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Sample records for day case surgery

  1. Case Report: Red Urine After Day Care Strabismus Surgery.

    PubMed

    Caroline, Pregardien; Marie-Cécile, Nassogne; Demet, Yuksel; Francis, Veyckemans

    2017-02-15

    In the absence of surgery on the urinary tract, the emission of red urine after anesthesia should be considered as a diagnostic emergency because it can be a sign of hematuria, hemoglobinuria, blood transfusion reaction, significant myoglobinuria, or porphyria.This case describes the management of a 12-year-old boy who presented red urine at the day care unit after strabismus surgery.

  2. Day-case surgery: enhanced recovery with flumazenil.

    PubMed Central

    Birch, B R; Anson, K M; Clifford, E; Miller, R A

    1990-01-01

    In an open, randomized, parallel group study of 84 adult patients undergoing elective day-case urological surgery the specific benzodiazepine antagonist flumazenil was shown to reverse effectively subjective postoperative sedation due to midazolam and enabled 83% of patients to recover and be ready for potential discharge within 15 min of surgery (control group 24% p less than 0.001). The significantly shorter recovery time has benefits in terms of increased patient cooperation and reduced demands on postoperative nursing care. The implications of these findings for day-case surgery are discussed. PMID:2118572

  3. Changes in mood state after day case forefoot surgery.

    PubMed

    Mandy, Anne; Feeney, Sally

    2014-01-01

    Limited published data exploring patients' emotional recovery after day case foot surgery are available. The aim of the present study was to explore the changes in patient mood from preoperatively to 8 weeks postoperatively after outpatient forefoot surgery. The patients completed the Profile of Mood States-Bipolar™ questionnaire, Speilberger State-Trait Anxiety Inventory, and a 10-cm visual analog scale to measure pain preoperatively and again at 1, 2, and 8 weeks postoperatively. Of the 6 mood subscales, 3 showed statistically significant improvements by 8 weeks postoperatively: composed-anxious (Student's t test, t = -5.319; df = 84; p = .05); confident-unsure (t = -2.074; df = 84; p = .02); and clearheaded-confused (t = -2.46; df = 84; p = .007). Furthermore, the decrease in anxiety and pain was statistically significant after foot surgery. These findings have contributed to the understanding of patients' psychological needs in relation to outpatient day case foot surgery, and foot and ankle surgeons' understanding of patients' mood and anxiety levels can contribute to improving patient care and enhancing patient-practitioner relationships, which, in turn, could improve patients' perceived outcomes of their surgery.

  4. The Evaluation of Nursing Care Satisfaction and Patient Learning Needs in day Case Surgery.

    PubMed

    Goktas, Sonay B; Yildiz, Tülin; Nargiz, Sibel Kosucu

    2015-12-01

    Patients in surgical service units have higher expectations for treatment and care. The aims of this study were to determine nursing care satisfaction and information requirements at the time of discharge of patients from a day surgery unit and to assess the effects of demographics. The study was conducted on 291 patients undergoing day case surgery. Patient perception scale for nursing care (PPSN) and the patient learning needs scale (PLNS) were used and total and sub-dimension points averages were calculated and then compared with demographic data using the Kruskal-Wallis test. The results were evaluated at the p < 0.05 significance level with 95 % confidence intervals. Of the patients, 58.8 % (n = 171) were females and the average age was 49.5 ± 15.3 years. PPSN and PLNS total point averages were 68.16 ± 10.17 and 178.53 ± 27.59, respectively. A significant difference was determined in PPSN total point average with regard to previous hospitalisations; the PPSN total point average was higher for patients with prior hospitalisations (p < 0.001). Significant differences were determined between PLNS total point average and age group, marital status, receiving discharge training, and education level (p = 0.008, 0.006, <0.001, and 0.015, respectively). Differences were found in the PLNS sub-dimension point averages between groups, especially with regard to age group and educational level. We showed that patient satisfaction and patient information requirements could change according to demographic features of the patients at a day case surgery unit. In this respect, healthcare providers should offer healthcare services by evaluating the personal characteristics of patients because this is important for their satisfaction.

  5. The day of your surgery - adult

    MedlinePlus

    Same-day surgery - adult; Ambulatory surgery - adult; Surgical procedure - adult; Preoperative care - day of surgery ... meet with them at an appointment before the day of surgery or on the same day of ...

  6. [Nursing workload in Day Surgery].

    PubMed

    Bulfone, Giampiera; Dell'Aglio, Agostino; Rizzato, Mariuccia; Conte, Luigi

    2010-01-01

    The "workload" is defined as the whole of the activities completed by a group of professionals in a period of time. The different conceptualization of nursing workload has determined different methods and tools of evaluation. The aim of this study is to evaluate the nursing workload in a Day Surgery Unit with a quantitative (time in activities) and qualitative approach (perceived complexity). We want analyze also every correlation with the time in the activities. The study design is observational. We have analyzed 147 patients admitted to the Day Surgery Unit of a University Hospital in Italy. The nurses have dedicated the average of 164,8 minutes in care. The nursing care time is correlated to anesthesiological risk class and to the general surgery procedure. The patients in specialistic surgery are considered more complexes from the nurses then the general surgery patients. Another indicator associated to the high perceived complexity is the "comorbidity management". This study will help to manage nursing resources and the admission of the patients.

  7. The day of surgery for your child

    MedlinePlus

    Same-day surgery - child; Ambulatory surgery - child; Surgical procedure - child ... The anesthesia and surgery team will talk with you and your child before surgery. You may meet with them at an appointment before ...

  8. Similar levels of pain are reported in forefoot surgery after management as a day case and admission for 48 hours: A continuous prospective study of 317 patients.

    PubMed

    Chaudier, P; Bourdin, M; Gauthier, J; Fessy, M H; Besse, J L

    2015-12-01

    While many forefoot procedures may be performed as a day case, there are no specific guidelines as to which procedures are suitable. This study assessed the early post-operative pain after forefoot surgery performed a day case, compared with conventional inpatient management. A total of 317 consecutive operations performed by a single surgeon were included in the study. Those eligible according to the criteria of the French Society of Anaesthesia (SFAR) were managed as day cases (127; 40%), while the remainder were managed as inpatients. The groups were comparable in terms of gender, body mass index and smoking status, although the mean age of the inpatients was higher (p < 0.001) and they had higher mean American Society of Anaesthesiologists scores (p = 0.002). The most severe daily pain was on the first post-operative day, but the levels of pain were similar in the two groups; (4.2/10, SD 2.5 for day cases, 4.4/10, SD 2.4 for inpatients; p = 0.53). Overall, 28 (9%) of patients who had their surgery as a day case and 34 (11%) of inpatients reported extreme pain (≥ 8/10). There were more day case patients rather than inpatients that declared their pain disappeared seven days after the surgery (p = 0.02). One day-case patient with excessive bleeding was admitted post-operatively. Apart from the most complicated cases, forefoot surgery can safely be performed as a day case without an increased risk of pain, or complications compared with management as an inpatient.

  9. Outpatient Follow-Up versus 30-day Readmission among General and Vascular Surgery Patients: A Case for Redesigning Transitional Care

    PubMed Central

    Saunders, Richard Scott; Fernandes-Taylor, Sara; Rathouz, Paul J.; Saha, Sandeep; Wiseman, Jason T.; Havlena, Jeffrey; Matsumura, Jon; Kent, K. Craig

    2014-01-01

    Background The association between early outpatient follow-up and 30-day readmission has not been evaluated in any surgical population. Our study characterizes the relationship between outpatient follow-up and early readmissions among surgical patients. Methods We queried the medical record at a large, tertiary care institution (July 2008-December 2012) to determine rates of 30-day outpatient follow-up and readmission for general or vascular surgical procedures. Results The majority of discharges for general (84% of 7552) and vascular (75% of 2362) surgery had a follow-up visit before readmission or within 30 days of discharge. General surgery patients who were not readmitted had high rates of follow-up (88%) and received follow-up at approximately 2-weeks post-discharge (median time 11 days after discharge). In contrast, readmitted general surgery patients received first follow-up at one week (a median time of 8 days); 49% had follow-up. Vascular surgery patients showed a similar trend. Over half of patients readmitted after follow-up were readmitted within 24 hours of their most recent outpatient visit. Conclusions Current routine follow-up does not occur early enough to detect adverse events and prevent readmission. Early outpatient care may prevent readmission in some patients, but often serves as a conduit for readmission among patients already experiencing complications. PMID:25239351

  10. A new vision for day surgery.

    PubMed

    Baskerville, Paul

    2006-07-01

    The premise that underlines this article (based on a presentation delivered at AfPP's Annual Congress in October 2006) is that all elective surgery performed in this country should be day surgery. This should eventually include patients undergoing hip replacements, radical prostatectomies, aortic aneurysm repair and hepatectomies, to name a few. All of these procedures we should perform, safely and well, under the British definition of day surgery as 'going home at the end of the day'.

  11. A prospective double-blind randomized controlled trial comparing the suitability of KTP laser tonsillectomy with conventional dissection tonsillectomy for day case surgery.

    PubMed

    Kothari, P; Patel, S; Brown, P; Obara, L; O'Malley, S

    2002-10-01

    Tonsillectomy using a KTP laser has been performed increasingly but is not a routinely practised technique in the UK. In the USA, tonsillectomy is often performed as a day case procedure but, here in the UK, it is still standard practice to admit patients for overnight stay. We present the largest prospective double-blind randomized controlled trial to date (151 patients) comparing KTP laser with standard dissection tonsillectomy and assess the suitability of both procedures for day case surgery. We found that there was significantly less peroperative haemorrhage if tonsillectomy was performed using the KTP laser, but it did cause more postoperative pain, more depression in mood and a higher rate of both reactionary and secondary haemorrhage, which was not significant when compared with conventional dissection. There was no difference in operating time, and over 40% of patients in each group needed overnight admission. We conclude that KTP laser tonsillectomy offers no benefit apart from less intraoperative bleeding over standard dissection tonsillectomy. Discharge from hospital after tonsillectomy was found to be unpredictable. Tonsillectomy is therefore an unsuitable procedure for planned surgery through a day unit, but approximately 58% of patients could be discharged on the same day from an extended day surgery unit, and the rest have one night in hospital.

  12. 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.

  13. [Organization of nurses' work in day surgery].

    PubMed

    Acker, Françoise

    2015-05-01

    Day surgery articulates strongly the dimensions of time, space and work organisation. This modifies the nursing practice itself, the visibility and the recognition of the tasks: maintaining the flow of the pathways, monitoring, informing the patient and seeing to their comfort.

  14. Questionable safety of thyroid surgery with same day discharge

    PubMed Central

    Doran, HE; England, J; Palazzo, F

    2012-01-01

    INTRODUCTION Over the last two decades increasing numbers of surgical procedures have been performed on an outpatient basis. In 2000 the National Health Service in England set the target of performing 75% or more of all elective surgical procedures as day cases and in 2001 the British Association of Day Surgery added thyroidectomy to the list of day case procedures. However, same day discharge following thyroidectomies has been adopted by only a very small number of UK centres. The aim of this review was to establish the evidence base surrounding same day discharge thyroid surgery. METHODS The British Association of Endocrine and Thyroid Surgeons commissioned the authors to perform a review of the best available evidence regarding day case thyroid surgery as a part of a consensus position to be adopted by the organisation. A MEDLINE® review of the English medical literature was performed and the relevant articles were collated and reviewed. RESULTS There are limited comparative data on day case thyroid surgery. It is feasible and may save individual hospitals the cost of inpatient stay. However, the risk of airway compromising and life threatening post-operative bleeding remains a major concern since it is not possible to positively identify those patients most and least at risk of bleeding after thyroidectomy. It is estimated that half of all post-thyroidectomy bleeds would occur outside of the hospital environment if patients were discharged six hours after surgery. CONCLUSIONS Same day discharge in a UK setting cannot be endorsed. Any financial benefits may be outweighed by the exposure of patients to an increased risk of an adverse outcome. Consequently, 23-hour surgery is recommended. PMID:23131222

  15. The Safety and Efficacy of Day Care Cataract Surgery

    PubMed Central

    Cabric, Emir; Zvornicanin, Jasmin; Jusufovic, Vahid

    2014-01-01

    ABSTRACT Purpose: To evaluate safety and efficacy of day care cataract surgery in developing country. Patients and Methods: This prospective study included 200 patients planned for cataract surgery during October and November 2012 divided in to two groups, day care cataract surgery (DCCS) and inpatient cataract surgery (ICS), with same number of male and female patients right and left eyes. All patients had same operative conditions and postoperative follow up. Results: The average age of patients in this study was 68.4 ± 7.47 years. Visual acuity before cataract extraction was 0.1754 where 44.5% of patients had severe visual impairment and another 23% had complicated cataract. Posterior capsule rupture was noted in 4.5% of cases. The main risk factors in both groups were: higher age, female gender, left side, complicated cataract, higher dioptric power of IOL and ECCE. Regular control opthalmologic examinations 30, 90 and 180 days after the cataract extraction did not reveal signs bullous keratopathy, wound dehiscence, cystoid macular edema and endophtalmitis in any of patients. Postoperative visual acuity 180 days after the operation in DCCS was 0.920 ± 0.154 and 0.928 ± 0.144 in ICS. Visual acuity less than 0.5 was noted in 4.5% due to posterior eye segment changes. Patients in DCCS group had 30 control examinations more and 95 days of hospitalization less than ICS with 16.5% cost reduction. Conclusion: The concept of day care cataract surgery is equally safe and more cost effective than inpatient cataract surgery. PMID:24937936

  16. Day surgery management model in china: practical experience and initial evaluation

    PubMed Central

    Jiang, Huiyong; Han, Junyi; Lu, Aiguo; Liu, Xiufeng

    2014-01-01

    Objectives: Day surgery has been increasingly performed in some major teaching hospitals in China. We aimed to evaluate the current day surgery management model (DSMM) and compare the clinical outcome and health service utility of day surgery with inpatient surgery. Methods: We reviewed 14482 day surgery cases under the DSMM and 2591 inpatient surgery cases under the non-DSMM between September 2006 and September 2012 in Shanghai East Hospital. The endpoints of interest were hospitalization days, incision infection rate and hospital cost. Results: Among 14482 day surgery cases, only 52 (0.4%) were converted to hospitalization. The average hospitalization time of the patients was 2-10 hours. None of them had incision infection. Hospital cost of DSMM was less than 50% of non-DSMM (inpatient surgery). The most common postoperative complications were nausea, vomiting and dizziness. Nearly half of patients had mild to moderate pain after surgery. Conclusions: DSMM optimizes the utilization of healthcare resources by reducing hospital admission, hospital cost and incision infection in China. PMID:25550971

  17. Consensus statement on anaesthesia for day care surgeries

    PubMed Central

    Kulkarni, Satish; Harsoor, SS; Chandrasekar, M; Bhaskar, S Bala; Bapat, Jitendra; Ramdas, Edakeparavan Keloth; Valecha, Umesh Kumar; Pradhan, Amol Shashikumar; Swami, Adarsh Chandra

    2017-01-01

    The primary aim of day-care surgery units is to allow for early recovery of the patients so that they can return to their familiar 'home' environment; the management hence should be focused towards achieving these ends. The benefits could include a possible reduction in the risk of thromboembolism and hospital-acquired infections. Furthermore, day-care surgery is believed to reduce the average unit cost of treatment by up to 70% as compared to inpatient surgery. With more than 20% of the world's disease burden, India only has 6% of the world's hospital beds. Hence, there is an immense opportunity for expansion in day-care surgery in India to ensure faster and safer, cost-effective patient turnover. For this to happen, there is a need of change in the mindset of all concerned clinicians, surgeons, anaesthesiologists and even the patients. A group of nine senior consultants from various parts of India, a mix of private and government anaesthesiologists, assembled in Mumbai and deliberated and discussed on the various aspects of day-care surgery. They formulated a consensus statement, the first of its kind in the Indian scenario, which can act as a guidance and tool for day-care anaesthesia in India. The statements are derived from the available published evidence in peer-reviewed literature including guidelines of several bodies such as the American Society of Anesthesiologists, British Association of Day Surgery and International Association of Ambulatory Surgery. The authors also offer interpretive comments wherever such evidence is inadequate or contradictory. PMID:28250479

  18. Consensus statement on anaesthesia for day care surgeries.

    PubMed

    Kulkarni, Satish; Harsoor, S S; Chandrasekar, M; Bhaskar, S Bala; Bapat, Jitendra; Ramdas, Edakeparavan Keloth; Valecha, Umesh Kumar; Pradhan, Amol Shashikumar; Swami, Adarsh Chandra

    2017-02-01

    The primary aim of day-care surgery units is to allow for early recovery of the patients so that they can return to their familiar 'home' environment; the management hence should be focused towards achieving these ends. The benefits could include a possible reduction in the risk of thromboembolism and hospital-acquired infections. Furthermore, day-care surgery is believed to reduce the average unit cost of treatment by up to 70% as compared to inpatient surgery. With more than 20% of the world's disease burden, India only has 6% of the world's hospital beds. Hence, there is an immense opportunity for expansion in day-care surgery in India to ensure faster and safer, cost-effective patient turnover. For this to happen, there is a need of change in the mindset of all concerned clinicians, surgeons, anaesthesiologists and even the patients. A group of nine senior consultants from various parts of India, a mix of private and government anaesthesiologists, assembled in Mumbai and deliberated and discussed on the various aspects of day-care surgery. They formulated a consensus statement, the first of its kind in the Indian scenario, which can act as a guidance and tool for day-care anaesthesia in India. The statements are derived from the available published evidence in peer-reviewed literature including guidelines of several bodies such as the American Society of Anesthesiologists, British Association of Day Surgery and International Association of Ambulatory Surgery. The authors also offer interpretive comments wherever such evidence is inadequate or contradictory.

  19. [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.

  20. Day-case laparoscopic hernia repair.

    PubMed

    Evans, D S; Ghaneh, P; Khan, I M

    1996-10-01

    Some 114 patients (median age 52 years) underwent laparoscopic hernia repair as a day-case procedure. Twenty-one patients had bilateral and 11 recurrent hernias. Some 113 patients underwent transabdominal preperitoneal mesh repair but one required conversion to open operation. Mean operating time was 24 min for unilateral and 38 min for bilateral repair. In an operating session of 3.5 h, up to five patients (mean 4.4) underwent surgery and as many as seven hernias were repaired. More than 10 per cent of patients were found to have a previously undiagnosed hernia on the opposite side. A total of 111 patients were discharged home on the day of surgery. Major complications included one omental bleed and one small bowel obstruction. Seroma was the commonest minor complication and occurred in 7 per cent of patients. More than 35 per cent of patients needed no postoperative analgesia. To date there has been one recurrence (follow-up range 2-18 months).

  1. A prospective, randomised, controlled study examining binaural beat audio and pre-operative anxiety in patients undergoing general anaesthesia for day case surgery.

    PubMed

    Padmanabhan, R; Hildreth, A J; Laws, D

    2005-09-01

    Pre-operative anxiety is common and often significant. Ambulatory surgery challenges our pre-operative goal of an anxiety-free patient by requiring people to be 'street ready' within a brief period of time after surgery. Recently, it has been demonstrated that music can be used successfully to relieve patient anxiety before operations, and that audio embedded with tones that create binaural beats within the brain of the listener decreases subjective levels of anxiety in patients with chronic anxiety states. We measured anxiety with the State-Trait Anxiety Inventory questionnaire and compared binaural beat audio (Binaural Group) with an identical soundtrack but without these added tones (Audio Group) and with a third group who received no specific intervention (No Intervention Group). Mean [95% confidence intervals] decreases in anxiety scores were 26.3%[19-33%] in the Binaural Group (p = 0.001 vs. Audio Group, p < 0.0001 vs. No Intervention Group), 11.1%[6-16%] in the Audio Group (p = 0.15 vs. No Intervention Group) and 3.8%[0-7%] in the No Intervention Group. Binaural beat audio has the potential to decrease acute pre-operative anxiety significantly.

  2. Same-day discharge in benign esophageal surgery: a prospective cohort study.

    PubMed

    Desbeaux, A; Gronnier, C; Piessen, G; Vanderbeken, M; Ruolt, N; Triboulet, J-P; Mariette, C

    2017-04-01

    Day-case esophageal surgery has been demonstrated to be safe in small prospective cohorts and only for laparoscopic fundoplication. The aims of this study are to assess the feasibility and safety of a large series of esophageal day-case surgeries, including laparoscopic Nissen fundoplication (LNF), Zenker diverticulectomy (ZD), and laparoscopic Heller myotomy (LHM) and to compare the outcomes among three procedures.This was a prospective, observational study of selected patients who underwent day-case LNF, ZD, and LHM between 2003 and 2013. Postoperative outcomes, the patients' satisfaction, and functional results were evaluated with dedicated scores and compared.Of the 427 patients who underwent surgery for those indications during the study period, 168 (39.3%) eligible patients underwent day-case procedures (134 LNF, 14 LHM, and 20 ZD). The overnight unplanned admission rate was 16.2% and was similar among the groups (P = 0.681). Ten patients were readmitted during the first postoperative week because of dysphagia (n = 6, all in the LNF group), flu-like syndrome (n = 1), and secondary perforation (n = 3, all in the LHM group). The unplanned seven-day readmission rate was significantly higher in the LHM group than in the ZD and LNF groups (P = 0.042). The 30-day rates of unplanned readmission and consultation were 8.9% (P = 0.300) and 4.8%, respectively. At follow-up, 87.5% of the patients were satisfied with day-case treatment, and the functional results were good for 81.4% of the patients.Day-case esophageal surgery is feasible for LNF and seems to be feasible for ZD. Safety criteria have not yet been met for LHM, requiring further adaptations.

  3. [Readaptation after total intravenous anesthesia in one-day surgery].

    PubMed

    Buravtsev, V A; Medvinskiĭ, I D

    1997-01-01

    The authors analyze the stages of readaptation and recovery of clear consciousness in the immediate postoperative period in 200 patients administered one of the four variants of intravenous anesthesia in a one-day surgical hospital. The purpose of this work was to optimize the anesthetic care and the readaptation period. The stages of readaptation were assessed by psychophysiological testing. This process coursed most smoothly after propofol-phentanyl and hypnomidate-phentanyl anesthesia. Readaptation after sombrevin-phentanyl coursed reliably slower. The longest recovery was observed after calipsol-diazepam anesthesia, despite drug stimulation. This type of narcosis is irrational for one-day surgery, for it requires prolonged postoperative monitoring and thus makes the hospital stay longer.

  4. A methodology to estimate the potential to move inpatient to one day surgery

    PubMed Central

    Gilliard, Nicolas; Eggli, Yves; Halfon, Patricia

    2006-01-01

    Background The proportion of surgery performed as a day case varies greatly between countries. Low rates suggest a large growth potential in many countries. Measuring the potential development of one day surgery should be grounded on a comprehensive list of eligible procedures, based on a priori criteria, independent of local practices. We propose an algorithmic method, using only routinely available hospital data to identify surgical hospitalizations that could have been performed as one day treatment. Methods Moving inpatient surgery to one day surgery was considered feasible if at least one surgical intervention was eligible for one day surgery and if none of the following criteria were present: intervention or affection requiring an inpatient stay, patient transferred or died, and length of stay greater than four days. The eligibility of a procedure to be treated as a day case was mainly established on three a priori criteria: surgical access (endoscopic or not), the invasiveness of the procedure and the size of the operated organ. Few overrides of these criteria occurred when procedures were associated with risk of immediate complications, slow physiological recovery or pain treatment requiring hospital infrastructure. The algorithm was applied to a random sample of one million inpatient US stays and more than 600 thousand Swiss inpatient stays, in the year 2002. Results The validity of our method was demonstrated by the few discrepancies between the a priori criteria based list of eligible procedures, and a state list used for reimbursement purposes, the low proportion of hospitalizations eligible for one day care found in the US sample (4.9 versus 19.4% in the Swiss sample), and the distribution of the elective procedures found eligible in Swiss hospitals, well supported by the literature. There were large variations of the proportion of candidates for one day surgery among elective surgical hospitalizations between Swiss hospitals (3 to 45.3%). Conclusion

  5. Breaking Barriers to Successful Implementation of Day Case Laparoscopic Cholecystectomy.

    PubMed

    Reynolds, I; Bolger, J; Al-Hilli, Z; Hill, A D K

    2015-01-01

    Laparoscopic cholecystectomy is a common procedure performed in both emergency and elective settings. Our aim was to analyse the trends in laparoscopic surgery in Ireland in the public and private healthcare systems. In particular we studied the trend in day case laparoscopic cholecystectomy. National HIPE data for the years 2010-2012 was obtained. Similar datasets were obtained from the three main health insurers. 19,214 laparoscopic cholecystectomies were carried out in Ireland over the 3-year period. More procedures were performed in the public system than the private system from 2010-2012. There was a steady increase in surgeries performed in the public sector, while the private sector remained static. Although the ALOS was significantly higher in the public sector, there was an increase in the rate of day case procedures from 416 (13%) to 762 (21.9%). The day case rates in private hospitals increased only slightly from 29 (5.1%) in 2010 to 40 (5.9%) in 2012. Day case laparoscopic cholecystectomy has been shown to be a safe procedure, however significant barriers remain in place to the implementation of successful day case units nationwide.

  6. Are we ready for day-case partial nephrectomy?

    PubMed

    Bernhard, Jean-Christophe; Payan, Anne; Bensadoun, Henri; Cornelis, François; Pierquet, Grégory; Pasticier, Gilles; Robert, Grégoire; Capon, Grégoire; Ravaud, Alain; Ferriere, Jean-Marie

    2016-06-01

    Fast-track and day-case surgeries are gaining more and more importance. Their development was eased by the diffusion of minimal invasive surgical strategies and the consequential morbidity reduction. In the field of kidney cancer, seven cases of ambulatory radical nephrectomy were previously reported in the international literature. Regarding robotic partial nephrectomy (PN), short postoperative pathways resulting in patients' discharge on postoperative day 1 were shown to be safe and feasible. We report our initial experience of robot-assisted PN discharged on postoperative day zero and discuss the criteria for adequate patient selection. Indeed, outpatient PN will obviously not be suitable for all patients, and careful selection will be mandatory. Both specific baseline patient's factors and postoperative events will have to be recognized for the first ones and prevented for the second ones. Safety, patient satisfaction, cost efficiency, and reproducibility will be the key factors to assess and promote day-case PN.

  7. [Percutaneous Endovascular Aortic Repair with Local Anesthesia - One Day Surgery].

    PubMed

    Sousa, Joel; Brandão, Daniel; Barreto, Paulo; Ferreira, Joana; Almeida Lopes, José; Mansilha, Armando

    2016-06-01

    Introdução: Avaliar os resultados do tratamento endovascular do aneurisma da aorta abdominal (EVAR) por via percutânea e anestesia local, segundo o conceito de one day surgery.Material e Métodos: Análise retrospetiva, unicêntrica dos doentes com doença aneurismática aorto-ilíaca, consecutivamente submetidos a tratamento endovascular do aneurisma da aorta abdominal por via percutânea (pEVAR) pela técnica de Preclose, seguindo critérios de ambulatorização com pernoita após o procedimento. O sucesso técnico, exclusão do saco aneurismático, endoleak, reintervenção e tempo de internamento foram avaliados.Resultados: Vinte doentes consecutivos (todos homens, idade média 74,65 anos) foram tratados por pEVAR e anestesia local, dos quais 95% (19) apresentavam aneurisma da aorta abdominal e 5% (1) aneurisma da artéria ilíaca comum. Todos os implantes foram realizados com sucesso, com uma taxa de endoleak inicial de 10% (2), à custa de um endoleak 1a corrigido intraoperatoriamente com sucesso, e um endoleak 2a diagnosticado na primeira angio-tomografia computorizada pós-operatória, que selou espontaneamente no controlo aos 6 meses. O sucesso técnico inicial do encerramento percutâneo foi de 97,5%, com um caso reportado de pseudo-aneurisma femoral, corrigido posteriormente por injeção percutânea de trombina. A mediana de internamento foi de 1 dia [1-10], com follow-up médio de 11,4 meses [1-36]. A reintervenção e mortalidade são de 0% no período descrito. Conclusão: O tratamento ambulatório do aneurisma da aorta abdominal por via endovascular com acesso percutâneo segundo o nosso modelo de one day surgery é inovador, seguro e eficaz, respeitando os critérios de seleção.

  8. Day-case septoplasty: a default pathway or is case selection the key?

    PubMed

    Al-Hussaini, Ali; Walijee, Hussein; Khan, Anwar; Cuddihy, Patrick

    2015-01-01

    Septoplasty has been identified as suitable for day surgery, but is not commonly performed as such. Guidelines for day surgery stipulate that the unexpected re-admission rate should be 2-3 %; however previous studies have not attained this target. The purpose of this study was to ascertain the surgical and patient factors associated with re-admission following day-case septoplasty. A retrospective case-notes analysis of day-case septoplasties between 1 January 2010 and 31 December 2012 was undertaken. Data on patient demographics, surgeon grade and operative technique were examined using a univariate analysis model. A total of 256 septoplasties were performed. 23 patients were admitted, overwhelmingly due to bleeding in the immediate post-operative period, giving an overall admission rate of 9.0 % within the first 24 h. Factors associated with re-admission included the use of intranasal splints (relative risk (RR) 5.34, p < 0.001), the performance of additional operative procedures (RR 4.96, p < 0.001) and surgery on patients with co-morbidities (RR 3.37, p = 0.002). There was no correlation between unexpected admission and patient gender, age, surgeon grade, performance of revision surgery and operative factors including nasal preparation with cocaine, local anaesthetic infiltration, type of incision, number of mucoperichondrial flaps raised, extensive bony dissection, performance of a turbinate procedure, quilting, closure of incision and post-operative packing. Day-case septoplasty in patients with co-morbidities and where additional surgical procedures are performed may be associated with unexpected overnight admission. Thus, safe and efficient day-case septoplasty may not be suitable as a universal default pathway but one where case selection is key.

  9. [Weak evidence for the use of graduated elastic compression stockings by laparoscopic day surgery].

    PubMed

    Reza, Joan Anwar; Gögenur, Ismail; Rasmussen, Hans Morten Schnack

    2016-03-07

    Deep vein thrombosis and pulmonary embolism are well-known complications after surgery. Despite the widespread use of graduated elastic compression stockings as a mechanical prophylaxis method against thromboembolic complications, data supporting their use for patients under-going laparoscopic surgery for benign conditions are sparse. In this paper, we address the evidence for the effectiveness of the stockings as a method of prophylaxis in laparoscopic day surgery.

  10. Postoperative Pain, an Unmet Problem in Day or Overnight Italian Surgery Patients: A Prospective Study.

    PubMed

    Campagna, Sara; Antonielli D'Oulx, Maria Delfina; Paradiso, Rosetta; Perretta, Laura; Re Viglietti, Silvia; Berchialla, Paola; Dimonte, Valerio

    2016-01-01

    Background. Because of economic reasons, day surgery rates have steadily increased in many countries and the trend is to perform around 70% of all surgical procedures as day surgery. Literature shows that postoperative pain treatment remains unfulfilled in several fields such as orthopedic and general surgery patients. In Italy, the day surgery program is not yet under governmental authority and is managed regionally by local practices. Aim. To investigate the trends in pain intensity and its relation to type of surgeries and pain therapy protocols, in postoperative patients, discharged from three different Ambulatory Surgeries located in North West Italy (Piedmont region). Method. The present study enrolled 276 patients who undergone different surgical procedures in ambulatory regimen. Patients recorded postoperative pain score twice a day, compliance with prescribed drugs, and pain related reasons for contacting the hospital. Monitoring lasted for 7 days. Results. At discharge, 72% of patients were under weak opioids, 12% interrupted the treatment due to side effects, 17% of patients required extra drugs, and 15% contacted the hospital reporting pain problems. About 50% of patients experienced moderate pain during the first day after surgery. Results from our study show that most of the patients experienced avoidable pain after discharge.

  11. Postoperative Pain, an Unmet Problem in Day or Overnight Italian Surgery Patients: A Prospective Study

    PubMed Central

    Antonielli D'Oulx, Maria Delfina; Paradiso, Rosetta; Perretta, Laura; Dimonte, Valerio

    2016-01-01

    Background. Because of economic reasons, day surgery rates have steadily increased in many countries and the trend is to perform around 70% of all surgical procedures as day surgery. Literature shows that postoperative pain treatment remains unfulfilled in several fields such as orthopedic and general surgery patients. In Italy, the day surgery program is not yet under governmental authority and is managed regionally by local practices. Aim. To investigate the trends in pain intensity and its relation to type of surgeries and pain therapy protocols, in postoperative patients, discharged from three different Ambulatory Surgeries located in North West Italy (Piedmont region). Method. The present study enrolled 276 patients who undergone different surgical procedures in ambulatory regimen. Patients recorded postoperative pain score twice a day, compliance with prescribed drugs, and pain related reasons for contacting the hospital. Monitoring lasted for 7 days. Results. At discharge, 72% of patients were under weak opioids, 12% interrupted the treatment due to side effects, 17% of patients required extra drugs, and 15% contacted the hospital reporting pain problems. About 50% of patients experienced moderate pain during the first day after surgery. Results from our study show that most of the patients experienced avoidable pain after discharge. PMID:28115878

  12. A nested case–control study to determine the incidence and factors associated with unanticipated admissions following day care surgery

    PubMed Central

    Singh, Madhurita; Ponniah, Manickam; Jacob, KS

    2016-01-01

    Background and Aims: Day care surgery offers respite from hospitalisation for specific surgical procedures and has many advantages. However, occasionally patients who undergo such surgery require hospitalisation for unanticipated complications. We aimed to determine their incidence and to identify factors associated with unanticipated admissions in a tertiary care hospital in South India. Methods: During the 3-month study, 63 cases requiring admission and 126 randomly selected controls were taken from the 776 procedures that were performed were compared. The variables studied were patients’ demographic characteristics, pre-operative medical illness, personal habits, American Society of Anesthesiologists status, the diagnosis and surgical procedures, time since last meal, duration of anaesthesia and surgery, experience of the surgeon and anaesthetist, and intraoperative management (techniques, drugs, monitoring, etc.). Univariate and bivariate statistics were used to determine factors associated with unanticipated admissions. Results: The incidence of unanticipated admissions following day care surgery was 8.11%. The reasons for admission were anaesthetic (33.33%), surgical (15.87%), medical (6.34%) and social (44.44%). The factors significantly associated with unanticipated admissions included duration of anaesthesia more than 50 min (odds ratio [OR]: 3.179; 95% confidence interval [CI]: 1.503–6.722), and starting the last case after 3 pm (OR: 10.095; 95% CI: 2.418–42.148). Conclusion: Unanticipated admissions following day care surgery occur mainly due to anaesthetic, surgical, medical and social reasons. PMID:27942057

  13. Day-care versus inpatient pediatric surgery: a comparison of costs incurred by parents.

    PubMed Central

    Stanwick, R S; Horne, J M; Peabody, D M; Postuma, R

    1987-01-01

    The cost-effectiveness for parents of day-care pediatric surgery was assessed by comparing time and financial costs associated with two surgical procedures, one (squint repair) performed exclusively as a day-care procedure, the other (adenoidectomy) performed exclusively as an inpatient procedure. All but 1 of 165 eligible families participated. The children underwent surgery between February and July 1981. The day-care surgery group (59 families) incurred average total time costs of 16.1 hours, compared with 37.1 hours for the inpatient surgery group (105 families), as parents in the latter group remained with their child during the longer hospital stay. Parents from out of town incurred the greater time and financial costs. In both groups parents of younger children tended to spend more time at the hospital than parents of older children. Type of surgical management was not a significant factor in out-of-pocket expenses. Loss of income was associated with employment of the mother as a professional or a manager and may reflect inequalities in access to compassionate leave between men and women in equivalent positions. Opening day-care surgery facilities on weekends might reduce the financial burden on working mothers. Overall, day-care surgery was found to be cost-effective for families. PMID:3594330

  14. Reasons for delayed patient discharge following day surgery: a literature review.

    PubMed

    Rae, Alison

    2016-11-09

    Aim The aim of this literature review was to explore the reasons why some patients are not suitable for discharge following day surgery. Method A pragmatic, mixed-methods approach was used to undertake a critical evaluation of the literature and current practice to determine what is already known about discharge following day surgery. Thematic analysis was used to identify the main themes and issues, enabling recommendations to be made to reduce the incidence of patients unable to be discharged following day surgery. Findings The main themes or reasons for delayed discharge following day surgery identified from the literature review were: post-operative nausea and vomiting, post-operative pain, going late to theatre and social factors. These themes were supported by the findings of an unpublished audit carried out in one day surgery unit in an NHS healthcare organisation in the south of England between June and August 2014, which indicated that 54 out of 1,180 day surgery patients required an overnight stay during this 12-week period. The audit also showed that a patient going late to theatre had the greatest effect on discharge outcomes. Conclusion Recommendations for practice include: the introduction of post-operative nausea and vomiting risk scoring and prophylactic protocols; reorganisation of theatre lists to ensure patients have enough time to recover; and provision of information during the pre-assessment process about the requirement for a responsible adult escort to take patients home and stay with them for the first 24 hours. These changes may help NHS organisations to improve discharge outcomes for day surgery patients and reduce unplanned costs.

  15. Association between day of the week of elective surgery and postoperative mortality

    PubMed Central

    Dubois, Luc; Vogt, Kelly; Vinden, Chris; Winick-Ng, Jennifer; McClure, J. Andrew; Roshanov, Pavel S.; Bell, Chaim M.; Garg, Amit X.

    2017-01-01

    BACKGROUND: In prior studies, higher mortality was observed among patients who had elective surgery on a Friday rather than earlier in the week. We investigated whether mortality after elective surgery was associated with day of the week of surgery in a Canadian population and whether the association was influenced by surgeon experience and volume. METHODS: We conducted a population-based retrospective cohort study in the province of Ontario, Canada. We included adults who underwent 1 of 12 elective daytime surgical procedures from Apr. 1, 2002, to Dec. 31, 2012. The primary outcome was 30-day mortality. We used generalized estimating equations to compare outcomes for surgeries performed on different days of the week, adjusting for patient and surgeon factors. RESULTS: A total of 402 899 procedures performed by 1691 surgeons met our inclusion criteria. The median length of hospital stay was 6 (interquartile range 5–8) days. Surgeon experience varied significantly by day of week (p < 0.001), with surgeons operating on Fridays having the least experience. Nearly all of the patients who had their procedure on a Friday had postoperative care on the weekend, as compared with 49.1% of those whose surgery was on a Monday (p < 0.001). We found no difference in the 30-day mortality between procedures performed on Fridays and those performed on Mondays (adjusted odds ratio 1.08, 95% confidence interval 0.97–1.21). INTERPRETATION: Although surgeon experience differed across days of the week, the risk of 30-day mortality after elective surgery was similar regardless of which day of the week the procedure took place. PMID:27754897

  16. 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.

  17. Pharyngoesophageal perforation 3 years after anterior cervical spine surgery: a rare case report and literature review.

    PubMed

    Yin, Dan-Hui; Yang, Xin-Ming; Huang, Qi; Yang, Mi; Tang, Qin-Lai; Wang, Shu-Hui; Wang, Shuang; Liu, Jia-Jia; Yang, Tao; Li, Shi-Sheng

    2015-08-01

    Pharyngoesophageal perforation after anterior cervical spine surgery is rare and the delayed cases were more rarely reported but potentially life-threatening. We report a case of pharyngoesophageal perforation 3 years after anterior cervical spine surgery. The patient presented with dysphagia, fever, left cervical mass and developing dyspnea 3 years after cervical spine surgery for trauma. After careful examinations, he underwent an emergency tracheostomy, neck exploration, hardware removal, abscess drainage and infected tissue debridement. 14 days after surgery, CT of the neck with oral contrast demonstrated no contrast extravasation from the esophagus. Upon review of literature, only 14 cases of pharyngoesophageal perforation more than 1 year after anterior cervical spine surgery were found. We discussed possible etiology, diagnosis and management and concluded that in cases of dysphagia, dyspnea, cervical pain, swelling and edema of the cervical area even long time after anterior cervical spine surgery, potential pharyngoesophageal damage should be considered.

  18. Same day admission for elective cardiac surgery: how to improve outcome with satisfaction and decrease expenses.

    PubMed

    Silvay, George; Goldberg, Andrew; Gutsche, Jacob T; T Augoustides, John G

    2016-06-01

    Admission on the day of surgery for elective cardiac and non-cardiac surgery has been established as a prevalent, critical practice. This approach realizes medical, logistical, psychological and fiscal benefits, and its success is predicated on an effective outpatient pre-operative evaluation. The establishment of a highly functional pre-operative clinic with a comprehensive set-up and efficient logistical pathways is invaluable. This notion has been expanded in recent years to include the entire peri-operative period and the concept of a 'peri-operative anesthesia/surgical home' is gaining popularity and support. Evaluating patients prior to admission for surgery, anesthesiologists can place themselves at the forefront of reducing unnecessary pre-operative hospital admissions, excess lab tests, unneeded consultations, and ultimately decrease the cancellations on the day of surgery. Furthermore, by taking a leadership role in the pre-operative clinic, anesthesiologists place themselves squarely at the forefront of the burgeoning movement for the peri-operative surgical home and continue to cement the indispensability of the anesthesiologist during the entire peri-operative course. The authors present this review as a follow-up describing the successful implementation of a pre-operative same-day cardiac surgery clinic and offer these experiences over the last 8 years as a guide to helping other anesthesiologists do the same.

  19. Abstracts from the First Annual Baylor Scott and White Surgery Research Day

    PubMed Central

    2014-01-01

    The First Annual Baylor Scott and White Surgery Research Day was held on May 2, 2014, in Temple, Texas. The program built on the tradition of eight previous research days for the Texas A&M Health Science Center College of Medicine and Scott & White Memorial Hospital and this year included the Department of Surgery at Baylor University Medical Center at Dallas. The forum is open to all Baylor Scott and White surgery fellows, residents, and medical students and includes a variety of basic science, clinical, and educational research projects with a focus on trainees’ research. The 2014 forum was organized by Dr. J. Scott Thomas and Dr. Raman C. Mahabir, under the guidance of Dr. Harry T. Papaconstantinou. This article highlights the top 16 abstracts selected from the submissions for presentation from the podium. PMID:25484497

  20. Surgical site infections in breast surgery: case-control study.

    PubMed

    Vilar-Compte, Diana; Jacquemin, Benedicte; Robles-Vidal, Carlos; Volkow, Patricia

    2004-03-01

    The purpose of this study was to estimate the frequency of surgical site infections (SSIs) and identify associated risk factors for each type of breast surgery at a cancer hospital. We used a nested case-control design. Between February 1, 2000 and July 31, 2000, all breast surgeries performed were recorded on a daily basis. After hospital discharge, we evaluated patients simultaneously with surgeons three times a week for 30 days or longer. The odds ratio (OR) was estimated using logistic regression analysis. The study followed 280 patients (298 wounds). Altogether, 77 SSIs were detected, for an overall SSI rate of 25.8% (77/298). For excisions, conservative surgery, and radical mastectomies the SSI rates were 1.4%, 18.0%, and 38.3%, respectively. Excisions were excluded ( n = 68) for risk factor analysis. After multivariate analysis, risk factors associated with SSIs were obesity [OR 2.5, 95% confidence interval (CI) 1.2-4.3], concomitant chemotherapy and radiation (OR 2.3, 95% CI 1.2-4.3), radical surgery (OR 3.1, 95% CI 1.1-8.6), insertion of a second drain during the late postoperative period (OR 3.7, 95% CI 1.8-7.8), and drainage duration > or = 19 days (OR 2.9, 95% CI 1.5-5.6). The bacteria most frequently isolated were Pseudomonas aeruginosa ( n = 18 ), Serratia sp. ( n = 18), Staphylococcus aureus ( n = 10), and Staphylococcus epidermidis ( n = 10). Poor compliance with infection control practices and wound management was detected throughout the study period. The overall frequency of SSIs for mastectomies was higher than the reported rates, which was principally related to the more radical surgery required for advanced-stage disease, preoperative irradiation, and inadequate wound and drain care.

  1. [Bilateral pheochromocytoma: laparoscopic surgery in 2 cases].

    PubMed

    Lam, J; Castillo, O; Bravo, J; Henríquez, R; Tagle, F

    2001-01-01

    Laparoscopic adrenalectomy, if done by skilled surgeons, is now the first choice for treating most adrenal tumors, including bilateral pheochromocytoma. We report two women, aged 35 and 34 years old, with bilateral adrenal pheochromocytoma successfully excised by laparoscopic surgery. Both had severe hypertension, high urinary catecholamine values (epinephrine + norepinephrine: 528 and 1083 ug/24 h) and bilateral adrenal tumors at CT scan. After 4 weeks of doxazosin treatment, a laparoscopic transperitoneal adrenalectomy was done (Gugner's technique), with surgical times of 7 and 5 hours respectively. Both patients received hydrocortisone and only the second one required one unit of packed cells. Postoperative evolution was uneventful and both patients were discharged at the fifth postoperative day. At two months of follow up, both patients are asymptomatic and normotensive.

  2. The impact of day of surgery on the length of stay for major urological procedures

    PubMed Central

    Nason, Gregory J.; O’Connor, Eabhann M.; O’Neill, Cathleen; Izzeldin, Omer; Considine, Shane W.; O’Brien, M. Frank

    2016-01-01

    Introduction Surgery performed later in the week has been associated with longer length of stay (LOS). The aim of this study was to assess if the day of the surgery impacted the LOS for two major urological procedures in a tertiary referral university teaching hospital. Methods A retrospective review was performed of two major urological procedures consecutively performed by a single surgeon in our unit from March 2012 to December 2015. Patient demographics, histopathological characteristics, operative details, and LOS were obtained from the patients’ medical records. Procedures performed on Monday or Tuesday were defined as early in the week and procedures performed on Wednesday, Thursday, or Friday were defined as late in the week. Results During the study period, 140 open radical prostatectomy (ORP) and 42 open partial nephrectomy (OPN) procedures were performed. There was a significant difference in median LOS for major urological procedures performed early in the week compared to late in the week (3 [3–4] days vs. 4 [4–5] days; p= 0.0001). There was a significant difference in median LOS for ORP performed early in the week compared to late in the week (3 [3–4] days vs. 4 [4–5] days; p= 0.0004). There was a similar significant difference in OPN performed early in the week compared to late in the week (4 [3–5.5] days vs. 5 [4–5] days; p= 0.029). Conclusions The day of surgery impacts LOS for major urological procedures. Major procedures should be performed early in the week, when it is feasible to facilitate prompt safe discharge and better use of hospital resources. PMID:28096920

  3. The use of standard operating procedures in day case anterior cruciate ligament reconstruction.

    PubMed

    Khan, T; Jackson, W F; Beard, D J; Marfin, A; Ahmad, M; Spacie, R; Jones, R; Howes, S; Barker, K; Price, A J

    2012-08-01

    The current rate of day-case anterior cruciate ligament reconstruction (ACLR) in the UK remains low. Although specialised care pathways with standard operating procedures (SOPs) have been effective in reducing length of stay following some surgical procedures, this has not been previously reported for ACLR. We evaluate the effectiveness of SOPs for establishing day-case ACLR in a specialist unit. Fifty patients undergoing ACLR between May and September 2010 were studied prospectively ("study group"). SOPs were designed for pre-operative assessment, anaesthesia, surgical procedure, mobilisation and discharge. We evaluated length of stay, readmission rates, patient satisfaction and compliance to SOPs. A retrospective analysis of 50 patients who underwent ACLR prior to implementation of the day-case pathway was performed ("standard practice group"). Eighty percent of patients in the study group were discharged on the day of surgery (mean length of stay=5.3h) compared to 16% in the standard practice group (mean length of stay=21.6h). This difference was statistically significant (p<0.05, Mann-Whitney U test). All patients were satisfied with the day case pathway. Ninety-two percent of the study group were discharged on the day of surgery when all SOPs were followed and 46% where they were not. High rates of day-case ACLR with excellent patient satisfaction can be achieved with the use of a specialised patient pathway with SOPs.

  4. 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.

  5. 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

  6. Temporal Changes in Survival after Cardiac Surgery Are Associated with the Thirty-Day Mortality Benchmark

    PubMed Central

    Maxwell, Bryan G; Wong, Jim K; Miller, D Craig; Lobato, Robert L

    2014-01-01

    Objective To assess the hypothesis that postoperative survival exhibits heterogeneity associated with the timing of quality metrics. Data Sources Retrospective observational study using the Nationwide Inpatient Sample from 2005 through 2009. Study Design Survival analysis was performed on all admission records with a procedure code for major cardiac surgery (n = 595,089). The day-by-day hazard function for all-cause in-hospital mortality at 1-day intervals was analyzed using joinpoint regression (a data-driven method of testing for changes in hazard). Data Extraction Methods A comprehensive analysis of a publicly available national administrative database was performed. Principal Findings Statistically significant shifts in the pattern of postoperative mortality occurred at day 6 (95 percent CI = day 5–8) and day 30 (95 percent CI = day 20–35). Conclusions While the shift at day 6 plausibly can be attributed to the separation between routine recovery and a complicated postoperative course, the abrupt increase in mortality at day 30 has no clear organic etiology. This analysis raises the possibility that this observed shift may be related to clinician behavior because of the use of 30-day mortality as a quality metric, but further studies will be required to establish causality. PMID:24713085

  7. Pneumocephalus and Pneumorrhachis after Spinal Surgery: Case Report and Review of the Literature

    PubMed Central

    KARAVELIOGLU, Ergun; ESER, Olcay; HAKTANIR, Alpay

    2014-01-01

    Trauma is a common cause of pneumocephalus, or air in the cranial cavity, and of pneumorrhachis, or the presence of intraspinal air. After spinal surgery, occurrence of pneumocephalus, especially with pneumorrhachis, is extremely rare. We report the case of a patient who developed pneumocephalus and pneumorrhachis after lumbar disc surgery and pedicle screw fixation. There was no cerebrospinal fluid leakage during surgery. On postoperative day 1, the patient complained of headache, nausea, and dizziness. Brain and lumbar computed tomography scans revealed pneumocephalus and pneumorrhachis. With conservative treatment, the patient's complaints resolved within 10 days. PMID:24305016

  8. [Decree of anaesthesia of 1994, day surgery and medical responsibility: necessary reflections on the inevitable conciliation between regulations and recommendations].

    PubMed

    Bontemps, G; Daver, C; Ecoffey, C

    2014-12-01

    Day surgery is often considered as a marker of the necessity of reorganizing the hospital to take care globally and so better meet the expectations of improvement of the management of patients. But the actual deployment of day surgery can also act as a real revelation of the stakes of conciliation between the regulations, which supervise professional practices and organization, and the functioning of hospitals. Between the regulations supervising hospitals and professional practices and the place of the recommendations, between the general legal framework of the medical activity and specific legal framework (decree of anesthesia of 1994) and the Evidence-Based Medicine, the pretext of the improvement of the patient flow in day surgery, recommended by several institutions (Sfar, ANAP, HAS), questions about the legal obligation of the passage of all the patients in the postanesthesia care unit (PACU). Seen under the angle of a legal action against a medical doctor, the study of the French jurisprudence reveals that every practitioner has to respect the recommendations and the Evidence-Based Medicine, and this in the standardized frame of the MD's activity and the respect for a very strict legal environment. The question of an obvious conciliation between all these measures arises today clearly. In the case of a potential conflict, the key of resolution, based only on legal standards (constitution, laws, decrees), is not enough for arbitrating. Applying that the only respect for the decree of anesthesia would be enough for exempting itself from any contentious risk does not satisfy more. There is a real difficulty defining the legal precise nature of the recommendations, so best practices as better organization, which are more and more frequently. Even if these recommendations originally had not their place in the hierarchy of the legal standards, they are brought in there today. There is a real brake in the deployment of the day surgery because the strict respect for

  9. [Spontaneous epidural hematoma after open heart surgery: case report].

    PubMed

    Anegawa, S; Hayashi, T; Furukawa, Y; Nagashima, T; Kumate, M

    1999-11-01

    Acute epidural hematoma not associated with head injury is rarely encountered and is known as spontaneous epidural hematoma. To our knowledge, only five cases with epidural hematoma after open-heart surgery have been published. Pathogenesis and preventive measures have not yet been determined. We report a case of such spontaneous epidural hematoma and consider the possible pathogenesis. A 12-year-old female received a radical operation for severe subaortic stenosis. The intraoperative course was uneventful except for massive hemorrhage which was adequately controlled. Postoperatively, she was moved to the CCU still not having aroused from anesthesia. Eleven hours later, it was found that her pupils were fixed and dilated. CT scan demonstrated a huge bifrontal epidural hematoma with disappearance of the basal cistern. Even though immediate emergency evacuation was performed, the patient died of acute brain swelling four days after the operation.

  10. 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

  11. Discharge to a rehabilitation facility is associated with decreased 30-day readmission in elective spinal surgery.

    PubMed

    Abt, Nicholas B; McCutcheon, Brandon A; Kerezoudis, Panagiotis; Murphy, Meghan; Rinaldo, Lorenzo; Fogelson, Jeremy; Nassr, Ahmad; Currier, Bradford L; Bydon, Mohamad

    2017-02-01

    The aim of our study was to determine independent predictors of discharge disposition to rehabilitation or skilled care (SC) facilities and investigate whether discharge location is associated with unplanned readmission and/or reoperation rates. All elective spinal surgery patients in a national surgical registry were analyzed using between 2011 and 2012. Multivariable logistic regression analysis was used to assess for predictors of discharge to rehabilitation or SC facilities versus home as well as to determine whether discharge disposition was significantly associated with the 30-day unplanned readmission or reoperation. Of 34,023 elective spinal surgery patients, the distribution of discharge locations was as follows: 30,606 (90.0%) discharged home, 1674 (4.9%) discharged to rehabilitation, and 1743 (5.1%) discharged to SC. Patients discharged home were associated with the lowest complication rate relative to rehabilitation and SC facilities. Following multivariable regression analysis, there was a significant increase in the odds of discharge to rehabilitation associated with age, male gender, current smoking, ASA class three and four, history of diabetes, operative time, total hospital length of stay, preoperative neurologic morbidity and having at least one postoperative morbidity event. Moreover, there were 804 (4.06%) 30-day unplanned readmissions and 822 (2.45%) unplanned reoperations. After risk adjustment, discharge to rehabilitation was independently associated with decreased odds of 30-day unplanned readmission (OR=0.41; p=0.008) but not reoperation.

  12. Sedation in oral and maxillofacial day care surgery: A comparative study between intravenous dexmedetomidine and midazolam

    PubMed Central

    Mishra, Niranjan; Birmiwal, Krishna Gopal; Pani, Nibedita; Raut, Subhrajit; Sharma, Gaurav; Rath, Krushna Chandra

    2016-01-01

    Introduction: Sedation is an important component of day care oral and maxillofacial surgical procedures under local anesthesia. Although various sedative drugs in different regimens have been used for sedation, an ideal agent and regimen are yet to be established. Aim: The aim of this study is to compare the efficacy of intravenous (IV) dexmedetomidine and midazolam as a sedative agent for day care oral and maxillofacial surgical procedures. Settings: The study was conducted in the Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha, India. Materials and Methods: A total of sixty adult patients of age group 18–65 years, of either sex were randomly selected equally in two groups for the study. One group named Group D received dexmedetomidine and the other named Group M received midazolam. Patients were evaluated for oxygen saturation (SPO2), respiration rate (RR), systolic blood pressure (SBP), diastolic blood pressure (DBP), Ramsay sedation score, bispectral index (BIS) score, amnesia, Aldrete score, relaxation during the surgery, and drug preference. Results: Midazolam was associated with greater amnesia. Dexmedetomidine was associated with lower heart rate, SBP, and DBP. There was no significant difference in SPO2, RR, Aldrete score, Ramsay sedation score, and BIS score between the two drugs. Patient preference and relaxation were more in dexmedetomidine group. Conclusion: IV dexmedetomidine is a comparable alternative to midazolam for sedation in day care oral and maxillofacial surgery under local anesthesia. It is the preferred drug when a lower heart rate and blood pressure or less amnesia is needed without any serious side effects.

  13. 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.

  14. 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.

  15. 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

  16. 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

  17. 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

  18. A Case of Unexpected Symptomatic Vasospasm after Clipping Surgery for an Unruptured Intracranial Aneurysm.

    PubMed

    Hashimoto, Hiroaki; Kameda, Masahiro; Yasuhara, Takao; Date, Isao

    2016-03-01

    Delayed symptomatic vasospasm after clipping surgery for unruptured aneurysm is rarely reported. We report a case of a 62-year-old woman who presented with symptomatic vasospasm 11 days after clipping surgery for an unruptured aneurysm. We could not predict the existence of vasospasm until ischemic symptoms developed. We retrospectively found mild vasospasm in the computed tomography angiogram taken 8 days after the operation. The patient complained of a prolonged unexpected headache 1 week after the operation. We should recognize prolonged unexpected headache as a warning sign of vasospasm.

  19. [Paediatric one-stop surgery: a series of 75 cases].

    PubMed

    López Alvarez-Buhilla, P; Astigarraga Aguirre, I; Torres Piedra, C; Azcona Zorrilla, M I; Olaizola Mendibil, A; Latorre Guisasola, M

    2009-01-01

    By one-stop surgery is meant the performing of both the pre-surgery assessment and the surgical procedure on the same day. We report our experience with a pilot study on one-stop surgery in the province of Bizkaia, with a population of 124,494 children aged 1 to 14 years old. Under the new scheme, the patient average of four visits to the hospital outpatient clinics was cut down to only one. Diagnosis and pre-surgery assessments were made by the children's Primary Care Paediatricians at their NHS clinics. Seventy-five children were treated over 10 months. They had abdominal wall, genital or soft tissue surgery. Only two developed minor complications. Families were generally satisfied with the quality of the medical care received as shown by a survey: 32.7% scored it as "excellent", 36.2% "very good", 24.1% "good" and 3.4% "medium". We think that one-stop surgery is a breakthrough in ambulatory surgery. Not only does it dramatically lower the number of visits to hospital outpatient clinics, but also the waiting time for surgery, the costs, and the surgeon's workload, and helps streamline the Public Health Services and the quality of the medical care as perceived by both patients and families. Ensuring a close relationship between Paediatric Surgeons and Primary Care Paediatricians is paramount.

  20. 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

  1. Variability in Trauma Case Volume in Orthopedic Surgery Residents

    PubMed Central

    Blood, Travis D.; Gil, Joseph A.; Born, Christopher T.; Daniels, Alan H.

    2017-01-01

    Orthopedic trauma surgery is a critical component of resident education. Surgical case logs obtained from the Accreditation Council of Graduate Medical Students from 2009 to 2013 for orthopedic surgery residents were examined for variability between the 90th and 10th percentiles in regards to the volume of cases performed. There was an upward trend in the mean number of cases performed by senior residents from 484.4 in 2009 to 534.5 in 2013, representing a 10.3% increase. There was a statistically significant increase in the number of cases performed for humerus/elbow, forearm/wrist, and pelvis/hip during this period (P<0.05). Although the difference between the 10th and 90th percentile case volumes narrowed over the study period, the difference between these groups remained significant in 2013 (P=0.02). In 2013, all categories of trauma cases had a greater than 2.2-fold difference between the 10th and 90th percentile of residents for numbers of trauma cases performed. Although case volume is not the sole determinant of residency education and competency, evidence suggests that case volume plays a crucial role in surgeon confidence and efficiency in performing surgery. Further studies are needed to better understand the effect of this variability seen among residents performing orthopedic trauma surgery. PMID:28286621

  2. A Comprehensive Analysis of the Causes and Predictors of 30-Day Mortality Following Hip Fracture Surgery

    PubMed Central

    Hossain, Fahad Siddique; Aqil, Adeel; Akinbamijo, Babawande; Mushtaq, Vhaid; Kapoor, Harish

    2017-01-01

    Background A fracture neck of femur is the leading cause of injury-related mortality in the elderly population. The 30-day mortality figure is a well utilised marker of clinical outcome following a fracture neck of femur. Current studies fail to analyse all patient demographic, biochemical and comorbid parameters associated with increased 30-day mortality. We aimed to assess medical risk factors for mortality, which are easily identifiable on admission for patients presenting with a fractured neck of femur. Methods A retrospective review of a prospectively populated database was undertaken to identify all consecutive patients with a fracture neck of femur between October 2008 and March 2011. All factors related to the patient, injury and surgery were identified. The primary outcome of interest was 30-day mortality. Univariate and subsequent multivariate analyses using a backward stepwise likelihood ratio Cox regression model were performed in order to establish all parameters that significantly increased the risk of death. Results A total of 1,356 patients were included in the study. The 30-day mortality was 8.7%. The most common causes of death included pneumonia, sepsis and acute myocardial infarction. Multiple regression analysis revealed male gender, increasing age, admission source other than the patient's own home, admission haemoglobin of less than 10 g/dL, a history of myocardial infarction, concomitant chest infection during admission, increasing Charlson comorbidity score and liver disease to be significant predictors of mortality. Conclusions This study has elucidated risk factors for mortality using clinical and biochemical information which are easily gathered at the point of hospitalization. These results allow for identification of vulnerable patients who may benefit from a prioritisation of resources. PMID:28261422

  3. Rapid prototyping in maxillofacial surgery and traumatology: case report.

    PubMed

    da Rosa, Everton Luis Santos; Oleskovicz, César Fernando; Aragão, Bruno Nogueira

    2004-01-01

    Review of the literature from 1991 to 2002 on the use of rapid prototyping in the biomedical area emphasizes the applicability of this technique to aid diagnosis and planning in Maxillofacial Surgery and Traumatology. A case report in which a TMJ ankylosis relapse was treated using rapid prototyping (selective laser sintering) for surgery planning is presented. After one year, the patient's buccal opening was 45 mm. Transitory paralysis of the facial nerve disappeared totally in six months.

  4. 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

  5. [Experience in transumbilical endoscopic surgery diagnosis for 3 cases of pseudomyxoma peritonei].

    PubMed

    Tian, Li; Tang, Anliu; Liu, Fen; Shen, Shourong; Wang, Xiaoyan

    2016-11-28

    Three patients of pseudomyxoma peritonei who were diagnozed by transumbilical endoscopic surgery (TUES) were reviewed retrospectively from September 2014 to November 2014. Three cases of ascites patients underwent TUES were diagnozed as pseudomyxoma peritonei. All operations were successful. No open surgery or laparoscopic surgery was required. The mean operative time was (45±16) min; the mean intraoperative blood loss was 510 mL; the mean hospital stay time was 3 days. During the follow up of 911 months, no obvious scar was observed. Cosmetic results appear to be excellent. All patients were treated with intraperitoneal hyperthermia and chemotherapy. The survival rate was 100%. As a novel scarless endoscopic invasive abdominal surgery, TUES has high clinical value with the advantages such as small trauma, no scars, small risk and low cost in the diagnosis of unexplained ascites.

  6. 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.

  7. [Causal analysis and management strategies of 30-day unplanned revision surgery following single-stage posterior vertebral column resection for severe spinal deformity].

    PubMed

    Tao, Y P; Wu, J G; Ma, H S; Shao, S L; Zhang, L L; Gao, B; Li, H X

    2017-03-01

    Objective: To investigate the causes of 30-day unplanned revision surgery following one-stage posterior vertebral column resection (PVCR) for severe spinal deformity and the methods of prevention and management. Methods: A total of 112 severe deformity patients underwent one-stage PVCR for surgical treatment in the 306(th) Hospital of People's Liberation Army from May 2010 to December 2015 were retrospectively reviewed. Six patients required reoperation within 30 days after PVCR, including 2 males and 4 females with average age of 21 years (ranging from 12 to 38 years). Four cases were congenital kyphoscoliosis, 1 was post-laminectomy kyphoscoliosis and 1 was post-tuberculous angular kyphosis. Three cases associated with preoperative neurologic deficit (Frankel C in 1 patient and D in 2 patients). The causes, management and outcomes of unplanned revision surgery within 30 days after PVCR were recorded. Results: The total incidence of unplanned revision surgery within 30 days following PVCR was 5.4% (6/112). There was 1 case due to cerebrospinal fluid leak, 5 cases with varying degrees of new neurologic deficits, the causes were as followed: dural buckling in 1 case, residual bone compression in 1 case, epidural hematoma compression in 2 cases, spinal subdural hematoma in 1 case. All the 6 cases underwent surgical exploration again, including further dural repair, decompression and hematoma clearance. After unplanned reoperation, 6 cases recovered completely. The average follow-up time after surgery was 30.8 months (ranging from 10 to 60 months). The major curve at coronal plane was improved from preoperative 87.7° to 34.2°, with a mean correction of 61.0% at final follow-up; the sagittal kyphosis curve was improved from preoperative 119.5° to 45.5°, with a mean correction of 61.9% at final follow-up. Two patients' neurological status improved from Frankel D to Frankel E, one patient's neurological status improved from Frankel C to Frankel E. Conclusions: One

  8. Day Care vs Overnight Stay after Laparoscopic Cholecystectomy even with Co-morbidity and a Possible Second Surgery: A Patient’s Choice

    PubMed Central

    2016-01-01

    Introduction Laparoscopic Cholecystectomy (LC) has become the gold standard for symptomatic gall stone disease. It is being practiced as a day care procedure in healthy individuals in American Society of Anaesthesialogists (ASA) grade I and II. It is not yet established in presence of co-morbidity and when a second surgery is added. In most of the study, patient’s choice and the psycho-social factors were not considered in deciding the day care procedure. Aim To find the safety of LC and a second surgery as day care in presence of compensated co-morbidity. To study the choice of the patient whether to stay in hospital or go home after declaring them fit for day care. Materials and Methods All the patients of symptomatic cholelithiasis with co-morbidity and associations were evaluated and made uncompromising for elective surgery. All the LC were done at 8mmHg CO2 peumo-peritoneal pressure using harmonic scalpel as the energy source for dissection of gall bladder from the liver bed. Cases with conversion and placement of drain were excluded. Results A total of 1029 out of 1042 patients was included from Jan 2005 to Jan 2015. The age range was 38 to 91years (mean 44.65, SD 14.15). There were 634 females and 395 males. A total of 121(11.7%) of them had co-morbidity and associations. A total of 72(7%) had undergone a second surgery. Only 0.8% had real day care. A total of 95.7% had overnight stay even after fulfilling all the criteria. Only 0.2% needed re-admission in 30 days and one required intervention. Conclusion Patients like to stay over night in the hospital even if found fit for day care after LC. Overnight stay makes them happy, psycho-socially confident in developing nation and best suited for all patients including co-morbidity. PMID:27891393

  9. Lymphopenia at 4 Days Postoperatively Is the Most Significant Laboratory Marker for Early Detection of Surgical Site Infection Following Posterior Lumbar Instrumentation Surgery

    PubMed Central

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

    2016-01-01

    Study Design Case control study. Purpose To identify the most significant laboratory marker for early detection of surgical site infection (SSI) using multiple logistic regression analysis. Overview of Literature SSI is a serious complication of spinal instrumentation surgery. Early diagnosis and treatment are crucial. Methods We retrospectively reviewed the laboratory data of patients who underwent posterior lumbar instrumentation surgery for degenerative spinal disease from January 2003 to December 2014. Six laboratory markers for early SSI detection were considered: renewed elevation of the white blood cell count, higher at 7 than 4 days postoperatively; renewed elevation of the C-reactive protein (CRP) level, higher at 7 than 4 days postoperatively; CRP level of >10 mg/dL at 4 days postoperatively; neutrophil percentage of >75% at 4 days postoperatively; lymphocyte percentage of <10% at 4 days postoperatively; and lymphocyte count of <1,000/µL at 4 days postoperatively. Results Ninety patients were enrolled; five developed deep SSI. Multivariate regression analysis showed that a lymphocyte count of <1,000/µL at 4 days postoperatively was the sole significant independent laboratory marker for early detection of SSI (p=0.037; odds ratio, 11.9; 95% confidence interval, 1.2–122.7). Conclusions A lymphocyte count of <1,000/µL at 4 days postoperatively is the most significant laboratory marker for early detection of SSI. PMID:27994779

  10. 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

  11. Day of Surgery Admission in Total Joint Arthroplasty: Why Are Surgeries Cancelled? An Analysis of 3195 Planned Procedures and 114 Cancellations

    PubMed Central

    Kelly, Enda G.; Murphy, Terence P.; McCoy, Gerry F.; Glynn, Aaron A.

    2016-01-01

    Background. Day of surgery admission (DOSA) is becoming standard practice as a means of reducing cost in total joint arthroplasty. Aims. The aim of our study was to audit the use of DOSA in a specialty hospital and identify reasons for cancellation. Methods. A retrospective study of patients presenting for hip or knee arthroplasty between 2008 and 2013 was performed. All patients were assessed at the preoperative assessment clinic (PAC). Results. Of 3195 patients deemed fit for surgery, 114 patients (3.5%) had their surgery cancelled. Ninety-two cancellations (80%) were due to the patient being deemed medically unsuitable for surgery by the anaesthetist. Cardiac disease was the most common reason for cancellation (n = 27), followed by pulmonary disease (n = 22). 77 patients (67.5%) had their operation rescheduled and successfully performed in our institution at a later date. Conclusion. DOSA is associated with a low rate of cancellations on the day of surgery. Patients with cardiorespiratory comorbidities are at greatest risk of cancellation. PMID:27974973

  12. Short Hospitalization system: a new way of interpreting day surgery care.

    PubMed

    Rago, Rocco; Franceschini, Francesca; Tomassini, Carlo R

    2016-01-01

    Today's poorer income on the one hand and the more and more unbearable costs on the other, call for solutions to maintain public health through proper and collective care. We need to think of a new dimension of health, to found a modern and innovative approach, which can combine the respect of healthcare rights with the optimization of resources. Worldwide, franchises serving millions of people every year succeed in limiting operating costs and still offer a service and a quality equal to single businesses. Let's imagine every single Day Surgery Unit (DSU), within its own hospital, as a single trade: starting a process of centralized management and subsequent affiliation with other DSUs, they would increase their healthcare offer by means of solid organization, efficiency and foresight that with a strong focus on innovation and continuous updating, thus increasing its range of consumers and containing management costs. The Short Hospitalization System (SHS) is the proposed project, which is not only a type of hospitalization which is different from the ordinary, but also an innovative clinical-organizational model, with an important economic impact, where the management and maximization of the different hospital flows (care, professional, logistical, information), as well as the ability to implement strategies to anticipate them are crucial. The expected benefits are both clinically and socially relevant. Among them: 1) best practice build up; 2) lower impact on daily habits and increased patient satisfaction; 3) reduction of social and health expenditure.

  13. 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.

  14. 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.

  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. A case of anaphylactic shock attributed to latex allergy during gastric cancer surgery

    PubMed Central

    Lee, Woohyung; Lee, Jue Hee; Kim, Hyung-Ho

    2011-01-01

    Latex allergy is a known cause of allergic contact dermatitis. It produces mild symptoms, including skin rash and itching, which usually subside in a few days. However, latex allergy can also induce anaphylaxis, a severe type I hypersensitivity reaction that can cause urticaria, angioedema, hypotension, tachycardia, and bronchospasm. We report a case of anaphylactic shock during gastric cancer surgery in a patient with no previous allergic history. Surgery was suspended when hypotension, tachycardia, and wheezing developed. A thorough workup revealed that the patient had a latex allergy. The patient subsequently underwent curative gastrectomy performed with latex-free procedures. PMID:22319734

  17. Single port access laparoscopic surgery for large adnexal tumors: Initial 51 cases of a single institute

    PubMed Central

    Cho, Bo Ra; Han, Jae Won; Kim, Tae Hyun; Han, Ae Ra; Hur, Sung Eun; Lee, Sung Ki

    2017-01-01

    Objective Investigation of initial 51 cases of single port access (SPA) laparoscopic surgery for large adnexal tumors and evaluation of safety and feasibility of the surgical technique. Methods We retrospectively reviewed the medical records of the first 51 patients who received SPA laparoscopic surgery for large adnexal tumors greater than 10 cm, from July 2010 to February 2015. Results SPA adnexal surgeries were successfully completed in 51 patients (100%). The mean age, body mass index of the patients were 43.1 years and 22.83 kg/m2, respectively. The median operative time, median blood loss were 73.5 (range, 20 to 185) minutes, 54 (range, 5 to 500) mL, and the median tumor diameter was 13.6 (range, 10 to 30) cm. The procedures included bilateral salpingo-oophorectomy (n=18, 36.0%), unilateral salpingo-oophorectomy (n=14, 27.45%), and paratubal cystectomy (n=1, 1.96%). There were no cases of malignancy and none were insertion of additional ports or conversion to laparotomy. The cases with intraoperative spillage were 3 (5.88%) and benign cystic tumors. No other intraoperative and postoperative complications were observed during hospital days and 6-weeks follow-up period after discharge. Conclusion Our results suggest that SPA laparoscopic surgery for large adnexal tumors may be a safe and feasible alternative to conventional laparoscopic surgery. PMID:28217669

  18. A peripherally inserted central catheter line, inserted the day before surgery, decreases the time from induction to incision for spinal deformity surgery and safely provides central venous access during surgery: a pilot study.

    PubMed

    Stuedemann, Anne E; Schwend, Richard M; Thomas, Valorie K; Leamon, Julia M; Lightner, Tammy S

    2017-02-24

    Pediatric patients undergoing surgery for spinal deformity may benefit from central venous access to provide intraoperative monitoring and fluid resuscitation. For pediatric surgical patients requiring central access, we hypothesized that placing a peripherally inserted central catheter (PICC) line preoperatively should decrease time from induction of anesthesia to incision and result in improved patient safety and decreased operating room charges. This was a retrospective, nonrandomized, and case comparison study. Clinical records of all children with adolescent idiopathic scoliosis or neuromuscular scoliosis treated surgically by the senior author between December 2007 and April 2012 were reviewed. Control group patients had a central venous catheter (CVC) placed by the anesthesiologist after induction of anesthesia. The trial group had a PICC placed under local anesthesia the day before surgery by an experienced vascular access team. The time from induction of anesthesia to the time for the surgical incision was determined for each study group. The CVC line placement charges were determined by the operating room time charges at $214/min. Charges saved were the mean time difference multiplied by the operating room time charge, less the charge for PICC line insertion ($1282). There were 29 neuromuscular patients, the mean age was 13 years (SD: 4 years). The mean time from induction to incision for the PICC group was 91 min [95% confidence interval (CI): 67-115 min] and for the CVC group 113 min (95% CI: 99-127 min, P=0.083). For this mean time difference of 22 min, the estimated cost savings would be $3426 per patient. There were 59 patients with adolescent idiopathic scoliosis, the mean age was 14 years (SD: 2 years). The mean time from induction to incision for the PICC group was 78 min (95% CI: 74-82 min) and for the CVC group 106 min (95% CI: 96-116  min, P≤0.001). For this mean time difference of 28 min, the estimated cost savings would

  19. 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

  20. [A case of Mycobacterium fortuitum meningitis following surgery for meningioma].

    PubMed

    Fujikawa, Keita; Suenaga, Akihito; Motomura, Masakatsu; Fukuda, Taku; Ooe, Nobuharu; Eguchi, Katsumi

    2006-07-01

    A 57-year-old woman had undergone surgery for meningioma. After the surgery, she suffered from repeated fever and headache. One year after surgery, she was admitted to our hospital for further examination. Cerebro-spinal fluid (CSF) findings indicated bacterial meningitis infection. Germ culture, acid-fast bacterium culture, PCR for mycobacteriosis and cryptococcus antigens as well as cytological examination of CSF were checked repeatedly. However, all examinations were negative and etiology was unknown. We treated with many anti-bacterial, anti-fungal and anti-tubercular drugs, but CSF findings were not improved. We repeated CSF examination and finally Mycobacterium fortuitum (M. fortuitum) was isolated. Clarithromycin (CAM) was started for M. fortuitum meningitis. After drug sensitivity testing, levofloxacin (LVFX), which was effective against M. fortuitum, was added to CAM, after which clinical and CSF findings improved dramatically. M. fortuitum rarely causes CNS infection. Several English literatures on M. fortuitum meningitis after traumatic injury and surgery have been published. Its CSF findings distinctly resemble those of bacterial meningitis, but are resistant to the usual antituberculosis drugs. We reported a case of M. fortuitum meningitis associated with surgery for meningioma.

  1. 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.

  2. Late Bleeding after Total Thyroidectomy: Report of Two Cases occurring 13 Days after Operation

    PubMed Central

    Calò, Pietro Giorgio; Erdas, Enrico; Medas, Fabio; Pisano, Giuseppe; Barbarossa, Michela; Pomata, Mariano; Nicolosi, Angelo

    2013-01-01

    Postoperative hematoma is a rare but potentially life-threatening and unpredictable complication of thyroid surgery. We report two cases of very late postoperative bleeding occurring on the 13th postoperative day in patients treated with low-molecular-weight heparin and acenocoumarol. Patient 1 was readmitted with complaints of progressive anterior neck swelling and bleeding from the cervical wound without respiratory distress. The patient had restarted therapy with Acenocoumarol associated with Nadroparin one day before. Under general anesthesia, cervical exploration allowed detection of a superficial hematoma. Patient 2 returned to our institution with subhyoid ecchymosis and moderate blood loss from the left drainage wound. The patient underwent drainage and was treated conservatively. Although most bleeding occurs within 24 hours, caution should be taken in patients on oral anticoagulants and low-molecular weight heparin and close monitoring should also be advised at home after discharge, particularly if anticoagulant therapy has restarted. PMID:24250239

  3. 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.

  4. [Maxillary mucocele after an orthognathic surgery: case report].

    PubMed

    Carrillo Andrades, Vicente Alfonso; Carrillo Venezian, Bernardita Claudia

    2017-01-16

    Mucoceles are not often found in the maxillary sinus, and is a rare surgery complication, in this case, orthognathic. This review describes a mucocele that partially occupies the right maxillary sinus, causing a chronic nasal obstruction. This is the case of a 44 year-old female patient, which after 12 years of several orthognathic surgeries, presents facial pain and right nasal obstruction. The paranasal sinus computed tomography reveals a mass with liquid content that occupies the lower part of the right maxillary sinus and compromises the right nasal cavity. The patient was treated with an intranasal marsupialization and a middle meatotomy with endoscopic nasal approach. Evolution was satisfactory two years after the intervention.

  5. [34,450 days of cardiac surgery in the Czech Republic].

    PubMed

    Pirk, J

    2005-01-01

    Professor Karel Maydl was born in Rokytnice nad Jizerou, where his father was employed at the local court. Czech cardio-surgery was born with the first successful treatment of the stab in the heart, which was done by professor Rychlík in 1910. The next few years the cardio-surgery was represented only by occasional treatment of heart injury. Only in 1934 Jirí Divis excided ganglion stelatum to cure angina pectoris and in 1936 he performed surgical treatment of constrictive pericarditis. Article reviews all Essentials moments in the development of cardio-surgery in Bohemia and Moravia. The second part of the paper gives at present the most frequently performed surgeries. It is concluded that the Czech cardio-surgery has according to the numbers and duality of the treatment the west-European level. At the end Professor Maydl, who died for heart failure, is quoted, why he himself had to be stroked by the disease, which is not possible to treat with the knife. In the 100 years since that it is possible to evaluate that in ICEM 283 medical doctors have been treated for the heart disease and results of their operations were Berger than in standard population. It reproves the bad record of doctors to be bad patients.

  6. 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.

  7. Benefit of Oral Feeding as Early as One Day After Elective Surgery for Colorectal Cancer: Oral Feeding on First Versus Second Postoperative Day

    PubMed Central

    Fujii, Takaaki; Morita, Hiroki; Sutoh, Toshinaga; Yajima, Reina; Yamaguchi, Satoru; Tsutsumi, Soichi; Asao, Takayuki; Kuwano, Hiroyuki

    2014-01-01

    The optimal timing of early oral intake after surgery has not been fully established. The objective of this study was to compare early oral intake at postoperative day 1 after resection of colorectal cancer with that of day 2 to identify the optimal timing for resumption of oral intake in such patients. Consecutive patients with colorectal cancer who underwent elective colorectal resection were separated into two groups. Sixty-two patients began a liquid diet on the first postoperative day (POD1 group) and 58 patients began on POD2 (POD2 group) and advanced to a regular diet within the next 24 hours as tolerated. As for gastrointestinal recovery, the first passage of flatus was experienced, on average, on postoperative day 3.1 ± 1.0 in the POD2 group and on day 2.3 ± 0.7 in the POD1 group. The first defecation was also significantly earlier in patients in the POD1 group than those in the POD2 group (POD 3.2 ± 1.2 versus 4.2 ± 1.4, respectively). No statistical difference was found between the two groups in terms of postoperative complications. Our results suggest that very early feeding on POD1 after colorectal resection is safe and feasible and that induced a quicker recovery of postoperative gastrointestinal movement in patients. PMID:24833141

  8. Distress and Psychosocial Needs in Patients Accessing a Cancer Day Surgery Division: Implications for Clinical Decision Making

    PubMed Central

    Arnaboldi, Paola; Riva, Silvia; Vadilonga, Valeria; Tadini, Liliana; Magon, Giorgio; Pravettoni, Gabriella

    2016-01-01

    Introduction: The Distress Thermometer (DT) was built and validated for screening cancer patients for distress, as suggested by the National Comprehensive Cancer Network. The current work was designed to measure the rates of distress in a sample of patients being hospitalized in a multidisciplinary outpatient surgery clinic. Objective: To measure the rates of distress in a sample of patients referring to a multidisciplinary day surgery division in a comprehensive cancer center based in Northern Italy. Methods: A total of 177 patients were asked to fill in the (DT) before surgery. Results: Out of 177 patients, 154 (87%) patients completed the DT. While 13% of the patients indicated a total absence of distress, more than half of the sample declared a moderate or high distress. A total of 55% of patients presented at least three difficulties in the Problem List Checklist. Distress was not correlated with age or other medical and clinical variables. Number of emotional problems was the best predictor of distress at admission (β = 0.655, p = 0.000). Conclusion: Screening for distress in a day surgery multidisciplinary oncology division is feasible and a relevant percentage of patients can be identified as clinically distressed. Outcomes also highlight the impact of age and precise physical and psycho-social signs as prognostic indicators of clinically significant distress. Measurement of distress and associated problems list represent the preliminary endpoint toward adequate recommendations that contribute to taking care of distress in cancer patients in cost-effective clinical setting. PMID:28082946

  9. The effect of foot massage on patients' perception of care following laparoscopic sterilization as day case patients.

    PubMed

    Hulme, J; Waterman, H; Hillier, V F

    1999-08-01

    This randomized-controlled study examined the effects of foot massage on patients' perception of care received following surgery. The sample of 59 women who underwent laparoscopic sterilization as day case patients were randomly allocated into two groups. The experimental group received a foot massage and analgesia post-operatively, whilst the control group received only analgesia post-operatively. Each participant was asked to complete a questionnaire on the day following surgery. This examined satisfaction, memory and analgesia taken. The 76% response rate was comparable with other patient satisfaction studies following day-case surgery. Statistical analysis showed no overall significant difference in the pain experienced by the two groups; however, the mean pain scores recorded following surgery showed a significantly different pattern over time, such that the experimental group consistently reported less pain following a foot massage than the control group. This study has attempted to explore the use of foot massage in a systematic way and is therefore a basis for further study.

  10. Utility of ultrasound-guided transversus abdominis plane block for day-case inguinal hernia repair

    PubMed Central

    Pitoni, Sara; Gonnella, Gianluigi; Alfieri, Sergio; Catarci, Stefano; Draisci, Gaetano

    2017-01-01

    Background The transversus abdominis plane (TAP) block is a regional anesthesia technique that effectively reduces the pain intensity and use of analgesia in abdominal surgery. The aim of this study was to determine the utility of the ultrasound-guided TAP block in improving the efficacy of the ultrasound-guided ilioinguinal/iliohypogastric nerve (IIN/IHN) block for intraoperative anesthesia and postoperative pain control in day-case inguinal hernia repair (IHR). Methods We conducted a descriptive study of patients undergoing elective primary unilateral open IHR. Fifty-nine patients were divided into two groups according to the anesthetic technique used: ultrasound-guided TAP block plus ultrasound-guided IIN/IHN block (TAP group) vs. ultrasound-guided IIN/IHN block alone (IIN/IHN group). The outcome measures were the adequacy of anesthesia during surgery and postoperative analgesia. Results Four patients (12.5%) in the TAP group and 10 patients (37.0%) in the IIN/IHN group experienced inadequate anesthesia and needed systemic sedation (P < 0.05). No significant differences in additional local anesthetic volume were found between the two groups. Patients in the TAP group reported lower pain scores at the end of surgery (0.4 ± 0.8 vs. 2.1 ± 2.5, P < 0.01), at 2 hours after surgery (0.8 ± 1.3 vs. 3.0 ± 2.2, P < 0.01), at discharge (1.4 ± 1.2 vs. 4.3 ± 2.2, P < 0.01), and at 24 hours (1.5 ± 1.1 vs. 4.5 ± 2.3, P < 0.01). Conclusions The combination of the TAP and IIN/IHN blocks is associated with better intraoperative anesthesia and lower postoperative pain scores compared with the IIN/IHN block alone. PMID:28184266

  11. Readmission Rate and Causes at 90-Day after Radical Cystectomy in Patients on Early Recovery after Surgery Protocol

    PubMed Central

    Altobelli, Emanuela; Buscarini, Maurizio; Gill, Harcharan S.; Skinner, Eila C.

    2017-01-01

    Background: Radical cystectomy (RC) is associated with high risk of early and late perioperative complications, and readmissions. The Enhanced Recovery After Surgery (ERAS) protocol has been applied to RC showing decreased hospital stay without increased morbidity. Objective: To evaluate the specific causes of hospital readmissions in RC patients treated before and after adoption of an ERAS protocol at our institution. Methods: We retrospectively evaluated the outcome of 207 RC patients on ERAS protocol at the Stanford University Hospital from January 2012 to December 2014. We focused on early (30-day) and late (90-day) postoperative readmission rate and causes. Results were compared with a pre-ERAS consecutive series of 177 RC patients from January 2009 to December 2011. Results: In the post-ERAS time period a total of 56 patients were readmitted, 41 within the first 30 days after surgery (20%) and 15 within the following 60 days (7%). Fever, often associated with dehydration, was the most common reason for presentation to the hospital, accounting for 57% of all readmissions. At 90 days infection accounted for 53% of readmissions. Of all the patients readmitted during the first 90 days after surgery, 32 had positive urine cultures, mostly caused by Enterococcus faecalis isolated in 18 (56%). Readmission rates did not increase since the introduction of the ERAS protocol, with an incidence of 27% in the post-ERAS group versus 30% in the pre-ERAS group. Conclusions: Despite accurate adherence to most recent perioperative antibiotic guidelines, the incidence of readmissions after RC due to infection still remains significant. PMID:28149935

  12. Readmission Rate and Causes at 90-Day after Radical Cystectomy in Patients on Early Recovery after Surgery Protocol.

    PubMed

    Altobelli, Emanuela; Buscarini, Maurizio; Gill, Harcharan S; Skinner, Eila C

    2017-01-27

    Background: Radical cystectomy (RC) is associated with high risk of early and late perioperative complications, and readmissions. The Enhanced Recovery After Surgery (ERAS) protocol has been applied to RC showing decreased hospital stay without increased morbidity. Objective: To evaluate the specific causes of hospital readmissions in RC patients treated before and after adoption of an ERAS protocol at our institution. Methods: We retrospectively evaluated the outcome of 207 RC patients on ERAS protocol at the Stanford University Hospital from January 2012 to December 2014. We focused on early (30-day) and late (90-day) postoperative readmission rate and causes. Results were compared with a pre-ERAS consecutive series of 177 RC patients from January 2009 to December 2011. Results: In the post-ERAS time period a total of 56 patients were readmitted, 41 within the first 30 days after surgery (20%) and 15 within the following 60 days (7%). Fever, often associated with dehydration, was the most common reason for presentation to the hospital, accounting for 57% of all readmissions. At 90 days infection accounted for 53% of readmissions. Of all the patients readmitted during the first 90 days after surgery, 32 had positive urine cultures, mostly caused by Enterococcus faecalis isolated in 18 (56%). Readmission rates did not increase since the introduction of the ERAS protocol, with an incidence of 27% in the post-ERAS group versus 30% in the pre-ERAS group. Conclusions: Despite accurate adherence to most recent perioperative antibiotic guidelines, the incidence of readmissions after RC due to infection still remains significant.

  13. Two rare cases of Acremonium acute endophthalmitis after cataract surgery in a tertiary care hospital.

    PubMed

    Calderaro, Adriana; Motta, Federica; Larini, Sandra; Gorrini, Chiara; Martinelli, Monica; Piscopo, Giovanni; Benecchi, Magda; Arcangeletti, Maria Cristina; Medici, Maria Cristina; De Conto, Flora; Montecchini, Sara; Neri, Alberto; Scaroni, Patrizia; Gandolfi, Stefano; Chezzi, Carlo

    2013-10-01

    This report describes two cases of Acremonium sp. endophthalmitis, occurring in two patients who underwent cataract surgery on the same day in the same operating room of our hospital ophthalmology clinic. Diagnosis of fungal endophthalmitis was established by the repeated isolation of the same fungal agent from vitreous washing, acqueous fluid and intraocular lens samples and by its identification on the basis of morphological and molecular features. The cases reported in this study emphasize the need for clinical microbiology laboratories to be prepared to face the diagnosis of uncommon infectious diseases such as exogenous fungal endophthalmitis by Acremonium, and to enhance the awareness of surgeons and clinicians of this occurrence.

  14. 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.

  15. Impact of Peri-Operative Acute Kidney Injury as a Severity Index for 30-day Readmission After Cardiac Surgery

    PubMed Central

    Brown, Jeremiah R.; Parikh, Chirag R.; Ross, Cathy S.; Kramer, Robert S.; Magnus, Patrick C.; Chaisson, Kristine; Boss, Richard A.; Helm, Robert E.; Horton, Susan R.; Hofmaster, Patricia; Desaulniers, Helen; Blajda, Pamela; Westbrook, Benjamin M.; Duquette, Dennis; LeBlond, Kelly; Quinn, Reed D.; Jones, Cheryl; DiScipio, Anthony W.; Malenka, David J.

    2014-01-01

    Background Of patients undergoing cardiac surgery in the United States, 15–20% are re-hospitalized within 30-days. Current models to predict readmission have not evaluated the association between severity of post-operative acute kidney injury (AKI) and 30-day readmissions. Methods We collected data from 2,209 consecutive patients who underwent either coronary artery bypass (CABG) or valve surgery at seven member hospitals of the Northern New England Cardiovascular Disease Study Group Cardiac Surgery Registry (NNE) between July 2008 and December 2010. Administrative data at each hospital was searched to identify all patients readmitted to the index hospital within 30 days of discharge. We defined AKI Stages by the AKI Network definition of 0.3 or 50% increase (Stage 1), 2-fold increase (stage 2) and a 3-fold or 0.5 increase if the baseline serum creatinine was at least 4.0 (mg/dL) or new dialysis (stage 3). We evaluate the association between stages of AKI and 30-day readmission using multivariate logistic regression. Results There were 260 patients readmitted within 30-days (12.1%). The median time to readmission was 9 (IQR 4–16) days. Patients not developing AKI following cardiac surgery had a 30-day readmission rate of 9.3% compared to patients developing AKI stage 1 (16.1%), AKI stage 2 (21.8%) and AKI stage 3 (28.6%, p <0.001). Adjusted odds ratios for AKI stage 1 (1.81; 1.35, 2.44), stage 2 (2.39; 1.38, 4.14) and stage 3 (3.47; 1.85–6.50). Models to predict readmission were significantly improved with the addition of AKI stage (c-statistic 0.65, p = 0.001) and net reclassification rate of 14.6% (95%CI: 5.05% to 24.14%, p = .003). Conclusions In addition to more traditional patient characteristics, the severity of post-operative AKI should be used when assessing a patient’s risk for readmission. PMID:24119985

  16. 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.

  17. 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

  18. Anesthetic Complication during Maxillofacial Trauma Surgery: A Case Report of Intraoperative Tension Pneumothorax.

    PubMed

    Al Shetawi, Al Haitham; Golden, Leonard; Turner, Michael

    2016-09-01

    Tension pneumothorax is a life-threatening emergency that requires a high index of suspension and immediate intervention to prevent circulatory collapse and death. Only five cases of pneumothorax were described in the Oral and Maxillofacial Surgery literature. All cases were postoperative complications associated with orthognathic surgery. We report a case of intraoperative tension pneumothorax during a routine facial trauma surgery requiring emergency chest decompression. The possible causes, classification, and reported cases will be presented.

  19. 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

  20. 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

  1. 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.

  2. Minimally invasive surgery for giant esophageal leiomyoma: a case report & review of the literatures

    PubMed Central

    Chen, Xiaosang; Xi, Yong; Wang, Hao

    2017-01-01

    Despite the rapid development of minimally invasive surgery, the treatment of esophageal lesions remains controversial. Giant esophageal leiomyoma could be removed once diagnosed, but its operative method is not quite the same as esophageal leiomyoma of small size. We report a case of giant esophageal leiomyoma and review published cases of giant leiomyomas in the past 10 years. A 29-year-old man was admitted to the clinic for the complaints of 2-month history of dysphagia and discomfort. Radiologic and endoscopic findings suggested esophageal lesion in the muscular layer. The VATS enucleation was performed to relieve the patient’s symptoms. The patient started oral intake on the 1st postoperative day, with following solid meal. The postoperative course was uneventful, and the patient was discharged on the 8th postoperative day. PMID:28203434

  3. 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

  4. Staged bilateral single-port thoracoscopic lung volume reduction surgery: A report of 11 cases

    PubMed Central

    Zhang, Miao; Wang, Heng; Pan, Xue-Feng; Wu, Wen-Bin; Zhang, Hui

    2016-01-01

    The aim of the present study was to investigate the feasibility and efficacy of staged bilateral single-port thoracoscopic lung volume reduction surgery (LVRS) for patients with chronic obstructive pulmonary emphysema (COPE). Eleven male patients with a mean age of 60.27±12.11 years with bilateral COPE and bullae were admitted to the Department of Thoracic Surgery, Xuzhou Central Hospital from January 2013 to June 2014. The patients underwent staged bilateral single-port thoracoscopic LVRS. The hyperinflated bullae were resected using endoscopic staplers (Endo-GIA), followed by continuous suture and biological glue for reinforcement of the margin. In addition, pulmonary function, blood gas assay, 6-min walk distance (6MWD) and life quality evaluated by a short form 36-item health survey questionnaire (SF-36) were recorded before and after LVRS, respectively. All the patients survived after surgery. The chest tube drainage time was 9.09±1.31 days and postoperative hospital stay was 15.73±2.75 days, with 5 cases of persistent air leakage and 7 cases of pulmonary infection which were finally cured. The patients were followed up for 3 to 12 months, and the pulmonary function, partial pressure of oxygen (pO2), 6MWD and life quality after unilateral or bilateral LVRS were improved compared to these parameters before surgery. However, there was no significant difference between unilateral and bilateral LVRS in terms of life quality. In conclusion, staged bilateral single-port thoracoscopic LVRS may improve the short-term life quality of patients with COPE. PMID:27882084

  5. 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

  6. Metal hypersensitivity in total knee arthroplasty: revision surgery using a ceramic femoral component - a case report.

    PubMed

    Bergschmidt, Philipp; Bader, Rainer; Mittelmeier, Wolfram

    2012-03-01

    We present a case involving the revision of a total knee arthroplasty with a metal femoral component using a ceramic implant due to metal hypersensitivity. A 58-year-old female patient underwent total knee arthroplasty (TKA) with a standard metal bicondylar knee system. She suffered from persistent pain and strong limitations in her range of motion (ROM) associated with flexion during the early postoperative period. Arthroscopic arthrolysis of the knee joint and intensive active and passive physical treatment, in combination with a cortisone regime, temporarily increased the ROM and reduced pain. No signs of low grade infection or other causes of implant failure were evident. Histology of synovial tissue revealed lymphoplasmacellular fibrinous tissue, consistent with a type IV allergic reaction. Allergometry (skin reaction) revealed type IV hypersensitivity against nickel-II-sulfate and palladium chloride. Revision surgery of the metal components was performed with a cemented ceramic femoral component (same bicondylar design) and a cemented titanium alloy tibial component. Postoperative evaluations were performed 10days, and 3 and 12months after the revision surgery. There was an increased ROM in flexion to 90° at the 12month follow-up. No swelling or effusion was observed at all clinical examinations after the revision surgery. No pain at rest and moderate walking pain were evident. The presented case demonstrates that ceramic implants are a promising solution for patients suffering from hypersensitivity to metal ions in total knee arthroplasty.

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

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 2 2012-10-01 2012-10-01 false Payment for extended length-of-stay cases (day... Certain Replaced Devices Payment for Outlier Cases § 412.82 Payment for extended length-of-stay cases (day... discharge includes covered days of care beyond the applicable threshold criterion, the intermediary...

  8. 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... Certain Replaced Devices Payment for Outlier Cases § 412.82 Payment for extended length-of-stay cases (day... discharge includes covered days of care beyond the applicable threshold criterion, the intermediary...

  9. 42 CFR 412.82 - Payment for extended length-of-stay cases (day outliers).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 2 2013-10-01 2013-10-01 false Payment for extended length-of-stay cases (day... Certain Replaced Devices Payment for Outlier Cases § 412.82 Payment for extended length-of-stay cases (day... discharge includes covered days of care beyond the applicable threshold criterion, the intermediary...

  10. 42 CFR 412.82 - Payment for extended length-of-stay cases (day outliers).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 2 2014-10-01 2014-10-01 false Payment for extended length-of-stay cases (day... Certain Replaced Devices Payment for Outlier Cases § 412.82 Payment for extended length-of-stay cases (day... discharge includes covered days of care beyond the applicable threshold criterion, the intermediary...

  11. [Nursing care in patients undergoing radiological surgery. A case report].

    PubMed

    Armero-Barranco, David; Ruiz-Mateos, María; Alcaraz-Baños, Miguel; Bernal-Páez, Fernando Luis

    2007-01-01

    We report the case of a 73-year-old man with medical diagnoses of long-standing diabetes mellitus, chronic ischemia of the lower limbs and intermittent claudication, for which the patient had been treated with minimally invasive radiological surgery. On arrival at the radiology unit, the patient had nursing diagnoses of anxiety and fear. Intraoperatively, the client had nursing diagnoses of pain, urine retention and infection risk. At discharge, a collaboration problem was detected and hemorrhagic risk. The patient received individualized nursing care. Interventions were planned following the nursing intervention classification (NIC) and the expected results for these interventions followed the Nursing Outcomes Classification (NOC) taxonomy. The application of an appropriate nursing care plan contributes to making the patient's hospital stay easier, more comfortable and less traumatic.

  12. A case-control study to identify predictors of 14-day mortality following carbapenem-resistant Acinetobacter baumannii bacteraemia.

    PubMed

    Nutman, A; Glick, R; Temkin, E; Hoshen, M; Edgar, R; Braun, T; Carmeli, Y

    2014-12-01

    Carbapenem-resistant Acinetobacter baumannii (CRAB) is an increasingly common nosocomial pathogen. We sought to identify clinical and microbiological predictors of 14-day mortality among patients with CRAB bacteraemia. This case-control study included all adult patients in one Israeli hospital with CRAB on blood culture between July 2008 and June 2011. Cases were defined as patients who died within 14 days of bacteraemia onset and controls as patients who survived over 14 days. Sequence-typing of the blaOXA-51-like gene and REP-PCR identified CRAB clone groups. Logistic regression was performed to analyze predictors of 14-day all-cause mortality. To correct for differences in treatment onset, Cox regression was used to examine the effect of receiving an active antibiotic. Eighty-three cases and 89 controls were included. Six major CRAB clone groups were identified, with 14-day mortality ranging from 17 to 66%. Independent predictors of 14-day mortality were severity of illness (OR = 1.38 for each 1-point increase in Sequential Organ Failure Assessment (SOFA) score; 95% CI, 1.21, 1.56), independence in activities of daily living (ADL) on admission (OR = 3.40; 95% CI, 1.20, 9.67, for fully dependent vs. independent), surgery before bacteraemia (OR = 0.25; 95% CI, 0.11, 0.59) and clone group (OR = 7.76; 95% CI, 2.52, 23.85, for the most virulent group vs. the reference group). In the multivariate Cox model using a propensity score to adjust for SOFA, clone, ADL and surgery, active antibiotic treatment was protective (HR = 0.30; 95% CI, 0.15, 0.60). Differences in virulence between CRAB clones may partly explain heterogeneous results in previous studies of mortality following CRAB infection.

  13. Indocyanine green fluorescent dye during bowel surgery: are the blood supply "guessing days" over?

    PubMed

    Foppa, C; Denoya, P I; Tarta, C; Bergamaschi, R

    2014-08-01

    Assessing the blood supply of the bowel is a difficult task even for experienced surgeons. Laser-assisted indocyanine green (ICG) fluorescent dye angiography provides intraoperative visual assessment of blood flow to the bowel wall and surrounding tissues, allowing for modification to the surgical plan, which can reduce the risk of postoperative complications. ICG angiography was prospectively performed in a single center during a 1-year period for small bowel ischemia and left colorectal resections. ICG angiography played a major role in the intraoperative decision making in 4 of 160 patients, whose clinical and operative details are here reported. In case of acute small intestine ischemia, resection is not warranted unless absolute perfusion units are below 19 (relative 21%). When evaluating blood supply to the left colon prior to anastomosing, resection is recommended with absolute units lower than 18 (relative 31%) even if the bowel appears macroscopically perfused.

  14. Sacrohysteropexy performed as uterus conserving surgery for pelvic organ prolapse: Review of case files

    PubMed Central

    Khan, Ayesha; Jaleel, Riffat; Nasrullah, Farah Deeba

    2016-01-01

    Objective: To assess the outcome and safety of sacrohysteropexy as uterus conserving surgery for pelvic organ prolapse in young women and to assess patients’ satisfaction with the procedure. Methods: This is a case series of patients operated at Sind Government Lyari General Hospital and Civil Hospital Karachi, between January, 2007 to October, 2015. Data of the patients who had sacrohysteropexy were reviewed. Complications during surgery and post-operative period including haemorrhage, visceral injury, paralytic ileus and peritonitis were studied. Success of procedure, need of blood transfusion, hospital stay and condition on discharge and six weeks follow-up were noted. Data were analyzed using SPSS version 16. Mean ± SD was calculated for numerical, while frequencies were computed for categorical variables. Results: Data of 60 patients were reviewed. Early post-operative success was 100%. Duration of surgery was less than two hours in 57 (95%) patients. Blood loss was negligible in majority of cases. Out of all 60 cases, 52 (86.7%) did not suffer any complication. One patient had ureteric injury, while one patient sustained bowel injury. Two patients had paralytic ileus. Four patients suffered from abdominal wound infection. All patients were managed satisfactorily. Mean duration of stay in hospital was four days. Upon follow up 96.7% patients were satisfied with results of operative procedure. Sixteen (26.7%) patients complained of backache on follow-up visit. Conclusion: This review concludes that sacrohysteropexy was successful in all cases in early post-operative period. It is a safe procedure and should be considered as an option for the treatment of pelvic organ prolapse in young women, in whom uterine conservation is required. PMID:27882016

  15. Subcutaneous emphysema during third molar surgery: a case report.

    PubMed

    Romeo, Umberto; Galanakis, Alexandros; Lerario, Francesco; Daniele, Gabriele Maria; Tenore, Gianluca; Palaia, Gaspare

    2011-01-01

    Extraction of third molars is the most common surgical procedure performed in oral surgery on a daily basis and, despite surgical skills and expertise, complications may occur. Complications observed during or after third molar removal may include pain, swelling, bleeding, infection, sinus perforation and nerve damage. Fortunately, with a proper management and a good surgical technique, the incidence of such events is low. Subcutaneous emphysema associated with dental extraction occurs when the air from the high-speed dental handpiece is forced into the soft tissue through the reflected flap and invades the adjacent tissues, leading to swelling, crepitus on palpation and occasionally spreading through the tissue spaces of the fascial planes. Although rare, iatrogenic subcutaneous emphysema can have serious and potentially life-threatening consequences. Care should be taken when using air-driven handpieces. The access of air into the facial tissues is not limited to tooth extractions, but may also occur through other portals of entrance, such as endodontically treated teeth, periodontium and lacerations of intraoral soft tissues. When subcutaneous emphysema occurs, it must be quickly diagnosed and properly managed to reduce the risk of further complications. This report presents a case of subcutaneous emphysema occurred during extraction of a mandibular third molar extraction with the use of an air turbine handpiece. Case management is described and issues relative to the diagnosis and prevention of this surgical complication are discussed.

  16. 9 CFR 96.12 - Uncertified casings not disinfected in 30 days; disposition.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 30 days; disposition. 96.12 Section 96.12 Animals and Animal Products ANIMAL AND PLANT HEALTH... STATES § 96.12 Uncertified casings not disinfected in 30 days; disposition. Foreign animal casings... period of 30 days after arrival in the United States, subject to the ability of Division inspectors...

  17. 9 CFR 96.12 - Uncertified casings not disinfected in 30 days; disposition.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 30 days; disposition. 96.12 Section 96.12 Animals and Animal Products ANIMAL AND PLANT HEALTH... STATES § 96.12 Uncertified casings not disinfected in 30 days; disposition. Foreign animal casings... period of 30 days after arrival in the United States, subject to the ability of Division inspectors...

  18. 9 CFR 96.12 - Uncertified casings not disinfected in 30 days; disposition.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 30 days; disposition. 96.12 Section 96.12 Animals and Animal Products ANIMAL AND PLANT HEALTH... STATES § 96.12 Uncertified casings not disinfected in 30 days; disposition. Foreign animal casings... period of 30 days after arrival in the United States, subject to the ability of Division inspectors...

  19. 9 CFR 96.12 - Uncertified casings not disinfected in 30 days; disposition.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 30 days; disposition. 96.12 Section 96.12 Animals and Animal Products ANIMAL AND PLANT HEALTH... STATES § 96.12 Uncertified casings not disinfected in 30 days; disposition. Foreign animal casings... period of 30 days after arrival in the United States, subject to the ability of Division inspectors...

  20. [Prepuce plastic surgery, known as the Lille operation, in distal hypospadias. Apropos of 138 cases].

    PubMed

    Wallon, P; Saint-Supery, G; Bucco, P

    1984-01-01

    Distal hypospadias with meatus situated on the glans, in the balano-penile furrow, even on the distal part of the shaft, are the most frequent hypospadias. Without chordee, it's only a cosmetic handicap. The aim of surgery is to produce the esthetic appearance of a normal penis. In France, circumcision is not usual and most people prefer a child with prepuce. The best technique in this case is to keep the meatus in its hypospadial situation and get the prepuce circular with a ventral suture. It's an easy technique. The hospital stay is short, 2 or 3 days, without any diversion of the urine. This operation is made when the child is about 3 years. Saint-Aubert described this procedure in 1967. The authors present their technique and results. Since 1971, 138 boys underwent this operation with few complications: 2% of fistulas and 2% of phimosis on the last hundred of cases.

  1. Infrahyoid muscle flap for pharyngeal fistulae after cervical spine surgery: a novel approach—Report of six cases

    PubMed Central

    Niedeggen, Andreas; Todt, Ingo; Westhofen, Martin; Ernst, Arne

    2006-01-01

    A report of our experiences involving the treatment six male patients with a new method of closing perforations in the pharynx and upper esophagus, following surgery of the cervical spine region. Perforation of the pharynx and upper esophagus are rare complications following cervical spine surgery. The grave consequences of these complications necessitate in most cases immediate surgical therapy. In most cases, the first step involves the removal of the cervical plate and screws. The defect was then closed using a vascular pedicled musculofascia flap derived from the infrahyoid musculature. In all cases, the flap healed into place without complications. The patients began taking oral nutrients after an average of seven postoperative (5–12) days. In none of the cases did functional disorders or complications arise during the follow-up period (1–5 years). The infrahyoid muscle flap is well suited for reconstruction of the posterior pharyngeal wall and the upper esophagus. PMID:16927070

  2. 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.

  3. Improvement of chronic back pain or failed back surgery with vitamin D repletion: a case series.

    PubMed

    Schwalfenberg, Gerry

    2009-01-01

    This article reviews 6 selected cases of improvement/resolution of chronic back pain or failed back surgery after vitamin D repletion in a Canadian family practice setting. Pub Med was searched for articles on chronic back pain, failed back surgery, and vitamin D deficiency. Chronic low back pain and failed back surgery may improve with repletion of vitamin D from a state of deficiency/insufficiency to sufficiency. Vitamin D insufficiency is common; repletion of vitamin D to normal levels in patients who have chronic low back pain or have had failed back surgery may improve quality of life or, in some cases, result in complete resolution of symptoms.

  4. A Study to Determine the Feasibility of Establishing a Same-Day Surgery Program at General Leonard Wood Army Community Hospital, Fort Leonard Wood, Missouri

    DTIC Science & Technology

    1989-05-23

    grows stronger every year as advancing technology allows more procedures to be performed safely in this modality. For example, lasers and faster...diagnostic laparoscopy - laser - cone biopsy - laparoscopic surgery 0 0 c C) m 0 0 m z APPENDIX H m z .I, TOP 30 SUGGESTED SAME-DAY SURGERIES -Dm z BY HIGHEST...OTHER BIOPSY OF BREAST 75 Z 3 2830 TONSILLECTOMY WITH ADENOIDECTOMY 67 4 5421 LAPAROSCOPY 64 5 1359 OTHER EXTRACAPSULAR EXTRACTION OF LENS 54 6 5300

  5. Prophylactic use of fibrin sealant (ARTISS(™) ) for facilitating safe transition to drain-free thyroid surgery: a single-centre case series review of 109 procedures.

    PubMed

    Heyes, Richard; Ramdoo, Krishan; Manjaly, Joseph G; Charn, Tze Choong; Tatla, Taran

    2017-02-24

    Despite a lack of evidence to support drain insertion in thyroid surgery, drain placement, to prevent rapidly expanding haematoma which occurs in around 1% of cases, remains common (1,2,3) . Throughout surgery there has been a drive towards reducing postoperative length of hospital admission. For day-case thyroidectomy to become a widely adopted clinical reality, the use of drains requires abandonment, but beyond this, the cause for surgeons' reticence to practise drain-free surgery, namely haematoma risk, needs to be addressed. This paper describes a study conducted to examine the efficacy of ARTISS(™) , a commercially available thrombin-dilute fibrin sealant, in thyroid surgery to permit safe transition to drain-free surgery. This article is protected by copyright. All rights reserved.

  6. 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

  7. Cataract surgery in a case of carotid cavernous fistula

    PubMed Central

    Nair, Akshay Gopinathan; Praveen, Smita Vittal; Noronha, Veena Olma

    2014-01-01

    A carotid-cavernous fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system. The ocular manifestations include conjunctival chemosis, proptosis, globe displacement, raised intraocular pressure and optic neuropathy. Although management of CCF in these patients is necessary, the ophthalmologist may also have to treat other ocular morbidities such as cataract. Cataract surgery in patients with CCF may be associated with many possible complications, including suprachoroidal hemorrhage. We describe cataract extraction surgery in 60-year-old female with bilateral spontaneous low-flow CCF. She underwent phacoemulsification via a clear corneal route under topical anesthesia and had an uneventful postoperative phase and recovered successfully. Given the various possible ocular changes in CCF, one must proceed with an intraocular surgery with caution. In this communication, we wish to describe the surgical precautions and the possible pitfalls in cataract surgery in patients with CCF. PMID:25370401

  8. Outcomes of endoscopic ethmoidectomy performed on a day-case basis: a prospective bi-centric study.

    PubMed

    Oker, N; Dupuch, V; Herman, P; Leclerc, N; Vironneau, P; Dang, H; Majer, J; Pastourel, R; Pavier, Y; Blancal, J-P; Saroul, N; Mom, T; Kania, R; Vicaut, E; Gilain, L; Verillaud, B

    2017-01-01

    Evaluation of endoscopic ethmoidectomy performed as a day-case in terms of security, quality, and satisfaction of the patient. This prospective observatory bi-centric study over 1 year included 74 patients undergoing an ethmoidectomy respecting the eligibility criteria of ambulatory care. We recorded patients' demographic data, operative details, satisfaction, postoperative course, and follow-up results. Nasal symptoms were evaluated by SNOT-22 on preoperative appointment and postoperatively at D30. No non-absorbable nasal packing was used, eventually in the case of preoperative-bleeding absorbable gelatine packing. The postoperative follow-up took place at D1 by phone call and at D10 and D30 to assess complications, Visual Analogue Scale, and state of ethmoidal corridors by endoscopic exam. Patients benefited of bilateral ethmoidectomy in 82.4 % cases associated with septoplasty in 42 %. The majority (95 %) was discharged on the same day. Only one patient had bleeding at D0 and was kept in standard hospitalization, such as three other patients for medical or organizational reasons not related to surgery. At D1, 23 % described postoperative light bleeding but needed no revisit and pain was estimated at 1.3 (VAS). No readmission was observed, and no major complication was noted. SNOT-22 decreased successfully by 56 %, statistically related to postoperative treatment of corticosteroids and in the case of Samter triad. 97 % of patients were satisfied of the ambulatory care. These results suggest that within an experienced and dedicated day-case medical and paramedical team, ethmoidectomy can be safely performed on a day-case basis with high quality of taking care and satisfaction of patients.

  9. Facial nerve paralysis after impacted lower third molar surgery: a literature review and case report.

    PubMed

    Vasconcelos, Belmiro Cavalcanti do Egito; Bessa-Nogueira, Ricardo Viana; Maurette, Paul Edward; Carneiro, Suzana Célia Soares de Aguiar

    2006-03-01

    Facial nerve paralysis (FNP) is the most common cranial nerve disorders and it results in a characteristic facial distortion that is determined in part by the nerves branches involved. With multiples etiologies, these included trauma, tumor formation, idiopathic conditions, cerebral infarct, pseudobulbar palsy and viruses. FNP during dental treatment is very rare and can be associated with the injection of local anesthetic, prolonged attempt to remove a mandibular third molar and subsequent infection. We report a case of a 21 years-old black woman who developed a Bell's palsy after an impacted third molar surgery under local anaesthesia, present a FNP classified like a grade IV by the House-Brackmann's grading system. The treatment was based of prescription of a cytidine and uridine complex (NUCLEO CMP tm) one tablet twice per day and a close follow up. Three months later that had beginning the treatment, the patient recovery her normal facial muscle activity.

  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. [Medical, social, and economic effectiveness of treatment of day-case patients with peptic ulcer].

    PubMed

    Butorov, I V; Osoianu, Iu P; Maksimov, V V; Butorov, S I

    2006-01-01

    The purpose of the study was to evaluate medical, social, and economic effectiveness of treatment of day-case patients with peptic ulcer (PU). The subjects of the study were 60 day-case patients with duodenal ulcer aged 18 to 60, who underwent clinical and instrumental examination including esophagogastroduodenoscopy with biopsy and Helicobacter pylori (HP) detection. The patients received 7-day eradication therapy, which included omeprazol in a dose of 20 mg twice a day, clarithromycin--500 mg twice a day, and metronidazole--500 mg twice a day. There was a control group, which included 60 inpatients treated in Gastroenterology Division of the hospital. The use of the three-component medication in the day-case patients and the inpatients led to disappearance of pain syndrome 7.4 +/- 0.3 and 8.6 +/- 0.2 days after the beginning of the treatment, respectively; dyspepsia disappeared in the day-case patients and the inpatients 7.6 +/- 0.2 and 8.8 +/- 0.3 days after the beginning of the treatment, respectively. HP eradication was effective in 86.7% of the day-case patients, and in 88.3% of the inpatients. The course of the disease was recurrence-free during two years in 80% of the day-case patients, and in 76.4% of the inpatients; the cost of the treatment was 2.1 times higher in the group of inpatients. The results show that high effectiveness of the three-component medication, judging by the results of HP eradication, terms of disappearance of pain syndrome and ulcer healing, allows recommending this regimen for wide clinical application in day-case patients with PU.

  14. Post-endodontic treatment periodontal surgery: a case report.

    PubMed

    Azaripour, Adriano; Willershausen, Ines; Kämmerer, Philipp; Willershausen, Brita

    2013-02-01

    Two patients were diagnosed with combined endodontic-periodontal lesions. Endodontic treatment was performed, followed by surgery. In addition, the regeneration process was supported by the application of an enamel matrix derivate alone or in combination with guided bone regeneration techniques. At recall visits after 24 months, the teeth were asymptomatic and marked bone regeneration had occurred in both patients. The successful post-endodontic treatment of combined endodontic-periodontal lesions, using periodontal surgery and as adjunct guided tissue regenerative techniques, is presented. Further, the possibility of saving teeth, even with severely apparent pathology, should be highlighted.

  15. Instrument malfunction during robotic surgery: A case report

    PubMed Central

    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

  16. Day-care for breast cancer: ambulatory surgery and intra-operative radiation. Techniques and preliminary results of the Centre Val-d'Aurelle--Montpellier.

    PubMed

    Mourregot, A; Lemanski, C; Gutowski, M; Colombo, P-E; Charissoux, M; Dubois, J-B; Azria, D; Saint-Aubert, B; Domergue, J; Mathieu-Daude, H; Rouanet, P

    2014-04-01

    One-day breast carcinoma treatment is defined as association of ambulatory surgery and intra-operative irradiation. Selection and rigorous process of patients is the key to success. The surgical technique is not changed by the radiotherapy. Patient's satisfaction index is very high. Financial loss should not be a hurdle to its implementation.

  17. Compensatory quadrant-hyperhidrosis after contralateral intrathoracic surgery: a case report

    PubMed Central

    2013-01-01

    Introduction Unilateral hyperhidrosis can be a neurological manifestation of irritations of the central or peripheral nervous system. Case presentation We present the case of a 67-year-old German man who had hyperhidrosis of his right upper body quadrant (including face, arm, and chest) following intrathoracic surgery of a left-sided pleural lipoma. Conclusion An isolated unilateral hyperhidrosis might occur after intrathoracic surgery. Besides anticholinergic drugs the use of botulinum toxin should be considered. PMID:23331641

  18. Symptomatic Triple-Region Spinal Stenosis Treated with Simultaneous Surgery: Case Report and Review of the Literature

    PubMed Central

    Schaffer, Joseph C.; Raudenbush, Brandon L.; Molinari, Christine; Molinari, Robert W.

    2015-01-01

    Study Design Case report. Objectives Symptomatic triple-region spinal stenosis (TRSS), defined as spinal stenosis in three different regions of the spine, is extremely rare. To our knowledge, treatment with simultaneous decompressive surgery is not described in the literature. We report a case of a patient with TRSS who was treated successfully with simultaneous decompressive surgery in three separate regions of the spine. Methods A 50-year-old man presented with combined progressive cervical and thoracic myelopathy along with severe lumbar spinal claudication and radiculopathy. He underwent simultaneous decompressive surgery in all three regions of his spine and concomitant instrumented fusion in the cervical and thoracic regions. Results Estimated blood loss for the procedure was 600 mL total (250 mL cervical, 250 mL thoracic, 100 mL lumbar) and operative time was ∼3.5 hours. No changes were noted on intraoperative monitoring. The postoperative course was uncomplicated. The patient was discharged to inpatient rehabilitation on postoperative day (POD) 7 and discharged home on POD 11. At 6-month follow-up, his gait and motor function was improved and returned to normal in all extremities. He remains partially disabled due to chronic back pain. Conclusions This report is the first of symptomatic TRSS treated with simultaneous surgery in three different regions of the spine. Simultaneous triple region stenosis surgery appears to be an effective treatment option for this rare condition, but may be associated with prolonged hospital stay after surgery. PMID:26682102

  19. Post-operative delirium is an independent predictor of 30-day hospital readmission after spine surgery in the elderly (≥65years old): A study of 453 consecutive elderly spine surgery patients.

    PubMed

    Elsamadicy, Aladine A; Wang, Timothy Y; Back, Adam G; Lydon, Emily; Reddy, Gireesh B; Karikari, Isaac O; Gottfried, Oren N

    2017-03-02

    In the last decade, costs of U.S. healthcare expenditures have been soaring, with billions of dollars spent on hospital readmissions. Identifying causes and risk factors can reduce soaring readmission rates and help lower healthcare costs. The aim of this is to determine if post-operative delirium in the elderly is an independent risk factor for 30-day hospital readmission after spine surgery. The medical records of 453 consecutive elderly (≥65years old) patients undergoing spine surgery at Duke University Medical Center from 2008 to 2010 were reviewed. We identified 17 (3.75%) patients who experienced post-operative delirium according to DSM-V criteria. Patient demographics, comorbidities, and post-operative complication rates were collected for each patient. Elderly patients experiencing post-operative delirium had an increased length of hospital stay (10.47days vs. 5.70days, p=0.009). Complication rates were similar between the cohorts with the post-operative delirium patients having increased UTI and superficial surgical site infections. In total, 12.14% of patients were re-admitted within 30-days of discharge, with post-operative delirium patients experiencing approximately a 4-fold increase in 30-day readmission rates (Delirium: 41.18% vs. No Delirium: 11.01%, p=0.002). In a multivariate logistic regression analysis, post-operative delirium is an independent predictor of 30-day readmission after spine surgery in the elderly (p=0.03). Elderly patients experiencing post-operative delirium after spine surgery is an independent risk factor for unplanned readmission within 30-days of discharge. Preventable measures and early awareness of post-operative delirium in the elderly may help reduce readmission rates.

  20. Reconstructive surgery for giant penoscrotal elephantiasis: about one case.

    PubMed

    Kirakoya, Brahima; Zango, Barnabé; Paré, Abdoul Karim; Kaboré, Aristide Fasnéwendé; Yaméogo, Clotaire

    2014-01-01

    Elephantiasis of the external genitalia is characterized by lymphedema and thickening of the subcutaneous tissues. This gives the skin an appearance similar to a pachyderm skin. This pathology is invalidating for the patient. Reconstructive surgery is often the only way to restaure aesthetic and functional aspects of the external genitalia. We aim to report a 52 year man with huge penoscrotal elephantiasis who underwent excision and penoscrotal reconstruction at the department of Urology, Yalgado Ouedraogo Teaching Hospital at Ouagadougou.

  1. 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

  2. Portomesenteric venous thrombosis: A rare but probably under-reported complication of laparoscopic surgery: A case series

    PubMed Central

    Goh, Yan Mei; Tokala, Ajay; Hany, Tarek; Pursnani, Kishore G.; Date, Ravindra S.

    2017-01-01

    Portomesenteric venous thrombosis (PMVT) is a rare but well-reported complication following laparoscopic surgery. We present three cases of PMVT following laparoscopic surgery. Our first case is a 71-year-old morbidly obese woman admitted for elective laparoscopic giant hiatus hernia (LGHH) repair. Post-operatively, she developed multi-organ dysfunction and computed tomography scan revealed portal venous gas and extensive small bowel infarct. The second patient is a 51-year-old man with known previous deep venous thrombosis who also had elective LGHH repair. He presented 8 weeks post-operatively with severe abdominal pain and required major bowel resection. Our third case is an 86-year-old woman who developed worsening abdominal tenderness 3 days after laparoscopic right hemicolectomy for adenocarcinoma and was diagnosed with an incidental finding of thrombus in the portal vein. She did not require further surgical intervention. The current guidelines for thromboprophylaxis follow-up in this patient group may not be adequate for the patients at risk. Hence, we propose prolonged period of thromboprophylaxis in the patients undergoing major laparoscopic surgery. PMID:28281480

  3. Tapia's Syndrome after Corrective Jaw Surgery under General Anesthesia: A Case Report

    PubMed Central

    Izadi, Farzad; Ahmadi, Aslan; Daneshvar, Ali; Safdarian, Mahdi

    2017-01-01

    Introduction: Tapia’s syndrome is a rare complication of recurrent laryngeal and hypoglossal nerve paralysis due to anesthetic airway mismanagement or malpositioning of the patient’s head during surgery. Case Report: Here we present a case of Tapia's syndrome in a 22-year-old male after corrective jaw surgery under general anesthesia, with a long period of recovery, related to airway management procedures and/or overstretching of the neck during positioning for surgery. Conclusion: Although it is a rare condition, every surgeon should be aware of Tapia’s syndrome in order to consider the correct positioning of the head and endotracheal tube during surgery and avoid this complication. PMID:28393059

  4. 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…

  5. 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

  6. Effectiveness of Maxillomandibular advancement (MMA) surgery in sleep apnea treatment: Case report.

    PubMed

    Ferraz, Otávio; Guimarães, Thais M; Rossi, Rowdley R; Cunali, Paulo A; Fabbro, Cibele Dal; Chaves, Cauby M; Maluly, Milton; Bittencourt, Lia; Tufik, Sergio

    2016-01-01

    Obstructive sleep apnea (OSA) is characterized by episodes of pharyngeal collapse during sleep. Craniofacial alterations such as retrognathia are often found in OSA patients. Maxillomandibular advancement (MMA) surgeries increase the pharyngeal space and are a treatment option for OSA. The aim of this study was to present a successful case of MMA surgery in the treatment of OSA. A patient with moderate OSA (apnea-hypopnea index (AHI)=25.2) and mandibular retrognathism and Maxillomandibular asymmetry underwent MMA surgery. The apnea-hypopnea index (AHI) were considerably improved after six months (IAH =6.7) and one year of treatment (IAH=0.2).

  7. An Unusual Lacerated Tracheal Tube during Le Fort Surgery: Literature Review and Case Report

    PubMed Central

    George, Preeta; Fiadjoe, John E.

    2016-01-01

    Maxillofacial surgeries can present unique anesthetic challenges due to potentially complex anatomy and the close proximity of the patient's airway to the surgical field. Damage to the tracheal tube (TT) during maxillofacial surgery may lead to significant airway compromise. We report the management of a patient with a partially severed TT during Le Fort surgery for midfacial hypoplasia and management strategies based on peer-reviewed literature. This case illustrates the clinical clues associated with a damaged TT and explores the challenges of managing this potentially catastrophic issue. PMID:27895942

  8. 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.

  9. Gamma knife surgery-induced ependymoma after the treatment of meningioma - a case report.

    PubMed

    Wang, Ke; Pan, Li; Che, Xiaoming; Lou, Meiqing

    2012-01-01

    Gamma knife surgery is widely used for a number of neurological disorders. However, little is known about its long-term complications such as carcinogenic risks. Here, we present a case of a radiosurgery-induced ependymoma by gamma knife surgery for the treatment of a spinal meningioma in a 7-year-old patient. In light of reviewing the previous reports, we advocate high caution in making young patients receive this treatment.

  10. Severe cellulitis and abdominal wall emphysema following laparoscopic colonic surgery: A case report.

    PubMed

    Tanaka, Ryo; Kameyama, Hitoshi; Chida, Tadasu; Kanda, Tatsuo; Kano, Yosuke; Ichikawa, Hiroshi; Hanyu, Takaaki; Ishikawa, Takashi; Kosugi, Shin-Ichi; Wakai, Toshifumi

    2015-05-01

    Abdominal wall emphysema is a common complication of laparoscopic surgery. This condition is usually harmless; however, if an infection occurs, it can develop into a serious condition such as necrotizing fasciitis. We report a case of a 51-year-old woman suffering from severe cellulitis that spread from an area of abdominal wall emphysema after laparoscopic surgery for sigmoid colon cancer. Recognizing this complication, early diagnosis, and prompt treatment are cornerstones for successful management of this potentially fatal disease.

  11. [Mortality and morbidity in HIV-infected patients undergoing coronary artery bypass surgery: a case control study].

    PubMed

    Jiménez-Expósito, María J; Mestres, Carlos A; Claramonte, Xavier; Cartañá, Ramón; Josa, Miquel; Pomar, José L; Mulet, Jaume; Miró, José M

    2006-03-01

    The use of highly active antiretroviral therapy (HAART) in patients with HIV infection has improved survival. This improvement combined with the metabolic effects of treatment has increased cardiovascular risk and the need for cardiac surgery in these patients. We compared morbidity and mortality in HIV-infected patients (cases, n=7) and non-HIV-infected patients (controls, n=21) who underwent isolated coronary artery surgery between 1997 and 2004. The durations of extracorporeal circulation and aortic cross-clamping were shorter in HIV-infected patients (P=.002 and P=.014, respectively). The percentage of patients who experienced complications was similar, at 57.1% in both groups, but there was a slightly higher number of complications per patient in non-HIV-infected individuals. The mean length of total hospitalization was greater in HIV-infected patients (27.1 [13.3] versus 8.8 [5.3] days; P=.003), as was that of postoperative hospitalization (18.2 [15.4] vs 7.9 [4.2] days; P=.08). No HIV-infected patient died or needed a repeat cardiac operation. No progression of the HIV infection was observed. Isolated coronary artery surgery in HIV-infected patients produces good results, and there is no increase in morbidity or mortality. Extracorporeal circulation did not influence disease progression.

  12. 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

  13. 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

  14. 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

  15. 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

  16. Optic Nerve Injury Secondary to Endoscopic Sinus Surgery: an Analysis of Three Cases

    PubMed Central

    Kim, Jin Young; Kim, Hyun Jun; Kim, Chang-Hoon; Lee, Jeung-Gweon

    2005-01-01

    Major orbital complications after the endoscopic sinus surgeries are rare and of these, optic nerve injury is one of the most serious. This study was to undertaken to analyze 3 cases of optic nerve injury after endoscopic sinus surgery. The three cases included one patient with a loss of visual acuity and visual field defect, and two patients with total blindness. In all cases, no improvement of visual acuity was observed despite treatment. It is important to frequently check the location and direction of the endoscope during surgery to avoid optic nerve injury. In addition, surgeons must have a precise knowledge of the detailed anatomy through cadaver dissections, an ability to interpret the PNS CT scan and experienced procedural surgical skills. PMID:15861507

  17. 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…

  18. 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

  19. A rare case of Ramsay Hunt syndrome following temporomandibular joint surgery.

    PubMed

    Lehman, H; Rushinek, H

    2015-08-01

    Surgical approaches to the temporomandibular joint (TMJ) have been designed specifically to minimize injury to the temporal branch of the facial nerve. In spite of this, facial nerve dysfunction occurs in 1-32% of patients undergoing TMJ surgery. Ramsay Hunt syndrome is characterized by peripheral facial paralysis that often involves other cranial nerves, mostly cranial nerve VIII. The pathology is attributed to the reactivation of latent varicella zoster virus in the geniculate ganglion. The diagnosis is based mostly on history and physical findings. Surgical procedures have been known to reactivate varicella zoster virus, but Ramsay Hunt syndrome subsequent to TMJ surgery has not been described yet. This report describes a case of Ramsay Hunt syndrome associated with TMJ surgery. Because of the relatively high incidence of facial nerve dysfunction associated with TMJ surgery, patients with varicella zoster virus reactivation may initially be misdiagnosed with iatrogenic facial palsy, or vice versa.

  20. Epinephrine-induced lactic acidosis in orthognathic surgery: a report of two cases

    PubMed Central

    2016-01-01

    Submucosal infiltration and the topical application of epinephrine as a vasoconstrictor produce excellent hemostasis during surgery. The hemodynamic effects of epinephrine have been documented in numerous studies. However, its metabolic effects (especially during surgery) have been seldom recognized clinically. We report two cases of significant metabolic effects (including lactic acidosis and hyperglycemia) as well as hemodynamic effects in healthy patients undergoing orthognathic surgery with general anesthesia. Epinephrine can induce glycolysis and pyruvate generation, which result in lactic acidosis, via β2-adrenergic receptors. Therefore, careful perioperative observation for changes in plasma lactate and glucose levels along with intensive monitoring of vital signs should be carried out when epinephrine is excessively used as a vasoconstrictor during surgery. PMID:27847739

  1. Rare and massive odontogenic parakeratotic cyst treated by endoscopic sinus surgery: a case report

    PubMed Central

    2014-01-01

    Introduction Keratocystic odontogenic tumors are benign neoplasms of odontogenic origin with a potential for aggressive and infiltrative behavior. Many different treatments for this type of lesion have been reported. However, no common consensus has emerged to date regarding the most effective therapeutic approach. Cases of maxillary sinus giant keratocystic odontogenic tumors completely excised by enucleation or marsupialization via endoscopic sinus surgery are extremely rare, and, to the best of our knowledge, only one case has been described in the literature since 2005. Case presentation We report a case of a 24-year-old Italian man who came to our department with maxillary sinus region swelling, pain and left nasal obstruction. A massive keratocystic odontogenic tumor involving the right maxillary sinus and causing focal erosions of the bony walls was diagnosed. The keratocystic odontogenic tumor was removed as much as possible by a transnasal approach using endoscopic sinus surgery, which produced optimal surgical and prognostic outcomes. Follow-up is reported for an 8-year period. Conclusion Conservative management in this case demonstrated good therapeutic efficacy with a low risk of recurrence. For injuries involving the maxillary sinus, the possibility of decompression or marsupialization by endoscopic sinus surgery should always be considered because it demonstrated the potential to lead to excellent results even after 8 years of follow-up in our patient. To our knowledge, no case report has described follow-up longer than 8 years for a maxillary sinus keratocystic odontogenic tumor treated with endoscopic sinus surgery. PMID:25193270

  2. 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 ...

  3. Major surgery in an osteosarcoma patient refusing blood transfusion: case report

    PubMed Central

    2010-01-01

    We describe an unusual case of osteosarcoma in a Jehovah's Witness patient who underwent chemotherapy and major surgery without the need for blood transfusion. This 16-year-old girl presented with osteosarcoma of the right proximal tibia requiring proximal tibia resection, followed by endoprosthesis replacement. She was successfully treated with neoadjuvant chemotherapy and surgery with the support of haematinics, granulocyte colony-stimulating factor, recombinant erythropoietin and intraoperative normovolaemic haemodilution. This case illustrates the importance of maintaining effective, open communication and exploring acceptable therapeutic alternative in the management of these patients, whilst still respecting their beliefs. PMID:21059231

  4. Alveolar recruitment maneuver in refractory hypoxemia and lobar atelectasis after cardiac surgery: A case report

    PubMed Central

    2012-01-01

    Objective This case report describes an unusual presentation of right upper lobe atelectasis associated with refractory hypoxemia to conventional alveolar recruitment maneuvers in a patient soon after coronary artery bypass grafting surgery. Method Case-report. Results The alveolar recruitment with PEEP = 40cmH2O improved the patient’s atelectasis and hypoxemia. Conclusion In the present report, the unusual alveolar recruitment maneuver with PEEP 40cmH2O showed to be safe and efficient to reverse refractory hypoxemia and uncommon atelectasis in a patient after cardiac surgery. PMID:22726992

  5. Regenerative therapy as an adjunct to periapical surgery: a case report.

    PubMed

    Chaturvedy, Vivek; Chaturvedy, Shefali

    2012-01-01

    Large periapical defects may adversely affect the success rate of endodontic surgery. Use of regenerative therapy may enhance the prognosis of such teeth. A case of traumatized upper anterior teeth with infected radicular cyst and associated sinus tract reported to the dental hospital. A periradicular surgical procedure was performed to remove the nonhealing pathological tissue. To augment the repair a bioactive bone graft material was placed. Six months interim results showed positive outcome of application of graft. How to cite this article: Chaturvedy V, Chaturvedy S. Regenerative Therapy as an Adjunct to Periapical Surgery: A Case Report. Int J Clin Pediatr Dent 2012;5(1):75-77.

  6. A Case of Proliferative Retinopathy Complicated with Tuberous Sclerosis Treated by Vitreous Surgery

    PubMed Central

    Nemoto, Emika; Morishita, Seita; Akashi, Mari; Kohmoto, Ryohsuke; Fukumoto, Masanori; Suzuki, Hiroyuki; Kobayashi, Takatoshi; Kida, Teruyo; Sugasawa, Jun; Ikeda, Tsunehiko

    2016-01-01

    We report a case of proliferative retinopathy complicated with retinal hamartoma in a tuberous sclerosis patient. This study involved a 16-year-old female patient who was diagnosed as having tuberous sclerosis at birth. Ophthalmic examination revealed retinal hamartoma surrounding the optic disc in both eyes. Vitreous surgery involving a vitrectomy and resection of the proliferative membranes was performed for proliferative retinopathy in her right eye. Postoperative fundus findings showed improvement and decreased exudative changes. The proliferative and exudative changes appeared to be due to the retinal hamartoma, and vitreous surgery proved effective in this case. PMID:28101046

  7. 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

  8. 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

  9. 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

  10. 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…

  11. Metastatic virilizing adrenocortical carcinoma: a rare case of cure with surgery and mitotane therapy.

    PubMed

    Chalasani, Sreelatha; Vats, Hemender Singh; Banerjee, Tarit K; McKenzie, Alan K

    2009-06-01

    A 57-year-old white woman with metastases to lungs and liver from virilizing adrenocortical carcinoma (ACC) was treated with radical nephroadrenalectomy followed by oral mitotane 3 to 6 g/day for 5 months. She developed complete response and remained free of disease for more than 25 years. Here we present the case and review the literature. ACC is a rare tumor and may occur at any age. About 60% are functional tumors with hormonal secretions and clinical manifestations due to specific hormone secretions: Cushing's syndrome due to cortisone, virilizing tumor due to androgens, feminizing tumor due to estrogens, or hypertension due to aldosterone. Stage I and II disease is curable with surgery. Stage III and IV disease may benefit from mitotane orally with gradual adjustment of the dosage to a tolerable level. Plasma mitotane level at 14 to 20 g/L results in optimal response both in hormonal secretion and symptom control, as well as tumor regression. Addition of chemotherapy (streptozotocin or a combination of etoposide, cisplatin and doxorubicin) to mitotane also produced responses along with increased survival among responders. An international study has been started by randomizing between two of the above combinations by the Collaborative Group for Adrenocortical Carcinoma Treatment.

  12. 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

  13. A case study of infant physiologic response to skin-to-skin contact following surgery for complex congenital heart disease

    PubMed Central

    Harrison, Tondi M.; Ludington-Hoe, Susan

    2014-01-01

    Background Infants with complex congenital heart disease requiring surgical intervention within the first days or weeks of life may be the most seriously ill infants needing intensive nursing and medical care immediately after birth. Skin to skin contact (SSC) is well-accepted and practiced as a positive therapeutic intervention in premature infants, but is not routinely offered to infants in cardiac intensive care units. Physiologic effects of SSC in the congenital heart disease population must be examined before recommending incorporation of SSC into standard care routines. Objective The purpose of this case study was to describe the physiologic response to a single session of SSC in an 18-day-old infant with hypoplastic left heart syndrome. Methods Repeated measures of heart rate, respiratory rate, oxygen saturation, blood pressure, and temperature were recorded 30 minutes prior to SSC, during SSC (including interruptions for bottle and breast feedings), and 10 minutes after SSC was completed. Results All physiologic parameters were clinically acceptable throughout the 135-minute observation. Conclusion This case study provides beginning evidence that SSC is safe in full-term infants following surgery for complex congenital heart disease. Further research with a larger sample is needed to examine effects of SSC on infant physiology before surgery and earlier in the postoperative time period as well as on additional outcomes such as length of stay, maternal-infant interaction, and neurodevelopment. PMID:25325374

  14. [O-arm navigation in spinal surgery for complex cases].

    PubMed

    Pescador, D; Rendón, D; Blanco, J; González, R; Martín, J M; Cano-Gala, C; Pescador, D

    2016-01-01

    The intraoperative computer-assisted navigation technique has evolved and changed the way we approach certain complex cases in the vertebral pathologies. The main advantages of this technique are that it increases the accuracy of the procedure, reduces its morbidity and invasiveness, diminishes the radiation dose and improves surgical protocols. In addition to the transpedicular fixation, the navigation system is useful in a high variety of pathologies such as spinal decompression or tumor resection. In the present study, we show several cases where navigation is used intraoperatively in different pathologies and their clinical outcomes.

  15. Giant pseudomeningocele after spinal surgery: A case report

    PubMed Central

    Srilomsak, Prepram; Okuno, Kazuma; Sakakibara, Toshihiko; Wang, Zhuo; Kasai, Yuichi

    2012-01-01

    Very few reports have described giant pseudomeningoceles ≥ 8 cm in diameter. We report this case of the biggest giant pseudomeningocele at the unusual cervicothoracic level. A 59 year old man who underwent cervicothoracic laminectomy had a giant pseudomeningocele detected and the lesion gradually grew to about 15 cm in diameter by 2 years postoperatively. Cerebrospinal fluid leak closure was performed and the postoperative course was favorable. We present this case, review the literature and discuss the size and portion, mechanism of formation, symptoms and treatments of giant pseudomeningocele. PMID:22816066

  16. [A case report of a recurrence of Mooren's ulcer after cataract surgery].

    PubMed

    Schweitzer, C; Touboul, D; Ghiringhelli, C; Colin, J

    2007-03-01

    We report the case of Mooren's ulcer recurrence after uncomplicated cataract surgery in a 61-year-old woman. This cataract developed because of repetitive inflammation of the anterior chamber and corticotherapy. Local and general corticotherapy with cyclosporin 2% drops was started in association with an anterior lamellar graft and a conjunctival recession due to a preperforation condition. Secondarily cyclophosphamide was necessary to control recurrence with a good anatomic result and an increase in visual acuity. The case updates physiopathologic and diagnostic data on this rare limbic autoimmune ulcerative disease. The diagnosis was made by histology and the dosage of specific autoantibodies against cornea. The prevention of recurrence after surgery requires a long clinical quiescent period, minimally invasive surgery long after inflammation has subsided, and a gradual tapering of corticotherapy over several weeks.

  17. [Laparoscopic nephron-sparing surgery for Wilms tumor: description of two cases].

    PubMed

    López, L; Copete, M; Villamizar, P

    2016-01-25

    Surgical resection is the mainstay of treatment for Wilms tumor. The research progress of the large study groups worldwide has reduced mortality. However, searching to minimize morbidity, the minimally invasive approach has been applied in selected patients. This article describes two cases of Wilms tumor managed with laparoscopic nephron sparing surgery. The case 1 with Beckwith-Wiedemann syndrome and bilateral disease, and the case 2 non-syndromic unilateral. The approach was intraperitoneally, without intraoperative complications. The follow-up to 18 months (case 1) and six months (case 2) did not have recurrence or metastatic disease.

  18. Revision surgery of irreducible atlantoaxial dislocation: a retrospective study of 16 cases.

    PubMed

    Tan, Mingsheng; Jiang, Xin; Yi, Ping; Yang, Feng; Tang, Xiangsheng; Hao, Qingying; Zhang, Guangbo

    2011-12-01

    There is lack data concerning anterior cervical spine revision surgeries; even more data are missing concerning posterior cervical revision surgeries, to determine the feasibility, safety, and clinical efficacy of revision surgery for irreducible atlantoaxial dislocation (RS-IAAD). Patients with IAAD-FS underwent one-stage transoral release and posterior reduction. Their medical history was documented in detail. The JOA score system was used to evaluate each patient's neurological status pre and postoperatively, and serial MRI and radiographs were used to determine the status of the reduction and the autografts. 16 patients (average age, 36 years old) underwent successful surgery. There was no intraoperative or postoperative neurological deficit except in two cases that suffered transient neurological deficit that alleviated after conservative treatment. Solid bony union was seen at the end of 3 months after surgery in all patients. The mean follow-up period was 28.8 months (range 18-66 months). No pseudarthrosis was noted. Anterior transoral release and posterior instrumented fusion remain significant surgeries with the potential for serious complications, but in the current series there were no major complications.

  19. Propranolol therapy for cutaneous infantile haemangiomas initiated safely as a day-case procedure.

    PubMed

    McSwiney, Edward; Murray, Deirdre; Murphy, Michelle

    2014-01-01

    Propranolol is emerging as the treatment of choice for high-risk infantile haemangiomas. Current protocols recommend overnight admission for initiation of propranolol as well as baseline investigations including electrocardiography (ECG) and echocardiography (ECHO). Our study examined the safety profile of propranolol for the treatment of infantile haemangiomas using a simplified day-case initiation protocol. We evaluated 20 consecutive patients commencing propranolol as a day case for the treatment of an infantile haemangioma over an 18-month period. Investigations were carried out according to our local protocol. Cardiac investigations were not routinely performed. Patients were observed for 2 h following administration of the first dose of propranolol (0.5 mg/kg orally). If no adverse effects were observed, patients were discharged on a daily dose of propranolol of 1 mg/kg, increased to 2 mg/kg on day 4. Patients were reviewed on the day ward on day 8. All haemangiomas requiring treatment were small to moderate in size (median maximum diameter 2.35 cm). Except for capillary blood glucose measurement, no patient required venepuncture for additional blood investigations. As all patients had a normal clinical examination, none required ECHO. An ECG was performed on just one patient. No adverse reactions were observed following administration of propranolol. All patients were discharged home on the same day. No serious adverse events were reported at follow-up. We demonstrate that with targeted cardiac screening, propranolol can be safely initiated on a day-case basis for the treatment of small- to moderate-sized infantile haemangiomas.

  20. Necrotizing Soft Tissue Infection or Sweet Syndrome: Surgery Versus No Surgery?: A Case Report.

    PubMed

    Otero, Tiffany M N; Barber, Samuel R; Yeh, D Dante; Quraishi, Sadeq A

    2017-02-01

    The authors report a case of necrotizing Sweet syndrome in a 24-year-old transsexual male who presented with recurrent myonecrosis of the neck/upper chest. On index admission, computer tomography revealed gas and fat stranding of the sternocleidomastoid and pectoralis major muscle-findings suggestive of a necrotizing soft tissue infection. Despite debridement procedures and intravenous antibiotic therapy, myonecrosis of the affected areas persisted. Evaluation of tissue samples by dermatopathology revealed neutrophilic infiltration extending into the dermis and muscle necrosis, findings consistent with necrotizing Sweet syndrome. The initiation of IV corticosteroids, the gold-standard treatment for necrotizing Sweet syndrome, lead to significant clinical improvement. When soft tissue infections do not respond to debridement and broad-spectrum antimicrobial coverage, perioperative care providers should consider necrotizing Sweet syndrome as an underlying cause. By facilitating the early diagnosis and appropriate management of unique conditions such as necrotizing Sweet syndrome, anesthesiologists can not only play a more visible role as leaders in the emerging perioperative surgical home model, but they may also prevent significant patient morbidity and reduce unnecessary utilization of health care resources.

  1. The surgery and early postoperative radicular pain in cases with multifocal lumbar disc herniation

    PubMed Central

    Ulutaş, Murat; Çınar, Kadir; Seçer, Mehmet

    2017-01-01

    Abstract Persistence of postoperative radicular pain after surgery for multifocal disc herniation (MFDH) is a clinical problem. This study aims to evaluate the effects of a combined treatment approach compared with unilateral stabilization on early postoperative radicular pain in patients with MFDH. Age, sex, level of operation, clinical findings, and radicular pain visual analogue scale (VAS) scores before surgery in the early postoperative period and at 3 months after surgery were retrospectively reviewed for 20 cases of multifocal lumbar disc herniation. The combined approach (translaminar and far lateral) was used for 13 cases. Seven cases underwent transforaminal lumbar interbody fusion (TLIF) and unilateral transpedicular stabilization following total facetectomy. The mean age of the sample was 49.4 ± 10.1 years and the female-to-male ratio was 8:12. The mean VAS scores for radicular pain in cases treated with the combined approach were 8.2, 4.07, and 2.3 in the preoperative and early postoperative periods and 3 months after surgery, respectively. The mean score for radicular pain improved by 50.4% in the early postoperative period and by 72% in the late postoperative period. The mean VAS scores for radicular pain in cases who underwent TLIF and unilateral stabilization after facetectomy were 8.4, 2.1, and 1.4 in the preoperative and early postoperative periods and 3 months after surgery, respectively. The mean VAS score for radicular pain improved by 75% in the early postoperative period and by 83.3% in the late postoperative period. The combined approach is an effective alternative in cases with MFDH. TLIF and unilateral segmental stabilization provide substantial decompression and eliminate mechanical compression by conserving the height of the intervertebral foramen in the event that sufficient decompression is unable to obtain. We suggest that elimination of chemical mediators, particularly those causing pain in the dorsal ganglion, contributes to

  2. The surgery and early postoperative radicular pain in cases with multifocal lumbar disc herniation.

    PubMed

    Ulutaş, Murat; Çınar, Kadir; Seçer, Mehmet

    2017-03-01

    Persistence of postoperative radicular pain after surgery for multifocal disc herniation (MFDH) is a clinical problem. This study aims to evaluate the effects of a combined treatment approach compared with unilateral stabilization on early postoperative radicular pain in patients with MFDH.Age, sex, level of operation, clinical findings, and radicular pain visual analogue scale (VAS) scores before surgery in the early postoperative period and at 3 months after surgery were retrospectively reviewed for 20 cases of multifocal lumbar disc herniation. The combined approach (translaminar and far lateral) was used for 13 cases. Seven cases underwent transforaminal lumbar interbody fusion (TLIF) and unilateral transpedicular stabilization following total facetectomy.The mean age of the sample was 49.4 ± 10.1 years and the female-to-male ratio was 8:12. The mean VAS scores for radicular pain in cases treated with the combined approach were 8.2, 4.07, and 2.3 in the preoperative and early postoperative periods and 3 months after surgery, respectively. The mean score for radicular pain improved by 50.4% in the early postoperative period and by 72% in the late postoperative period. The mean VAS scores for radicular pain in cases who underwent TLIF and unilateral stabilization after facetectomy were 8.4, 2.1, and 1.4 in the preoperative and early postoperative periods and 3 months after surgery, respectively. The mean VAS score for radicular pain improved by 75% in the early postoperative period and by 83.3% in the late postoperative period.The combined approach is an effective alternative in cases with MFDH. TLIF and unilateral segmental stabilization provide substantial decompression and eliminate mechanical compression by conserving the height of the intervertebral foramen in the event that sufficient decompression is unable to obtain. We suggest that elimination of chemical mediators, particularly those causing pain in the dorsal ganglion, contributes to the absence

  3. Day-case laparoscopic cholecystectomy: analysis of the factors allowing early discharge.

    PubMed

    Tebala, Giovanni Domenico; Belvedere, Angela; Keane, Sean; Khan, Abdul Qayyum; Osman, Abdelsalam

    2017-03-21

    Despite a number of studies have already demonstrated that majority of patients can be safely discharged early after laparoscopic cholecystectomy, this approach did not gain widespread diffusion yet. The present study was set up to assess safety and feasibility of 24 h or same-day discharge after laparoscopic cholecystectomy and to identify the prognostic factors. Perioperative variables of 229 patients undergoing cholecystectomy have been analyzed. Primary endpoints were: postoperative length of stay, rate of patients discharged within 24 h, and rate of those discharged on the same day. Secondary endpoints were rate of 30-day readmission and rate of 30-day postoperative complications. Two-hundred twenty-three cases have been started by laparoscopy. Conversion rate was 3.1%. Overall mean postoperative stay was 1.8 ± 3.5 days (median 1 day). Seventy-eight percent of patients have been discharged within 24 h, and 22.3% have been discharged on the same day. Postoperative morbidity was 2.2%. Readmission rate was 3.9%. At univariate analysis, factors related to early discharge were age (more or less than 65), diagnosis (simple symptomatic gallstones vs complicated gallstones), ASA score, timing of operation (elective vs emergency), history of CBD stones, laparoscopic operation, and use of drain. No single factor was significantly related to readmission rate, but the use of drains in laparoscopic cases. At multivariate analysis, only elective operation, simple symptomatic gallstones, no history of CBD stones, laparoscopic approach, and no abdominal drain resulted independently associated with discharge within 24 h from the operation. The predictive models are all fit and significant. Early postoperative discharge within 24 h should be considered in all patients with simple symptomatic gallstones who had laparoscopic cholecystectomy. Same-day discharge should be considered if no drain was left at the end of the operation.

  4. Quadratus Lumborum Block as an Alternative to Lumbar Plexus Block for Hip Surgery: A Report of 2 Cases.

    PubMed

    La Colla, Luca; Ben-David, Bruce; Merman, Rita

    2017-01-01

    Quadratus lumborum (QL) block was first described several years ago, but few articles have been published regarding this technique, for the most part case series involving abdominal surgery. We report 2 cases of prolonged, extensive block of thoracic and lumbar dermatomes after QL block in patients undergoing different hip surgery procedures for whom QL block was used in place of lumbar plexus block. Further prospective studies comparing these 2 techniques are necessary to better characterize the role of QL block in hip surgery.

  5. Air embolism during off-pump coronary artery bypass graft surgery -A case report-.

    PubMed

    Chang, Choo-Hoon; Shin, Young Hee; Cho, Hyun-Sung

    2012-07-01

    There have been several reports of gas embolism occurring during off-pump coronary artery bypass graft (OPCAB) surgery. However, all these cases of air embolism were associated with the repair of venous circulation, using a CO(2) blower. In this report, we describe a rare case of air embolism in the coronary arteries associated with the use of a CO(2) blower during OPCAB. There was no injury to the veins during OPCAB. The air embolism was treated successfully with cardiopulmonary bypass.

  6. Temporomandibular joint ankylosis surgery in a child: case report.

    PubMed

    Lima, Paulo Valério Presser; Kramer, Paulo Floriani; Ioppi, Letícia; Hoffmann, Renata da Rocha

    2011-07-01

    Temporomandibular joint ankylosis is one of the most significant disorders of the stomatognathic system because it causes pain associated with severe functional limitations, such as difficulty in chewing and psychological and clinical problems due to poor oral hygiene. These disorders are quite significant in children, since the treatment is even more complex due to the fact that the condylar region is a site of active growth. The earlier the diagnosis is established, the better the treatment prognosis. Ankylosis can be treated by interposition arthroplasty of the temporalis muscle fascia in conjunction with ipsilateral coronoidectomy. The purpose of the present study was to report a clinical case of temporomandibular joint ankylosis in a pediatric patient treated by interposition arthroplasty of the temporalis muscle fascia associated with coronoidectomy.

  7. Pulmonary Embolism Following Laparoscopic Antireflux Surgery: A Case Report and Review of the Literature

    PubMed Central

    Luketich, James D.; Friedman, David M.; Ikramuddin, Sayeed; Schauer, Phil R.

    1999-01-01

    Deep venous thrombosis and pulmonary embolism are concerning causes of morbidity and mortality in patients undergoing general surgical procedures. Laparoscopic surgery has gained rapid acceptance in the past several years and is now a commonly performed procedure by most general surgeons. Multiple anecdotal reports of pulmonary embolism following laparoscopic cholecystectomy have been reported, but the true incidence of deep venous thrombosis and pulmonary embolism in patients undergoing laparoscopic surgery is not known. We present a case of pulmonary embolism following laparoscopic repair of paraesophageal hernia. The literature is then reviewed regarding the incidence of pulmonary embolism following laparoscopic surgery, the mechanism of deep venous thrombosis formation, and the recommendations for deep venous thrombosis prophylaxis in patients undergoing laparoscopic procedures. PMID:10444017

  8. Wernicke Encephalopathy in Adolescents After Bariatric Surgery: Case Report and Review.

    PubMed

    Armstrong-Javors, Amy; Pratt, Janey; Kharasch, Sigmund

    2016-12-01

    Roughly 1% of all weight loss surgery is performed in adolescents. There is strong evidence demonstrating significant postsurgical weight loss, improvement in quality of life, and reduction in comorbidities such as hypertension and diabetes. Reports of postoperative complications in adolescents are few because of the small sample size in most series. Despite vitamin supplementation, nutritional deficiencies requiring hospitalization occur occasionally after Roux-en-Y gastric bypass. Wernicke encephalopathy, a triad of ophthalmoplegia, ataxia, and altered mental status, is a serious consequence of thiamine (vitamin B1) deficiency. Few cases of Wernicke encephalopathy after weight loss surgery have been reported in the literature and even fewer in the pediatric population. Here we describe a teenage girl who develops vomiting after Roux-en-Y gastric bypass and presented with nystagmus, irritability, and ataxia. The clinical presentation, diagnosis, and treatment of Wernicke encephalopathy in adolescents after bariatric surgery are discussed.

  9. [Abdominal aortic aneurysm treated by endovascular surgery: a case report].

    PubMed

    Alconero-Camarero, Ana Rosa; Cobo-Sánchez, José Luis; Casaus-Pérez, María; García-Campo, María Elena; García-Zarrabeitia, María José; Calvo-Diez, Marta; Mirones-Valdeolivas, Luz Elena

    2008-01-01

    An aneurysm is an abnormal dilation or irreversible convex of a portion of an artery. The most common site of aneurysms is the abdominal aorta and their appearance is often due to degeneration of the arterial wall, associated with atherosclerosis and favored by risk factors such as smoking and hypertension, among others. Left untreated, aneurysm of the abdominal aorta usually leads to rupture. Treatment is surgical, consisting of the introduction of a prosthesis, composed basically of a stent and an introducer, into the aorta. We report the case of a person diagnosed with abdominal aortic aneurysm in a routine examination who was admitted for ambulatory surgical treatment. We designed a nursing care plan, following Virginia Henderson's conceptual model. The care plan was divided into 2 parts, a first preoperative phase and a second postimplantation or monitoring phase. The care plan contained the principal nursing diagnoses, based on the taxonomies of the North American Nursing Diagnosis Association (NANDA), nursing interventions classification (NIC) and nursing outcomes classifications (NOC), and collaboration problems/potential complications. The patient was discharged to home after contact was made with his reference nurse in the primary health center, since during the hospital phase, some NOC indicators remained unresolved.

  10. 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

  11. Left-Sided Inferior Vena Cava Encountered During Organ Retrieval Surgery: Report of Two Cases

    PubMed Central

    Rajabnejad, Y.; Aliakbarian, M.; Rajabnejad, A.; Motie, M. R.

    2016-01-01

    Left-sided inferior vena cava (IVC) is the second most common anatomical anomaly of the IVC after duplication. Herein, we present two cases of left-sided IVC, diagnosed during organ retrieval procedure. In a young brain-dead man, a single left-sided IVC was observed; it originated from iliac confluence in the left side of the aorta and extended throughout the abdomen. There was no retrohepatic IVC in the patient; hepatic veins drained directly into the right atrium. The second case was a brain-dead young woman with a left-sided IVC originated from iliac confluence to the kidney level; then, the IVC crossed anterior to the abdominal aorta to join a normally positioned retrohepatic IVC. In cases of retroperitoneal surgeries, IVC anomalies should be considered during preoperative imaging studies, because they may be misdiagnosed as para-aortic lymphadenopathy, tumor or dilated gonadal vein that may result in iatrogenic damage during surgery. PMID:28078062

  12. 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.

  13. Persistent cough associated with osteophyte formation and vagus nerve impingement following cervical spinal surgery: case report.

    PubMed

    Orhan, Kadir Serkan; Acar, Senol; Ulusan, Murat; Aydoseli, Aydın; Güldiken, Yahya

    2013-08-01

    Persistent cough due to irritation of the vagus nerve by osteophytes resulting from cervical spinal surgery is a very rare condition. The authors report the case of a 49-year-old woman who presented with a persistent cough subsequent to cervical spinal surgery. One year after the initial operation, the patient underwent surgery to free the larynx from the prevertebral fascia and cut the pharyngeal plexus, but her symptoms persisted. In order to control the cough, she used a soft cervical collar with padding inserted in the left side so that the larynx would be pushed to the right, a solution she discovered on her own. Without the collar, she coughed uncontrollably. A CT scan was performed and showed an osteophyte that had developed at the level of the prosthesis. Based on these findings, the authors hypothesized that the cough was caused by vagus nerve irritation due to the osteophyte. The osteophyte was resected and the vagus nerve was moved to a position anterior to the carotid artery and was isolated by means of an autogenous tensor fascia lata graft. The patient's symptom disappeared immediately after the surgery. At the most recent follow-up visit, 18 months after surgery, the patient was symptom free and was pursuing regular daily activities without using a cervical collar.

  14. [Usefulness of reductive surgery for elderly advanced breast cancer with bone metastases - a case report].

    PubMed

    Sakurai, Kenichi; Fujisaki, Shigeru; Nagashima, Saki; Maeda, Tetsuyo; Tomita, Ryouichi; Suzuki, Shuhei; Hara, Yukiko; Hirano, Tomohiro; Enomoto, Katsuhisa; Amano, Sadao

    2014-11-01

    We report the case of an elderly, advanced breast cancer patient with multiple bone metastases. Breast reduction surgery was useful for this patient. The patient was an 81-year-old woman who had a breast lump. A core needle biopsy for breast cancer led to a diagnosis of invasive ductal carcinoma. The mucinous carcinoma was estrogen receptor (ER) nd progesterone receptor (PgR) positive and HER2/neu negative. Due to patient complications, it was not possible to treat with chemotherapy. The patient was administrated aromatase inhibitors (AI) and zoledronic acid hydrate. However, the AI treatment was not effective, and so she was administered toremifene. Toremifene treatment was effective for 6 months, after which she received fulvestrant. Fulvestrant treatment maintained stable disease (SD)for 14 months. After 14 months of fulvestrant treatment, serum concentrations of the tumor markers CA15-3, CEA, and BCA225 increased. We therefore decided to perform surgical breast reduction surgery. The pathological diagnosis from the surgically resected specimen was mucinous carcinoma, positive for ER and HER2, and negative for PgR. After surgery, serum concentrations of the tumor markers decreased. Following surgery, the patient was administrated lapatinib plus denosumab plus fulvestrant. The patient remains well, without bone metastases, 2 years and 6 months after surgery.

  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

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

    2016-09-01

    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.

  16. No evidence for race and socioeconomic status as independent predictors of 30-day readmission rates following orthopedic surgery.

    PubMed

    Hunter, Tracey; Yoon, Richard S; Hutzler, Lorraine; Band, Philip; Liublinksa, Victoria; Slover, James; Bosco, Joseph A

    2015-01-01

    The Centers for Medicare & Medicaid Services considers readmissions within 30 days of discharge to be a quality indicator. Hospitals' and eventually physicians' readmission rates will be used to determine payment for services. It is imperative that health care providers understand which patients are at risk for readmission so that they can apply the appropriate preventive interventions. The research team analyzed all orthopedic admissions and readmissions at their institution from September 2008 to April 2011 in this study. Preparing for the next stage in health care reform, identifying any preoperative factors that may place certain patients into a "high-risk" category for readmission following an orthopedic procedure is of paramount importance. This data analysis of more than 13 000 patients noted that race-based and income-based risk factors did not translate into significant risk factors or predictors of 30-day readmission following orthopedic admission.

  17. Cyst decreased in size post maxillary sinus floor augmentation surgery in diabetic patient: A case report

    PubMed Central

    Zhang, Sijia; Song, Yingliang; Wei, Hongbo; Ren, Shuai

    2015-01-01

    Introduction Whether mucosal cyst of maxillary sinus is contraindication for sinus floor augmentation surgery has been a controversial hot spot for years. Presentation of case This case aims to present the surgical procedure of sinus floor augmentation surgery with cyst (18.72 mm × 24.61 mm) in diabetic patient. And 6 months later, the cyst decreased in size. The authors elevated the sinus floor and cyst simultaneously. The surgery was carried out successfully without sinus membrane perforation and the alveolar ridge gained about 8 mm height. Six months later, the cyst decreased in size and osseointegration was observed. Discussion Interdisciplinary cooperation is encouraged to diagnose benign mucosal cyst. The isolation between sinus lumen and the grafted sub-sinus space is important. Graft contamination or dispersion into the sinus lumen should be avoided. The integrity of the sinus membrane and use of antibiotics are very important to prevent the occurrence of postoperative sinus infection Conclusion The authors conclude that sinus augmentation surgery could be done with mucosal cyst in diabetic patient. PMID:26479781

  18. Coronary artery bypass surgery in a patient with Kartagener syndrome: a case report and literature review.

    PubMed

    Bougioukas, Ioannis; Mikroulis, Dimitrios; Danner, Bernhard; Lawal, Lukman; Eleftheriadis, Savvas; Bougioukas, George; Didilis, Vassilios

    2010-08-26

    Kartagener syndrome consists of congenital bronchiectasis, sinusitis, and total situs inversus in half of the patients. A patient diagnosed with Kartagener syndrome was referred to our department due to 3-vessel coronary disease. An off-pump coronary artery bypass operation was performed using both internal thoracic arteries and a saphenous vein graft. We performed a literature review for cases with Kartagener syndrome, coronary surgery and dextrocardia. Although a few cases of dextrocardia were found in the literature, no case of Kartagener syndrome was mentioned.

  19. Clinical Characteristics of Streptococcus Pneumoniae Meningoencephalitis after Transsphenoidal Surgery: Three Case Reports

    PubMed Central

    KOBAYASHI, Nobuyuki; FUKUHARA, Noriaki; FUKUI, Takahito; YAMAGUCHI-OKADA, Mitsuo; NISHIOKA, Hiroshi; YAMADA, Shozo

    2014-01-01

    We report three extremely rare cases of Streptococcus pneumoniae meningoencephalitis (SPM) after transsphenoidal surgery (TSS). Between 2004 and 2010, we experienced three cases of severe SPM after surgery out of 1,965 patients undergoing TSS (0.15%). The three cases included a 4-year-old boy with a large cystic craniopharyngioma, a 40-year-old man with a non-functioning pituitary adenoma, and a 55-year-old man with acromegaly. The similarity among these SPM patients was that severe clinical events occurred suddenly 1–2 months postoperatively without any history of sinusitis or pneumonia. Despite intensive care these patients notably had residual neurological sequelae. In no case was rhinorrhea associated with SPM. It should be noted that SPM was not detected from bacterial cultures of the sphenoidal sinus mucous membranes (BCSM) obtained during TSS in two of the patients examined. Severe postoperative SPM can occur suddenly without cerebrospinal fluid (CSF) leakage within 2 months after surgery and requires emergency treatment. Reduced resistance to infection may play a role in the occurrence of SPM in our three patients. Our study indicates that BCSM is not useful for predicting postoperative meningitis. PMID:24418784

  20. Anesthesia management of surgery for sigmoid perforation and acute peritonitis patient following heart transplantation: case report.

    PubMed

    Yang, Xu-Li; Dai, Shu-Hong; Zhang, Juan; Zhang, Jing; Liu, Yan-Jun; Yang, Yan; Sun, Yu-E; Ma, Zheng-Liang; Gu, Xiao-Ping

    2015-01-01

    Here we described a case in which a patient underwent emergency laparotomy for acute peritonitis and sigmoid perforation under general anesthesia with a history of heart transplantation. A good knowledge in the physiology of the transplanted heart is critical for effective and safe general anesthesia. We chose etomidate that have a weaker impact on cardiovascular function plus propofol for induction, and propofol plus cisatracurium for maintenance with intermittently analgesics and vasoactive drugs to facilitate the anesthesia. In addition, fluid input, electrolyte and acid-base balance were well adjusted during the whole procedure. The patient was in good condition after the surgery. In this case report we are aiming to provide some guidance for those scheduled for non-cardiac surgery after heart transplant.

  1. Rotationplasty after failed limb-sparing tumor surgery: a report of two cases.

    PubMed

    Brigman, Brian E; Kumagai, Steven G; McGuire, Michael H

    2003-10-01

    Rotationplasty was used in two cases of failed limb salvage in adults after tumor resection and reconstruction. Each patient had distal femoral osteosarcoma, one treated with osteoarticular allograft reconstruction, the other with a custom endoprosthetic reconstruction. Both patients had failure attributable to infection, and after multiple surgeries, elected to have rotationplasty. Both had complications associated with the rotationplasty but went on to have functional limbs with Musculoskeletal Tumor Society functional scores of 67% and 87%. One patient died of metastatic disease 29 months after rotationplasty, the other had no problems 50 months after rotationplasty. Although rotationplasty offers a functional improvement over transfemoral amputation in the salvage of failed tumor reconstructions, only 10 such cases have been reported in adults. Rotationplasty should be considered in selected patients for whom an amputation is being considered after failed limb salvage surgery.

  2. Anesthesia management of surgery for sigmoid perforation and acute peritonitis patient following heart transplantation: case report

    PubMed Central

    Yang, Xu-Li; Dai, Shu-Hong; Zhang, Juan; Zhang, Jing; Liu, Yan-Jun; Yang, Yan; Sun, Yu-E; Ma, Zheng-Liang; Gu, Xiao-Ping

    2015-01-01

    Here we described a case in which a patient underwent emergency laparotomy for acute peritonitis and sigmoid perforation under general anesthesia with a history of heart transplantation. A good knowledge in the physiology of the transplanted heart is critical for effective and safe general anesthesia. We chose etomidate that have a weaker impact on cardiovascular function plus propofol for induction, and propofol plus cisatracurium for maintenance with intermittently analgesics and vasoactive drugs to facilitate the anesthesia. In addition, fluid input, electrolyte and acid-base balance were well adjusted during the whole procedure. The patient was in good condition after the surgery. In this case report we are aiming to provide some guidance for those scheduled for non-cardiac surgery after heart transplant. PMID:26379997

  3. 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

  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. Piezosurgery in head and neck oncological and reconstructive surgery: personal experience on 127 cases

    PubMed Central

    Crosetti, E; Battiston, B; Succo, G

    2009-01-01

    Summary Piezoelectric bone surgery, known simply as piezosurgery, is a new technique of osteotomy and osteoplasty, which requires the use of microvibrations of ultrasonic frequency scalpels. The principle of piezosurgery is ultrasonic transduction, obtained by piezoelectric ceramic contraction and expansion. The vibrations thus obtained are amplified and transferred onto the insert of a drill which, when rapidly applied, with slight pressure, upon the bony tissue, results, in the presence of irrigation with physiological solution, in the cavitation phenomenon, with a mechanical cutting effect, exclusively on mineralized tissues. Personal experience with the use of piezosurgery in head and neck oncological and reconstructive surgery is relatively recent, having been developed in 2002-2006, and, so far, involves 127 cases; preliminary results are interesting and improving in the, hopefully, developmental phases of inserts with specific geometrics on account of the characteristics of the various aspects of surgical ENT operations. Furthermore, with piezoelectric surgery it has been possible to perform precise osteotomy lines, micrometric and curvilinear with absolute confidence, particularly in close proximity to the vessels and nerves and other important facial structures (dura mater). There can be no doubt, since this is a new cutting method, that piezosurgery involves a different learning curve compared to other techniques, requiring obstacles of a psychological nature to be overcome as well as that concerning surgical expertise. Given the numbers of cases treated and the relative power of this instrument, analysis of complications, intra-operative time (which would appear, on average, to be 20% longer) and, therefore, morbility, shows interesting potentiality of the technique. This new ultrasound cutting method will, no doubt, in the future, be increasingly used in ENT surgery, particularly with improvements in power and geometry of the inserts, with possible

  6. An unusual case of adrenocortical carcinoma with liver metastasis that occurred at 23 years after surgery

    PubMed Central

    Rayar, Michel; Beuzit, Luc; Levi Sandri, Giovanni Battista; Dagher, Julien; Merdrignac, Aude; Tanguy, Laetitia; Boudjema, Karim; Sulpice, Laurent; Meunier, Bernard

    2016-01-01

    Adrenocortical carcinoma (ACC) is an uncommon and aggressive cancer occurring more frequently in women; local or distant recurrences occur in 80% of cases, typically within 1 year after curative resection. Liver is the preferred metastatic site. Herein, we report the case of a unique liver metastasis from ACC occurring 23 years after the curative prior tumor surgery. A 45-year-old woman was operated in 1991 for adrenocortical stage II without microvascular involvement or capsular infiltration. At that time, no adjuvant treatment was indicated. The initial surgery consisted on a left adrenalectomy with contemporaneous left nephrectomy and regional lymphadenectomy. Five years after surgery, the patient was considered cured. However, 23 years later, the patient presented an atypical right subcostal pain. A 4 cm liver ACC metastasis involving the segment 4 and initially diagnosed as a hemangioma was discovered. A curative resection of the segment 4 was performed. Final pathological examination confirmed the diagnosis of ACC metastasis with a complete R0 resection; no lymph node metastases were observed. This case is the latest metachronous ACC metastasis ever reported in literature. To date, the patient is alive with no signs of recurrence after a post-surgical follow-up of 13 months. PMID:27275470

  7. Combined Soft and Hard Tissue Peri-Implant Plastic Surgery Techniques to Enhance Implant Rehabilitation: A Case Report

    PubMed Central

    Baltacıoğlu, Esra; Korkmaz, Fatih Mehmet; Bağış, Nilsun; Aydın, Güven; Yuva, Pınar; Korkmaz, Yavuz Tolga; Bağış, Bora

    2014-01-01

    This case report presents an implant-aided prosthetic treatment in which peri-implant plastic surgery techniques were applied in combination to satisfactorily attain functional aesthetic expectations. Peri-implant plastic surgery enables the successful reconstruction and restoration of the balance between soft and hard tissues and allows the option of implant-aided fixed prosthetic rehabilitation. PMID:25489351

  8. Robotic surgery of locally advanced gastric cancer: a single-surgeon experience of 41 cases.

    PubMed

    Vasilescu, C; Procopiuc, L

    2012-01-01

    The mainstay of curative gastric cancer treatment is open gastric resection with regional lymph node dissection. Minimally invasive surgery is yet to become an established technique with a well defined role. Robotic surgery has by-passed some of the limitations of conventional laparoscopy and has proven both safe and feasible. We present our initial experience with robotic surgery based on 41 gastric cancer patients. We especially wish to underline the advantages of the robotic system when performing the digestive tract anastomoses. We present the techniques of end-to-side eso-jejunoanastomoses (using a circular stapler or manual suture) and side-to-side eso-jejunoanastomoses. In our hands, the results with circular stapled anastomoses were good and we advocate against manual suturing when performing anastomoses in robotic surgery. Moreover, we recommend performing totally intracorporeal anastomoses which have a better post-operative outcome, especially in obese patients. We present three methods of realising the total intracorporeal eso-jejuno-anastomosis with a circular stapler: manual purse-string suture, using the OrVil and the double stapling technique. The eso-jejunoanastomosis is one of the most difficult steps in performing the total gastrectomy, but these techniques allow the surgeon to choose the best option for each case. We consider that surgeons who undertake total gastrectomies must have a special training in performing these anastomoses.

  9. Sparing Surgery for the Successful Treatment of Thyroid Papillary Carcinoma Invading the Trachea: A Case Report

    PubMed Central

    Kulbakin, Denis; Chekalkin, Timofey; Muhamedov, Marat; Choynzonov, Evgeniy; Kang, Ji-hoon; Kang, Seung-baik; Gunther, Victor

    2016-01-01

    Published reports on salvage treatment for trachea reconstruction after total thyroidectomy or partial tracheotomy are available, some of them using structures of the trachea itself, auricular cartilage, a musculocutaneous flap, or other methods. In our report, we emphasize the importance of a search for a new material and approach for sparing surgery. The purpose of this article is to describe a case of a successful sparing surgery in a patient with advanced thyroid papillary carcinoma invading the trachea. After total thyroidectomy in 2012, partial resection of the trachea was performed in 2014. The lesion defect was 5.5 × 2.3 cm in size, located between 4 (2nd–6th) tracheal cartilaginous rings and involving about a semicircumference. It was reconstructed with the aid of the knitted TiNi-based mesh endograft, which has been prefabricated in the sternocleidomastoid muscle and further covered with the skin draped over the wound. The tracheostoma was fully closed 6 weeks after the surgery. There were neither side effects nor complications. This kind of tracheal surgery for extensive lesions demonstrates good functional and cosmetic outcomes. PMID:27990114

  10. Cerebral oxygenation monitoring in patients with bilateral carotid stenosis undergoing urgent cardiac surgery: Observational case series

    PubMed Central

    Aktuerk, Dincer; Mishra, Pankaj Kumar; Luckraz, Heyman; Garnham, Andrew; Khazi, Fayaz Mohammed

    2016-01-01

    Background: Patients with significant bilateral carotid artery stenosis requiring urgent cardiac surgery have an increased risk of stroke and death. The optimal management strategy remains inconclusive, and the available evidence does not support the superiority of one strategy over another. Materials and Methods: A number of noninvasive strategies have been developed for minimizing perioperative stroke including continuous real-time monitoring of cerebral oxygenation with near-infrared spectroscopy (NIRS). The number of patients presenting with this combination (bilateral significant carotid stenosis requiring urgent cardiac surgery) in any single institution will be small and hence there is a lack of large randomized studies. Results: This case series describes our early experience with NIRS in a select group of patients with significant bilateral carotid stenosis undergoing urgent cardiac surgery (n = 8). In contrast to other studies, this series is a single surgeon, single center study, where the entire surgery (both distal ends and proximal ends) was performed during single aortic clamp technique, which effectively removes several confounding variables. NIRS monitoring led to the early recognition of decreased cerebral oxygenation, and corrective steps (increased cardiopulmonary bypass flow, increased pCO2, etc.,) were taken. Conclusion: The study shows good clinical outcome with the use of NIRS. This is our “work in progress,” and we aim to conduct a larger study. PMID:26750675

  11. Surgical glove perforation among nurses in ophthalmic surgery: a case-control study.

    PubMed

    Shek, Karen Mei-Yan; Chau, Janita Pak-Chun

    2014-04-01

    Many of the ophthalmic surgical instruments are extremely fine and sharp. Due to the dim light environment required for ophthalmic surgical procedures, the passing of sharp instruments among surgeons and scrub nurses also poses a risk for glove perforations. A case-control study was performed to determine the number and site of perforations in the surgical gloves used by a group of scrub nurses during ophthalmic surgery. All six nurses working in an eye and refractive surgery centre in Hong Kong participated in the study. A total of 100 (50 pairs) used surgical gloves were collected following 50 ophthalmic surgeries. Fifty pairs of new surgical gloves were also collected. Every collected surgical glove underwent the water leak test. The surgical procedure perforation rate was 8%, and none of the perforations were detected by the scrub nurses. No perforations were found in any unused gloves. The findings indicate that glove perforations for scrub nurses during ophthalmic surgery do occur and mostly go unnoticed. Future studies should continue to explore factors contributing to surgical glove perforation.

  12. Midazolam intravenous conscious sedation in oral surgery. A retrospective study of 372 cases.

    PubMed

    Runes, J; Ström, C

    1996-01-01

    In 1987 the Swedish Dental Act was amended to allow Swedish dentists who have undergone a specific accreditation course to administer intra-venous sedation. Midazolam is a benzodiazepin derivate with express sedative and hypnotic qualities, powerful amnesia, a short half-life time and few secondary effects. From 1989-1994 midazolam intravenous conscious sedation (ICS) was administered in 372 cases in the Department of Oral and Maxillofacial Surgery, County Hospital, Falun. This study presents data on the 298 patients. Although surgical removal of impacted wisdom teeth predominated, implant surgery, reduction of fractures and correction of anomalies were also carried out. Supplementary sedative premedication was rarely used. Most patients were treated under local anaesthesia. The mean dosage was 10.45 mg (range 1.25-40 mg). Mean dosage/kg was 0.15 mg (range 0.03-0.50 mg). The average duration of anaesthesia was 50 minutes. The average recovery time was 94 minutes. Three hundred and sixty-nine of 372 planned treatments were completed. No serious complications occurred. The patients were co-operative during surgery and were satisfied with the treatment. Compared with full anaesthesia this method required less resources and is a valuable complement in management of anxious patients undergoing oral surgery.

  13. Cost justification of clinical pharmacy services on a general surgery team: focus on diagnosis-related group cases.

    PubMed

    Bertch, K E; Hatoum, H T; Willett, M S; Witte, K W

    1988-11-01

    We used a novel approach to cost-justify clinical pharmacy services on a general surgery team in nine diagnosis-related group cases. The clinical pharmacist monitored nine patients longitudinally on a general surgery team from admission to discharge and intervened in their therapeutic management. Each recommendation was analyzed for rationale, acceptance, perceived impact on quality and/or cost of patient care, whether self-initiated or solicited, and impact on patient outcome. Types of recommendations and outcomes were categorized by process and outcome measurement criteria. Total cost avoidance per patient was calculated using costs of drug therapy, laboratory tests, and length of stay. Accounting for cost of clinical pharmacy services, net cost avoidance per patient was calculated. The clinical pharmacist made 101 recommendations on nine patients. Physicians accepted 82 percent of the recommendations; 77 percent of the recommendations were self-initiated and 23 percent were solicited. Recommendations had a perceived impact on cost, quality, or both at 13, 31, and 56 percent, respectively. Most recommendations (79 percent) brought patient therapy to a level of conformance with current standards of practice as documented in the medical literature. Recommendations that potentially preserved a major organ function by preventing drug-induced toxicity or the exacerbation of existing problems constituted 16 percent of the total. None of the accepted recommendations adversely affected patient outcome and 23 percent directly resulted in a measurable positive outcome in patient care. A total of four hospital days was potentially saved for two cases. Based on objective outcome criteria, a 1.9-day increase in therapeutic control was documented per patient.(ABSTRACT TRUNCATED AT 250 WORDS)

  14. KTP-532 laser tonsillectomy--a potential day-case procedure?

    PubMed

    Raine, N M; Whittet, H B; Marks, N J; Ryan, R M

    1995-06-01

    We report the results of a prospective pilot study of 54 adult patients undergoing tonsillectomy using the KTP-532 laser, designed to assess whether the technique would facilitate day-case adult tonsillectomy. Subjective and objective assessment at six hours post-operatively showed that only 43 per cent could, in our judgement, have been discharged at this interval. Furthermore, the overall complication rate was 31 per cent with a secondary haemorrhage rate of 19 per cent. We conclude that KTP-532 laser tonsillectomy as performed in this pilot study compares unfavourably with dissection tonsillectomy and we discuss possible reasons for this.

  15. 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.

  16. An Eye Popping Case of Orbital Necrotizing Fasciitis Treated with Antibiotics, Surgery, and Hyperbaric Oxygen Therapy.

    PubMed

    Singam, Narayanasarma V; Rusia, Deepam; Prakash, Rajan

    2017-04-01

    BACKGROUND Necrotizing fasciitis (NF) of the orbit is a rare and deadly condition that requires prompt surgical and medical management to decrease morbidity and mortality.  CASE REPORT Here we present an interesting case of an individual who developed fulminant NF of the left orbit requiring emergent surgical intervention, antibiotics, and subsequent hyperbaric oxygen therapy in an attempt to save the eye.  CONCLUSIONS With an early and aggressive multifaceted approach using antibiotics, surgery, and hyperbaric oxygen it may be possible to preserve eye structure and function. Without treatment NF is a rapidly progressive condition and can result in significant morbidity.

  17. Isolated long thoracic nerve paralysis - a rare complication of anterior spinal surgery: a case report

    PubMed Central

    2009-01-01

    Introduction Isolated long thoracic nerve injury causes paralysis of the serratus anterior muscle. Patients with serratus anterior palsy may present with periscapular pain, weakness, limitation of shoulder elevation and scapular winging. Case presentation We present the case of a 23-year-old woman who sustained isolated long thoracic nerve palsy during anterior spinal surgery which caused external compressive force on the nerve. Conclusion During positioning of patients into the lateral decubitus position, the course of the long thoracic nerve must be attended to carefully and the nerve should be protected from any external pressure. PMID:19830192

  18. Two Cases of Late Shone Syndrome With Pulmonary Hypertension: Heart-Lung Transplant or Valve Surgery?

    PubMed

    Robich, Michael P; Stewart, Robert D; Zahka, Kenneth G; Krasuski, Richard A; Hanna, Mazen; Blackstone, Eugene H; Pettersson, Gosta B

    2016-01-01

    Two cases of Shone syndrome with severe mitral and aortic valve problems and pulmonary hypertension were referred for heart-lung transplantation. Severely elevated pulmonary vascular resistance (PVR) was confirmed as was severe periprosthetic mitral and aortic regurgitation. Based on the severity of the valve lesions in both patients, surgery was decided upon and undertaken. Both experienced early pulmonary hypertensive crises, one more than the other, that gradually subsided, followed by excellent recovery and reversal of pulmonary hypertension and PVR. These cases illustrate Braunwald's concept that pulmonary hypertension secondary to left-sided valve disease is reversible.

  19. [A case of pineoblastoma successfully treated with surgery, combined chemotherapy of cisplatin and etoposide, and radiotherapy].

    PubMed

    Akiyama, Y; Akiyama, Y; Kumai, J; Nishikawa, M

    1995-10-01

    A 5-year-old girl was admitted to another clinic because of vomiting and convulsions. She was brought to our clinic after a ventriculoperitoneal shunt was inserted. CT scan on admission in our clinic showed a tumor in the pineal region with tumoral hemorrhage. Tumor markers such as HCG, AFP, CEA, P-LAP were within normal range. A biopsy of the tumor was performed and the histological diagnosis was pineoblastoma. Her recovery was excellent and disseminated metastasis was not recognized. A subtotal removal of the tumor was performed through the occipital transtentorial approach. She had no neurological deficits after surgery. She then received two 5-day cycles of chemotherapy, consisting of intravenous administration of 20 mg/m2/day cisplatin and 60 mg/m2/day etoposide, and craniospinal radiotherapy. After these therapies, the tumor responded and disappeared completely. Follow-up radiographic investigations also demonstrated no abnormal evidence except for brain atrophy. She is attending a primary school without any problems. Pineoblastoma is quite rare and remarkably malignant. Hence, aggressive therapies including surgery, radiotherapy and chemotherapy is indicated for this tumor.

  20. Surgery without consent or miscommunication? A new look at a landmark legal case.

    PubMed

    Chervenak, Judith; McCullough, Laurence B; Chervenak, Frank A

    2015-05-01

    Schloendorff v Society of New York Hospital is regarded widely as a landmark in the history of informed consent because it is thought to have established individual self-determination as the legal basis of consent and respect for patient autonomy as the ethical basis of consent. For a century, it has been understood as a laparotomy done without consent when a pelvic mass was discovered unexpectedly in an anesthetized patient after an examination. We believe it was a case of surgeons failing to communicate properly with each other and their patient. To support this reinterpretation, we present evidence from the original medical and surgical records, letters of key participants in the case, and the trial court record. We also consider the case from the perspective of the modern culture of safety in gynecologic surgery. Contrary to what is commonly assumed, Ms Schloendorff lost her legal case, and her surgery might not have been performed at all had her clinicians known, understood, communicated, documented, and reaffirmed what the patient actually wanted. This new perspective on Schloendorff is important for gynecologic surgeons because it vividly documents the perils of implicit consent, delegating the obtaining of consent, and miscommunication among clinicians. The Schloendorff case underscores the constant need for continuous quality improvement to reduce medical errors and the risk of litigation by improving communication among surgeons.

  1. Sudden falls as a persistent complication of selective dorsal rhizotomy surgery in children with bilateral spasticity: report of 3 cases.

    PubMed

    Grootveld, Laura R; van Schie, Petra E M; Buizer, Annemieke I; Jeroen Vermeulen, R; van Ouwerkerk, Willem J R; Strijers, Rob L M; Becher, Jules J G

    2016-08-01

    Selective dorsal rhizotomy (SDR) surgery is a well-established treatment for ambulatory children with bilateral spastic paresis and is performed to eliminate spasticity and improve walking. The objective of this case report is to describe sudden falls as a persistent complication of SDR. The authors report on 3 patients with bilateral spastic paresis, aged 12, 6, and 7 years at the time of surgery. The percentage of transected dorsal rootlets was around 40% at the L2-S1 levels. Sudden falls were reported with a frequency of several a day, continuing for years after SDR. The falls were often triggered by performing dual tasks as well as occurring in the transition from sitting to standing, during running, after strenuous exercise, or following a fright. Patients also had residual hyperesthesia and dysesthesia of the foot sole. The authors hypothesize that the sudden falls are caused by a muscle inhibition reflex of the muscles in the legs, as an abnormal reaction to a sensory stimulus that is perceived with increased intensity by a patient with hyperesthesia. A favorable effect of gabapentin medication supports this hypothesis.

  2. [The incidence of intraoperative conciousness in emergency surgery and its possible relation to the post-traumatic stress syndrome. Presentation of three cases].

    PubMed

    Ruiz, V; Koo, M; García, E; Crespo, J M; Mayoral, V; Casals, P; Cochs, J

    1998-03-01

    Intraoperative awakening and recall of specific events is a rare complication (0.2 to 1.3%) of surgery. The possibility of developing serious psychiatric complications, such as posttraumatic stress disorder (PTSD) makes the prevention and detection of intraoperative awareness a subject of special interest. We describe our experience with three patients in whom awareness was detected during emergency surgery under general anesthesia. We conducted two structured interviews with the patients three months after surgery in order to detect the possible development of psychiatric complications. One patient suffered insomnia and reexperience of the event during the first two weeks after surgery. Improvement was spontaneous. None of the patients suffered PTSD. Efforts to decrease the incidence of episodes of intraoperative awakening with specific recall must be based on clinical observation and exhaustive monitoring of the patient, including anesthetic gases, given that no ideal method of monitoring depth of anesthesia exists. Cases should be detected in the first few days after surgery by means of a specific test. Likewise, possible causes for the episode should be explained to the patient, who should be followed for six months so that early diagnosis of PTSD or other psychiatric complications can be made.

  3. 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

  4. 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

  5. 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.

  6. 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

  7. Successfull management of a life threatening cerebellar haemorrhage following spine surgery - a case report -.

    PubMed

    Pallud, Johan; Belaïd, Hayat; Aldea, Sorin

    2009-06-01

    Cerebellar haemorrhages are rare life-threatening complications following spine surgery that present challenges for their diagnostic and their therapeutic management. Their patho-physiology remains unclear.We report a case of a life-threatening cerebellar haemorrhage secondary to an occult dural tear following a planned L5-S1 laminectomy. The patient was treated with emergent external ventriculostomy following by a posterior fossa decompressive craniectomy. Cerebellar haemorrhages have to be suspected systematically when unexpected neurological signs occur after spine surgery since their rapid management lead to favourable outcomes. The present imaging findings allow us proposing that cerebellar haemorrhages result primarily from superior cerebellar venous stretching and tearing, and that cerebellar infarction and swelling occur secondarily.

  8. Cerebellar Mutism Syndrome After Posterior Fossa Surgery: A Report of Two Cases of Pilocytic Astrocytoma

    PubMed Central

    GÜNDÜZ, Hasan Burak; YASSA, Mustafa İlker Kuntay; OFLUOĞLU, Ali Ender; POSTALCI, Lütfü; EMEL, Erhan

    2013-01-01

    Cerebellar mutism is a type of syndrome including decreased speech, hypotonia, ataxia and emotional instability which occurs after posterior fossa surgery. It has been first reported by Rekate et al. and Yonemasu in 1985. It is well known that long tract signs and lower cranial nerve involvement are not seen with this syndrome and understanding is preserved. However, the pathophysiology of cerebellar mutism has not been well clarified yet. It is mainly seen in patients with medulloblastoma and brainstem involvement. In this report, we present two extraordinary cases of cerebellar mutism after posterior fossa surgery. They were considered extraordinary because their hystopathological analysis results yielded pilocytic astrocytoma which is out of the predefined risk factors.

  9. [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.

  10. Novel hemostatic patch achieves sutureless epicardial wound closure during complex cardiac surgery, a case report.

    PubMed

    Jainandunsing, Jayant S; Al-Ansari, Sali; Woltersom, Bozena D; Scheeren, Thomas W L; Natour, Ehsan

    2015-01-27

    Treatment of damaged cardiac tissue in patients with high bleeding tendency can be very challenging, damaged myocardial tissue has a high rupture risk when being sutured subsequently on-going bleeding is a major risk factor for poor clinical outcome. We present a case demonstrating the feasibility in using a novel haemostatic collagen sponge for the management of a myocardial wound. This report is the first description in cardiac surgery where Hemopatch sponges are used to successfully seal a left ventricle wound. Our patient was diagnosed with endocarditis, had a low pre-operative haemoglobin count and underwent cardiac surgery for multiple valve repairs. The procedure was performed on cardiopulmonary bypass, which meant our patient had to be heparinized. Despite these major risk factors for bleeding Hemopatch managed to contain bleeding and seal the wound, no sutures were needed.

  11. CE-Chirp® ABR in cerebellopontine angle surgery neuromonitoring: technical assessment in four cases.

    PubMed

    Di Scipio, Ettore; Mastronardi, Luciano

    2015-04-01

    Continuous monitoring of wave V of auditory brainstem response (ABR), also called brainstem auditory evoked potential (BAEP), is the most common method used in intraoperative neuromonitoring (IONM) functionality of cochlear nerve during surgery in cerebellopontine angle (CPA). CE-Chirp® ABR represents a recent development of classical ABR. CE-Chirp® is a new acoustic stimulus used in newborn hearing testing, designed to provide enhanced neural synchronicity and faster detection of larger amplitude wave V. In four cases, CE-Chirp® ABR was performed during cerebellopontine angle (CPA) surgery. CE-Chirp® ABR represented a safe and effective method in neuromonitoring functionality of vestibulocochlear nerve. A faster neuromonitoring feedback to surgical equipe was possible with CE-Chirp ABR®.

  12. Tranexamic Acid in cardiac surgery and postoperative seizures: a case report series.

    PubMed

    Bell, David; Marasco, Silvana; Almeida, Aubrey; Rowland, Michael

    2010-08-01

    With the recent withdrawal of the antifibrinolytic aprotinin from the market, tranexamic acid (TxA) has become more widely used. This change has led to increasing concern about the side-effect profile of TxA, particularly the incidence of postoperative seizures. In this case series, we describe 7 patients over an 18-month period who had open-chamber cardiac surgery and developed seizures in the postoperative period. This incidence is increased compared with that of a cohort of patients in the previous 36 months who did not receive TxA (0.66% versus 0%; P < .05). The exact mechanism of TxA-induced seizures is thought to be via inhibition of gamma-aminobutyric acid receptors in neurons. Data from the neurosurgical literature show a well-established link between this antifibrinolytic and seizures. There is now increasing awareness of this association in cardiac surgery, particularly when high TxA doses are used.

  13. 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

  14. A Case of Syphilitic Uveitis in Which Vitreous Surgery Was Useful for the Diagnosis and Treatment

    PubMed Central

    Kobayashi, Takatoshi; Katsumura, Chihiro; Shoda, Hiromi; Takai, Nanae; Takeda, Sayako; Okamoto, Takako; Maruyama, Koichi; Tada, Rei; Tajiri, Kensuke; Kida, Teruyo; Ikeda, Tsunehiko

    2017-01-01

    Purpose To report a case of atypical syphilitic uveitis complicated with retinal vasculitis, proliferative retinopathy, and vitreous hemorrhage in which vitreous surgery was useful for the diagnosis and treatment. Case Report A 38-year-old female was referred to our hospital after noticing visual disturbance in her right eye. Fundoscopy examination of that eye revealed retinal phlebitis accompanied by retinal hemorrhage and soft exudate, and remarkable exudative changes in the retinal vessels from the upper arcade to the macula region. After a blood examination, a serological test showed positive for syphilis; however, systemic findings were scarce. Syphilitic uveitis was suspected, so we administered treatment for syphilis, anticoagulant treatment for retinal vasculitis, steroids for intraocular inflammation, and photocoagulation for the retinal nonperfusion area. However, her visual acuity (VA) decreased to 30 cm/counting fingers due to vitreous hemorrhage resulting from fibrovascular membrane at the optic disc. Since the vitreous hemorrhage was insufficiently absorbed, vitreous surgery was performed to remove the hemorrhage and fibrovascular tissue. Following surgery, the uveitis and retinal vasculitis subsided, and her corrected VA improved to 0.3. Postoperative examination of a fixed quantity of collected vitreous fluid for syphilis showed a Treponema pallidum hemagglutination value of 5,120 times the normal amount, thus confirming the syphilitic uveitis diagnosis. Conclusions Our findings show that when observing patients with obstructive retinal vasculitis of unknown causes, syphilitic uveitis should be considered as a differential diagnosis, and that vitreous surgery is useful for the diagnosis and treatment of atypical syphilitic uveitis which has progressed to proliferative retinopathy. PMID:28203197

  15. Primary hip and knee replacement surgery: Ontario criteria for case selection and surgical priority.

    PubMed Central

    Naylor, C D; Williams, J I

    1996-01-01

    OBJECTIVES--To develop, from simple clinical factors, criteria to identify appropriate patients for referral to a surgeon for consideration for arthroplasty, and to rank them in the queue once surgery is agreed. DESIGN--Delphi process, with a panel including orthopaedic surgeons, rheumatologists, general practitioners, epidemiologists, and physiotherapists, who rated 120 case scenarios for appropriateness and 42 for waiting list priority. Scenarios incorporated combinations of relevant clinical factors. It was assumed that queues should be organised not simply by chronology but by clinical and social impact of delayed surgery. The panel focused on information obtained from clinical histories, to ensure the utility of the guidelines in practice. Relevant high quality research evidence was limited. SETTING--Ontario, Canada. MAIN MEASURES--Appropriateness ratings on a 7-point scale, and urgency rankings on a 4-point scale keyed to specific waiting times. RESULTS--Despite incomplete evidence panellists agreed on ratings in 92.5% of appropriateness and 73.8% of urgency scenarios versus 15% and 18% agreement expected by chance, respectively. Statistically validated algorithms in decision tree form, which should permit rapid estimation of urgency or appropriateness in practice, were compiled by recursive partitioning. Rating patterns and algorithms were also used to make brief written guidelines on how clinical factors affect appropriateness and urgency of surgery. A summary score was provided for each case scenario; scenarios could then be matched to chart audit results, with scoring for quality management. CONCLUSIONS--These algorithms and criteria can be used by managers or practitioners to assess appropriateness of referral for hip or knee replacement and relative rankings of patients in the queue for surgery. PMID:10157268

  16. United Kingdom National Ophthalmology Database Study of Vitreoretinal Surgery: Report 1; Case mix, complications, and cataract

    PubMed Central

    Jackson, T L; Donachie, P H J; Sparrow, J M; Johnston, R L

    2013-01-01

    Aim To report the vitreoretinal (VR) surgical case mix in the United Kingdom, the intraoperative complication rate of pars plana vitrectomy (PPV), and the incidence of post-vitrectomy cataract extraction. Methods Participating hospitals prospectively collected ophthalmic data using a single electronic medical record system, with automatic extraction of anonymised data to a national database. This study included the subset of 11 618 VR operations undertaken on 9619 eyes, of 8741 patients, over 8 years, from 27 sites. Surgical data included the indication for surgery, all procedure elements, and whether or not an intraoperative complication occurred. Post-vitrectomy cataract data were also analysed. The main outcome measures were a description of the indications for surgery, intraoperative PPV complication rate, and percentage of eyes undergoing post-vitrectomy cataract surgery (PVCS). Results The most common indications for VR intervention were retinal breaks and rhegmatogenous retinal detachment (48.5%), macular hole (9.8%), epiretinal membrane (9.6%), and diabetic eye disease (7.3%). Overall, 7.8% of PPVs had at least one intraoperative complication—the most common were iatrogenic retinal breaks (3.2%), and lens touch (1.2–1.6% of phakic eyes). PVCS occurred in 50.2, 68.7, and 74.0% of eyes at 1, 2, and 3 years, respectively. Conclusion VR surgery is undertaken for a wide range of conditions, but a small number of diagnoses encompass the majority of cases. Intraoperative PPV complications are not uncommon, and post-vitrectomy cataract is to be expected in most phakic eyes. PMID:23449509

  17. Spontaneous healing of retroperitoneal chylous leakage following anterior lumbar spinal surgery: a case report and literature review

    PubMed Central

    Su, I-Chang

    2007-01-01

    Cisterna chyli is prone to injury in any retroperitoneal surgery. However, retroperitoneal chylous leakage is a rare complication after anterior spinal surgery. To the best of our knowledge, only ten cases have been reported in the English literature. We present a case of a 49-year-old man who had lumbar metastasis and associated radiculopathy. He had transient retroperitoneal chylous leakage after anterior tumor decompression, interbody bony fusion, and instrumental fixation from L2 to L4. The leakage stopped spontaneously after we temporarily clamped the drain tube. Intraperitoneal ascites accumulation developed thereafter due to nutritional loss and impaired hepatic reserves. We gathered ten reported cases of chylous leak after anterior thoracolumbar or lumbar spinal surgery, and categorized all these cases into two groups, depending on the integrity of diaphragm. Six patients received anterior spinal surgery without diaphragm splitting. Postoperative chylous leak stopped after conservative treatment. Another five cases received diaphragm splitting in the interim of anterior spinal surgery. Chylous leakage stopped spontaneously in four patients. The remaining one had a chylothorax secondary to postop chyloretroperitoneum. It was resolved only after surgical intervention. In view of these cases, all the chylous leakage could be spontaneously closed without complications, except for one who had a secondary chylothorax and required thoracic duct ligation and chemopleurodesis. We conclude that intraoperative diaphragm splitting or incision does not increase the risk of secondary chylothorax if it was closed tightly at the end of the surgery and the chest tube drainage properly done. PMID:17273839

  18. 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!

  19. 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

  20. Fatal transfusion related acute lung injury following coronary artery by-pass surgery: a case report

    PubMed Central

    Bawany, Fauzia Ahmad; Sharif, Hasanat

    2008-01-01

    Background Transfusion related acute lung injury (TRALI) is a potentially fatal Acute Lung Injury following transfusion of blood components. Hypotheses implicate donor-derived anti-human leukocyte antigen or granulocyte antibodies reacting with recipients' leukocytes, releasing inflammatory mediators. Lack of agreement on underlying cellular and molecular mechanisms renders improving transfusion safety difficult and expensive. Case Presentation Literature search has not revealed any case of TRALI from Pakistan. We report the case of fatal TRALI in a 68 year old male who received blood products after coronary artery by-pass surgery. Conclusion This article aims to create awareness about this complication and suggests that post transfusion cardiopulmonary instability should alert to the possibility of TRALI. PMID:19055759

  1. Peri-operative second molar tube failure during orthognathic surgery: two case reports.

    PubMed

    Wenger, N A; Atack, N E; Mitchell, C N; Ireland, A J

    2007-06-01

    With improvements in bonding techniques, bracket base design and bond strengths, molar tubes are becoming more popular in orthodontics. Molar tubes make an attractive alternative to conventional banding due to a reduction in clinical bonding time and ease of placement on partially erupted teeth. The use of molar tubes negates the need for orthodontic separation and subsequent cementation of bands, and offers improved periodontal health. Their use on terminal molars, however, should be limited to non-orthognathic cases. This paper presents two cases of peri-operative second molar tube failure during orthognathic surgery. They are presented in the hope that it will highlight the importance of banding the distal terminal molar in orthognathic cases to prevent loss of molar tubes and peri-operative contamination of the surgical wound site.

  2. Multicenter experiences in temporal bone cancer surgery based on 89 cases

    PubMed Central

    Wierzbicka, Małgorzata; Niemczyk, Kazimierz; Bruzgielewicz, Antoni; Durko, Marcin; Klatka, Janusz; Kopeć, Tomasz; Osuch-Wójcikiewicz, Ewa; Pietruszewska, Wioletta; Szymański, Marcin; Szyfter, Witold

    2017-01-01

    Objective To present outcomes of extensive surgery: lateral, subtotal, total petrosectomies in patients with temporal bone invasion resulting from specific primary cancers. Study design Retrospective case review. Setting Four tertiary referral centers. Material 89 patients with cancer of the temporal bone treated between January 2006 and December 2010. Intervention Multidisciplinary team approach including surgical resection, reconstruction, and postoperative radiotherapy. Main outcome measure Disease-specific survival, overall survival. Results In 27.0% of the patients, relapse was reported, with an average of 6.3 months after surgery; 31 patients (34.8%) died during the follow-up. The average mortality was 22.1 months. Fifty-four patients (58.7%) stayed alive during the time of observation. The average survival time was 42.0 months. The median time of survival with relapse was 12 months (range: 1–51 months). The three-year disease-free rate was 38.0% and the overall survival rate was 58.7%. Conclusions Petrosectomy is an effective treatment for malignant temporal bone invasion. The probability of a good outcome was statistically decreased with a high T grade, positive margins, and salvage surgery. Younger age is connected with better prognosis. One of the major tasks remains to improve detection and to shorten the time to diagnosis, keeping in mind that symptoms are insidious and in younger people, the time before diagnosis was longer. PMID:28225795

  3. Precautionary Measures for Successful Open Heart Surgery in G6PD Deficient Patient- A Case Report

    PubMed Central

    2016-01-01

    Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency is among the most common enzymatic disorders of red blood cells. Cardiac surgeries on this group of individuals are associated with an additional risk in terms of impaired oxygenation, prolonged ventilation and increased risk of haemolysis. These patients have a very low threshold for haemolysis due to oxidative stress. Many commonly used drugs also predispose the individual for haemolysis when they are subjected to surgery. Here we present a known case of G6PD deficient patient with symptoms of breathlessness for the last nine years who was taken for surgery with pre-planned precautionary measures to avoid unnecessary haemolysis. The echocardiography report revealed severe mixed mitral lesion and moderate tricuspid regurgitation. On general examination she had mild pallor and icterus. We planned for a thorough investigation to prepare her for mitral valve replacement and tricuspid annuloplasty. These groups of patients are at high risk of haemolysis during perioperative period and need prolonged mechanical ventilation and hospital stay due to impaired oxygen carrying capacity and oxidative stress due to deficient free radical scavenging system. The patient underwent mechanical mitral valve replacement and tricuspid annuloplasty under cardiopulmonary bypass with precautionary measures to prevent the risk of haemolysis and associated complications. She had an uneventful recovery. PMID:28208930

  4. Precautionary Measures for Successful Open Heart Surgery in G6PD Deficient Patient- A Case Report.

    PubMed

    Kumar, Rupesh

    2016-12-01

    Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency is among the most common enzymatic disorders of red blood cells. Cardiac surgeries on this group of individuals are associated with an additional risk in terms of impaired oxygenation, prolonged ventilation and increased risk of haemolysis. These patients have a very low threshold for haemolysis due to oxidative stress. Many commonly used drugs also predispose the individual for haemolysis when they are subjected to surgery. Here we present a known case of G6PD deficient patient with symptoms of breathlessness for the last nine years who was taken for surgery with pre-planned precautionary measures to avoid unnecessary haemolysis. The echocardiography report revealed severe mixed mitral lesion and moderate tricuspid regurgitation. On general examination she had mild pallor and icterus. We planned for a thorough investigation to prepare her for mitral valve replacement and tricuspid annuloplasty. These groups of patients are at high risk of haemolysis during perioperative period and need prolonged mechanical ventilation and hospital stay due to impaired oxygen carrying capacity and oxidative stress due to deficient free radical scavenging system. The patient underwent mechanical mitral valve replacement and tricuspid annuloplasty under cardiopulmonary bypass with precautionary measures to prevent the risk of haemolysis and associated complications. She had an uneventful recovery.

  5. Analysis of anastomotic leakage after rectal surgery: A case-control study

    PubMed Central

    Tanaka, Junichiro; Nishikawa, Takeshi; Tanaka, Toshiaki; Kiyomatsu, Tomomichi; Hata, Keisuke; Kawai, Kazushige; Kazama, Shinsuke; Nozawa, Hiroaki; Yamaguchi, Hironori; Ishihara, Soichiro; Sunami, Eiji; Kitayama, Joji; Watanabe, Toshiaki

    2015-01-01

    Background The incidence of anastomotic leakage in rectal surgery is around 10 percent. Poor blood supply to the anastomosis, high anastomotic pressure and tension, increased operative blood loss, long operative time, and male sex are risk factors of anastomotic leakage. In the present study, we examined anastomotic leakage cases in rectal surgery at our institute and tried to ascertain the risk factors. Methods Three hundred fifty-seven consecutive patients who underwent rectal resection with anastomosis between January 2008 and October 2013 were included in the study. Patients were divided into two groups according to the existence of anastomotic leakage. Clinicopathological features, operative procedures, and intraoperative outcomes were compared between the two groups. Regarding intraoperative procedure, we focused on the ligation level of the inferior mesenteric artery, installing a transanal drainage tube in the rectum, and constructing a diverting stoma. Results Anastomotic leakage occurred in eight patients. All of them were male (p = 0.0284). There were no statistical differences in other characteristics of the patients or tumors, in operative procedures, or in intraoperative outcomes. Conclusions In the present study, no statistically significant risk factors for anastomotic leakage in rectal surgery were detected, except for male sex. However, the rate of anastomotic leakage at our institute was revealed to be rather low. Our exertion to preserve good blood flow and to prevent high tension and pressure on the anastomosis in operation may have led to this result. PMID:26042185

  6. Normothermic bypass in pediatric surgery: technical aspect and clinical experience with 1400 cases.

    PubMed

    Durandy, Yves D; Hulin, Sylvie H

    2006-01-01

    We analyzed our experience with warm perfusion and blood cardioplegia in pediatric surgery. Warm surgery was performed in 1400 patients. Prime and perfusate are kept at 37 degrees C before and during bypass and intermittent warm blood cardioplegia is used for myocardial protection. Analyzed parameters were: perioperative blood gas, hydric balance of cardioplegia, spontaneous resumption of rhythm after aortic unclamping, troponin I level, postoperative neurologic and renal function, duration of mechanical ventilation (five diagnostic groups), and duration of intensive care unit (ICU) stay. Satisfactory gas exchange is the rule, and fluid addition is negligible during warm cardioplegia. Spontaneous resumption of sinus rhythm occurred in 99% of patients, Troponin I elevation was < 10 ng/ml in 46% of cases. Prevalence of neurologic complications (0.3%) and of renal insufficiency treated by peritoneal dialysis (0.35%) favorably compares with data reported in the literature. Average mechanical ventilation time was < 48 hours in each diagnostic group. Duration of ICU stay was < 48 hours in 86% of the 1400 patients. In our experience, normothermic surgery is an excellent alternative to hypothermia.

  7. 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.

  8. Treatment of chylothorax developed after congenital heart disease surgery: a case report

    PubMed Central

    Bulut, Ozgul; Gul, Doruk; Sevuk, Sibel; Mungan, Ilke; Buyukkayhan, Derya

    2015-01-01

    Chylothorax is defined as the accumulation of lymphatic fluid or chyle in the pleural space. Chylothorax treatment is composed of conservative; pleural drainage, termination of enteral feeding, total parenteral nutrition and supplementation with medium- chain triglycerides and surgical therapies; ductus thoracicus ligation, pleuroperitoneal shunts or pleuredesis. Nowadays, for cases among which conservative therapies fail, treatment with octreotide has been reported to be beneficial with promising results. A neonate who developed chylothorax after surgery performed for congenital heart disease was treated successfully with octreotide. PMID:28058372

  9. Stomach arteriovenous malformation resected by laparoscopy-assisted surgery: A case report.

    PubMed

    Hotta, Masahiro; Yamamoto, Kazuhito; Cho, Kazumitsu; Takao, Yoshimune; Fukuoka, Takeshi; Uchida, Eiji

    2016-05-01

    Arteriovenous malformations of the stomach are an uncommon cause of upper GI bleeding. We report a case of stomach arteriovenous malformation in an 85-year-old Asian man who presented with massive hematemesis. Initial esophagogastroduodenoscopy did not detect this lesion, but contrast multi-detector CT confirmed GI bleeding. Multi-detector CT revealed a mass of blood vessels underlying the submucosa that arose from the right gastroepiploic artery. Repeat esophagogastroduodenoscopy showed that the lesion was a submucosal tumor with erosion and without active bleeding in the lower body of the stomach on the greater curvature. We performed partial gastrectomy via laparoscopy-assisted surgery. The histopathological diagnosis was arteriovenous malformation.

  10. 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.

  11. Case Report of Successful Childbearing after Conservative Surgery for Cervical Mullerian Adenosarcoma

    PubMed Central

    Nakamura, Masako; Oi, Hidekazu; Sugimoto, Sumire; Sasaki, Yoshikazu; Uchiyama, Tomoko; Ohbayashi, Chiho; Kobayashi, Hiroshi

    2017-01-01

    Mullerian adenosarcoma (MA) is a rare tumor variant with low malignancy potential and is reported to account for 8% of all uterine sarcomas. Cervical MAs are reported to occur in relatively younger patients with the mean age of 27 years, while those in the uterine corpus generally present in postmenopausal women. Due to the rarity of cervical MAs, optimal management for these patients (especially younger women) is still under exploration. Here, we describe a case of cervical MA in a woman of reproductive age who was treated by fertility-preserving surgery and successfully delivered a child 18 months later. PMID:28154764

  12. [Surgery of the descending thoracic and thoraco-abdominal arteries. Report of 105 cases].

    PubMed

    Zanetti, P P; Rosa, G; Sorisio, V; Cavanenghi, D; Amerio, G M; Stillo, R; Zappa, A; Cardellino, S; Franco, M; Muncinelli, M

    1997-07-01

    The Authors show their casistic of about 105 cases of thoracic descending and thoraco-abdominal aorta pathologies between 1.1.1993 and 30.12.1995. After a short introduction about the improvements in anesthesia and reanimation of these pathologies as well as the good reliability of diagnostic and currently available instruments, mortality and mobility parameters are taken into account, the last one referring to paraplegia and ARF. The casistic is evaluated splitting the cases into 2 groups, urgent surgery and election surgery, and differentiating the aneurysm type from the dissection type. Besides, the mortality and mobility are reported for any pathology, with a discussion of the parameters which drove the choice of the most suitable methodology to be adopted (ECC femoro-subclavian shunt, simple clamping). The results achieved show a mortality of 40% in urgency, between 5 and 15% in election, with a rate of paraplegia around 8-10% and a ARF between 5 and 15%. These data match the literature statistics and support the quality of the adopted methodologies.

  13. 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

  14. Immediate provisional restoration of implant placed using flapless surgery and ridge mapping. Case report.

    PubMed

    Turkyilmaz, Ilser

    2011-04-01

    Loss of an anterior tooth as the result of trauma is relatively common, especially in the young. Orthodontic treatment is not always the definitive therapy of choice; instead, an implant can be placed to replace the missing tooth. This article describes the case of a 19-year-old woman whose maxillary left central incisor was replaced by an immediately restored dental implant, placed using flapless surgery. The implant achieved excellent primary stability, as determined by resonance frequency analysis, so it was immediately restored with a provisional acrylic resin crown in no centric occlusion. This case report supports the use of single implants for replacing a missing anterior tooth where esthetics are a priority.

  15. Virginity sparing surgery for imperforate hymen: report of two cases and review of literature

    PubMed Central

    Temizkan, Osman; Kucur, Suna Kabil; Ağar, Sema; Gözükara, İlay; Akyol, Atıf; Davas, İnci

    2012-01-01

    Imperforate Hymen (IH), an obstructive congenital anomaly of the female genital tract, is seen in 1 in 2000 female births. Treatment of IH is hymenotomy or hymenectomy. Different types of incisions are mentioned in the literature. We reported two cases of IH with different clinical presentations and described a simple virginity preserving and socially acceptable procedure to protect the virginity of the patient. In cultures and religions where the destruction of the hymen is a social problem in unmarried girls, virginity sparing surgery should be chosen in gynecological practice. Here we described a simple procedure without need for prophylactic antibiotic treatment and foley catheter application to form an intact annular hymen in two cases. PMID:24592057

  16. Virginity sparing surgery for imperforate hymen: report of two cases and review of literature.

    PubMed

    Temizkan, Osman; Kucur, Suna Kabil; Ağar, Sema; Gözükara, Ilay; Akyol, Atıf; Davas, Inci

    2012-01-01

    Imperforate Hymen (IH), an obstructive congenital anomaly of the female genital tract, is seen in 1 in 2000 female births. Treatment of IH is hymenotomy or hymenectomy. Different types of incisions are mentioned in the literature. We reported two cases of IH with different clinical presentations and described a simple virginity preserving and socially acceptable procedure to protect the virginity of the patient. In cultures and religions where the destruction of the hymen is a social problem in unmarried girls, virginity sparing surgery should be chosen in gynecological practice. Here we described a simple procedure without need for prophylactic antibiotic treatment and foley catheter application to form an intact annular hymen in two cases.

  17. An Eye Popping Case of Orbital Necrotizing Fasciitis Treated with Antibiotics, Surgery, and Hyperbaric Oxygen Therapy

    PubMed Central

    Singam, Narayanasarma V.; Rusia, Deepam; Prakash, Rajan

    2017-01-01

    Patient: Female, 60 Final Diagnosis: Necrotizing fasciitis of the eye Symptoms: Eye pain Medication: — Clinical Procedure: — Specialty: Infectious Diseases Objective: Unusual clinical course Background: Necrotizing fasciitis (NF) of the orbit is a rare and deadly condition that requires prompt surgical and medical management to decrease morbidity and mortality. Case Report: Here we present an interesting case of an individual who developed fulminant NF of the left orbit requiring emergent surgical intervention, antibiotics, and subsequent hyperbaric oxygen therapy in an attempt to save the eye. Conclusions: With an early and aggressive multifaceted approach using antibiotics, surgery, and hyperbaric oxygen it may be possible to preserve eye structure and function. Without treatment NF is a rapidly progressive condition and can result in significant morbidity. PMID:28364115

  18. Intravenous zinc therapy for acquired zinc deficiency secondary to gastric bypass surgery: a case report.

    PubMed

    Vick, Garrett; Mahmoudizad, Rod; Fiala, Katherine

    2015-01-01

    Zinc deficiency may result from either a congenitally inherited defect of zinc absorption or is acquired secondarily from a variety of factors affecting dietary zinc intake, absorption, or loss. We report a case of acquired zinc deficiency secondary to gastric bypass surgery that resulted in vulvar cutaneous manifestations of delayed onset, with failure to clear after oral supplementation with zinc. The patient experienced improvement of symptoms only after administration of intravenous zinc supplementation. Upon review of the current literature, it is thought that the patient's original suboptimal response to oral supplementation and improvement after receiving intravenous zinc were related to the intentional surgical alteration and bypass of the absorptive capacity of the duodenum and jejunum. With the current prevalence of obesity and availability of surgical weight loss therapies, it is important to be mindful of the resulting nutritional deficiencies, their clinical manifestations, and factors affecting the efficacy of therapeutic approaches as seen in this case.

  19. Unusual findings in inguinal hernia surgery: Report of 6 rare cases

    PubMed Central

    Ballas, K; Kontoulis, Th; Skouras, Ch; Triantafyllou, A; Symeonidis, N; Pavlidis, Th; Marakis, G; Sakadamis, A

    2009-01-01

    Background and aim: To present our experience with unexpected findings during hernia surgery, either unusual hernial contents or pathologic entities, like neoplastic masses, masquerading as a hernia. Patients and methods: We studied retrospectively 856 patients with inguinal hernia who were admitted to our surgical department over a 9-year period. In addition, our study included patients complaining of inguinal protrusion, even without a definitive diagnosis of inguinal hernia upon admission. Results: Five patients presented with unusual hernial contents. Three of them had a vermiform appendix in their sac. Acute appendicitis (Amyands hernia) was found in only one case. One patient had epiploic appendagitis related with a groin hernia. Moreover, an adult woman was diagnosed with ovarian and tubal inguinal hernia. Finally, we report a case of a massive extratesticular intrascrotal lipoma, initially misdiagnosed as a scrotal hernia. Conclusion: a hernia surgeon may encounter unexpected intraoperative findings. It is important to be prepared to detect them and apply the appropriate treatment. PMID:19918306

  20. A case of giant saphenous vein graft aneurysm followed serially after coronary artery bypass surgery

    PubMed Central

    Akutsu, Naotaka; Hiro, Takafumi; Oya, Toshiyuki; Fukamachi, Daisuke; Haruta, Hironori; Iida, Korehito; Kougo, Takaaki; Mineki, Takashi; Nishida, Toshihiko; Murata, Nobuhiro; Oshima, Toru; Hata, Hiroaki; Shiono, Motomi; Hirayama, Atsushi

    2016-01-01

    Abstract Saphenous vein graft aneurysm (SVGA) is one of the chronic complications after coronary aorta bypass grafting (CABG) and may be caused by atherosclerosis-like phenomena of the vein graft, weakness around the vein valve, rupturing of the suture of the graft anastomosis, or perioperative graft injury. We describe a case of a large, growing saphenous vein graft aneurysm that was followed serially by chest radiography and computed tomography. Eighteen years after CABG, an SVGA (23 × 24 mm) was incidentally detected. The patient was asymptomatic and was followed conservatively. Four years later, coronary computed tomographic angiography showed that the giant aneurysm had grown to 52.1 by 63.8 mm and revealed a second, smaller aneurysm. Finally, the SVG was ultimately resected without bypass via off-pump surgery. Therefore, this case suggested that aggressive treatment that includes surgical intervention should be considered before the aneurysm becomes larger, even if it is asymptomatic.

  1. Ability of patients to retain and recall new information in the post-anaesthetic recovery period: a prospective clinical study in day surgery.

    PubMed

    Blandford, C M; Gupta, B C; Montgomery, J; Stocker, M E

    2011-12-01

    Patients are frequently told new information in the early postoperative period and may retain little of it. Two hundred patients undergoing general anaesthesia for day surgery procedures were randomly allocated into two equal groups, 'Early' and 'Late'. Both groups were asked to undertake a simple memory test either in the early or late postoperative phase of their recovery. A list of five objects was verbally presented and recall of these five objects was tested after 30 min. A control group of 100 patients performed the same test. Patients in the control group received no sedative medications. Statistically significant differences (p < 0.001) in recall ability were demonstrable between each of the three groups. Twenty-three percent of patients in the 'Early' group had total amnesia of any test information given. Only 1% of the 'Late' group were unable to remember any information; a mean interval of 40 min separated the two groups. We recommend that verbal information given postoperatively be delayed until a recovery interval of at least 40 in, and should be supported with written material.

  2. A case series of complicated infective otitis media requiring surgery in adults

    PubMed Central

    Heah, Harold; Soon, Sue Rene; Yuen, Heng-Wai

    2016-01-01

    INTRODUCTION With the advent of antibiotics, complications of otitis media have become less common. It is crucial for physicians to recognise otitis media and treat its complications early. Herein, we present our institution’s experience with patients who required emergency surgical intervention for complications of otitis media. METHODS Data on patients who underwent emergency surgery for complications of otitis media from 2004 to 2011 was retrieved from the archives of the Department of Otolaryngology, Changi General Hospital, Singapore. RESULTS A total of 12 patients (10 male, two female) underwent emergency surgery for complications of otitis media. The median age of the patients was 25 years. Otalgia, otorrhoea, headache and fever were the main presenting symptoms. Extracranial complications were observed in 11 patients, and six patients had associated intracranial complications. The primary otologic disease was acute otitis media in six patients, chronic otitis media without cholesteatoma in three patients and chronic otitis media with cholesteatoma in three patients. Mastoidectomy and drainage of abscess through the mastoid, with insertion of grommet tube, was the main surgical approach. Two patients required craniotomy. The mean length of hospital stay was 16.2 days and the mean follow-up period was 16.3 months. Five patients had residual conductive hearing loss; two patients with facial palsy had full recovery. CONCLUSION Otitis media can still result in serious complications in the post-antibiotic era. Patients with otitis media should be monitored, and prompt surgical intervention should be performed when necessary to attain good outcomes. PMID:26843060

  3. Antidepressant treatment with MAO-inhibitors during general and regional anesthesia: a review and case report of spinal anesthesia for lower extremity surgery without discontinuation of tranylcypromine.

    PubMed

    Krings-Ernst, Ilana; Ulrich, Sven; Adli, Mazda

    2013-10-01

    Monoamine oxidase-(MAO)-inhibitors are a treatment of last resort in treatment resistant depression, which is regarded as a condition of increased psychiatric risk. General and regional anesthesia for elective surgery during use of long-term MAO-inhibitors remains a matter of debate because of an increased risk of drug interactions and decreased sympathetic stability. A series of case reports and new comparative studies reveal the safety of anesthesia/analgesia in non-cardiac surgery without discontinuation of the MAO-inhibitor if best effort is made for maintenance of sympathetic homeostasis and if known drug interactions are avoided. Very few reports with severe adverse incidents have been noted. Severe cardiovascular morbidity, a contraindication of MAO-inhibitors, probably contributed to peri- and postoperative complications. According to new studies, the risk of pharmacokinetic drug interactions is lower for tranylcypromine than for phenelzine. In the present case, a 66-year-old psychiatric patient on permanent treatment with 20 mg/day tranylcypromine was admitted for forefoot surgery. Anesthetic premedication consisted of 7.5 mg oral midazolam. Intravenous midazolam (0.5 mg) was dispensed for intraoperative sedation. After local anesthesia of the puncture site with 30 mg isobar prilocaine, spinal anesthesia was achieved by a single shot of 13.5 mg hyperbar bupivacaine (0.5%) intrathecally. Postoperative regional and general analgesia were accomplished by a peripheral nerve block with 50 mg isobar bupivacaine as well as oral etoricoxib and oxycodone. No peri- or postoperative complications were encountered. It is concluded that general or regional anesthesia for noncardiac surgery without discontinuation of MAO-inhibitor treatment may be a safe intervention after careful evaluation of an individual's perioperative and psychiatric risk. The increased psychiatric risk in patients treated with MAO-inhibitors outweighs the increased, however manageable

  4. 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

  5. Synchronous Open Heart Surgery and Laparoscopic Cholecystectomy: An Observational Case Study with 28 Patients.

    PubMed

    Bilge Erdogan, Mustafa; Kaplan, Mehmet; Kazaz, Hakki; Salman, Bulent

    2017-03-01

    Acute cholecystitis (AC) may be a severe problem and may increase the mortality rate and hospital stay in patients who undergo open heart surgery (OHS), due to its aggressive course; therefore, AC should be treated as soon as possible. We aimed to present data on our synchronous cardiac and laparoscopic cholecystectomy (LC) operations performed for AC complicating patients with cardiac disease and who were waiting to undergo OHS. Between January 2008 and September 2014, we performed 2773 OHSs in Medical Park Gaziantep Hospital. Among these, 28 (1%) patients underwent concomitant LC in the same session by the same experienced surgeon. The mean age of the patients was 61.4 ± 9.1 years, and the proportion of males was 71.4 per cent. Acalculous cholecystitis was found in 42.9 per cent of the patients. Patients stayed in the intensive care unit for 3.1 ± 1.4 days and were discharged from the hospital after 16.5 ± 6.3 days. Postoperative 2-year follow-up was completed in all patients with a mean follow-up period of 3.4 ± 2.0 years. The overall complication rate was 28.6 per cent. LC-related complications were seen in four patients. No inhospital mortality was observed. Only one patient who underwent mitral valve replacement and tricuspid valve repair died in the second year after the operation due to congestive heart failure. Three patients died due to noncardiac reasons in the follow-up period. By increasing the experiences of surgeons in laparoscopic surgery in critically ill patients, LC can be safely performed concurrently in patients scheduled for OHS.

  6. 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…

  7. Risk factors for unavoidable removal of instrumentation after surgical site infection of spine surgery: A retrospective case-control study.

    PubMed

    Tominaga, Hiroyuki; Setoguchi, Takao; Kawamura, Hideki; Kawamura, Ichiro; Nagano, Satoshi; Abematsu, Masahiko; Tanabe, Fumito; Ishidou, Yasuhiro; Yamamoto, Takuya; Komiya, Setsuro

    2016-10-01

    Surgical site infection (SSI) after spine instrumentation is difficult to treat, and often requires removal of instrumentation. The removal of instrumentation after spine surgery is a severe complication that can lead to the deterioration of activities of daily living and poor prognosis. Although there are many reports on SSI after spine surgery, few reports have investigated the risk factors for the removal of instrumentation after spine surgery SSI. This study aimed to identify the risk factors for unavoidable removal of instrumentation after SSI of spine surgery. We retrospectively reviewed 511 patients who underwent spine surgery with instrumentation at Kagoshima University Hospital from January 2006 to December 2014. Risk factors associated with SSI were analyzed via multiple logistic regression analysis. Parameters of the group that needed instrumentation removal were compared with the group that did not require instrumentation removal using the Mann-Whitney U and Fisher's exact tests. The posterior approach was used in most cases (453 of 511 cases, 88.6%). SSI occurred in 16 of 511 cases (3.14%) of spine surgery with instrumentation. Multivariate logistic regression analysis identified 2 significant risk factors for SSI: operation time, and American Society of Anesthesiologists physical status classification ≥ 3. Twelve of the 16 patients with SSI (75%) were able to keep the instrumentation after SSI. Pseudarthrosis occurred in 2 of 4 cases (50%) after instrumentation removal. Risk factors identified for instrumentation removal after spine SSI were a greater number of past surgeries, low preoperative hemoglobin, high preoperative creatinine, high postoperative infection treatment score for the spine, and the presence of methicillin-resistant Staphylococcus aureus. In these high risk cases, attempts should be made to decrease the risk factors preoperatively, and careful postoperative monitoring should be conducted.

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

    PubMed

    Belleggia, F; Pozzi, A; Rocci, M; Barlattani, A; Gargari, M

    2008-10-01

    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.

  9. 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

  10. A randomised comparison of the single use LMA Flexible with the reusable LMA Flexible in paediatric dental day-case patients.

    PubMed

    Flynn, P; Ahmed, F B; Mitchell, V; Patel, A; Clarke, S

    2007-12-01

    In this study we compared the performance of the single use flexible laryngeal mask airway (LMA Flexible) with the original reusable LMA Flexible in paediatric dento-alveolar day-case surgery. The aim of the study was to determine whether these two supraglottic airway devices were clinically equivalent when used for simple dental extractions in children under general anaesthesia. This randomised comparative trial in 100 healthy children used first attempt airway insertion success as its primary outcome measure. Secondary outcomes included the adequacy of ventilation, incidence of airway obstruction and the requirement for device manipulation and the incidence of adverse airway outcomes during recovery from anaesthesia. No difference was found between the devices in first attempt insertion success rate (94% with reusable LMA Flexible and 90% with single use LMA Flexible, p = 0.358), and ease of insertion was also similar (p = 0.5). Both devices performed equally well during surgery, with no significant differences in episodes of intra-operative airway compromise (p = 0.387), and both the single use and reusable LMA Flexible displayed excellent recovery characteristics, with no occurrences of emergence airway obstruction. No blood was discovered within the inner LMA tube shaft in either device, implying that both protected against tracheobronchial soiling. We conclude therefore that the single use LMA Flexible is an acceptable alternative to the reusable LMA Flexible.

  11. 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

  12. 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

  13. 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

  14. [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.

  15. [New technologies in planning and performance of osteotonics: example cases in hand surgery].

    PubMed

    Schweizer, Andreas

    2013-05-08

    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.

  16. Use of a new retrograde filling material (Biodentine) for endodontic surgery: two case reports

    PubMed Central

    Caron, Grégory; Azérad, Jean; Faure, Marie-Odile; Machtou, Pierre; Boucher, Yves

    2014-01-01

    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. PMID:24810806

  17. 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

  18. Nephron-sparing surgery in bilateral Wilms’ tumor: A report of two cases

    PubMed Central

    Arora, Sohrab; Kudchadkar, Sharmad; Yadav, Priyank; Ansari, M. S.

    2016-01-01

    Nephron-sparing surgery (NSS) has been proposed by many as an alternative to bilateral nephrectomies and renal replacement therapy in bilateral Wilms’ tumor (BWT). NSS is not without significant recurrence, morbidity, and mortality. Long-term follow-up, especially with regard to the renal function, remains lacking. Preoperative computed tomography angiogram can help prepare a roadmap for NSS but can underestimate the salvageable parenchyma due to compression of normal adjacent parenchyma. Intraoperative ultrasound can delineate the boundary of surgical margin and help achieve negative margins. We present two cases of BWT, aged 7 and 13 months, managed with neoadjuvant chemotherapy followed by bilateral NSS and adjuvant chemotherapy and report the follow-up of the same. We also explore the role of preoperative imaging and intraoperative ultrasound in the management. Both patients are alive without recurrence at a follow-up of 12 and 8 months. PMID:28057999

  19. Surgical audit in day care myringoplasty.

    PubMed

    Subramaniam, S; Abdul, R

    2006-10-01

    Day-case surgery is preferred for adults, allowing post-operative fast recovery in family environment and support. Myringoplasty using the traditional method of underlay temporalis fascia or tragal perichondrium is usually performed as an in-patient. From 2003 to 2004, 22 myringoplasty procedures were performed in a dedicated day surgery unit at the Hospital Melaka. We report the retrospectively review of the outcome results of these procedures. None of the patients need admission overnight. There were no surgical or anesthetic complications noted and this series suggests that day-case surgery is a safe and desirable practice for patients undergoing myringoplasty. However, there should be the facility for admission if required.

  20. 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…

  1. [Facial surgery].

    PubMed

    Meningaud, Jean-Paul

    2010-11-20

    The patient who has to sustain facial surgery is doubly concerned by the functional issues of his case and his cosmetic appearance. Fortunately, in the recent period of time, huge advancements have been done permitting to offer a solution in more and more difficult situations. The aim of the present article is to give a panorama of facial plastic surgery for non-specialized physicians. The main aspects of the specialty are approached through the surgical techniques born from the progress of technology and biology. This paper treats issues of orthognatic surgery, endoscopic techniques, osteogenic distraction, different types of graft, cosmetic surgery, skin expander-balloons.

  2. [Prevention of post-operative infection in heart surgery with extracorporeal circulation (apropos of 295 cases)].

    PubMed

    Hubscher, C; Coulombe, G; Oksenhendler, G; Laborde, F; Soyer, R; Winckler, C

    1979-01-01

    From April 1977 to November 1978, 295 patients were operated on using artificial circulation. 31 p. 100 of these developed a post-operative infectious complication, 7.3 p. 100 being of a serious nature (3.3 p. 100 suffered from mediastinitis, and 4 p. 100 from septicaemia). The organisms responsible are, in the case of the mediastinal infections the staphylococcus Citreus, and Gram negative bacilli in the case of the septicaemias. A retrospective analysis shows that there are two successive periods and that in the course of the second there is a decrease in the occurence of all of the infections and particularly in the cases of mediastinitis. This improvment would seem on superficial analysis to correspond with a change in the preventive antibiotic treatment, the cephradine--gentamicin combination having replaced penicillin G. However, the statistical study shows that other factors were altered between the two periods (type of antiseptic, duration of treatments, time of postoperative intubation) and that these equally contributed to the fall in the incidence of infection. In the light of this study, it would seem that if prophylactic antibiotic treatment essentially directed against staphylococci has a place in cardiac surgery with artificial circulation, it can only be regarded as one of several preventive factors. The statistical data gathered so far is not sufficient to prove the efficacy of this treatment.

  3. Surgery and perioperative management for post-intubation tracheoesophageal fistula: case series analysis

    PubMed Central

    Puma, Francesco; Santoprete, Stefano; Urbani, Moira; Cagini, Lucio; Andolfi, Marco; Potenza, Rossella; Daddi, Niccolò

    2017-01-01

    Background Post-intubation tracheoesophageal fistula (PITEF) is an often mistreated, severe condition. This case series reviewed for both the choice and timing of surgical technique and outcome PITEF patients. Methods This case series reviewed ten consecutive patients who had undergone esophageal defect repair and airway resection/reconstruction between 2000 and 2014. All cases were examined for patients: general condition, medical history, preparation to surgery, diagnostic work-up, timing of surgery and procedure, fistula size and site, ventilation type, nutrition, post-operative course and complications. Results All patients were treated according to Grillo’s technique. Overall, 6/10 patients had undergone a preliminary period of medical preparation. Additionally, 3 patients had already had a tracheostomy, one had had a gastrostomy and 4 had both. One patient had a Dumon stent with enlargement of the fistula. Concomitant tracheal stenosis had been found in 7 patients. The mean length of the fistulas was 20.5 mm (median 17.5 mm; range, 8–45 mm), at a median distance from the glottis of 43 mm (range, 20–68 mm). Tracheal resection was performed in all ten cases. The fistula was included in the resection in 6 patients, while it was excluded in the remaining 4 due to their distance. Post-repair tracheotomy was performed in 3 patients. The procedure was performed in 2 ventilated patients. Morbidity related to fistula and anastomosis was recorded in 3 patients (30%), with one postoperative death (10%); T-Tube placement was necessary in 3 patients, with 2/3 decannulations after long-stenting. Definitive PITEF closure was obtained for all patients. At 5-year follow-up, the 9 surviving patients had no fistula-related morbidity. Conclusions Primary esophageal closure with tracheal resection/reconstruction seemed to be effective treatment both short and long-term. Systemic conditions, mechanical ventilation, detailed preoperative assessment and appropriate preparation

  4. Early results and complications of colorectal laparoscopic surgery and analysis of risk factors in 492 operated cases.

    PubMed

    Santoro, Emanuele; Carboni, Fabio; Ettorre, Giuseppe Maria; Lepiane, Pasquale; Mancini, Pietro; Santoro, Roberto; Santoro, Eugenio

    2010-12-01

    This study aimed to evaluate the early results of colorectal laparoscopic surgery with special attention to surgical and medical complications. The risk factors of such surgery are also investigated on the basis of a large series of operated cases: the preoperative knowledge of such factors could guide the operative program and the postoperative treatment with reduction of complications and improvement of the outcome. Between 1998 and 2008, 492 patients had been submitted to colorectal laparoscopic surgery by the same team: 387 for cancer and 105 for benign disease. All colorectal surgical operations are included in the series. No selection of the patients was made: laparoscopy was performed in all cases accepting the procedure. Several risk factors have been analysed in cases of fistula (age, pathology sex, type of the operation, cancer stages, preoperative radiochemotherapy, stool diversion and team experience) and in cases of medical complications (age, pathology, cancer stages and type of operation). The overall results in this series of laparoscopic colorectal operated cases are similar to other results published at present by the main surgical Department all over the world; no mortality and low number of medical (2.4%) and surgical complications (9.3%), with no differences also with the best open surgery series. Complete or partial conversion to open surgery was required in few cases (1.2%) and same others (1.4%) were operated again for bleeding or sudden anastomotic leakage. Regarding the risk factors in such surgery, a good correlation has been discovered between anastomotic leakage and the team experience, the age over 70 of the patients, the rectal tumour site in man, the advanced tumour stages, the previous radiochemotherapy, while medical complications seem to depend on advanced patients age and advanced cancer stages. Laparoscopic colorectal surgery at present is going to be considered the gold standard in the large majority of colorectal diseases

  5. 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

  6. Venous thromboembolism after oral and maxillofacial oncologic surgery: Report and analysis of 14 cases in Chinese population

    PubMed Central

    Wang, Yang; Liu, Jiannan; Yin, Xuelai; Hu, Jingzhou; Kalfarentzos, Evagelos; Zhang, Chenping

    2017-01-01

    Background Venous thromboembolism (VTE) including deep vein thrombosis (DVT) and pulmonary embolism (PE) is a leading cause of death in cancer patients. The aim of this study was to explore the potential risk factor of VTE in oral and maxillofacial oncological surgery. Material and Methods The data of patients who received operation in our institution were gathered in this retrospective study. A diagnosis of VTE was screened and confirmed by computer tomography angiography (CTA) of pulmonary artery or ultrasonography examination of lower extremity. Medical history and all perioperative details were analyzed. Results 14 patients were diagnosed as VTE, including 6 cases of PE, 7 cases of DVT, 1case of DVT and PE. The mean age of these patients was 62.07 years. Reconstruction was performed in 12 patients of these cases, most of which were diagnosed as malignance. Mean length of surgery was 8.74 hours, and lower extremity deep venous cannula (DVC) was performed in all these patients. Conclusions We analyzed several characters of oral and maxillofacial surgery and suggested pay attention to lower extremity DVC which had a high correlation with DVT according to our data. Key words:Venous thromboembolism, pulmonary embolism, deep vein thrombosis, oral and maxillofacial surgery. PMID:27918738

  7. Infection of laparoscopically inserted inguinal hernia repair mesh following subsequent emergency open surgery: a report of two cases

    PubMed Central

    Panagiotopoulou, IG; Richardson, C; Gurunathan-Mani, S; Lagattolla, NRF

    2012-01-01

    We present two cases of laparoscopically inserted mesh for inguinal hernia repair that became infected following emergency open bowel surgery. We believe that there is an increased risk of infection due to the larger size of mesh used in the laparoscopic repair but also due to the patient not volunteering the information because of the minimally invasive nature of the procedure. PMID:22524902

  8. Leveraging Health-Related Quality of Life in Population Health Management: The Case for Healthy Days

    PubMed Central

    Slabaugh, S. Lane; Shah, Mona; Zack, Matthew; Cordier, Tristan; Havens, Eric; Davidson, Evan; Miao, Michael; Prewitt, Todd; Jia, Haomiao

    2017-01-01

    Abstract Measuring population health with morbidity and mortality data, often collected at the site of care, fails to capture the individual's perspective on health and well-being. Because health happens outside the walls of medical facilities, a holistic and singular measure of health that can easily be captured for an entire population could aid in understanding the well-being of communities. This paper postulates that Healthy Days, a health-related quality of life measure developed and validated by the Centers for Disease Control and Prevention, is an ideal survey instrument to advance population health. A systematic literature review was conducted and revealed a strong evidence base using Healthy Days with significant correlations to chronic disease conditions. Building on the literature base and experience, methods for analyzing Healthy Days data are discussed, including stratified sampling techniques, statistical measures to account for variance, and modeling techniques for skewed distributions. Using such analytic techniques, Healthy Days has been used extensively in national health surveillance. As the health care system faces increasing costs and constrained resources, the Healthy Days survey instrument can be used to inform public policies and allocate health service resources. Because Healthy Days captures broad dimensions of health from the individual's perspective, it is a simple way to holistically measure the health and well-being of a population and its trend over time. Expanded use of Healthy Days can aid population health managers and contribute to the understanding of the broader determinants of the nation's and individual community's health and aid in evaluating progress toward health goals. PMID:27031869

  9. Identical twins with mature cystic teratomas treated with laparoscopic surgery: Two case reports

    PubMed Central

    Mabuchi, Yasushi; Ota, Nami; Kobayashi, Aya; Tanizaki, Yuko; Minami, Sawako; Ino, Kazuhiko

    2017-01-01

    Mature cystic teratomas are the most common among all ovarian neoplasms, representing 30–40% of the cases. However, to the best of our knowledge, there have been only two reports of mature cystic teratomas occurring in identical twins to date. We herein report a case of identical twins with mature cystic teratomas who were treated with laparoscopic surgery. A 32-year-old woman was referred to our hospital due to a tumor in the right ovary. The patient underwent laparoscopic resection of the ovarian tumor and the pathological diagnosis was benign mature cystic teratoma. Two years later, the identical twin of the abovementioned patient was referred to our hospital also due to a right ovarian tumor. The patient underwent laparoscopic resection of the ovarian tumor and the pathological diagnosis was benign mature cystic teratoma. Therefore, for early diagnosis, it may be important to consider the possibility of mature cystic teratoma in the identical twin of a patient, even in the absence of symptoms.

  10. [A Case of Rectal Cancer Successfully Treated with Surgery and Stereotactic Radiotherapy for Metachronous Lung Metastases].

    PubMed

    Oshima, Yu; Hosoda, Yohei; Tachi, Hidekazu; Sugimoto, Takashi; Okabe, Asami; Nishiyama, Kazuhiro; Ogura, Nobuko; Komoto, Izumi; Kiyochi, Hidenori; Tsunekawa, Shoji; Tanaka, Toru; Taki, Yoshiro; Imamura, Masayuki

    2016-11-01

    A 64-year-old woman underwent polypectomy for a rectal polyp(Isp). Pathological findings were invasion of the submucosa( 3,500 mm diameter), and she underwent anterior resection for rectal cancer(RS, pT1b, pN0, cM0, Stage I )without adjuvant chemotherapy. Lung masses were found in her right(8mm)and left lung(7mm). The tumors enlarged during the 4 month follow-up period. We decided to perform left partial pneumonectomy. The tumor was diagnosed as a lung metastasis from colon cancer by pathology. Because the right tumor was located towards the center, performing right pneumonectomy would have been quite invasive and we feared occult metastases. We decided to apply SRT(50 Gy)to the right tumor. The tumor shrunk and became a scar after treatment. There were no complications such as radiation pneumonitis. The patient was in good health without any recurrence for 12 months after SRT. Surgical resection is an optimal method to control lung metastasis from colon cancer if the lesion is operable. However, in the case of a tumor centrally located, surgical resection may cause deterioration of lung function. There are also cases with contraindications for surgery due to co-morbidities. In addition, there is no consensus on observation periods to exclude occult metastases. SRT can be an effective treatment for lung metastases from colon cancer when there are bilateral lung metastases and no metastases outside the lungs.

  11. Computer tomography prototyping and virtual procedure simulation in difficult cases of hip replacement surgery.

    PubMed

    Parchi, Paolo Domenico; Ferrari, Vincenzo; Piolanti, Nicola; Andreani, Lorenzo; Condino, Sara; Evangelisti, Gisberto; Lisanti, Michele

    2013-09-01

    Each year approximately 1 million total hip replacements (THR) are performed worldwide. A percentage of failure due to surgical approach and imprecise implant placement still exists. These result in several serious complications. We propose an approach to plan, to simulate, and to assist prosthesis implantation for difficult cases of THR based on 3-D virtual models, generated by segmenting patients' CT images, 3-D solid models, obtained by rapid prototyping (RP), and virtual procedure simulation. We carried out 8 THR with the aid of 3-D reconstruction and RP. After each procedure a questionnaire was submitted to the surgeon to assess the perceived added value of the technology. In all cases, the surgeon evaluated the 3-D model as useful in order to perform the planning. The clinical results showed a mean increase in the Harris Hip Score of about 42.5 points. The mean time of prototyping was 7.3 hours, (min 3.5 hours, max 9.3 hours). The mean surgery time was 65 minutes (min 50 minutes, max 88 minutes). Our study suggests that meticulous preoperative planning is necessary in front of a great aberration of the joint and in absence of normal anatomical landmarks, CT scan is mandatory, and 3-D reconstruction with solid model is useful.

  12. 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.

  13. Lesson learned from early and long-term results of 327 cases of coexisting surgical abdominal diseases and aortic aneurysms treated in open and endovascular surgery.

    PubMed

    Bonardelli, Stefano; Cervi, Edoardo; Nodari, Franco; Guadrini, Cristina; Zanotti, Camilla; Giulini, Stefano Maria

    2012-06-01

    Patients with abdominal aortic aneurysm (AAA) frequently have other abdominal pathologies of surgical interest (other diseases, OD). Out of 1,375 elective open aortic replacements for AAA, 315 cases with OD were subdivided in Group 1 (82 patients with "clean wound" OD) and Group 2 (233 patients with "clean-contaminated wound" OD). The results of the sub-groups in which OD was treated at the same time as AAA were analysed (1a, 66 cases and 2a, 86 cases) and compared with OD not treated at the same time as AAA (1b, 16 cases and 2b, 147 cases). EVAR was done in 12 patients with a infrarenal AAA and concomitant abdominal disease. In this group post-operative complications occurred in two patients (endoleaks) and no sign of endograft infection was developed. Mean follow-up was 36 months. Mortality was 0% in Group 1a, 1b, 2b and 5.8% in Group 2a. In Group 1a there were one haemoperitoneum, one ischaemic colitis and one graft infection. In Group 1b there were 4 nefrectomies for renal carcinoma and three emergency hernia repairs within 18 months from AAA operation. In Group 2a the follow-up was uneventful. In Group 2b there was no acute complication of OD and 57.2% of patients were subsequently operated for OD. In the EVAR group the 30-day and late mortality rates were 0 and 25%, respectively and all deaths were cancer-related. Contemporary correction of OD in open surgery for AAA should be performed in clean wound cases, while clean-contaminated operations can be done only in selected cases. EVAR is a valid alternative technique to open vascular surgery for the concomitant treatment of aortic aneurysms and abdominal pathologies.

  14. Learning Time of Day and Students' Academic Achievement at School Certificate Level: A Case Study of Chibote Girls' Secondary School

    ERIC Educational Resources Information Center

    Mulenga, Henry M.; Mukuka, Angel

    2016-01-01

    A case study presented here is an investigation into whether time of day for instruction has an effect on students' academic achievement in Mathematics, Science, Biology and English at school certificate level by focusing on the grades candidates obtained after sitting for national examinations. The focus is primarily on 33 randomly selected…

  15. 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

  16. Bilateral periorbital and cervicofacial emphysema following retinal surgery and fluid gas exchange in a case of inadvertent globe perforation.

    PubMed

    Asnani, Haresh T; Mehta, Vinod C; Nair, Akshay Gopinathan; Jain, Vandana

    2015-06-01

    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.

  17. Acute visual loss with ophthalmoplegia after spinal surgery: report of a case and review of the literature.

    PubMed

    Mukherjee, Bipasha; Alam, Mohammad Shahid

    2014-09-01

    We report a case of a 15-year-old boy who presented with profound visual loss and complete ophthalmoplegia after an uneventful spinal surgery for removal of cervical osteoblastoma. Postoperative visual loss following nonocular surgery is, fortunately rare, yet a devastating complication. The most common cause is ischemic optic neuropathy, but it can also be due to central retinal occlusion or cortical blindness. Visual loss in conjunction with ophthalmoplegia is rarely seen, and there are very few reports in the literature. We also review the related literature and highlight the mechanism and preventive measures.

  18. [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.

  19. 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.

  20. 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,…

  1. Two iniencephaly cases born the same day in the same hospital of Cali, Colombia. Iniencephaly cluster?

    PubMed Central

    Saldarriaga, Wilmar; Isaza De Lourido, Carolina; Ruiz Murcia, Fabian Andres

    2014-01-01

    Two patients with short and hyperextended neck, cervical meningocele and other birth defects, were born the same day at the same hospital, both died. The autopsy report and X-rays show iniencephaly's classic findings. Revision of clinical histories did not show consanguinity between the parents, or exposure to environmental factors. PMID:24810450

  2. 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…

  3. Organophosphate poisoning in a 12-day-old infant: case report.

    PubMed

    O'Reilly, D A; Heikens, G T

    2011-01-01

    A 12-day-old infant girl was admitted with increasing lethargy and respiratory distress. Initial treatment was for pneumonia but deterioration despite appropriate treatment prompted review of her diagnosis and consideration of organophosphate poisoning. There was a brisk response to atropine. To our knowledge, this is the youngest infant reported to have been exposed to poisoning by organophosphates.

  4. 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…

  5. [Prolonged cerebral salt wasting following craniopharyngioma surgery and posterior reversible encephalopathy syndrome: a case report].

    PubMed

    Ohtonari, Tatsuya; Hashimoto, Masanori; Urasaki, Eiichiro; Yokota, Akira; Araki, Shunsuke; Asayama, Koutaro; Shirahata, Akira

    2005-01-01

    A 9-year-old boy was admitted to our hospital with daytime urinary incontinence for the past one year. MRI showed craniopharyngioma occupying the third ventricle. The tumor was excised by interhemispheric approach. Because hyponatremia and polyuria with high renal loss of sodium were observed on postoperative day 3, hydrocortisone and DDAVP were replaced. On postoperative day 24, successive general convulsions and hyponatremia recurred, and MRI FLAIR imaging showed marked brain edema in the bilateral parieto-occipital lobes. This finding disappeared late in the course of treatment, and the case was diagnosed as posterior reversible encephalopathy syndrome. The pathophysiology of cerebral salt wasting and posterior reversible encephalopathy syndrome in a craniopharyngioma patient are also discussed in the article.

  6. Limb-sparing surgery as an alternative for limb amputation in an invasive myxoid liposarcoma--case report.

    PubMed

    Adameșteanu, M O; Enache, V; Zamfirescu, D; Lascăr, I

    2015-01-01

    In medical practice, plastic surgeons confront with patients with sarcomas of the extremities that require a radical surgical approach. Knowing when to attempt limb-sparing surgery and when to give in to limb amputation is one of the most difficult decisions a surgeon can take. The correct approach and management of such cases ensure surgical success and the patient survival. In this paper, the case of a 56-year-old man, admitted in our clinic with a crush injury of the right calf and subsequent haematoma is presented. During haematoma drainage, the surgeon noticed abnormal tissue and performed an incisional biopsy. The patient was diagnosed with myxoid liposarcoma of the external compartment of the right calf. Limb amputation was proposed, but the patient refused. After the clinical examination, blood tests and diagnostic imaging, which allowed the correct evaluation of the case-tumor sizes and neighboring tissue reports, and preoperatory radiotherapy, limb sparing surgery, respectively primary tumor excision was decided to be performed. Negative margins could not be obtained by 3 successive resections or by adjuvant chemotherapy. The presented case supports the idea that limb-sparing surgery is only applicable to carefully selected patients with soft tissue sarcoma. In some cases, radical excision involving even mutilating amputations may provide a better oncologic and functional result.

  7. Cardiac-surgery associated acute kidney injury requiring renal replacement therapy. A Spanish retrospective case-cohort study

    PubMed Central

    2009-01-01

    Background Acute kidney injury is among the most serious complications after cardiac surgery and is associated with an impaired outcome. Multiple factors may concur in the development of this disease. Moreover, severe renal failure requiring renal replacement therapy (RRT) presents a high mortality rate. Consequently, we studied a Spanish cohort of patients to assess the risk factors for RRT in cardiac surgery-associated acute kidney injury (CSA-AKI). Methods A retrospective case-cohort study in 24 Spanish hospitals. All cases of RRT after cardiac surgery in 2007 were matched in a crude ratio of 1:4 consecutive patients based on age, sex, treated in the same year, at the same hospital and by the same group of surgeons. Results We analyzed the data from 864 patients enrolled in 2007. In multivariate analysis, severe acute kidney injury requiring postoperative RRT was significantly associated with the following variables: lower glomerular filtration rates, less basal haemoglobin, lower left ventricular ejection fraction, diabetes, prior diuretic treatment, urgent surgery, longer aortic cross clamp times, intraoperative administration of aprotinin, and increased number of packed red blood cells (PRBC) transfused. When we conducted a propensity analysis using best-matched of 137 available pairs of patients, prior diuretic treatment, longer aortic cross clamp times and number of PRBC transfused were significantly associated with CSA-AKI. Patients requiring RRT needed longer hospital stays, and suffered higher mortality rates. Conclusion Cardiac-surgery associated acute kidney injury requiring RRT is associated with worse outcomes. For this reason, modifiable risk factors should be optimised and higher risk patients for acute kidney injury should be identified before undertaking cardiac surgery. PMID:19772621

  8. Is surgery mandatory in locally advanced gastrointestinal stromal tumors after imatinib? A case report and literature review

    PubMed Central

    Congedo, Teresa; Ricci, Riccardo; Martini, Maurizio; Di Noia, Vincenzo; Di Dio, Carmela; Quirino, Michela; Barone, Carlo; Cassano, Alessandra

    2017-01-01

    Oesophageal gastrointestinal stromal tumors (GISTs) are rare neoplasms (about 2% of all GISTs); radical surgery is the standard treatment of all GISTs but in case of locally advanced and unresectable disease no clear treatment guide lines are available. Studies including neoadjuvant imatinib mesylate (IM) are relatively recent, includes small sample size of heterogeneous patients and do not report a standardized duration of neoadjuvant treatment. The main question still remains whether surgery after neoadjuvant IM gives a survival benefit in locally advanced disease. A 46-year-old man with locally advanced unresectable oesophageal GIST harboring KIT exon 11 mutation was treated in our institution for 12 months with neoadjuvant IM; a reduction of 83% of tumor volume was obtained in 9-month of neoadjuvant IM, but in the last 3 months no further response was seen. After neoadjuvant therapy, patient underwent radical surgery and adjuvant IM, which is still ongoing. Since no definitive data are available about survival benefit of surgery after neoadjuvant IM in locally advanced GISTs, a careful balance between morbidity and mortality derived from surgery should be considered and more studies are needed to better define the utility and the optimal duration of neoadjuvant treatment. PMID:28280629

  9. Endoscopic surgery for hemorrhagic pineal cyst following antiplatelet therapy: case report.

    PubMed

    Tamura, Yoji; Yamada, Yoshitaka; Tucker, Adam; Ukita, Tohru; Tsuji, Masao; Miyake, Hiroji; Kuroiwa, Toshihiko

    2013-01-01

    Pineal cysts of the third ventricle presenting with acute obstructive hydrocephalus due to internal cystic hemorrhage are a rare clinical entity. The authors report a case of a 61-year-old man taking antiplatelet medication who suffered from a hemorrhagic pineal cyst and was treated with endoscopic surgery. One month prior to treatment, the patient was diagnosed with a brainstem infarction and received clopidogrel in addition to aspirin. A small incidental pineal cyst was concurrently diagnosed using magnetic resonance (MR) imaging which was intended to be followed conservatively. The patient presented with a sudden onset of headache and diplopia. On admission, the neurological examination revealed clouding of consciousness and Parinaud syndrome. Computerized tomography (CT) scans demonstrated a hemorrhagic mass lesion in the posterior third ventricle. The patient underwent emergency external ventricular drainage with staged endoscopic biopsy and third ventriculostomy using a flexible videoscope. Histological examination revealed pineal tissue with necrotic change and no evidence of tumor cells. One year later MR imaging demonstrated no evidence of cystic lesion and a flow void between third ventricle and prepontine cistern. In patients with asymptomatic pineal cysts who are treated with antiplatelet therapy, it is important to be aware of the risk of pineal apoplexy. Endoscopic management can be effective for treatment of hemorrhagic pineal cyst with obstructive hydrocephalus.

  10. Extracorporeal membrane oxygenation for cardiac arrest during moyamoya cerebral revascularization surgery: case report.

    PubMed

    Choudhri, Omar; Shah, Aatman; Basarab-Tung, Jennifer; Jaffe, Richard A; Steinberg, Gary K

    2015-09-01

    The authors describe the case of a 51-year-old man with bilateral moyamoya disease and prior strokes who developed an asystolic cardiac arrest while undergoing revascularization surgery under mild hypothermia. The patient was successfully treated with venoarterial (VA) extracorporeal membrane oxygenation (ECMO) after manual cardiopulmonary resuscitation (CPR) was unsuccessful for 45 minutes. ECMO is a cardiopulmonary support system that is indicated for respiratory failure in pediatric and adult patients. It is increasingly being used as an extension to mechanical CPR for patients who have suffered cardiac arrest if the underlying cause of cardiac arrest is thought to be reversible. Identifying which patients should be placed on emergency ECMO after cardiac arrest is controversial given its high morbidity and mortality. ECMO in neurosurgical settings has associated risks of intracranial hemorrhage and neurological compromise, while resource utilization is paramount given the high costs of this treatment. This paper is significant because it describes the use of ECMO in an unindicated setting. Limited data are available for ECMO usage after cardiac arrest with baseline cerebral ischemia. Furthermore, this paper raises important considerations for extracorporeal CPR use in a patient who had recently undergone craniotomy. The patient in this report remained on ECMO for 48 hours, after which he was successfully weaned. He developed a pericardial effusion and compartment syndrome from the ECMO but made a complete neurological recovery. Use of ECMO emergently in an appropriately chosen neurosurgical patient is safe, even in the setting of baseline cerebral ischemia and recent craniotomy.

  11. Transpedicular endoscopic surgery for lumbar spinal synovial cyst—report of two cases

    PubMed Central

    Krzok, Guntram; Wagner, Ralf; Iprenburg, Menno

    2016-01-01

    Background Lumbar facet cysts are a benign, degenerative, and fairly uncommon cause for lumbar radiculopathy. The standard surgical treatment for lumbar facet cysts often requires a laminectomy and medial facetectomy which can further destabilize a pathological motion segment. The authors present here a novel technique for transpedicular endoscopic access to the pathology that obviates the need to violate the lamina or facet. Methods Two patient cases are described where the lumbar 4–5 facet cysts arise medial to the pedicle. Percutaneous access to the cysts was established by drilling through the adjacent pedicle creating a 7-mm corridor to establish access for the endoscopic tubular retractor and the working channel endoscope. Straight and bendable forceps were used to remove the cysts under direct visualization. Results Following surgery, the patients’ symptoms showed immediate regression with complete relief of one patient’s foot drop by 6 months. Conclusions Transpedicular endoscopic access is described as novel minimally invasive surgical option in the awake patient for lumbar facet cysts adjacent to the Lumbar 4 or 5 pedicle. PMID:28097248

  12. [Bariatric surgery in inflammatory bowel disease; case report and review of the literature].

    PubMed

    Tenorio Jiménez, Carmen; Manzano García, Gregorio; Prior Sánchez, Inmaculada; Corpas Jiménez, María Sierra; Molina Puerta, María José; Benito López, Pedro

    2013-01-01

    Inflammatory bowel disease (IBD) is rarely associated with obesity, as malabsorption is a common feature of these diseases (1). However, some patients may experience morbid obesity and associated complications refractory to dietary treatment and benefit from bariatric surgery. It has even been postulated that surgery may result in improvement of IBD by reducing inflammatory markers (2). However, patients may experience a higher incidence of complications following surgery in the context of immunosuppressive therapy and prior malabsorption. Therefore, if surgery is performed, careful patient selection and individualization of technique are essential. We present a patient diagnosed with ulcerative colitis who presented severe protein malnutrition after bariatric surgery type bilio-pancreatic diversion and review the available literature.

  13. Presentation of two cases of immediate restoration of implants in the esthetic region, using facilitate software and guides with stereolithographic model surgery prior to patient surgery.

    PubMed

    Kamposiora, Phophi; Papavasiliou, George; Madianos, Phoebous

    2012-02-01

    Improvements in both implant microsurfaces and placement techniques have reduced healing time and increased survival rates. CAD/CAM technology and improved ceramic materials allow for achievement of improved esthetics at the implant restoration level. Two clinical procedures have the capacity to decrease patient postoperative discomfort and improve esthetics. Flapless surgery reduces surgical trauma and postoperative problems. Placement of the final prosthetic abutment at the time of implant placement stabilizes soft tissue adhesion and position to the implant. Both results require careful presurgical planning with precise implant and abutment placement. This is a clinical report of two cases that are part of a larger ongoing clinical trial of 20 patients. The inclusion criterion was that patients should be missing a single tooth in the esthetic zone. Facilitate™ software was used in conjunction with dicom files transferred from CT scans for diagnosis. Stereolithographic models and surgical guides were fabricated from the digital information. Surgical guides were used preoperatively so implant replicas could be placed in stereolithographic models as simulated surgery. A ZirDesign™ ceramic abutment was adapted on the model, and a provisional crown was fabricated. At the time of actual implant surgery, the same surgical guide was used with a flapless approach. The previously modified ceramic abutment was screw-retained and torqued to place into the implant. The provisional crown was then cemented after blocking out the screw access hole. A final restoration was fabricated from all-ceramic material after several months. Success requires careful patient selection and attention to each step of the technique. Preliminary outcomes from the ongoing clinical trial are promising.

  14. Proximal junctional vertebral fracture-subluxation after adult spine deformity surgery. Does vertebral augmentation avoid this complication? A case report

    PubMed Central

    2012-01-01

    Background To report to the orthopedic community a case of vertebral fracture and adjacent vertebral subluxation through the upper instrumented vertebra after thoracolumbar fusion with augmentation of the cranial level. Methods This report reviewed the patient`s medical record, her imaging studies and related literature. The possible factors contributing to this fracture are hypothesized. Results A 70-year-old woman underwent decompressive surgery and posterolateral fusion for adult lumbar scoliosis. We used pedicular screws from T10 to S1 and iliac screw at the right side, augmented with cement at T10, T11, L1, L5 and S1; and prophylactic vertebroplasty at T9 to avoid the "topping-off syndrome". Thirty days after discharge, without recognizable inciting trauma, the patient complained of pain in the lower thoracic area. The exam revealed overall neurological deficit below the level of fracture. CT scan and MRI demonstrated a T10 vertebral collapse and T9 vertebral subluxation with morphologic features of flexion-distraction fracture through the upper edge of the screw. At this point, the authors performed posterior decompression at T9 to T10 and extended posterolateral arthrodesis from T2 to T10. To our knowledge, this is an unreported fracture. Conclusions Augmentation of the cranial level in a long thoracolumbar fusion has been developed to avoid the junctional kyphosis and compression fractures at that level. We alert the orthopedic community that this augmentation may lead to further and more severe fractures, although this opinion requires investigation for confirmation. PMID:22947422

  15. Tourniquet-Related Iatrogenic Femoral Nerve Palsy after Knee Surgery: Case Report and Review of the Literature

    PubMed Central

    Mingo-Robinet, Juan; Castañeda-Cabrero, Carlos; Alvarez, Vicente; León Alonso-Cortés, José Miguel; Monge-Casares, Eva

    2013-01-01

    Purpose. Tourniquet-induced nerve injuries have been reported in the literature, but even if electromyography abnormalities in knee surgery are frequent, only two cases of permanent femoral nerve palsies have been reported, both after prolonged tourniquet time. We report a case of tourniquet-related permanent femoral nerve palsy after knee surgery. Case Report. We report a case of a 58-year-old woman who underwent surgical treatment of a patella fracture. Tourniquet was inflated to 310 mmHg for 45 minutes. After surgery, patient complained about paralysis of the quadriceps femoris with inability to extend the knee. Electromyography and nerve conduction study showed a severe axonal neuropathy of the left femoral nerve, without clinical remission after several months. Discussion. Even if complications are not rare, safe duration and pressure for tourniquet use remain a controversy. Nevertheless, subtle clinical lesions of the femoral nerve or even subclinical lesions only detectable by nerve conduction and EMG activity are frequent, so persistent neurologic dysfunction, even if rare, may be an underreported complication of tourniquet application. Elderly persons with muscle atrophy and flaccid, loose skin might be in risk for iatrogenic nerve injury secondary to tourniquet. PMID:24371536

  16. [Surgery of Wolff-Parkinson-White: value of the epicardial approach. Apropos of 28 surgically treated cases].

    PubMed

    Menasché, P; Leclercq, J F; Cauchemez, B; Coumel, P; Slama, R; Piwnica, A

    1987-01-01

    The authors report their experience of 28 cases of the Wolff-Parkinson-White (WPW) syndrome treated by surgery. Four patients had multiple accessory pathways; of the 32 bundles of Kent detected, 16 were in the postero-septal region. Surgery, performed under cardio-pulmonary bypass after epicardial mapping, consisted in atrioventricular disconnection using no special physical agent. With the exception of 2 cases, the left lateral accessory pathways were operated using a classical left intraatrial approach whereas in the right lateral and septal forms the main procedure of dissection of the right atrioventricular groove was carried out by an epicardial approach. There was one operative death due to haemodynamic and haemorrhagic problems in a top class athlete with two bundles of Kent, the interruption of which required two consecutive bypass procedures. In the 27 survivors, 29 of the 30 accessory pathways were successfully interrupted (96 p. 100). The only failure occurred in a patient with two bundles of Kent. On the other hand, in 2 patients, complete atrioventricular block was successfully obtained by surgical section of the His bundle during the same procedure in one case, and by postoperative catheter ablation in the other case in which surgery had failed. There were no cases of accidental permanent atrioventricular block. The results in this series confirm the value of surgery in the treatment of the WPW syndrome, especially in the septal forms which are reputed to be the most difficult but in which the approach is greatly simplified by the initial dissection of the tricuspid ring by an epicardial approach.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. How to treat splenic marginal zone lymphoma (SMZL) in patients unfit for surgery or more aggressive therapies: experience in 30 cases.

    PubMed

    Cervetti, Giulia; Ghio, Francesco; Cecconi, Nadia; Morganti, Riccardo; Galimberti, Sara; Petrini, Mario

    2017-04-01

    Splenic marginal zone lymphoma (SMZL) is an indolent disease that typically affects elderly patients. Thanks to its outcome, most patients don't need any specific therapy and 'a watch and wait' policy is frequently employed. Treatment is required in symptomatic cases. Splenectomy remains one of the first line options in patients fit for surgery. The best pharmacological strategy has not yet been identified for poor surgical risk cases. Amongst different possible chemotherapeutic approaches, alkylating agents, alone or in association with Rituximab, could employ in 'frail' patients. In the present study, the role of oral cyclophosphamide (100 mg per day for 15 consecutive days, every 30 for a total of six cycles) associated with anti-CD20 monoclonal antibody has been evaluated in 30 newly diagnosed SMZL patients, not fit for splenectomy or more toxic chemotherapic regimens. Overall response rate was 87% (CR 70%; PR 17%). Median PFS was 20 months (range, 1-53), with better outcome for low-risk cases according to IIL score prognostic index. Toxicity profile resulted mild.

  18. Use of Right Ventricular Support with a Centrifugal Pump in Post-Valve Surgery Right Ventricular Failure: A Case Series

    PubMed Central

    Moulodi, Abdol Rasoul; Sheibat Zadeh, Gholam Reza; Sabzi, Feridoun

    2014-01-01

    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. PMID:25561969

  19. Epilepsy surgery in professional musicians: subjective and objective reports of three cases.

    PubMed

    Schulz, Reinhard; Horstmann, Simone; Jokeit, Hennric; Woermann, Friedrich G; Ebner, Alois

    2005-11-01

    We describe a small series of three professional musicians who had right (two patients) and left (one patient) temporal lobe epilepsy surgery with the histological diagnoses of hippocampal sclerosis (two patients) and benign tumor (one patient, xanthoastrocytoma). The musicians were asked to complete a questionnaire about their musical abilities before and after surgery with respect to special musical skills like melody processing, musical memory, rhythm, meter, harmony/dissonance, timbre, concentration and endurance, emotionality, and absolute pitch. In addition, the musicians submitted reports of their experiences. Surgical outcome was excellent with respect to seizures and professional skills. The two patients with right temporal lobe epilepsy reported improvements of specific musical abilities. Vocational development was very positive in all three patients. We conclude that epilepsy surgery can be safe and rewarding in professional musicians and propose initiating a database on epilepsy surgery in this special group of patients.

  20. [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.

  1. Angiomatous lesion and delayed cyst formation after gamma knife surgery for intracranial meningioma: case report and review of literatures.

    PubMed

    Liu, Zhiyong; He, Min; Chen, Hongxu; Liu, Yi; Li, Qiang; Li, Lin; Li, Jin; Chen, Haifeng; Xu, Jianguo

    2015-01-01

    Gamma Knife has become a major therapeutic method for intracranial meningiomas, vascular malformations and schwannomas with exact effect. In recent years an increasing number of delayed complications after Gamma Knife surgery have been reported, such as secondary tumors, cystic changes or cyst formation. But angiomatous lesion and delayed cyst formation after Gamma Knife for intracranial lesion has rarely been reported. Here we report the first case of angiomatous lesion and delayed cyst formation following Gamma Knife for intracranial meningioma and discuss its pathogenesis.

  2. Canaletto implant in revision surgery for carpal tunnel syndrome: 21 case series.

    PubMed

    Bilasy, A; Facca, S; Gouzou, S; Liverneaux, P A

    2012-09-01

    Revision carpal tunnel surgery varies from 0.3% to 19%. It involves a delayed neurolysis and prevention of perineural fibrosis. Despite numerous available procedures, the results remain mediocre. The aim of this study is to evaluate the results of the Canaletto implant in this indication. Our series includes 20 patients (1 bilateral affection) reoperated for carpal tunnel between October 2008 and December 2009. After the first operation, the symptom-free period was 112 weeks, on average. The average incision was 27 mm. After neurolysis, the Canaletto implant was placed in contact with the nerve. Immediate postoperative mobilization was commenced. Sensory (pain, DN4, and hypoesthesia), motor (Jamar, muscle wasting), and functional (disabilities of the arm, should, and hand; DASH) criteria were evaluated. Nerve conduction velocity (NCV) of the median nerve was measured. Average follow up was 12.1 months. All measurements were improved after insertion of the Canaletto implant: pain (6.45-3.68), DN4 (4.29-3.48), Quick DASH (55.30-34.96), Jamar (66.11-84.76), NCV (29.79-39.06 m/s), hypoesthesia (76.2-23.8%), wasting (42.9-23.8%). Nevertheless, four patients did not improve, and pain was the same or worse in six cases. Our results show that in recurrent carpal tunnel syndrome, Canaletto implant insertion gives results at least as good as other techniques, with the added advantage of a smaller access incision, a rapid, less invasive technique, and the eliminated morbidity of raising a flap to cover the median nerve.

  3. Rehabilitation of a One-day-Old Neonate with Cleft Lip and Palate using Palatal Obturator: A Case Report

    PubMed Central

    Kumar Pathak, Ashish; Bhatia, Baldev; Gupta, Sailesh; Kumar Gautam, Keshav

    2012-01-01

    ABSTRACT Feeding a neonate with a complete cleft lip and palate is difficult pursuit due to communication between oral cavity and nasal cavity. A multidisciplinary approach is required to manage the complex problems involved in case of such neonates and their families. Present case is of a 1-day-old neonate having complete bilateral cleft lip and palate for which palatal obturator was constructed. A stepwise simple, easy and uncomplicated procedure for making accurate impressions, maxillary cast and fabrication of palatal obturator in infants with cleft lip and palate has been presented. The objective to present this case report is to emphasize the fact that how these palatal obturators /plates help in feeding, speech/language development, presurgical orthopedics and prevent other associated otorhinolaryngeal problems. How to cite this article: Bansal R, Pathak AK, Bhatia B, Gupta S, Gautam KK. Rehabilitation of a One-day Old Neonate with Cleft Lip and Palate using Palatal Obturator: A Case Report. Int J Clin Pediatr Dent 2012;5(2):145-147. PMID:25206156

  4. [Oncoplastic versus conventional breast conserving surgery. A comparison of clinicopathological findings, cosmetic results and quality of life in 60 cases].

    PubMed

    Mátrai, Zoltán; Gulyás, Gusztáv; Kovács, Eszter; Sándor, Zsuzsanna; Polgár, Csaba; Bartal, Alexandra; Kásler, Miklós

    2014-06-01

    Oncoplastic surgical techniques seem to be suitable for realizing the goal of retaining cosmesis following radical removal of breast tumors. The purpose of the present study is to provide a clinical and pathological comparison of conventional (BCS) and oncoplastic (OPS) breast-conserving surgeries, supplemented by a subjective assessment of cosmesis and quality of life of patients, the first time on a Hungarian sample. The authors performed a retrospective assessment of clinicopathological data of 60 advanced oncoplastic and 60 conventional breast-conserving surgery cases, and following adjuvant radiotherapy, the authors also surveyed patients for cosmetic results and quality of life (EORTC BR23). Comparison of the results was performed by statistical methods. The two groups did not differ substantially in age, tumor location, breast size, type of axillary surgery (sentinel node biopsy vs. axillary lymphadenectomy), tumor grade and receptor status. Tumor size was significantly greater (p=0.0009), the rate of quadranectomies was higher (p=0.0032), metastases in the regional lymph nodes (p=0.0043) and the administration of adjuvant chemotherapy (p=0.0122) were more frequent in the OPS group. The duration of surgeries was longer (p<0.001), the weight of the specimens was greater (p=0.0308), the rate of completion surgeries due to microscopically positive surgical margins was significantly smaller (p=0.0306) in the OPS than in the BCS group. There was no difference between the two groups in the rate of complications and the time elapsed to the start of adjuvant treatment. The cosmetic outcome was clearly superior in the OPS group (p<0.001), and OPS patients had fewer arm, shoulder (p=0.0399), and chest pain (of the affected side) (p=0.0304), upper limb movements of the operated side were also better (p=0.006). The short follow-up period of the OPS group (mean 32.2 vs. 8.7 months in BCS and OPS, respectively) did not allow a meaningful assessment of oncologic endpoints

  5. Taking Statins May Boost Heart Surgery Outcomes

    MedlinePlus

    ... taking your statin for even one day before cardiac surgery may increase your risk of death after surgery," ... cause-and-effect relationship. SOURCE: The Annals of Thoracic Surgery , news release, March 16, 2017 HealthDay Copyright (c) ...

  6. Satellite remote sensing of Asian aerosols: a case study of clean, polluted and dust storm days

    NASA Astrophysics Data System (ADS)

    Lee, K. H.; Kim, Y. J.

    2010-06-01

    Satellite-based aerosol observation is a useful tool for the estimation of microphysical and optical characteristics of aerosol during more than three decades. Until now, a lot of satellite remote sensing techniques have been developed for aerosol detection. In East Asian region, the role of satellite observation is quite important because aerosols originating from natural and man-made pollution in this region have been recognized as an important source for regional and global scale air pollution. However, it is still difficult to retrieve aerosol over land because of the complexity of the surface reflection and complex aerosol composition, in particular, aerosol absorption. In this study, aerosol retrievals using Look-up Table (LUT) based method was applied to MODerate Resolution Imaging Spectroradiometer (MODIS) Level 1 (L1) calibrated reflectance data to retrieve aerosol optical thickness (AOT) over East Asia. Three case studies show how the methodology works to identify those differences to obtain a better AOT retrieval. The comparison between the MODIS and Aerosol Robotic Network (AERONET) shows better results when the suggested methodology using the cluster based LUTs is applied (linear slope=0.94, R=0.92) than when operational MODIS aerosol products are used (linear slope=0.78, R=0.87). In conclusion, the suggested methodology is shown to work well with aerosol models acquired by statistical clustering the observation data in East Asia.

  7. 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.

  8. The effect of funding policy on day of week admissions and discharges in hospitals: the cases of Austria and Canada.

    PubMed

    Leonard, Kevin J; Rauner, Marion S; Schaffhauser-Linzatti, Michaela Maria; Yap, Richard

    2003-03-01

    This paper compares two different funding policies for inpatients, the case-based approach in Austria versus the global budgeting approach in Canada. It examines the impact of these funding policies on length of stay of inpatients as one key measure of health outcome. In our study, six major clinical categories for inpatients are selected in which the day of the week for admission is matched to the particular day of the week of discharge for each individual case. The strategic statistical analysis proves that funding policies have a significant impact on the expected length of stay of inpatients. For all six clinical categories, Austrian inpatients stayed longer in hospitals compared to Canadian inpatients. Moreover, inpatients were not admitted and discharged equally throughout the week. We also statistically prove for certain clinical categories that more inpatients are discharged on certain days such as Mondays or Fridays depending on the funding policy. Our study is unique in the literature and our conclusions indicate that, with the right incentives in place, the length of stay can be decreased and discharge anomalies can be eliminated, which ultimately leads to a decrease in healthcare expenditures and an increase in healthcare effectiveness.

  9. Cataract Surgery in a Patient with Amyotrophic Lateral Sclerosis: A Case Report

    PubMed Central

    Cenk Kohen, Maryo; Beril Kucumen, Raciha

    2011-01-01

    Abstract We report a cataract operation with complications in a patient with amyotrophic lateral sclerosis (ALS). The patient had a grade 4 mature brown cataract. Phacoemulsification with intraocular lens (IOL) implantation was planned; however, due to unexpected complications occurring during surgery, the operating technique was revised to an intracapsular cataract extraction. A very high vitreous pressure was found and therefore scleral fixating IOL was not implanted after anterior vitrectomy because of the possibility of choroidal effusion. The postoperative visual acuity improved sufficiently for the patient to communicate. Visual communication is of vital importance for an ALS patient and his caregivers. Therefore, surgery may be advisable in patients at a terminal stage with an advanced cataract, even if their general health condition may not seem appropriate for such an operation. Nevertheless, the intra- and postoperative course of the surgery may show unexpected complications and the surgeon should be prepared for such conditions. PMID:21886620

  10. 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.

  11. The First 90 Days of the New Middle School Principal in a Turnaround School: In-Depth Case Study of the Transition Period (First 90 Days)

    ERIC Educational Resources Information Center

    Baeza, Marco A.

    2010-01-01

    This study analyzed skills, strategies, and theories that new middle school principals used to be successful during their transition period (the first 90 days) in turnaround schools. Based on research on transitions, three research questions guided the study: 1. Do middle school principals in a turnaround school situation find the transition…

  12. Neuropathic pain following multilevel surgery in children with cerebral palsy: a case series and review.

    PubMed

    Lauder, G R; White, M C

    2005-05-01

    Six children with cerebral palsy are presented who developed neuropathic pain following multilevel orthopedic surgery. This significant complication is previously unreported. The diagnosis and treatment options are reviewed. Treatment should be kept as simple and noninvasive as possible, and aim to enable physiotherapy to continue. Early recognition and interdisciplinary treatment is important to prevent a downward spiral of increasing pain and decreased function. A good outcome in respect of improved pain and functioning was achieved in five of these six children. It is our opinion that this complication should form part of informed consent for multilevel surgery and that anesthetists should be aware of this complication when managing postoperative pain control.

  13. 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.

  14. 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…

  15. 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

  16. 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.

  17. Penile squamous cell carcinoma: a review of the literature and case report treated with Mohs micrographic surgery*

    PubMed Central

    Marchionne, Elizabeth; Perez, Caroline; Hui, Andrea; Khachemoune, Amor

    2017-01-01

    The majority of penile carcinoma is squamous cell carcinoma. Although uncommon in the United States, it represents a larger proportion of cancers in the underdeveloped world. Invasive squamous cell carcinoma may arise from precursor lesions or de novo , and has been associated with lack of circumcision and HPV infection. Early diagnosis is imperative as lymphatic spread is associated with a poor prognosis. Radical surgical treatment is no longer the mainstay, and penile sparing treatments now are often used, including Mohs micrographic surgery. Therapeutic decisions should be made with regard to the size and location of the tumor, as well as the functional desires of the patient. It is critical for the dermatologist to be familiar with the evaluation, grading/staging, and treatment advances of penile squamous cell carcinoma. Herein, we present a review of the literature regarding penile squamous cell carcinoma, as well as a case report of invasive squamous cell carcinoma treated with Mohs micrographic surgery. PMID:28225964

  18. 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

  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. 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

  1. A Case-Control Study of Elective Hip Surgery among HIV-Infected Patients: Exposure to Systemic Glucocorticoids Significantly Increases the Risk

    PubMed Central

    Kerr, Elizabeth; Middleton, Annie; Churchill, Duncan; Walker-Bone, Karen

    2017-01-01

    Objectives This was a cross-sectional case-control study amongst a cohort of HIV-infected adults aiming to explore the prevalence of and risk factors for elective hip surgery (total hip arthroplasty and resurfacing). Methods Cases were identified from the outpatient database of HIV-infected adults attending one tertiary hospital service. For each case, 5 controls matched by age, gender and ethnicity were identified. From the case notes, information about demographic factors, HIV factors and risk factors for hip surgery due to osteoarthritis or avascular necrosis (body mass index, lipids, alcohol, comorbidities and treatment with oral glucocorticoids) were extracted. Results Amongst the cohort of 1900 HIV-infected outpatients, 13 cases (12 male) who had undergone hip surgery (0.7%) were identified, median age 47 years.11/13 (85%) were Caucasian and 7/13 were in stage 3 of HIV. Significantly more of the control subjects (46% vs. 16%, p=0.04) were in the asymptomatic stage of infection. Ever use of oral glucocorticoids was highly significantly associated with elective hip surgery (92% vs. 11%, P<0.001). Conclusions Amongst this young cohort, the prevalence of elective hip surgery was 0.7% with median age at surgery (47 years) considerably younger than that amongst the general population. Ever exposure to systemic glucocorticoids was highly significantly associated with elective hip surgery, suggesting that the principal mechanism underlying the need for surgery was avascular necrosis. There may be an increased need for elective hip surgery associated with HIV. PMID:24025108

  2. Clinical improvement of secondary focal limb dystonia in neurodegenerative disease following a five-day lidocaine infusion: a case report.

    PubMed

    Irwin, D; Revuelta, G; Lippa, C F

    2009-02-15

    Dystonia associated with neurodegenerative disease has minimal effective treatment options and can be devastating to a patient's ability to perform tasks of daily living. We present a case of a 55 year-old man who had progressive symptoms of an atypical asymmetric parkinsonian neurodegenerative disease. This patient presented with a dystonic left upper extremity that was refractory to treatment. In an attempt to treat worsening pain associated with the dystonia, he was given a five-day lidocaine infusion for associated pain and within 24 h had improvement in mobility of his dystonic extremity. Dystonia was measured by the Burke-Fahn-Marsden (BFM) dystonia rating and disability scales on hospital day five and at an eight week follow up visit. These scores were compared with scores derived from his previous pre-treatment neurologic examination. The BFM dystonia scale score was initially 16 and improved to 12 on both immediate post-treatment and eight-week follow-up. The BFM disability score improved from 16 to 6 post treatment and to 8 on follow-up appointment. Most importantly, the patient could feed and dress himself for the first time in several years. No adverse events of treatment were encountered. Treatment effect lasted three months with a slow return to baseline motor function. This case report raises interesting questions regarding the mechanism of dystonia in neurodegenerative disease and suggests the afferent sensory system as a potential target for therapeutics.

  3. [Endoscopic surgery].

    PubMed

    Rushfeldt, Christian; Pham, Khanh Do-Cong; Aabakken, Lars

    2016-05-01

    Endoscopic surgery of the stomach/gastrointestinal tract was developed in the 1990s in Japan as a minimally invasive method of removing early-stage tumours, using a gastro-/coloscope instead of open or laparoscopic surgery. Its advantages are obvious, in that the patient is spared more major surgery, the hospital saves on resources as well as admission to a ward, and society is spared the costs of days of sickness absence. Endoscopic submucosal dissection is considered the most difficult technique, but it allows for the accurate dissection of large tumours. In 1999, Japanese surgeon Takuji Gotoda and his team were the first to perform these types of dissections of early cancers in the rectum using a diathermic needle and a flexible scope.

  4. 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

  5. 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

  6. 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

  7. Comparison of Intraoperative Portable CT Scanners in Skull Base and Endoscopic Sinus Surgery: Single Center Case Series

    PubMed Central

    Conley, David B.; Tan, Bruce; Bendok, Bernard R.; Batjer, H. Hunt; Chandra, Rakesh; Sidle, Douglas; Rahme, Rudy J.; Adel, Joseph G.; Fishman, Andrew J.

    2011-01-01

    Precise and safe management of complex skull base lesions can be enhanced by intraoperative computed tomography (CT) scanning. Surgery in these areas requires real-time feedback of anatomic landmarks. Several portable CT scanners are currently available. We present a comparison of our clinical experience with three portable scanners in skull base and craniofacial surgery. We present clinical case series and the participants were from the Northwestern Memorial Hospital. Three scanners are studied: one conventional multidetector CT (MDCT), two digital flat panel cone-beam CT (CBCT) devices. Technical considerations, ease of use, image characteristics, and integration with image guidance are presented for each device. All three scanners provide good quality images. Intraoperative scanning can be used to update the image guidance system in real time. The conventional MDCT is unique in its ability to resolve soft tissue. The flat panel CBCT scanners generally emit lower levels of radiation and have less metal artifact effect. In this series, intraoperative CT scanning was technically feasible and deemed useful in surgical decision-making in 75% of patients. Intraoperative portable CT scanning has significant utility in complex skull base surgery. This technology informs the surgeon of the precise extent of dissection and updates intraoperative stereotactic navigation. PMID:22470270

  8. Patient Specific Instruments for Complex Tumor Resection-Reconstruction Surgery within the Pelvis: A Series of 4 Cases.

    PubMed

    Cernat, Eduard; Docquier, Pierre-Louis; Paul, Laurent; Banse, Xavier; Codorean, Ion-Bogdan

    2016-01-01

    The pelvis bone resection-reconstruction surgery is one of the most challenging fields in orthopedics. Being applied for tumors, as for other complex reconstruction cases, this type of surgery needs careful planning and is time consuming, in order to obtain proper accuracy. Unfortunately not all the time the expected accuracy is met, with consequences for the patients. PSI proved to provide good cutting accuracy during simulated tumor surgery within the pelvis. This article present a series of 4 patients operated in our department between June 2014 and Mars 2015 for tumors resectionreconstructions. The patients were imaged using a CT and an MRI scan and the images were reconstructed in 3D. According to the bone bank stock, the most similar allograft was chosen and the stored CT scan was reconstructed in 3D. Patient specific instruments (PSI) were designed and manufactured using rapid-prototyping technology for the resection of the native tissues as for the resection of the careful selected hemipelvic allografts. Allografts fitting to the pelvis of the patients was excellent and allowed stable osteosynthesis.

  9. 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

  10. Effect of day-case unilateral cochlear implantation in adults on general and disease-specific quality of life, postoperative complications and hearing results, tinnitus, vertigo and cost-effectiveness: protocol for a randomised controlled trial

    PubMed Central

    Derks, Laura S M; Wegner, Inge; Smit, Adriana L; Thomeer, Hans G X M; Topsakal, Vedat; Grolman, Wilko

    2016-01-01

    Introduction Cochlear implantation is an increasingly common procedure in the treatment of severe to profound sensorineural hearing loss (SNHL) in children and adults. It is often performed as a day-case procedure. The major drive towards day-case surgery has been from a logistical, economical and societal perspective, but we also speculate that the patient's quality of life (QoL) is at least equal to inpatient surgery if not increased as a result of rapid discharge and rehabilitation. Even though cochlear implantation seems well suited to a day-case approach and this even seems to be common practice in some countries, evidence is scarce and of low quality to guide us towards the preferred treatment option. Methods and analysis A single-centre, non-blinded, randomised, controlled trial was designed to (primarily) investigate the effect on general QoL of day-case cochlear implantation compared to inpatient cochlear implantation and (secondarily) the effect of both methods on (subjective) hearing improvement, disease-specific QoL, tinnitus, vertigo and cost-effectiveness. 30 adult patients with severe to profound bilateral postlingual SNHL who are eligible for unilateral cochlear implantation will be randomly assigned to either the day-case or inpatient treatment group. The outcome measures will be assessed using auditory evaluations, questionnaires (preoperatively, at 1-week, 3-week, 3-month and 1-year follow-up) and costs diaries (weekly during the first month postoperatively, after which once in a month until 1-year follow-up). Preoperative and postoperative outcomes will be compared. The difference in costs and benefit will be represented using the incremental cost utility/effectiveness ratio. The analyses will be carried out on an intention-to-treat basis. Ethics and dissemination This research protocol was approved by the Institutional Review Board of the UMC Utrecht (NL45590.041.13; V.5, November 2015). The trial results will be disseminated through peer

  11. 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 ...

  12. 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

  13. 3D Printed Models and Navigation for Skull Base Surgery: Case Report and Virtual Validation.

    PubMed

    Ritacco, Lucas E; Di Lella, Federico; Mancino, Axel; Gonzalez Bernaldo de Quiros, Fernan; Boccio, Carlos; Milano, Federico E

    2015-01-01

    In recent years, computer-assisted surgery tools have become more versatile. Having access to a 3D printed model expands the possibility for surgeons to practice with the particular anatomy of a patient before surgery and improve their skills. Optical navigation is capable of guiding a surgeon according to a previously defined plan. These methods improve accuracy and safety at the moment of executing the operation. We intend to carry on a validation process for computed-assisted tools. The aim of this project is to propose a comparative validation method to enable physicians to evaluate differences between a virtual planned approach trajectory and a real executed course. Summarily, this project is focused on decoding data in order to obtain numerical values so as to establish the quality of surgical procedures.

  14. Retropharyngeal hematoma secondary to cervical spine surgery: report of one fatal case.

    PubMed

    Dedouit, Fabrice; Grill, Stéphane; Guilbeau-Frugier, Céline; Savall, Frédéric; Rougé, Daniel; Telmon, Norbert

    2014-09-01

    A 53-year-old woman suffering from radicular pain due to cervical herniation underwent a spinal surgery consisting of anterior cervical discectomy and fusion with an implantable titanium cage. Five hours after the procedure, the patient developed cervical swelling and dyspnea. An emergency surgery permitted evacuation of a deep cervical hematoma and intubation of the patient, who died some minutes later. The family of the deceased lodged a complaint with the public prosecutor because of unclear circumstances of death. After analysis of the medical records by two forensic pathologists, a medicolegal autopsy was ordered. Massive retropharyngeal and mediastinal hematomas were diagnosed. Pathological study confirmed acute cervical hemorrhage, but failed to detect the source of bleeding. The forensic pathologists concluded that death was due to mechanical asphyxia secondary to pharyngeal compression by the cervical hematoma. To the best of our knowledge, death secondary to retropharyngeal hematoma in this neurosurgical context is rarely encountered.

  15. Two cases of cystic enlargement of vestibular schwannoma as a late complication following gamma knife surgery.

    PubMed

    Shuto, Takashi; Matsunaga, Shigeo

    2016-11-01

    Cyst formation is the most common long-term complication after gamma knife surgery (GKS) for cerebral arteriovenous malformations; however, this rarely occurs after GKS for vestibular schwannoma (VS). We describe two patients that developed aggressive, symptomatic large cysts at more than 4 and 12years after GKS for VS, although the tumor control for these patients had been acceptable at 3 and 11years, respectively. During the surgery, a reddish lesion, which was distinct from the surrounding tumor, was observed. The microscopic examination of the reddish lesion revealed dilated capillary vessels and hemorrhage, which was compatible with late radiation changes; these were usually seen in arteriovenous malformations following radiosurgery. The present patients indicated that cyst formation and enlargement may occur as a late complication following GKS even in extra-axial benign tumors such as VS.

  16. 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.

  17. Complete prefrontal lobe isolation surgery for recurrent epilepsy: A case report

    PubMed Central

    Yin, Shaoya; Jin, Weipeng; Li, Qingyun; Feng, Mei; Feng, Keke; Shao, Hui; Zhang, Xueqing; Wang, Shimin

    2016-01-01

    Epileptogenic focus resection is less effective for the treatment of frontal lobe epilepsy compared with temporal lobe epilepsy. However, there is currently a lack of effective therapeutic options for patients with frontal lobe epilepsy who are unsuitable for epileptogenic focus resection (such patients with epileptogenic foci in one frontal lobe in which the precise epileptic foci cannot be determined), or who experience recurrent epilepsy following epileptogenic focus resection. The present study reports a patient with frontal lobe epilepsy who underwent successful frontal lobe isolation surgery following a previous unsuccessful epileptogenic focus resection surgery. To ensure complete isolation of the prefrontal lobe, the surgery included division of the anterior commissure and the anterior part of the corpus callosum. The patient was followed-up for 16 months. Although the follow-up electroencephalogram presented a number of sharp waves on the affected side, the patient did not experience any seizures. The results suggest that prefrontal lobe isolation is an effective method of treating frontal lobe epilepsy, as division of the anterior commissure and the anterior part of the corpus callosum ensures disconnection of the prefrontal lobe from other regions of the brain. PMID:27882111

  18. 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.

  19. [Treatment in the event of antibiotic prophylaxis failure in gynecologic surgery. A retrospective study of 20 cases].

    PubMed

    Paparella, P; Zullo, M A; Astorri, A L; Bondì, M; Maglione, A; Oliva, C; Mancuso Bondì, S

    1994-09-01

    A retrospective study was performed of the type of treatment used in 20 patients undergoing gynecological surgery in whom antibiotic prophylaxis with Mezlocillin (2 g i.v.) had failed. Patients were subdivided into three groups: A) Initial therapy with Mezlocillin (8 patients, 2 g/die i.m.) or Cefotetan (2 patients, 2 g/die i.m.) and subsequent addition of Gentamicin (8 patients, 240 mg/die i.m.) or Tobramycin (2 patients, 200 mg/die i.m.) and subsequently Metronidazole (7 patients, 1.5 g/die per os). B) Therapy with Imipenem/Cilastatin (6 patients, 1.5 g/die i.m.). C) Therapy with Imipenem/Cilastatin (4 patients, 1.5 g/die i.m.) after a variety of antibiotics: Cotrimoxazole (Trimethoprim 160 mg/die and sulphamethoxazole 800 mg/die per os), Pefloxacin (800 mg/die per os), Cefotetan (2 g/die i.m.) and Mezlocillin (2 g/die i.m.). Time taken to lower temperature was shorter in Group B (3.5 days) compared to Group A (6.8 days) and Group C (10 days). Postoperative hospital stay was also shorter in Group B (9 days) compared to Group C (16.5 days) and Group A (11.1 days). The immediate administration of an antibiotic active against Gram+ and Gram- germs, aerobes and anaerobes is therefore useful in the event of failure of antibiotic prophylaxis, rather than the use in succession of associations of antibiotics with a limited spectrum.

  20. Tension-free mesh hernia repair: review of 1098 cases using local anaesthesia in a day unit.

    PubMed Central

    Kark, A. E.; Kurzer, M.; Waters, K. J.

    1995-01-01

    The technical problems, early complications and short-term results of a tension-free method of 1098 inguinal hernia repairs in 1017 patients have been assessed. The operation was conducted under local anaesthesia, and the inguinal canal floor was reinforced by a polypropylene mesh. Patients were discharged home the same day. There was no mortality, no urinary complications and one case of venous thrombosis. There was one recurrence after a primary hernia repair and two patients have developed recurrences after repair of a recurrent hernia. The overall sepsis rate was 0.9% and 1% of patients had persistent neuralgia. No prosthesis required removal. In all, 49.6% of office workers returned to work in 1 week or less and 61% of manual workers in 2 weeks or less. The major advantages of the tension-free mesh repair under local anaesthesia are simplicity, substantial cost savings and very low rates of complications. PMID:7574324

  1. 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.

  2. [Case report of acute death on the 7th day due to exposure to the vapor of the insecticide chlorfenapyr].

    PubMed

    Hoshiko, Michiko; Naito, Shinji; Koga, Mitsuaki; Mori, Mihoko; Hara, Kunio; Ishitake, Tatsuya

    2007-04-01

    We present the case of a 55-year-old male agricultural worker who complained of severe general fatigue and hyperperspiration after exposure to an insecticide vapor. He worked in a tea plantation and used chlorfenapyr, a broad spectrum for harmful insects, without any protective mask or clothes. After one day of insecticide spray work, he gradually began to complain of general fatigue, hyperperspiration, nausea and vomiting. At first, he was diagnosed as being dehydrated and was treated with fluid replacement therapy. Although he received this conservative therapy, there was no effect on the above mentioned symptoms. On the 7th day of the onset of his symptoms, his consciousness level deteriorated rapidly and body temperature exceeded 40 degrees C. No cerebral vascular disease or meningitis was observed. Finally, he died despite intensive care. The findings of the clinical course and laboratory data suggest a clinical diagnosis of acute pesticide poisoning due to exposure to chlorfenapyr vapor. We suggest that agricultural workers should use this insecticide with caution and sufficient protective gear.

  3. Three-dimensional virtual reality simulation of periarticular tumors using Dextroscope reconstruction and simulated surgery: A preliminary 10-case study

    PubMed Central

    Shi, JingSheng; Xia, Jun; Wei, YiBing; Wang, SiQun; Wu, JianGuo; Chen, FeiYan; Huang, GangYong; Chen, Jie

    2014-01-01

    Background Dextroscope® three-dimensional (3D) imaging has been extensively used to generate virtual reality (VR) workspaces for neurosurgery and laparoscopy, but few applications have been reported for orthopedic surgery. Here, we investigated orthopedic periarticular tumor surgery planning and anatomical characteristics using a Dextroscope. Material/Methods Patients undergoing surgery for periarticular tumors (n=10) between October 2008 and June 2010 were enrolled and presurgically subjected to computed tomography (CT), magnetic resonance imaging (MRI), and MRI angiography (MRI-A). Imaging data were transferred and integrated in a Dextroscope to produce a VR simulation. The presurgical 3D anatomical reconstructions and intraoperative anatomical characteristics (virtual vs. actual data) and surgical approach (virtual vs. actual situation) measurement and subjective appearance were compared. Results Anatomical characteristics in the area of interest and tumor diameters in all 3 planes (superior-inferior, medial-lateral, and anteroposterior) were consistent between virtual and actual data (3.92±1.22, 1.96±0.53, and 1.73±0.44 vs. 3.92±1.13, 1.91±0.44, and 1.81±0.41; P=0.99, 0.24, and 0.09, respectively). However, the virtual surgical situations were inconsistent with the actual intraoperative situation in many cases, leading to complications. The resolutions of the original CT, MRI, and MRI-A images directly correlated with 3D simulation quality, with soft tissues most poorly represented. Tumor tissue imaging quality in 3D varied extensively by tumor type. Conclusions Anatomical structures of periarticular tumors can be reconstructed using the Dextroscope system with good accuracy in the case of simple fenestration, increasing treatment individualization, surgical competence level, and potentially reducing intraoperative complications. However, further specialization of VR tools for use in orthopedic applications that involve specialized tools and procedures

  4. Sickle cell disease and complex congenital cardiac surgery: a case report and review of the pathophysiology and perioperative management.

    PubMed

    Sanders, D B; Smith, B P; Sowell, S R; Nguyen, D H; Derby, C; Eshun, F; Nigro, J J

    2014-03-01

    Sickle cell anemia and thalassemia are hemoglobinopathies rarely encountered in the United States. Compounded with congenital heart disease, patients with sickle cell disease (SCD) requiring cardiopulmonary bypass and open-heart surgery represent the proverbial "needle in the haystack". As such, there is some trepidation on the part of clinicians when these patients present for complex cardiac surgery. SCD is an autosomal, recessive condition that results from a single nucleotide polymorphism in the β-globin gene. Hemoglobin SS molecules (HgbSS) with this point mutation can polymerize under the right conditions, stiffening the erythrocyte membrane and distorting the cellular structure to the characteristic sickle shape. This shape change alters cellular transit through the microvasculature. As a result, circumstances such as hypoxia, hypothermia, acidosis or diminished blood flow can lead to aggregation, vascular occlusion and thrombosis. Chronically, SCD can give rise to multiorgan damage secondary to hemolysis and vascular obstruction. This review and case study details an 11-year-old African-American male with known SCD who presented to the cardiothoracic surgical service with congenital heart disease consisting of an anomalous, intramural right coronary artery arising from the left coronary sinus for surgical consultation and subsequent surgical correction. This case report will include a review of the pathophysiology and current literature regarding preoperative, intraoperative and postoperative management of SCD patients.

  5. Unnecessary multiple epidural steroid injections delay surgery for massive lumbar disc: Case discussion and review

    PubMed Central

    Epstein, Nancy E.

    2015-01-01

    Background: Epidural steroid injections (ESI) in the lumbar spine are not effective over the long-term for resolving “surgical” lesions. Here, we present a patient with a massive L2–L3 lumbar disk herniation whose surgery was delayed for 4 months by multiple unnecessary ESI, resulting in a cauda equina syndrome. Methods: A 54-year-old male acutely developed increased low back and radiating left leg pain in October of 2014. In December of 2014, a magnetic resonance imaging (MRI) scan showed a massive central/left sided disk herniation at the L2–L3 level resulting in marked thecal sac and left L2 foraminal and L3 lateral recess root compression. Despite the marked degree of neural compression, pain management treated him with 3 ESI over the next 3 months. Results: At the end of April of 2015, he presented to spine surgeon with a cauda equina syndrome. When the new MRI scan confirmed the previously documented massive central-left sided L2–L3 disk herniation, the patient emergently underwent an L1–L3 laminectomy with central-left sided L2–L3 lateral/foraminal diskectomy. Postoperatively, the patient was neurologically intact. Conclusions: Pain specialists performed multiple unnecessary lumbar ESI critically delaying spinal surgery for 4 months in this patient with a massive lumbar disk herniation who ultimately developed a cauda equina syndrome. Unfortunately, pain specialists (e.g., radiologists, anesthesiologists, and physiatrists), not specifically trained to perform neurological examinations or spinal surgery, are increasingly mismanaging spinal disease with ESI/variants. It is time for spine surgeons to speak out against this, and “take back” the care of patients with spinal surgical disease. PMID:26425398

  6. 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.

  7. Cardiac surgery and heparin induced thrombocytopaenia (HIT): a case report and short review.

    PubMed

    McMeniman, W J; Chard, R B; Norrie, J; Posen, J

    2012-05-01

    This patient presented for emergency cardiac surgery following two episodes of thrombocytopaenia, one before and one associated with exposure to unfractionated heparin in a seven-week period of intensive care management. Although the diagnosis of heparin induced thrombocytopaenia (HIT) was uncertain on clinical grounds when assessed by current criteria, the positive antibody status directed management in accordance with the internationally recognised guidelines published by the American College of Chest Physicians (ACCP) Evidence-based Clinical Practice Guidelines. An alternative anticoagulant to unfractionated heparin was indicated for cardiopulmonary bypass. Bivalirudin was selected because of recent literature supporting its safe use.

  8. Gallstone ileus inducing obstructive jaundice at the afferent loop of Roux-en-Y hepaticojejunostomy after bile duct cancer surgery: a case report.

    PubMed

    Lee, Hyun Gu; Hwang, Shin; Joo, Yo-Han; Cho, Yu-Jeong; Choi, Kyunghak

    2015-05-01

    The diagnosis of gallstone ileus is occasionally challenging due to the variability of its presentation. We herein present a very rare case of gallstone ileus inducing obstructive jaundice at the afferent loop of Roux-en-Y hepaticojejunostomy after 10 years of bile duct cancer surgery. We describe the case of a 74-year-old Korean woman with obstructive jaundice, treated conservatively. She showed severely impaired liver function test and obstructive jaundice. The computed tomography (CT) scan led to a diagnosis of very rare type of gallstones ileus at the afferent jejunal loop. Since the clinical manifestation was improved, we decided to observe her closely. On the next follow-up CT scan, the gallstone disappeared with mild distension of the afferent bowel loop, implicating spontaneous passage of the gallstone. She recovered and returned to normal life after 10 days of initiation of clinical manifestations. We presume that the gallstone may enter the afferent jejunal loop through the hepaticojejunostomy and later increase in size. The presence of narrow tract of intestine may facilitate the incidence of gallstone ileus. It appears to be the first report on this rare type of gallstone ileus inducing obstructive jaundice.

  9. A Cost-Benefit Analysis on the Feasibility of Implementing A Same-Day Surgery Program at the 121ST General Hospital, Seoul, Korea

    DTIC Science & Technology

    2000-04-27

    complete my research include the following: Mr. Craig Carter, LTC Jane Denio, Ms. Patricia Felder, Mr. Al Rayos , Mr. Modesto Rivera, Mrs. Helen Shinn...3,100,392, calculated as such: (*Average DRG Cost x 894) – (*Average SDS Cost x 894) = $3,100,392 There were 22 cases that could be clearly identified as a... x 1. INTRODUCTION…………………………………………………..…… 1 Conditions Which Prompted the Study……………………….…. 2 Statement of the Problem

  10. Previous gastric bypass surgery complicating total thyroidectomy.

    PubMed

    Alfonso, Bianca; Jacobson, Adam S; Alon, Eran E; Via, Michael A

    2015-03-01

    Hypocalcemia is a well-known complication of total thyroidectomy. Patients who have previously undergone gastric bypass surgery may be at increased risk of hypocalcemia due to gastrointestinal malabsorption, secondary hyperparathyroidism, and an underlying vitamin D deficiency. We present the case of a 58-year-old woman who underwent a total thyroidectomy for the follicular variant of papillary thyroid carcinoma. Her history included Roux-en-Y gastric bypass surgery. Following the thyroid surgery, she developed postoperative hypocalcemia that required large doses of oral calcium carbonate (7.5 g/day), oral calcitriol (up to 4 μg/day), intravenous calcium gluconate (2.0 g/day), calcium citrate (2.0 g/day), and ergocalciferol (50,000 IU/day). Her serum calcium levels remained normal on this regimen after hospital discharge despite persistent hypoparathyroidism. Bariatric surgery patients who undergo thyroid surgery require aggressive supplementation to maintain normal serum calcium levels. Preoperative supplementation with calcium and vitamin D is strongly recommended.

  11. 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.

  12. A Pregnancy with Severe Hypertrophic Obstructive Cardiomyopathy after Surgery for an Implantable Cardioverter Defibrillator: A Case Report and Literature Review

    PubMed Central

    Mitsui, Takashi; Ejiri, Kentaro; Hayata, Kei; Ito, Hiroshi; Hiramatsu, Yuji

    2016-01-01

    Hypertrophic obstructive cardiomyopathy (HOCM) is cardiac hypertrophy of ventricular myocardium with left ventricular outflow tract obstruction. We report a pregnancy with HOCM after defibrillator implantation surgery. The patient was a 33-year-old nulligravida and was categorized as New York Heart Association class II. Her brain natriuretic peptide (BNP) level was 724.6 pg/dL at preconception. She received careful pregnancy management. However, because frequent uterine contractions were observed at 25 weeks and 6 days of pregnancy, she was hospitalized, and magnesium sulfate was started as a tocolytic agent. At 27 weeks and 5 days of pregnancy, she had respiratory discomfort and orthopnea with a sudden decrease in peripheral oxygen saturation. Cardiac ultrasonography showed a worsened condition of HOCM and her BNP level was 1418.0 pg/mL. We performed an emergent cesarean section and she delivered a boy weighing 999 g. The Apgar score was 8 and 9 points at 1 and 5 minutes, respectively. The mother's heart failure quickly improved after birth and she was discharged at 10 days postoperatively. Fluctuations in circulatory dynamics during pregnancy may sometimes exacerbate heart disease. Therefore, the risks should be fully explained and careful assessment of cardiac function should be performed during pregnancy in patients with severe HOCM. PMID:27830098

  13. [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.

  14. 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

  15. 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

  16. 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…

  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.

  18. [Indications and results of Politano-Leadbetter antireflux-plasty in 565 cases of ureterorenal surgery].

    PubMed

    Steffens, L; Steffens, J; Sohn, M

    1986-11-01

    The Politano-Leadbetter antireflux procedure is a standardized and safe method for the treatment of primary and secondary reflux persisting after successful therapy of infravesical obstruction. Indications for antireflux surgery depend on reflux classification, age, urethral calibration and evaluation of position and shape of the ureteral orifice, associated malformations and successful antimicrobial therapy. Reflux was cured in 90.4 per cent of 565 ureterorenal units in 361 children and 103 adults. A persisting reflux occurred in 5.1 per cent and a stenosis of the terminal ureter requiring reimplantation occurred in 0.7 per cent. The overall rate of reinterventions was 8.1 per cent. This low complication rate makes surgical correction advisable if urinary tract infection and primary reflux cannot be eradicated by continuous antimicrobial therapy.

  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. Anatomic findings in revision endoscopic sinus surgery: Case series and review of contributory factors

    PubMed Central

    Bewick, Jessica; Egro, Francesco M.; Masterson, Liam; Javer, Amin R.

    2016-01-01

    Background: It is recognized that patients who undergo endoscopic sinus surgery (ESS) do not always achieve control of their disease. The causes are multifactorial; variations in surgical practice have been identified as possible factors in refractory disease. Objective: To reflect on the frequent anatomic findings of patients with chronic rhinosinusitis (CRS) who require revision ESS. Methods: A retrospective review of patients who required revision ESS at a tertiary institution over a 3-year period. Patients for whom maximal medical therapy failed for CRS underwent computed tomography of the paranasal sinuses and image-guided surgery. Surgical records of anatomic findings were reviewed and analyzed. Results: Over 3 years, a total of 75 patients underwent revision procedures, 28% of all ESS performed in the unit. The most frequent finding was a residual uncinate process in 64% of the patients (n = 48); other findings included a maxillary antrostomy not based on the natural ostium of the maxillary sinus in 47% (n = 35), an oversized antrostomy in 29% (n = 22), resected middle turbinates in 35% (n = 26), middle meatal stenosis in 15% (n = 11), synechiae in 29% (n = 22), and osteitic bone that required drilling in 13% (n = 10). Conclusion: Surgical technique can give rise to anatomic variations that may prevent adequate mucociliary clearance and medication delivery, which leads to failure in ESS in patients with CRS. This study demonstrated the surgical findings encountered in revision ESS that should be highlighted in the training of Ear, Nose and Throat surgeons to help prevent primary failure and reduce health care costs. PMID:28107148

  1. The night before your surgery - children

    MedlinePlus

    Surgery - child; Preoperative - night before ... food after 11 p.m. the night before surgery. Your child should not eat or drink any ... child the night before or the day of surgery, call the doctor. Stop giving your child any ...

  2. Plastic Surgery

    MedlinePlus

    ... Loss Surgery? A Week of Healthy Breakfasts Shyness 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 " ...

  3. Outpatient Surgery

    MedlinePlus

    ... Outpatient Surgery Share this Page Preparing For Surgery Effects of Anesthesia Children and Anesthesia Pregnancy and Anesthesia Seniors and Anesthesia Surgery Risks Anesthesia Awareness Obesity and Anesthesia Sleep Apnea and Anesthesia Smoking and Anesthesia Outpatient Surgery ...

  4. Current treatment of nasal vestibular stenosis with CO2-laser surgery: prolonged vestibular stenting versus intraoperative mitomycin application. A case series of 3 patients.

    PubMed

    van Schijndel, Olaf; van Heerbeek, Niels; Ingels, Koen J A O

    2014-12-01

    These case studies describe three cases of unilateral nasal vestibular stenoses caused by chemical cauterization. Each case was treated with CO2-laser surgery together with intraoperative topic application of mitomycin or prolonged vestibular stenting for prevention of restenosis. Two patients received intraoperative mitomycin application and one patient received prolonged vestibular stenting. Results were documented using high-resolution photographs. The follow up period ranged from 1 year and 3 months to 4 years and 9 months. All patients improved after CO2-laser surgery. No complications were reported. We consider CO2-laser surgery for relief of nasal vestibular stenosis as a feasible surgical technique for relieve of nasal vestibular stenosis. Prolonged vestibular stenting seems to be an important factor for the prevention of restenosis in which the value of intraoperative mitomycin application without prolonged vestibular stenting remains uncertain.

  5. 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.

  6. [Infected subdural hematoma having a surgery of chronic subdural hematoma 1 year ago:a case report].

    PubMed

    Nagao, Takaaki; Miyazaki, Chikao; Ando, Shunpei; Haga, Daisuke; Kuroki, Takao; Sugo, Nobuo; Nagao, Takeki

    2015-02-01

    We report a case of an infected subdural hematoma that occurred 1 year after burr-hole irrigation for chronic subdural hematoma. A 78-year-old woman who had developed left hemiparesis was admitted to our hospital. A computed tomography(CT)scan revealed the presence of a chronic subdural hematoma in the right hemisphere. Her clinical symptoms improved immediately after emergency burr-hole irrigation, which allowed her discharge from the hospital. One year after the initial surgery, she developed an infection of the urinary tract infection, which led to severe pyelonephritis and septic shock. Treatment of the urological symptoms eliminated the systemic inflammation. One month after the urinary infection, the patient was readmitted to the hospital in a comatose state. A CT scan showed regrowth of a residual subdural hematoma surrounded by a thick capsule, causing a midline shift in the brain. An emergency operation for removal of the subdural hematoma by burr-hole irrigation was performed, and pus was drained from the subdural mass. Microbiological cultures of the abscess revealed the presence of Proteus mirabilis. After surgery, the patient was administered an antibiotic treatment for three weeks and she was discharged with no neurological deficits. Cultures of blood from the septic shock as well as from the abscess both revealed the presence of Proteus mirabilis. Therefore, a diagnosis of infected subdural hematoma, which was caused by hematogenous infection, was made. We conclude that attention should be paid to the risk of infection of the hematoma capsule in subdural hematomas.

  7. Case report: central venous catheterization via internal jugular vein with associated formation of perioperative venous thrombosis during surgery in the prone position.

    PubMed

    Minami, Kimito; Mimami, Kimito; Iida, Miki; Iida, Hiroki

    2012-06-01

    An unusual case of central venous catheter (CVC)-related thrombosis during supine surgery in the prone position is presented. A 76-year-old woman was scheduled for elective surgery to repair a broken lumbar instrument. A single-lumen CVC was inserted via the right internal jugular vein. Surgery was performed in the prone position, with the patient's face directed downward in the standard median position (i.e., no rotation), but with slight forward flexion at the neck. After the surgery, the external jugular vein was dilated, and a postoperative X-ray revealed an infiltrative shadow in the right thoracic cavity. Because cervical echography showed dilated cervical veins with a "moyamoya-type" echo, possibly indicating a thrombus, contrast-enhanced computed tomography was performed, revealing a venous thrombus in the right internal jugular vein. An internal jugular venous-velocity measurement suggested that her slightly flexed neck position and her prone position during surgery may have kinked the internal jugular vein, causing engorgement with venous blood. The presence of the internal jugular venous catheter may have created thrombogenic conditions. A patient's position during surgery can reduce deep venous-flow velocity, and venous blood may stagnate, contributing greatly to thrombogenicity. We should consider a patient's position during surgery as a risk factor for thrombus formation, and a careful preoperative evaluation should be made as to which route should be chosen for CVC.

  8. Colonic cavernous hemangiomas: a report of two cases treated by laparoscopic surgery.

    PubMed

    Rodríguez-Zentner, H; Castañeda-Argáiz, R; Tapia, H; Vergara-Fernandez, O; González, Q H

    2011-05-01

    Hemangiomas are rare vascular tumors. They most commonly appear in the small bowel, as well as the colon and the rectum. Here, we report two cases of male patients who were admitted to our hospital for low rectal painless bleeding, misdiagnosed of hemorrhoid bleeding. Colonoscopy reported vascular tumors in both cases, which we surgically removed.

  9. Percutaneous reduction of mitral valve regurgitation using the MitraClip system - immediate and 90-day follow-up of 3 cases.

    PubMed

    Kübler, Piotr; Kustrzycka-Kratochwil, Dorota; Telichowski, Artur; Witkowski, Tomasz; Banasiak, Waldemar; Jankowska, Ewa A; Ponikowski, Piotr; Reczuch, Krzysztof

    2013-01-01

    Treatment of hemodynamically significant valvular heart diseases has been the domain of cardiac surgery for decades. However, a promising novel method is the MitraClip system, involving percutaneous connection of insufficient valve leaflets with special cobalt-chrome clips. Our study presents clinical characteristics, course of treatment with the MitraClip system, and immediate and 90-day clinical and echocardiographic follow-up of the first 3 patients treated in our institution. Subsequently, based on data from the literature and our own experience, the current position around the world, and the target group of patients who are most likely to benefit from treatment using the MitraClip system, are discussed.

  10. Transoral robotic surgery for the pediatric head and neck surgeries.

    PubMed

    Erkul, Evren; Duvvuri, Umamaheswar; Mehta, Deepak; Aydil, Utku

    2017-03-01

    Pediatric robotic surgery is a relatively new technology that has been shown to be safe and feasible for a number of pediatric procedures. Our literature analysis was performed using Pubmed database between January 2005 and December 2015, using key words: "robotic," "robotic surgery," "TORS," "pediatric," "children," "head and neck," and "da Vinci". We selected only publications in English. Eight published reports met the selection criteria. We totally found 41 patients, and the age range was between 2 months and 19 years. The cases are 16 only lingual tonsillectomy, nine base of tongue and lingual tonsillectomy, two malignant disease in the oropharynx (high-grade undifferentiated sarcoma and biphasic synovial sarcoma), one tongue base thyroglossal duct cyst, 11 laryngeal cleft cyst, one posterior glottic stenosis, and one congenital true vocal cord paralysis surgeries. One intraoperative complication was reported. No patient needed postoperative tracheotomy. Hospital duration time had a range of 1-16 days. TORS is new for pediatric patients in head and neck areas, and there were few reports. It is becoming increasingly used in head and neck surgeries and those reports above are encouraging for pediatric robotic airway surgeries in otolaryngology in the future.

  11. Progressive Paraparesis after CABG Surgery

    PubMed Central

    Shadvar, Kamran; Eslampoor, Yashar

    2013-01-01

    CABG is one of the most common cardiac surgeries all over the world. Similar to other surgeries, it may be associated with some undesirable complications including neurologic complications which might cause morbidity and mortality after surgery. We will describe a case of Progressive Paraparesis after CABG Surgery and review its etiology, diagnosis and management. PMID:24251008

  12. [Conversion Surgery for Initially Unresectable Locally Advanced Pancreatic Cancer Following Gemcitabine plus Nab-Paclitaxel - A Case Report].

    PubMed

    Nakamoto, Shuji; Nishiyama, Ryo; Kaneda, Takayoshi; Yokota, Mitsuo; Kawamata, Hiroshi; Tajima, Hiroshi; Kaizu, Takashi; Kumamoto, Yusuke; Yamauchi, Hiroshi; Okuwaki, Kosuke; Iwai, Tomohisa; Imaizumi, Hiroshi; Suzuki, Erina; Hara, Atsuko; Ichinoe, Masaaki; Kida, Mitsuhiro; Watanabe, Masahiko

    2017-02-01

    We report a case of unresectable locally advanced pancreatic cancer successfully resected after gemcitabine(GEM)plus nab-paclitaxel(PTX)treatment. A 68-year-old man was referred to our institution with jaundice. We diagnosed pancreatic head cancer using computed tomography(CT)and endoscopic retrograde cholangiopancreatography. We initially diagnosed it as locally advanced unresectable pancreatic cancer because of extensive invasion to the portal vein. GEM plus nab- PTX was administered to the patient as systemic chemotherapy. After 9 courses of chemotherapy, a CT scan revealed that the tumor had significantly reduced in size and range of portal vein invasion. Therefore, we performed pancreaticoduodenectomy with resection of the portal vein and achieved R0 resection. Currently, the patient is alive without recurrence. Therefore, conversion surgery after treatment with GEM plus nab-PTX chemotherapy for unresectable pancreatic cancer should be considered.

  13. Laparoscopic revision surgery for gastroesophageal reflux disease

    PubMed Central

    Celasin, Haydar; Genc, Volkan; Celik, Suleyman Utku; Turkcapar, Ahmet Gökhan

    2017-01-01

    Abstract Laparoscopic antireflux surgery is a frequently performed procedure for the treatment of gastroesophageal reflux in surgical clinics. Reflux can recur in between 3% and 30% of patients on whom antireflux surgery has been performed, and so revision surgery can be required due to recurrent symptoms or dysphagia in approximately 3% to 6% of the patients. The objective of this study is to evaluate the mechanism of recurrences after antireflux surgery and to share our results after revision surgery in recurrent cases. From 2001 to 2014, revision surgery was performed on 43 patients (31 men, 12 women) between the ages of 24 and 70 years. The technical details of the first operation, recurrence symptoms, endoscopy, and manometry findings were evaluated. The findings of revision surgery, surgical techniques, morbidity rates, length of hospitalization, and follow-up period were also recorded and evaluated. The first operation was Nissen fundoplication in 34 patients and Toupet fundoplication in 9 patients. Mesh hiatoplasty was performed for enforcement in 18 (41.9%) of these patients. The period between the first operation and the revision surgery ranged from 4 days to 60 months. The most common finding was slipped fundoplication and presence of hiatal hernia during revision surgery. Revision fundoplication and hernia repair with mesh reinforcement were used in 33 patients. The other techniques were Collis gastroplasty, revision fundoplication, and hernia repair without mesh. The range of follow-up period was from 2 to 134 months. Recurrence occurred in 3 patients after revision surgery (6.9%). Although revision surgery is difficult and it has higher morbidity, it can be performed effectively and safely in experienced centers. PMID:28072725

  14. [Complications in bland struma surgery. A retrospective study based on 2,035 personal cases].

    PubMed

    Vara-Thorbeck, R; Tovar, J L; Rosell, J; Guerero, J A; Ruiz, M; Salvi, M; Morales, O I; Vara-Thorbeck, C

    1989-01-01

    In the present retrospective study we examine the complications arising from simple goiter operations based on the analysis of 2,035 cases. The mortality rate is extremely low (0.3%). The most typical intraoperative complications - such as unilateral vocal cord paralysis (1.6%) and permanent parathyroprival hypocalcemia (0.4%) were observed to occur much more frequently in cases of subtotal thyroidectomy than in those of partial resection. - As a result of the introduction of synthetic reabsorbent sewing materials, healing problems have been drastically reduced (0.4%). Hypothyreosis and goiter recurrence can be avoided in cases of subtotal thyroidectomy by life-long and individually adjusted administration of thyroid hormones (rate of incidence in our study 3.1%). - In our view a subtotal thyroidectomy is indicate in cases where malignity is suspected (one or more cold nodules).

  15. Long-Term Prognostic Analysis after Endoscopic Endonasal Surgery for Olfactory Neuroblastoma: A Retrospective Study of 13 Cases

    PubMed Central

    Zhang, Luyao; Zhu, Kang; Xia, Cui; Yan, Jing; Zhao, Wei; Wei, Junrong; Duan, Maoli; Zheng, Guoxi

    2016-01-01

    Objectives To summarize the characteristics and long–term outcomes of olfactory neuroblastoma through the analysis of 13 cases in single institution, with the assessment of treatment modality, prognostic factors. Method A retrospective study of thirteen cases diagnosed as olfactory neuroblastoma and underwent combined treatments during the period 2000–2010. Statistical analysis was performed to search for prognostic factors and compared different treatment modalities. Results 13 patients were enrolled in this study, including 8 male and 5 female, ranging from 15 to 69 (median 43) years old. One patient at stage A was only treated with endoscopic endonasal surgery (EES). Seven patients were treated with preoperative radiotherapy and EES, two with EES and postoperative radiotherapy, and the other three with combined radiotherapy and chemotherapy. The range of follow-up time varied from 23 to 116 months (median 65 months). The 5-year overall survival rate was 46.2% (6/13). To date, these thirteen patients have not suffered local recurrences while two patients had lymph node recurrences and one had distant metastasis in the bone marrow. In 13 patients, 61.5% were diagnosed as late T stage (T3/4), 69.2% late Kadish stage (C/D) and 53.8% were high Hyams grade (I/ II), which indicated poor prognosis. Related prognostic factors were the TNM stage (T stage P = 0.028, N stage P = 0.000, M stage P = 0.007), Kadish stage (P = 0.025) and treatment modality (P = 0.015). Conclusion Late stage of TNM and Kadish staging system indicated a poor prognosis. Combined treatment modality, including endoscopic endonasal surgery, achieved a better outcome than non-surgical approach. PMID:27806104

  16. 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

  17. Laparoscopic robotic-assisted gastrointestinal surgery: the Geneva experience.

    PubMed

    Soravia, Claudio; Schwieger, Ian; Witzig, Jacques-Alain; Wassmer, Frank-Alain; Vedrenne, Thierry; Sutter, Pierre; Dufour, Jean-Philippe; Racloz, Yves

    2008-01-01

    The continuing development of robotic surgery supports its use in laparoscopic gastrointestinal surgery. Our study retrospectively reviewed the surgical outcome and patient's satisfaction of gastrointestinal laparoscopic robotic procedures. From January 2003 to September 2007, 94 patients (27 women, 67 men) with a mean age of 53 years (range 19-84 years) underwent laparoscopic surgery with a da Vinci robotic system. There were 40 colorectal cases (43%), 31 anti-reflux surgery cases (33%) and 14 obesity surgery cases (15%); the remaining cases consisted of gastric and gallbladder surgery, intra-abdominal tumour excisions, and hepatic cyst resections. The majority of the cases (88, 94%) were performed for benign disease. The mean operative time was 153 min (range 60-330 min). One patient needed a blood transfusion. The mean body mass index was 25 (range 16-47). No death occurred. Five cases (5.3%) were converted to conventional laparoscopic surgery (n = 3) or to laparotomy (n = 2). Morbidity consisted of one Nissen redo surgery to loosen a tight anti-reflux valve 6 days after robotic surgery, a robotic left ureter repair and pelvic haemorrhage following proctectomy requiring re-operation to control haemostasis and to remove pelvic haematoma. Mean follow-up time was 11 months (range 15 days to 34 months). One case of incisional trocar hernia needed re-operation. Overall patient's satisfaction was high: few scars were cheloïd, while functional surgical outcome was rated high by most of the patients. Our preliminary experience was encouraging, with minimal morbidity and very high acceptance by patients.

  18. Retrospective analysis of 697 septoplasty surgery cases: packing versus trans-septal suturing method.

    PubMed

    Cukurova, I; Cetinkaya, E A; Mercan, G C; Demirhan, E; Gumussoy, M

    2012-04-01

    The trans-septal suturing method has been developed in septoplasty as an alternative to packing. This study was carried out to compare the postoperative results of trans-septal suturing with the anterior Merocel packing technique. The study involved 697 patients who underwent septoplasty. Following surgery, patients were randomly divided into two groups, one with trans-septal suturing and the other with Merocel packing. Patients were asked to record pain levels using a visual analogue scale. Postoperative symptoms and complications were compared. A total of 697 nasal operations were evaluated in the postoperative period considering pain, bleeding, haematoma, septal perforation synechiae and septal perforation. The results for haemorrhage, haematoma, synechiae and perforation were not statistically different (p > 0.05) between groups. In contrast, the level of postoperative pain in patients undergoing trans-septal suturing was significantly less than in the group who received Merocel packing (p < 0.05). Patients with Merocel packing had significantly more pain and nasal discomfort when assessed 1 week after intervention. Therefore, the trans-septal suturing technique may be the preferred option to provide higher patient satisfaction.

  19. Fluorescein sodium-guided surgery of a brain abscess: A case report

    PubMed Central

    Höhne, Julius; Brawanski, Alexander; Schebesch, Karl-Michael

    2016-01-01

    Background: Up to now, the feasibility and benefit of using fluorescein sodium under a dedicated surgical microscope filter (YE560, YELLOW 560 nm filter, Carl Zeiss Meditec, Germany) has never been clinically evaluated in infectious disorders of the brain. Case Description: Here, we report the case of a male patient with a brain abscess in the right parietal lobe that was removed under fluorescence-guidance (intravenous administration of fluorescein sodium 10%, 5 mg/kg bodyweight). The abscess capsule showed intensive yellow fluorescent staining, while − under white light − the cortex appeared normal. Conclusion: This technique may improve the identification and surgical removal of brain abscesses. PMID:28031990

  20. Cytoreductive surgery and intraperitoneal chemotherapy for colorectal peritoneal and hepatic metastases: a case-control study

    PubMed Central

    Duraj, Frans F.

    2013-01-01

    Background Concomitant treatment of colorectal peritoneal metastases (PM) and hepatic metastases (HM) remains controversial. This study compares the cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) treatment of colorectal peritoneal metastases (PM) with the CRS/IPC/hepatic resection treatment of colorectal PM and HM. Methods All patients from a prospective PM registry at the Uppsala institution treated concomitantly for PM/HM with CRS/IPC/hepatic resections were included in a PM/HM-group, n=11. They were matched 1:2 with patients from the registry being treated only for PM with CRS/IPC, n=22. Overall survival (OS), disease-free survival (DFS), morbidity, mortality, and recurrences were compared. Results The PM/HM-group had median OS of 15 months (95% CI: 6-46 months) and the PM-group had a median OS of 34 months (95% CI: 19-37 months), P=0.2. The DFS was 10 months (95% CI: 3-14 months) 
and 24 months (95% CI: 10-32 months) respectively, P=0.1. Morbidity was 27% in both groups and one postoperative death in the PM/HM-group. Currently, 1/10 (10%) patients with an R1 resection are 
disease-free in the PM/HM group while 9/20 (45%) are disease-free in the PM group (P=0.05). Conclusions Concomitant treatment of PM and HM with CRS/IPC/hepatic resections is feasible with no significant increase in morbidity compared to CRS/IPC. The risk of recurrences is higher in the PM/HM group with a tendency towards worse DFS. PMID:24294511

  1. Cutaneous mucormycosis postcosmetic surgery

    PubMed Central

    Al-Tarrah, Khaled; Abdelaty, Mahmoud; Behbahani, Ahmad; Mokaddas, Eman; Soliman, Helmy; Albader, Ahdi

    2016-01-01

    Abstract Background: Mucormycosis is a rare, aggressive, and life-threatening infection that is caused by organisms belonging to the order Mucorales. It is usually acquired through direct means and virtually always affects immunocompromised patients with the port of entry reflecting the site of infection, in this case, cutaneous. Unlike other mucormycoses, patients affected by Apophysomyces elegans (A elegans) are known to be immunocompetent. This locally aggressive disease penetrates through different tissue plains invading adjacent muscles, fascia, and even bone causing extensive morbidity and may prove fatal if treated inadequately. Cutaneous mucormycosis is associated with disruption of cutaneous barriers such as trauma. However, rarely, it may be iatrogenic. No cases have been previously reported postcosmetic surgery, especially one that is so commonly performed, lipofilling. Case Report: The patient is a, previously healthy, 41-year-old middle-eastern female who was admitted to the plastic surgery department 17 days after undergoing cosmetic surgery. She suffered from extensive tissue inflammation and necrosis in both gluteal regions. Following admission, she was initially started on empirical antimicrobial therapy which was changed to an antifungal agent, voriconazole, when preliminary microbiological results showed filamentous fungi. This was discontinued and liposomal amphotericin B was commenced when further mycological analysis identified A elegans. Furthermore, she underwent a total of 10 sessions of extensive debridement to the extent that portions of the sacrum and left femoral head became exposed. Her clinical status and wounds improved with the appropriate management and she remained an inpatient for 62 days. Subsequently, she had defects in both gluteal regions which required reconstructive surgery. Conclusion: A elegans is an uncommon cause of iatrogenic cutaneous mucormycosis. A high index of clinical suspicion is required, especially in the

  2. The early days of arterial surgery.

    PubMed

    Ellis, Harold

    2011-11-01

    Severe arterial bleeding must have been a common, much feared and often fatal complication of trauma since man appeared on Earth. The early surgeons would have used direct pressure on the wound, which would only have provided temporary relief, or learned to apply a tight dressing. If it was an injured limb, this would often result in gangrene. Application of styptics such as turpentine or the use of the cautery or boiling oil is described in ancient Greek, Roman, Hindu and Arab manuscripts. Indeed, boiling oil to cauterise gunshot wounds was strongly advised by John de Vigo in his surgical textbook that was widely used in the 16th century.

  3. Applied Sports Nutrition Support, Dietary Intake and Body Composition Changes of a Female Athlete Completing 26 Marathons in 26 Days: A Case Study

    PubMed Central

    McManus, Chris J.; Murray, Kelly A.; Parry, David A.

    2017-01-01

    The aim of this case study is to describe the nutrition practices of a female recreational runner (VO2max 48.9 ml·kg-1·min-1) who completed 26 marathons (42.195 km) in 26 consecutive days. Information relating to the nutritional intake of female runners during multi-day endurance events is extremely limited, yet the number of people participating year-on-year continues to increase. This case study reports the nutrition intervention, dietary intake, body composition changes and performance in the lead-up and during the 26 days. Prior to undertaking the 26 marathon challenge, three consultations were held between the athlete and a sports nutrition advisor; planning and tailoring the general diet and race-specific strategies to the endurance challenge. During the marathons, the mean energy and fluid intake was 1039.7 ± 207.9 kcal (607.1 – 1453.2) and 2.39 ± 0.35 L (1.98 – 3.19). Mean hourly carbohydrate intake was 38.9 g·hr-1. 11 days following the completion of the 26 marathons, body mass had reduced by 4.6 kg and lean body mass increasing by 0.53 kg when compared with 20 days prior. This case study highlights the importance of providing general and event-specific nutrition education when training for such an event. This is particularly prudent for multi-day endurance running events. Key points Multi-day endurance running (MDER) events are increasingly prevalent among recreational and elite runners, as such, reporting the practices of populations underrepresented in the literature are important. This case study reports nutritional practices of a female recreational runner undertaking 26 marathons in 26 consecutive days. This case study highlights the importance of providing general and event-specific nutrition education when training for such an event. This is particularly prudent for MDER events. PMID:28344459

  4. Tracheal rupture related to endotracheal intubation after thyroid surgery: a case report and systematic review.

    PubMed

    Xu, Xiaohan; Xing, Na; Chang, Yanzi; Du, Yingying; Li, Zhisong; Wang, Zhongyu; Yan, Jie; Zhang, Wei

    2016-04-01

    Tracheobronchial rupture is an uncommon but potentially serious complication of endotracheal intubation. The most likely cause of tracheal injury is massive overinflation of the endotracheal tube cuff and pre-existing tracheal wall weakness. We review the relevant literature and predisposing factors contributing to this complication. Only articles that reported at least the demographic data (age and sex), the treatment performed and the outcome were included. Papers that did not detail these variables were excluded. We also focus on a case of tracheal laceration after tracheal intubation in a patient with severe thyroid carcinoma. This patient received surgical repair and recovered uneventfully. Two hundred and eight studies that reported cases or case series were selected for analysis. Most of the reported cases (57·2%) showed an uneventful recovery after surgical therapy. The overall mortality was 19·2% (40 patients). Our patient too recovered without any serious complication. Careful prevention, early detection and proper treatment of the problem are necessary when tracheal rupture occurs. The morbidity and mortality associated with tracheal injury mandate a high level of suspicion and expedient management.

  5. External validation of the Revised Cardiac Risk Index and update of its renal variable to predict 30-day risk of major cardiac complications after non-cardiac surgery: rationale and plan for analyses of the VISION study

    PubMed Central

    Walsh, Michael; Devereaux, P J; MacNeil, S Danielle; Lam, Ngan N; Hildebrand, Ainslie M; Acedillo, Rey R; Mrkobrada, Marko; Chow, Clara K; Lee, Vincent W; Thabane, Lehana; Garg, Amit X

    2017-01-01

    Introduction The Revised Cardiac Risk Index (RCRI) is a popular classification system to estimate patients' risk of postoperative cardiac complications based on preoperative risk factors. Renal impairment, defined as serum creatinine >2.0 mg/dL (177 µmol/L), is a component of the RCRI. The estimated glomerular filtration rate has become accepted as a more accurate indicator of renal function. We will externally validate the RCRI in a modern cohort of patients undergoing non-cardiac surgery and update its renal component. Methods and analysis The Vascular Events in Non-cardiac Surgery Patients Cohort Evaluation (VISION) study is an international prospective cohort study. In this prespecified secondary analysis of VISION, we will test the risk estimation performance of the RCRI in ∼34 000 participants who underwent elective non-cardiac surgery between 2007 and 2013 from 29 hospitals in 15 countries. Using data from the first 20 000 eligible participants (the derivation set), we will derive an optimal threshold for dichotomising preoperative renal function quantified using the Chronic Kidney Disease Epidemiology Collaboration (CKD-Epi) glomerular filtration rate estimating equation in a manner that preserves the original structure of the RCRI. We will also develop a continuous risk estimating equation integrating age and CKD-Epi with existing RCRI risk factors. In the remaining (approximately) 14 000 participants, we will compare the risk estimation for cardiac complications of the original RCRI to this modified version. Cardiac complications will include 30-day non-fatal myocardial infarction, non-fatal cardiac arrest and death due to cardiac causes. We have examined an early sample to estimate the number of events and the distribution of predictors and missing data, but have not seen the validation data at the time of writing. Ethics and dissemination The research ethics board at each site approved the VISION protocol prior to recruitment. We will

  6. 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.

  7. Reversible coma and Duret hemorrhage after intracranial hypotension from remote lumbar spine surgery: case report.

    PubMed

    Bonow, Robert H; Bales, James W; Morton, Ryan P; Levitt, Michael R; Zhang, Fangyi

    2016-03-01

    Intracranial hypotension is a rare condition caused by spontaneous or iatrogenic CSF leaks that alter normal CSF dynamics. Symptoms range from mild headaches to transtentorial herniation, coma, and death. Duret hemorrhages have been reported to occur in some patients with this condition and are traditionally believed to be associated with a poor neurological outcome. A 73-year-old man with a remote history of spinal fusion presented with syncope and was found to have small subdural hematomas on head CT studies. He was managed nonoperatively and discharged with a Glasgow Coma Scale score of 15, only to return 3 days later with obtundation, fixed downward gaze, anisocoria, and absent cranial nerve reflexes. A CT scan showed Duret hemorrhages and subtle enlargement of the subdural hematomas, though the hematomas remained too small to account for his poor clinical condition. Magnetic resonance imaging of the spine revealed a large lumbar pseudomeningocele in the area of prior fusion. His condition dramatically improved when he was placed in the Trendelenburg position and underwent repair of the pseudomeningocele. He was kept flat for 7 days and was ultimately discharged in good condition. On long-term follow-up, his only identifiable deficit was diplopia due to an internuclear ophthalmoplegia. Intracranial hypotension is a rare condition that can cause profound morbidity, including tonsillar herniation and brainstem hemorrhage. With proper identification and treatment of the CSF leak, patients can make functional recoveries.

  8. 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,…

  9. Day Service Provision for People with Intellectual Disabilities: A Case Study Mapping 15-Year Trends in Ireland

    ERIC Educational Resources Information Center

    Fleming, Padraic; McGilloway, Sinead; Barry, Sarah

    2017-01-01

    Background: Day services for people with intellectual disabilities are experiencing a global paradigm shift towards innovative person-centred models of care. This study maps changing trends in day service utilization to highlight how policy, emergent patterns and demographic trends influence service delivery. Methods: National intellectual…

  10. 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…

  11. Hybrid Surgery Options for Complex Clinical Scenarios in Adult Patients with Congenital Heart Disease: Three Case Reports

    PubMed Central

    Rapetto, Filippo; Kenny, Damien; Turner, Mark; Parry, Andrew; Stoica, Serban; Uzun, Orhan; Caputo, Massimo

    2017-01-01

    The strategy for the management of adult patients with congenital heart disease (CHD) often represents a challenge for cardiac surgeons and cardiologists due to complex anatomy, wide range of clinical presentations, and a high-risk profile. However, hybrid approach may represent an attractive solution. We report three cases of adult patients previously operated for CHD and recently treated with a hybrid approach in our institution. Case 1: a 76-year-old woman with permanent atrial fibrillation, lung disease, chronic kidney disease, microcytic anemia, and type II diabetes mellitus, previously operated for atrial septal defect closure and pulmonary valvotomy, presented with severe pulmonary regurgitation and advanced right ventricular failure. In order to minimize the surgical risk, a hybrid approach was used: an extensive right ventricular outflow tract (RVOT) plication was followed by implantation of an Edwards Sapien XT prosthesis in the RVOT through the right ventricular apex, without cardiopulmonary bypass. Case 2: a 64-year-old man with previous atrial septum excision and pericardial baffle for partial anomalous pulmonary venous drainage with intact interatrial septum, presented with worsening dyspnea, right ventricular failure, and pulmonary hypertension caused by baffle stenosis. His comorbidities included coronary artery disease, atrial flutter, and previous left pneumonectomy. After performing a redo longitudinal median sternotomy, a 20-mm stent was implanted in the baffle with access through the superior vena cava. Case 3: a 50-year-old man, with previous atrioventricular septal defect repair, followed by mitral valve replacement with a mechanical prosthesis, subsequently developed a paravalvular leak (PVL) with severe mitral regurgitation and severe left ventricular dysfunction. He underwent a transapical PVL device closure with two Amplatzer Vascular Plugs. In our opinion, hybrid surgery is a promising therapeutic modality that increases the available

  12. 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

  13. 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

  14. Fatal hyperkalemia during rapid and massive blood transfusion in a child undergoing hip surgery--a case report.

    PubMed

    Chen, C H; Hong, C L; Kau, Y C; Lee, H L; Chen, C K; Shyr, M H

    1999-09-01

    We report a girl who developed severe and fatal hyperkalemia following rapid and massive blood transfusion during surgery. She was 7-year-old, 20-kg in weight, and received wide resection of the femoral bone with custom prosthesis implant because of malignant femoral osteosarcoma. During the procedure, bleeding was active and profuse and amounted to about 3,000 mL in 4 h, eventuating in shock. Despite rapid transfusion with 15 units of packed red blood cells (RBC) still she remained hypotensive and hypovolemic. When we switched to give her whole blood, actually 100 mL having been given, widening of QRS complex followed immediately by cardiac arrest developed. Cardiopulmonary resuscitation although started at once was unsuccessful. At this juncture, arterial blood gas analysis showed acidosis and severe hyperkalemia (10.3 mmol/L), possibly resulting from transfusion of blood of older storage. The case reminded us once again the importance and necessity of the use of potassium-low blood component (fresh, saline-washed RBCs) in case of massive and rapid blood transfusion especially in pediatric patients with hypovolemia and low cardiac output.

  15. Traumatic Neuroma at the Inferior Mesenteric Artery Stump after Rectal Cancer Surgery: A Case Report and Literature Review.

    PubMed

    Jeon, Sung Mi; Lee, Jae Young; Byeon, Sun Ju

    2016-11-25

    Traumatic neuroma results from regeneration attempts of the proximal end of an injured or severed nerve, resulting in a non-neoplastic nodular lesion. The lower extremity after amputation is the most common site, followed by the head and neck. Traumatic neuromas occurring in the abdomen, however, are rare. In the abdominal region, traumatic neuromas occur in the cystic duct stump and the common bile ducts as well as around the celiac trunk. This study reports a case of a 59-year-old man who presented with a traumatic neuroma arising at the stump of the inferior mesenteric artery after rectal cancer surgery. Traumatic neuromas at the stump of the inferior mesenteric artery have not been previously reported. The lesion exhibited atypical imaging features, including a well-enhanced nodule, a significant interval growth in size and a mild increase in 18F-fluo-rodeoxyglucose uptake, resembling lymph node metastasis. This case report will help physicians understand the sites of occurrence and imaging features of traumatic neuromas in the abdomen.

  16. Free Vascularized Fibular Strut Autografts to the Lumbar Spine in Complex Revision Surgery: A Report of Two Cases

    PubMed Central

    Levy, David M.; Vakhshori, Venus; DeWald, Christopher J.

    2015-01-01

    This case report presents two patients who underwent fibular strut grafting for complex revisions of previous lumbar spine arthrodeses. A case review of the Electronic Medical Record at the index institution was performed to evaluate the timeline of events of the two patients who underwent fibular strut grafting for complex revisions of previous lumbar spine arthrodesis, including imaging studies, progress notes, and laboratory results. One patient had developed chronic L3 vertebral body osteomyelitis from a prior fibular allograft and instrumentation placed for a traumatic burst fracture. The second patient had a severe scoliosis recalcitrant to prior arthrodeses in the context of Marfan syndrome and a persistent L4-5 pseudarthrosis. Both patients underwent free vascularized fibular autograft revision arthrodeses. At most recent long-term follow-up, both patients had improved clinically and neither had required further revision. The use of free vascularized fibular grafting is an excellent option for a variety of spinal indications, and these two reports indicate that the technology may have an indication for use after multiple failed surgeries for osteomyelitis or correction of a multi-level large spinal deformity secondary to Marfan syndrome. PMID:26512280

  17. Factors Associated with Complications and Postoperative Visual Outcomes of Cataract Surgery; a Study of 1,632 Cases

    PubMed Central

    Thanigasalam, Thevi; Reddy, Sagili Chandrashekara; Zaki, Rafdzah Ahmad

    2015-01-01

    Purpose: Cataract surgery is the most common intraocular surgery performed all over the world and has advanced technically in recent years. As in all surgeries, complications are unavoidable. Herein we report factors associated with complications and visual outcomes of cataract surgery. Methods: This retrospective cohort study included data of 1,632 cataract surgeries performed from 2007 to 2010 which was obtained from the cataract registry of the Malaysian National Eye Database. Demographic features, ocular and systemic comorbidites, grade of surgeon expertise and duration of surgery, type of anesthesia, intraoperative and postoperative complications, and the type of intraocular lens were recorded. Best corrected visual acuities were compared before and after the operation. Results: Mean patient age was 66.9 years with equal gender distribution. The majority of subjects had age related cataracts. Phacoemulsification was done faster than other surgeries, especially by specialist surgeons. History of prior ocular surgery and operations performed under general anesthesia were associated with greater complications. Phacoemulsification was associated with less complications and better visual outcomes. The age and etiology of cataract did not affect complications. Malays, absence of ocular comorbidities, left eyes and eyes operated under local anesthesia were more likely to experience more visual improvement. Gender, age, cause of cataract, systemic comorbidities and surgeon expertise as well as intra-and postoperative complications did not affect the visual outcomes. Conclusion: Phacoemulsification had good visual outcomes in cataract surgery. Duration of surgery, expertise of the surgeon and complications did not affect the visual outcomes. PMID:27051481

  18. [Pediatric plunging ranula and its surgery with transoral approach: a case report].

    PubMed

    Eyibilen, Ahmet; Aladağ, Ibrahim; Güven, Mehmet

    2009-01-01

    The plunging ranula is an uncommon condition which presents itself as a fluctuating swelling in the neck. It is less frequent during childhood. The ranula, which is usually originated from sublingual gland, is called the plunging ranula when it affects the submandibulary space and adjacent structures in the neck. There are a lot of different methods used in surgical treatment. In this study, we present a plunging ranula case which was performed by excision of the pseudocyst and ipsilateral sublingual gland with transoral approach in a five-year-old girl. There has been no recurrence in four-year follow-up period.

  19. 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

  20. [Internal jugular thrombophlebitis: complications of the cervical oncological surgery. A case report].

    PubMed

    Alvarez Marcos, C A; Noval Menéndez, J; Alfonso Megido, J; Domínguez Iglesias, F; Hevia Llama, R; Ramos Barriga, M A

    1995-01-01

    Internal jugular vein thrombophlebitis is an infrequent complications, associated in the past to pharyngeal and amygdaline infections but related today to the use of catheters and intravenous drugs. The present paper reports the case of a patient who underwent total laryngectomy and functional neck dissection, developing recurrent neumonias and sepsis in the postoperative period which were secondary to an homolateral jugular thrombophlebitis. A physical exploration with no findings and the poor resolution of CT scan and ultrasound due to postsurgical alterations, lead to a late diagnosis and fatal evolution, in spite of the medical and surgical treatment.

  1. Applied Sports Nutrition Support, Dietary Intake and Body Composition Changes of a Female Athlete Completing 26 Marathons in 26 Days: A Case Study.

    PubMed

    McManus, Chris J; Murray, Kelly A; Parry, David A

    2017-03-01

    The aim of this case study is to describe the nutrition practices of a female recreational runner (VO2max 48.9 ml·kg(-1)·min(-1)) who completed 26 marathons (42.195 km) in 26 consecutive days. Information relating to the nutritional intake of female runners during multi-day endurance events is extremely limited, yet the number of people participating year-on-year continues to increase. This case study reports the nutrition intervention, dietary intake, body composition changes and performance in the lead-up and during the 26 days. Prior to undertaking the 26 marathon challenge, three consultations were held between the athlete and a sports nutrition advisor; planning and tailoring the general diet and race-specific strategies to the endurance challenge. During the marathons, the mean energy and fluid intake was 1039.7 ± 207.9 kcal (607.1 - 1453.2) and 2.39 ± 0.35 L (1.98 - 3.19). Mean hourly carbohydrate intake was 38.9 g·hr(-1). 11 days following the completion of the 26 marathons, body mass had reduced by 4.6 kg and lean body mass increasing by 0.53 kg when compared with 20 days prior. This case study highlights the importance of providing general and event-specific nutrition education when training for such an event. This is particularly prudent for multi-day endurance running events.

  2. A Case of Malignant Pheochromocytoma Presenting 7 Years After the Initial Surgery

    PubMed Central

    Al-Omaishi, Larsa; Babin, Jonathan; Corsetti, Ralph L.

    2017-01-01

    Background: Pheochromocytoma (PHEO) is a rare tumor of the adrenal medulla and sympathetic ganglion that produces the catecholamines norepinephrine and epinephrine. Traditionally, approximately 10% of PHEOs were thought to be malignant, but recent developments in PHEO research have noted that specific genetic mutations are associated with higher risk of metastatic spread. Case Report: We report the case of a 71-year-old female who presented with abdominal pain in September 2009 when she was 64 years old. Evaluation at that time revealed cholelithiasis and bilateral adrenal masses. Workup showed elevated free normetanephrines, and positron emission tomography-computed tomography demonstrated bilateral adrenal hypermetabolic lesions concerning for malignancy. She underwent open bilateral adrenalectomies and cholecystectomy. The right adrenal mass was identified as a PHEO with nonaggressive features and negative margins, and the left adrenal mass was an adrenal cortical adenoma without dysplasia. In April 2016, the patient was referred by her endocrinologist for elevated blood pressure and 16-lb weight loss. The patient reported weakness, headaches, hot flashes, cold sweats, and fatigue. Laboratory workup revealed elevated plasma free normetanephrine, and imaging showed a recurrence of the PHEO in both the right adrenal bed and the head of the right humerus. Conclusion: Current predictors of PHEO recurrence failed to identify the original tumor as aggressive or likely to return as a metastatic lesion. Because of the rarity of these tumors, few consistent laboratory or radiologic predictors of malignancy based on initial presentation have been identified; predictors of malignancy in PHEO warrant further investigation. PMID:28331462

  3. Luxury perfusion syndrome confirmed by sequential studies of regional cerebral blood flow and volume after extracranial to intracranial bypass surgery: case report.

    PubMed

    Higashi, S; Matsuda, H; Fujii, H; Ito, H; Yamashita, J

    1989-07-01

    We report a case of luxury perfusion syndrome with temporary neurological deterioration after extracranial to intracranial bypass surgery. A preoperative computed tomographic scan showed no detectable infarct, and the measurement of regional cerebral blood flow showed severe depression of ipsilateral hemispheric perfusion. The patient developed temporary neurological deterioration after bypass surgery, with no recognizable pathological signs on postoperative computed tomographic and angiographic studies. Regional cerebral blood flow and volume were more elevated during the period of neurological deterioration than after the subsequent recovery. This strongly suggests that excessive blood flow directed into chronically ischemic brain through a graft may induce a luxury perfusion syndrome resulting in neurological deterioration.

  4. Robotic surgery

    MedlinePlus

    Robot-assisted surgery; Robotic-assisted laparoscopic surgery; Laparoscopic surgery with robotic assistance ... computer station and directs the movements of a robot. Small surgical tools are attached to the robot's ...

  5. Hypnotic relaxation therapy for treatment of hot flashes following prostate cancer surgery: a case study.

    PubMed

    Elkins, Gary R; Kendrick, Cassie; Koep, Lauren

    2014-01-01

    This case study reports on a 69-year-old African American male who presented with hot flashes following a diagnosis of prostate cancer and subsequent prostatectomy. Measures include both self-reported and physiologically measured hot flash frequency and sleep quality. The intervention involved 7 weekly sessions of hypnotic relaxation therapy directed toward alleviation of hot flashes. Posttreatment self-reported hot flashes decreased 94%; physiologically measured hot flashes decreased 100%; and sleep quality improved 87.5%. At week 12, both self-reported and physiologically measured hot flashes decreased 95% and sleep quality improved 37.5% over baseline, suggesting hypnotic relaxation therapy may be an effective intervention for men with hot flashes following treatment for prostate cancer.

  6. Type IV hypersensitivity reactions following Dermabond adhesive utilization in knee surgery: A Report of Three Cases.

    PubMed

    Yagnatovsky, Michelle; Pham, Hien; Rokito, Andrew; Jazrawi, Laith; Strauss, Eric

    2017-01-25

    ​We retrospectively reviewed the records of 3 patients (3 knees) with a delayed type hypersensitivity reaction following Dermabond exposure after an orthopaedic knee procedure. Delayed hypersensitivity reactions are mediated by CD4+ helper T cells. The use of skin adhesives in place of traditional sutures is increasing in popularity given Dermabond's potential benefits of decreased wound infection rate and better wound approximation. However, hypersensitivity reactions to the cyanoacrylate material in Dermabond have been described. Differentiating hypersensitivity reactions from post-operative infections is important as septic arthritis is a potentially devastating complication. This case series presents the challenge of properly diagnosing and managing hypersensitivity reactions. Consultation with allergists and dermatologists may be appropriate for ascertaining the nature of the surgical site complication and proper management. The recommended management of hypersensitivity-type reactions is a course of topical steroids and infection work up if needed.

  7. Periodontal plastic surgery for management of cleft alveolar ridge: a case report.

    PubMed

    Agrawal, Amit A; Yeltiwar, Ramreddy K

    2012-02-01

    Cleft lips, alveoli, and palates are the most common congenital malformations of the head and neck region, all of which often can be managed successfully when presented at a young age. It is a common belief that clefts in the alveolar ridge should be treated with the help of bone grafting materials. This could be the best option when the cleft is to be treated in early age, when the patient is still developing and has high regenerative potential. However, in adults, the literature supports the fact that bone grafting in alveolar clefts has a higher chance for failure. The present case report exemplifies a periodontal plastic surgical procedure involving a combination of connective tissue and free gingival grafting to restore the form and function of a cleft alveolar ridge in an adult patient.

  8. Two stage surgery in IV Class of Misch with SIS device: a case report

    PubMed Central

    GRANDI, C.; PACIFICI, L.

    2009-01-01

    SUMMARY 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. PMID:23285349

  9. Uterine conserving surgery in a case of cervicovaginal agenesis with unicornuate uterus

    PubMed Central

    Mishra, Vineet; Saini, Suwa Ram; Nanda, Sakshi; Choudhary, Sumesh; Roy, Priyankur; Singh, Tanvir

    2016-01-01

    The presence of cervicovaginal agenesis with unicornuate uterus is a very rare mullerian anomaly. Its true incidence is still unknown. The presence of functioning unicornuate uterus poses a great challenge for a gynecologist because a successful repair could restore normal menses and may preserve a patient's fertility. Hence, we report a case of 16-year-old unmarried female who presented with chief complaints of primary amenorrhea with cyclical lower abdominal pain. On clinical and radiological evaluation, she was diagnosed with complete cervicovaginal agenesis with right unicornuate uterus (hematometra and hematosalpinx). She underwent vaginoplasty (McIndoes method) along with uterovaginal anastomosis by neocervix formation, in order to preserve her uterus. On follow-up, her vagina was completely healed, and she was menstruating normally. PMID:28216917

  10. 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.

  11. Endodontic surgery.

    PubMed

    Lieblich, Stuart E

    2012-01-01

    Conventional endodontic therapy is successful approximately 80-85% of the time. Many of these failures will occur after one year. The presence of continued pain, drainage, mobility or an increasing size of a radiolucent area are some of the indications to treat the case surgically. Since many of these cases may have had final restorations placed by the dentist, the salvage of these cases is of importance to the patient. Advances in periapical surgery have included the use of ultrasonic root end preparation. With the use of these piezoelectric devices, a more controlled apical preparation can be achieved. Additionally, isthmus areas between canals can be appropriately prepared and sealed. The precision afforded with these devices reduces the chances for a malpositioned fill and a more successful outcome.

  12. 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.

  13. Neurophysiological criteria for intraoperative prediction of pure motor hemiplegia during aneurysm surgery. Case report.

    PubMed

    Szelényi, Andrea; Bueno de Camargo, Adauri; Flamm, Eugene; Deletis, Vedran

    2003-09-01

    The value of motor evoked potentials (MEPs) as an intraoperative neurophysiological monitoring tool for detecting selective subcortical ischemia of the motor pathways during intracerebral aneurysm repair is described and the use of such measures to predict postoperative motor status is discussed. The authors present the case of a 64-year-old woman in whom there was an incidental finding of two right middle cerebral artery (MCA) aneurysms. During the aneurysm clipping procedure, an intraoperative MEP loss in the left abductor pollicis brevis and tibial anterior muscles occurred during an attempt at permanent clip placement. There were no concurrent changes in somatosensory evoked potentials. Postoperatively, the patient demonstrated a left hemiplegia with intact sensation. A computerized tomography scan revealed an infarct in the anterior division of the MCA territory, including the posterior limb of the internal capsule. In this patient, intraoperative neurophysiological monitoring with MEPs has been shown to be a sensitive tool for indicating subcortical ischemia affecting selective motor pathways in the internal capsule. Therefore, intraoperative loss of MEPs can be used to predict postoperative motor deficits.

  14. Post-hysterectomy intravenous leiomyomatosis: A case of successful multidisciplinary surgery under non-extracorporeal circulation

    PubMed Central

    Zeng, Yucui; Tang, Huiru; Zeng, Liping; Wei, Lihui; Zhang, Xiaoming; Wu, Ruifang

    2017-01-01

    Intravenous leiomyomatosis is a rare benign disease. We here in present the case of a 39-year-old woman with a history of hysterectomy who presented with intermittent abdominal pain, palpitations and tightness of the chest. Physical examination revealed the presence of a pelvic mass of regular shape. Gynecological ultrasonography, computed tomography scans and three-dimensional (3D) cardiac ultrasonography were used to evaluate the imaging characteristics of the mass and reach a final diagnosis. The mass appeared to extend to the iliac veins, renal veins and inferior vena cava on imaging examination. The mass was successfully excised under non-extracorporeal circulation in one stage. Pathological examination of tumor samples indicated intravenous leiomyomatosis. After the operation, the symptoms were dissipated and no abnormal echo was observed in the inferior vena cava or the right atrium on 3D-cardiac ultrasonography. The patient is currently followed up without signs of recurrence. The aim of the present study was to describe in detail the diagnostic procedure and treatment in order to improve our current understanding of this disease. PMID:28123726

  15. [Cardiac arrest after epidural anesthesia for aesthetic plastic surgery: a case report].

    PubMed

    Pinheiro, Larissa Cardoso; Carmona, Bruno Mendes; de Nazareth Chaves Fascio, Mário; de Souza, Iris Santos; de Azevedo, Rui Antonio Aquino; Barbosa, Fabiano Timbó

    2016-01-22

    Cardiac arrest during neuraxial anesthesia is a serious adverse event, which may lead to significant neurological damage and death if not treated promptly. The associated mechanisms are neglected respiratory failure, extensive sympathetic block, local anesthetic toxicity, total spinal block, in addition to the growing awareness of the vagal predominance as a predisposing factor. In the case reported, the patient was 25 years old, ASA I, scheduled for esthetic lipoplasty. After sedation with midazolam and fentany, epidural anesthesia in interspaces T12-L1 and T2-T3 and catheter insertion into inferior puncture were performed. The patient remained in the supine position for 10minutes. Then, she was placed in the prone position, developing asystolic cardiac arrest 20minutes after the completion of neuraxial blockade. The medical team immediately placed the patient in the supine position and began cardiopulmonary resuscitation. Spontaneous circulation was achieved after twenty minutes of resuscitation. We discuss in this report the exacerbated vagal response as the main event mechanism. The patient's successful outcome emphasizes the importance of anesthetic monitoring by anesthesiologists, prompt recognition and treatment of rhythm changes on the electrocardiogram.

  16. Weight Loss Surgery (Bariatric Surgery) (For Parents)

    MedlinePlus

    ... 1- to 2-Year-Old Weight Loss Surgery (Bariatric Surgery) KidsHealth > For Parents > Weight Loss Surgery (Bariatric Surgery) ... or bariatric surgery might be an option. About Bariatric Surgery Bariatric surgery had its beginnings in the 1960s, ...

  17. African Easterly Waves in 30-day High-Resolution Global Simulations: A Case Study During the 2006 NAMMA Period

    NASA Technical Reports Server (NTRS)

    Shen, Bo-Wen; Tao, Wei-Kuo; Wu, Man-Li C.

    2010-01-01

    In this study, extended -range (30 -day) high-resolution simulations with the NASA global mesoscale model are conducted to simulate the initiation and propagation of six consecutive African easterly waves (AEWs) from late August to September 2006 and their association with hurricane formation. It is shown that the statistical characteristics of individual AEWs are realistically simulated with larger errors in the 5th and 6th AEWs. Remarkable simulations of a mean African easterly jet (AEJ) are also obtained. Nine additional 30 -day experiments suggest that although land surface processes might contribute to the predictability of the AEJ and AEWs, the initiation and detailed evolution of AEWs still depend on the accurate representation of dynamic and land surface initial conditions and their time -varying nonlinear interactions. Of interest is the potential to extend the lead time for predicting hurricane formation (e.g., a lead time of up to 22 days) as the 4th AEW is realistically simulated.

  18. Giant cell tumor of the bone: aggressive case initially treated with denosumab and intralesional surgery.

    PubMed

    von Borstel, Donald; A Taguibao, Roberto; A Strle, Nicholas; E Burns, Joseph

    2017-04-01

    Giant cell tumor of the bone (GCTB) is a locally aggressive benign tumor, which has historically been treated with wide surgical excision. We report a case of a 29-year-old male with histology-proven GCTB of the distal ulna. The initial imaging study was a contrast-enhanced magnetic resonance imaging (MRI) examination of the left wrist, which was from an outside facility performed before presenting to our institution. On the initial MRI, the lesion had homogenous T2-hyperintense and T1-hypointense signal with expansive remodeling of the osseous contour. A radiographic study performed upon presentation to our institution 1 month later showed progression of the lesion with atypical imaging characteristics. After confirming the diagnosis, denosumab therapy was implemented allowing for reconstitution of bone and intralesional treatment. The patient was treated with five doses of denosumab over the duration of 7 weeks. Therapeutic changes of the GCTB were evaluated by radiography and a post-treatment MRI. This MRI was interpreted as suspicious for worsening disease due to the imaging appearance of intralesional signal heterogeneity, increased perilesional fluid-like signal, and circumferential cortical irregularity. However, on subsequent intralesional curettage and bone autografting 6 weeks later, no giant cells were seen on the specimen. Thus, the appearance on the MRI, rather than representing a manifestation of lesion aggressiveness or a non-responding tumor, conversely represented the imaging appearance of a positive response to denosumab therapy. On follow-up evaluation, 5 months after intralesional treatment, the patient had recurrent disease and is now scheduled for wide-excision with joint prosthesis.

  19. Reversal of childhood idiopathic scoliosis in an adult, without surgery: a case report and literature review

    PubMed Central

    2009-01-01

    Background Some patients with mild or moderate thoracic scoliosis (Cobb angle <50-60 degrees) suffer disproportionate impairment of pulmonary function associated with deformities in the sagittal plane and reduced flexibility of the spine and chest cage. Long-term improvement in the clinical signs and symptoms of childhood onset scoliosis in an adult, without surgical intervention, has not been documented previously. Case presentation A diagnosis of thoracic scoliosis (Cobb angle 45 degrees) with pectus excavatum and thoracic hypokyphosis in a female patient (DOB 9/17/52) was made in June 1964. Immediate spinal fusion was strongly recommended, but the patient elected a daily home exercise program taught during a 6-week period of training by a physical therapist. This regime was carried out through 1992, with daily aerobic exercise added in 1974. The Cobb angle of the primary thoracic curvature remained unchanged. Ongoing clinical symptoms included dyspnea at rest and recurrent respiratory infections. A period of multimodal treatment with clinical monitoring and treatment by an osteopathic physician was initiated when the patient was 40 years old. This included deep tissue massage (1992-1996); outpatient psychological therapy (1992-1993); a daily home exercise program focused on mobilization of the chest wall (1992-2005); and manipulative medicine (1994-1995, 1999-2000). Progressive improvement in chest wall excursion, increased thoracic kyphosis, and resolution of long-standing respiratory symptoms occurred concomitant with a >10 degree decrease in Cobb angle magnitude of the primary thoracic curvature. Conclusion This report documents improved chest wall function and resolution of respiratory symptoms in response to nonsurgical approaches in an adult female, diagnosed at age eleven years with idiopathic scoliosis. PMID:20003501

  20. Atypical Parathyroid Adenoma Complicated with Protracted Hungry Bone Syndrome after Surgery: A Case Report and Literature Review

    PubMed Central

    Juárez-León, Óscar Alfredo; Gómez-Sámano, Miguel Ángel; Cuevas-Ramos, Daniel; Almeda-Valdés, Paloma; López-Flores A La Torre, Manuel Alejandro; Reza-Albarrán, Alfredo Adolfo; Gómez-Pérez, Francisco Javier

    2015-01-01

    Hungry Bone Syndrome refers to the severe and prolonged hypocalcemia and hypophosphatemia, following parathyroidectomy in patients with hyperparathyroidism. We present the case of an eighteen-year-old woman with a four-year history of hyporexia, polydipsia, weight loss, growth retardation, and poor academic performance. The diagnostic work-up demonstrated primary hyperparathyroidism with hypercalcemia of 13.36 mg/dL, a PTH level of 2551 pg/mL, bone brown tumors, and microcalcifications within pancreas and kidneys. Neck ultrasonography revealed a parathyroid adenoma of 33 × 14 × 14 mm, also identified on 99Tc-sestamibi scan. Bone densitometry showed decreased Z-Score values (total lumbar Z-Score of −4.2). A right hemithyroidectomy and right lower parathyroidectomy were performed. Pathological examination showed an atypical parathyroid adenoma, of 3.8 g of weight and 2.8 cm in diameter. After surgery she developed hypocalcemia with tetany and QTc interval prolongation. The patient required 3 months of oral and intravenous calcium supplementation due to Hungry Bone Syndrome (HBS). After 42 months, she is still under oral calcium. Usually HBS lasts less than 12 months. Therefore we propose the term “Protracted HBS” in patients with particularly long recovery of 1 year. We present a literature review of the diagnosis, pathophysiology, and treatment of HBS. PMID:26640724

  1. A multiscale model for the study of cardiac biomechanics in single-ventricle surgeries: a clinical case.

    PubMed

    Meoli, Alessio; Cutrì, Elena; Krishnamurthy, Adarsh; Dubini, Gabriele; Migliavacca, Francesco; Hsia, Tain-Yen; Pennati, Giancarlo; Taylor, Andrew; Giardini, Alessandro; Khambadkone, Sachin; Schievano, Silvia; de Leval, Marc; Hsia, T-Y; Bove, Edward; Dorfman, Adam; Baker, G Hamilton; Hlavacek, Anthony; Migliavacca, Francesco; Pennati, Giancarlo; Dubini, Gabriele; Marsden, Alison; Feinstein, Jeffrey; Vignon-Clementel, Irene; Figliola, Richard; McGregor, John

    2015-04-06

    Complex congenital heart disease characterized by the underdevelopment of one ventricular chamber (single ventricle (SV) circulation) is normally treated with a three-stage surgical repair. This study aims at developing a multiscale computational framework able to couple a patient-specific three-dimensional finite-element model of the SV to a patient-specific lumped parameter (LP) model of the whole circulation, in a closed-loop fashion. A sequential approach was carried out: (i) cardiocirculatory parameters were estimated by using a fully LP model; (ii) ventricular material parameters and unloaded geometry were identified by means of the stand-alone, three-dimensional model of the SV; and (iii) the three-dimensional model of SV was coupled to the LP model of the circulation, thus closing the loop and creating a multiscale model. Once the patient-specific multiscale model was set using pre-operative clinical data, the virtual surgery was performed, and the post-operative conditions were simulated. This approach allows the analysis of local information on ventricular function as well as global parameters of the cardiovascular system. This methodology is generally applicable to patients suffering from SV disease for surgical planning at different stages of treatment. As an example, a clinical case from stage 1 to stage 2 is considered here.

  2. Refractory invasive aspergillosis controlled with posaconazole and pulmonary surgery in a patient with chronic granulomatous disease: case report.

    PubMed

    Kepenekli, Eda; Soysal, Ahmet; Kuzdan, Canan; Ermerak, Nezih Onur; Yüksel, Mustafa; Bakır, Mustafa

    2014-01-08

    Invasive aspergillosis is an important cause of morbidity and mortality in immunocompromised patients. Among primary immunodefiencies, chronic granulomatous disease (CGD) has the highest prevalence of invasive fungal diseases. Voriconazole is recommended for the primary treatment of invasive aspergillosis in most patients. In patients whose aspergillosis is refractory to voriconazole, therapeutic options include changing class of antifungal, for example using an amphotericin B formulation, an echinocandin, combination therapy, or further use of azoles. Posaconazole is a triazole derivative which is effective in Aspergillosis prophylaxis and treatment. Rarely, surgical therapy may be needed in some patients. Lesions those are contiguous with the great vessels or the pericardium, single cavitary lesion that cause hemoptysis, lesions invading the chest wall, aspergillosis that involves the skin and the bone are the indications for surgical therapy.Chronic granulomatous disease (CGD) is an inherited immundeficiency caused by defects in the phagocyte nicotinamide adenine dinucleotidephosphate (NADPH) oxidase complex which is mainstay of killing microorganisms. CGD is characterized by recurrent life-threatening bacterial and fungal infections and by abnormally exuberant inflammatory responses leading to granuloma formation, such as granulomatous enteritis, genitourinary obstruction, and wound dehiscence. The diagnosis is made by neutrophil function testing and the genotyping.Herein, we present a case with CGD who had invasive pulmonary aspergillosis refractory to voriconazole and liposomal amphotericine B combination therapy that was controlled with posaconazole treatment and pulmonary surgery.

  3. [A case report of the use of laparoscopic surgery to remove an adrenal tumor following resection of sigmoid colon cancer].

    PubMed

    Okano, Miho; Yasui, Masayoshi; Nishino, Masaya; Hosoda, Yohei; Nagai, Kenichi; Kim, Yongkook; Tsujinaka, Toshimasa

    2014-11-01

    A 58-year-old woman underwent sigmoidectomy and partial cystectomy for sigmoid colon cancer following colostomy. The final staging of the tumor was T3, N1, tub2, M0, fStage IIIa. She received 6 courses of CapeOX (oxaliplatin 130mg/m², capecitabine 200mg/m²) as adjuvant chemotherapy, which was discontinued because of severe general fatigue. At the same time, an increase in the levels of serum carcinoembryonic antigen (CEA) was detected and abdominal computed tomography (CT) revealed an expanded adrenal mass. Since whole-body ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) showed no evidence of multiple organ metastases except for the right adrenal tumor, a solitary adrenal metastasis from sigmoid colon cancer was strongly suspected. Hence, colostomy closure and laparoscopic adrenalectomy were concurrently performed. Histological examination revealed non-functional adrenal adenoma. Therefore, laparoscopic surgery was a reasonable choice even in this complex case.

  4. Highly cross-linked polyethylene acetabular liners retrieved four to five years after revision surgery: a report of two cases.

    PubMed

    Teeter, Matthew G; Naudie, Douglas D R; Charron, Kory D; Holdsworth, David W

    2010-08-01

    There is currently considerable interest in the use of highly cross-linked polyethylene (XLPE) acetabular liners for total hip arthroplasty (THA). In literature, only a single retrieval analysis of one type of XLPE liner implanted for greater than four years exists. The purpose of the present report is to quantify surface deviations in two XLPE liners implanted during revision THA and retrieved between four to five years after implantation. The two XLPE acetabular liners (Reflection, Smith and Nephew Inc., Memphis, TN) were retrieved from patients undergoing their second revision surgery, at 4.90 and 4.07 years. The retrieved liners and a new, non-implanted, unworn liner of the same size were scanned using micro-computed tomography (micro-CT). Articular surface deviation maps were created by comparing the retrievals to the unworn liner, based on the liner geometry obtained from micro-CT. The linear penetration rates were found to be 0.018 and 0.008 mm/year. Localized scratches and pits with deviations greater than 0.205 mm were also found on the articular surfaces of both liners. The XLPE liners retrieved from the two cases demonstrated low linear penetration rates. Regions with greater focal deviations were also apparent, likely due to third-body wear. The results are consistent with previously published clinical follow-ups of other XLPE liners.

  5. Continuing the Original Stanford Sleep Surgery Protocol From Upper Airway Reconstruction to Upper Airway Stimulation: Our First Successful Case.

    PubMed

    Liu, Stanley Yung; Riley, Robert Wayne

    2017-02-20

    In 1993, a surgical protocol for dynamic upper airway reconstruction in patients with obstructive sleep apnea (OSA) was published, and it became commonly known as the Stanford phase 1 and 2 sleep surgery protocol. It served as a platform on which research and clinical studies have continued to perfect the surgical care of patients with OSA. However, relapse is inevitable in a chronic condition such as OSA, and a subset of previously cured surgical patients return with complaints of excessive daytime sleepiness. This report describes a patient who was successfully treated with phase 1 and 2 operations more than a decade previously. He returned at 65 years of age with relapse of moderate OSA, and after workup with polysomnography and drug-induced sleep endoscopy, he underwent upper airway stimulation of the hypoglossal nerve that resulted in a cure of OSA. This case shows why upper airway stimulation is an appropriate option for patients with OSA relapse, after previously successful maxillomandibular advancement.

  6. 42 CFR 484.220 - Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 5 2013-10-01 2013-10-01 false Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and area wage levels. 484.220 Section 484.220 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED)...

  7. 42 CFR 484.220 - Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 5 2014-10-01 2014-10-01 false Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and area wage levels. 484.220 Section 484.220 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED)...

  8. Examining the Transition to a Four-Day School Week and Investigating Post-Change Faculty/Staff Work-Life Balance: A Community College Case Study

    ERIC Educational Resources Information Center

    Cardinale, Nelly

    2013-01-01

    This single descriptive embedded case study examined the process of implementing a four-day work/school week at a community college and investigated post-change faculty/staff work-life balance. All of the students attending this college live at home. The change was implemented due to state funding shortfalls, increasing college utility expenses…

  9. Case Study: A snapshot of fatty acids composition of grass herbage as affected by time of day

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Manipulation of functional poly unsaturated fatty acid (PUFA) in ruminant products depends on rumen biohydrogenation and the net amount and composition of fatty acid ingested. Total non-structural carbohydrates and DM concentrations of herbage increase during the day; however, it is not known if fat...

  10. A Study in Child Care (Case Study from Volume II-A): "Tacos and Tulips." Day Care Programs Reprint Series.

    ERIC Educational Resources Information Center

    O'Farrell, Brigid

    The Holland Day Care Center in Michigan serves a diverse community of Anglo children of Dutch ancestry and children of former migrant workers of Chicano, Black, Puerto Rican and Cuban origins who have settled in the area. Located in two churches which are about three blocks apart, the program divides children by ability and age into five…

  11. Lung surgery

    MedlinePlus

    ... are thoracotomy and video-assisted thoracoscopic surgery (VATS). Robotic surgery may also be used. Lung surgery using a ... clot from the pulmonary artery ( pulmonary embolism ) Treat complications of tuberculosis Video-assisted thoracoscopic surgery can be used to treat many of these ...

  12. Intracorneal and Intraocular Invasion of Ocular Surface Squamous Neoplasia after Intraocular Surgery: Report of Two Cases and Review of the Literature

    PubMed Central

    Murillo, Juan C.; Galor, Anat; Wu, Michael C.; Kye, Natasha K.; Wong, James; Ahmed, Ibrahim O.; Joag, Madhura; Shalabi, Nabeel; Lahners, William; Dubovy, Sander; Karp, Carol L.

    2017-01-01

    Purpose The aim of this paper was to describe 2 cases of ocular surface squamous neoplasia (OSSN) of the conjunctiva with intracorneal and intraocular extension following intraocular surgery. Methods We conducted a clinical pathological retrospective case series. Results Case 1 underwent cataract surgery in the setting of an unnoticed adjacent OSSN. An excisional biopsy with cryotherapy and intraoperative mitomycin C was subsequently performed, confirming OSSN. The patient had two recurrences treated topically with resolution. While the conjunctiva remained clear, a corneal haze emanating from the cataract incision site was noted. Penetrating keratoplasty (PK) for this haze revealed midstromal infiltrative carcinoma. Case 2 had a history of herpes simplex keratitis that ultimately required corneal grafts. Fifteen years later, he developed an OSSN treated with excisional biopsy and had clear margins. Eight months later, he presented with a recurrence of his OSSN and was treated briefly with topical interferon for 4 weeks; however, he developed an infectious keratitis with a corneal perforation requiring another PK. Four months after PK, low-grade inflammation was noted. Cytology of the anterior chamber aspirate revealed neoplastic squamous cells. Another PK was then performed. Pathology confirmed extensive intraocular neoplasia. Limited exenteration was performed. Conclusion Patients with a history of OSSN may be at increased risk of neoplastic intraocular extension following intraocular surgery. PMID:28275607

  13. Use of Articaine in loco-regional anesthesia for day care surgical procedures

    PubMed Central

    Bajwa, Sukhminder Jit Singh; Jindal, Ravi

    2012-01-01

    The popularity of day case surgical procedures has increased immensely over the last few years. Though various techniques are available for carrying out day-case anesthesia, preference for a technique depends upon the type of procedure, patient profile, associated co-morbidities, available infrastructure and back-up facilities, monitoring devices and comfort of the attending anesthesiologist with the technique. Day-case spinal anesthesia for ambulatory surgery has gained a wider acceptance and numerous drugs are available for use in loco-regional anesthesia. Articaine is one such amide local anesthetic drug which is increasingly being used in day care surgeries. Properties of articaine such as faster onset, shorter elimination time and rapid recovery from sensory and motor blockade make it a very useful agent in local and regional anesthesia for day care surgical procedures. This article aims to review these properties of articaine so as to evaluate how useful articaine can be for ambulatory surgical procedures. PMID:23225921

  14. Debakey forceps crushing technique for hepatic parenchymal transection in liver surgery: a review of 100 cases and ergonomic advantages.

    PubMed

    Jain, Sundeep; Sharma, Bharat; Kaushik, Mitesh; Jain, Lokendra

    2014-01-01

    Introduction and Objective. Bleeding is an important complication in liver transections. To determine the safety and efficacy of Debakey forceps for liver parenchymal transection and its ergonomic advantages over clamp crushing method we analysed our data. Methods. We used Debakey crushing technique in 100 liver resections and analysed data for transection time, transfusion rate, morbidity, mortality, hospital stay, influence of different types of liver conditions, and ergonomi features of Debakey forceps. Results. Mean age, transection time and hospital stay of 100 patients were 52.38 ± 17.44 years, 63.36 ± 33.4 minutes, and 10.27 ± 5.7 days. Transection time, and hospital stay in patients with cirrhotic liver (130.4 ± 44.4 mins, 14.6 ± 5.5 days) and cholestatic liver (75.8 ± 19.7 mins, 16.5 ± 5.1 days) were significantly greater than in patients with normal liver (48.1 ± 20.1 mins, 6.7 ± 1.8 days) (P < 0.01). Transection time improved significantly with experience (first fifty versus second fifty cases-70.2 ± 31.1 mins versus 56.5 ± 34.5 mins, P < 0.04). Qualitative evaluation revealed that Debakey forceps had ergonomic advantages over Kelly clamp. Conclusions. Debakey forceps crushing technique is safe and effective for liver parenchymal transection in all kinds of liver. Transection time improves with surgeon's experience. It has ergonomic advantages over Kelly clamp and is a better choice for liver transection.

  15. Pregnancy achieved by transfer of thawed day 3 embryos that had been frozen after assisted hatching: a case report.

    PubMed

    Haydardedeoğlu, Bülent; Kılıçdağ, Esra Bulgan; Bağış, Tayfun

    2010-01-01

    Assisted Hatching (AH) is performed to increase implantation rates in assisted reproductive techniques, especially recurrent implantation failure and older age group. AH can be performed to four different techniques as laser, mechanical, enzymatic, chemical methods. In the literature, there is limited data about embryo freezing after AH. Herein, a successful pregnancy, which was achieved by transfer of thawed 3rd day embryos that had been frozen after AH, is presented.

  16. A case study: the effect of visitors on two captive pumas with respect to the time of the day.

    PubMed

    Maia, Caroline M; Volpato, Gilson L; Santos, Eliana F

    2012-01-01

    This study analyzed the effects of noise levels and number of visitors on the behaviors of a mother puma and her daughter in a zoo environment with respect to the time of day. The study monitored visitation (noise and number) over two 1-week periods (4 weeks between periods) and frequency of various puma behaviors (videorecorded). The study analyzed videotaped behavior of the pumas based on the time of day and visitors' number and noise levels. There was a direct association of puma behaviors with visitors' number and noise levels. The daughter puma was the most affected and behavioral changes of both pumas correlated more strongly with the noise level than the number of visitors. The noise level and number of visitors affected the behavior of the mother and her daughter only in the morning. The results of this study indicate that both noise level and number of visitors affected these pumas but revealed the noise as predominant. Moreover, the response of these pumas to visitors depended on the time of the day.

  17. Dinosaur Day!

    ERIC Educational Resources Information Center

    Nakamura, Sandra; Baptiste, H. Prentice

    2006-01-01

    In this article, the authors describe how they capitalized on their first-grade students' love of dinosaurs by hosting a fun-filled Dinosaur Day in their classroom. On Dinosaur Day, students rotated through four dinosaur-related learning stations that integrated science content with art, language arts, math, and history in a fun and time-efficient…

  18. CEMI Days

    SciTech Connect

    2015-07-01

    CEMI Days are an important channel of engagement between DOE and the manufacturing industry to identify challenges and opportunities for increasing U.S. manufacturing competitiveness. CEMI Days that are held at manufacturing companies’ facilities can include tours of R&D operations or other points of interest determined by the host company.

  19. Accidental ten times overdose administration of recombinant human erythropoietin (rh-EPO) up to 318,000 units a day in acute myocardial infarction: report of two cases.

    PubMed

    Shin, Dae-Hee; Kwon, Young-Il; Choi, Sung-Il; Park, Ui-Soon; Lee, Je; Shin, Jin-Ho; Lee, Jae-Ung; Kim, Soon-Gil; Kim, Jeong-Hyun; Lim, Heon-Kil; Lee, Bang-Hun; Kim, Kyung-Soo

    2006-02-01

    The cytokine erythropoietin protects the heart from ischaemic injury, in part by preventing apoptosis. But appropriate dose of erythropoietin for the protection of injured heart has not been studied. While we were researching the cardiac protective effects of erythropoietin in acute myocardial infarction, we experienced two cases of accidental nearly ten times overdose administration of erythropoietin up to 318,000 units instead of 33,000 units on the second day of three scheduled days of treatment. So a total of 384,000 units of erythropoietin were administered during three days. In case 1, the ALT level soared up to 386 U/l on the second day of administration and decreased slowly. It was back to normal state 3 months later. The AST level increased slowly up to 391 U/l and normalized 3 months later. Haemoglobin level was elevated up to 15.7 g/dl (14.7 g/dl at admission) and, 3 months later, normalized to 14.8 g/dl. In case 2, the ALT level was elevated up to 98 U/l on the second day of administration and decreased slowly. Three months later, the ALT level was normalized. The AST level also increased slowly up to 71 U/l and normalized 3 months later. Haemoglobin level was elevated up to 15.6 g/dl (13.8 g/dl at admission) and, 3 months later, normalized to 13.6 g/dl. In these two cases reported, these patients, even after massive overdose, tolerated it relatively well and the only side-effects we found were elevated liver enzyme and haemoglobin levels.

  20. Oophorectomy (Ovary Removal Surgery)

    MedlinePlus

    ... also be robotically assisted in certain cases. During robotic surgery, the surgeon watches a 3-D monitor ... Whether your oophorectomy is an open, laparoscopic or robotic procedure depends on your situation. Laparoscopic or robotic ...

  1. Clinical Use of Diffusion Tensor Image-Merged Functional Neuronavigation for Brain Tumor Surgeries: Review of Preoperative, Intraoperative, and Postoperative Data for 123 Cases

    PubMed Central

    Cho, Jin Mo; Kim, Eui Hyun; Kim, Jinna; Lee, Seung Koo; Kim, Sun Ho; Lee, Kyu Sung

    2014-01-01

    Purpose To achieve maximal safe resection during brain tumor surgery, functional image-merged neuronavigation is widely used. We retrospectively reviewed our cases in which diffusion tensor image (DTI)-merged functional neuronavigation was performed during surgery. Materials and Methods Between November 2008 and May 2010, 123 patients underwent surgery utilizing DTI-merged neuronavigation. Anatomical magnetic resonance images (MRI) were obtained preoperatively and fused with DTI of major white matter tracts, such as the corticospinal tract, optic radiation, or arcuate fasciculus. We used this fused image for functional neuronavigation during brain tumor surgery of eloquent areas. We checked the DTI images together with postoperative MRI images and evaluated the integrity of white matter tracts. Results A single white matter tract was inspected in 78 patients, and two or more white matter tracts were checked in 45 patients. Among the 123 patients, a grossly total resection was achieved in 90 patients (73.2%), subtotal resection in 29 patients (23.6%), and partial resection in 4 patients (3.3%). Postoperative neurologic outcomes, compared with preoperative function, included the following: 100 patients (81.3%) displayed improvement of neurologic symptoms or no change, 7 patients (5.7%) experienced postoperative permanent neurologic deterioration (additional or aggravated neurologic symptoms), and 16 patients (13.0%) demonstrated transient worsening. Conclusion DTI-merged functional neuronavigation could be a useful tool in brain tumor surgery for maximal safe resection. However, there are still limitations, including white matter tract shift, during surgery and in DTI itself. Further studies should be conducted to overcome these limitations. PMID:25048489

  2. [A Case of Laparoscopic Surgery for Early Gastric Cancer that Occurred after Coronary Artery Bypass Grafting using the Right Gastroepiploic Artery].

    PubMed

    Kusumoto, Eiji; Ota, Mitsuhiko; Tsutsumi, Norifumi; Hashimoto, Kenkichi; Egashira, Akinori; Sakaguchi, Yoshihisa; Kusumoto, Tetsuya; Ikejiri, Koji

    2015-10-01

    We herein report a case involving a 70-year-old man who was diagnosed with early gastric cancer that occurred after coronary artery bypass grafting (CABG) using the right gastroepiploic artery (RGEA) for effort-induced angina. He was successfully treated by laparoscopic surgery. Preoperative cardiac three-dimensional computed tomography and coronary angiography showed an occlusion of the RGEA graft, which could lead to ligation of the RGEA to dissect the lymph nodes along the RGEA. The laparoscopic approach helps to identify and avoid injury to the RGEA graft because of its enlarged and precise viewing field compared with laparotomy followed by retractor placement. Laparoscopic surgery is a useful method in such cases to reduce perioperative complications risk.

  3. Individual Plans for Children in Transition to Pre-School: A Case Study in One Finnish Day-Care Centre

    ERIC Educational Resources Information Center

    Turunen, Tuija A.

    2012-01-01

    This paper outlines a case study on teachers' and parents' perspectives on children's individual plans in transition from early childhood education to pre-school in Finland. The study was based on the importance of continuity as a part of positive educational transition experiences. The national curricula, educators' interpretations and parents'…

  4. [Pulmonary Carcinoid Tumor with Cushing's Syndrome in a Patient who Underwent Pulmonary Resection by Video-Assisted Thoracic Surgery;Report of a Case].

    PubMed

    Sato, Hiroshi; Mishina, Taijiro; Miyajima, Masahiro; Watanabe, Atsushi

    2015-07-01

    Pulmonary carcinoid tumor with Cushing's syndrome is comparatively rare disease. It is difficult to make an early diagnosis due to small size lesion in its early stage. We report a case of pulmonary carcinoid tumor with Cushing's syndrome successfully localised by positron emission tomography/computed tomography and was resected in the early stage. The levels of serum cortisol and adrenocorticotropic hormone( ACTH) decreased immediately after surgery, and the symptoms of Cushing's syndrome were relieved.

  5. [Mount Fuji sign in postoperative period after surgery for ependymoma of the third ventricle (V3): case report and review of the literature].

    PubMed

    Boumadiane, Abderrahmane; Derkaoui, Ali; Shimi, Abdelkarim; Khatouf, Mohamed

    2016-01-01

    Mount Fuji sign also known as compressive pneumocephalus is a redoubtable postoperative neurosurgical complication. We report the clinical case of a 10 months-old patient, hospitalized in reanimation for postoperative management following surgery for ependymoma of the third ventricle. The evolution was marked by the occurrence of early postoperative compressive pneumocephalus, responsible for neurological and hemodynamic worsening. This study highlights the possibility of occurrence of such an adverse event, as well as the therapeutic and especially preventive measures for this complication.

  6. A Rare Case of Left Ventricular Intramural Hemangioma Diagnosed Using 1.5-T Cardiac MRI with Histopathological Correlation and Successfully Treated by Surgery

    SciTech Connect

    Marrone, Gianluca; Sciacca, Sergio D'Ancona, Giuseppe Pilato, Michele; Luca, Angelo; Gridelli, Bruno

    2010-02-15

    Hemangiomas are vascular tumors composed of blood vessels, frequently localized in the skin and subcutaneous muscles; their localization in the heart is exceptional. The most common localizations are the lateral walls of the left ventricle, the anterior wall, and the septum. Mostly, these tumors grow intracavitarily, rarely intramurally. We describe a singular case of left ventricular intramural hemangioma, detected and diagnosed using newer magnetic resonance imaging (MRI) modalities, confirmed by histopathological results, and treated successfully by surgery.

  7. Career Day

    NASA Video Gallery

    NASA's 2013 Career Days was a joint collaboration between NASA Langley and the Newport News Shipbuilding where 600 high school students from Virginia took on two design challenges -- designing a ca...

  8. Cataract surgery and quality of life implications

    PubMed Central

    Morris, Daniel; Fraser, Scott G; Gray, Christopher

    2007-01-01

    Cataract surgery in the developed world has undergone a revolution over the last 20 years. An operation which used to require a stay in hospital and long visual rehabilitation is now a quick day-case procedure with immediate benefits. As with any surgery there is an associated morbidity, but there is now the potential to provide cataract surgery at an earlier stage of cataract maturation and save patients from a period of severe visual impairment. This article reviews the new techniques available to measure the impact that cataracts have not only on a patient’s visual acuity but also their general physical health, function, cognition, and emotional well-being. New research is described that takes into account these more holistic tests and how they can be used to judge the best time to refer and operate on a patient with cataracts. PMID:18044082

  9. Video-Assisted Thoracoscopic Surgery and Minimal Access Spinal Surgery Compared in Anterior Thoracic or Thoracolumbar Junctional Spinal Reconstruction: A Case-Control Study and Review of the Literature

    PubMed Central

    Lee, Ching-Yu; Wu, Meng-Huang; Li, Yen-Yao; Cheng, Chin-Chang; Lee, Chien-Yin

    2016-01-01

    There are no published reports that compare the outcomes of video-assisted thoracoscopic surgery (VATS) and minimal access spinal surgery (MASS) in anterior spinal reconstruction. We conducted a retrospective case-control study in a single center and systematically reviewed the literature to compare the efficacy and safety of VATS and MASS in anterior thoracic (T) and thoracolumbar junctional (TLJ) spinal reconstruction. From 1995 to 2012, there were 111 VATS patients and 76 MASS patients treated at our hospital. VATS patients had significantly (p < 0.001) longer operating times and significantly (p < 0.022) higher thoracotomy conversion rates. We reviewed 6 VATS articles and 10 MASS articles, in which there were 625 VATS patients and 399 MASS patients. We recorded clinical complications and a thoracotomy conversion rate from our cases and the selected articles. The incidence of approach-related complications was significantly (p = 0.021) higher in VATS patients. The conversion rate was 2% in VATS patients and 0% in MASS patients (p = 0.001). In conclusion, MASS is associated with reduction in operating time, approach-related complications, and the thoracotomy conversion rate. PMID:28101511

  10. Citizen science land cover classification based on ground and satellite imagery: Case study Day River in Vietnam

    NASA Astrophysics Data System (ADS)

    Nguyen, Son Tung; Minkman, Ellen; Rutten, Martine

    2016-04-01

    Citizen science is being increasingly used in the context of environmental research, thus there are needs to evaluate cognitive ability of humans in classifying environmental features. With the focus on land cover, this study explores the extent to which citizen science can be applied in sensing and measuring the environment that contribute to the creation and validation of land cover data. The Day Basin in Vietnam was selected to be the study area. Different methods to examine humans' ability to classify land cover were implemented using different information sources: ground based photos - satellite images - field observation and investigation. Most of the participants were solicited from local people and/or volunteers. Results show that across methods and sources of information, there are similar patterns of agreement and disagreement on land cover classes among participants. Understanding these patterns is critical to create a solid basis for implementing human sensors in earth observation. Keywords: Land cover, classification, citizen science, Landsat 8

  11. Do Emotions Expressed Online Correlate with Actual Changes in Decision-Making?: The Case of Stock Day Traders

    PubMed Central

    Liu, Bin; Govindan, Ramesh; Uzzi, Brian

    2016-01-01

    Emotions are increasingly inferred linguistically from online data with a goal of predicting off-line behavior. Yet, it is unknown whether emotions inferred linguistically from online communications correlate with actual changes in off-line activity. We analyzed all 886,000 trading decisions and 1,234,822 instant messages of 30 professional day traders over a continuous 2 year period. Linguistically inferring the traders’ emotional states from instant messages, we find that emotions expressed in online communications reflect the same distributions of emotions found in controlled experiments done on traders. Further, we find that expressed online emotions predict the profitability of actual trading behavior. Relative to their baselines, traders who expressed little emotion or traders that expressed high levels of emotion made relatively unprofitable trades. Conversely, traders expressing moderate levels of emotional activation made relatively profitable trades. PMID:26765539

  12. A numerical model simulation of the regional air pollution meteorology of the greater Chesapeake Bay area - Summer day case study

    NASA Technical Reports Server (NTRS)

    Segal, M.; Pielke, R. A.; Mcnider, R. T.; Mcdougal, D. S.

    1982-01-01

    The mesoscale numerical model of the University of Virginia (UVMM), has been applied to the greater Chesapeake Bay area in order to provide a detailed description of the air pollution meteorology during a typical summer day. This model provides state of the art simulations for land-sea thermally induced circulations. The model-predicted results agree favorably with available observed data. The effects of synoptic flow and sea breeze coupling on air pollution meteorological characteristics in this region, are demonstrated by a spatial and temporal presentation of various model predicted fields. A transport analysis based on predicted wind velocities indicated possible recirculation of pollutants back onto the Atlantic coast due to the sea breeze circulation.

  13. Changes in daily pollen concentration based on meteorological data and days after seasonal initiation - a case study for Japanese hop

    NASA Astrophysics Data System (ADS)

    Choe, H.; Kim, K. R.; Kim, M.; Han, M. J.; Cho, C.; Choi, B. C.

    2014-12-01

    Pollinosis causes various allergy symptoms such as seasonal rhinitis, asthma, and conjunctivitis (Min, 1991). Japanese hop (Humulus japonicus) is a major allergen in southern Gyonggi-do during the fall seasons (Park, 1998). So that it is needed to forecast the concentration of its pollens.For the germination of Japanese hop, a period of low temperature (<5C) followed by warm (~20C) and humid conditions is needed (Growing and Protecting New Zealand(2010)). The daily concentration of the pollens increases rapidly then decreases a few days afterward. In this study, the changes in daily pollen concentration were analyzed to yield a prediction model.As a result, a regression model was produced to forecast daily pollen concentration. It can be integrated into the daily pollinosis warning system of the Korea Meteorological Administration (KMA) and provide more accurate daily risk information.

  14. Do Emotions Expressed Online Correlate with Actual Changes in Decision-Making?: The Case of Stock Day Traders.

    PubMed

    Liu, Bin; Govindan, Ramesh; Uzzi, Brian

    2016-01-01

    Emotions are increasingly inferred linguistically from online data with a goal of predicting off-line behavior. Yet, it is unknown whether emotions inferred linguistically from online communications correlate with actual changes in off-line activity. We analyzed all 886,000 trading decisions and 1,234,822 instant messages of 30 professional day traders over a continuous 2 year period. Linguistically inferring the traders' emotional states from instant messages, we find that emotions expressed in online communications reflect the same distributions of emotions found in controlled experiments done on traders. Further, we find that expressed online emotions predict the profitability of actual trading behavior. Relative to their baselines, traders who expressed little emotion or traders that expressed high levels of emotion made relatively unprofitable trades. Conversely, traders expressing moderate levels of emotional activation made relatively profitable trades.

  15. Development and dissemination of collaborative family-oriented services: the case of community/day residential care in Israel.

    PubMed

    Elizur, Yoel

    2012-03-01

    The initiation, development, and dissemination of family-oriented programs are a unifying thread that highlights family therapy's contribution to the fields of mental/physical health and social services. These demanding tasks require an ecosystemic vision, a supportive larger context, and a range of skills. This article delineates the evolution of community and day residential care in Israel by examining processes at different ecological levels: the formulation and implementation of national social policy, the follow-up of two family-oriented facilities, one of which thrived while the other eventually closed, and the residential care provided to 1 family with 3 children. The analysis of this multilevel data highlights 4 facilitating/obstructing factors that have had major impact on family-oriented programs: support by both national and local sociopolitical-professional administration, program's management autonomy, staff training, support and development, and effective facility leadership that establishes and nurtures family-oriented organizational structure and culture.

  16. A rare case of neonatal cryptococcal meningitis in an HIV-unexposed 2-day-old infant: the youngest to date?

    PubMed

    O'Reilly, Dominic Anthony

    2016-05-01

    Cryptococcal meningitis is uncommon in children, particularly in infants. A 2-day-old boy was admitted with signs suggestive of meningitis. Lumbar puncture confirmed meningitis and cryptococcal infection (cryptococcal antigen and Indian ink stain-positive). His mother was HIV-negative. This is thought to be the youngest case of cryptococcal meningitis to be reported. Cryptococcal infection should be considered in children of all ages with meningitis where there is possible immunodeficiency or failure to respond to initial treatment with antibiotics.

  17. Robotic Versus Laparoscopic Surgery for Rectal Cancer after Preoperative Chemoradiotherapy: Case-Matched Study of Short-Term Outcomes

    PubMed Central

    Kim, Yong Sok; Kim, Min Jung; Park, Sung Chan; Sohn, Dae Kyung; Kim, Dae Yong; Chang, Hee Jin; Nam, Byung-Ho; Oh, Jae Hwan

    2016-01-01

    Purpose Robotic surgery is expected to have advantages over laparoscopic surgery; however, there are limited data regarding the feasibility of robotic surgery for rectal cancer after preoperative chemoradiotherapy (CRT). Therefore, we evaluated the short-term outcomes of robotic surgery for rectal cancer. Materials and Methods Thirty-three patients with cT3N0-2 rectal cancer after preoperative CRT who underwent robotic low anterior resection (R-LAR) between March 2010 and January 2012 were matched with 66 patients undergoing laparoscopic low anterior resection (L-LAR). Perioperative clinical outcomes and pathological data were compared between the two groups. Results Patient characteristics did not differ significantly different between groups. The mean operation time was 441 minutes (R-LAR) versus 277 minutes (L-LAR, p < 0.001). The open conversion rate was 6.1% in the R-LAR group and 0% in the L-LAR group (p=0.11). There were no significant differences in the time to flatus passage, length of hospital stay, and postoperative morbidity. In pathological review, the mean number of harvested lymph nodes was 22.3 in R-LAR and 21.6 in L-LAR (p=0.82). Involvement of circumferential resection margin was positive in 16.1% and 6.7%, respectively (p=0.42). Total mesorectal excision (TME) quality was complete in 97.0% in R-LAR and 91.0% in L-LAR (p=0.41). Conclusion In our study, short-term outcomes of robotic surgery for rectal cancer after CRT were similar to those of laparoscopic surgery in respect to bowel function recovery, morbidity, and TME quality. Well-designed clinical trials are needed to evaluate the functional results and long-term outcomes of robotic surgery for rectal cancer. PMID:25779367

  18. Development of anterior inferior cerebellar artery pseudoaneurysm after gamma knife surgery for vestibular schwannoma. A case report and review of the literature.

    PubMed

    Sunderland, Geraint; Hassan, Faizul; Bhatnagar, Priya; Mitchell, Patrick; Jayakrishnan, Vijayam; Forster, David; Mendelow, Alexander David

    2014-08-01

    Gamma knife surgery (GKS) is a well-established modality for controlling the progression of vestibular schwannomas. Adverse effects of this treatment are extremely rare but include cyst formation and malignant transformation. We report a case of anterior inferior cerebellar artery (AICA) pseudoaneurysm development rupture presenting as a poor WFNS grade subarachnoid haemorrhage. This is only the fourth case of aneurysm development (AICA aneurysm) following GKS reported but due to its serious nature we believe this potential complication warrants awareness in those offering this treatment.

  19. Satellite remote sensing of Asian aerosols: a case study of clean, polluted, and Asian dust storm days

    NASA Astrophysics Data System (ADS)

    Lee, K. H.; Kim, Y. J.

    2010-12-01

    In East Asia, satellite observation is important because aerosols from natural and anthropogenic sources have been recognized as a major source of regional and global air pollution. However, retrieving aerosols properties from satellite observations over land can be difficult because of the surface reflection, complex aerosol composition, and aerosol absorption. In this study, a new aerosol retrieval method called as the Moderate Resolution Imaging Spectroradiometer (MODIS) satellite aerosol retrieval (MSTAR) was developed and applied to three different aerosol event cases over East Asia. MSTAR uses a separation technique that can distinguish aerosol reflectance from top-of-atmosphere (TOA) reflectance. The aerosol optical thickness (AOT) was determined by comparing this aerosol reflectance with pre-calculated values. Three case studies show how the methodology identifies discrepancies between measured and calculated values to retrieve more accurate AOT. The comparison between MODIS and the Aerosol Robotic Network (AERONET) showed improvement using the suggested methodology with the cluster-based look-up-tables (LUTs) (linear slope = 0.94, R = 0.92) than using operational MODIS collection 5 aerosol products (linear slope = 0.78, R = 0.87). In conclusion, the suggested methodology is shown to work well with aerosol models acquired by statistical clustering of the observation data in East Asia.

  20. Complex Bedforms and Complex Water Masses: A Case Study from the Tertiary to Present-day, Pelotas Basin, Offshore Uruguay

    NASA Astrophysics Data System (ADS)

    Thompson, P.; Badalini, G.; Wrigley, S.; Walker, R.; Argent, J.; Hernandez-Molina, J.; de Santa Ana, H.; Soto, M.; Tomasini, J.

    2015-12-01

    varied both spatially and temporally and operated at various water depths. This complexity continues Present-day and is spectacularly imaged by pseudo time-lapse seismic data from the Present-day water column. These data, which are commonly neglected, highlight the true complexity of ocean currents and show how discrete dynamic water masses mix and move over time.

  1. Gay Days.

    ERIC Educational Resources Information Center

    Zirkel, Perry A.

    2003-01-01

    Discusses case of peer-to-peer harassment of a homosexual high school student in Nevada involving "Tinker" First Amendment expression issues and Title IX peer-harassment case law. Prior to trial, school district agreed to a substantial monetary settlement, but did not admit to First Amendment or Title IX violations. (Contains 13…

  2. SFE/SFHTA/AFCE consensus on primary aldosteronism, part 6: Adrenal surgery.

    PubMed

    Steichen, Olivier; Amar, Laurence; Chaffanjon, Philippe; Kraimps, Jean-Louis; Ménégaux, Fabrice; Zinzindohoue, Franck

    2016-07-01

    Treatment of primary aldosteronism (PA) aims at preventing or correcting hypertension, hypokalemia and target organ damage. Patients with lateralized PA and candidates for surgery may be managed by laparoscopic adrenalectomy. Partial adrenalectomy and non-surgical ablation have no proven advantage over total adrenalectomy. Intraoperative morbidity and mortality are low in reference centers, and day-surgery is warranted in selected cases. Spironolactone administered during the weeks preceding surgery controls hypertension and hypokalemia and may prevent postoperative hypoaldosteronism. In most cases, surgery corrects hypokalemia, improves control of hypertension and reduces the burden of pharmacologic treatment; in about 40% of cases, it resolves hypertension. However, success in controlling hypertension and reversing target organ damage is comparable with mineralocorticoid receptor antagonists. Informed patient preference with regard to surgery is thus an important factor in therapeutic decision-making.

  3. Maze Surgery

    MedlinePlus

    ... surgery to treat an arrhythmia called chronic atrial fibrillation (AF). AF is a fast, irregular heart rhythm ... Surgeons http://www.sts.org/node/2275 Atrial Fibrillation Surgery – Maze Procedure Updated August 2016 Please contact ...

  4. Turbinate surgery

    MedlinePlus

    Turbinectomy; Turbinoplasty; Turbinate reduction; Nasal airway surgery ... There are several types of turbinate surgery: Turbinectomy: All or part of the lower turbinate is taken out. This can be done in several different ways, but sometimes a ...

  5. Brightening the Day With Flashes of Positive Mental Imagery: A Case Study of an Individual With Depression.

    PubMed

    Blackwell, Simon E; Holmes, Emily A

    2017-02-02

    This article presents a case example of an individual with current major depression engaging in a positive mental imagery intervention, specifically a computerized cognitive training paradigm involving repeated practice in generating positive imagery in response to ambiguous scenarios. The patient's reported experience of the intervention suggests the potential of the positive imagery intervention to "brighten" everyday life via promoting involuntary "flashes" of positive mental imagery in situations related to the scenarios, with associated beneficial effects on positive affect, future expectations, and behavior. Enhancing this aspect of the training-i.e., involuntary positive imagery in contexts where it is adaptive-may hold particular promise for reducing anhedonic symptoms of depression. Developing simple computerized interventions to increase the experience of positive mental imagery in everyday life could therefore provide a useful addition to the drive to improve treatment outcomes.

  6. An apple a day may hold colorectal cancer at bay: recent evidence from a case-control study.

    PubMed

    Jedrychowski, Wieslaw; Maugeri, Umberto

    2009-01-01

    Environmental factors play an important role in the etiology of colorectal cancer, the second-most common malignancy in both genders in developed countries. Evidence has shown that potential cancer-inducing oxidative damage might be prevented or restricted largely by the presence of dietary antioxidants of plant origin, such as fruits or vegetables. The protective antioxidant effect of fruits and vegetables has been attributed to flavonoids, a major class of phytochemicals naturally occurring in fruits, vegetables, and various foods of plant origin. Yet, epidemiologic cohort studies relating flavonoid intake to risk of colorectal cancer have been sparse and inconclusive. Apples are a rich source of flavonoids and have the second highest level of antioxidant power among all fruits, with peels having a stronger antioxidant activity than apple flesh. A recent reanalysis of several case-control studies in Italy demonstrated a consistent inverse association between apple consumption and the risk of various cancers, and among them ofcolorectal cancer. Here we assessed the potential protective impact of apples on risk of colorectal cancer in the course of a recently performed hospital-based case-control study in a country with dietary habits very different from those of Mediterranean region. The results showed that highest risk of colorectal cancer was among older persons and those who were residents of villages or small towns. The risk of colorectal cancer was inversely correlated with daily number of apple servings, but the most significant reductions of OR estimates were observed for an intake one or more apple servings daily (OR = 0.37, 95% CI: 0.15-0.91). No other fruit was significantly associated with altering the risk of colorectal cancer.

  7. Capitol Day

    NASA Technical Reports Server (NTRS)

    2009-01-01

    Stennis Space Center Director Gene Goldman visits with Mississippi Gov. Haley Barbour during NASA Day at the Capitol activities on Feb. 19. During the visit, Goldman presented the governor with a model of the J-2X rocket engine currently in development. Stennis engineers did early component testing for the new engine.

  8. Inspire Day

    ERIC Educational Resources Information Center

    Bohach, Barbara M.; Meade, Birgitta

    2014-01-01

    The authors collaborated on hosting a "Spring Inspire Day." planned and delivered by preservice elementary teachers as a social studies/science methods project. Projects that have authentic application opportunities can make learning meaningful for prospective teachers as well as elementary students. With the impetus for an integrated…

  9. A Case of Successful Foraminotomy for Severe Bilateral C5 Palsy following Posterior Decompression and Fusion Surgery for Cervical Ossification of Posterior Longitudinal Ligament

    PubMed Central

    Toyone, Tomoaki; Shirahata, Toshiyuki; Ozawa, Tomoyuki; Matsuoka, Akira; Jin, Yoichi; Inagaki, Katsunori

    2016-01-01

    We report a very rare (5~7%) case of bilateral C5 palsy after cervical surgery. A 71-year-old male patient with cervical ossification of posterior longitudinal ligament (OPLL) with foraminal stenosis at bilateral C4/5 underwent posterior decompression and fusion surgery. After surgery, muscle weakness in his both deltoid and biceps was detected and gradually deteriorated to complete paralysis. Postoperative MRI showed sufficient decompression of the spinal cord and posterior shifting. Subsequently, an additional bilateral foraminotomy at C4/5 was performed, with a suspicion that bilateral foraminal stenosis at C4/5 may have been the cause of the paresis. After foraminotomy, muscular contraction was seen in both deltoid and biceps. Finally, complete motor recovery was achieved in a year. Although the gold standard procedure for the prevention and treatment of postoperative C5 palsy has not yet been established, an additional foraminotomy may be recommended for severe C5 palsy in cases of foraminal stenosis even after the occurrence of palsy. PMID:27672463

  10. Customer response to day-ahead wholesale market electricity prices: Case study of RTP program experience in New York

    SciTech Connect

    Goldman, C.; Hopper, N.; Sezgen, O.; Moezzi, M.; Bharvirkar, R.; Neenan, B.; Boisvert, R.; Cappers, P.; Pratt, D.

    2004-07-01

    There is growing interest in policies, programs and tariffs that encourage customer loads to provide demand response (DR) to help discipline wholesale electricity markets. Proposals at the retail level range from eliminating fixed rate tariffs as the default service for some or all customer groups to reinstituting utility-sponsored load management programs with market-based inducements to curtail. Alternative rate designs include time-of-use (TOU), day-ahead real-time pricing (RTP), critical peak pricing, and even pricing usage at real-time market balancing prices. Some Independent System Operators (ISOs) have implemented their own DR programs whereby load curtailment capabilities are treated as a system resource and are paid an equivalent value. The resulting load reductions from these tariffs and programs provide a variety of benefits, including limiting the ability of suppliers to increase spot and long-term market-clearing prices above competitive levels (Neenan et al., 2002; Boren stein, 2002; Ruff, 2002). Unfortunately, there is little information in the public domain to characterize and quantify how customers actually respond to these alternative dynamic pricing schemes. A few empirical studies of large customer RTP response have shown modest results for most customers, with a few very price-responsive customers providing most of the aggregate response (Herriges et al., 1993; Schwarz et al., 2002). However, these studies examined response to voluntary, two-part RTP programs implemented by utilities in states without retail competition.1 Furthermore, the researchers had limited information on customer characteristics so they were unable to identify the drivers to price response. In the absence of a compelling characterization of why customers join RTP programs and how they respond to prices, many initiatives to modernize retail electricity rates seem to be stymied.

  11. Long-Term Outcome of a Hepatocellular Carcinoma 71/2 Years After Surgery and Repeated Radiofrequency Ablation: Case Report and Review of the Literature

    SciTech Connect

    Thanos, L. Mylona, S.; Nikita, A.; Ptohis, N.; Kelekis, D.A.

    2007-04-15

    An interesting case is presented of a 78-year-old patient with cirrhosis who was managed with combined treatment (surgery and radiofrequency (RF) ablation) for hepatocellular carcinoma (HCC) and has survived for 71/2 years. Elevation of the {alpha}-FP (alpha-fetoprotein) levels was noted 2 years after surgery. CT demonstrated two lesions: one central at the remaining right liver lobe, and the other at the excision site. Biopsy of the lesions confirmed the diagnosis of HCC for both of them. RF ablation of these two lesions was performed in one session with technical success. Four and a half years after the first RF ablation a new recurrence was demonstrated at the CT follow-up control. RF ablation was again applied successfully. The imaging findings and the therapeutic percutaneous management of this patient along with the natural course of HCC and its recurrence are discussed, and the literature concerning risk factors is reviewed.

  12. What to Expect After Heart Surgery

    MedlinePlus

    ... on Twitter. What To Expect After Heart Surgery Recovery in the Hospital You may spend a day ... heart rate, blood pressure, breathing, and incision site(s). Recovery at Home People respond differently to heart surgery. ...

  13. Intestinal Infarction Through Arterial Vascular Obstruction - Case Series from 1st and 3rd Surgery Clinics Cluj-Napoca.

    PubMed

    Jeican, Ionuţ Isaia; Mocan, Mihaela; Gheban, Dan

    2016-01-01

    This article presents a case series of intestinal infarction through obstruction of superior mesenteric artery - two cases of acute mesenteric artery embolism, two cases of acute mesenteric artery thrombosis and a case of volvulus.

  14. 34 CFR 300.11 - Day; business day; school day.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 34 Education 2 2012-07-01 2012-07-01 false Day; business day; school day. 300.11 Section 300.11... CHILDREN WITH DISABILITIES General Definitions Used in This Part § 300.11 Day; business day; school day. (a) Day means calendar day unless otherwise indicated as business day or school day. (b) Business...

  15. 34 CFR 300.11 - Day; business day; school day.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 34 Education 2 2011-07-01 2010-07-01 true Day; business day; school day. 300.11 Section 300.11... CHILDREN WITH DISABILITIES General Definitions Used in This Part § 300.11 Day; business day; school day. (a) Day means calendar day unless otherwise indicated as business day or school day. (b) Business...

  16. Use of T-Tube Enterostomy in Neonatal Gastro-intestinal Surgery.

    PubMed

    Al-Zaiem, Maher; Al-Garni, Abdulhai F; Al-Maghrebi, Abdulrahman; Asghar, Asim A

    2016-01-01

    Aim: To evaluate the results of the use of the T-tube ileostomy in neonatal intestinal surgery cases. Materials and Methods: A retrospective review of sixty two neonates underwent intestinal obstruction surgery by using T-tube ileostomy was conducted between January 1990 and January 2013.The pathologies of the intestinal obstruction were; thirty four of jejunoileal atresia cases, thirteen case meconium ileus, eight cases perforated necrotizing enterocolitis (NEC), three cases meconium peritonitis, three cases with bowel resection due to intestinal volvulus, and one case of gastroschisis. Results: Mean duration of T-tube placement was 13 days (range9-20days) and the sites of T-tube insertion closed spontaneously in 2 days (range 1-4 days). The mean duration for starting oral intake postoperatively in these patients was 9 days (6-16 days). All patients well tolerated the procedure and there were no serious complications related to the T-tube insertion. However, four patients died due to other reasons like sepsis, respiratory failure and prematurity. Conclusion: T-tube enterostomy is an effective and safe technique for treatment of selected cases of neonatal intestinal surgery. It showed less morbidity and mortality rates than the conventional stoma. Therefore, it is considered a helpful approach in cases where there is danger of hypoperistaltic dilated bowel proximal to the anastomosis.

  17. Validity of NBME Parts I and II for the Selection of Residents: The Case of Orthopaedic Surgery.

    ERIC Educational Resources Information Center

    Case, Susan M.

    The predictive validity of scores on the National Board of Medical Examiners (NBME) Part I and Part II examinations for the selection of residents in orthopaedic surgery was investigated. Use of NBME scores has been criticized because of the time lag between taking Part I and entering residency and because Part I content is not directly linked to…

  18. Full protein alimentation and nitrogen equilibrium in a renal failure patient treated with continuous hemodiafiltration: a case report of 67 days of continuous hemodiafiltration.

    PubMed

    Reynolds, H N; Borg, U; Frankenfield, D

    1992-01-01

    Standard care for patients with renal failure while in an intensive care unit involves traditional hemodialysis or peritoneal dialysis and protein restriction. We present a case of a patient with renal failure supported with continuous arteriovenous hemofiltration with dialysis (CAVH-D) who was given full protein alimentation. Total daily urea clearance was measured from the CAVH-D output. Protein load was 196 +/- 34 g/day while receiving total parenteral nutrition and 164 +/- 30 g/day while receiving enteral alimentation. Serum blood urea nitrogen was controlled between 40 and 75 mg/dL, except during septic episodes. Nitrogen balance was estimated based upon known alimentation protein load and measurable and estimated nitrogenous losses. The patient was potentially in nitrogen equilibrium during most of the dialysis period. The cumulative nitrogen balance was positive by 5.2 g after 67 days of dialysis. Volume of alimentation was 3.49 +/- 0.7 liters/day. With CAVH-D, the renal failure patient can receive full alimentation without volume or protein load limitations. Furthermore, nitrogen balances can be estimated easily while the patient is on CAVH-D.

  19. Excessive masturbation after epilepsy surgery.

    PubMed

    Ozmen, Mine; Erdogan, Ayten; Duvenci, Sirin; Ozyurt, Emin; Ozkara, Cigdem

    2004-02-01

    Sexual behavior changes as well as depression, anxiety, and organic mood/personality disorders have been reported in temporal lobe epilepsy (TLE) patients before and after epilepsy surgery. The authors describe a 14-year-old girl with symptoms of excessive masturbation in inappropriate places, social withdrawal, irritability, aggressive behavior, and crying spells after selective amygdalohippocampectomy for medically intractable TLE with hippocampal sclerosis. Since the family members felt extremely embarrassed, they were upset and angry with the patient which, in turn, increased her depressive symptoms. Both her excessive masturbation behavior and depressive symptoms remitted within 2 months of psychoeducative intervention and treatment with citalopram 20mg/day. Excessive masturbation is proposed to be related to the psychosocial changes due to seizure-free status after surgery as well as other possible mechanisms such as Kluver-Bucy syndrome features and neurophysiologic changes associated with the cessation of epileptic discharges. This case demonstrates that psychiatric problems and sexual changes encountered after epilepsy surgery are possibly multifactorial and in adolescence hypersexuality may be manifested as excessive masturbation behavior.

  20. Corneoplastique™: Art of vision surgery

    PubMed Central

    Gulani, Arun C

    2014-01-01

    Corneoplastique incorporates the entire spectrum of Vision corrective surgery including Lasik, premium cataract surgery, corneal surgery, ocular surface surgery and the full range of anterior segment surgery itself in manipulating the optics of every eye towards unaided emmetropia to define each and every eye surgeon as a “Vision Corrective Surgeon”. This concept of approaching each case individually and designing vision therewith enables surgeons to correct not only virgin eyes but also approach complex cases and complications with the goal of 20/20 vision. Armed with this holistic approach, eye surgeons can use minimally invasive, aesthetically pleasing and visually focused surgery in single or staged process aiming for each patient's Best Vision Potential (BVP) raising eye surgery itself then to an Art! PMID:24492495