomas in the petrous apex. However, endoscopic endonasal surgery has become a choice of treatment for these lesions with recent advancements in surgical techniques and instruments. We report a successful case of cholesterol granuloma managed with endoscopic endonasal surgery. A 45-year-old woman, who had a long-standing history of otitis media, presented with left abducens nerve palsy and discomfort around the left eye. Magnetic resonance (MR) imaging showed a large cystic lesion, suggesting cholesterol granuloma, in the left middle fossa abutting the cavernous sinus and lateral wall of the sphenoid sinus. We chose an endoscopic endonasal approach to drain the contents of the cyst because the lesion protruded into the left sphenoid sinus. The sphenoid sinus was widely opened and the cyst wall was fenestrated with the assistance of an image guidance navigation system. Postoperative MR images confirmed the complete collapse of the cyst. She has been free from symptoms since the operation. PMID:25707092

  17. [Continuous cervical epidural with ropivacaine in carotid surgery. Description of a case].

    PubMed

    Musinu, C; Cagetti, M

    1998-12-01

    In the light of the recent addition of ropivacaine as a local anesthetic to our pharmacopeia, its effects at the cervical level are examined. A patient undergoing TEAC was given continuous epidural anesthesia with ropivacaine 0.5% (total dose: 167.5 mg in three hours) at C6-C7. No supplementary i.v. anesthetic was administered intraoperatively. The results obtained were compared with those of a similar case as to type of pathology and anesthetic technique, who was anesthetised with bupivacaine 0.375% (total dose: 112.5 mg in three hours-continuous epidural anesthesia) + fentanyl (0.18 mg), supplemented intravenously with ketoprophene (200 mg) + fentanyl (0.15 mg) for analgesic reasons. From this comparison, ropivacaine 0.5% was found to have greater anesthetic potential than bupivacaine 0.375%. However, it did not appear that ropivacaine exerted a protective effect on cardiovascular conditions in the course of carotid surgery. Further anesthesiologic experiences are needed to define the validity of ropivacaine in cervical surgery.

  18. Technical considerations in transforaminal endoscopic spine surgery at the thoracolumbar junction: report of 3 cases.

    PubMed

    Telfeian, Albert E; Jasper, Gabriele P; Oyelese, Adetokunbo A; Gokaslan, Ziya L

    2016-02-01

    OBJECTIVE In this study the authors describe the technical considerations and feasibility of transforaminal discectomy and foraminoplasty for the treatment of lumbar radiculopathy in patients who have herniated discs at the thoracolumbar junction. METHODS After institutional review board approval, charts from 3 consecutive patients with lumbar radiculopathy and T12-L1 herniated discs who underwent endoscopic procedures between 2006 and 2014 were reviewed. RESULTS Consecutive cases (n = 1316) were reviewed to determine the incidence and success of surgery performed at the T12-L1 level. Only 3 patients (0.23%) treated with endoscopic surgery for their herniated discs had T12-L1 herniated discs; the rest were lumbar or lumbosacral herniations. For patients with T12-L1 disc herniations, the average preoperative visual analog scale score was 8.3 (indicated in the questionnaire as describing severe and constant pain). The average 1-year postoperative visual analog scale score was 1.7 (indicated in the questionnaire as mild and intermittent pain). CONCLUSIONS Transforaminal endoscopic discectomy and foraminotomy can be used as a safe yet minimally invasive technique for the treatment of lumbar radiculopathy in the setting of a thoracolumbar disc herniation. PMID:26828890

  19. LDL apheresis for cholesterol embolism following coronary artery bypass graft surgery--a case report.

    PubMed

    Sanai, Toru; Matsui, Rei; Hirano, Tadashi

    2006-01-01

    A 76-year-old man without any prior history of abnormal urinalysis findings or renal insufficiency demonstrated mild renal dysfunction after coronary bypass graft surgery (CABG). Two months after CABG, pain and blueness in the toes (blue toe syndrome) appeared and, the serum creatinine level (S-Cr) increased from 1.2 to 2.0 mg/dL. On admission (3 months later), the urinary protein level was 0.5 g/day, white blood cell count 8,300/microL with eosinophils (Eo) 10.5%, S-Cr 2.1 mg/dL, and low-density lipoprotein (LDL) 106 mg/dL. Acute renal failure and blue toe syndrome due to a cholesterol embolism (CE) were diagnosed. Alprostadil 40 microg/day orally for 2 weeks and alprostadil 40 microg/day intravenously were used for 5 weeks, and Eo were 250/microL, S-Cr 2.5 mg/dL; however, blue toe syndrome gradually developed. At 8 weeks after admission, limaprost alfadex 30 microg/day orally was used for 3 weeks. However, the Eo gradually rose to 1,520/microL, S-Cr to 3.0 mg/dL, and LDL to 135 mg/dL, and LDL apheresis was therefore performed 20 times for CE. The data just after LDL apheresis was performed 10 times were as follows: Eo 1,120/microL, S-Cr 4.0 mg/dL, and LDL 89 mg/dL, and blue toe syndrome had disappeared. At 10 months after the first LDL apheresis, the Eo were 630/microL, S-Cr 2.9 mg/dL, and LDL 109 mg/dL. As a result, LDL apheresis was found to be beneficial for the treatment of CE with acute renal failure and blue toe syndrome after CABG.

  20. [Two cases of acute large bowel obstruction caused by advanced cancer treated with stenting "bridge to surgery" procedure].

    PubMed

    Ishii, Aya; Sugiyama, Masahiko; Ohta, Mitsuhiko; Sumida, Yorinobu; Kimura, Yasue; Tsutsumi, Norifumi; Yamashita, Yo-Ichi; Saeki, Hiroshi; Uchiyama, Hideaki; Kawanaka, Hirofumi; Morita, Masaru; Sakaguchi, Yoshihisa; Ikeda, Tetsuo; Kusumoto, Tetsuya; Harada, Naohiko; Ikejiri, Koji; Maehara, Yoshihiko

    2013-12-01

    Obstructive colorectal cancer accounts for 3.1-15.8% of total colorectal cancer cases, therefore it is not a rare condition. Formerly, it has been often treated with emergent operation such as colostomy or trans-anal tube decompression. Since 2012, revision of the medical payment system, it has become possible to be treated with elective operation when using endoscopic metal stent placement that enable to decompress enlarged intestine by transanal approach. This procedure provides safe elective surgery with sufficient preoperative inspection and conventional bowel preparation. We report two cases of acute large bowel obstruction due to colon cancer treated with endoscopic stent placement as a "bridge to surgery".

  1. [A case of laparoscopic surgery for a rectal carcinoid after ALTA therapy for an internal hemorrhoid].

    PubMed

    Aomatsu, Naoki; Nakamura, Masanori; Hasegawa, Tsuyoshi; Nakao, Shigetomi; Uchima, Yasutake; Aomatsu, Keiho

    2014-11-01

    We report a case of laparoscopic surgery for a rectal carcinoid after aluminum potassium and tannic acid (ALTA) therapy for an internal hemorrhoid. A 66-year-old man was admitted to our hospital because of bleeding during defecation. He was diagnosed via anoscopy with Goligher grade II internal hemorrhoids. Examination via colonoscopy revealed 2 yellowish submucosal tumors in the lower rectum that were 5mm and 10mm in diameter. A rectal carcinoid tumor was diagnosed based on histopathology. Abdominal computed tomography demonstrated no metastases to the liver or lymph nodes. First, we performed ALTA therapy for the internal hemorrhoids. Two weeks later, we performed laparoscopic-assisted low anterior resection (D2) for the rectal carcinoid. The patient was discharged without complications and has not experienced recurrence during the 2 years of follow-up care.

  2. [New technologies in planning and performance of osteotonics: example cases in hand surgery].

    PubMed

    Schweizer, Andreas

    2013-05-01

    New technologies improved the techniques of osteotomies, which remained over decades unchanged, and made bone cuts possible, which earlier on hardly were feasible. The introduction of simple applicable software can process CT data on a PC to reconstruct 3D models of a bone and to compare its shape with the mirror of the opposite side. This first allows an exact analysis of a malunion, the development of a plan for the correction and finally the virtual performance of the operation. The production of individualised drill-an saw-guides with the laser-sintering process (3D printer) which can be definitely positioned on the surface of the bone, implements exactly the planning into the operation. The new possibilities of this ostetomy technique are presented with 4 examples/cases from the hand surgery.

  3. Use of a new retrograde filling material (Biodentine) for endodontic surgery: two case reports.

    PubMed

    Caron, Grégory; Azérad, Jean; Faure, Marie-Odile; Machtou, Pierre; Boucher, Yves

    2014-12-01

    Mineral trioxide aggregate (MTA) is considered at the present time as the gold standard for root-end filling in endodontic surgery. However, this biocompatible material presents several drawbacks such as a long setting time and handling difficulties. The aim of this article is to present a new commercialized calcium silicate-based material named Biodentine with physical improved properties compared to MTA in a clinical application. Two endodontic microsurgeries were performed by using specific armamentarium (microsurgical instrumentation, ultrasonic tips) under high-power magnification with an operatory microscope. Biodentine was used as a root-end filling in order to seal the root canal system. The two cases were considered completely healed at 1 year and were followed for one more year. The 2-year follow-up consolidated the previous observation with absence of clinical symptoms and radiographic evidence of regeneration of the periapical tissues.

  4. An Unusual Case of Asystole Occurring during Deep Brain Stimulation Surgery

    PubMed Central

    Nguyen, Ha Son; Woehlck, Harvey; Pahapill, Peter

    2016-01-01

    Background. Symptomatic bradycardia and hypotension in neurosurgery can produce severe consequences if not managed appropriately. The literature is scarce regarding its occurrence during deep brain stimulation (DBS) surgery. Case Presentation. A 67-year-old female presented for left DBS lead placement for essential tremors. During lead implantation, heart rate and blood pressure dropped rapidly; the patient became unresponsive and asystolic. Chest compressions were initiated and epinephrine was given. Within 30 seconds, the patient became hemodynamically stable and conscious. A head CT demonstrated no acute findings. After deliberation, a decision was made to complete the procedure. Assuming the etiology of the episode was the Bezold-Jarisch reflex (BJR), appropriate accommodations were made. The procedure was completed uneventfully. Conclusion. The episode was consistent with a manifestation of the BJR. The patient had a history of neurocardiogenic syncope and a relatively low-volume state, factors prone to the BJR. Overall, lead implantation can still occur safely if preventive measures are employed. PMID:27217962

  5. [A case of laparoscopic surgery for a rectal carcinoid after ALTA therapy for an internal hemorrhoid].

    PubMed

    Aomatsu, Naoki; Nakamura, Masanori; Hasegawa, Tsuyoshi; Nakao, Shigetomi; Uchima, Yasutake; Aomatsu, Keiho

    2014-11-01

    We report a case of laparoscopic surgery for a rectal carcinoid after aluminum potassium and tannic acid (ALTA) therapy for an internal hemorrhoid. A 66-year-old man was admitted to our hospital because of bleeding during defecation. He was diagnosed via anoscopy with Goligher grade II internal hemorrhoids. Examination via colonoscopy revealed 2 yellowish submucosal tumors in the lower rectum that were 5mm and 10mm in diameter. A rectal carcinoid tumor was diagnosed based on histopathology. Abdominal computed tomography demonstrated no metastases to the liver or lymph nodes. First, we performed ALTA therapy for the internal hemorrhoids. Two weeks later, we performed laparoscopic-assisted low anterior resection (D2) for the rectal carcinoid. The patient was discharged without complications and has not experienced recurrence during the 2 years of follow-up care. PMID:25731340

  6. Bariatric Bypass Surgery to Resolve Complicated Childhood Morbid Obesity: Case Report Study.

    PubMed

    Elbanna, Abduh; Eldin, Mohammed Tag; Fathy, Mohammad; Osman, Osama; Abdelfattah, Mohammed; Safwat, Abdelrahman; Elkader, Mohammed Sedki Abd; Bilasy, Shymaa E; Salama, Khaled; Elnour, Asim A; Shehab, Abdullah; Baghdady, Shazly; Amer, Mohamed; Alboraie, Mohamed; Ragb, Aly; Abd Elrazek, Abd Elrazek

    2015-12-01

    Children obesity has become one of the most important public health problems in many countries worldwide. Although the awareness of childhood obesity as a modifiable health risk is high, but many societies do not prioritize this issue as a health care problem, which may lead to comorbidities and even premature death. Despite the rising interest in bariatric surgery for children, only laparoscopic sleeve gastrectomy (LSG) is being considered in resolving childhood obesity who failed other dietary or drug therapies; however many of LSG procedures failed to reduce the weight in children or resulted in complications postsurgery.Here, we present a novel bariatric procedure to clue out a female child 13 years old presented with Legg-Calvé-Perthes disease-associated morbid obesity. The surgical bariatric technique applied both fundal resection and surgical bypass in pediatric obesity using the Elbanna novel bariatric technique.Bariatric surgical bypass may be considered in complicated-childhood cases who failed all other options.

  7. Endoscopic Sinus Surgery for Treatment of Kartagener Syndrome: A Case Report

    PubMed Central

    Tang, Xinghua; Zou, Jian; Liu, Shixi

    2013-01-01

    Background: Kartagener syndrome (KS) is a rare congenital disease characterised by a clinical triad of symptoms: situs inversus, chronic rhinosinusitis, and bronchiectasis. Although congenital ciliary defect is recognised as the main cause of this syndrome, it remains difficult to treat the associated airway infection. Case Report: A 17-year-old female patient presented with repeated refractory airway infection. She also had bronchiectasis and situs inversus. Electron microscopic evaluation of her nasal mucosa revealed ciliary defect and confirmed the diagnosis of KS. She underwent functional endoscopic sinus surgery (FESS) followed by long-term postoperative debridement of the sinonasal cavity. This treatment reduced chronic rhinosinusitis and protected against subsequent airway infection in a 7-year follow-up. Conclusion: FESS is effective for relieving both chronic rhinosinusitis and lung infection of KS in the long term. PMID:25207108

  8. A rare case of massive carpal osteoblastoma requiring complex reconstructive surgery.

    PubMed

    Dunda, S E; Kauczok, J; Demir, E; Braunschweig, T; Pallua, N

    2013-07-01

    An osteoblastoma is a rare, commonly benign, osteoid-producing neoplasm of the bone with an incidence of 2% of all primary bone tumours. We present a case of a 54-year-old patient with persisting carpal pain and massive swelling of the hand for a period of 4 years. Incision biopsies revealed the histopathological finding of a carpal osteoblastoma. After complete tumour excision, including the carpal and, in parts, metacarpal bones, reconstructive surgery was performed with a free osteocutaneous iliac crest flap to obtain a natural hand contour and the best possible hand function. Follow-up revealed improvement of the hand function in terms of flexion, extension and strength without discomfort or further pain. Thus, ongoing carpal pain should lead to an intensive search with further diagnostic measures such as magnetic resonance imaging (MRI) scan as well as biopsies, if necessary, to obtain the correct diagnosis.

  9. Transoral robotic surgery for removal of a second branchial arch cyst: a case report.

    PubMed

    Vidhyadharan, S; Krishnan, S; King, G; Morley, A

    2012-12-01

    Second branchial arch cysts are a common cause of cystic neck mass in adults. The type-IV variant of the second branchial arch cyst is uncommon and presents as a parapharyngeal space mass. It lies medial to the carotid sheath and it is not easily amenable to access by the traditional, trans-cervical approach to the parapharyngeal space. Trans-oral robotic surgery is a new application of the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, CA, USA). The system has only recently been approved by the FDA for trans-oral robotic resection of oropharyngeal cancers. The technology has since been used for new trans-oral applications, including resection of parapharyngeal space tumours. This is a case report of successful trans-oral robotic resection of a type IV second branchial arch cyst in the parapharyngeal space. PMID:27628477

  10. Traumatic pericallosal artery aneurysm: a rare complication of transcallosal surgery. Case report.

    PubMed

    Dunn, Ian F; Woodworth, Graeme F; Siddiqui, Adnan H; Smith, Edward R; Vates, G Edward; Day, Arthur L; Goumnerova, Liliana C

    2007-02-01

    Traumatic intracranial aneurysms are rare in adults but account for up to 33% of all aneurysms encountered in a pediatric population. The most common location of such lesions in children is the pericallosal or adjacent branch of the anterior cerebral artery, where a head impact exerts sudden decelerating shearing forces on the arteries tethered on the brain surface against an immobile falx cerebri, weakening the arterial wall. This action can lead to dissection of the damaged vascular layers, with resultant expansion of the affected site into a fusiform aneurysm. Pericallosal aneurysms following a penetrating intracranial injury have also been described, and the resultant lesion in some cases can be a pseudoaneurysm. The incidence of iatrogenic pericallosal artery aneurysms, however, is extremely rare. The authors describe the first reported case of a traumatic pericallosal artery aneurysm following transcallosal surgery. This 6-year-old boy underwent resection of a hypothalamic pilocytic astrocytoma, which was approached via the transcallosal corridor. A follow-up magnetic resonance image obtained within 1 year of surgery disclosed a small flow void off the right pericallosal artery, which was initially interpreted as residual tumor. Serial investigations showed the lesion enlarging over time, and subsequent angiography revealed a round 7-mm pericallosal artery aneurysm with an irregularly shaped 2- to 3-mm lumen. The aneurysm was difficult to treat with clip reconstruction or suturing of the affected segment, and an excellent outcome was ultimately achieved with resection of the lesion and autogenous arterial graft interposition. The authors also discuss the likely pathophysiology of the aneurysm and the surgical procedures undertaken to treat it.

  11. National History Day: An Ethnohistorical Case Study or Taking the Lid Off the Pot.

    ERIC Educational Resources Information Center

    Page, Marilyn

    This document is a study of the dynamics of National History Day (NHD). The report notices a discrepancy between accounts of National History Day and those concerning contemporary history education. Contemporary history instruction was seen as boring and unimportant, while National History Day activities were seen as a fun opportunity for students…

  12. Endoscopic internal drainage as first-line treatment for fistula following gastrointestinal surgery: a case series

    PubMed Central

    Donatelli, Gianfranco; Dumont, Jean-Loup; Cereatti, Fabrizio; Dhumane, Parag; Tuszynski, Thierry; Vergeau, Bertrand Marie; Meduri, Bruno

    2016-01-01

    Background and study aims: Leaks following gastrointestinal surgery are a dreadful complication burdened by high morbidity and not irrelevant mortality. Endoscopic internal drainage (EID) has showed optimal results in the treatment of leaks following bariatric surgery. We report our experience with EID as first-line treatment for fistulas following surgery along all gastrointestinal tract. PMID:27556072

  13. The Unkindest Cut of All: Portrayals of Pain and Surgery in the Tracy Latimer Case

    ERIC Educational Resources Information Center

    Janz, Heidi L.

    2009-01-01

    The paper examines the language used to describe pain and surgery in the trials and the media discussions of the killing of Tracy Latimer by her father. Descriptions of proposed surgical procedures, that were planned before Tracy was killed, exaggerate the intrusiveness of surgeries to be performed so as to suggest that surgery would be worse than…

  14. RAPP, a systematic e-assessment of postoperative recovery in patients undergoing day surgery: study protocol for a mixed-methods study design including a multicentre, two-group, parallel, single-blind randomised controlled trial and qualitative interview studies

    PubMed Central

    Dahlberg, K; Odencrants, S; Hagberg, L

    2016-01-01

    Introduction Day surgery is a well-established practice in many European countries, but only limited information is available regarding postoperative recovery at home though there is a current lack of a standard procedure regarding postoperative follow-up. Furthermore, there is also a need for improvement of modern technology in assessing patient-related outcomes such as mobile applications. This article describes the Recovery Assessment by Phone Points (RAPP) study protocol, a mixed-methods study to evaluate if a systematic e-assessment follow-up in patients undergoing day surgery is cost-effective and improves postoperative recovery, health and quality of life. Methods and analysis This study has a mixed-methods study design that includes a multicentre, two-group, parallel, single-blind randomised controlled trial and qualitative interview studies. 1000 patients >17 years of age who are undergoing day surgery will be randomly assigned to either e-assessed postoperative recovery follow-up daily in 14 days measured via smartphone app including the Swedish web-version of Quality of Recovery (SwQoR) or to standard care (ie, no follow-up). The primary aim is cost-effectiveness. Secondary aims are (A) to explore whether a systematic e-assessment follow-up after day surgery has a positive effect on postoperative recovery, health-related quality of life (QoL) and overall health; (B) to determine whether differences in postoperative recovery have an association with patient characteristic, type of surgery and anaesthesia; (C) to determine whether differences in health literacy have a substantial and distinct effect on postoperative recovery, health and QoL; and (D) to describe day surgery patient and staff experiences with a systematic e-assessment follow-up after day surgery. The primary aim will be measured at 2 weeks postoperatively and secondary outcomes (A–C) at 1 and 2 weeks and (D) at 1 and 4 months. Trial registration number NCT02492191; Pre

  15. A complicated case of vascular Pythium insidiosum infection treated with limb-sparing surgery

    PubMed Central

    Pan, Jenny H.; Kerkar, Sid P.; Siegenthaler, Michael P.; Hughes, Marybeth; Pandalai, Prakash K.

    2014-01-01

    INTRODUCTION Pythiosis is a serious life- and limb-threatening infection endemic to Thailand, but rarely seen in the Western hemisphere. Here, we present a unique case of vascular pythiosis initially managed with limb-sparing vascular bypass grafts complicated by a pseudoaneurysm in our repair. PRESENTATION OF CASE The patient is a 17 year-old Jamaican male with severe aplastic anemia. He sustained a minor injury to his left leg while fishing in Jamaica, which evolved to become an exquisitely tender inguinal swelling. His physical exam and imaging were significant for arteriovenous fistula with limb ischemia. Pathology obtained during surgery for an extra-anatomic vascular bypass showed extensive invasion by Pythium insidiosum. He later developed a pseudoaneurysm at the site of proximal anastomosis and required urgent intervention. DISCUSSION This patient presented with a rare, but classic case of vascular pythiosis, which was unrecognized at the time of presentation. A variety of therapeutic modalities have been used to treat this disease, including antibiotics, antifungals, and immunotherapy, but the ultimate management of vascular pythiosis is surgical source control. CONCLUSION A high index of suspicion in susceptible patients is needed for timely diagnosis of vascular pythiosis to achieve optimal source control. PMID:25194603

  16. Surgery Combined with LPRF in Denosumab Osteonecrosis of the Jaw: Case Report.

    PubMed

    Maluf, Gustavo; Pinho, Milena Correia de; Cunha, Sandra Ribeiro de Barros da; Santos, Paulo Sérgio da Silva; Fregnani, Eduardo Rodrigues

    2016-01-01

    This paper describes two cases in which the use of leucocyte-rich and platelet-rich fibrin (LPRF) combined with bone resection did not result in complete tissue response in the treatment of medication-related osteonecrosis of the jaw (MRONJ). It has been recently described in patients receiving subcutaneous administration of RANK-inhibitors, such as Denosumab, and anti-angiogenic drugs, such as Bevacizumab, as observed in our cases. Due to promising results in recent studies, more patients will receive these medications in order to avoid skeletal complications due to metastatic bone disease and, therefore, this scenario has a potential to become a comparable challenge to the bisphosphonate- induced jaw necrosis in the area of Oral and Maxillofacial Surgery. No convincing surgical technique has been described to overcome the non-healing mucosal lesions with exposed bone due to RANK-inhibitor therapy. Based on the findings in the literature and in both cases described herein can be concluded that the use of LPRF should be considered in the treatment of patients with DRONJ. PMID:27224573

  17. TAOK3, a novel genome-wide association study locus associated with morphine requirement and postoperative pain in a retrospective pediatric day surgery population

    PubMed Central

    Cook-Sather, Scott D.; Li, Jin; Goebel, Theodora K.; Sussman, Emily M.; Rehman, Mohamed A.; Hakonarson, Hakon

    2014-01-01

    Candidate gene studies have revealed limited genetic bases for opioid analgesic response variability. Genome-wide association studies (GWAS) facilitate impartial queries of common genetic variants, allowing identification of novel genetic contributions to drug effect. Illumina single nucleotide polymorphism (SNP) arrays were used to investigate SNP associations with total morphine requirement as a quantitative trait locus and with postoperative pain in a retrospective population of opioid-naïve children age 4 – 18 y who had undergone day surgery tonsillectomy and adenoidectomy. In an independent replication cohort, significant GWAS-identified SNPs were assayed using Taqman probes. Among 617 comprehensively phenotyped children, the 277 subjects of European Caucasian (EC) ancestry demonstrated nominal association between morphine dose and a series of novel SNPs (top rs795484, p=1.01×10-6 and rs1277441, p=2.77×10-6) at the TAOK3 locus. Age, body mass index, and physical status were included covariates. Morphine requirement averaged 132.4 mcg/kg (SD 40.9). Each minor allele at rs795484 (G>A) contributed +17.6 mcg/kg (95% CI=10.7-24.4) to dose. Effect direction and magnitude were replicated in an independent cohort of 75 EC children (p<0.05). No association with morphine dose was detected in African Americans (AA) (n=241). Postoperative pain scores ≥ 7/10 were associated with rs795484 (G>A) in the EC cohort (OR=2.35, 95% CI=1.56-3.52, p<0.00005) and this association replicated in AA children (OR=1.76, 95% CI=1.14-2.71, p<0.01). Variants in TAOK3 encoding the serine/threonine-protein kinase, TAO3, are associated with increased morphine requirement in children of EC ancestry and with increased acute postoperative pain in both EC and AA subjects. PMID:24909733

  18. Controlled hypotension in day care functional endoscopic sinus surgery: A comparison between esmolol and dexmedetomidine: A prospective, double-blind, and randomized study

    PubMed Central

    Das, A; Chhaule, S; Bhattacharya, S; Basunia, SR; Mitra, T; Halder, PS; Chattopadhyay, S; Mandal, SK

    2016-01-01

    Background: Functional endoscopic sinus surgery (FESS) is the cornerstone of therapeutic management for nasal pathologies. This study is to compare the ability of preoperative and intraoperative esmolol versus dexmedetomidine for producing induced hypotension during FESS in adults in a day care setting. Materials and Methods: Sixty patients (20-45 years) posted for FESS under general anesthesia were randomly divided into Group E (n = 30) receiving esmolol, loading dose 1 mg/kg over 1 min followed by 0.5 mg/kg/h infusion during maintenance and Group D (n = 30) receiving dexmedetomidine 1 μg/kg over 15 min before induction of anesthesia followed by 0.5 μg/Kg/h infusion during maintenance, respectively. Nasal bleeding and Surgeon's satisfaction score; amount and number of patients receiving fentanyl and nitroglycerine for analgesia and deliberate hypotension, Postanesthesia Care Unit (PACU) and hospital stay; hemodynamic parameters and side effects were recorded for each patient. Results: Significantly less number and dosage of nitroglycerine was required (P = 0.0032 and 0.0001, respectively) in Group D compared to that in Group E. Again the number and dosage of patients requiring fentanyl were significantly lower in Group D. However, the duration of controlled hypotension was almost similar in both the groups. Group D patients suffered from significantly less nasal bleeding, and surgeon's satisfaction score was also high in this group. Discharge from PACU and hospital were significantly earlier in Group D. Intraoperative hemodynamics were quite comparable (P > 0.05) without any appreciable side effects. Conclusion: Dexmedetomidine found to be providing more effectively controlled hypotension and analgesia and thus allowing less nasal bleeding as well as more surgeons’ satisfaction score. PMID:27375381

  19. A case report on acute severe hyponatraemia following parathyroid surgery for primary hyperparathyroidism—A rare but life threatening complication

    PubMed Central

    Hillary, S.L.; Hemead, H.; Berthoud, M.; Balasubramanian, S.P.

    2016-01-01

    Introduction Parathyroidectomy is a common operation, which is well tolerated and associated with low morbidity. Patients are usually discharged within 24 hours of surgery. Severe postoperative hyponatraemia is a rare complication which can cause significant morbidity including seizure, coma, respiratory arrest and even death. Presentation of case We present two patients with clinically significant hyponatremia resulting in seizures and collapse within 24 hours after parathyroidectomy, an unreported complication following surgery for primary hyperparathyroidism. One patient required support on the High Dependency Unit and both were treated with fluid restriction which resulted in correction of their electrolyte balance. Discussion We believe this was caused by the relative inability to secrete a water load after surgery and non-psychogenic polydipsia. Preoperatively, neither patient was prescribed any routine medications nor did they have any risk factors for hyponatremia. Both had normal preoperative sodium levels. It is usual practice is to advise patients to increase oral water intake when they are hypercalcaemic. The aim of parathyroidectomy is to treat hypercalcaemia by stopping excess PTH secretion from abnormal parathyroid glands. These patients continued to follow this advice after surgery when they were eucalcaemic after their operation and because they were thirsty. The patients drank several litres of water in 12–24 hours after surgery. We believe that this may have contributed to this complication. Conclusion Healthcare professionals need to be aware of this complication and patients should be advised to restrict intake of free water after surgery. PMID:26994458

  20. Adjunct Antimicrobial Therapy and Periodontal Surgery to Treat Generalized Aggressive Periodontitis: A Case Report.

    PubMed

    Irokawa, Daisuke; Makino-Oi, Asako; Fujita, Takahisa; Yamamoto, Shigeki; Tomita, Sachiyo; Saito, Atsushi

    2016-01-01

    Here we report a case of generalized aggressive periodontitis treated with periodontal therapy including adjunct antimicrobial therapy and periodontal surgery. The patient was a 22-year-old woman who presented with the chief complaint of gingival recession. Baseline examination revealed generalized plaque deposition and gingival inflammation. Thirty-nine percent of the sites had a probing depth (PD) of 4-6 mm and 2% a PD of ≥7 mm; 63% exhibited bleeding on probing (BOP). Radiographic examination revealed vertical bone loss in the molars and horizontal bone loss in other teeth. Microbiological examination of subgingival plaque revealed the presence of Aggregatibacter actinomycetemcomitans and Tannerella forsythia. Oral health-related quality of life was assessed as a measure of patient-reported outcome. Based on a clinical diagnosis of generalized aggressive periodontitis, initial periodontal therapy and adjunct antimicrobial therapy were implemented. After reducing inflammation and subgingival bacteria, open flap debridement was performed for teeth with a PD of ≥4 mm. Reevaluation showed no sites with a PD of ≥5 mm, a minimal level of BOP, and a marked reduction in the level of the targeted periodontal pathogens. The patient's oral health-related quality of life was slightly worsened during supportive periodontal therapy (SPT). Implementation of adjunct antimicrobial therapy targeting periodontal pathogens and subsequent periodontal surgery resulted in improvement in periodontal and microbiological parameters. This improvement has been adequately maintained over a 2-year period. However, additional care is necessary to further improve the patient's oral health-related quality of life during SPT. PMID:27320300

  1. [Our experience with surgery of esophageal stenosis caused by caustic soda. Apropos of 128 cases].

    PubMed

    Pavlicic, Z; Cissoko, I S

    1988-11-01

    The authors report a series of 128 cases of esophageal burns due to caustic soda, treated between 1974 and 1987 in the Dept. of Surgery of the Friguia Kimbo Alumina Factory Hospital. 95% of patients were children aged less than 15. Ingestion was generally accidental. In view of the delay before patients were seen, in addition to parenteral alimentation, nutrition was covered by an alimentation gastrostomy performed in 96% of patients immediately following admission. Dilator treatment was used in 37 patients with 29 good result, 6 failures, and 2 perforations with 1 death. Retrosternal esophagoplasty using the transverse colon was performed in 95 cases with a 96.8% cure rate over a total follow-up period of 1 to 10 years, and 3 deaths. Overall mortality taking all categories together was 5.4%. The authors used these results as a basis for reviewing this condition, attempting to define as a basis for reviewing this condition, attempting to define the therapeutic methods successively used in the Guinea medico-social context.

  2. Advantage of microscope integrated for both indocyanine green and fluorescein videoangiography on aneurysmal surgery: case report.

    PubMed

    Yoshioka, Hideyuki; Kinouchi, Hiroyuki; Nishiyama, Yoshihisa; Kanemaru, Kazuya; Yagi, Takashi; Hanihara, Mitsuto; Horikoshi, Toru

    2014-01-01

    Neck clipping of a large middle cerebral artery aneurysm was performed using a newly developed surgical microscope integrated with modules for both indocyanine green (ICG) and fluorescein videoangiography. During surgery, ICG and fluorescein videoangiography by intra-arterial or intravenous injection were safely carried out without interrupting the surgical procedure. Based on the findings obtained from the case, we evaluated the differences between the dyes and the injection routes. With intra-arterial injection, fluorescein offered sharper contrast images and was better at depicting fine arteries than ICG. Patchy staining of vessel walls was observed in intravenous fluorescein videoangiography, while it was not evident in ICG. Intra-arterial injection method had a great advantage in the rapid clearance of the dyes, which allowed us to perform repeated videoangiography within a short period, and was useful in detecting incomplete clipping in this case; however, catheter insertion requires additional work and carries a potential risk. Use of a microscope integrated for both ICG and fluorescein videoangiography would be another method for repeated evaluation. Namely, alternate use of the dyes enables us to perform videoangiography in a short time even via intravenous injection.

  3. Effects of He-Ne regional irradiation on 53 cases in the field of pediatric surgery

    NASA Astrophysics Data System (ADS)

    Guo, Jing-Zhen

    1991-06-01

    We report the clinical observation of the effect on 53 surgical cases with Helium-Neon laser local irradiation therapy. Of those cases 15 were suffered from chronic and acute infection, 5 were traumatic, 15 of hemangioma had been treated by solid CO freezing therapy and sclerosing injection previously. 18 cases were received incisional irradiation postoperatively. All showed remarkable results. There were no infection, and the healing process was shortened by Helium-Neon laser local irradiation for 2-3 days. The results showed that the curative rate was 88.68%, the marked effective rate was 9.43%, and the fair was 1.89$. We emphasize that because of the characteristic of anatomical physiology and histology in children. so the result in children is better than in adults. Thus, we strongly recommend using Helium-Laser local irradiation in surgical pediatric field. It is reliable, safe, painless, convenient, economic, and no side effects at all.

  4. [Nasal endoscope surgery of acinic cell carcinoma of salivary gland on nasal septum: a case report].

    PubMed

    Tang, Yuanyuan; Sun, Xiuzhen; Wang, Jizhe

    2016-02-01

    A 67-year-old male patient was admitted because of "the right side nasal obstruction repeatedly for 4 years". He got nasal obstruction 4 years ago, especially for the right side nasal cavity, sometimes got blood in his nasal discharge, then the symptom relieved after accepting treatment in local hospital. During the 4 years, the symptom repeatedly occurrence. Three days before hospitalization, the CT examination indicated abnormal things in his nasal cavity and the bone of his nasal sinus had been destroyed. Some abnormal organism were sent to pathological examination, and the report indicated it is acinic cell carcinoma of salivary gland. During the nasal endoscope surgery, a red goiter was found in his nose with its surface crude and brittle. Then we cut the goiter by nasal endoscope, during the operation we find the bottom of the goiter is on the nasal septum. Two weeks after the operation, the patient received the radiation therapy. One year after the operation he doesn't get the abnormal symptom and the nasal MRI not found recidivation. PMID:27373103

  5. Bilateral periorbital and cervicofacial emphysema following retinal surgery and fluid gas exchange in a case of inadvertent globe perforation

    PubMed Central

    Asnani, Haresh T; Mehta, Vinod C; Nair, Akshay Gopinathan; Jain, Vandana

    2015-01-01

    Surgical emphysema is defined as gas or air trapped in the subcutaneous tissue plane. Here, we report a rare case of bilateral periorbital and cervicofacial subcutaneous emphysema following a vitreoretinal surgery for inadvertent globe perforation during the administration of peribulbar anesthesia. This condition, although self-resolving when restricted to the subcutaneous plane has the potential to spread into deeper tissue planes such as the retropharyngeal space. The presence of crepitus helps to distinguish it from angioneurotic edema. Ophthalmologists must be sensitive to the fact that surgical emphysema can be a very rare, but possible complication of an intraocular surgery following globe perforation. PMID:26265649

  6. [Ectopic mediastinal parathyroid tumor resected by video-assisted thoracic surgery with intraoperative methylene blue infusion; report of a case].

    PubMed

    Okagawa, Takehiko; Hiramatsu, Yoshinori

    2014-03-01

    We report a surgical case of ectopic mediastinal parathyroid tumor resected by video-assisted thoracic surgery with intraoperative methylene blue infusion. It is often difficult to detect ectopic mediastinal parathyroid tumor during the operation because the tumor is soft, small and buried under mediastinal tissue. After methylene blue 4 mg/kg intravenously administration, the tumor was gradually dyed blue and easily detected and resected by video-assisted thoracic surgery. It is useful of methylene blue for detection of ectopic mediastinal parathyroid tumor.

  7. Usefulness of case reports to improve medical knowledge regarding trigemino-cardiac reflex in skull base surgery

    PubMed Central

    2011-01-01

    We describe the discovery of the trigemino-cardiac reflex by Schaller in 1999 and the continued improvement of the knowledge about the trigemino-cardiac reflex involved in neurosurgery, especially in skull base surgery, during the past several years. The achieved medical progress could be gained only by the practical experience described by different case reports and later case series that have been published in several principal scientific journals. Additionally, we explain the scientific as well as clinical importance of the communication of the case reports on TCR. Special reference has been given to the validity of the case reports for new phenomena in clinical medicine. PMID:21496216

  8. Prediction of 30-day mortality after hip fracture surgery by the Nottingham Hip Fracture Score and the Surgical Outcome Risk Tool.

    PubMed

    Marufu, T C; White, S M; Griffiths, R; Moonesinghe, S R; Moppett, I K

    2016-05-01

    The care of the elderly with hip fractures and their outcomes might be improved with resources targeted by the accurate calculation of risks of mortality and morbidity. We used a multicentre national dataset to evaluate and recalibrate the Nottingham Hip Fracture Score and Surgical Outcome Risk Tool. We split 9,017 hip fracture cases from the Anaesthesia Sprint Audit of Practice into derivation and validation data sets and used logistic regression to derive new model co-efficients for death at 30 postoperative days. The area (95% CI) under the receiver operator characteristic curve of 0.71 (0.67-0.75) indicated acceptable discrimination by the Nottingham Hip Fracture Score and acceptable calibration fit (Hosmer-Lemeshow test), p = 0.23, with a similar discrimination by the Surgical Outcome Risk Tool, 0.70 (0.66-0.74), which was miscalibrated to the observed data, p = 0.001. We recommend that studies test these scores for patients with hip fractures in other countries. We also recommend these models are compared with case-mix adjustment tools used in the UK.

  9. [First synchronous liver resection as a part of cytoreductive surgery, peritonectomy and HIPEC in Croatia--case report].

    PubMed

    Budak, Ana Majsec; Škegro, Mate; Majerović, Mate; Smud, Dubravko; Jelinčić, Željko; Kinda, Emil; Kekez, Tihomir; Augustin, Goran; Silovski, Hrvoje; Matošević, Petar; Bruketa, Tomislav

    2015-01-01

    We present a case of a 37-year-old female, with large adenocarcinoma of transverse colon, and metastases in spleen, liver, peritoneum, greater omentum, gall bladder and right adnexa. She was transferred to our Hospital, and extensive elective cytoreductive surgery with intraabdominal hyperthermal chemotherapy (HIPEC) was performed. Couple of months later, she was operated on for a newly evidenced secondary nodus in liver segment VII, and metastasectomy was performed. Throughout entire postoperative period she was receiving cyclic chemotherapy. At this point, 2 years from the first operation, she was without evidenced recurrence of the disease. Aggressive cytoreductive surgery with multiorgan resection, peritonectomy, HIPEC and adjuvant chemotherapy which was proved to be a feasible option in some patients, with synchronous liver resection (LR) proved to be feasible and beneficial for patients with three or fewer liver metastases. This is the first liver resection included in usually performed cytoreductive surgery and HIPEC in Croatia.

  10. [A Case of Multiple HCC with Vp2 and Vv3 Invasion Controlled by Multidisciplinary Treatment Including Surgery].

    PubMed

    Deguchi, Sota; Tsukamoto, Tadashi; Kanazawa, Akishige; Shimizu, Sadatoshi; Yamamoto, Satoshi; Murata, Akihiro; Nakajima, Takayoshi; Sakae, Masayuki; Tachimori, Akiko; Tamamori, Yutaka; Yamamoto, Atsushi; Inoue, Toru; Yamashita, Yoshito; Nishiguchi, Yukio

    2015-11-01

    The prognosis of HCC with vascular invasion is dismal, but surgery is elected when the hepatic reserve is adequate. The case involved a 68-year-old male HCV carrier. A 10 cm diameter tumor occupying the central 2 segments of the liver and liver metastasis in the left lobe were detected. The patient was diagnosed with multiple HCC with severe vascular invasion of Vp2 and Vv3. The tumor shrunk dramatically after starting HAIC therapy with cisplatin and oral administration of sorafenib. A laparoscopic partial hepatectomy was performed for the viable lesion. The tumor showed almost complete coagulative necrosis. Multiple hepatic metastases were found 4 months after surgery, but the tumor was under control at 25 months after the first HAIC due to HAIC, oral administration of sorafenib, and RFA. An improved prognosis for multiple HCC with severe vascular invasion can be expected by performing multidisciplinary treatments including surgery. PMID:26805192

  11. Risk factors associated with postoperative seizures in patients undergoing cardiac surgery who received tranexamic acid: a case-control study.

    PubMed

    Montes, Felix R; Pardo, Daniel F; Carreño, Marisol; Arciniegas, Catalina; Dennis, Rodolfo J; Umaña, Juan P

    2012-01-01

    Antifibrinolytic agents are used during cardiac surgery to minimize bleeding and reduce exposure to blood products. Several reports suggest that tranexamic acid (TA) can induce seizure activity in the postoperative period. To examine factors associated with postoperative seizures in patients undergoing cardiac surgery who received TA. University-affiliated hospital. Case-control study. Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) between January 2008 and December 2009 were identified. During this time, all patients undergoing heart surgery with CPB received TA. Cases were defined as patients who developed seizures that required initiation of anticonvulsive therapy within 48 h of surgery. Exclusion criteria included subjects with preexisting epilepsy and patients in whom the convulsive episode was secondary to a new ischemic lesion on brain imaging. Controls who did not develop seizures were randomly selected from the initial cohort. From an initial cohort of 903 patients, we identified 32 patients with postoperative seizures. Four patients were excluded. Twenty-eight cases and 112 controls were analyzed. Cases were more likely to have a history of renal impairment and higher preoperative creatinine values compared with controls (1.39 ± 1.1 vs. 0.98 ± 0.02 mg/dL, P = 0.02). Significant differences in the intensive care unit, postoperative and total lengths of stay were observed. An association between high preoperative creatinine value and postoperative seizure was identified. TA may be associated with the development of postoperative seizures in patients with renal dysfunction. Doses of TA should be reduced or even avoided in this population. PMID:22234015

  12. Advanced Hysteroscopic Surgery Training

    PubMed Central

    McLaren, Glenda R.; Erian, Anna-Marie

    2014-01-01

    Hysteroscopic surgery is pivotal in management of many gynecological pathologies. The skills required for performing advanced hysteroscopic surgery (AHS), eg, transcervical hysteroscopic endometrial resection (TCRE), hysteroscopic polypectomy and myomectomy in the management of menorrhagia, hysteroscopic septulysis in fertility-related gynecological problems and hysteroscopic removal of chronically retained products of conception and excision of intramural ectopic pregnancy ought to be practiced by contemporary gynecological surgeons in their day-to-day clinical practice. AHS is a minimally invasive procedure that preserves the uterus in most cases. Whilst the outcome is of paramount importance, proper training should be adopted and followed through so that doctors, nurses, and institutions may deliver the highest standard of patient care. PMID:25392678

  13. Spinal cord stimulation for treatment of failed back surgery syndrome--two case reports.

    PubMed

    Vijayan, R; Ahmad, T S

    1999-12-01

    Severe, persistent back pain following back surgery is often referred to as Failed Back Surgery Syndrome (FBSS). Conservative measures such as physiotherapy, back strengthening exercises, transcutaneous electrical nerve stimulation and epidural steroids may be inadequate to alleviate pain. Spinal Cord Stimulators were implanted into two patients suffering from FBSS. Both patients responded successfully to spinal cord stimulation with reduction of pain and disability.

  14. The use of methylene blue in abdominal aortic surgery: a case report.

    PubMed

    Piraccini, E; Agnoletti, V; Corso, R; Maitan, S; Gambale, G

    2010-01-01

    The open abdominal aortic surgery includes a well-known phase in which arterial blood flow is stopped by occluding clamps, resulting in peculiar physiologic changes usually superimposed on advanced pathologic conditions. An anesthetic plan should aim at providing hemodynamic stability and preserving organ function. Clamp removal leads to an acute fall in blood pressure following a decrease in systemic vascular resistance, caused by reactive hyperemia due to opening of the previously minimally perfused vascular beds. Several different mediators, including the nitrous oxide (NO) pathway, have been thought to be responsible for this hemodynamic effect. The massive production of NO by the inducible isoform of NO synthase could be partially responsible for the profound vasodilatation and myocardial dysfunction. The dye methylene blue (MB) has been used as to prevent vasodilatation in other clinical situations like sepsis, cardiopulmonary bypass and liver transplantation. We describe its use in a patient with poor hemodynamic status, who was submitted to aortic aneurism repair with infrarenal cross clamp. The intervention was also associated with a severe bleeding. In this case MB allowed us to control hypotension with relatively low doses of vasopressors. PMID:23440623

  15. [Childhood transverse sinus dural arteriovenous fistula treated with endovascular and direct surgery: a case report].

    PubMed

    Niizuma, Kuniyasu; Sakata, Hiroyuki; Koyama, Shinya; Kon, Hiroyuki; Chonan, Masashi; Sasaki, Tatsuya; Nishijima, Michiharu; Ezura, Masayuki; Tominaga, Teiji

    2012-11-01

    Infantile dural arteriovenous fistula is a rare cerebrovascular malformation carrying a poor prognosis with an anatomic cure of only 9%. Endovascular embolization is mainly selected to treat this entity, aiming to obtain normal development of the patients. We present a case of a 20-month-old girl with epilepsy. Digital subtraction angiography revealed a dural arteriovenous fistula involving the right transverse sinus. The arteriovenous fistula was fed by multiple dural branches from the middle meningeal, occipital, meningohypophyseal, and anteroinferior cerebellar arteries. The right transverse sinus was transvenously embolized with platinum coils. Although the shunt flow remained, the patient was liberated from epilepsy. Nine months later, the patient suffered from a recurrence of epilepsy. Digital subtraction angiography demonstrated some increase in shunt flow. Right middle meningeal, occipital, posterior deep temporal, and tentorial arteries were transarterially embolized using N-butyl cyanoacrylate, followed by complete surgical resection of the right transverse sinus. The shunt flow disappeared after surgery, and her epilepsy improved significantly. Our experience suggests that the combination of endovascular and surgical treatment is effective for recurrent infantile dural arteriovenous fistula.

  16. [A case of solitary fibrous tumor from the greater omentum resected via laparoscopic surgery].

    PubMed

    Osawa, Hideki; Nishimura, Junichi; Inoue, Akira; Ueda, Masami; Mokutani, Yukako; Miyo, Masaaki; Naito, Atsushi; Hamabe, Atsushi; Hiraki, Masayuki; Matsumura, Tae; Munakata, Koji; Ogino, Takayuki; Takahashi, Yusuke; Uemura, Mamoru; Hata, Taishi; Takemasa, Ichiro; Mizushima, Tsunekazu; Yamamoto, Hirofumi; Doki, Yuichiro; Mori, Masaki

    2014-11-01

    Solitary fibrous tumor (SFT) are relatively rare neoplasms that usually arise in the thoracic cavity in adults. Although many cases of extrathoracic SFT have been recently reported, SFT from the omentum is rare. A 32-year-old woman consulted a gynecologist complaining of irregular vaginal bleeding. Magnetic resonance imaging (MRI) revealed a tumor in the omentum, and the patient was admitted to our department. The patient underwent laparoscopic tumorectomy. The tumor size was 48 × 35 × 30 mm, and grayish-white nodules were observed. Histological examination showed hyperplastic spindle-shaped tumor cells with a pattern-less arrangement. Immunohistochemical staining showed the tumor was positive for CD34 and bcl-2, slightly positive for alpha smooth muscle actin(a-SMA), and negative for S-100 and c-kit. Accordingly, a diagnosis of SFT was made. The patient has not shown any recurrence 12 months after surgery. Most SFTs are benign, although there are some reports of recurring tumors. There are no clear guidelines for the treatment of SFT because of its rarity. Therefore, close long-term follow-up should be performed. PMID:25731568

  17. [A case of solitary fibrous tumor from the greater omentum resected via laparoscopic surgery].

    PubMed

    Osawa, Hideki; Nishimura, Junichi; Inoue, Akira; Ueda, Masami; Mokutani, Yukako; Miyo, Masaaki; Naito, Atsushi; Hamabe, Atsushi; Hiraki, Masayuki; Matsumura, Tae; Munakata, Koji; Ogino, Takayuki; Takahashi, Yusuke; Uemura, Mamoru; Hata, Taishi; Takemasa, Ichiro; Mizushima, Tsunekazu; Yamamoto, Hirofumi; Doki, Yuichiro; Mori, Masaki

    2014-11-01

    Solitary fibrous tumor (SFT) are relatively rare neoplasms that usually arise in the thoracic cavity in adults. Although many cases of extrathoracic SFT have been recently reported, SFT from the omentum is rare. A 32-year-old woman consulted a gynecologist complaining of irregular vaginal bleeding. Magnetic resonance imaging (MRI) revealed a tumor in the omentum, and the patient was admitted to our department. The patient underwent laparoscopic tumorectomy. The tumor size was 48 × 35 × 30 mm, and grayish-white nodules were observed. Histological examination showed hyperplastic spindle-shaped tumor cells with a pattern-less arrangement. Immunohistochemical staining showed the tumor was positive for CD34 and bcl-2, slightly positive for alpha smooth muscle actin(a-SMA), and negative for S-100 and c-kit. Accordingly, a diagnosis of SFT was made. The patient has not shown any recurrence 12 months after surgery. Most SFTs are benign, although there are some reports of recurring tumors. There are no clear guidelines for the treatment of SFT because of its rarity. Therefore, close long-term follow-up should be performed.

  18. Symptomatic pneumorachis associated with incidental durotomy during microscopic lumbar disc surgery. Case report.

    PubMed

    Rovlias, Aristedis; Pavlakis, Emmanuel; Kotsou, Serafim

    2006-08-01

    Unintended incidental durotomy is not a rare complication of lumbar microsurgery and is usually recognized and treated immediately. The reconstruction process can be complicated further by unpredictable factors. To their knowledge, the authors report the first case of a symptomatic pneumorachis associated with the accidental awakening of a patient during reconstruction of an incidental durotomy following lumbar microdiscectomy. Incomplete cauda equina syndrome developed in the patient on awakening from surgery after reconstruction of an unintended incidental dural tear that occurred during lumbar microdiscectomy. Symptomatic pneumorachis was revealed on an emergency computed tomography scan, and the patient underwent immediate repeated operation to remove air and decompress the spinal canal. The increasing number and complexity of surgical procedures in the lumbar spine contribute to the growing incidence of unintended durotomy. The surgeon should be aware of rare complications that may arise. Development of a vacuum phenomenon in conjunction with a ball-valve mechanism may lead to pneumorachis during durotomy repair. If this rare complication is promptly recognized and confronted, the outcome will not be associated with long-term sequelae.

  19. Bariatric Bypass Surgery to Resolve Complicated Childhood Morbid Obesity: Case Report Study.

    PubMed

    Elbanna, Abduh; Eldin, Mohammed Tag; Fathy, Mohammad; Osman, Osama; Abdelfattah, Mohammed; Safwat, Abdelrahman; Elkader, Mohammed Sedki Abd; Bilasy, Shymaa E; Salama, Khaled; Elnour, Asim A; Shehab, Abdullah; Baghdady, Shazly; Amer, Mohamed; Alboraie, Mohamed; Ragb, Aly; Abd Elrazek, Abd Elrazek

    2015-12-01

    Children obesity has become one of the most important public health problems in many countries worldwide. Although the awareness of childhood obesity as a modifiable health risk is high, but many societies do not prioritize this issue as a health care problem, which may lead to comorbidities and even premature death. Despite the rising interest in bariatric surgery for children, only laparoscopic sleeve gastrectomy (LSG) is being considered in resolving childhood obesity who failed other dietary or drug therapies; however many of LSG procedures failed to reduce the weight in children or resulted in complications postsurgery.Here, we present a novel bariatric procedure to clue out a female child 13 years old presented with Legg-Calvé-Perthes disease-associated morbid obesity. The surgical bariatric technique applied both fundal resection and surgical bypass in pediatric obesity using the Elbanna novel bariatric technique.Bariatric surgical bypass may be considered in complicated-childhood cases who failed all other options. PMID:26656361

  20. Identity formation in adolescence: case study of gender identity disorder and treatment through an intermediate-care day hospital.

    PubMed

    Babinski, S; Reyes, A

    1994-01-01

    A review of the literature on gender identity disorders is integrated with a case study presentation of a psychiatrically disturbed nineteen-year-old transvestite youth. Accommodations and interventions made both with this patient and in the day care program for psychiatrically disturbed youths that allowed him to live at home and be maintained despite severe pathology are discussed.

  1. The Little Rascals Day Care Center Case: Commentary on Clinical Testimony on Prominent Public Trials.

    ERIC Educational Resources Information Center

    Summit, Ronald C.

    1994-01-01

    Comments on some of the philosophical and moral problems inherent in prosecuting a child sexual abuse case. This particular case was complicated by the multiple victims and multiple perpetrators. Both medical and psychological clinical expert witnesses need to be aware of and respectful of the ground rules of the courtroom. (JPS)

  2. Prevalence and risk factors of deep vein thrombosis in patients after spine surgery: a retrospective case-cohort study.

    PubMed

    Yang, Si-Dong; Liu, Huan; Sun, Ya-Peng; Yang, Da-Long; Shen, Yong; Feng, Shi-Qing; Zhao, Feng-Dong; Ding, Wen-Yuan

    2015-01-01

    Deep vein thrombosis (DVT) is common seen in patients undergoing spine surgery. However, its prevalence and associated risk factors have not been well understood yet. This retrospective case-cohort study was designed to investigate risk factors for postoperative DVT using retrospectively collected data from department of spine surgery between 07/2013 and 07/2014. Univariate analysis and binary logistic regression analysis were used to determine risk factors for DVT. A total of 861 patients were admitted into DVT-associated analyses, including 410 males and 451 females, aged from 15 to 87 years old (median 54, IQR 18). Of them, 147 cases (17%) sustained postoperative DVT. DVT incidence was 15.9% in patients undergoing lumbar interbody fusion, 13.5% in patients treated by low-molecular-weight heparin (LMWH), while only 8.1% in patients without LMWH. However, it revealed no significant difference between LMWH group and non-LMWH group (χ(2) = 1.933, p = 0.164). Logistic regression equation was logit P = -4.09 + 0.05*X1 - 0.55*X2 + 0.41*X3 + 1.41*X7, (X1 = age; X2 = regions; X3 = hypertension; X7 = D-dimer). In this study, LMWH prophylaxis after spine surgery proved ineffective. Advanced age, D-dimer and hypertension have proved to be the risk factors for postoperative DVT in patients undergoing spine surgery.

  3. Lessons from a case of oromandibular mucormycosis treated with surgery and a combination of amphotericin B lipid formulation plus caspofungin.

    PubMed

    Ojeda-Uribe, Mario; Herbrecht, Raoul; Kiefer, Marie Hélène; Schultz, Philippe; Chain, Jorge; Chenard, Marie-Pierre; Servant, Jean Marie; Debry, Christian

    2010-01-01

    A rare case of oromandibular Rhizopus oryzae infection is described in a 55-year-old woman with acute myeloid leukaemia and decompensated diabetes mellitus. The infection developed during induction chemotherapy when the patient was neutropenic. She was treated with a combination of amphotericin B lipid formulation and caspofungin plus surgery. Debridement surgery included excision of the lower lip, chin, floor of the mouth, a portion of the tongue, as well as mandibular resection at the level of the horizontal branches. Eight weeks of combined antifungal therapy were followed by secondary prophylaxis with amphotericin B lipid formulation during consolidation chemotherapy after achieving complete response of both leukaemia and mucormycosis. Reconstructive surgery was carried out including insertion of a new biomaterial porous mandibular prosthesis, which showed excellent functionality after long-term follow-up, followed by several plastic surgery procedures once good tolerability and no adverse effects of the prosthesis were observed. This case shows that a well-coordinated multidisciplinary approach is critical to increase the chances of clinical success in this life-threatening infection. PMID:20689269

  4. Decreased human circadian pacemaker influence after 100 days in space: a case study

    NASA Technical Reports Server (NTRS)

    Monk, T. H.; Kennedy, K. S.; Rose, L. R.; Linenger, J. M.

    2001-01-01

    OBJECTIVE: The objectives of this study were (1) to assess the circadian rhythms and sleep of a healthy, 42-year-old male astronaut experiencing microgravity (weightlessness) for nearly 5 months while living aboard Space Station Mir as it orbited Earth and (2) to determine the effects of prolonged space flight on the endogenous circadian pacemaker, as indicated by oral temperature and subjective alertness rhythms, and their ramifications for sleep, alertness, and performance. METHODS: For three 12- to 14-day blocks of time (spread throughout the mission), oral temperatures were taken and subjective alertness was self-rated five times per day. Sleep diaries and performance tests were also completed daily during each block. RESULTS: Examination of the subject's circadian alertness and oral temperature rhythms suggested that the endogenous circadian pacemaker seemed to function quite well up to 90 days in space. Thereafter (on days 110-122), the influence of the endogenous circadian pacemaker on oral temperature and subjective alertness circadian rhythms was considerably weakened, with consequent disruptions in sleep. CONCLUSIONS: Space missions lasting more than 3 months might result in diminished circadian pacemaker influence in astronauts, leading to eventual sleep problems.

  5. Two-Day, Intensive Cognitive-Behavioral Therapy for Panic Disorder: A Case Study

    ERIC Educational Resources Information Center

    Deacon, Brett

    2007-01-01

    Cognitive-behavioral therapy (CBT) is a highly effective treatment for panic disorder. However, few patients have access to this treatment, particularly those living in rural areas. In a pilot study, the author previously described the efficacy of a 2-day, intensive, exposure-based CBT intervention that was developed for the purpose of delivering…

  6. Greek Day Education in and around Montreal: The Case for a Greek Trilingual High School.

    ERIC Educational Resources Information Center

    Bombas, Leonidas C.

    The history of the education of Montreal's Greek population is traced in this report, which is partly intended to act as a stimulus for future planning and development. Six chapters contain, respectively: (1) a history of Greek day education in and around Montreal, from its origin in 1910 with the founding of the "Plato" school to its securing of…

  7. [Separate birth 30 days after a premature delivery in a twin pregnancy. A case report].

    PubMed

    Kisoka, R

    1994-01-01

    The author reports an exceptional observation concerning a delayed delivery of a second twin born at 34 weeks' gestation. The first infant was born 30 days before. The "fetal retention" of the second twin seems to improve its vital prognostic, 12 months later, the infant was in full growth and showing a good health. PMID:7995920

  8. All-Day Recordings to Investigate Vocabulary Development: A Case Study of a Trilingual Toddler

    ERIC Educational Resources Information Center

    Oller, D. Kimbrough

    2010-01-01

    Major innovations are becoming available for research in language development and disorders. Among these innovations, recent tools allow naturalistic recording in children's homes and automated analysis to facilitate representative sampling. This study employed all-day recordings during the 2nd year of life in a child exposed to three languages,…

  9. 42 CFR 484.220 - Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...-day episode payment rate for case-mix and area wage levels. 484.220 Section 484.220 Public Health... Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and area wage levels... case-mix using a case-mix index to explain the relative resource utilization of different patients....

  10. Transcatheter Closure of Iatrogenic VSDs after Aortic Valve Replacement Surgery: 2 Case Reports and a Literature Review

    PubMed Central

    Henderson, Robert A.

    2016-01-01

    We report 2 new cases of transcatheter closure of iatrogenic ventricular septal defects after aortic valve replacement surgery, together with our finding, in a literature review, of 9 additional patients who had undergone this procedure from 2004 through 2013. In all 11 cases, transcatheter device closure was indicated for a substantial intracardiac shunt with symptomatic heart failure, and such a device was successfully deployed across the iatrogenic ventricular septal defect, with clinical improvement. Our review suggests that transcatheter closure of iatrogenic ventricular septal defects in patients with previous aortic valve replacement surgery is a safe and effective treatment option, providing anatomic defect closure and relief of symptoms in the short-to-medium term. PMID:27547145

  11. Transcatheter Closure of Iatrogenic VSDs after Aortic Valve Replacement Surgery: 2 Case Reports and a Literature Review.

    PubMed

    Taleyratne, John D S; Henderson, Robert A

    2016-08-01

    We report 2 new cases of transcatheter closure of iatrogenic ventricular septal defects after aortic valve replacement surgery, together with our finding, in a literature review, of 9 additional patients who had undergone this procedure from 2004 through 2013. In all 11 cases, transcatheter device closure was indicated for a substantial intracardiac shunt with symptomatic heart failure, and such a device was successfully deployed across the iatrogenic ventricular septal defect, with clinical improvement. Our review suggests that transcatheter closure of iatrogenic ventricular septal defects in patients with previous aortic valve replacement surgery is a safe and effective treatment option, providing anatomic defect closure and relief of symptoms in the short-to-medium term. PMID:27547145

  12. Use of right ventricular support with a centrifugal pump in post-valve surgery right ventricular failure: a case series.

    PubMed

    Moulodi, Abdol Rasoul; Sheibat Zadeh, Gholam Reza; Sabzi, Feridoun

    2014-01-12

    The optimal treatment method for right ventricular failure after valve surgery complicated by a low cardiac output has not been determined, although several case reports have been published on patients with ventricular failure and arrhythmia who were bridged to cardiac transplantation using biventricular or left ventricular assist devices. This case series illustrates successful circulatory support of 4 patients with prolonged low cardiac outputs and right ventricular failure and arrhythmias after valvular heart surgery with or without severe pulmonary hypertension. In-hospital death occurred in one patient and 3 patients were discharged from the hospital with good general condition. At two years' follow-up, 2 patients were in functional class one but another patient underwent laparotomy for multiple splenic abscesses and died from multiple organ failure.

  13. [Surgery for tympanosclerotic stapes fixation accompanied by malleus fixation at the anterior malleus: report of 2 cases].

    PubMed

    Kawano, Hirokazu; Ohhashi, Mitsuru; Nakajima, Munehiro; Tsuboi, Yasuhiro; Komune, Shizuo

    2004-11-01

    Most tympanosclerotic stapes fixation involves fixation or erosion of the malleus and/or incus. This status of the ossicular chain is one reason that ossiculoplasty for tympanosclerotic stapes fixation is more difficult than that for otosclerosis. In some cases, the malleus is fixed only at the anterior, while the incus is intact. In such cases, anterior spinotomy can recover mobilization of the malleus, then a prosthesis can be used for the long process of the incus during ossiculoplasty. We conducted stapedectomy with anterior spinotomy on 3 ears in 2 patients. Over 15 dB of hearing was regained in all 3 ears 6 months after surgery. No significant sensorineural hearing loss was seen in any ear. To adapt this surgical procedure, it is necessary to evaluate preoperative CT findings and the status of the ossicular chain during surgery. PMID:15624507

  14. A case report of metastatic neuroendocrine carcinoma of the right adrenal gland successfully treated with chemotherapy and surgery.

    PubMed

    Ochiai, Toshiya; Komiyama, Sosuke; Ikoma, Hisashi; Kubota, Takeshi; Nakanishi, Masayoshi; Ichikawa, Daisuke; Kikuchi, Shojiro; Fujiwara, Hitoshi; Sakakura, Chohei; Kokuba, Yukihito; Sonoyama, Teruhisa; Otsuji, Eigo

    2010-08-01

    Poorly differentiated neuroendocrine carcinoma has a poor prognosis, especially when associated with distant metastasis. A 60-year-old man was admitted to a private hospital because of dyspnea at work in 2007. Computed tomography revealed lung infarction and a right adrenal tumor sized 12 cm in diameter that was tightly compressed against the inferior vena cava (IVC). Moreover, multiple lymph node metastases around the celiac axis and a solitary liver metastasis at the lateral segment were observed. Thus, we planned chemotherapy without surgery. We selected a combination therapy of irinotecan (CPT-11) and cisplatin (CDDP) (i.e., IP therapy): administration of CDDP [60 mg/m(2) body surface area (BSA)] on day 1 plus CPT-11 (80 mg/m(2)) BSA on days 1 and 8. Thereafter, this protocol was repeated at 3-week intervals. After 15 months of this chemotherapy strategy, the whole lesions showed a partial response by RECIST. The primary tumor had shrunk to 4.2 cm in diameter. In November 2008, we planned surgery to perform resection of the whole lesions. Histological diagnosis of the specimen was a poorly differentiated neuroendocrine carcinoma based on the immunostaining features, i.e., synaptophysin- and chromogranin positive. There were no viable tumor cells at the dissected lymph nodes or at the liver tumor. After surgery, CPT-11 administration was continued. The patient has remained well for 9 months without recurrence.

  15. [Changes in the pattern of substance use after bariatric surgery: report of one case].

    PubMed

    Quevedo, Yamil; Kirsten, Kurt; Ponce de León, Consuelo; Fernández, Alejandro

    2015-01-01

    Even though the benefits of bariatric surgery are supported by scientific evidence, its indications and contraindications must be revised to avoid its indiscriminate use. Substance use is more common in patients subjected to bariatric surgery than in the general population. After surgery, an increase in alcohol abuse has been reported. We report a 41 years old male, with morbid obesity, alcohol and cocaine use. After bariatric surgery, his alcohol tolerance significantly decreased, increasing the doses of cocaine and starting to consume it without alcohol. His high anxiety level and paranoid delusions, motivated him to seek help in a rehabilitation center where a Substance Dependence Disorder was diagnosed and received initial treatment. The cause of this adverse effect needs further research. Functional and anatomic changes in the digestive tract lead to a greater alcohol absorption and reduced alcohol dehydrogenase activity. Also neurochemical alterations may produce a displacement from compulsive use of food to compulsive use of addictive substances.

  16. Individual prefabricated titanium implants and titanium mesh in skull base reconstructive surgery. A report of cases.

    PubMed

    Schipper, J; Ridder, G J; Spetzger, U; Teszler, C B; Fradis, M; Maier, W

    2004-05-01

    Titanium implants can be shaped by traditional hand forming, press shaping, modular construction by welding, construction on full-size models shaped from CT coordinates and, most recently, by computer-assisted design and computer-assisted manufacturing (CAD/CAM) that consist in the direct prefabrication of individual implants by milling them out of a solid block of titanium. The aim of our study was to present a set of preliminary cases of an ongoing program of reconstructive procedures of the skull base using titanium implants. The subjects underwent ablative procedures of the skull base with reconstruction either by titanium mesh or individual prefabricated CAD/CAM implants. Six patients have been operated on successfully since 2000: two received prefabricated CAD/CAM titanium plates and four others underwent reconstruction with titanium mesh. The stability of CAD/CAM plates is superior to that of mesh, thus it is more useful in reconstructing large lesions of the frontal skull base and the temporal and occipital bones. Titanium mesh was successfully used for defects smaller than 100 cm(2) or where selected viscerocranial defects are complicated in design and less reproducible by CAD/CAM. The intraoperative design, shaping and adjustment characteristic of titanium mesh can be dispensed with when CAD/CAM implants are used. The 3-D data set used in the CAD/CAM process also operates in the navigated simulation and planning of the ablation contours, the latter being of great assistance in establishing the optimal future defect. As a disadvantage, CAD/CAM technology is more expensive than titanium mesh, and the process is time-consuming as it is carried out in advance of surgery.

  17. Bilateral Postoperative Cyst after Maxillary Sinus Surgery: Report of a Case and Systematic Review of the Literature.

    PubMed

    Niederquell, Boris-Mark; Brennan, Peter A; Dau, Michael; Moergel, Maximilian; Frerich, Bernhard; Kämmerer, Peer Wolfgang

    2016-01-01

    Purpose. We present a case of a bilateral postoperative maxillary cyst (PMC) and discuss this with a systemic review. Case Report and Literature Review. A 68-year-old female with pain and swelling on the right side of the face. MRI and CT showed a cystic tumors of the right and left maxillary sinus. Radical maxillary surgery via a Caldwell-Luc procedure had been performed 55 years ago and bilateral PMC was diagnosed. The PubMed database was searched for PMC within the last 30 years. Results. Together with the current case, we found 23 reports including 284 patients describing PMC. It was diagnosed at a mean time of 22 years after causal surgery at a mean age of 47 years. Initial symptoms were mostly pain with or without swelling. The main radiological sign was a unilocular radiolucency with a slight preference for the left side. Discussion. PMC is a long-term complication that can occur after maxillary sinus surgery and a second surgical approach is required in order to stop cystic expansion. Therefore, patients' informed consent on this complication as well as a prolonged follow-up is recommended. Simple paranasal ultrasound or paranasal sinus plain radiography may lead to an earlier detection reducing interventional morbidity. PMID:27478654

  18. Bilateral Postoperative Cyst after Maxillary Sinus Surgery: Report of a Case and Systematic Review of the Literature

    PubMed Central

    Brennan, Peter A.; Dau, Michael; Moergel, Maximilian; Frerich, Bernhard

    2016-01-01

    Purpose. We present a case of a bilateral postoperative maxillary cyst (PMC) and discuss this with a systemic review. Case Report and Literature Review. A 68-year-old female with pain and swelling on the right side of the face. MRI and CT showed a cystic tumors of the right and left maxillary sinus. Radical maxillary surgery via a Caldwell-Luc procedure had been performed 55 years ago and bilateral PMC was diagnosed. The PubMed database was searched for PMC within the last 30 years. Results. Together with the current case, we found 23 reports including 284 patients describing PMC. It was diagnosed at a mean time of 22 years after causal surgery at a mean age of 47 years. Initial symptoms were mostly pain with or without swelling. The main radiological sign was a unilocular radiolucency with a slight preference for the left side. Discussion. PMC is a long-term complication that can occur after maxillary sinus surgery and a second surgical approach is required in order to stop cystic expansion. Therefore, patients' informed consent on this complication as well as a prolonged follow-up is recommended. Simple paranasal ultrasound or paranasal sinus plain radiography may lead to an earlier detection reducing interventional morbidity. PMID:27478654

  19. Long-term outcome of epilepsy surgery: a retrospective study in a population of 379 cases.

    PubMed

    Yu, Shengkun; Lin, Zhiguo; Liu, Li; Pu, Song; Wang, Haiyang; Wang, Jiabin; Xie, Chuncheng; Yang, Changlin; Li, Meng; Shen, Hong

    2014-03-01

    We evaluated the long-term outcome of epilepsy surgery in drug-resistant epilepsy patients, and investigated preoperative factors associated with postoperative long-term surgical outcome. We performed a retrospective study of 379 patients who received epilepsy surgeries from 2000 to 2010. Patients had completed a minimum of 2-year and up to 12-year follow-up. Preoperative evaluations, surgical outcomes and clinical data of patients were collected and analyzed. We found that the epilepsy surgery was effective in drug-resistant patients and the long-term outcome of epilepsy surgery was satisfactory. The bipolar electro-coagulation could improve the surgical outcome when the epileptogenic focus was on the functional cortex. Results of the 2-year follow-up showed that preoperative seizure characteristics including the history of febrile seizure, seizure frequency, and location, quantity and range of seizure foci were significantly associated with the surgical outcome. The surgery procedure including the surgery type and the extent of resection also affected outcome. Abnormal head or hippocampus MRI, inconsistent results of preoperative investigations, seizure types, and pathology type might also be predictors of long-term surgical outcome. PMID:24461543

  20. Malnutrition in pregnancy following bariatric surgery: three clinical cases of fetal neural defects

    PubMed Central

    2014-01-01

    Objective Bariatric surgery results in decreased food intake and a variable degree of malabsorption. Without adequate supplementation, the most common complications of this surgery are nutritional disorders. Pregnancy following surgery for obesity is a particular condition requiring strict monitoring of nutrient intake necessary for fetal development and a favourable neonatal prognosis. Patients Malnutrition in pregnancy and congenital neural malformations are reported in three women who had previously undergone bariatric surgery (1, 5 and 18 years before pregnancy, respectively). Two patients underwent the Roux en Y bypass and one bilio-pancreatic diversion with gastroplasty. None of the three received pre-conceptional nutritional counselling. Patients 1 and 2 did not undergo postoperative nutritional surveillance; nutrient supplementation was started at 22 and 20 weeks gestation, respectively. In patient 3, supplementation was stopped at six weeks gestation. Results Newborns 1 and 2 presented with dorsal myelomeningocele and ventricular dilation. Both underwent surgery and a ventriculo-peritoneal shunt was inserted in the first month of life. Newborn 3 had microcephaly, bilateral microphthalmia and sensorineural deafness. Conclusions Diet and nutritional status, before and during pregnancy, play an important role in the early processes of fetal development and neonatal outcome. Women of childbearing age who have had bariatric surgery, should be encouraged to follow a well-balanced diet as part of a weight management strategy. They should be advised to take recommended maternal supplements. PMID:24929556

  1. Long-term outcome of epilepsy surgery: a retrospective study in a population of 379 cases.

    PubMed

    Yu, Shengkun; Lin, Zhiguo; Liu, Li; Pu, Song; Wang, Haiyang; Wang, Jiabin; Xie, Chuncheng; Yang, Changlin; Li, Meng; Shen, Hong

    2014-03-01

    We evaluated the long-term outcome of epilepsy surgery in drug-resistant epilepsy patients, and investigated preoperative factors associated with postoperative long-term surgical outcome. We performed a retrospective study of 379 patients who received epilepsy surgeries from 2000 to 2010. Patients had completed a minimum of 2-year and up to 12-year follow-up. Preoperative evaluations, surgical outcomes and clinical data of patients were collected and analyzed. We found that the epilepsy surgery was effective in drug-resistant patients and the long-term outcome of epilepsy surgery was satisfactory. The bipolar electro-coagulation could improve the surgical outcome when the epileptogenic focus was on the functional cortex. Results of the 2-year follow-up showed that preoperative seizure characteristics including the history of febrile seizure, seizure frequency, and location, quantity and range of seizure foci were significantly associated with the surgical outcome. The surgery procedure including the surgery type and the extent of resection also affected outcome. Abnormal head or hippocampus MRI, inconsistent results of preoperative investigations, seizure types, and pathology type might also be predictors of long-term surgical outcome.

  2. Robotic surgery

    MedlinePlus

    Robot-assisted surgery; Robotic-assisted laparoscopic surgery; Laparoscopic surgery with robotic assistance ... Robotic surgery is similar to laparoscopic surgery. It can be performed through smaller cuts than open surgery. ...

  3. Delayed postoperative hemorrhage complicating chalazion surgery.

    PubMed Central

    Procope, J. A.; Kidwell, E. D.

    1994-01-01

    Chalazion surgery is a common minor ophthalmic surgical procedure used to treat chalazia after conservative measures have failed. Complications are infrequent and generally easily managed with minimal morbidity. This article presents an atypical case of an elderly woman with a history of hypertension who experienced sudden profuse hemorrhaging 10 days after chalazion surgery. The clinical findings are presented along with a brief overview of the relevant vascular anatomy of the eyelid and a discussion of possible etiologic factors. PMID:7807576

  4. Use of a gesture user interface as a touchless image navigation system in dental surgery: Case series report

    PubMed Central

    Elizondo, María L.

    2014-01-01

    Purpose The purposes of this study were to develop a workstation computer that allowed intraoperative touchless control of diagnostic and surgical images by a surgeon, and to report the preliminary experience with the use of the system in a series of cases in which dental surgery was performed. Materials and Methods A custom workstation with a new motion sensing input device (Leap Motion) was set up in order to use a natural user interface (NUI) to manipulate the imaging software by hand gestures. The system allowed intraoperative touchless control of the surgical images. Results For the first time in the literature, an NUI system was used for a pilot study during 11 dental surgery procedures including tooth extractions, dental implant placements, and guided bone regeneration. No complications were reported. The system performed very well and was very useful. Conclusion The proposed system fulfilled the objective of providing touchless access and control of the system of images and a three-dimensional surgical plan, thus allowing the maintenance of sterile conditions. The interaction between surgical staff, under sterile conditions, and computer equipment has been a key issue. The solution with an NUI with touchless control of the images seems to be closer to an ideal. The cost of the sensor system is quite low; this could facilitate its incorporation into the practice of routine dental surgery. This technology has enormous potential in dental surgery and other healthcare specialties. PMID:24944966

  5. Predictive factors for surgical site infection in head and neck cancer surgery: A case-control study.

    PubMed

    Henry, J S; Buffet-Bataillon, S; Deberge, S; Jegoux, F

    2014-01-01

    Surgical Site Infection (SSI) after head and neck cancer surgery may be life threatening and induces increasing in healthcare cost. The objective of this present study was to identify predictive factors associated to surgical site infection in head and neck cancer surgery. Numerous predictive factors were analyzed with univariate case-control method, then with multivariate method. This retrospective study included 71 patients who have been hospitalized in our department during 2010 for a head and neck cancer surgery. The incidence of surgical site infection was 15.5%. The T3-T4 stages were identified as an independent predictive factor (p = 0.04). Our study does not find other predictive factor for a SSI. The NNIS index (National Nosocomial Infections Surveillance), used by the Center for disease control and prevention as predictive factor, was not valid in our study. A specific predictive index should include the tumor stage for Head and Neck Cancer surgery and should be taken into account for the management of a preventive antibiotic treatment.

  6. Torsion of an accessory spleen: a rare case preoperatively diagnosed and cured by single-port surgery.

    PubMed

    Ozeki, Maiko; Asakuma, Mitsuhiro; Go, Nakai; Ogura, Takeshi; Inoue, Yoshihiro; Shimizu, Tetsunosuke; Hirokawa, Fumitoshi; Yamamoto, Kazuhiro; Hayashi, Michihiro; Narumi, Yoshifumi; Higuchi, Kazuhide; Uchiyama, Kazuhisa

    2015-12-01

    We report a very rare case of acute abdomen caused by torsion of an accessory spleen that was preoperatively diagnosed and cured by single-port surgery. A 31-year-old woman was admitted to our hospital with severe left abdominal pain. Physical examination revealed a left upper quadrant abdominal tenderness with voluntary guarding. Ultrasound demonstrated a well-defined round mass isoechoic to the spleen, measuring 3.0 cm in diameter in the left upper quadrant adjacent to the spleen. A contrast-enhanced CT scan showed a normally enhanced spleen and a 3.0 × 3.0, hypodense, non-enhancing mass anterior to the spleen with a twisted funicular structure. Torsion of an accessory spleen was suspected, and emergency single-port surgery was performed. During surgery, a rounded violet mass measuring 3.0 cm in diameter, suggestive of an accessory spleen, with a 1800° torsion around a long vascular pedicle along the left side of the greater omentum was discovered. The mass was removed and post-operative recovery was uneventful. A review of the literature revealed 26 cases (including ours) of torsion of an accessory spleen in English. Even with the recent advances in radiologic imaging modalities, making a preoperative diagnosis of this is difficult and most cases are diagnosed during laparotomy. This is the first report preoperatively diagnosed and cured by single-port surgery. We decided to start the operation by using a single port, not only for cosmetic reasons for this young female patient, but also for final confirmation of our diagnosis. We believe that single-port laparoscopy is valuable as a diagnostic tool as long as safety is assured for patients with acute abdomen. Although torsion of an accessory spleen is extremely rare, it should be considered in the differential diagnosis of acute abdomen in children and young adults. PMID:26943424

  7. Access to essential paediatric eye surgery in the developing world: a case of congenital cataracts left untreated.

    PubMed

    Vinluan, Marilyn L; Olveda, Remigio M; Olveda, David U; Chy, Delia; Ross, Allen G

    2015-01-01

    Childhood cataracts are a major cause of treatable blindness. Early recognition, surgical intervention and appropriate follow-up after surgery can result in good visual outcomes. However, several factors may impact on the availability of such services, including lack of an available, affordable and accessible comprehensive eye care centre, financial limitations affecting coverage by the national healthcare provider, and household socioeconomic status. We report a case of congenital cataracts in a 12-year-old male adolescent from Northern Samar, the Philippines, who was left blind since birth. This case highlights the disparities in essential health services in the developing world and the challenges patients face in getting the care they need.

  8. Progression-free survival of two cases of high-risk neuroblastoma with refractory/relapsed disease following surgery alone.

    PubMed

    Sokol, Elizabeth; Haut, Paul R; Gosiengfiao, Yasmin; Feinstein, Kate; Pytel, Peter; Cohn, Susan L

    2013-03-01

    Outcome for the vast majority of high-risk neuroblastoma patients with refractory or relapsed disease is dismal. We report two high-risk patients who remain progression-free for more than 113 and 18 months following the diagnosis of refractory/relapsed disease who were treated with surgery alone. Complete resolution of a refractory thoracic mass and relapsed liver nodules was observed in one patient. The refractory/relapsed disease in the second patient has remained stable. In both cases, the tumor showed histologic evidence of neuroblastoma maturation. These cases demonstrate that refractory/relapsed neuroblastoma is clinically heterogeneous and highlight the need for better biomarkers to optimize patient care.

  9. Case studies of multi-day 3He-rich solar energetic particle periods

    NASA Astrophysics Data System (ADS)

    Chen, Nai-hwa; Bučík, Radoslav; Innes, Davina E.; Mason, Glenn M.

    2015-08-01

    Context. Impulsive solar energetic particle events in the inner heliosphere show the long-lasting enrichment of 3He. Aims: We study the source regions of long-lasting 3He-rich solar energetic particle (SEP) events Methods: We located the responsible open magnetic field regions, we combined potential field source surface extrapolations with the Parker spiral, and compared the magnetic field of the identified source regions with in situ magnetic fields. The candidate open field regions are active region plages. The activity was examined by using extreme ultraviolet images from the Solar Dynamics Observatory (SDO) and STEREO together with radio observations from STEREO and WIND. Results: Multi-day periods of 3He-rich SEP events are associated with ion production in single active region. Small flares or coronal jets are their responsible solar sources. We also find that the 3He enrichment may depend on the occurrence rate of coronal jets.

  10. Benefits of increased streamflow: The case of the John Day River Steelhead Fishery

    NASA Astrophysics Data System (ADS)

    Johnson, Neal S.; Adams, Richard M.

    1988-11-01

    Conflicts between instream water uses such as fish production and traditional out-of-stream uses are an important water resource issue. One criterion for evaluating the merits of alternative water allocations is economic efficiency. This study uses an integrated approach to measure the recreational steelhead fishery benefits of incremental streamflow changes in the John Day River in Oregon. The analysis combines a steelhead fishery production model with a contingent valuation assessment of changes in fishing quality to obtain estimates of the marginal value of water in producing fishing quality. The results suggest that increased summer flows to enhance fishing have a marginal value of about $2.40 acre-foot. When expressed in terms of water actually consumed, the value may be up to 10 times higher. These values are sensitive to the location of flow alterations in the river, potential for downstream uses and number of anglers in the fishery.

  11. The cost of Child Health Days: a case study of Ethiopia's Enhanced Outreach Strategy (EOS).

    PubMed

    Fiedler, John L; Chuko, Tesfaye

    2008-07-01

    Child Health Days (CHDs) are twice-annual campaign-style events designed to increase the coverage of vitamin A and one or more other child health services. Although more than two dozen countries have had a CHD, little has been published about them. This paper presents an activity-based costing study of Ethiopia's version of CHDs, the Enhanced Outreach Strategy (EOS). The December 2006 round reached more than 10 million beneficiaries at an average cost per beneficiary of US$0.56. When measles is added, the cost of the package doubles. Given the way the distribution day delivery system and the service package are structured, there are economies of scope. Because most of the costs are determined by the number of delivery sites and are independent of the number of beneficiaries, other things equal, increasing the beneficiaries would reduce the average cost per beneficiary. Taking into account only the mortality impact of vitamin A, EOS saved 20,200 lives and averted 230,000 DALYs of children 6-59 months. The average cost per life saved was US$228 and the cost per DALY averted was equivalent to 6% of per capita GDP (US$9), making the EOS cost-effective, according to WHO criteria. While CHDs are generally construed as a temporary strategy for improving coverage of supply-constrained systems, inadequate attention has been paid to demand-side considerations that suggest CHDs have an important role to play in changing care-seeking behaviour, in increasing community organization and participation, and in promoting district autonomy and capacity. Recognition of these effects suggests the need for decisions about where and when to introduce, and when to end, a CHD to take into account more than 'just' health sector considerations: they are more broadly about community development. UNICEF played a key role in initiating the EOS and finances 68% of costs, raising concern about the programme's long-term sustainability.

  12. Functional cortical reorganization in cases of cervical spondylotic myelopathy and changes associated with surgery.

    PubMed

    Bhagavatula, Indira Devi; Shukla, Dhaval; Sadashiva, Nishanth; Saligoudar, Praveen; Prasad, Chandrajit; Bhat, Dhananjaya I

    2016-06-01

    OBJECTIVE The physiological mechanisms underlying the recovery of motor function after cervical spondylotic myelopathy (CSM) surgery are poorly understood. Neuronal plasticity allows neurons to compensate for injury and disease and to adjust their activities in response to new situations or changes in their environment. Cortical reorganization as well as improvement in corticospinal conduction happens during motor recovery after stroke and spinal cord injury. In this study the authors aimed to understand the cortical changes that occur due to CSM and following CSM surgery and to correlate these changes with functional recovery by using blood oxygen level-dependent (BOLD) functional MRI (fMRI). METHODS Twenty-two patients having symptoms related to cervical cord compression due to spondylotic changes along with 12 age- and sex-matched healthy controls were included in this study. Patients underwent cervical spine MRI and BOLD fMRI at 1 month before surgery (baseline) and 6 months after surgery. RESULTS Five patients were excluded from analysis because of technical problems; thus, 17 patients made up the study cohort. The mean overall modified Japanese Orthopaedic Association score improved in patients following surgery. Mean upper-extremity, lower-extremity, and sensory scores improved significantly. In the preoperative patient group the volume of activation (VOA) was significantly higher than that in controls. The VOA after surgery was reduced as compared with that before surgery, although it remained higher than that in the control group. In the preoperative patient group, activations were noted only in the left precentral gyrus (PrCG). In the postoperative group, activations were seen in the left postcentral gyrus (PoCG), as well as the PrCG and premotor and supplementary motor cortices. In postoperative group, the VOA was higher in both the PrCG and PoCG as compared with those in the control group. CONCLUSIONS There is over-recruitment of sensorimotor cortices

  13. Smoking Is Associated with an Increased Risk for Surgery in Diverticulitis: A Case Control Study

    PubMed Central

    Diamant, Michael J.; Schaffer, Samuel; Coward, Stephanie; Kuenzig, M. Ellen; Hubbard, James; Eksteen, Bertus; Heitman, Steven; Panaccione, Remo; Ghosh, Subrata; Kaplan, Gilaad G.

    2016-01-01

    Importance Cigarette smoking increases the risk of surgery in Crohn’s disease. However, the effect of smoking on the need for surgery for diverticulitis is unknown. Objective We evaluated whether smoking was a risk factor for surgery among patients admitted to hospital with acute diverticulitis. Design We conducted a population-based comparative cohort study of patients admitted to hospital for diverticulitis who were treated with medical versus surgical management. Setting & Participants We used the population-based Discharge Abstract Database to identify 176 adults admitted emergently with a diagnosis of diverticulitis between 2009 and 2010 in Calgary. Intervention & Main Outcome We performed a medical chart review to confirm the diagnosis of diverticulitis and to extract clinical data. The primary outcome was a partial colectomy during hospitalization. Logistic regression evaluated the association between smoking and surgery after adjusting for potential confounders, including age, sex, comorbidity, and disease severity. Results A partial colectomy was performed on 35.6% of patients with diverticulitis and 1.3% died. Among diverticulitis patients, 26.8% were current smokers, 31.5% were ex-smokers, and 41.6% never smoked. Compared to non-smokers, current smokers (adjusted odds ratio [OR] 9.02; 95% confidence interval [CI]: 2.47–32.97) and former smokers (adjusted OR 5.41; 95% CI: 1.54–18.96) had increased odds of surgery. Conclusion and Relevance Smoking is associated with the need for surgical management of diverticulitis. PMID:27467077

  14. Diode Laser in Minor Oral Surgery: A Case Series of Laser Removal of Different Benign Exophytic Lesions

    PubMed Central

    Sotoode, Somaye Mazarei; Azimi, Somayyeh; Taheri, Sayed Alinaghi; Asnaashari, Mohammad; Khalighi, Hamidreza; Rahmani, Somayeh; Jafari, Soudeh; Elmi Rankohi, Zahra

    2015-01-01

    Introduction: The role of laser in conservative management of oral disease is well established. Laser procedures are common in the fields of oral surgery, implant dentistry, endodontic, and periodontic therapy. Case: This case series describes the use of diode laser for the excision of oral exophytic lesions. All the patients attended the oral medicine department of Shahid Beheshti University of Medical Sciences, Tehran, Iran. Criteria in patient selection were accessibility to lesions, patient fear from blade surgery, aesthetics, and probability of bleeding. An informed consent was filled by every patient. All of the lesions were completely excised under local anaesthesia by diode laser with 300 μm-fibre tip, 808 nm continuous wavelength and 3-3.5 W power for 3×60 seconds (Dr Smile, Italia). During surgery, the fibre tip was in contact with lesions. No analgesics were prescribed to the patients. The patients were followed for the first, second, and forth week after treatment. Conclusion: The lesions could be excised using the diode laser. This procedure was a quick clinical technique without bleeding. PMID:26464782

  15. [Overcoming disease and biography of lumbar disk surgery patients--a typology based on 30 case studies].

    PubMed

    Brücher, K; Longinus, B

    1991-07-01

    A random sample of 30 patients hospitalized for lumbar disc surgery was studied on four specific occasions: before surgery in a biographic interview; during post-operative treatment by behavioural observations; at discharge from hospital and 15 months on average after surgery in further interviews about their ability to cope with the illness and about their social adaptation. Data analysis was carried out according to the method of structural hermeneutics (Oevermann et al. 1979). By contrastive comparison of the cases, a typology of coping behaviour in patients during the out-patient, in-patient, and post-hospitalization phase was developed. 15 patients showed a consistent type of coping behaviour which we have termed "autonomistic". This finds expression at the behavioural level in a patient-doctor struggle who determines treatment. It is motivated by an ambivalence conflict between fear of and desire for dependence and care. Variants of autonomistic coping behaviour and their dependence on biographic influences are presented using 2 case histories. Against this background the problem of adaptivity is discussed.

  16. Bariatric surgery in type 1 diabetes mellitus; long-term experience in two cases.

    PubMed

    Fuertes-Zamorano, Nuria; Sánchez-Pernaute, Andrés; Torres García, Antonio J; Rubio Herrera, Miguel A

    2013-01-01

    In patients with obesity and type 2 diabetes, recommendations for bariatric surgery are well established. However, no consensus exists regarding its role for the management of patients with type 1 diabetes and morbid obesity. We present the long-term follow-up of two women with type 1 diabetes, morbid obesity and associated comorbidities, who underwent malabsorptive bariatric surgery. More than four years after the procedure, both have a body mass index (BMI) within the normal range and HbA1c levels below 7%. Also, they have been able to reduce their insulin requirements in more than 50%, their associated comorbidities have disappeared, and their overall quality of life has significantly improved. We compare our results with other recently published ones, emphasizing potential indications of bariatric surgery for patients with type 1 diabetes.

  17. Evaluation of the effects of rehabilitation after surgery using the Ravitch and Nuss methods: a case study

    PubMed Central

    2016-01-01

    Rehabilitation may be helpful in the prevention of complications associated with the treatment of patients with pectus excavatum who are subjected to surgery using the Ravitch and Nuss methods. This paper presents the case of a patient who underwent successful physical rehabilitation after 8 weeks from the surgery using the combined method. As part of the Nuss procedure, two plates were implanted to form a scaffolding for the patient's chest, which had previously been corrected with the Ravitch method. The plates were to be removed after 24 months of treatment. After the procedure, in spite of the favorable cosmetic effect of the repair, there was a significant decrease in the spirometric values and physical fitness of the patient. He underwent an individual physiotherapy program, which lasted four weeks. The streamlining of the respiratory system has significantly improved the spirometric values and raised the overall performance of the patient's organism. PMID:27212987

  18. Evaluation of the effects of rehabilitation after surgery using the Ravitch and Nuss methods: a case study.

    PubMed

    Bal-Bocheńska, Monika Anna

    2016-03-01

    Rehabilitation may be helpful in the prevention of complications associated with the treatment of patients with pectus excavatum who are subjected to surgery using the Ravitch and Nuss methods. This paper presents the case of a patient who underwent successful physical rehabilitation after 8 weeks from the surgery using the combined method. As part of the Nuss procedure, two plates were implanted to form a scaffolding for the patient's chest, which had previously been corrected with the Ravitch method. The plates were to be removed after 24 months of treatment. After the procedure, in spite of the favorable cosmetic effect of the repair, there was a significant decrease in the spirometric values and physical fitness of the patient. He underwent an individual physiotherapy program, which lasted four weeks. The streamlining of the respiratory system has significantly improved the spirometric values and raised the overall performance of the patient's organism. PMID:27212987

  19. Arytenoid cartilage dislocation after reversed total shoulder replacement surgery in the beach chair position: a case report

    PubMed Central

    Sim, Yeo Hae; Choi, Jeong-Hyun

    2016-01-01

    Arytenoid cartilage dislocation is not a common complication, but its delayed diagnosis reduces the therapeutic effect of treatment. A male patient underwent reversed total shoulder replacement surgery in the beach chair position under general anesthesia. The patient experienced postoperative hoarseness, and it was revealed that he had right arytenoid dislocation. Voice restoration was accomplished with closed reduction. We discussed changes in patient position during the operation and how they may contribute to the arytenoid dislocation. Flexion and a slight rotation of the neck during the operation can lead to an increase in intracuff pressure of the endotracheal tube. It is necessary to check neck position and monitor intracuff pressure in patients undergoing operations in the beach chair position. Also, the anesthesiologist should suspect arytenoid dislocation in the case of persistent hoarseness after surgery in the beach chair position. PMID:27482316

  20. Prone Position-Related Meralgia Paresthetica after Lumbar Spinal Surgery : A Case Report and Review of the Literature

    PubMed Central

    Lee, Ho Jun

    2008-01-01

    Lateral femoral cutaneous neuropathy occurring during spinal surgery is frequently related to iliac bone graft harvesting, but meralgia paresthetica (MP) can result from the patient being in the prone position. Prone position-related MP is not an uncommon complication after posterior spine surgery but there are only few reports in the literature on this subject. It is usually overlooked because of its mild symptoms and self-limiting course, or patients and physicians may misunderstand the persistence of lower extremity symptoms in the early postoperative period to be a reflection of poor surgical outcome. The authors report a case of prone position-related MP after posterior lumbar interbody fusion at the L3-4 and reviewed the literature with discussion on the incidence, pathogenesis, and possible risk factors related to this entity. PMID:19137086

  1. The case for advanced physics topics in oral and maxillofacial surgery.

    PubMed

    Tandon, Rahul; Herford, Alan S

    2014-10-01

    Research in oral and maxillofacial surgery has focused mainly on principles founded in the biological and chemical sciences, which have provided excellent answers to many questions. However, recent technologic advances have begun to gain prominence in many of the medical sciences, providing clinicians with more effective tools for diagnosis and treatment. The era of modern physics has led to the development of diagnostic techniques that could provide information at a more basic level than many of the current biochemical methods used. The goal of this report is to introduce 2 of these methods and describe how they can be applied to oral and maxillofacial surgery.

  2. Trauma surgery and traffic policy in Germany in the 1930s: a case study in the coevolution of modern surgery and society.

    PubMed

    Schlich, Thomas

    2006-01-01

    This paper analyzes how in Germany in the first half of the twentieth century the development of surgery and modern automobile traffic were intertwined. It describes the mutual influence of traffic policy and trauma surgery under the conditions of National Socialist politics of modernization. This coevolutionary development provides an example of how the rise of much of modern surgery can be better understood by taking into account other, nonmedical developments in society.

  3. Prevalence and risk factors of deep vein thrombosis in patients after spine surgery: a retrospective case-cohort study

    PubMed Central

    Yang, Si-Dong; Liu, Huan; Sun, Ya-Peng; Yang, Da-Long; Shen, Yong; Feng, Shi-Qing; Zhao, Feng-Dong; Ding, Wen-Yuan

    2015-01-01

    Deep vein thrombosis (DVT) is common seen in patients undergoing spine surgery. However, its prevalence and associated risk factors have not been well understood yet. This retrospective case-cohort study was designed to investigate risk factors for postoperative DVT using retrospectively collected data from department of spine surgery between 07/2013 and 07/2014. Univariate analysis and binary logistic regression analysis were used to determine risk factors for DVT. A total of 861 patients were admitted into DVT-associated analyses, including 410 males and 451 females, aged from 15 to 87 years old (median 54, IQR 18). Of them, 147 cases (17%) sustained postoperative DVT. DVT incidence was 15.9% in patients undergoing lumbar interbody fusion, 13.5% in patients treated by low-molecular-weight heparin (LMWH), while only 8.1% in patients without LMWH. However, it revealed no significant difference between LMWH group and non-LMWH group (χ2 = 1.933, p = 0.164). Logistic regression equation was logit P = −4.09 + 0.05*X1 − 0.55*X2 + 0.41*X3 + 1.41*X7, (X1 = age; X2 = regions; X3 = hypertension; X7 = D-dimer). In this study, LMWH prophylaxis after spine surgery proved ineffective. Advanced age, D-dimer and hypertension have proved to be the risk factors for postoperative DVT in patients undergoing spine surgery. PMID:26135271

  4. Case study: Nutrition and hydration status during 4,254 km of running over 78 consecutive days.

    PubMed

    Dempster, Sarah; Britton, Rhiannon; Murray, Andrew; Costa, Ricardo J S

    2013-10-01

    The aims of this study were to assess the dietary intake and monitor self-reported recovery quality and clinical symptomology of a male ultra-endurance runner who completed a multiday ultra-endurance running challenge covering 4,254 km from North Scotland to the Moroccan Sahara desert over 78 consecutive days. Food and fluid intakes were recorded and analyzed through dietary analysis software. Body mass (BM) was determined before and after running each day, and before sleep. Clinical symptomology and perceived recovery quality were recorded each day. Whole blood hemoglobin and serum ferritin were determined before and after the challenge. Total daily energy (mean ± SD: 23.2 ± 3.2 MJ · day(-1)) and macronutrient intake (182 ± 31 g · day(-1) protein, 842 ± 115 g · day(-1) carbohydrate, 159 ± 55 g · day(-1) fat) met consensus nutritional guidelines for endurance performance. Total daily water intake through foods and fluids was 4.8 ± 2.0 L · day(-1). Water and carbohydrate intake rates during running were 239 ± 143 ml · h(-1) and 56 ± 19 g · h(-1), respectively. Immediately after running, carbohydrate and protein intakes were 1.3 ± 1.0 g · kg BM(-1) and 0.4 ± 0.2 g · kg BM(-1), respectively. Daily micronutrient intakes ranged from 109 to 662% of UK RNIs. Prerunning BM was generally maintained throughout. Overall exercise-induced BM loss averaged 0.8 ± 1.0%; although BM losses of ≥ 2% occurred in the latter stages, a reflection of the warmer climate. Varying degrees of self-reported perceived recovery quality and clinical symptomology occurred throughout the challenge. This case study highlights oscillations in dietary habits along 78 consecutive days of ultra-endurance running, dependent on changes in ambient conditions and course topography. Nevertheless, nutrition and hydration status were maintained throughout the challenge. Despite dietary iron intake above RNI and iron supplementation, this alone did not prevent deficiency symptoms. PMID

  5. Trends of 28 days case fatality rate after first acute myocardial infarction in Isfahan, Iran, from 2000 to 2009

    PubMed Central

    Mohammadian, Mahdi; Hosseini, Shidokht; Sadeghi, Masoumeh; Sarrafzadegan, Nizal; Salehiniya, Hamid; Roohafza, Hamidreza; Khazaei, Salman; Mohammadian-Hafshejani, Abdollah

    2015-01-01

    BACKGROUND The purpose of the present study was the analysis of the trends in case fatality rate of acute myocardial infarction (AMI) in Isfahan, Iran. This analysis was performed based on gender, age groups, and type of AMI according to the International Classification of Diseases, version 10, during 2000-2009. METHODS Disregarding the Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA), this cohort study considered all AMI events registered between 2000 and 2009 in 13 hospitals in Isfahan. All patients were followed for 28 days. In order to assess the case fatality rate, the Kaplan-Meier analysis, and to compare survival rate, log-rank test were used. Using the Cox regression model, 28 days case fatality hazard ratio (HR) was calculated. RESULTS In total, 12,900 patients with first AMI were entered into the study. Among them, 9307 (72.10%) were men and 3593 (27.90%) women. The mean age in all patients increased from 61.36 ± 12.19 in 2000-2001 to 62.15 ± 12.74 in 2008-2009, (P = 0.0070); in women, from 65.38 ± 10.95 to 67.15 ± 11.72 (P = 0.0200), and in men, from 59.75 ± 12.29 to 59.84 ± 12.54 (P = 0.0170),. In addition, the 28 days case fatality rate in 2000-2009 had a steady descending trend. Thus, it decreased from 11.20% in 2000-2001 to 07.90% in 2008-2009; in men, from 09.20% to 06.70%, and in women, from 16.10% to 10.90%. During the study, HR of case fatality rate in 2000-2001 declined; therefore, in 2002-2003, it was 0.93 [95% confidence interval (CI) = 0.77-1.11], in 2004-2005, 0.88 (95% CI = 0.73-1.04), in 2006-2007, 0.67 (95% CI = 0.56-0.82), and in 2008-2009, 0.69 (95% CI = 0.56-0.82). CONCLUSION In Isfahan, a reduction was observable in the trend of case fatality rate in both genders and all age groups. Thus, there was a 29.46% reduction in case fatality rate (27.17% in men, 32.29% in women) during the study period. PMID:26478731

  6. Transforaminal epidural steroid injections prevent the need for surgery in patients with sciatica secondary to lumbar disc herniation: a retrospective case series

    PubMed Central

    Manson, Neil A.; McKeon, Melissa D.; Abraham, Edward P.

    2013-01-01

    Background The median orthopedic surgery wait time in Canada is 33.7 weeks, thus alternative treatments for pathologies such as lumbar disc herniations (LDH) are needed. We sought to determine whether transforaminal epidural steroid injections (TFESIs) alleviate or merely delay the need for surgery. Methods We retrospectively reviewed the charts of patients with LDH who received TFESIs between September 2006 and July 2008. Patient demographics, level and side of pathology, workers’ compensation status, levels injected, treatment outcome and time from referral to treatment were evaluated. The primary outcome measure was the need for versus the avoidance of surgery. Results We included 91 patients in our analysis. Time from family physician referral to injection was 123 (standard deviation [SD] 88) days; no significant differences in wait times were found between TFESI patients and those requiring surgery. In all, 51 patients (22 women, 29 men) with a mean age of 45.8 (SD 10.2) years avoided surgery following TFESI, whereas 40 patients (16 women, 24 mean) with a mean age of 43.1 (SD 12.0) years proceeded to surgery within 189 (SD 125) days postinjection. In all, 15 patients received multiple injections, and of these, 9 did not require surgical intervention. Age, sex and level/side of pathology did not influence the treatment outcome. Workers’ compensation status influenced outcome significantly; these patients demonstrated less benefit from TFESI. Conclusion Transforaminal epidural steroid injections are an important treatment tool, preventing the need for surgery in 56% of patients with LDH. PMID:23351495

  7. Solo hand surgery.

    PubMed

    Bell, Michael Sg; Reitsma, Bert J

    2005-01-01

    Unassisted hand surgery is being undertaken by necessity for both elective and emergency cases, due to hospital resource restrictions. The authors outline the principles of local anesthesia, surgeon-controlled tourniquet techniques, and a number of new instruments which allow a surgeon to work in comfort and safety, unassisted. The traditional surgical instruments designed for the days when trained surgical assistants were available to hold them are no longer suitable. We are entering a new era of surgical design with safer instruments that can complement our skills rather than challenge them. There are significant cost savings and efficiency when hand procedures are undertaken in the emergency and outpatient clinic settings.

  8. Cosmetic Surgery

    MedlinePlus

    ... Body Looking and feeling your best Cosmetic surgery Cosmetic surgery Teens might have cosmetic surgery for a ... about my body? What are the risks of cosmetic surgery? top People who have cosmetic surgery face ...

  9. A Study in Child Care (Case Study from Volume II-A): "A Rolls-Royce of Day Care." Day Care Programs Reprint Series.

    ERIC Educational Resources Information Center

    O'Farrell, Brigid

    The Amalgamated Day Care Center is an independent trust established through a collective bargaining agreement between the Amalgamated Clothing Workers of America, AFL-CIO, and the employers of the garment industry. The free center, open from 6:00 a.m. to 6:00 p.m., is located near the Chicago garment industries to minimize transportation problems…

  10. Guillain-Barré syndrome: report of two rare clinical cases occurring after allergenic bone grafting in oral maxillofacial surgery

    PubMed Central

    Cicciù, Marco; Herford, Alan Scott; Bramanti, Ennio; Maiorana, Carlo

    2015-01-01

    Guillaine-Barré Syndrome (GBS), also known as post-infectious polyneuropathy or acute idiopathic polyneuritis, is an infrequent disorder of the peripheral nervous system. The cause of GBS is unknown. It has been associated in the past with microbial infections, vaccinations, surgical procedures and debilitation of the patient. The classic signs of GBS occurring in the two patients being reported here are muscle weakness, motor and sensory impairment and ascending paralysis with respiratory involvement. The documented cases involved GBS syndrome following oral and maxillofacial surgery in which allogeneic-banked freeze-dried bone have been utilized along with autogenous grafting. There were no incidents of viral infection, vaccination or the other prodromal incidents involved in these cases. It is believed that the description of these two cases would be of interest in that it may stimulate the reporting of similar anecdotal occurrences by other surgeons. Both patients fully recovered from the GBS and are presently alive and well. PMID:26261679

  11. Guillain-Barré syndrome: report of two rare clinical cases occurring after allergenic bone grafting in oral maxillofacial surgery.

    PubMed

    Cicciù, Marco; Herford, Alan Scott; Bramanti, Ennio; Maiorana, Carlo

    2015-01-01

    Guillaine-Barré Syndrome (GBS), also known as post-infectious polyneuropathy or acute idiopathic polyneuritis, is an infrequent disorder of the peripheral nervous system. The cause of GBS is unknown. It has been associated in the past with microbial infections, vaccinations, surgical procedures and debilitation of the patient. The classic signs of GBS occurring in the two patients being reported here are muscle weakness, motor and sensory impairment and ascending paralysis with respiratory involvement. The documented cases involved GBS syndrome following oral and maxillofacial surgery in which allogeneic-banked freeze-dried bone have been utilized along with autogenous grafting. There were no incidents of viral infection, vaccination or the other prodromal incidents involved in these cases. It is believed that the description of these two cases would be of interest in that it may stimulate the reporting of similar anecdotal occurrences by other surgeons. Both patients fully recovered from the GBS and are presently alive and well. PMID:26261679

  12. The use of intraoperative computed tomography navigation in pituitary surgery promises a better intraoperative orientation in special cases

    PubMed Central

    Linsler, Stefan; Antes, Sebastian; Senger, Sebastian; Oertel, Joachim

    2016-01-01

    Objective: The safety of endoscopic skull base surgery can be enhanced by accurate navigation in preoperative computed tomography (CT) and magnetic resonance imaging (MRI). Here, we report our initial experience of real-time intraoperative CT-guided navigation surgery for pituitary tumors in childhood. Materials and Methods: We report the case of a 15-year-old girl with a huge growth hormone-secreting pituitary adenoma with supra- and perisellar extension. Furthermore, the skull base was infiltrated. In this case, we performed an endonasal transsphenoidal approach for debulking the adenoma and for chiasma decompression. We used an MRI neuronavigation (Medtronic Stealth Air System) which was registered via intraoperative CT scan (Siemens CT Somatom). Preexisting MRI studies (navigation protocol) were fused with the intraoperative CT scans to enable three-dimensional navigation based on MR and CT imaging data. Intraoperatively, we did a further CT scan for resection control. Results: The intraoperative accuracy of the neuronavigation was excellent. There was an adjustment of <1 mm. The navigation was very helpful for orientation on the destroyed skull base in the sphenoid sinus. After opening the sellar region and tumor debulking, we did a CT scan for resection control because the extent of resection was not credible evaluable in this huge infiltrating adenoma. Thereby, we were able to demonstrate a sufficient decompression of the chiasma and complete resection of the medial part of the adenoma in the intraoperative CT images. Conclusions: The use of intraoperative CT/MRI-guided neuronavigation for transsphenoidal surgery is a time-effective, safe, and technically beneficial technique for special cases.

  13. The use of intraoperative computed tomography navigation in pituitary surgery promises a better intraoperative orientation in special cases

    PubMed Central

    Linsler, Stefan; Antes, Sebastian; Senger, Sebastian; Oertel, Joachim

    2016-01-01

    Objective: The safety of endoscopic skull base surgery can be enhanced by accurate navigation in preoperative computed tomography (CT) and magnetic resonance imaging (MRI). Here, we report our initial experience of real-time intraoperative CT-guided navigation surgery for pituitary tumors in childhood. Materials and Methods: We report the case of a 15-year-old girl with a huge growth hormone-secreting pituitary adenoma with supra- and perisellar extension. Furthermore, the skull base was infiltrated. In this case, we performed an endonasal transsphenoidal approach for debulking the adenoma and for chiasma decompression. We used an MRI neuronavigation (Medtronic Stealth Air System) which was registered via intraoperative CT scan (Siemens CT Somatom). Preexisting MRI studies (navigation protocol) were fused with the intraoperative CT scans to enable three-dimensional navigation based on MR and CT imaging data. Intraoperatively, we did a further CT scan for resection control. Results: The intraoperative accuracy of the neuronavigation was excellent. There was an adjustment of <1 mm. The navigation was very helpful for orientation on the destroyed skull base in the sphenoid sinus. After opening the sellar region and tumor debulking, we did a CT scan for resection control because the extent of resection was not credible evaluable in this huge infiltrating adenoma. Thereby, we were able to demonstrate a sufficient decompression of the chiasma and complete resection of the medial part of the adenoma in the intraoperative CT images. Conclusions: The use of intraoperative CT/MRI-guided neuronavigation for transsphenoidal surgery is a time-effective, safe, and technically beneficial technique for special cases. PMID:27695249

  14. Perioperative acute coronary syndrome during functional endoscopic sinus surgery in a young HIV-infected patient. A case report.

    PubMed

    Choppin, E; De Wit, S; Sosnowski, M

    2010-01-01

    We report a case of a young HIV-infected woman treated for more than ten years by highly active antiretroviral therapy, presenting a peroperative acute coronary syndrome caused by a hypertensive episode after systemic resorption of locally applied epinephrine during a functional endoscopic sinus surgery. Since patients with multiple risk factors for coronary artery desease seems to be more susceptible to complications of epinephrine injection, this reminds us of the higher cardiovascular risk for HIV patients with long term treatment. Therefore anesthesiologists should be susceptible to consider specifically the pre- and postoperative evaluation of patients with long term antiretroviral therapy. PMID:21388080

  15. Myocardial perfusion SPECT in a case of retropulmonary looping of left coronary artery in a baby after arterial switch surgery

    PubMed Central

    Padma, Subramanyam; Sundaram, Palaniswamy Shanmuga

    2014-01-01

    Pediatric myocardial perfusion imaging (MPI) is not a routine investigation in an Indian setting due to under referrals and logistic problems. However, MPI is a frequently performed and established modality of investigation in adults for the identification of myocardial ischemia and viability. We report myocardial perfusion scintigraphy in a case of retropulmonary looping of left coronary artery in a baby after arterial switch surgery. Adenosine stress MPI revealed a large infarct involving anterior segment with moderate reversible ischemia of the lateral left ventricular segment. Coronary angiogram later confirmed left main coronary artery ostial occlusion with retrograde collateral supply from dilated right coronary artery. PMID:24761067

  16. Ectopic Cervical Thymoma Excised through a Transcervical Approach Combined with Video-assisted Thoracoscopic Surgery: A Case Report

    PubMed Central

    Hayashida, Ryozo; Yoshiyama, Koichi; Ozaki, Kunihiro; Matsuo, Toshihiro; Takamori, Shinzo; Akagi, Yoshito

    2015-01-01

    Ectopic cervical thymoma (ECT) is a rare tumor. We present a case of 56-year-old woman with an ECT in the anterior neck that was correctly diagnosed preoperatively. The patient had no symptoms of myasthenia gravis or other immune disorders, and the tumor was not invading any adjacent structures. We performed tumor resection and thymectomy through a transcervical approach using video-assisted thoracoscopic surgery with a multi-access single port. To our knowledge, this is a novel combined technique for the resection of an ECT. PMID:25740445

  17. Severe neurologic manifestations in acute intermittent porphyria developed after spine surgery under general anesthesia: a case report

    PubMed Central

    Park, Eun Young; Kim, Yi Seul; Lim, Kyung-Jee; Lee, Hye Kyoung; Lee, Soo Kyung; Choi, Hyun

    2014-01-01

    Porphyrias are inherited metabolic disorders resulting from a specific enzyme defect in the heme biosynthetic pathway. Porphyrias are induced by various precipitants. Clinical features include abdominal pain, neurologic manifestations, autonomic neuropathy, and mental disturbance. Diagnosis may be delayed because of variable symptoms that mimic other diseases and because of the rarity of of porphyrias. Although most patients with known porphyria can complete anesthesia and surgery safely, undiagnosed porphyric patients are in danger of porphyric crisis due to inadvertent exposure to precipitating drugs and environment. We report a case of a patient who experienced delayed emergence with neurological disturbance after general anesthesia, ultimately diagnosed as acute intermittent porphyria. PMID:25302100

  18. Non-Exposed Endoscopic Wall-Inversion Surgery for Gastrointestinal Stromal Tumor of the Stomach: First Case Report in Korea

    PubMed Central

    Kim, Da Won; Kim, Joon Sung; Kim, Byung-Wook; Jung, Ji Yun; Kim, Gi Jun; Kim, Jin-Jo

    2016-01-01

    Laparoscopic wedge resection of the stomach is a widely accepted treatment for primary resectable gastrointestinal stromal tumors (GISTs). However, it is difficult to determine the appropriate incision line from outside of the stomach, and many attempts have been made to avoid unnecessary resection of unaffected gastric tissues. Recently a technique called non-exposed endoscopic wall-inversion surgery (NEWS) was introduced to avoid exposure of GIST to the peritoneum. Here, we describe the first published case of NEWS for GIST of the stomach practiced in Korea. PMID:26975860

  19. A day in the life: a case series of acute care palliative medicine--the Cleveland model.

    PubMed

    Lagman, Ruth; Walsh, Declan; Heintz, Jessica; Legrand, Susan B; Davis, Mellar P

    2008-01-01

    Palliative care in advanced disease is complex. Knowledge and experience of symptom control and management of multiple complications are essential. An interdisciplinary team is also required to meet the medical and psychosocial needs in life-limiting illness. Acute care palliative medicine is a new concept in the spectrum of palliative care services. Acute care palliative medicine, integrated into a tertiary academic medical center, provides expert medical management and specialized care as part of the spectrum of acute medical care services to this challenging patient population. The authors describe a case series to provide a snapshot of a typical day in an acute care inpatient palliative medicine unit. The cases illustrate the sophisticated medical care involved for each individual and the important skill sets of the palliative medicine specialist required to provide high-quality acute medical care for the very ill.

  20. Rehabilitation Nutrition for Possible Sarcopenic Dysphagia After Lung Cancer Surgery: A Case Report.

    PubMed

    Wakabayashi, Hidetaka; Uwano, Rimiko

    2016-06-01

    Sarcopenic dysphagia is characterized by the loss of swallowing muscle mass and function associated with generalized loss of skeletal muscle mass and function. In this report, the authors describe a patient with possible sarcopenic dysphagia after lung cancer surgery and was treated subsequently by rehabilitation nutrition. A 71-year-old man with lung cancer experienced complications of an acute myocardial infarction and pneumonia after surgery. He was ventilated artificially, and a tracheotomy was performed. The patient received diagnoses of malnutrition, severe sarcopenia, and possible sarcopenic dysphagia. His dysphagia was improved by a combination of dysphagia rehabilitation including physical and speech therapy and an improvement in nutrition initiated by a nutrition support team. Finally, he no longer had dysphagia and malnutrition. Sarcopenic dysphagia should be considered in patients with sarcopenia and dysphagia. Rehabilitation nutrition using a combination of both rehabilitation and nutritional care management is presumptively useful for treating sarcopenic dysphagia. PMID:26829095

  1. Indocyanine Green Fluorescence Endoscopy at Endonasal Transsphenoidal Surgery for an Intracavernous Sinus Dermoid Cyst: Case Report

    PubMed Central

    HIDE, Takuichiro; YANO, Shigetoshi; KURATSU, Jun-ichi

    2014-01-01

    The complete resection of intracavernous sinus dermoid cysts is very difficult due to tumor tissue adherence to important anatomical structures such as the internal carotid artery (ICA), cavernous sinus, and cranial nerves. As residual dermoid cyst tissue sometimes induces symptoms and repeat surgery may be required after cyst recurrence, minimal invasiveness is an important consideration when selecting the surgical approach to the lesion. We addressed a recurrent intracavernous sinus dermoid cyst by the endoscopic endonasal transsphenoidal approach assisted by neuronavigation and indocyanine green (ICG) endoscopy to confirm the ICA and patency of the cavernous sinus. The ICG endoscope detected the fluorescence signal from the ICA and cavernous sinus; its intensity changed with the passage of time. The ICG endoscope was very useful for real-time imaging, and its high spatial resolution facilitated the detection of the ICA and the patent cavernous sinus. We found it to be of great value for successful endonasal transsphenoidal surgery. PMID:25446381

  2. Day to Day

    ERIC Educational Resources Information Center

    Jurecki, Dennis

    2006-01-01

    A clean, healthy and safe school provides students, faculty and staff with an environment conducive to learning and working. However, budget and staff reductions can lead to substandard cleaning practices and unsanitary conditions. Some school facility managers have been making the switch to a day-schedule to reduce security and energy costs, and…

  3. Safety and feasibility of day case ureteroscopy and laser lithotripsy (URSL) in patients with a solitary kidney

    PubMed Central

    Ghosh, Anngona

    2016-01-01

    Introduction The management of nephrolithiasis in patients with a solitary kidney poses a treatment challenge. The study aimed to evaluate the outcomes of ureteroscopy and laser stone fragmentation (URSL) for renal stones in these patients treated in our university teaching hospital. Material and methods Between July 2012 and December 2014, seventeen cases of URSL for stones in a solitary kidney were reviewed. Patient demographics, stone dimensions, perioperative and post-operative outcomes were recorded in a prospectively maintained database. Serum creatinine levels pre-procedure and at follow-up were also compared. Results Seventeen cases of URSL were conducted with a mean age of 52.9 ±19.9 years. 8 of the 17 (47%) patients had stones in multiple locations and 13 (76%) were in the lower pole. The mean ± SD stone size and BMI were 13.0 ±8.9 mm and 31.6 ±5.8 kg/m2, respectively. The stone free rate (SFR) was 82.5%. Fourteen (82.5%) patients were discharged the same day and 16 cases (94%) were discharged within 24 hours. For patients with deranged pre-operative serum creatinine, the mean serum creatinine level improved from 131.2 ±68.3 µmol/L pre-URSL to 106.5 ±36.7 µmol/L at follow-up. There was one Clavien grade II complication with a patient requiring additional antibiotics for post-operative urinary tract infection. There were no other major or minor complications. Conclusions Day case ureteroscopy for stone disease in a solitary kidney is safe and feasible with a low complication rate and an overall improvement in renal function. PMID:27123333

  4. The Unresolved Case of Sacral Chordoma: From Misdiagnosis to Challenging Surgery and Medical Therapy Resistance

    PubMed Central

    Garofalo, Fabio; Christoforidis, Dimitrios; di Summa, Pietro G.; Gay, Béatrice; Cherix, Stéphane; Raffoul, Wassim; Matter, Maurice

    2014-01-01

    Purpose A sacral chordoma is a rare, slow-growing, primary bone tumor, arising from embryonic notochordal remnants. Radical surgery is the only hope for cure. The aim of our present study is to analyse our experience with the challenging treatment of this rare tumor, to review current treatment modalities and to assess the outcome based on R status. Methods Eight patients were treated in our institution between 2001 and 2011. All patients were discussed by a multidisciplinary tumor board, and an en bloc surgical resection by posterior perineal access only or by combined anterior/posterior accesses was planned based on tumor extension. Results Seven patients underwent radical surgery, and one was treated by using local cryotherapy alone due to low performance status. Three misdiagnosed patients had primary surgery at another hospital with R1 margins. Reresection margins in our institution were R1 in two and R0 in one, and all three recurred. Four patients were primarily operated on at our institution and had en bloc surgery with R0 resection margins. One had local recurrence after 18 months. The overall morbidity rate was 86% (6/7 patients) and was mostly related to the perineal wound. Overall, 3 out of 7 resected patients were disease-free at a median follow-up of 2.9 years (range, 1.6-8.0 years). Conclusion Our experience confirms the importance of early correct diagnosis and of an R0 resection for a sacral chordoma invading pelvic structures. It is a rare disease that requires a challenging multidisciplinary treatment, which should ideally be performed in a tertiary referral center. PMID:24999463

  5. Early surgery in Crohn’s disease a benefit in selected cases

    PubMed Central

    An, Vinna; Cohen, Lauren; Lawrence, Matthew; Thomas, Michelle; Andrews, Jane; Moore, James

    2016-01-01

    AIM: To compare the outcomes of a cohort of Crohn’s disease (CD) patients undergoing early surgery (ES) to those undergoing initial medical therapy (IMT). METHODS: We performed a review of a prospective database CD patients managed at a single tertiary institution. Inclusion criteria were all patients with ileal or ileocolonic CD between 1995-2014. Patients with incomplete data, isolated colonic or perianal CD were excluded. Primary endpoints included the need for, and time to subsequent surgery. Secondary endpoints included the number and duration of hospital admissions, and medical therapy. RESULTS: Forty-two patients underwent ES and 115 underwent IMT. The operative intervention rate at 5 years in the ES group was 14.2% vs IMT 31.3% (HR = 0.41, 95%CI: 0.23-0.72, P = 0.041). The ES group had fewer hospital admissions per patient [median 1 vs 3 (P = 0.012)] and fewer patients required anti-TNF therapy than IMT (33.3% vs 57%, P = 0.003). A subgroup analysis of 62 IMT patients who had undergone surgery were compared to ES patients, and showed similar 5 year (from index surgery) re-operation rates 16.1% vs 14.3%. In this subset, a significant difference was still found in median number of hospital admissions favouring ES, 1 vs 2 (P = 0.002). CONCLUSION: Our data supports other recent studies suggesting that patients with ileocolonic CD may have a more benign disease course if undergoing early surgical intervention, with fewer admissions to hospital and a trend to reduced overall operation rates. PMID:27462391

  6. Plastic surgery in 17th century Europe. case study: Nicolae Milescu, the snub-nosed.

    PubMed

    Dumbravă, Daniela; Luchian, Stefan

    2013-01-01

    The rising and the existence of plastic and aesthetic surgery in early modern Europe did not have a specific pattern, but was completely different from one nation to another. Colleges of Physicians could only be found in some places in Europe; different Parliaments of Europe's nations did not always elevate being a surgeon to the dignity of a profession, and being a surgeon did not always come with corporate and municipal privileges, or with attractive stipends. Conversely, corporal punishments for treacherous surgeons were ubiquitous. Rhinoplasty falls into the category of what Ambroise Paré named "facial plastic surgery". The technique is a medical source from which many histories derive, one more fascinating than the other: the history of those whose nose was cut off (because of state betrayal, adultery, abjuration, or duelling with swords), the history of those who invented the surgery of nose reconstruction (e.g. SuSruta-samhita or Tagliacozzi?), the history of surgeries kept secret in early modern Europe (e.g. Tropea, Calabria, Leiden, Padua, Paris, Berlin), and so on. Where does the history of Nicolae Milescu the Snub-nosed fall in all of this? How much of this history do the Moldavian Chronicles record? Is there any "scholarly gossip" in the aristocratic and diplomatic environments at Constantinople? What exactly do the British ambassadors learn concerning Rhinoplasty when they meet Milescu? How do we "walk" within these histories, and why should we be interested at all? What is their stike for modernity? Such are the interrogations that this article seeks to provoke; its purpose is to question (and eventually, synchronise) histories, and not exclusively history, both in academic terms but also by reassessing the practical knowledge of the 17th century. PMID:24502038

  7. Pleural Effusion in Spinal Deformity Correction Surgery- A Report of 28 Cases in a Single Center

    PubMed Central

    Liang, Weiqiang; Yu, Bin; Wang, Yipeng; Qiu, Guixing; Shen, Jianxiong; Zhang, Jianguo; Zhao, Hong; Zhao, Yu; Tian, Ye; Li, Shugang

    2016-01-01

    Objectives To analyze the occurrence, risk factors, treatment and prognosis of postoperative pleural effusion after spinal deformity correction surgery. Methods The clinical and imaging data of 3325 patients undergoing spinal deformity correction were collected from the database of our hospital. We analyzed the therapeutic process of the 28 patients who had postoperative pleural effusion, and we identified the potential risk factors using logistic regression. Results Among the 28 patients with postoperative pleural effusion, 24 (85.7%) suffered from hemothorax, 2 (7.1%) from chylothorax, and 2 (7.1%) from subarachnoid-pleural fistula. The pleural effusion occurred on the convex side in 19 patients (67.9%), on the concave side in 4 patients (14.3%), and on both sides in 4 patients (14.3%). One patient with left hemothorax was diagnosed with kyphosis. The treatment included conservative clinical observation for 5 patients and chest tube drainage for 23 patients. One patient also underwent thoracic duct ligation and pleurodesis. All of these treatments were successful. Logistic regression analysis showed that adult patients(≥18 years old), congenital scoliosis, osteotomy and thoracoplasty were risk factors for postoperative pleural effusion in spinal deformity correction surgery. Conclusions The incidence of postoperative pleural effusion in spinal deformity correction surgery was approximately 0.84% (28/3325), and hemothorax was the most common type. Chest tube drainage treatment was usually successful, and the prognosis was good. Adult patients(≥18 years old), congenital scoliosis, and had undergone osteotomy or surgery with thoracoplasty were more likely to suffer from postoperative pleural effusion. PMID:27167221

  8. Cardiopulmonary bypass in surgery for complex-combined vascular malformation of the lower limb: case report.

    PubMed

    Ismail, M S; Sharaf, I; Thambidorai, C R; Zainal, A; Somasundaram, S; Adeeb, S; Sajjad, M Y; Bilkis, B; Felicia, L S K

    2005-05-01

    A 16-year-old boy was referred with features of Parkes Weber syndrome (PWS) involving the right lower limb. He had presented at birth with cutaneous vascular malformations (VM) in the right thigh and at the age of 7 years developed congestive cardiac failure, which was controlled with drugs. He received alpha interferon and steroids during this period without any benefit. He defaulted follow-up and at 12 years of age presented with further enlargement of the VM in the right thigh and leg with skin and soft tissue thickening. At this stage, embolization and subsequent excision of the VM were tried, but the surgery was abandoned because of massive hemorrhage. Over the next 4 years, the boy became totally bedridden because of massive increase in the size of the limb, repeated hemorrhages, and secondary infection of the VM. Right hip disarticulation was considered the best option to improve his quality of life. To prevent uncontrollable hemorrhage during surgery, the disarticulation was done under cardiopulmonary bypass with low circulatory flow. Postoperatively, the patient required intensive care nursing for a week. He is presently ambulatory with crutches. Cardiopulmonary bypass with low flow has been used for treating posttraumatic arteriovenous malformations. However, its use in surgery for PWS has not been reported earlier.

  9. Day to day with COPD

    MedlinePlus

    ... day; Chronic obstructive airways disease - day to day; Chronic obstructive lung disease - day to day; Chronic bronchitis - day to day; ... strategy for the diagnosis, management, and prevention of chronic ... disease. Updated 2015. www.goldcopd.it/materiale/2015/GOLD_ ...

  10. Half-day release in vocational GP training: a case study of redesign based on qualitative evaluation.

    PubMed

    Rigby, Carolyn

    2010-11-01

    Mindful of the changes to general practice (GP) and GP training over recent years, one vocational training scheme (VTS) decided to thoroughly evaluate its long-running half-day release scheme to decide if it remained fit for purpose, and to plan and implement changes in the light of findings. A literature review was first carried out to ascertain what is known about the contribution that day release and half-day release (HDR) programmes make to GP training. Little has been published on content or evaluation but there is varied experience of incorporating release training into hospital training. This case study reports the views of trainers and trainees on the HDR at Tees Valley Vocational Training Scheme, and the resultant changes made to this HDR programme by the participants. Trainers mostly valued their commitment to HDR small group teaching for their personal development as teachers and for the opportunity to 'keep in touch' with trainees during their hospital posts. Trainees were positive about the HDR programme, but requested more continuity. The plan that evolved is to continue weekly HDR throughout the training programme, keeping trainees in the same small group for three years. In ST1 and ST3 years one programme director per group facilitates each session, maintaining consistency over the year, and liaising with specialists around content. Trainers each teach two sessions in ST2 year. Elective sessions are planned for extended training.

  11. Unilateral Acute Closed-Angle Glaucoma After Elective Lumbar Surgery Reveals Multiple Intracranial Aneurysms. A Case Report and Discussion on Workup of Differential Diagnoses.

    PubMed

    Storey, Christopher; Menger, Richard; Hefner, Matthew; Keating, Patrick; Ahmed, Osama; Guthikonda, Bharat

    2015-11-01

    The purpose of our paper is to present a case of a rare complication of posterior lumbar surgery. Our patient presented for elective lumbar decompression, which was complicated by durotomy. She then developed sudden headache and right eye pain once upright on postoperative day 2. Then on postoperative day 3, she developed a dilated nonreactive pupil with extraocular movements intact. A computed tomography scan of the head was negative for subarachnoid hemorrhage. Magnetic resonance angiography showed a possible right posterior communicating artery aneurysm. She was transferred to a tertiary center with a severe headache and a nonreactive pupil, raising concern for evolving third nerve palsy due to aneurysm. A cerebral angiogram was performed and showed multiple aneurysms. Aneurysm location did not explain the patient's symptoms, and ophthalmology was consulted. Elevated intraocular pressure was noted, and the patient was diagnosed with acute angle-closure glaucoma (AACG). Our patient was medically treated and subsequently underwent laser peripheral iridotomy. She has had improved vision and pupillary function at 1 month follow-up. The diagnosis is complicated by a durotomy, which led to cascade in the differential diagnosis to rule out intracranial pathology. Her age and home medications, which had sympathomimetic effects, placed her at increased risk, but lying prone in the dark under the drapes was likely the lead causative factor. In conclusion, a postoperative posterior spine patient with eye pain and changes in vision and pupils should be evaluated with AACG in mind due to the devastating consequences if left untreated or treatment is delayed.

  12. Alternate-day dosing of linagliptin in type 2 diabetes patients controlled on once daily dose: A case series

    PubMed Central

    Baruah, Manash P.; Bhuyan, Sonali B.; Deka, Jumi; Bora, Jatin; Bora, Smritisikha; Barkakati, Murchana

    2016-01-01

    Linagliptin, a dipeptidyl peptidase 4 (DPP 4) inhibitor with a long terminal half life, significantly inhibits the DPP 4 enzyme at a steady state up to 48 h after the last dose. The present case series examined the hypothesis that linagliptin retains its efficacy during alternate day dosing in type 2 diabetes patients when switched over from once daily (OD) dosing. Eight type 2 diabetes patients maintaining stable glycosylated hemoglobin (HbA1c) with acceptable fasting plasma glucose and postprandial glucose levels and receiving linagliptin 5 mg OD for at least 6 weeks, with a stable dose of concomitant antidiabetic medications were given linagliptin 5 mg every alternate day. The median HbA1c while on the OD regimen was 6.1% (43 mmol/mol) (range: 5.8–6.9% [40–52 mmol/mol]) and median duration of diabetes was 7 years (range: 0.75–16 years). After a median follow-up period of 21weeks,the glycemic control was maintained in all patients similar to their baseline values (median HbA1c: 6.0% [42 mmol/mol], range: 5.1–7.1% [32–54 mmol/mol]). The body weight, fasting, and random glucose levels at baseline were also well maintained at the end of treatment. Optimal glycemic status maintained in our study population favors our hypothesis that linagliptin used alternate daily after switching from initial OD dose of the drug in patients on a stable background antidiabetic medications retains its efficacy. Paradoxically, alternate day dosing may affect compliance if the patient forgets when they took the last dose. Further studies including larger cohorts are needed to validate this finding and identify patients who can benefit from the alternate day regimen. PMID:27366728

  13. An Unusual Case of Clear Cell Chondrosarcoma with Very Late Recurrence and Lung Metastases, 29 Years after Primary Surgery

    PubMed Central

    Nieminen, Jyrki; Pakarinen, Toni-Karri

    2014-01-01

    Clear cell chondrosarcoma is a rare bone neoplasm with low-grade clinical course and the potential to metastasize to the skeleton and lungs. The aim of this report is to present a case that is extremely rare, but in accordance with the literature where the clear cell chondrosarcoma reportedly has a tendency for late metastases. In our patient the primary surgery was intralesional, since it was mistakenly interpreted as a benign tumour in the early 80s. The local recurrence and lung metastases occurred, however, 29 years after the initial treatment. The local recurrence was resected with wide margins, no additional surgery or oncological treatments were given, and two and half years postoperatively patient is doing well and there is no progression in the disease. In conclusion, it is important to have a long follow-up to the clear cell chondrosarcoma patients even for decades or lifelong, because the malignancy tends to metastasize or recur after an extended period. The course of metastasized disease may be unusually slow, so relatively aggressive treatment in metastasized and recurring cases is justified. PMID:25143849

  14. Critical analysis of cases of endometrial carcinoma of the uterine corpus incidentally diagnosed after incomplete surgery for other indications. Three case reports and a review of the literature

    PubMed Central

    Wielgoś, Mirosław; Panek, Grzegorz

    2014-01-01

    Incidental diagnosis of endometrial carcinoma after the operation for presumed benign disease is rare. At present, there are no recognized guidelines on optimal management of uterine malignancy diagnosed after incomplete surgery for other indications and the reported experience is limited. Although the risk of histological diagnosis of endometrial carcinoma in the uterus removed for pre-operatively diagnosed benign disease is very low, one should always bear in mind that it may indeed occur. Omission of certain diagnostic procedures prior to hysterectomy may result in incidental finding of a malignancy at or after surgery, even when preoperative imaging studies reveal benign disease. Many centres develop their own strategies, although in most cases the adnexa and cervix are removed and thorough exploration of the abdominal cavity is performed. Also, in view of the technical difficulties involved in removing the uterus and adnexa via the vagina and a potential high risk of cancer either developing in the cervical stump or disseminated from inadvertently morcellated uterine fragments, one should carefully consider the potential benefits and risks of supracervical hysterectomy. We present three patients with endometrial carcinoma diagnosed after hysterectomy, who subsequently underwent completion surgery. A review of the literature follows, which presents opinions from international centres. PMID:26327871

  15. Femoral nerve palsy after arthroscopic surgery with an infusion pump irrigation system. A report of three cases.

    PubMed

    DiStefano, V J; Kalman, V R; O'Malley, J S

    1996-02-01

    One patient developed complete, and two patients, partial, femoral nerve palsy after arthroscopic surgery in which an infusion pump was used to operate an irrigation system. In one case, hip flexor and quadricep function was completely lost after the patient underwent arthroscopic partial medial meniscectomy without the use of a tourniquet. A CT scan of the pelvis demonstrated considerable fluid accumulation in the thigh and inguinal regions. The remaining two patients developed quadriceps weakness, but not complete femoral nerve palsy, after arthroscopic-assisted anterior cruciate ligament reconstructions. Although tourniquets were used in these latter two procedures, the pressures were low (300 to 325 mm Hg) and the tourniquet times not excessive, suggesting that femoral nerve palsy in these two patients resulted from fluid extravasation. In all three cases, muscle function returned within 6 to 7 months, but sensory nerve deficits were still present at that time.

  16. Traumatic pseudoaneurysm of the brachiocephalic artery following medianoscopy: initial endovascular repair followed by open surgery--a case report.

    PubMed

    Biebl, Matthias; Neuhauser, B; Perkmann, R; Tauscher, T; Waldenberger, P; Fraedrich, G

    2003-06-01

    Endovascular stent graft repair of traumatic vessel injuries is gaining worldwide acceptance as a minimally invasive alternative to open surgical repair. However, effective endovascular repair fails if the aneurysm is not completely excluded. Conversion to open surgery may be unavoidable in such cases. Herein we describe the case of a 45-year-old man who was referred to our hospital with a pseudoaneurysm of the proximal brachiocephalic artery caused by biopsy during diagnostic medianoscopy. The pseudoaneurysm was primarily treated by stent-graft implantation into the proximal brachiocephalic artery. As a result of the unfavorable location of the lesion exclusion of the aneurysm failed and the initial therapy had to be extended to open reconstruction of the brachiocephalic artery. A bypass procedure from the aortic arch to the right common carotid artery was performed with reinsertion of the right subclavian artery to exclude the pseudoaneurysm.

  17. Access to essential paediatric eye surgery in the developing world: a case of congenital cataracts left untreated.

    PubMed

    Vinluan, Marilyn L; Olveda, Remigio M; Olveda, David U; Chy, Delia; Ross, Allen G

    2015-01-01

    Childhood cataracts are a major cause of treatable blindness. Early recognition, surgical intervention and appropriate follow-up after surgery can result in good visual outcomes. However, several factors may impact on the availability of such services, including lack of an available, affordable and accessible comprehensive eye care centre, financial limitations affecting coverage by the national healthcare provider, and household socioeconomic status. We report a case of congenital cataracts in a 12-year-old male adolescent from Northern Samar, the Philippines, who was left blind since birth. This case highlights the disparities in essential health services in the developing world and the challenges patients face in getting the care they need. PMID:25903202

  18. Accidental burns during surgery.

    PubMed

    Demir, Erhan; O'Dey, Dan Mon; Pallua, Norbert

    2006-01-01

    The purpose of this report is to increase awareness of intraoperative burns during standard procedures, to discuss their possible causes and warning signs and to provide recommendations for prevention and procedures to follow after their occurrence. A total of 19 patients associated with intraoperative burn accidents were treated surgically and analyzed after a mean follow-up of 5 +/- 3.5 months. Review included retrospective patient chart analysis, clinical examination, and technical device and equipment testing. A total of 15 patients recently underwent cardiac surgery, and 4 pediatric patients recovered after standard surgical procedures. A total of 15 patients had superficial and 4 presented with deep dermal or full-thickness burns. The average injured TBSA was 2.1 +/- 1% (range, 0.5-4%). Delay between primary surgery and consultation of plastic surgeons was 4.5 +/- 3.4 days. A total of 44% required surgery, including débridment, skin grafting or musculocutaneous gluteus maximus flaps, and the remaining patients were treated conservatively. Successful durable soft-tissue coverage of the burn region was achieved in 18 patients, and 1 patient died after a course of pneumonia. Technical analysis demonstrated one malfunctioning electrosurgical device, one incorrect positioned neutral electrode, three incidents occurred after moisture under the negative electrode, eight burns occurred during surgery while fluid or blood created alternate current pathways, five accidents were chemical burns after skin preparation with Betadine solution, and in one case, the cause was not clear. The surgical team should pay more attention to the probability of burns during surgery. Early patient examination and immediate involvement of plastic and burn surgeons may prevent further complications or ease handling after the occurrence.

  19. Experiences as input to eHealth design - a hip surgery patient journey case.

    PubMed

    Hägglund, Maria; Bolin, Peter; Koch, Sabine

    2015-01-01

    The objective of the study is to describe the planned hip-surgery care process as experienced by patients and healthcare professionals, as well as a qualitative analysis of problems. Data was collected through 3 focus group meetings with patients and healthcare professionals. We present the results in form of a patient journey model, examples of problems as expressed by patients and examples of proposed eHealth services by both patients and care professionals. The results indicate that although the patient journey is similar for most patients, their experiences are highly individual and designing eHealth to improve the patient journey will require flexibility and adaptability to the individual's needs.

  20. Multiple Rib Exostoses in a Boy: A Rare Case Resulting in Surgery Secondary to Cosmetic Concerns

    PubMed Central

    Masoum, Seyed Hosein Fattahi; Moradi, Ali; Ebrahimzadeh, Mohammad H

    2014-01-01

    A seven year-old boy with several painless masses on the ribs and shoulder was referred to our hospital. The masses were so prominent that they prevented the child’s sleep. Since the patient had been ridiculed by his friends due to the rib prominences, he had refused to attend school. After clinical and radiological evaluations, the masses were diagnosed as hereditary multiple exostoses of the shoulder and ribs. He underwent surgery for cosmetic reasons resulting in the patient’s return to a normal life. PMID:25386591

  1. [Nasal endoscopic surgery for osteoid osteoma of the periorbital skull base: a case report].

    PubMed

    Huang, Yun; Zhu, Xinhua; Liu, Yuehui

    2016-02-01

    Osteoid osteoma was first reported in 1935 by Jaffe. It is a kind of benign bone disease with the limitation of well-defined lesions. It is rarely seen in the periorbital region. The only symptom of the patient was unilateral proptosis of right. The result of MRI examination was cystic masses in the edge of the right orbit. The tumor was complete removed by the nasal endoscopic approach during the surgery. Pathology result was reported as osteoid osteoma. There was no significant complications of diplopia, visual acuity decreased, enophthalmos, cerebrospinal fluid leakage and others. PMID:27373105

  2. Perioperative spinal cord infarction in nonaortic surgery: report of three cases and review of the literature.

    PubMed

    Hobai, Ion A; Bittner, Edward A; Grecu, Loreta

    2008-06-01

    Paraplegia caused by a spinal cord infarction (SCI) is a devastating perioperative complication, most often associated with aortic and spine surgery. We present two other clinical scenarios in which perioperative SCI may occur. They happened during surgical procedures performed with epidural anesthesia, in the presence of several specific risk factors such as spinal stenosis, vascular disease, intraoperative hypotension, or the use of epinephrine in the local anesthetic solution. Second, SCI may occur during episodes of postoperative hypotension in patients with a history of aortic aneurysms.

  3. Advantages of robot-assisted surgery in anorectal malformations: Report of a case

    PubMed Central

    Ruiz, María Rodríguez; Kalfa, Nicolas; Allal, Hossein

    2016-01-01

    Laparoscopy has been widely used to repair anorectal malformations (ARMs) by paediatric surgeons in an attempt to be less invasive, offer better cosmetic results, enable a faster return of bowel function, decrease length of hospital stay and pain, and lately to improve functional results. Robotic technology assists the paediatric surgeon by increasing dexterity and precision of movement with a robotic wrist-like mechanism that allows up to 90° of articulation and 7° of freedom. This is important in ARM surgery, where the dissection of the fistula and the pull-through of the rectum into the muscular complex are crucial to achieve continence in future. PMID:27073314

  4. Upper airway surgery of obstructive sleep apnea in pycnodysostosis: case report and literature review.

    PubMed

    Testani, Elisa; Scarano, Emanuele; Leoni, Chiara; Dittoni, Serena; Losurdo, Anna; Colicchio, Salvatore; Gnoni, Valentina; Vollono, Catello; Zampino, Giuseppe; Paludetti, Gaetano; Della Marca, Giacomo

    2014-08-01

    Pycnodysostosis is an autosomal recessive disorder due to a mutation in the cathepsin K gene, which causes a decrease of the bone turnover; a review of the literature suggests that pycnodysostosis is frequently associated with severe respiratory obstruction, which needs surgical treatment. The aim of this paper is to describe the surgical treatment of a 3½-year-old girl affected by Pycnodysostosis complicated by a severe sleep-related respiratory disorder. The surgical treatment, consisting of adenotonsillectomy and palatoplasty, resulted in a striking amelioration of respiratory parameters and increased posterior airway space, and allowed the patient to avoid tracheotomy while awaiting for maxillo-mandibular surgery.

  5. Observed outcomes on the use of oxidized and regenerated cellulose polymer for breast conserving surgery – A case series

    PubMed Central

    Rassu, Pier Carlo

    2015-01-01

    Background Oxidized regenerated cellulose polymer (ORCP) may be used for reshaping and filling lack of volume in breast-conserving surgery (BCS). The study aimed to observe both the aesthetic and diagnostic outcomes in patients with different age, BMI, breast volume, and breast tissue composition over 36 months after BCS with ORCP. Patients and methods 18 patients with early breast cancer and with proliferative benign lesions underwent BCS with ORCP that was layered in three-dimensional wafer, and placed into the Chassaignac space between the mammary gland and the fascia of pectoralis major with no fixation. After surgery, patients started a clinical and instrumental 36-month follow-up with mammography, ultrasonography, magnetic resonance imaging (MRI) and cytological examination with fine needle aspiration when seroma occurred. Results Below the median age of 66 years old no complications were observed even in case both of overweight, and large breasts with low density. Over the median age seromas occurred with either small or large skin retraction, with the exception of 1 patient having quite dense breasts and low BMI, which had no complications. In elderly patients, 1 case with quite dense breasts and high BMI showed severe seroma and skin retraction, while 1 case with low BMI and less dense breasts highlighted milder complications. Conclusion During 36 months after BCS with ORCP, a significant correlation between positive diagnostic and aesthetic outcomes and low age, dense breasts, and low BMI of patient was observed. Despite of the few number of cases, either low BMI, or high breast density improved the aesthetic outcomes and reduced the entity of complications even in the elderly patients. PMID:26865976

  6. [Combined crown lengthening surgery with restorative therapy for inducing papilla growth: a case report].

    PubMed

    Le, Di; Hu, Wen-jie; Zhang, Hao

    2013-04-18

    A young lady with unsatisfied restorations of upper anterior teeth and swollen gum wanted to improve aesthetics. Oral examination showed that 12-22 were provisional crowns with normal occlusion, poorly gingival contour and gummy smile. The gingiva was red, light swollen and bleeding on probing. X-ray showed the roots of 11, 21 were short and the alveolar bone absorbed. After the periodontal initial treatment, an ideal location of gingival margin was determined. Then, an esthetic periodontal surgery was performed to recover the biology width and the gingival margin was fitted with the anterior teeth. The temporary restorations were made twice to guide the gingiva growth by changing the shape of the restorations and moving up the contact points of the restorations. The ceramic crowns were completed 3 months after the operation. The gummy smile disappeared and the gingival margin was filled well with the upper anterior ceramic crowns. The 14-month follow-up presented a satisfied effect. Crown lengthening surgery combined restorative therapy could lead papilla to grow well. This process is beneficial for the future treatment plan and clinical esthetic evaluation.

  7. Cardiac Surgery

    PubMed Central

    Weisse, Allen B.

    2011-01-01

    Well into the first decades of the 20th century, medical opinion held that any surgical attempts to treat heart disease were not only misguided, but unethical. Despite such reservations, innovative surgeons showed that heart wounds could be successfully repaired. Then, extracardiac procedures were performed to correct patent ductus arteriosus, coarctation of the aorta, and tetralogy of Fallot. Direct surgery on the heart was accomplished with closed commissurotomy for mitral stenosis. The introduction of the heart-lung machine and cardiopulmonary bypass enabled the surgical treatment of other congenital and acquired heart diseases. Advances in aortic surgery paralleled these successes. The development of coronary artery bypass grafting greatly aided the treatment of coronary heart disease. Cardiac transplantation, attempts to use the total artificial heart, and the application of ventricular assist devices have brought us to the present day. Although progress in the field of cardiovascular surgery appears to have slowed when compared with the halcyon times of the past, substantial challenges still face cardiac surgeons. It can only be hoped that sufficient resources and incentive can carry the triumphs of the 20th century into the 21st. This review covers past developments and future opportunities in cardiac surgery. PMID:22163121

  8. Two days with a broken knife blade in the neck – an interesting case of Horner's syndrome

    PubMed Central

    Dubois-Marshall, S; De Kock, S

    2010-01-01

    A 25-year-old man presented to the Emergency department in a rural South African hospital after a left, submental neck stab with a knife. Examination was deemed unremarkable, and the patient was discharged, but re-attended 2 days later complaining of a painful, swollen neck. Further examination identified Horner's syndrome, and further investigation revealed that the blade of the knife had remained in the patient's neck. This was successfully removed in theatre. This case illustrates the importance of careful history, examination and diagnostic imaging in the management of penetrating neck injuries. Horner's syndrome can be easily missed in a busy Emergency department and may indicate life-threatening pathology in the context of neck trauma. The difficulties in assessing and managing this type of injury are discussed. PMID:22766569

  9. Performance assessment of different day-of-the-year-based models for estimating global solar radiation - Case study: Egypt

    NASA Astrophysics Data System (ADS)

    Hassan, Gasser E.; Youssef, M. Elsayed; Ali, Mohamed A.; Mohamed, Zahraa E.; Shehata, Ali I.

    2016-11-01

    Different models are introduced to predict the daily global solar radiation in different locations but there is no specific model based on the day of the year is proposed for many locations around the world. In this study, more than 20 years of measured data for daily global solar radiation on a horizontal surface are used to develop and validate seven models to estimate the daily global solar radiation by day of the year for ten cities around Egypt as a case study. Moreover, the generalization capability for the best models is examined all over the country. The regression analysis is employed to calculate the coefficients of different suggested models. The statistical indicators namely, RMSE, MABE, MAPE, r and R2 are calculated to evaluate the performance of the developed models. Based on the validation with the available data, the results show that the hybrid sine and cosine wave model and 4th order polynomial model have the best performance among other suggested models. Consequently, these two models coupled with suitable coefficients can be used for estimating the daily global solar radiation on a horizontal surface for each city, and also for all the locations around the studied region. It is believed that the established models in this work are applicable and significant for quick estimation for the average daily global solar radiation on a horizontal surface with higher accuracy. The values of global solar radiation generated by this approach can be utilized in the design and estimation of the performance of different solar applications.

  10. Cataract Surgery

    MedlinePlus

    ... Uveitis Focus On Pediatric Ophthalmology Education Center Oculofacial Plastic Surgery Center Laser Surgery Education Center Redmond Ethics ... Uveitis Focus On Pediatric Ophthalmology Education Center Oculofacial Plastic Surgery Center Laser Surgery Education Center Redmond Ethics ...

  11. Modified connective tissue punch technique to increase the vestibular/buccal keratinized tissue on flapless implant surgery: a case series.

    PubMed

    Andreasi Bassi, M; Andrisani, C; Lopez, M A; Gaudio, R M; Lombardo, L; Lauritano, D

    2016-01-01

    The aim of this article is to show a simple and predictable technique to enhance both the vestibular/buccal (V/B) gingival thickness (GT) and keratinized tissue width (KTW) improving the soft-tissue profile after flapless implant placement. The technique proposed was named Modified Connective Tissue Punch (MCTP). Fourteen patients (6 men and 8 women) aged between 35 and 69 years (mean value 48.07±13.023 years) were enrolled in this case series. Seventeen implant sites were submitted to flapless procedure. The connective punch (CP) was harvested with a motor-driven circular tissue punch and then a full-split dissection was executed, in order to create a deep pouch, beyond the mucogingival junction, on the V/B side. In this recipient site the CP was placed. The normal flapless surgical protocol was used; implants were inserted and covered with transgingival healing cap screws. GT and KTW were measured: both immediately before and after surgery; at the time of the prosthetic finalization (3-4months, respectively, for mandible and maxilla); 1 year post surgery follow-up. GT was measured at 1 mm, 2 mm and 5 mm on the V/B side, from the outline of the punch. Both KTW and GT at 1 and 2 mm can be effectively increased, while no significant effects for GT at 5 mm can be expected from this technique. Furthermore, the mean values of KTW and GT at 1 mm and 2 mm show significant increases at 3-4 months post-operative, while no further significant increments are shown at 1 year post-operative follow-up. The Authors recommend the use of the MCTP technique to reduce the number of aesthetic complications and soft tissue defects in flapless implant surgery. Longer follow-ups are needed to evaluate the stability of peri-implant tissues over time. PMID:27469545

  12. Modified connective tissue punch technique to increase the vestibular/buccal keratinized tissue on flapless implant surgery: a case series.

    PubMed

    Andreasi Bassi, M; Andrisani, C; Lopez, M A; Gaudio, R M; Lombardo, L; Lauritano, D

    2016-01-01

    The aim of this article is to show a simple and predictable technique to enhance both the vestibular/buccal (V/B) gingival thickness (GT) and keratinized tissue width (KTW) improving the soft-tissue profile after flapless implant placement. The technique proposed was named Modified Connective Tissue Punch (MCTP). Fourteen patients (6 men and 8 women) aged between 35 and 69 years (mean value 48.07±13.023 years) were enrolled in this case series. Seventeen implant sites were submitted to flapless procedure. The connective punch (CP) was harvested with a motor-driven circular tissue punch and then a full-split dissection was executed, in order to create a deep pouch, beyond the mucogingival junction, on the V/B side. In this recipient site the CP was placed. The normal flapless surgical protocol was used; implants were inserted and covered with transgingival healing cap screws. GT and KTW were measured: both immediately before and after surgery; at the time of the prosthetic finalization (3-4months, respectively, for mandible and maxilla); 1 year post surgery follow-up. GT was measured at 1 mm, 2 mm and 5 mm on the V/B side, from the outline of the punch. Both KTW and GT at 1 and 2 mm can be effectively increased, while no significant effects for GT at 5 mm can be expected from this technique. Furthermore, the mean values of KTW and GT at 1 mm and 2 mm show significant increases at 3-4 months post-operative, while no further significant increments are shown at 1 year post-operative follow-up. The Authors recommend the use of the MCTP technique to reduce the number of aesthetic complications and soft tissue defects in flapless implant surgery. Longer follow-ups are needed to evaluate the stability of peri-implant tissues over time.

  13. A Case of Delayed-Onset Propionibacterium acnes Endophthalmitis after Cataract Surgery with Implantation of a Preloaded Intraocular Lens

    PubMed Central

    Hayashi, Yuki; Eguchi, Hiroshi; Miyamoto, Tatsuro; Inoue, Masayuki; Mitamura, Yoshinori

    2012-01-01

    Purpose To report a case of delayed-onset endophthalmitis after implantation of a preloaded intraocular lens (IOL) and examine the surgically removed IOL by scanning electron microscopy (SEM). Case A 77-year-old female underwent uneventful phacoemulsification and aspiration with preloaded silicone IOL implantation. Since intraocular inflammation unexpectedly worsened 1 month after the surgery, she was referred to our hospital. Her visual acuity was hand motion in the left eye. Hypopyon and fibrin formation were observed in the anterior chamber. A diagnosis of postoperative delayed-onset endophthalmitis was made, and vitrectomy with anterior chamber wash-out was performed. As intraocular inflammation remained unchanged postoperatively, an additional surgery with IOL removal was performed. We cultivated the surgically removed samples of aqueous humor and vitreous fluid under both aerobic and anaerobic conditions, performed 16S rDNA clone library analysis of these clinical samples, and examined the removed IOL by SEM. Result Inflammation subsided after the re-operation. Although cultures of aqueous and vitreous samples were negative, DNA of Propionibacterium acnes was detected in the aqueous humor. The SEM images showed that the rod bacteria and biofilm-like material formed on the tip of the IOL haptic. Conclusion Delayed-onset endophthalmitis may occur after uneventful implantation of a preloaded IOL. The SEM findings suggested that the tip of the preloaded IOL haptic might scratch bacteria which adhered to the tip of the injector nozzle when the IOL was inserted into the anterior chamber. In some cases with delayed-onset endophthalmitis, IOL removal is needed to eliminate the bacteria which adhere to the tip of the IOL haptic. PMID:23275791

  14. A case of a glomus tumor of the stomach resected by laparoscopy endoscopy cooperative surgery.

    PubMed

    Nakajo, Keiichiro; Chonan, Akimichi; Tsuboi, Rumiko; Nihei, Kousuke; Iwaki, Tomoyuki; Yamaoka, Hajime; Sato, Shun; Matsuda, Tomomi; Nakahori, Masato; Endo, Mareyuki

    2016-09-01

    A 56-year-old woman who was found to have a submucosal tumor (SMT) of the stomach in a medical check-up was admitted to our hospital for a detailed investigation of the SMT. Upper gastrointestinal endoscopy revealed an SMT of 20mm at the anterior wall of the antrum of the stomach. Endoscopic ultrasonography showed a hyperechoic tumor in the fourth layer of the stomach wall. CT examination showed a strongly enhancing tumor on arterial phase images and persistent enhancement on portal venous phase images. Laparoscopy endoscopy cooperative surgery was performed with a diagnosis of SMT of the stomach highly suspicious of a glomus tumor. Immunohistochemistry revealed expression of α-SMA but no expression of desmin, c-kit, CD34, or S-100. The tumor was finally diagnosed as a glomus tumor of the stomach.

  15. A case of unusual septic knee arthritis with Brucella abortus after arthroscopic meniscus surgery.

    PubMed

    Lee, Keun Hwa; Kang, Hyunseong; Kim, Taejung; Choi, Sungwook

    2016-01-01

    We present a 51-year-old male patient with Brucella abortus septic arthritis in the right knee following arthroscopic meniscus surgery. He had eaten a traditional dish of raw minced cattle conceptus (bovine fetus) that was prepared after the cow was slaughtered. Despite treatment with empirical antibiotics and debridement of the postoperative surgical wound, the infection persisted without improvement. Polymerase chain reaction sequencing identified Brucella abortus from tissue samples obtained from the patient. After confirmation of the diagnosis of brucellar infection, antibiotics were replaced with doxycycline and rifampin, which were used for 4 months. In patients with a non-specific arthralgia who eat raw meat or live close to animals, it is important to consider the possibility of septic arthritis due to infection with Brucella spp.

  16. A case of a glomus tumor of the stomach resected by laparoscopy endoscopy cooperative surgery.

    PubMed

    Nakajo, Keiichiro; Chonan, Akimichi; Tsuboi, Rumiko; Nihei, Kousuke; Iwaki, Tomoyuki; Yamaoka, Hajime; Sato, Shun; Matsuda, Tomomi; Nakahori, Masato; Endo, Mareyuki

    2016-09-01

    A 56-year-old woman who was found to have a submucosal tumor (SMT) of the stomach in a medical check-up was admitted to our hospital for a detailed investigation of the SMT. Upper gastrointestinal endoscopy revealed an SMT of 20mm at the anterior wall of the antrum of the stomach. Endoscopic ultrasonography showed a hyperechoic tumor in the fourth layer of the stomach wall. CT examination showed a strongly enhancing tumor on arterial phase images and persistent enhancement on portal venous phase images. Laparoscopy endoscopy cooperative surgery was performed with a diagnosis of SMT of the stomach highly suspicious of a glomus tumor. Immunohistochemistry revealed expression of α-SMA but no expression of desmin, c-kit, CD34, or S-100. The tumor was finally diagnosed as a glomus tumor of the stomach. PMID:27593365

  17. A case of unusual septic knee arthritis with Brucella abortus after arthroscopic meniscus surgery.

    PubMed

    Lee, Keun Hwa; Kang, Hyunseong; Kim, Taejung; Choi, Sungwook

    2016-01-01

    We present a 51-year-old male patient with Brucella abortus septic arthritis in the right knee following arthroscopic meniscus surgery. He had eaten a traditional dish of raw minced cattle conceptus (bovine fetus) that was prepared after the cow was slaughtered. Despite treatment with empirical antibiotics and debridement of the postoperative surgical wound, the infection persisted without improvement. Polymerase chain reaction sequencing identified Brucella abortus from tissue samples obtained from the patient. After confirmation of the diagnosis of brucellar infection, antibiotics were replaced with doxycycline and rifampin, which were used for 4 months. In patients with a non-specific arthralgia who eat raw meat or live close to animals, it is important to consider the possibility of septic arthritis due to infection with Brucella spp. PMID:27130400

  18. Palliative Surgery for Rare Cases of Anterior Urethral Metastasis in Prostate Cancer

    PubMed Central

    Gómez Gómez, Enrique; Carrasco Aznar, Jose Carlos; Moreno Rodríguez, Maria del Mar; Valero Rosa, José; Requena Tapia, Maria José

    2014-01-01

    Penis metastasis from prostate cancer is very rare, and its management varies from case to case as there are very few cases reported in the literature. We describe a patient with prostate cancer treated with radiotherapy and androgen deprivation therapy who presented with urethral bleeding as a symptom of anterior urethral metastasis during followup. We propose a way to manage this and review the literature. PMID:25161796

  19. Types of trust experienced in a risky medical operation (A case among cosmetic surgeries in Isfahan)

    PubMed Central

    Zhianpour, Mehdi; Ghasemi, Vahid; Keyvanara, Mahmood

    2015-01-01

    Background: In all areas of life including health, choices have widely increased and concerns over getting hold of further choices have made trust a necessary element. This study, taking into consideration the interconnection of three concepts of trust, risk, and body, aims at describing and interpreting different types of trust experienced in a risky medical operation (cosmetic surgery). Materials and Methods: To achieve the given purpose, within interpretative paradigm and employing qualitative method, in-depth phenomenological interviews were conducted with 26 people who volunteered to have a cosmetic surgery. Participants, who have been selected through purposive sampling techniques, were fully aware of their participation in the study and were insured that the data would be confidential and would be used only for the purpose of the study. Data were gathered within a one-year period of the study, from February 20, 2012 to February 20, 2013. Results of three-phase interviews were validated against participatory feedback and researchers’ triangulation and were further analyzed by means of seven-stage Colaizzi method. Findings: Consequently, five main themes, namely, vicarious trust, trust within the reach, institutionalized trust, criterion trust, and wrapped trust were extracted. Conclusion: Apart from existing differences among these five themes (e.g. degree of the subjectivity and objectivity in the patient), they can be regarded comparable in terms of being single-sided (from the patient's side). In other words, in all experiences, participants, having considered “the necessity of gaining trust” as a presupposition, have made a unilateral effort in creating the aforementioned phenomenon. PMID:25883995

  20. Preoperative Screening and Case Cancellation in Cocaine-Abusing Veterans Scheduled for Elective Surgery

    PubMed Central

    Elkassabany, Nabil; Speck, Rebecca M.; Oslin, David; Hawn, Mary; Sum-Ping, John; Sepulveda, Jorge; Whitley, Mary; Sakawi, Yasser

    2013-01-01

    Background. Perioperative management of cocaine-abusing patients scheduled for elective surgery varies widely based on individual anecdotes and personal experience. Methods. Chiefs of the anesthesia departments in the Veterans Affairs (VA) health system were surveyed to estimate how often they encounter surgical patients with cocaine use. Respondents were asked about their screening criteria, timing of screening, action resulting from positive screening, and if they have a formal policy for management of these patients. Interest in the development of VA guidelines for the perioperative management of patients with a history of cocaine use was also queried. Results. 172 VA anesthesia departments' chiefs were surveyed. Response rate was 62%. Over half of the facilities see cocaine-abusing patients at least once a week (52%). Two thirds of respondents canceled or delayed patients with a positive screen regardless of clinical symptoms. Only eleven facilities (10.6%) have a formal policy. The majority of facilities (80%) thought that having formal guidelines for perioperative management of cocaine-abusing patients would be helpful to some extent. Results. 172 VA anesthesia departments' chiefs were surveyed. Response rate was 62%. Over half of the facilities see cocaine-abusing patients at least once a week (52%). Two thirds of respondents canceled or delayed patients with a positive screen regardless of clinical symptoms. Only eleven facilities (10.6%) have a formal policy. The majority of facilities (80%) thought that having formal guidelines for perioperative management of cocaine-abusing patients would be helpful to some extent. Conclusions. There is a general consensus that formal guidelines would be helpful. Further studies are needed to help formulate evidence-based guidelines for managing patients screening positive for cocaine prior to elective surgery. PMID:24069030

  1. Bypass surgery for unresectable oesophageal cancer: early and late results in 124 cases.

    PubMed

    Mannell, A; Becker, P J; Nissenbaum, M

    1988-03-01

    The early and late results of bypass surgery in 124 patients with unresectable oesophageal cancer are reported. Patients were grouped according to the extent of disease: group A, tumour localized to the oesophagus where severe pulmonary disease contra-indicated oesophagectomy (n = 9); group B, tumour less than or equal to 10 cm in length with mediastinal invasion (n = 81); group C, tumour greater than 10 cm in length with mediastinal invasion and/or fixed malignant lymph nodes (n = 33). Extent of disease was not recorded in one patient. The operative mortality was 4 per cent but 9 other patients died in hospital (hospital mortality, 11 per cent). Mortality was increased in patients undergoing colon bypass and in those with a large tumour load but these differences failed to reach statistical significance. The most frequent complication was neck sepsis, secondary to leakage from the proximal end of the excluded oesophagus. Eighty-nine per cent of the survivors could eat a normal, unrestricted diet on discharge and eighty-two per cent of survivors had complete and lasting relief from dysphagia. Median survival after bypass was 5 months but survival was significantly improved by radiotherapy to the tumour (P less than 0.001). Gastric bypass with radiotherapy is indicated in patients with extra-oesophageal spread of malignancy and in patients with tumours localized to the oesophagus who are unfit for resection. Bypass surgery may be contra-indicated in patients with a primary tumour greater than 10 cm in length and/or fixed lymph node metastases because mortality is increased and survival after operation is short.

  2. Platelet gel biotechnology applied to regenerative surgery of intrabony defects in patients with refractory generalized aggressive peridontitis. Case report.

    PubMed

    Mauro, S; Orlando, L; Panzoni, R; Orlando, P F

    2003-01-01

    Platelet gel biotechnology, a method which has all the components of "tissue engineering" techniques, potentiates the already known healing process of guided tissue regeneration procedures (GTR) by multiplying the number of molecules that activate the healing response and by grafting in the host site various cell types, among which stem cells. Here are reported cases of patients affected by refractory generalized aggressive periodontitis treated with the association GTR and platelet gel biotechnology to verify if the contribution of the gel would produce superior results than those obtained by surgery alone which had been previously applied to the same sites with negative results. Three patients in therapy from 4 to 11 years, already subjected to surgery (GTR) and antibiotic therapy, were reoperated with the adjunct of autologous platelet gel. At a distance of 15.2 months (range 11-17 months) the operated sites showed a reduction in probing pocket depth of 3.4 mm (range 2.8-4.8 mm) and a gain in clinical attachment level of 3.1 mm (range 3-3.5 mm). The association of platelet gel biotechnology with GTR in the surgical treatment of intrabony defects of refractory generalized aggressive periodontitis patients seems to produce results similar to those reported for patients with chronic adult periodontitis. The observations at 15.2 months indicate that there is a stability over time of the results in those sites where previous surgical therapy had shown relapse.

  3. Iatrogenic femoral neuropathy following pelvic surgery: a rare and often overlooked complication--four case reports and literature review.

    PubMed

    Huang, Wen-Shih; Lin, Paul Y; Yeh, Chong-Hong; Chin, Chih-Chien; Hsieh, Ching-Chuan; Wang, Jeng-Yi

    2007-01-01

    Femoral neuropathy can result from diverse etiologies following abdominal surgery. We describe four cases of postoperative femoral neuropathy after proctological procedures that were carried out at our hospital. The related symptoms developed occultly but eventually impaired patient motor or sensory functions in the lower extremities. When the patient fails to address associated suffering, it is easy for clinicians to neglect this type of morbidity. All patients recovered from neuropathy following timely detection of the disease entity confirmed by electromyography and nerve conduction studies, followed by adequate rehabilitation management. We hypothesize that postoperative femoral neuropathy may be closely related to unsuitable applications of self-retaining retractors, rather than being associated with other factors, such as gender, age, surgery time or body mass index (BMI). Furthermore, we used a literature review to examine the pathophysiology, diagnoses and treatment modalities of femoral neuropathy resulting from inappropriate placement of self-retaining retractors. Based on a thorough comprehension of the femoral nerves anatomical course and meticulous placement of retractor blades, these types of iatrogenic complications may be prevented.

  4. A new disaster victim identification management strategy targeting "near identification-threshold" cases: Experiences from the Boxing Day tsunami.

    PubMed

    Wright, Kirsty; Mundorff, Amy; Chaseling, Janet; Forrest, Alexander; Maguire, Christopher; Crane, Denis I

    2015-05-01

    The international disaster victim identification (DVI) response to the Boxing Day tsunami, led by the Royal Thai Police in Phuket, Thailand, was one of the largest and most complex in DVI history. Referred to as the Thai Tsunami Victim Identification operation, the group comprised a multi-national, multi-agency, and multi-disciplinary team. The traditional DVI approach proved successful in identifying a large number of victims quickly. However, the team struggled to identify certain victims due to incomplete or poor quality ante-mortem and post-mortem data. In response to these challenges, a new 'near-threshold' DVI management strategy was implemented to target presumptive identifications and improve operational efficiency. The strategy was implemented by the DNA Team, therefore DNA kinship matches that just failed to reach the reporting threshold of 99.9% were prioritized, however the same approach could be taken by targeting, for example, cases with partial fingerprint matches. The presumptive DNA identifications were progressively filtered through the Investigation, Dental and Fingerprint Teams to add additional information necessary to either strengthen or conclusively exclude the identification. Over a five-month period 111 victims from ten countries were identified using this targeted approach. The new identifications comprised 87 adults, 24 children and included 97 Thai locals. New data from the Fingerprint Team established nearly 60% of the total near-threshold identifications and the combined DNA/Physical method was responsible for over 30%. Implementing the new strategy, targeting near-threshold cases, had positive management implications. The process initiated additional ante-mortem information collections, and established a much-needed, distinct "end-point" for unresolved cases.

  5. A new disaster victim identification management strategy targeting "near identification-threshold" cases: Experiences from the Boxing Day tsunami.

    PubMed

    Wright, Kirsty; Mundorff, Amy; Chaseling, Janet; Forrest, Alexander; Maguire, Christopher; Crane, Denis I

    2015-05-01

    The international disaster victim identification (DVI) response to the Boxing Day tsunami, led by the Royal Thai Police in Phuket, Thailand, was one of the largest and most complex in DVI history. Referred to as the Thai Tsunami Victim Identification operation, the group comprised a multi-national, multi-agency, and multi-disciplinary team. The traditional DVI approach proved successful in identifying a large number of victims quickly. However, the team struggled to identify certain victims due to incomplete or poor quality ante-mortem and post-mortem data. In response to these challenges, a new 'near-threshold' DVI management strategy was implemented to target presumptive identifications and improve operational efficiency. The strategy was implemented by the DNA Team, therefore DNA kinship matches that just failed to reach the reporting threshold of 99.9% were prioritized, however the same approach could be taken by targeting, for example, cases with partial fingerprint matches. The presumptive DNA identifications were progressively filtered through the Investigation, Dental and Fingerprint Teams to add additional information necessary to either strengthen or conclusively exclude the identification. Over a five-month period 111 victims from ten countries were identified using this targeted approach. The new identifications comprised 87 adults, 24 children and included 97 Thai locals. New data from the Fingerprint Team established nearly 60% of the total near-threshold identifications and the combined DNA/Physical method was responsible for over 30%. Implementing the new strategy, targeting near-threshold cases, had positive management implications. The process initiated additional ante-mortem information collections, and established a much-needed, distinct "end-point" for unresolved cases. PMID:25828381

  6. Anesthetic management during surgery for left ventricular aneurysm and false aneurysm occurring in stage: a case report

    PubMed Central

    Lee, Chung Hun; Lim, Sang Ho

    2016-01-01

    Left ventricular aneurysm (LVA) and false aneurysm are complications of acute myocardial infarction, trauma, and cardiac surgery. Left ventricular false aneurysm (LVFA) is a particularly catastrophic complication owing to its high propensity for rupture. Surgical resection should be considered for LVFA occurring within three months after myocardial infarction or development of congestive heart failure. In this report, we describe a case of acute heart failure with LVA and LVFA occurring in stage as a complication of myocardial infarction in a 55-year-old man. The patient was also at risk of brain ischemia due to abnormal vessel status and a previous cerebrovascular accident with left-sided weakness. Successful perioperative anesthetic management was achieved by focusing on maintaining marginal upper normal blood pressure to ensure cerebral perfusion and to reduce the risk of false aneurysm rupture. PMID:27703635

  7. Musculoskeletal and adipose tissue hydatidosis based on the iatrogenic spreading of cystic fluid during surgery: report of a case.

    PubMed

    Iuliano, L; Gurgo, A; Polettini, E; Gualdi, G; De Marzio, P

    2000-01-01

    Hydatidosis or echinococcosis is a parasitic disease caused by Echinococcus granulosus or E. multilocularis, which forms cysts in the liver and lung after penetrating the duodenal mucosa and entering the portal circulation. The liver and lung act as a filter but some embryos enter the general circulation and disseminate throughout the body. Musculoskeletal involvement is a rare manifestation of hydatidosis, which is usually reported to affect a single muscle. We report here a rare case of a 68-year-old man with widespread hydatidosis of the retroperitoneum and the subcutaneous adipose tissue, and with multiple muscle involvement in the absence of liver, lung, and spleen involvement. The patient underwent surgical excision of a subcutaneous hydatid cyst 7 years earlier. It is likely that the large dissemination of parasites resulted from accidental rupture of the primary focus during surgery with consequent release and spreading of scolices via lymphatics.

  8. Clinical comparison of laparoscopy vs open surgery in a radical operation for rectal cancer: A retrospective case-control study

    PubMed Central

    Huang, Chen; Shen, Jia-Cheng; Zhang, Jing; Jiang, Tao; Wu, Wei-Dong; Cao, Jun; Huang, Ke-Jian; Qiu, Zheng-Jun

    2015-01-01

    AIM: To assess the diverse immediate and long-term clinical outcomes, a retrospective comparison between laparoscopic and conventional operation was performed. METHODS: A total number of 916 clinical cases, from January 2006 to December 2013 in our hospital, were analyzed which covered 492 patients underwent the laparoscopy in radical resection (LRR) and 424 cases in open radical resection (ORR). A retrospective analysis was proceeded by comparing the general information, surgery performance, pathologic data, postoperative recovery and complications as well as long-term survival to investigate the diversity of immediate and long-term clinical outcomes of laparoscopic radical operation. RESULTS: There were no statistically significance differences between gender, age, height, weight, body mass index (BMI), tumor loci, tumor node metastasis stages, cell differentiation degree or American Society of Anesthesiologists scores of the patients (P > 0.05). In contrast to the ORR group, the LRR group experienced less operating time (P < 0.001), a lower blood loss (P < 0.001), and had a 2.44% probability of conversion to open surgery. Postoperative bowel function recovered more quickly, analgesic usage and the average hospital stay (P < 0.001) were reduced after LRR. Lymph node dissection during LRR appeared to be slightly more than in ORR (P = 0.338). There were no obvious differences in the lengths and margins (P = 0.182). And the occurrence rate in the two groups was similar (P = 0.081). Overall survival rate of ORR and LRR for 1, 3 and 5 years were 94.0% and 93.6% (P = 0.534), 78.1% and 80.9% (P = 0.284) and 75.2% and 77.0% (P = 0.416), respectively. CONCLUSION: Laparoscopy as a radical operation for rectal cancer was safe, produced better immediate outcomes. Long-term survival of laparoscopy revealed that it was similar to the open operation. PMID:26730165

  9. Developing Social Skills of Summer Campers with Autism Spectrum Disorder: A Case Study of Camps on TRACKS Implementation in an Inclusive Day-Camp Setting

    ERIC Educational Resources Information Center

    Maich, Kimberly; Hall, Carmen L.; van Rhijn, Tricia Marie; Quinlan, Laurie

    2015-01-01

    This research provides preliminary results of an exploratory case study conducted of the Camps on TRACKS program in an inclusive, municipal day-camp program in southwestern Ontario, Canada. Positive changes are demonstrated in the social skills of nine day campers with an autism spectrum disorder (ASD) who participated in the program. In this…

  10. Unusual Gross Pneumocephalus and Pneumoperitoneum after VP Shunt Surgery: A Case Report.

    PubMed

    A, Khanolkar; Yk, Sarin

    2015-01-01

    We report an unusual case where a two-month infant developed a simultaneous and spontaneous pneumocephalus and gross pneumoperitoneum along with progressive surgical emphysema after VP shunt procedure.

  11. A Rare Case of a Lost Suture Needle during Third Molar Surgery

    PubMed Central

    Aktop, Sertac; Gocmen, Gokhan; Özturk, M. Elif; Gonul, Onur; Varol, Altan

    2015-01-01

    The authors report a case that is started with a simple upper third molar's surgical extraction and a broken 3.0 suture needle tip incident occurred. Broken fragment's localization has been detected with 3D cone beam computed tomography (CBCT). Needle tip has been reached with the help of CBCT vision. CBCT's benefits have been discussed on these types of cases and further migration of the needle tip during surgical procedure is reported. PMID:26347829

  12. Study design in evidence-based surgery: What is the role of case-control studies?

    PubMed Central

    Cao, Amy M; Cox, Michael R; Eslick, Guy D

    2016-01-01

    Randomized controlled trials (RCTs) are the gold standard in terms of study design, however, in the surgical setting conducting RCTs can often be unethical or logistically impossible. Case-control studies should become the major study design used in surgical research when RCTs are unable to be conducted and definitely replacing case series which offer little insight into surgical outcomes and disease processes. PMID:27019801

  13. Anatomic Total Talar Prosthesis Replacement Surgery and Ankle Arthroplasty: An Early Case Series in Thailand

    PubMed Central

    2014-01-01

    Little is known about specific outcomes and early experiences of total talar prosthesis replacement surgery in the current literature, and ankle arthroplasty in Southeast Asia. This study reported on four patients with talar loss or ankle arthritis. Patients were treated with a custom total talar prosthesis (anatomic-metallic version) replacement (TPR, n=1) or with total ankle replacement (TAR, n=3). Baseline data, including Visual-Analog-Scale Foot and Ankle (VAS-FA) and Quality of Life scores via Short-Form-36 (SF-36), were collected for all patients. Mean follow-up time was 7.6 months. From preoperative to postoperative, VAS-FA score increased from 6.0 to 57.5, and SF-36 score increased from 19.3 to 73.7 in a patient with TPR. Mean VAS-FA scores increased from 51.5±15.6 to 85.7±4.7 (P=0.032), and mean SF-36 scores tended to increase from 65.2±13.3 to 99.3±1.2 (P=0.055) in TAR group. This study is the first report of anatomic-metallic TPR which appears to provide satisfactory outcomes for treatment of talar loss at a short-term follow-up. TAR also provides acceptable results for treatment of ankle arthritis at this point. PMID:25317313

  14. A Case of Gastric Cancer with Residual Tumor Only in the Para-Aortic Lymph Nodes after Systemic Chemotherapy followed by Conversion Surgery

    PubMed Central

    Tsutsuyama, Masayuki; Ito, Seiji; Ito, Yuichi; Misawa, Kazunari; Kawakami, Jiro; Natsume, Seiji; Uemura, Norihisa; Kinoshita, Takashi; Kimura, Kenya; Senda, Yoshiki; Abe, Tetsuya; Komori, Koji; Yatabe, Yasushi; Niwa, Yasumasa; Shimizu, Yasuhiro; Kinoshita, Taira

    2015-01-01

    We report the case of a 60-year-old male who was diagnosed with gastric cancer. Upper gastrointestinal endoscopy indicated advanced cancer in the posterior wall of the gastric body. Biopsy revealed poorly differentiated adenocarcinoma. Abdominal computed tomography demonstrated thickening of the gastric wall and enlargement of the regional lymph nodes and of the para-aortic lymph nodes (PAN). The involvement of the PAN extended from the celiac axis to the caudal area of the inferior mesenteric artery [cT3N3aH0P0M1(LYM), stage IV]. Systemic chemotherapy was initiated. After 3 courses of S-1 plus cisplatin combination chemotherapy, the primary lesion and the enlarged lymph nodes revealed marked regression except for a minute residual lesion in the lymph nodes. Upon obtaining informed consent, open distal gastrectomy, D2 lymphadenectomy with PAN dissection, and Roux-en-Y reconstruction were performed. The patient was discharged from the hospital 35 days after the operation. Histopathological examination of the resected samples revealed malignant cells only in the PAN, not in the stomach or in the regional lymph nodes [ypT0N0M1(LYM), stage IV]. Currently, the patient is undergoing postoperative adjuvant chemotherapy with S-1 and has remained well without any recurrence after 6 months following surgery. PMID:26351440

  15. Success of Minimally Invasive Transumbilical Single-Incision Laparoscopic Surgery (T-SILS) Plus Double-Balloon Endoscopy (DBE) for Pediatric Intestinal Angiodysplasia: A Case Report.

    PubMed

    Mori, Koichiro; Koike, Yuhki; Inoue, Mikihiro; Ohtake, Kohei; Tanaka, Koji; Uchida, Keichi; Mohri, Yasuhiko; Kusunoki, Masato

    2015-05-01

    We describe here a child with angiodysplasia of the small intestine, diagnosed by double-balloon endoscopy (DBE), who was treated with transumbilical single-incision laparoscopic surgery (T-SILS). A 9-year-old boy presented to another hospital with intermittent fresh melena of a duration of 5 months and 4 days. Anoscopy and gastric mucosal membrane scintigraphy were unsuccessful diagnostically, and he was referred to our hospital for further examination and treatment. Under general anesthesia, we performed DBE by an anal route, with the ileum assessed for a distance of about 150 cm from the ileocecal valve. Although no bleeding lesion was found in the colon, a flat elevated venous lake approximately 20 mm in size was observed 20 cm from the ileocecal valve, suggesting angiodysplasia of the small intestine. A tattoo was made under DBE, and wedge resection by T-SILS was performed 1 month later under general anesthesia. The excised specimen appeared as a flat, elevated venous lake approximately 20 mm in size. Histopathologic analysis revealed several dilated and distorted veins within the submucosa of the small intestine. The patient was diagnosed with angiodysplasia of the small intestine. His postoperative course was uneventful, and he remained free of recurrent gastrointestinal bleeding 18 months after the operation. This is the first case report showing the diagnosis, localization, and tattooing of an obscure gastrointestinal bleeding lesion of the small intestine by preoperative DBE and removal of the lesion by subsequent T-SILS in children. PMID:26011216

  16. Early and late surgical site infections in ear surgery.

    PubMed

    Bastier, P L; Leroyer, C; Lashéras, A; Rogues, A-M; Darrouzet, V; Franco-Vidal, V

    2016-04-01

    A retroauricular approach is routinely used for treating chronic otitis media. The incidence of surgical site infections after ear surgery is around 10% in contaminated or dirty procedures. This observational prospective study describes surgical site infections after chronic otitis media surgery with the retroauricular approach and investigated their potential predictive factors. This observational prospective study included patients suffering from chronic otitis media and eligible for therapeutic surgery with a retroauricular approach. During follow-up, surgical site infections were defined as "early" if occurring within 30 days after surgery or as "late" if occurring thereafter. The data of 102 patients were analysed. Concerning early surgical site infections, four cases were diagnosed (3.9%) and a significant association was found with preoperative antibiotic therapy, wet ear at pre-operative examination, class III (contaminated) in the surgical wound classification, NNIS (National Nosocomial Infection Surveillance) index > 1, and oral post-operative antibiotic use. Seven late surgical site infections were diagnosed (7.1%) between 90 and 160 days after surgery and were significantly correlated to otorrhoea during the 6 months before surgery, surgery duration ≤60 minutes, canal wall down technique and use of fibrin glue. Surgical site infections after chronic otitis media surgery seem to be associated with factors related to the inflammatory state of the middle ear at the time of surgery in early infections and with chronic inflammation in late infections.

  17. A Challenging Case of a Large Gastroduodenal Artery Pseudoaneurysm after Surgery of a Peptic Ulcer

    PubMed Central

    Santos-Rancaño, Rocio; Antona, Esteban Martín; Montero, José Vicente Méndez

    2015-01-01

    We report a 48-year-old man in whom a chronic postbulbar duodenal ulcer destroyed much of the back wall of the duodenum and gastroduodenal artery causing pseudoaneurysm. The lesion was found and evaluated by contrast-enhanced computed tomography (that revealed a large pseudoaneurysm of 83 mm × 75 mm in diameter) and by angiography and then treated with transcatheter embolization leading to a complete resolution of the lesion. The case is rare and important for several reasons. First, we demonstrate that pseudoaneurysm of the gastroduodenal artery caused by a duodenal ulcer can occur and present a diagnostic challenge (as far as we know, only three cases have been reported previously in the literature). Second, this case report focuses on the importance of ligation of the gastroduodenal artery when bleeding of peptic ulcers occurs. Additionally, we present an overview of the relevant literature. PMID:25648587

  18. Pericardial Effusion After Pediatric Cardiac Surgeries: A Single Center Observation

    PubMed Central

    Dalili, Mohammad; Zamani, Hassan; Aarabi-Moghaddam, Mohammadyousef

    2012-01-01

    Background: Development of fibrinous pericarditis after pericardiotomy is a well-recognized reaction. Within a few post-operative days, the inflammated surface of pericardium begins to fuse to the overlying sternum. Objectives: Our aim was to assess the prevalence, risk factors, time course and therapy response of pericardial effusion (PE) after cardiac surgeries in children. Patients and Methods: PE occurrence was assessed prospectively in 486 children who underwent cardiac surgery for congenital heart diseases by serial echocardiography. Clinical manifestations were observed and response to different therapies was analyzed. Results: The prevalence of PE was about 10% for all cardiac surgeries. Symptoms were exclusively seen in patients who had moderate to large effusions. The mean onset of pericardial effusion was 11 (± 8) days after surgery procedure, with 87 % (42 of 48) of cases being diagnosed on or before day 13 after operation. The prevalence of effusion after Fontan-type procedures and AVSD repair (29 %, 5 of 17 for both) was significantly higher than other types of cardiac surgeries. Aspirin administration was effective in 77 % and prednisone in 90 % of the cases. Conclusions: PE may be developed as late as weeks after cardiac surgeries. PE after palliative cardiac surgeries is not uncommon. Low doses of aspirin and corticosteroids are usually effective for treating this complication. PMID:25478485

  19. The case in favour of probiotics before, during and after pregnancy: insights from the first 1,500 days.

    PubMed

    Reid, G; Kumar, H; Khan, A I; Rautava, S; Tobin, J; Salminen, S

    2016-06-01

    Successful human reproduction requires microbial homeostasis in the female reproductive tract, and colonisation of the newborn with beneficial microbes. In order to prevent several complications associated with dysbiosis, the administration of probiotics is more often being considered. The objective of the enclosed review was to examine the rationale for probiotic utility before and during pregnancy and in the early phase of infant life. The conclusions emerged from a panel of researchers who met during the International Scientific Association for Probiotics and Prebiotics (ISAPP) workshop held in Washington, DC, USA in 2015. The group concluded based upon the current literature, that a case can be made for the use of a specific sets of probiotic organisms during the first 1,500 days of life, with the goal of a healthy pregnancy to term, and a healthy start to life with lowered risk of infections and inflammatory events. The key to successfully translating these recommendations to practice is that products be made available and affordable to women in developed and developing countries.

  20. A Study in Child Care (Case Study from Volume II-B): "Someplace Secure." Day Care Programs Reprint Series.

    ERIC Educational Resources Information Center

    Rosenthal, Kristine

    The Neighborhood Centers Day Care Association (NCDCA) is a private, nonprofit corporation which for 18 years has provided day care services to low income and welfare families in the Houston area. More than 1,100 children are presently being served. There are eight centers and about 180 day homes which are used to supplement the care available at…

  1. Breast augmentation surgery

    MedlinePlus

    ... a change in the shape of your breast, hardening of breast tissue, or some pain. Emotional risks ... starting 5 days after surgery. Massaging helps reduce hardening of the capsule that surrounds the implant. Ask ...

  2. [One stop surgery in pediatric surgery. Preliminary report].

    PubMed

    Sanges, G; Astuto, M; Sentina, P; Morinello, E; Di Benedetto, A

    2002-01-01

    The One-Stop Surgery (OSS) is a new method of Day Surgery, which combines preoperative evaluation and subsequent operation into one visit. This report describes the initial experience of the authors. Referring physicians were informed by fax about method and selected surgical procedures. Included form helped them to gain anamnestic data and to inform parents about preoperative fast. Form was then sent back by fax to the pediatric surgeon and anesthesiologist who determined the patient suitability and scheduled the day of the surgery. At hospital admission, if the diagnosis was confirmed and no anesthesiologic contraindications were discovered, the patient underwent the prescheduled surgical procedure and was discharged as a day case. Another form containing informations about home postoperative care and telephone numbers for emergency call was gave to the parents. From November 2000 through February 2001 43 patients, aged from 2 to 7 years, underwent one-stop surgical procedure: central venous catheter removal (n = 16), umbilical (n = 2) and inguinal (n = 10) hernia repair, prepuce dorsal slit (n = 15). Recovery of all patient was uneventful. None of them called during the period considered necessary for postoperative follow-up. Decreased costs and increased satisfaction of the patients and parents are the most important advantages of the OSS. Potential disadvantages are a not appropriate indication for the planned procedure and/or an anesthesiologic contraindication at hospital admission. It could involve a waste of human and financial resources and an useless psychologic stress for the family. Authors conclude it is not advisable the OSS use on a large scale without a sound experience in pediatric Day Surgery.

  3. Redislocation After a Failed Surgery to Treat C6/7 Fracture-Dislocation With Pedicular Fracture of the C6 Vertebra: Case Report of a Successful Revision Surgery, Analysis of the Causes, and Discussion of Revision Surgical Strategies.

    PubMed

    Yang, Yi; Ma, Litai; Li, Tao; Liu, Hao

    2016-03-01

    Cervical spinal fracture-dislocation with pedicular fracture of the vertebra has been little reported and the management of such a patient is difficult. Considering the little knowledge of this area, we present this special case of a successful revision surgery for the treatment of redislocation after a failed surgery to treat C6/7 fracture-dislocation with pedicular fracture of the C6 vertebra to share our experience.A 45-year-old male patient presented to our hospital with history of neck pain for 4 months. According to his medical records, he was involved in an architectural accident and diagnosed with C6/7 fracture-dislocation with pedicular fracture of the C6 vertebra (ASIA: D). A surgery of posterior lateral mass screw fixation (bilateral in C5 and C7; left side in C6) was performed in a different institution. However, 4 months after his primary surgery, he was still troubled by serious neck pain and muscle weakness in all right side limbs. The physical examination of the patient showed hypoesthesia in the right side limbs, myodynamia of the right side limbs weakened to Grade 4. Cervical X-rays, computed tomography (CT), and magnetic resonance imaging confirmed the redislocation of C6/7. A successful revision surgery of anterior cervical corpectomy and fusion (ACCF) with nanohydroxyapatite/polyamide 66 composite fulfilled with vertebral autograft plus anterior plate was performed. The 3 months postoperative X-rays and CT scan showed the good position of the implant and bony fusion. The patient's neck pain was relived and the neurological function recovered to ASIA E grade at the 3rd month follow-up.ACCF with nanohydroxyapatite/polyamide 66 composite fulfilled with vertebral autograft plus anterior plate is effective for the treatment of redislocation after a failed surgery in patients of fracture-dislocation with pedicular fracture. The best method to avoid such a failed surgery is a combined anterior-posterior approach surgery in our opinion. PMID:26962843

  4. [Intra-operative Acute Aortic Dissection during Aortic Root Reimplantation and Mitral Valve Reconstruction Surgery in a Patient with Marfan Syndrome;Report of a Case].

    PubMed

    Teramoto, Chikao; Kawaguchi, Osamu; Araki, Yoshimori; Yoshikawa, Masaharu; Uchida, Wataru; Takemura, Gennta; Makino, Naoki

    2016-08-01

    In patients with Marfan syndrome, cardiovascular complication due to aortic dissection represents the primary cause of death. Iatrogenic acute aortic dissection during cardiac surgery is a rare, but serious adverse event. A 51-year-old woman with Marfan syndrome underwent elective aortic surgery and mitral valve reconstruction surgery for the enlarged aortic root and severe mitral regurgitation. We replaced the aortic root and ascending aorta based on reimplantation technique. During subsequent mitral valve reconstruction, we found the heart pushed up from behind. Trans-esophageal echocardiography revealed a dissecting flap in the thoracic descending aorta. There was just weak signal of blood flow in the pseudolumen. We did not add any additional procedures such as an arch replacement. Cardio-pulmonary bypass was successfully discontinued. After protamine sulfate administration and blood transfusion, blood flow in the pseudolumen disappeared. The patient was successfully discharged from the hospital on 33th postoperative day without significant morbidities. PMID:27476568

  5. Percutaneous renal surgery for urolithiasis.

    PubMed

    Tan, H M; Cheung, H S

    1990-06-01

    Sixty eight consecutive cases of percutaneous renal surgery, percutaneous nephrolithotripsy (PCNL), were performed on 64 patients (male-41, female-23) at the Subang Jaya Medical Centre from April 1988 to July 1989. All the cases were done as a one stage procedure. Fifty eight stones were large renal or staghorn and ten were ureteric. Thirty cases (41%) were stone free after PCNL alone. Thirty eight cases had residual fragments needing extracorporeal shockwave lithotripsy (ESWL). Mean operating time was 109.6 +/- 36.0 minutes. Mean hospital stay was 4.5 +/- 1.8 days. At three months follow-up, 86% of the cases were stone free. The remaining had residual sand (less than 3mm). Minor complications occurred in six patients. None required major surgical intervention post PCNL.

  6. Cone Beam Computed Tomography Evaluation of the Diagnosis, Treatment Planning, and Long-Term Followup of Large Periapical Lesions Treated by Endodontic Surgery: Two Case Reports

    PubMed Central

    Shekhar, Vijay; Shashikala, K.

    2013-01-01

    The aim of this case report is to present two cases where cone beam computed tomography (CBCT) was used for the diagnosis, treatment planning, and followup of large periapical lesions in relation to maxillary anterior teeth treated by endodontic surgery. Periapical disease may be detected sooner using CBCT, and their true size, extent, nature, and position can be assessed. It allows clinician to select the most relevant views of the area of interest resulting in improved detection of periapical lesions. CBCT scan may provide a better, more accurate, and faster method to differentially diagnose a solid (granuloma) from a fluid-filled lesion or cavity (cyst). In the present case report, endodontic treatment was performed for both the cases followed by endodontic surgery. Biopsy was done to establish the confirmatory histopathological diagnosis of the periapical lesions. Long-term assessment of the periapical healing following surgery was done in all the three dimensions using CBCT and was found to be more accurate than IOPA radiography. It was concluded that CBCT was a useful modality in making the diagnosis and treatment plan and assessing the outcome of endodontic surgery for large periapical lesions. PMID:23762646

  7. Diagnosis and Treatment of Small Bowel Strangulation Due To Congenital Band: Three Cases of Congenital Band in Adults Lacking a History of Trauma or Surgery

    PubMed Central

    Nicolas, Gregory; Kfoury, Tony; Shimlati, Rasha; Koury, Elliott; Tohme, Maroon; Gharios, Elie; Wakim, Raja

    2016-01-01

    Case series Patients: Male, 33 • Male, 18 • Male, 19 Final Diagnosis: Congenital band causing a small bowel obstruction Symptoms: Progressive abdominal pain that eventually becomes excessive Medication: — Clinical Procedure: Laparoscopic band removal Specialty: Surgery Objective: Rare disease Background: Among the causes of constipation are bands and adhesions that lead to obstructions at different points in the intestinal tract. These can occur as a consequence of healing following surgery or trauma. However, an entity known as congenital band exists where a band is present from birth. Here we report three such cases of adults with symptoms of intestinal obstruction, in whom a congenital band was discovered through exploratory laparoscopy. Case Reports: All three of these patients presented lacking a history of any abdominal trauma or previous abdominal surgeries, a fact that is often used to exclude an adhesion as a differential. All three recovered quickly and had relief of their symptoms following surgical intervention. Conclusions: Bands and adhesions are common surgical causes of small bowel obstruction, leading to symptoms such as nausea, vomiting, constipation, and obstipation. These bands almost always result from a prior abdominal surgery or from a recent abdominal trauma. The three cases presented here show a far more unusual picture of a band, one that is congenitally present, as there was an absence of such a history. This is significant because clinical suspicion of a band is often very low due to a lack of distinguishing clinical and diagnostic features, and when the past history is negative. PMID:27713389

  8. Vitreous surgery in children.

    PubMed

    Aznabayev, M T; Aznabayev, R A; Kazakbayev, A G; Iskandarov, R H

    1994-01-01

    This study examines the results of research on the surgical treatment of children with various vitreous diseases. Vitrectomy was performed on 44 eyes in children, from four months to fifteen years of age, suffering from the following diseases: lensectomy complications as vitreocorneal adhesions or immersion of lens mass into the vitreous; persistent hyperplastic primary vitreous (PHPV), trauma consequences, uveitis and eyeball subatrophy. Preoperational examination included measurement of visual acuity, biomicroscopy, direct and indirect ophthalmoscopy, tonography, ultrasonography and electrophysiological examinations. Vitreotome 'ocutome' was used to perform the operations. A transcyliar approach was used in all but 14 cases, for which the operations were performed by limbal incision. Improvement of visual functions was noted in 28 eyes (63.3%), and relatively good visual function was achieved in 7 eyes (16.9%). Visual acuity remained unchanged in 6 eyes (13.6%) because of severe amblyopia, although the transparency of optic zone was restored and the fundus did become visible. IN 10 (22.7%) of the children visual acuity could not be measured because of too young an age. One day after surgery a cellular suspension in the vitreous was observed in many eyes. This however, resolved within 3 days. Intraocular pressure usually returned during the first week after surgery. Hypotonia remained for 1-2 months after subtotal vitrectomy. The transcyliar extraction of pathological vitreous in children is generally a less traumatic and more convenient means of intravitreal manipulation, but 2 cases of intraoperational hemophthalmia suggested that iridiocyclitis is a contraindication for transcyliar approach. Transcorneal extraction is a less traumatic surgical method in such cases. PMID:7835175

  9. Results of surgery in 88 consecutive cases of extrahepatic biliary atresia.

    PubMed Central

    Howard, E R; Driver, M; McClement, J; Mowat, A P

    1982-01-01

    Of 88 cases of extrahepatic biliary atresia, satisfactory bile flow has been established in 46% of the patients who have undergone portoenterostomies and in 25% of patients with hepaticojejunostomies. Histological analysis of the extrahepatic biliary tissue has not shown a consistent correlation with outcome of operation, except that the patients with one or two large residual ducts lined with columnar epithelium have a better chance of developing bile flow. Cholangitis developed in 43% of the cases, and co-trimoxazole was not shown to have any beneficial effect in a small prospective trial in 18 patients. Severe haemorrhage from oesophageal varices has occurred in 4 jaundice-free survivors. Seventeen patients are now over 3 years of age and thriving but many show persistent elevation of liver enzymes. PMID:7086788

  10. A case of solitary fibrous tumor in the pelvis presenting massive hemorrhage during surgery.

    PubMed

    Kim, Mi Young; Jeon, Seob; Choi, Seung Do; Nam, Kye Hyun; Sunwoo, Jae Gun; Lee, Ji-Hye

    2015-01-01

    Solitary fibrous tumors (SFTs) are unique soft-tissue tumors of submesothelial origin. These tumors are mainly located in the pleural space but they can be originated within a variety of sites, including the abdomen, the pelvis, the soft tissues and the retroperitoneum. SFTs from all sites are usually benign, and the surgical resection is curative in almost all cases. According to the review of literatures, during the surgical resection, massive hemorrhage could occur due to the hypervascular nature of SFTs. This is a case report on SFT in the pelvis presenting great vessel injury, which resulted in life threatening hemorrhage during the resection of tumor. We wish this paper alerts gynecologists about the risk of massive bleeding during the resection of tumor located at adjacent to great vessels in the pelvis.

  11. A case of primary adenocarcinoma of the third portion of the duodenum resected by laparoscopic and endoscopic cooperating surgery

    PubMed Central

    Tamaki, Ichiro; Obama, Kazutaka; Matsuo, Koichi; Kami, Kazuhiro; Uemoto, Yusuke; Sato, Teruyuki; Ito, Tetsuo; Tamaki, Nobuyuki; Kubota, Keiko; Inoue, Hidenobu; Yamamoto, Eiji; Morimoto, Taisuke

    2015-01-01

    Introduction We report a case of primary adenocarcinoma in the third portion of the duodenum (D3) curatively resected by laparoscopic and endoscopic cooperating surgery (LECS). Presentation of case A 65-year-old woman had a routine visit to our hospital for a follow-up of rectal cancer resected curatively 2 years ago. A routine screening gastroduodenal endoscopy revealed an elevated lesion of 20 mm in diameter in the D3. The preoperative diagnosis was adenoma with high-grade dysplasia; however, suspicion about potential adenocarcinoma was undeniable. Curative resection was performed by LECS. Pathological examination revealed intramucosal adenocarcinoma arising from normal duodenal mucosa. The tumor was stage I (T1/N0/M0) in terms of the tumor, nodes, metastasis (TNM) classification. LECS for duodenal tumor has seldom been reported previously, and this is the first report of LECS for primary adenocarcinoma in the D3. The transverse mesocolon was removed from the head of pancreas to expose the duodenum, and the accessory right colic vein was cut; this was followed by the Kocher maneuver for mobilization of the lesion site. Discussion LECS enabled en bloc resection with adequate surgical margins and secure intra-abdominal suturing. Thorough mobilization of the mesocolon and pancreas head is essential for this procedure because it facilitates correct resection and suturing. Conclusion LECS is a feasible treatment option for duodenal neoplasms, including intramucosal adenocarcinoma, even though it exists in the D3. PMID:25723745

  12. Esthetic Rehabilitation through Crown Lengthening Surgery and Conservative CAD/CAM Veneers: A Multidisciplinary Case Report.

    PubMed

    Passos, Leandro; Soares, Fernando Peixoto; Gallo, Mauricio

    2016-01-01

    This case report describes a successful multidisciplinary approach used to improve the smile esthetics of a patient presenting with excessive gingival display, asymmetric gingival margins, and small upper anterior teeth and lower anterior teeth. The treatment combined esthetic crown lengthening, dental bleaching, and restorative dentistry using CAD/CAM veneer. The 6-month follow-up examination confirmed the stability of the modification and absence of adverse effects.

  13. [Crescendo angina - an indication for surgery: A short literature survey and a discussion of three cases].

    PubMed

    Meyer, J M; Kleynhans, P H; Hugo, J M; Verwoerd, C A; Steyn, J G

    1980-08-01

    A definition of crescendo angina is given, followed by a short discussion of the literature on this disease. A case of a patient treated surgically for crescendo angina is reported, and the angiograms of 2 other patients are reviewed to further illustrate the problem. The favourable postoperative course of the patients who underwent an operation for this life-threatening disease is a strong indication for this mode of treatment.

  14. Functional Outcomes of the Surgery and Rehabilitation in a Challenging Case of Heterotopic Ossification after Encephalitis

    PubMed Central

    Ekiz, T; Aslan, M Doğan; Demir, S Özbudak; Altay, M; Özgirgin, N

    2015-01-01

    ABSTRACT Heterotopic ossification is the formation of the lamellar bone where normally osseous tissue does not exist. Since heterotopic ossification can cause severe functional loss, it is a challenging condition for both clinicians and patients. Neurogenic heterotopic ossification is a rare condition after encephalitis. Likewise, in this paper, we have presented a challenging case of heterotopic ossification after viral encephalitis and functional outcomes after the management of heterotopic ossification. PMID:26426185

  15. Long-term results of complex left ventricular reconstruction surgery: case report.

    PubMed

    Letsou, George V; Forrester, Matthew; Frazier, O H

    2011-01-01

    Left ventricular reconstruction is advocated as a surgical option for patients with severe congestive heart failure. Despite initial enthusiasm for this procedure, reports of long-term results are sparse. Herein, we describe a particularly gratifying case of left ventricular reconstruction in a 43-year-old man, who continues to have excellent left ventricular function 10 years postoperatively. This approach may be a reasonable alternative to cardiac transplantation in patients who lack other treatment options.

  16. Esthetic Rehabilitation through Crown Lengthening Surgery and Conservative CAD/CAM Veneers: A Multidisciplinary Case Report.

    PubMed

    Passos, Leandro; Soares, Fernando Peixoto; Gallo, Mauricio

    2016-01-01

    This case report describes a successful multidisciplinary approach used to improve the smile esthetics of a patient presenting with excessive gingival display, asymmetric gingival margins, and small upper anterior teeth and lower anterior teeth. The treatment combined esthetic crown lengthening, dental bleaching, and restorative dentistry using CAD/CAM veneer. The 6-month follow-up examination confirmed the stability of the modification and absence of adverse effects. PMID:27668099

  17. Esthetic Rehabilitation through Crown Lengthening Surgery and Conservative CAD/CAM Veneers: A Multidisciplinary Case Report

    PubMed Central

    Soares, Fernando Peixoto; Gallo, Mauricio

    2016-01-01

    This case report describes a successful multidisciplinary approach used to improve the smile esthetics of a patient presenting with excessive gingival display, asymmetric gingival margins, and small upper anterior teeth and lower anterior teeth. The treatment combined esthetic crown lengthening, dental bleaching, and restorative dentistry using CAD/CAM veneer. The 6-month follow-up examination confirmed the stability of the modification and absence of adverse effects. PMID:27668099

  18. Esthetic Rehabilitation through Crown Lengthening Surgery and Conservative CAD/CAM Veneers: A Multidisciplinary Case Report

    PubMed Central

    Soares, Fernando Peixoto; Gallo, Mauricio

    2016-01-01

    This case report describes a successful multidisciplinary approach used to improve the smile esthetics of a patient presenting with excessive gingival display, asymmetric gingival margins, and small upper anterior teeth and lower anterior teeth. The treatment combined esthetic crown lengthening, dental bleaching, and restorative dentistry using CAD/CAM veneer. The 6-month follow-up examination confirmed the stability of the modification and absence of adverse effects.

  19. Making a business case for quality by regional information sharing involving cardiothoracic surgery.

    PubMed

    Rich, Jeffrey B; Speir, Alan M; Fonner, Edwin

    2006-01-01

    A consortium of cardiac surgeons, nurses, and administrators in Virginia has developed a clinical/financial database to identify sites with best outcomes and replicate best practices statewide. The financial value of quality improvements is estimated from the incremental savings gained by reducing postoperative complications. The group studied 7,417 coronary artery bypass graft cases in 2003-2004. The average costs of atrial fibrillation, stroke, mediastinitis, renal failure, reoperation for bleeding, and prolonged use of ventilation were measured using charge data and ratios of costs-to-charges. Costs ranged from 18,093 US dollars to 28,136 US dollars in eight hospitals. Lower-cost hospitals had lower standardized mortality ratios. Average total costs were 19,049 US dollars for cases with no complications. Cases with postoperative atrial fibrillation were 21,415 US dollars, an incremental cost of 2,366 US dollars (p<0.0001), and reached 54,671 US dollars for mediastinitis (deep sternal wound infections) and 57,360 US dollars for renal failure. Overall, 16.1% of 5,230 coronary artery bypass graft patients developed atrial fibrillation in 2003. Incidence ranged from <5% to nearly 30% across 14 hospitals. Reducing the incidence of complications by small fractions can yield significant savings. Paying for performance may lead to more comparative analysis, peer-to-peer collaboration, and new approaches to quality improvement and efficiency measurement.

  20. Plastic Surgery

    MedlinePlus

    ... How Can I Help a Friend Who Cuts? Plastic Surgery KidsHealth > For Teens > Plastic Surgery Print A ... her forehead lightened with a laser? What Is Plastic Surgery? Just because the name includes the word " ...

  1. Lung surgery

    MedlinePlus

    ... Pneumonectomy; Lobectomy; Lung biopsy; Thoracoscopy; Video-assisted thoracoscopic surgery; VATS ... You will have general anesthesia before surgery. You will be asleep and unable to feel pain. Two common ways to do surgery on your lungs are thoracotomy and video- ...

  2. Foot Surgery

    MedlinePlus

    ... About Feet » Foot Health Information Surgery When is Foot Surgery Necessary? Many foot problems do not respond ... restore the function of your foot. Types of Foot Surgery Fusions: Fusions are usually performed to treat ...

  3. [A Rare Case in Hand Surgery: Adder Bite in an Index Finger].

    PubMed

    Jaehn, T; Zunker, C; Mägdefrau, H; Reichert, B

    2016-08-01

    The common European adder is an endangered animal species in Europe. Despite its endangerment, snake bite injuries do occur from time to time, even in Germany. This is a poisoning emergency. Detailed numbers concerning the incidence or lethality of adder bites in Germany do not exist. Only 13% of all cases have a severe course of disease, with children and elderly people prevailing in this patient group. We report the benign course of an adder bite injury of the index finger of a 60-year-old zoologist, which healed completely under symptomatic treatment and surveillance without any operative intervention. PMID:27442002

  4. 360° fusion for realignment of high grade cervical kyphosis by one step surgery: Case report.

    PubMed

    Landi, Alessandro; Marotta, Nicola; Mancarella, Cristina; Dugoni, Demo Eugenio; Tarantino, Roberto; Delfini, Roberto

    2014-07-16

    Surgical treatment for cervical kyphotic deformity is still controversial. Circumferential approach has been well described in the literature but long terms outcomes are not well reported. Important to decide the correct treatment option is the preoperative radiological exams to value the type of deformity (flexible or fixed). We report the case of a 67-year-old woman affected by a severe cervical kyphotic deformity who underwent combined anterior/posterior surgical approach, getting a good reduction of the deformity and an optimal stability in a long term follow up.

  5. 360° fusion for realignment of high grade cervical kyphosis by one step surgery: Case report

    PubMed Central

    Landi, Alessandro; Marotta, Nicola; Mancarella, Cristina; Dugoni, Demo Eugenio; Tarantino, Roberto; Delfini, Roberto

    2014-01-01

    Surgical treatment for cervical kyphotic deformity is still controversial. Circumferential approach has been well described in the literature but long terms outcomes are not well reported. Important to decide the correct treatment option is the preoperative radiological exams to value the type of deformity (flexible or fixed). We report the case of a 67-year-old woman affected by a severe cervical kyphotic deformity who underwent combined anterior/posterior surgical approach, getting a good reduction of the deformity and an optimal stability in a long term follow up. PMID:25032205

  6. Excellent Aesthetic and Functional Outcome After Fractionated Carbon Dioxide Laser Skin Graft Revision Surgery: Case Report and Review of Laser Skin Graft Revision Techniques.

    PubMed

    Ho, Derek; Jagdeo, Jared

    2015-11-01

    Skin grafts are utilized in dermatology to reconstruct a defect secondary to surgery or trauma of the skin. Common indications for skin grafts include surgical removal of cutaneous malignancies, replacement of tissue after burns or lacerations, and hair transplantation in alopecia. Skin grafts may be cosmetically displeasing, functionally limiting, and significantly impact patient's quality-of-life. There is limited published data regarding skin graft revision to enhance aesthetics and function. Here, we present a case demonstrating excellent aesthetic and functional outcome after fractionated carbon dioxide (CO2) laser skin graft revision surgery and review of the medical literature on laser skin graft revision techniques. PMID:26580878

  7. [A critical assessment of morcellation in case of uterine malignancies and its impact on gynecologic surgery: From "precautionary principle" to "realism"].

    PubMed

    Guyon, Frédéric; Cordeiro Vidal, Gloria; Babin, Guillaume; Stoeckle, Eberhard; Querleu, Denis

    2016-01-01

    Minimally invasive surgery has demonstrated benefits that include improved pain control, decreased infection risk, and faster surgical recovery and return to work. Morcellation is an integral part of making laparoscopic surgery possible for the removal of large uterine leiomyomata, and the development of power morcellation has increased efficiency during these procedures. Morcellation may expose patients to increased morbidity in certain circumstances. This is particularly true in cases of unrecognized malignancy, where intra-abdominal dissemination of cancer may worsen the prognosis (overall survival and disease free survival). A critical review of published data supports that tissue morcellation can be performed safely in screened and selected patients.

  8. Tailoring Tendon Transfer Surgery and Rehabilitation for a Musician: A Case Study

    PubMed Central

    Watkins, Cynthia; Rivlin, Michael; Beredjiklian, Pedro K.

    2016-01-01

    Tendon transfers in hand patients are a commonly performed procedure after extensor tendon rupture. However, the standard side to side technique is not applicable in every patient. We present a case of a musician with unique demands to demonstrate the option to customize surgical technique and therapy regimen to the unique needs of each patient. An extensor indicis proprius to extensor digitorum communis transfer was performed in a 73 year old musician. A controlled active motion therapy protocol was followed. The patients musical practice regimen was incorporated into the therapy. The patient was able to independently extend her ring and small fingers in order to play her instrument and resumed play within one month postoperatively. A patient’s functional goals including avocations need to be considered when selecting the appropriate surgical and therapeutic approach. PMID:27200400

  9. Tailoring Tendon Transfer Surgery and Rehabilitation for a Musician: A Case Study.

    PubMed

    Watkins, Cynthia; Rivlin, Michael; Beredjiklian, Pedro K

    2016-04-01

    Tendon transfers in hand patients are a commonly performed procedure after extensor tendon rupture. However, the standard side to side technique is not applicable in every patient. We present a case of a musician with unique demands to demonstrate the option to customize surgical technique and therapy regimen to the unique needs of each patient. An extensor indicis proprius to extensor digitorum communis transfer was performed in a 73 year old musician. A controlled active motion therapy protocol was followed. The patients musical practice regimen was incorporated into the therapy. The patient was able to independently extend her ring and small fingers in order to play her instrument and resumed play within one month postoperatively. A patient's functional goals including avocations need to be considered when selecting the appropriate surgical and therapeutic approach. PMID:27200400

  10. Two stage surgery in IV Class of Misch with SIS device: a case report.

    PubMed

    Grandi, C; Pacifici, L

    2008-10-01

    In IV Class of Misch classification is usually not possible insert fixtures at the same time of the sinus lift procedure. To solve all these situation the use of several appliances have been proposed. Among those the S.I.S. titan plane is the easiest to use. The S.I.S. plane allows to stabilize implants without primary stability and to fix them to osseous ridge. In IV Class of Misch it brings to a real treatment shortening. After six and twelve months RX assessments show bone levels comparables to literature implant success criteria. This technique seems to reach success in Misch IV Class with simultaneous insertion of dental implants, with a simple procedure and without further traumaticity. Literature on S.I.S. plane is lacking and mostly based on case reports. A further investigation based on a larger number of patients is needed.

  11. Full-Day Kindergarten: A Case Study on the Perceptions of District Leaders in Four Suburban Pennsylvania School Districts

    ERIC Educational Resources Information Center

    Santoro, Elizabeth A.

    2011-01-01

    This qualitative study explored the reasons why suburban district leaders opted for full-day or half-day kindergarten programming in a sample of four local suburban districts operating such programs in Southeastern, Pennsylvania. The primary data source was interviews with key district leaders including school board members, superintendents,…

  12. A Study in Child Care (Case Study from Volume II-A): "They Understand." Day Care Programs Reprint Series.

    ERIC Educational Resources Information Center

    O'Farrell, Brigid

    This day care center, operated by Syracuse University and serving 100 children (birth to 3-year-old), admits only one child per family. The child must be the first or second child in a family where both parents have high school education or less and earn less than $5,000 per year. The program philosophy maintains that quality day care must carry…

  13. Does antiepileptic drug withdrawal predispose patients undergoing temporal lobe epilepsy surgery to late onset of psychiatric morbidity? A report of three cases

    PubMed Central

    Shukla, Garima; Agarwal, Priya; Sagar, Rajesh; Sood, Mamta; Gupta, Aditya; Suri, Ashish; Garg, Ajay

    2016-01-01

    Surgery is an established and increasingly utilized treatment option in medically refractory temporal lobe epilepsy. Many psychiatric problems are known to complicate in the postoperative period. Most studies have a follow-up period of less than 24 months. We report the cases of three patients who developed severe psychiatric problems in the late postoperative period after successful temporal lobectomy for refractory epilepsy — Psychosis, major depression with psychosis, and severe anxiety disorder, respectively. None of the patients had past or family history of psychiatric disease. All three patients had undergone anterior temporal lobectomy on the right side for intractable epilepsy. They remained absolutely seizure-free after surgery. We conclude that psychiatric morbidity may arise de novo long after temporal lobectomy. This association between temporal lobectomy for epilepsy and late onset psychiatric morbidity should be carefully studied. Mechanisms underlying this late complication require deeper understanding of the effects of epilepsy surgery. PMID:27570392

  14. The combination of digital surface scanners and cone beam computed tomography technology for guided implant surgery using 3Shape implant studio software: a case history report.

    PubMed

    Lanis, Alejandro; Álvarez Del Canto, Orlando

    2015-01-01

    The incorporation of virtual engineering into dentistry and the digitization of information are providing new perspectives and innovative alternatives for dental treatment modalities. The use of digital surface scanners with surgical planning software allows for the combination of the radiographic, prosthetic, surgical, and laboratory fields under a common virtual scenario, permitting complete digital treatment planning. In this article, the authors present a clinical case in which a guided implant surgery was performed based on a complete digital surgical plan combining the information from a cone beam computed tomography scan and the virtual simulation obtained from the 3Shape TRIOS intraoral surface scanner. The information was imported to and combined in the 3Shape Implant Studio software for guided implant surgery planning. A surgical guide was obtained by a 3D printer, and the surgical procedure was done using the Biohorizons Guided Surgery Kit and its protocol. PMID:25822304

  15. Does antiepileptic drug withdrawal predispose patients undergoing temporal lobe epilepsy surgery to late onset of psychiatric morbidity? A report of three cases.

    PubMed

    Shukla, Garima; Agarwal, Priya; Sagar, Rajesh; Sood, Mamta; Gupta, Aditya; Suri, Ashish; Garg, Ajay

    2016-01-01

    Surgery is an established and increasingly utilized treatment option in medically refractory temporal lobe epilepsy. Many psychiatric problems are known to complicate in the postoperative period. Most studies have a follow-up period of less than 24 months. We report the cases of three patients who developed severe psychiatric problems in the late postoperative period after successful temporal lobectomy for refractory epilepsy - Psychosis, major depression with psychosis, and severe anxiety disorder, respectively. None of the patients had past or family history of psychiatric disease. All three patients had undergone anterior temporal lobectomy on the right side for intractable epilepsy. They remained absolutely seizure-free after surgery. We conclude that psychiatric morbidity may arise de novo long after temporal lobectomy. This association between temporal lobectomy for epilepsy and late onset psychiatric morbidity should be carefully studied. Mechanisms underlying this late complication require deeper understanding of the effects of epilepsy surgery. PMID:27570392

  16. The combination of digital surface scanners and cone beam computed tomography technology for guided implant surgery using 3Shape implant studio software: a case history report.

    PubMed

    Lanis, Alejandro; Álvarez Del Canto, Orlando

    2015-01-01

    The incorporation of virtual engineering into dentistry and the digitization of information are providing new perspectives and innovative alternatives for dental treatment modalities. The use of digital surface scanners with surgical planning software allows for the combination of the radiographic, prosthetic, surgical, and laboratory fields under a common virtual scenario, permitting complete digital treatment planning. In this article, the authors present a clinical case in which a guided implant surgery was performed based on a complete digital surgical plan combining the information from a cone beam computed tomography scan and the virtual simulation obtained from the 3Shape TRIOS intraoral surface scanner. The information was imported to and combined in the 3Shape Implant Studio software for guided implant surgery planning. A surgical guide was obtained by a 3D printer, and the surgical procedure was done using the Biohorizons Guided Surgery Kit and its protocol.

  17. Hemostasis in Laryngeal Surgery.

    PubMed

    Athanasiadis, Theodore; Allen, Jacqui

    2016-06-01

    The larynx is a highly vascularized organ supplied by the superior and inferior laryngeal arteries. Both microphonosurgery and external laryngeal surgery require excellent hemostasis. Topical agents including adrenalin and fibrin-based products as well as surgical instrumentation, such as coagulation devices or in some cases embolization, are in the surgeon's armamentarium and facilitate efficient and successful surgery. PMID:27267020

  18. Spontaneous Recurrent Hemarthrosis of the Knee: A Report of Two Cases with a Source of Bleeding Detected during Arthroscopic Surgery of the Knee Joint

    PubMed Central

    Nomura, Eisuke; Hiraoka, Hisatada

    2016-01-01

    We report two cases of the spontaneous recurrent hemarthrosis of the knee. In these cases lateral meniscus was severely torn and a small tubular soft tissue with pulsation was identified on the synovium in the posterolateral corner during arthroscopic surgery of the knee joint. Gentle grasping of this tissue by forceps led to pulsating bleeding, which stopped by electrocoagulation. This soft tissue was considered a source of bleeding, since no recurrence of hemarthrosis was observed for more than four years after surgery. It was highly probable that this soft tissue was the ruptured end of the lateral inferior genicular artery or its branch. This case report strongly supports the theory that the bleeding from the peripheral arteries of the posterior portion of the lateral meniscus is the cause of spontaneous recurrent hemarthrosis of the knee. PMID:27703824

  19. A newly developed robot suit hybrid assistive limb facilitated walking rehabilitation after spinal surgery for thoracic ossification of the posterior longitudinal ligament: a case report.

    PubMed

    Sakakima, Harutoshi; Ijiri, Kosei; Matsuda, Fumiyo; Tominaga, Hiroyuki; Biwa, Takanori; Yone, Kazunori; Sankai, Yoshiyuki

    2013-01-01

    Most patients with thoracic ossification of the posterior longitudinal ligament (OPLL) exhibit delayed recovery of gait dysfunction after spinal injury. The hybrid assistive limb (HAL) is a new robot suit controlling knee and hip joint motion by detecting very weak bioelectric signals on the surface of the skin. This study is to report the feasibility and benefits of patient-assistive HAL walking rehabilitation for facilitating locomotor function after spinal surgery. The patient was a 60-year-old woman with thoracic OPLL, and her motor and sensory paralyses did not improve after spinal surgery, indicating severe impairment in the paretic legs. The subject underwent 6 HAL sessions per week for 8 weeks, consisting of a standing and sitting exercise and walking on the ground with HAL. Clinical outcomes were evaluated before and after HAL training and 1 year after surgery. The subject improved considerably as a result of HAL training. Subsequently, her walking ability recovered rapidly, and she was able to walk unaided six months after surgery. This case study suggests that HAL training is a feasible and effective option to facilitating locomotor function and the early HAL training with physiotherapy may enhance motor recovery of patients with residual paralysis after surgery.

  20. [Efficacy of UFT in the treatment of para-aortic lymph node metastasis following gastric cancer surgery: case report].

    PubMed

    Ishikawa, T; Matsusaka, T; Wakasugi, K; Tashiro, H; Yanaga, K; Yamamura, S; Sonoda, K; Kume, K

    2000-05-01

    The patient was a 68-year-old man who underwent pyloric gastrectomy for advanced stomach cancer on December 6, 1996. The histopathological diagnosis was poorly differentiated adenocarcinoma, ss, ly3, v1, n2 (+), and stage IIIa. Postoperative adjuvant chemotherapy consisted of short-term intravenous infusion of 5-FU, 320 mg/m2/day (= 480 mg/body) for 5 days beginning on postoperative day (POD) 1, and oral 5-FU, 200 mg/day, for 1 year beginning on POD 14. The preoperative CEA value was 316.2 ng, but it fluctuated below 10 ng postoperatively. About one year after the operation, the patient began to complain of epigastric pain, loss of appetite, and general malaise. CT of the upper abdomen revealed a 1.5-cm para-aortic lymph node, and the CEA value of 319.0 ng was abnormally high. 5-FU was stopped, oral UFT at 300 mg/day was started, and the patient's course was followed. Three months after the start of UFT, the lymph node had shrunk on CT (shrinkage rate: 66.7%), and the CEA value had decreased to 14.3 ng. As though corresponding to these changes there was a gradual decrease in the epigastric pain, general malaise, etc., and the patient's appetite also returned. There were no subsequent elevations in the CEA values or increases in the size of the para-aortic lymph nodes, and the patient's general condition was favorably maintained. UFT appeared to be effective against the lymph node metastasis around the aorta in this case. PMID:10832445