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Sample records for surgery emergency case

  1. Nontrauma emergency surgery: optimal case mix for general surgery and acute care surgery training.

    Science.gov (United States)

    Cherry-Bukowiec, Jill R; Miller, Barbra S; Doherty, Gerard M; Brunsvold, Melissa E; Hemmila, Mark R; Park, Pauline K; Raghavendran, Krishnan; Sihler, Kristen C; Wahl, Wendy L; Wang, Stewart C; Napolitano, Lena M

    2011-11-01

    To examine the case mix and patient characteristics and outcomes of the nontrauma emergency (NTE) service in an academic Division of Acute Care Surgery. An NTE service (attending, chief resident, postgraduate year-3 and postgraduate year-2 residents, and two physician assistants) was created in July 2005 for all urgent and emergent inpatient and emergency department general surgery patient consults and admissions. An NTE database was created with prospective data collection of all NTE admissions initiated from November 1, 2007. Prospective data were collected by a dedicated trauma registrar and Acute Physiology and Chronic Health Evaluation-intensive care unit (ICU) coordinator daily. NTE case mix and ICU characteristics were reviewed for the 2-year time period January 1, 2008, through December 31, 2009. During the same time period, trauma operative cases and procedures were examined and compared with the NTE case mix. Thousand seven hundred eight patients were admitted to the NTE service during this time period (789 in 2008 and 910 in 2009). Surgical intervention was required in 70% of patients admitted to the NTE service. Exploratory laparotomy or laparoscopy was performed in 449 NTE patients, comprising 37% of all surgical procedures. In comparison, only 118 trauma patients (5.9% of admissions) required a major laparotomy or thoracotomy during the same time period. Acuity of illness of NTE patients was high, with a significant portion (13%) of NTE patients requiring ICU admission. NTE patients had higher admission Acute Physiology and Chronic Health Evaluation III scores [61.2 vs. 58.8 (2008); 58.2 vs. 55.8 (2009)], increased mortality [(9.71% vs. 4.89% (2008); 6.78% vs. 5.16% (2009)], and increased readmission rates (15.5% vs. 7.4%) compared with the total surgical ICU (SICU) admissions. In an era of declining operative caseload in trauma, the NTE service provides ample opportunity for complex general surgery decision making and operative procedures for

  2. Mesenteric panniculitis patients requiring emergency surgery: report of three cases.

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    Duman, Mustafa; Koçak, Osman; Fazli, Olgaç; Koçak, Cengiz; Atici, Ali Emre; Duman, Uğur

    2012-04-01

    Mesenteric panniculitis is a rare, benign disease characterized by a chronic non-specific inflammatory process of mesenteric fat tissue with unknown etiology. The small bowel mesentery is affected mostly. This process rarely involves the large intestine mesentery. Mesenteric panniculitis includes symptoms as abdominal pain, nausea and vomiting, diarrhea, constipation, and fever. In our cases, we had difficulty in the preoperative diagnosis as the clinical changes imitated an obstruction or ischemia of the small bowel. All the cases required emergency abdominal surgery and partial jejunal resection. The aim of this article was to present three cases of mesenteric panniculitis of the small bowel mesentery requiring emergency surgery together with a short review of the literature.

  3. Emergency surgery

    DEFF Research Database (Denmark)

    Stoneham, M; Murray, D; Foss, N

    2014-01-01

    National reports recommended that peri-operative care should be improved for elderly patients undergoing emergency surgery. Postoperative mortality and morbidity rates remain high, and indicate that emergency ruptured aneurysm repair, laparotomy and hip fracture fixation are high-risk procedures...... undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely...

  4. Emergency canine surgery in a deployed forward surgical team: a case report.

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    Beitler, Alan L; Jeanette, Joseph P; McGraw, Andrew L; Butera, Jennifer R; Vanfosson, Christopher A; Seery, Jason M

    2011-04-01

    Forward surgical teams (FSTs) perform a variety of non-doctrinal functions. During their deployment to Afghanistan, the 541st FST (Airborne) performed emergency surgery on a German shepherd military working dog (MWD). Retrospective examination of a case of veterinary surgery in a deployed FST. A 5 1/2-year-old German shepherd MWD presented with extreme lethargy, tachycardia, excessive drooling, and a firm, distended abdomen. These conditions resulted from gastric dilatation with volvulus. Since evacuation to a veterinarian was untenable, emergency laparotomy was performed in the FST. The gastric dilatation with volvulus was treated by detorsion and gastropexy, and the canine patient fully recovered. Canine surgery can be safely performed in an FST. Based on the number of MWDs deployed throughout the theater, FSTs may be called upon to care for them in the absence of available veterinary care.

  5. Is case triaging a useful tool for emergency surgeries? A review of 106 trauma surgery cases at a level 1 trauma center in South Africa.

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    Chowdhury, Sharfuddin; Nicol, Andrew John; Moydien, Mahammed Riyaad; Navsaria, Pradeep Harkison; Montoya-Pelaez, Luis Felipe

    2018-01-01

    The optimal timing for emergency surgical interventions and implementation of protocols for trauma surgery is insufficient in the literature. The Groote Schuur emergency surgery triage (GSEST) system, based on Cape Triaging Score (CTS), is followed at Groote Schuur Hospital (GSH) for triaging emergency surgical cases including trauma cases. The study aimed to look at the effect of delay in surgery after scheduling based on the GSEST system has an impact on outcome in terms of postoperative complications and death. Prospective audit of patients presenting to GSH trauma center following penetrating or blunt chest, abdominal, neck and peripheral vascular trauma who underwent surgery over a 4-month period was performed. Post-operative complications were graded according to Clavien-Dindo classification of surgical complications. One-hundred six patients underwent surgery during the study period. One-hundred two (96.2%) cases were related to penetrating trauma. Stab wounds comprised 71 (67%) and gunshot wounds (GSW) 31 (29.2%) cases. Of the 106 cases, 6, 47, 40, and 13 patients were booked as red, orange, yellow, and green, respectively. The median delay for green, yellow, and orange cases was within the expected time. The red patients took unexpectedly longer (median delay 48 min, IQR 35-60 min). Thirty-one (29.3%) patients developed postoperative complications. Among the booked red, orange, yellow, and green cases, postoperative complications developed in 3, 18, 9, and 1 cases, respectively. Only two (1.9%) postoperative deaths were documented during the study period. There was no statistically significant association between operative triage and post-operative complications ( p  = 0.074). Surgical case categorization has been shown to be useful in prioritizing emergency trauma surgical cases in a resource constraint high-volume trauma center.

  6. Emergency surgery for Crohn's disease.

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    Smida, Malek; Miloudi, Nizar; Hefaiedh, Rania; Zaibi, Rabaa

    2016-03-01

    Surgery has played an essential role in the treatment of Crohn's disease. Emergency can reveal previously unknown complications whose treatment affects prognosis. Indicate the incidence of indications in emergent surgery for Crohn's disease. Specify the types of procedures performed in these cases and assess the Results of emergency surgery for Crohn's disease postoperatively,  in short , medium and long term. Retrospective analysis of collected data of 38 patients, who underwent surgical resection for Crohn's disease during a period of 19 years from 1992 to 2011 at the department of surgery in MONGI SLIM Hospital, and among them 17 patients underwent emergency surgery for Crohn's disease. In addition to socio-demographic characteristics and clinical presentations of our study population, we evaluated the indications, the type of intervention, duration of evolution preoperative and postoperative complications and overall prognosis of the disease. Of the 38 patients with Crohn's disease requiring surgical intervention, 17/38 patients underwent emergency surgery. Crohn's disease was inaugurated by the complications requiring emergency surgery in 11 patients. The mean duration of symptoms prior to surgery was 1.5 year. The most common indication for emergency surgery was acute intestinal obstruction (n=6) followed by perforation and peritonitis (n=5). A misdiagnosis of appendicitis was found in 4 patients and a complicated severe acute colitis for undiagnosed Crohn's disease was found in 2 cases. The open conventional surgery was performed for 15 patients. Ileocolic resection was the most used intervention. There was one perioperative mortality and 5 postoperative morbidities. The mean of postoperative hospital stay was 14 days (range 4-60 days). Six patients required a second operation during the follow-up period. The incidence of emergency surgery for Crohn's disease in our experience was high (17/38 patients), and is not as rare as the published estimates

  7. Factors affecting mortality in emergency surgery in cases of complicated colorectal cancer.

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    Kızıltan, Remzi; Yılmaz, Özkan; Aras, Abbas; Çelik, Sebahattin; Kotan, Çetin

    2016-02-01

    To evaluate retrospectively demographic, clinical and histopathological variables effective on mortality in patients who had undergone emergency surgery due to complicated colorectal cancer. A total of 39 patients underwent urgent surgical interventions due to complicated colorectal cancer at the Department of General Surgery, Dursun Odabaş Medical Center, between January 2010 and January 2015. Thirty three of these were included in the study. Six patients were excluded because complete medical records had been missing. Medical records of the 33 cases were retrospectively reviewed. There were 14 (42.5%) male and 19 (57.5%) female patients. Mean age was 60 years (range: 32- 83 years); 14 (42.5%) patients were less than 60 years old , while 19 (57.5%) were 60 years old or older. Operations were performed due to perforation (39.3%) and obstruction (60.6%) in 13 and 20 patients, respectively. Tumor localization was in the right and transverse colon in nine (21.2%) and in the left colon in 24 cases (72.7%). Eleven (33.3%) patients underwent resection and anastomosis, 13 (39.3%) resection and ostomy, and nine (27.2%) patients underwent ostomy alone without any resection. Postoperative mortality occurred in nine cases (27.2%). High mortality should be expected in females older than 60 years with a left sided colon tumor or with another synchronous tumor and in perforated tumors. Unnecessary major resections should be avoided and primary pathology should be in the focus of treatment in order to decrease the mortality and morbidity rates. Copyright© by the Medical Assotiation of Zenica-Doboj Canton.

  8. Factors affecting mortality in emergency surgery in cases of complicated colorectal cancer

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    Remzi Kızıltan

    2016-02-01

    Full Text Available Aim To evaluate retrospectively demographic, clinical and histopathological variables effective on mortality in patients who had undergone emergency surgery due to complicated colorectal cancer. Methods A total of 39 patients underwent urgent surgical interventions due to complicated colorectal cancer at the Department of General Surgery, Dursun Odabaş Medical Center, between January 2010 and January 2015. Thirty three of these were included in the study. Six patients were excluded because complete medical records had been missing. Medical records of the 33 cases were retrospectively reviewed. Results There were 14 (42.5% male and 19 (57.5% female patients. Mean age was 60 years (range: 32- 83 years; 14 (42.5% patients were less than 60 years old , while 19 (57.5% were 60 years old or older. Operations were performed due to perforation (39.3% and obstruction (60.6% in 13 and 20 patients, respectively. Tumor localization was in the right and transverse colon in nine (21.2% and in the left colon in 24 cases (72.7%. Eleven (33.3% patients underwent resection and anastomosis, 13 (39.3% resection and ostomy, and nine (27.2% patients underwent ostomy alone without any resection. Postoperative mortality occurred in nine cases (27.2%. Conclusions High mortality should be expected in females older than 60 years with a left sided colon tumor or with another synchronous tumor and in perforated tumors. Unnecessary major resections should be avoided and primary pathology should be in the focus of treatment in order to decrease the mortality and morbidity rates.

  9. Analysis of 230 cases of emergent surgery for obstructing colon cancer--lessons learned.

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    Aslar, Ahmet Kessaf; Ozdemir, Süleyman; Mahmoudi, Hatim; Kuzu, Mehmet Ayhan

    2011-01-01

    We aimed to identify prognostic factors affecting clinical outcomes in emergent primary resection. A retrospective analysis of prospectively acquired data of 230 consecutive emergent patients between August 1994 and January 2005 were evaluated in this study. Sixty-nine patients applied with right colon obstruction and 161 patients with left. Resection and primary anastomosis was carried out in 128 patients and resection and stoma in 102 patients. The patients were divided into two cohorts: patients who developed poor outcome within 30 days after surgery and those who did not. Major morbidity or mortality were reported in 60 (26.1%) patients. Analysis revealed that the most important prognostic factors for poor outcome were American Anesthesiology Association (ASA) grade ≥3, Acute Physiology and Chronic Health Evaluation II (APACHE II) score ≥11, age >60 years, presence of peritonitis, and surgery during on-call hours. Age >60 years and on-call surgery were determinant factors in right-sided obstructions, whereas ASA grade ≥3, APACHE II score ≥11, and presence of peritonitis were determinant factors in left-sided obstructions. All these factors but the timing of the operation emphasize the pivotal role of the patient's physiological condition on admission. Accurate preoperative evaluation might predict the clinical outcome and help in establishing the most appropriate treatment.

  10. FREE ANTEROLATERAL FEMORAL FLAP IS THE FIRST CHOICE IN EMERGENCY RECONSTRUCTIVE SURGERY OF THE LOWER LIMB (ANALYSIS OF CLINICAL CASES

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    A. V. Nevedrov

    2015-01-01

    Full Text Available BACKGROUND. Requirements for the graft used in microsurgery are simple retrieval, minimal anatomic variability, the possibility to operate on one surgical area, great length and diameter of flap vessels.PURPOSE OF STUDY. Evaluation of the results and advantages of revascularized free anterolateral muscle flap usage in emergency surgery.MATERIALS AND METHODS. Free muscle flap of the lateral vastus muscle on a vascular pedicle of the descending branch of the lateral femoral circumflex artery (anterolateral flap was used to replace the defect in 2 patients. In one case, a patient had open fractures of the lower leg, complicated with primary defects of soft tissue, and in the other case a patient had incomplete traumatic amputation of the left foot. All the victims underwent soft tissue defects restoration within the first hours after the injury, next to fixation of the fracture.RESULTS. All grafts have completely healed, total necrosis of muscle flaps hasn’t been observed. All patients had primary wound healing after the transfer. Cases of deep purulent infection after the surgery haven’t been noted.CONCLUSION. The transfer of a free anterolateral muscle flap is the best method for emergency plastic and reconstructive surgery of the lower limbs. The advantages are simple and prompt retreival, no need to turn the patient to the lateral position, large amount of the flap, great length and caliber of vessels. 

  11. A rare case of small bowel volvulus after jenjunoileal bariatric bypass requiring emergency surgery: a case report

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    Patel Pranav H

    2012-03-01

    Full Text Available Abstract Introduction Bariatric surgery is on the increase throughout the world. Jejunoileal bypass bariatric procedures have fallen out of favor in western surgical centers due to the high rate of associated complications. They are, however, performed routinely in other centers and as a consequence of health tourism, management of complications related to these procedures may still be encountered. Case presentation We describe a rare case of small bowel obstruction in a 45-year-old British Caucasian woman, secondary to a volvulus of the jejunoileal anastomosis following bariatric bypass surgery. The pre-operative diagnosis was confirmed by radiology. We describe a successful surgical technique for this rare complication. Conclusions Bariatric surgery may be complicated by bowel obstruction. Early imaging is vital for diagnosis and effective management. The use of our surgical technique provides a simple and effective approach for the successful management of this bariatric complication.

  12. The incidence of emergence delirium and risk factors following sevoflurane use in pediatric patients for day case surgery, Kingston, Jamaica

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    Rachel Gooden

    2014-12-01

    Full Text Available Background and objectives: Emergence delirium is a distressing complication of the use of sevoflurane for general anesthesia. This study sought to determine the incidence of emergence delirium and risk factors in patients at a specialist pediatric hospital in Kingston, Jamaica. Methods: This was a cross-sectional, observational study including pediatric patients aged 3-10 years, ASA I and II, undergoing general anesthesia with sevoflurane for elective day-case procedures. Data collected included patients' level of anxiety pre-operatively using the modified Yale Preoperative Anxiety Scale, surgery performed, anesthetic duration and analgesics administered. Postoperatively, patients were assessed for emergence delirium, defined as agitation with non-purposeful movement, restlessness or thrashing; inconsolability and unresponsiveness to nursing and/or parental presence. The need for pharmacological treatment and post-operative complications related to emergence delirium episodes were also noted. Results: One hundred and forty-five (145 children were included, with emergence delirium occurring in 28 (19.3%. Emergence delirium episodes had a mean duration of 6.9±7.8 min, required pharmacologic intervention in 19 (67.8% children and were associated with a prolonged recovery time (49.4±11.9 versus 29.7± 10.8 min for non-agitated children; p<0.001. Factors positively associated with emergence delirium included younger age (p = 0.01, OR 3.3, 95% CI 1.2-8.6 and moderate and severe anxiety prior to induction (p <0.001, OR 5.6, 95% CI 2.3-13.0. Complications of emergence delirium included intravenous line removal (n = 1, and surgical site bleeding (n = 3. Conclusion: Children of younger age with greater preoperative anxiety are at increased risk of developing emergence delirium following general anesthesia with sevoflurane. The overall incidence of emergence delirium was 19%.

  13. [Emergency Surgery and Treatments for Pneumothorax].

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    Kurihara, Masatoshi

    2015-07-01

    The primary care in terms of emergency for pneumothorax is chest drainage in almost cases. The following cases of pneumothorax and the complications need something of surgery and treatments. Pneumothorax with subcutaneous emphysema often needs small skin incisions around the drainage tube. Tension pneumothorax often needs urgent chest drainage. Pneumothorax with intractable air leakage often needs interventional treatments like endobroncheal occlusion (EBO) or thoracographic fibrin glue sealing method (TGF) as well as urgent thoracoscopic surgery. Pneumothorax with acute empyema also often needs urgent thoracoscopic surgery within 2 weeks if chest drainage or drug therapy are unsuccessful. It will probably become chronic empyema of thorax after then. Pneumothorax with bleeding needs urgent thoracoscopic surgery in case of continuous bleeding over 200 ml/2 hours. In any cases of emergency for pneumothorax, respiratory physicians should collaborate with respiratory surgeons at the 1st stage because it is important to timely judge conversion of surgical treatments from medical treatments.

  14. Emergency Surgery in a Patient with Scleroderma - Anaesthetic Challenges: A Case Report

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    Teena Bansal

    2013-06-01

    Full Text Available Scleroderma (progressive systemic sclerosis is a multisystem disease involving the skin, airway, musculoskeletal, gastrointestinal, pulmonary, renal and cardiac systems that can pose a significant challenge for the anaesthetist. The multisystem involvement of scleroderma can impact on every aspect of anaesthetic care especially airway management. There are no specific contraindications to the use of any type of anaesthesia, although the selection must be guided by identification of organ dysfunction. The anaesthetist must be aware of the organs involved, the severity of the disease and the associated anaesthetic considerations and potential risks in order to safely & skilfully manage the patient with scleroderma. We hereby present a case report of a patient with scleroderma for emergency orbital decompression because of orbital cellulitis.

  15. Emerging technologies in surgery

    International Nuclear Information System (INIS)

    Satava, R.M.; Gaspari, A.; Di Lorenzo, N.

    2007-01-01

    Tremendous acceleration and changes in scientific discovery and progress are presently occurring. These important emerging technologies that will affect the practicing surgeon within the next 10 to 20 years are illustrated in detail in this volume. Its purpose is not to review clinical experience of the common surgical practice of the past decade, but to outline and illustrate the future trends. International experts in this field demonstrate emerging procedures and significant advances. (orig.)

  16. Emergency Surgery for Refractory Status Epilepticus.

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    Botre, Abhijeet; Udani, Vrajesh; Desai, Neelu; Jagadish, Spoorthy; Sankhe, Milind

    2017-08-15

    Management of refractory status epilepticus in children is extremely challenging. Two children with medically refractory status epilepticus, both of whom had lesional pathology on MRI and concordant data on EEG and PET scan. Emergency hemispherotomy performed in both patients. A complete, sustained seizure freedom obtained postoperatively. Emergency surgery is a treatment option in selected cases of drug refractory status epilepticus with lesional pathology and concordant data.

  17. [A case of emergency surgery in a patient with bronchial asthma under continuous spinal anesthesia].

    Science.gov (United States)

    Noda, Keiichi; Ryo, Kenshu; Nakamoto, Ai

    2003-10-01

    A 78-year-old male, observed for bronchial asthma, underwent two emergency operations within eight days. The first operation was performed under general anesthesia with tracheal intubation. Anesthesia was maintained by sevoflurane-oxygen and continuous infusion of propofol in combination with epidural injection of lidocaine. During the operation, respiratory sound was almost clear. But wheezing occurred as he awoke after discontinuation of the anesthetics. He needed ventilatory support for three days for status asthmatics. The second operation was performed under continuous spinal anesthesia using hypobaric tetracaine and hyperbaric bupivacaine. No ventilatory support was necessary after the operation and he was discharged uneventfully.

  18. Critical differences between elective and emergency surgery: identifying domains for quality improvement in emergency general surgery.

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    Columbus, Alexandra B; Morris, Megan A; Lilley, Elizabeth J; Harlow, Alyssa F; Haider, Adil H; Salim, Ali; Havens, Joaquim M

    2018-04-01

    The objective of our study was to characterize providers' impressions of factors contributing to disproportionate rates of morbidity and mortality in emergency general surgery to identify targets for care quality improvement. Emergency general surgery is characterized by a high-cost burden and disproportionate morbidity and mortality. Factors contributing to these observed disparities are not comprehensively understood and targets for quality improvement have not been formally developed. Using a grounded theory approach, emergency general surgery providers were recruited through purposive-criterion-based sampling to participate in semi-structured interviews and focus groups. Participants were asked to identify contributors to emergency general surgery outcomes, to define effective care for EGS patients, and to describe operating room team structure. Interviews were performed to thematic saturation. Transcripts were iteratively coded and analyzed within and across cases to identify emergent themes. Member checking was performed to establish credibility of the findings. A total of 40 participants from 5 academic hospitals participated in either individual interviews (n = 25 [9 anesthesia, 12 surgery, 4 nursing]) or focus groups (n = 2 [15 nursing]). Emergency general surgery was characterized by an exceptionally high level of variability, which can be subcategorized as patient-variability (acute physiology and comorbidities) and system-variability (operating room resources and workforce). Multidisciplinary communication is identified as a modifier to variability in emergency general surgery; however, nursing is often left out of early communication exchanges. Critical variability in emergency general surgery may impact outcomes. Patient-variability and system-variability, with focus on multidisciplinary communication, represent potential domains for quality improvement in this field. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Emergency general surgery in the geriatric patient.

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    Desserud, K F; Veen, T; Søreide, K

    2016-01-01

    Emergency general surgery in the elderly is a particular challenge to the surgeon in charge of their care. The aim was to review contemporary aspects of managing elderly patients needing emergency general surgery and possible alterations to their pathways of care. This was a narrative review based on a PubMed/MEDLINE literature search up until 15 September 2015 for publications relevant to emergency general surgery in the geriatric patient. The number of patients presenting as an emergency with a general surgical condition increases with age. Up to one-quarter of all emergency admissions to hospital may be for general surgical conditions. Elderly patients are a particular challenge owing to added co-morbidity, use of drugs and risk of poor outcome. Frailty is an important potential risk factor, but difficult to monitor or manage in the emergency setting. Risk scores are not available universally. Outcomes are usually severalfold worse than after elective surgery, in terms of both higher morbidity and increased mortality. A care bundle including early diagnosis, resuscitation and organ system monitoring may benefit the elderly in particular. Communication with the patient and relatives throughout the care pathway is essential, as indications for surgery, level of care and likely outcomes may evolve. Ethical issues should also be addressed at every step on the pathway of care. Emergency general surgery in the geriatric patient needs a tailored approach to improve outcomes and avoid futile care. Although some high-quality studies exist in related fields, the overall evidence base informing perioperative acute care for the elderly remains limited. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

  20. Emergency thoracic surgery in elderly patients

    OpenAIRE

    Limmer, Stefan; Unger, Lena; Czymek, Ralf; Kujath, Peter; Hoffmann, Martin

    2011-01-01

    Objectives Emergency thoracic surgery in the elderly represents an extreme situation for both the surgeon and patient. The lack of an adequate patient history as well as the inability to optimize any co-morbidities, which are the result of the emergent situation, are the cause of increased morbidity and mortality. We evaluated the outcome and prognostic factors for this selected group of patients. Design Retrospective chart review. Setting Academic tertiary care referral center. Participants ...

  1. Understanding the "Weekend Effect" for Emergency General Surgery.

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    Hoehn, Richard S; Go, Derek E; Dhar, Vikrom K; Kim, Young; Hanseman, Dennis J; Wima, Koffi; Shah, Shimul A

    2018-02-01

    Several studies have identified a "weekend effect" for surgical outcomes, but definitions vary and the cause is unclear. Our aim was to better characterize the weekend effect for emergency general surgery using mortality as a primary endpoint. Using data from the University HealthSystem Consortium from 2009 to 2013, we identified urgent/emergent hospital admissions for seven procedures representing 80% of the national burden of emergency general surgery. Patient characteristics and surgical outcomes were compared between cases that were performed on weekdays vs weekends. Hospitals varied widely in the proportion of procedures performed on the weekend. Of the procedures examined, four had higher mortality for weekend cases (laparotomy, lysis of adhesions, partial colectomy, and small bowel resection; p < 0.01), while three did not (appendectomy, cholecystectomy, and peptic ulcer disease repair). Among the four procedures with increased weekend mortality, patients undergoing weekend procedures also had increased severity of illness and shorter time from admission to surgery (p < 0.01). Multivariate analysis adjusting for patient characteristics demonstrated independently higher mortality on weekends for these same four procedures (p < 0.01). For the first time, we have identified specific emergency general surgery procedures that incur higher mortality when performed on weekends. This may be due to acute changes in patient status that require weekend surgery or indications for urgent procedures (ischemia, obstruction) compared to those without a weekend mortality difference (infection). Hospitals that perform weekend surgery must acknowledge and identify ways to manage this increased risk.

  2. Emergency thoracic surgery in elderly patients

    Science.gov (United States)

    Limmer, Stefan; Unger, Lena; Czymek, Ralf; Kujath, Peter; Hoffmann, Martin

    2011-01-01

    Objectives Emergency thoracic surgery in the elderly represents an extreme situation for both the surgeon and patient. The lack of an adequate patient history as well as the inability to optimize any co-morbidities, which are the result of the emergent situation, are the cause of increased morbidity and mortality. We evaluated the outcome and prognostic factors for this selected group of patients. Design Retrospective chart review. Setting Academic tertiary care referral center. Participants Emergency patients treated at the Department of Thoracic Surgery, University Hospital of Luebeck, Germany. Main outcome measures Co-morbidities, mortality, risk factors and hospital length of stay. Results A total of 124 thoracic procedures were performed on 114 patients. There were 79 men and 36 women (average age 72.5 ±6.4 years, range 65–94). The overall operative mortality was 25.4%. The most frequent indication was thoracic/mediastinal infection, followed by peri- or postoperative thoracic complications. Risk factors for hospital mortality were a high ASA score, pre-existing diabetes mellitus and renal insufficiency. Conclusions Our study documents a perioperative mortality rate of 25% in patients over 65 who required emergency thoracic surgery. The main indication for a surgical intervention was sepsis with a thoracic/mediastinal focus. Co-morbidities and the resulting perioperative complications were found to have a significant effect on both inpatient length of stay and outcome. Long-term systemic co-morbidities such as diabetes mellitus are difficult to equalize with respect to certain organ dysfunctions and significantly increase mortality. PMID:21369531

  3. Macula-Sparing rhegmatogenous retinal detachment: Is emergent surgery necessary?

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    Sasan Mahmoudi

    2016-01-01

    Full Text Available The status of the macula is a significant factor in determining final visual outcomes in rhegmatogenous retinal detachment (RRD and should be considered in the timing of surgical repair. Several studies have shown that macula-involving RRDs attain similar visual and anatomic outcomes when surgery is performed within seven days as compared to emergent surgery (within 24 hours. In contrast, surgery prior to macular detachment in macula-sparing RRDs generally yields the best visual outcomes. In the case of macula-sparing RRDs, it is not clear how long the macula may remain attached, therefore, standard practice dictates emergent surgery. Timing of presentation, examination findings, case complexity, co-existing medical conditions, surgeon expertise, and timing and quality of access to operating facilities and staff, however, should all be considered in determining whether a macula-sparing RRD requires immediate intervention or if equivalent visual and possibly better overall outcomes can be achieved with scheduled surgery within an appropriate time frame.

  4. Improving outcomes of emergency bowel surgery using nela model

    International Nuclear Information System (INIS)

    Sultan, R.; Zafar, H.

    2018-01-01

    To find outcomes of emergency bowel surgery and review the processes involved in the care of these patients on the same template used in National Emergency Laparotomy Audit (NELA). Study Design:An audit. Place and Duration of Study:Surgery Department, The Aga Khan University Hospital, Karachi, from December 2013 to November 2014. Methodology:Patients undergone emergency bowel surgery during the review period were included. Demographic data, type of admission, ASA grade, urgency of surgery, P-POSSUM score, indication of surgery, length of stay and outcome was recorded. Data was then compared with the data published by NELA team in their first report. P-value for categorical variables was calculated using Chi-square tests. Results:Although the patients were younger with nearly same spectrum of disease, the mortality rate was significantly more than reported in NELA (24% versus 11%, p=0.004). Comparison showed that care at AKUH was significantly lacking in terms of proper preoperative risk assessment and documentation, case booking to operating room timing, intraoperative goal directed fluid therapy using cardiac output monitoring, postoperative intensive care for highest risk patients and review of elderly patients by MCOP specialist. Conclusion:This study helped in understanding the deficiencies in the care of patients undergoing emergency bowel surgery and alarmingly poor outcomes in a very systematic manner. In view of results of this study, it is planned to do interventions in the deficient areas to improve care given to these patients and their outcomes with the limited resources of a developing country. (author)

  5. Interhospital transfer delays emergency abdominal surgery and prolongs stay.

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    Limmer, Alexandra M; Edye, Michael B

    2017-11-01

    Interhospital transfer of patients requiring emergency surgery is common practice. It has the potential to delay surgical intervention, increase rate of complications and thus length of hospital stay. A retrospective cohort study was conducted of adult patients who underwent emergency surgery for abdominal pain at a large metropolitan hospital in New South Wales (Hospital A) in 2013. The impact of interhospital transfer on time to surgical intervention, post-operative length of stay and overall length of stay was assessed. Of the 910 adult patients who underwent emergency surgery for abdominal pain at Hospital A in 2013, 31.9% (n = 290) were transferred by road ambulance from a local district hospital (Hospital B). The leading surgical procedures performed were appendicectomy (n = 299, 32.9%), cholecystectomy (n = 174, 19.1%), gastrointestinal endoscopy (n = 95, 10.4%), cystoscopy (n = 86, 9.5%), hernia repair (n = 45, 4.9%), salpingectomy (n = 19, 2.1%) and oversewing of perforated peptic ulcer (n = 13, 1.4%). Overall, interhospital transfer (n = 290, 31.9%) was associated with increases in mean time to surgical intervention (14.2 h, P < 0.001), post-operative length of stay (1.1 days, P = 0.001) and overall length of stay (1.6 days, P < 0.001). Delayed surgical intervention was observed across all procedure types except surgery for perforated peptic ulcer, where transferred patients underwent surgery within a comparable timeframe to direct admissions. Interhospital transfer delays surgical intervention and increases length of hospital stay. This mandates attention due to the implications for patient outcomes and added burden to the healthcare system. The system did, however, show capability to appropriately expedite surgery for acutely life-threatening cases. © 2016 Royal Australasian College of Surgeons.

  6. Enhanced Recovery after Emergency Surgery: A Systematic Review.

    Science.gov (United States)

    Paduraru, Mihai; Ponchietti, Luca; Casas, Isidro Martinez; Svenningsen, Peter; Zago, Mauro

    2017-04-01

    To evaluate the current scientific evidence for the applicability, safety and effectiveness of pathways of enhanced recovery after emergency surgery (ERAS). We undertook a search using PubMed and Cochrane databases for ERAS protocols in emergency cases. The search generated 65 titles; after eliminating the papers not meeting search criteria, we selected 4 cohort studies and 1 randomized clinical trial (RCT). Data extracted for analysis consisted of: patient age, type of surgery performed, ERAS elements implemented, surgical outcomes in terms of postoperative complications, mortality, length of stay (LOS) and readmission rate. The number of ERAS items applied was good, ranging from 11 to 18 of the 20 recommended by the ERAS Society. The implementation resulted in fewer postoperative complications. LOS for ES patients was shorter when compared to conventional care. Mortality, specifically reported in three studies, was equal or lower with ERAS. Readmission rates varied widely and were generally higher for the intervention group but without statistical significance. The studies reviewed agreed that ERAS in emergency surgery (ES) was feasible and safe with generally better outcomes. Lower compliance with some of the ERAS items shows the need for the protocol to be adapted to ES patients. More evidence is clearly required as to what can improve outcomes and how this can be formulated into an effective care pathway for the heterogeneous ES patient.

  7. Current status and future options for trauma and emergency surgery in Turkey.

    Science.gov (United States)

    Taviloğlu, Korhan; Ertekin, Cemalettin

    2008-01-01

    The number of trauma victims in Turkey is expected to increase as a consequence of the increasing vehicular traffic, potential for earthquakes, and risk of terrorist attacks. The Turkish Association for Trauma and Emergency Surgery monitors trauma cases, publishes a quarterly journal, organizes trauma courses and seminars for various health personnel nationwide. It is also extending efforts to improve in-hospital care by establishing trauma and emergency surgery fellowships and trauma and emergency surgery centers nationwide, which is run by General Surgeons currently. Turkey faces the same dilemma as the rest of the developed world regarding the future of trauma surgeons in the current era of nonoperative trauma management. We suggest that the field of trauma and emergency surgery be redefined to include emergency general surgery and cavitary trauma.

  8. The ongoing emergence of robotics in plastic and reconstructive surgery.

    Science.gov (United States)

    Struk, S; Qassemyar, Q; Leymarie, N; Honart, J-F; Alkhashnam, H; De Fremicourt, K; Conversano, A; Schaff, J-B; Rimareix, F; Kolb, F; Sarfati, B

    2018-04-01

    Robot-assisted surgery is more and more widely used in urology, general surgery and gynecological surgery. The interest of robotics in plastic and reconstructive surgery, a discipline that operates primarily on surfaces, has yet to be conclusively proved. However, the initial applications of robotic surgery in plastic and reconstructive surgery have been emerging in a number of fields including transoral reconstruction of posterior oropharyngeal defects, nipple-sparing mastectomy with immediate breast reconstruction, microsurgery, muscle harvesting for pelvic reconstruction and coverage of the scalp or the extremities. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  9. Enhanced Recovery After Surgery (ERAS) - The Evidence in Geriatric Emergency Surgery

    DEFF Research Database (Denmark)

    Paduraru, Mihai; Ponchietti, Luca; Casas, Isidro Martinez

    2017-01-01

    Background: Geriatric surgery is rising and projected to continue at a greater rate. There is already concern about the poor outcomes for the emergency surgery in elderly. How to manage the available resources to improve outcomes in this group of patients is an important object of debate...... to conventional care. Emergency surgical patients also had fewer postoperative complications with ERAS compared to conventional care. Hospital stay was reduced in 2 out of 3 studies for emergency surgery.Conclusions:ERAS can be safely applied to elderly and emergency patients with a reduction in postoperative....... OBJECTIVES: We aimed to determine the feasibility and safety of applying ERAS pathways to emergency elderly surgical patients. METHOD: Two searches were undertaken for ERAS protocols in elderly patients and emergency surgery, in order to gather evidence in relation to ERAS in geriatric emergency patients...

  10. Does the emergency surgery score accurately predict outcomes in emergent laparotomies?

    Science.gov (United States)

    Peponis, Thomas; Bohnen, Jordan D; Sangji, Naveen F; Nandan, Anirudh R; Han, Kelsey; Lee, Jarone; Yeh, D Dante; de Moya, Marc A; Velmahos, George C; Chang, David C; Kaafarani, Haytham M A

    2017-08-01

    The emergency surgery score is a mortality-risk calculator for emergency general operation patients. We sought to examine whether the emergency surgery score predicts 30-day morbidity and mortality in a high-risk group of patients undergoing emergent laparotomy. Using the 2011-2012 American College of Surgeons National Surgical Quality Improvement Program database, we identified all patients who underwent emergent laparotomy using (1) the American College of Surgeons National Surgical Quality Improvement Program definition of "emergent," and (2) all Current Procedural Terminology codes denoting a laparotomy, excluding aortic aneurysm rupture. Multivariable logistic regression analyses were performed to measure the correlation (c-statistic) between the emergency surgery score and (1) 30-day mortality, and (2) 30-day morbidity after emergent laparotomy. As sensitivity analyses, the correlation between the emergency surgery score and 30-day mortality was also evaluated in prespecified subgroups based on Current Procedural Terminology codes. A total of 26,410 emergent laparotomy patients were included. Thirty-day mortality and morbidity were 10.2% and 43.8%, respectively. The emergency surgery score correlated well with mortality (c-statistic = 0.84); scores of 1, 11, and 22 correlated with mortalities of 0.4%, 39%, and 100%, respectively. Similarly, the emergency surgery score correlated well with morbidity (c-statistic = 0.74); scores of 0, 7, and 11 correlated with complication rates of 13%, 58%, and 79%, respectively. The morbidity rates plateaued for scores higher than 11. Sensitivity analyses demonstrated that the emergency surgery score effectively predicts mortality in patients undergoing emergent (1) splenic, (2) gastroduodenal, (3) intestinal, (4) hepatobiliary, or (5) incarcerated ventral hernia operation. The emergency surgery score accurately predicts outcomes in all types of emergent laparotomy patients and may prove valuable as a bedside decision

  11. Management of novel oral anticoagulants in emergency and trauma surgery.

    Science.gov (United States)

    Pinho-Gomes, Ana-Catarina; Hague, Adam; Ghosh, Jonathan

    2016-08-01

    The compelling safety, efficacy and predictable effect of novel oral anticoagulants (NOACs) is driving a rapid expansion in their therapeutic indications. Management of the increasing number of patients on those new agents in the setting of emergency or trauma surgery can be challenging and the absence of specific reversal agents has been a matter of concern. This review summarises the key principles that underpin the management of those patients with a particular emphasis on the recent development of specific antidotes. As of 2015, a new line of antidotes, specific for these drugs, are at different stages of their development with their release imminent. However, as NOACs are innately reversible due to their short half-life, the use of reversal agents will probably be restricted to a few exceptional cases. Post-marketing surveillance will be paramount to better clarify the role of these promising drugs. Management of patients on NOACs in the context of emergency or trauma surgery relies on best supportive care in combination with the blood products and/or specific antidotes as required. Familiarity with the new reversal agents is essential but further evidence on their indications, safety and efficacy as well as consensus guidelines are warranted prior to widespread adoption. Copyright © 2016 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  12. Management of Complications Following Emergency and Elective Surgery for Diverticulitis.

    Science.gov (United States)

    Holmer, Christoph; Kreis, Martin E

    2015-04-01

    The clinical spectrum of sigmoid diverticulitis (SD) varies from asymptomatic diverticulosis to symptomatic disease with potentially fatal complications. Sigmoid colectomy with restoration of continuity has been the prevailing modality for treating acute and recurrent SD, and is often performed as a laparoscopy-assisted procedure. For elective sigmoid colectomy, the postoperative morbidity rate is 15-20% whereas morbidity rates reach up to 30% in patients who undergo emergency surgery for perforated SD. Some of the more common and serious surgical complications after sigmoid colectomy are anastomotic leaks and peritonitis, wound infections, small bowel obstruction, postoperative bleeding, and injuries to the urinary tract structures. Regarding the management of complications, it makes no difference whether the complication is a result of an emergency or an elective procedure. The present work gives an overview of the management of complications in the surgical treatment of SD based on the current literature. To achieve successful management, early diagnosis is mandatory in cases of deviation from the normal postoperative course. If diagnostic procedures fail to deliver a correlate for the clinical situation of the patient, re-laparotomy or re-laparoscopy still remain among the most important diagnostic and/or therapeutic principles in visceral surgery when a patient's clinical status deteriorates. The ability to recognize and successfully manage complications is a crucial part of the surgical treatment of diverticular disease and should be mastered by any surgeon qualified in this field.

  13. Changing trend in emergency surgery for perforated duodenal ulcer

    International Nuclear Information System (INIS)

    Gurteyik, E.

    2003-01-01

    Objective: To evaluate changes in the emergency surgery of the duodenal ulcer. Subjects and Methods: Hospital records of 523 surgically treated patients, with duodenal ulcer perforation, during the period of 25 years 91975-1999) in the same surgical department, was retrospectively analysed. Changing aspects of emergency surgery of peptic ulcer disease, in the recent period, were determined in respect to number of operations per year and in the choice of operative methods. Results: The average number of patients and emergency operations per year was 21. No significant change was observed during the study period. Elective operations gradually decreased in the last ten years, and none was performed in the last 4 years. On the other hand, 226 emergency interventions for duodenal ulcer perforation were performed in the last ten years and 84 interventions in the last 4 years. Definitive anti-ulcer surgery was performed in 42% of patients between 1985 and 1994. Simple closure of the perforation plus treatment with proton pump inhibitors and with anti-Helicobacter pylori medication was the method in 80% during the last year. Conclusion: Emergency surgery for perforated duodenal ulcer preserves its steady rate despite disappearance of elective operations after tremendous progress in medical control of peptic ulcer disease. There is an obvious return from definitive anti-ulcer surgery to simple closure of the perforation followed by antisecretory and antibacterial medications in the recent years. (author)

  14. Emergency abdominal surgery in Zaria, Nigeria

    African Journals Online (AJOL)

    high rate of emergency operations could be due to the large number of trauma ... of sanitation, which may trigger lymphoid tissue reaction in the appendix wall and .... future surgical training and help surgeons who practise in our setting to ...

  15. Day case surgery in Nigeria

    African Journals Online (AJOL)

    practice in Nigeria and how it conforms to ideal practice elsewhere. ... has been an established practice of the pediatric surgery unit of a teaching hospital in South Western Nigeria, for at least two .... and safe anesthetic conditions for surgical procedures, with ..... compete for time and ward space with more major elective.

  16. Epidemiological approach to emergent cranial surgery of cranial traumas

    Directory of Open Access Journals (Sweden)

    Hülagü Kaptan

    2008-03-01

    Full Text Available

    Objective: In this study, we aim to define the emergent cranial surgery of cranial trauma cases in terms of the reason of occurance, diagnosis, prognostic factors and results. Methods: 153 cases hospitalized in our clinic during a four year period were statistically analysed in accordance with trauma etiology, age, gender, application GCS (Glascow Coma Score mortality rate, location and established patology.

    Results: 76% (116 of the 153 cases were male. The most frequent etiological reasons were, in descending order, traffic accident 52% (n = 80, fall 34% (n = 53, direct trauma to the head 14(n =20. 45% (n = 69 were diagnosed epidural haematomas, 26% (n = 40 were diagnosed depression fractures and 3% (n = 5 were diagnosed intracerebral haematomas. A meaningful statistical difference was found in the comparison of the diagnosis regarding gender (p=0,012 age group (p=0,0282 and GCS (p=0,0001.

    Conclusions: In order to prevent cranial traumas, studies aimed at minimizing traffic accidents should be undertaken. The most essential action after the accident has occured is triage, and this is of great importance in order to establish communication among the health institutions.

  17. Outcomes following major emergency gastric surgery: the importance of specialist surgeons.

    Science.gov (United States)

    Khan, O A; McGlone, E R; Mercer, S J; Somers, S S; Toh, S K C

    2015-01-01

    The increasing subspecialisation of general surgeons in their elective work may result in problems for the provision of expert care for emergency cases. There is very little evidence of the impact of subspecialism on outcomes following emergency major upper gastrointestinal surgery. This prospective study investigated whether elective subspecialism of general surgeon is associated with a difference in outcome following major emergency gastric surgery. Between February 1994 and June 2010, the data from all emergency major gastric procedures (defined as patients who underwent laparotomy within 12 hours of referral to the surgical service for bleeding gastroduodenal ulcer and/or undergoing major gastric resection) was prospectively recorded. The sub-specialty interest of operating surgeon was noted and related to post-operative outcomes. Over the study period, a total of 63 major gastric procedures were performed of which 23 (37%) were performed by specialist upper gastrointestinal (UGI) consultants. Surgery performed by a specialist UGI surgeon was associated with a significantly lower surgical complication (4% vs. 28% of cases; p=0.04) and in-patient mortality rate (22% vs. 50%; p=0.03). Major emergency gastric surgery has significantly better clinical outcomes when performed by a specialist UGI surgeon. These results have important implications for provision of an emergency general surgical service. Copyright© Acta Chirurgica Belgica.

  18. Outcome of burr hole surgery in the emergency room for severe acute subdural hematoma

    International Nuclear Information System (INIS)

    Park, Young-Soo; Hironaka, Yasuhiro; Motoyama, Yasushi; Asai, Hideki; Watanabe, Tomoo; Nishio, Kenji; Nakase, Hiroyuki; Okuchi, Kazuo

    2010-01-01

    We have performed burr hole surgery in the emergency room for severe acute subdural hematoma from April 2007 in twenty five patients. All patients were deep comatose and showed cerebral herniation sign with bilateral pupillary abnormalities. Burr hole surgeries were performed as soon as possible after CT evaluation. Continually decomporresive craiectomies were followed if clinical improvements were achieved and mild baribiturate-moderate hypothermia combined (MB-MH) therapy was induced postoperatively in some cases. The mean average was 65.6 years (range 16-93). The causes of head injuries were traffic accident in 9, fall down in 13 and unknown in 3. The mean Glasgow coma scale (GCS) on admission was 4.4 (range 3-9). The mean time interval from arrival to burr hole surgery was 33.5 minutes (range 21-50 minutes). Decompressive craniectomy was indicated in 14 cases and MB-MH therapy was induced in 13 cases. The overall clinical outcome consisted of good recovery in 3, moderate disability in 2, severe disability in 3, persistent vegetative state in 3 and death in 14. Favorable results can be expected even in patients with serious acute subdural hematoma. Emergent burr hole surgery was effective to decrease intracranial pressure rapidly and to save time. So active burr hole surgery in the emergency room is strongly recommended to all cases of severe acute subdural hematoma. (author)

  19. Improving time to surgery for hip fracture patients. Impact of the introduction of an emergency theatre

    LENUS (Irish Health Repository)

    French-O’Carroll, F

    2017-01-01

    Hip fractures are a major cause of morbidity and mortality1. Surgery performed on the day of or after admission is associated with improved outcome2,3. An audit cycle was performed examining time to surgery for hip fracture patients. Our initial audit identified lack of theatre space as one factor delaying surgery. A dedicated daytime emergency theatre was subsequently opened and a re-audit was performed to assess its impact on time to surgery. Following the opening of the theatre, the proportion of patients with a delay to hip fracture surgery greater than 36 hours was reduced from 49% to 26% with lack of theatre space accounting for 23% (3 of 13) of delayed cases versus 28.6% (9 of 32) previously. 44% of hip fracture surgeries were performed in the emergency theatre during daytime hours, whilst in-hospital mortality rose from 4.6% to 6%. We conclude that access to an emergency theatre during daytime hours reduced inappropriate delays to hip fracture surgery.

  20. Encountering Meckel's diverticulum in emergency surgery for ascaridial intestinal obstruction

    Directory of Open Access Journals (Sweden)

    Amin Abid

    2010-06-01

    Full Text Available Abstract Background Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. In children with intestinal ascariasis, the diverticulum remains asymptomatic or rarely the Ascaris lumbricoides may lead to its complications in the presence of massive intestinal roundworm load. Given that preoperative diagnosis is seldom carried out, when Meckel's diverticulum is found at laparotomy for obstructive intestinal complications of roundworm, the diverticulum should be removed as complications may occur at any time. The aim of this study was to describe the findings of concomitant presence of Meckel's diverticulum who had surgical intervention in symptomatic intestinal ascariasis in children. Methods A retrospective case review study of 14 children who had surgical intervention for symptomatic intestinal ascariasis having the presence of concomitant Meckel's diverticulum was done. The study was done at SMHS Hospital Srinagar, Kashmir. Results A total of the 14 children who had ascaridial intestinal obstruction with concomitant presence of Meckel's diverticulum were studied. Age of children ranged from 4-12 years, male:female ratio was 1.8:1. Nine patients had asymptomatic Meckel's diverticulum, whereas 5 patients with symptomatic signs were found in the course of emergency surgery for ascaridial intestinal obstruction. Conclusion Meckel's diverticulum in intestinal ascariasis may pursue silent course or may be accompanied with complications of the diverticulitis, perforation or the gangrene. Incidental finding of the Meckel's diverticulum in the intestinal ascariasis should have removal.

  1. Increased risk environment for emergency general surgery in the context of regionalization and specialization.

    Science.gov (United States)

    Beecher, S; O'Leary, D P; McLaughlin, R

    2015-09-01

    The pressures on tertiary hospitals with increased volume and complexity related to regionalization and specialization has impacted upon availability of operating theatres with consequent displacement of emergencies to high risk out of hours settings. A retrospective review of an electronic emergency theatre list prospectively maintained database was performed over a two year period. Data gathered included type of operation performed, Time to Theatre (TTT), operation start time and length of stay (LOS). Of 7041 emergency operations 25% were performed out of hours. 2949 patient had general surgical emergency procedures with 910 (30%) performed out of hours. 53% of all emergency laparotomies and 54% of appendicectomies were out of hours. 57% of cases operated on out of hours had been awaiting surgery during the day. Mean TTT was shorter for those admitted at the weekend compared to those admitted during the week (15.6 vs 24.9 h) (p emergency surgery is performed out of hours in a way unfavorable to good clinical outcomes. It is of concern that more than half of the most life threating procedures involving laparotomy, take place out of hours. Regionalization needs to be accompanied by infrastructure planning to accommodate emergency surgery. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  2. Emergency general surgery: definition and estimated burden of disease.

    Science.gov (United States)

    Shafi, Shahid; Aboutanos, Michel B; Agarwal, Suresh; Brown, Carlos V R; Crandall, Marie; Feliciano, David V; Guillamondegui, Oscar; Haider, Adil; Inaba, Kenji; Osler, Turner M; Ross, Steven; Rozycki, Grace S; Tominaga, Gail T

    2013-04-01

    Acute care surgery encompasses trauma, surgical critical care, and emergency general surgery (EGS). While the first two components are well defined, the scope of EGS practice remains unclear. This article describes the work of the American Association for the Surgery of Trauma to define EGS. A total of 621 unique International Classification of Diseases-9th Rev. (ICD-9) diagnosis codes were identified using billing data (calendar year 2011) from seven large academic medical centers that practice EGS. A modified Delphi methodology was used by the American Association for the Surgery of Trauma Committee on Severity Assessment and Patient Outcomes to review these codes and achieve consensus on the definition of primary EGS diagnosis codes. National Inpatient Sample data from 2009 were used to develop a national estimate of EGS burden of disease. Several unique ICD-9 codes were identified as primary EGS diagnoses. These encompass a wide spectrum of general surgery practice, including upper and lower gastrointestinal tract, hepatobiliary and pancreatic disease, soft tissue infections, and hernias. National Inpatient Sample estimates revealed over 4 million inpatient encounters nationally in 2009 for EGS diseases. This article provides the first list of ICD-9 diagnoses codes that define the scope of EGS based on current clinical practices. These findings have wide implications for EGS workforce training, access to care, and research.

  3. Thyroid lymphoma surgery role about five cases

    International Nuclear Information System (INIS)

    Gonzalez, D.; Rodriguez, G.; Plazzotta; Otero, M.; Almeida, E.; Rondan, M.; Balboa, O.

    2003-01-01

    Thyroid lymphoma is a rare occurrence, its clinical presentation resembling that of undifferentiated carcinomas of this site.It is particularly responsive to poli chemotherapy, surgery being reserved for biopsy and urgency decompression of the airway.In the Maciel Hospital of Montevideo there were 5 such cases for the period extending from 1996 through 2001.Three of these had the clinical appearance of a rapidly growing goiter with loco-regional involvement, one of them having suffered respiratory arrest due to obstruction of airway.Diagnosis was arrived at through cytological puncture in three cases, surgical biopsy in one and the fifth was arrived to surgery with diagnosis of medullar carcinoma; consequently conclusive diagnosis was established through the final analysis of operative specimen.In 4 cases treatmen was based on poli chemotherapy with good response, while in the fifth no diagnosis was established either in pre-or intra-operative period and consequently underwent total thyroidectomy

  4. Logistics and outcome in urgent and emergency colorectal surgery

    DEFF Research Database (Denmark)

    Elshove-Bolk, J.; Ellensen, V. S.; Baatrup, G.

    2010-01-01

    died were less likely to be operated by a subspecialized colorectal surgeon (17%. vs 30%, P = 0.001). The anaesthesiologist was a resident in most of the cases (> 75%) for both those who survived and those who died. Surgery performed out-of-office hours was common in both groups, although the patients...

  5. Outcome of Emergency Abdominal Surgery at Kigali University ...

    African Journals Online (AJOL)

    There is little information regarding the clinical spectrum of disease in these patients ... was a case series study of 229 patients who underwent emergency abdominal ... The most common operative findings were peritonitis (41.5%), intestinal ...

  6. Disparities in access to emergency general surgery care in the United States.

    Science.gov (United States)

    Khubchandani, Jasmine A; Shen, Connie; Ayturk, Didem; Kiefe, Catarina I; Santry, Heena P

    2018-02-01

    As fewer surgeons take emergency general surgery call and hospitals decrease emergency services, a crisis in access looms in the United States. We examined national emergency general surgery capacity and county-level determinants of access to emergency general surgery care with special attention to disparities. To identify potential emergency general surgery hospitals, we queried the database of the American Hospital Association for "acute care general hospital," with "surgical services," and "emergency department," and ≥1 "operating room." Internet search and direct contact confirmed emergency general surgery services that covered the emergency room 7 days a week, 24 hours a day. Geographic and population-level emergency general surgery access was derived from Geographic Information Systems and US Census. Of the 6,356 hospitals in the 2013 American Hospital Association database, only 2,811 were emergency general surgery hospitals. Counties with greater percentages of black, Hispanic, uninsured, and low-education individuals and rural counties disproportionately lacked access to emergency general surgery care. For example, counties above the 75th percentile of African American population (10.2%) had >80% odds of not having an emergency general surgery hospital compared with counties below the 25th percentile of African American population (0.6%). Gaps in access to emergency general surgery services exist across the United States, disproportionately affecting underserved, rural communities. Policy initiatives need to increase emergency general surgery capacity nationwide. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Navigation in head and neck oncological surgery: an emerging concept.

    Science.gov (United States)

    Gangloff, P; Mastronicola, R; Cortese, S; Phulpin, B; Sergeant, C; Guillemin, F; Eluecque, H; Perrot, C; Dolivet, G

    2011-01-01

    Navigation surgery, initially applied in rhinology, neurosurgery and orthopaedic cases, has been developed over the last twenty years. Surgery based on computed tomography data has become increasingly important in the head and neck region. The technique for hardware fusion between RMI and computed tomography is also becoming more useful. We use such device since 2006 in head and neck carcinologic situation. Navigation allows control of the resection in order to avoid and protect the precise anatomical structures (vessels and nerves). It also guides biopsy and radiofrequency. Therefore, quality of life is much more increased and morbidity is decreased for these patients who undergo major and mutilating head and neck surgery. Here we report the results of 33 navigation procedures performed for 31 patients in our institution.

  8. Acute care surgery: defining mortality in emergency general surgery in the state of Maryland.

    Science.gov (United States)

    Narayan, Mayur; Tesoriero, Ronald; Bruns, Brandon R; Klyushnenkova, Elena N; Chen, Hegang; Diaz, Jose J

    2015-04-01

    Emergency general surgery (EGS) is a major component of acute care surgery, however, limited data exist on mortality with respect to trauma center (TC) designation. We hypothesized that mortality would be lower for EGS patients treated at a TC vs non-TC (NTC). A retrospective review of the Maryland Health Services Cost Review Commission database from 2009 to 2013 was performed. The American Association for the Surgery of Trauma EGS ICD-9 codes were used to identify EGS patients. Data collected included demographics, TC designation, emergency department admissions, and All Patients Refined Severity of Illness (APR_SOI). Trauma center designation was used as a marker of a formal acute care surgery program. Primary outcomes included in-hospital mortality. Multivariable logistic regression analysis was performed controlling for age. There were 817,942 EGS encounters. Mean ± SD age of patients was 60.1 ± 18.7 years, 46.5% were males; 71.1% of encounters were at NTCs; and 75.8% were emergency department admissions. Overall mortality was 4.05%. Mortality was calculated based on TC designation controlling for age across APR_SOI strata. Multivariable logistic regression analysis did not show statistically significant differences in mortality between hospital levels for minor APR_SOI. For moderate APR_SOI, mortality was significantly lower for TCs compared with NTCs (p surgery patients treated at TCs had lower mortality for moderate APR_SOI, but increased mortality for extreme APR_SOI when compared with NTCs. Additional investigation is required to better evaluate this unexpected finding. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  9. Surgery of the elderly in emergency room mode. Is there a place for laparoscopy?

    Science.gov (United States)

    Michalik, Maciej; Dowgiałło-Wnukiewicz, Natalia; Lech, Paweł; Zacharz, Krzysztof

    2017-06-01

    An important yet difficult problem is qualification for surgery in elderly patients. With age the risk of comorbidities increases - multi-disease syndrome. Elderly patients suffer from frailty syndrome. Many body functions become impaired. All these factors make the elderly patient a major challenge for surgical treatment. Analysis of the possibility of developing the indications and contraindications and the criteria for surgical treatment of the elderly based on our own cases. Discussion whether there is a place for laparoscopy during surgery of the elderly in emergency room (ER) mode. The analysis was performed based on seven cases involving surgical treatment of elderly patients who were admitted to the hospital in emergency room mode. The patients were hospitalized in the General and Minimally Invasive Surgery Clinic in Olsztyn in 2016. Surgical treatment of elderly patients should be planned with multidisciplinary teams. Geriatric surgery centers should be developed to minimize the risk of overzealous treatment and potential complications. Laparoscopy should always be considered in the case of ER procedures or diagnostics. Elderly patients should not be treated as typical adults, but as a separate group of patients requiring special treatment. Due to the existing additional disease in the elderly, the frailty syndrome, any surgical intervention should be minimally invasive. The discussion about therapy should be conducted by a team of specialists from a variety of medical fields.

  10. Increased ICU resource needs for an academic emergency general surgery service*.

    Science.gov (United States)

    Lissauer, Matthew E; Galvagno, Samuel M; Rock, Peter; Narayan, Mayur; Shah, Paulesh; Spencer, Heather; Hong, Caron; Diaz, Jose J

    2014-04-01

    ICU needs of nontrauma emergency general surgery patients are poorly described. This study was designed to compare ICU utilization of emergency general surgery patients admitted to an acute care emergency surgery service with other general surgery patients. Our hypothesis is that tertiary care emergency general surgery patients utilize more ICU resources than other general surgical patients. Retrospective database review. Academic, tertiary care, nontrauma surgical ICU. All patients admitted to the surgical ICU over age 18 between March 2004 and June 2012. None. Six thousand ninety-eight patients were evaluated: 1,053 acute care emergency surgery, 1,964 general surgery, 1,491 transplant surgery, 995 facial surgery/otolaryngology, and 595 neurosurgery. Acute care emergency surgery patients had statistically significantly longer ICU lengths of stay than other groups: acute care emergency surgery (13.5 ± 17.4 d) versus general surgery (8.7 ± 12.9), transplant (7.8 ± 11.6), oral-maxillofacial surgery (5.5 ± 4.2), and neurosurgery (4.47 ± 9.8) (all psurgery patients: acute care emergency surgery 73.4% versus general surgery 64.9%, transplant 63.3%, oral-maxillofacial surgery 58.4%, and neurosurgery 53.1% (all p surgery patients: acute care emergency surgery 10.8% versus general surgery 4.3%, transplant 6.6%, oral-maxillofacial surgery 0%, and neurosurgery 0.5% (all p surgery patients were more likely interhospital transfers for tertiary care services than general surgery or transplant (24.5% vs 15.5% and 8.3% respectively, p surgery (13.7% vs 6.7% and 3.5%, all p surgery and general surgery, whereas transplant had fewer. Emergency general surgery patients have increased ICU needs in terms of length of stay, ventilator usage, and continuous renal replacement therapy usage compared with other services, perhaps due to the higher percentage of transfers and emergent surgery required. These patients represent a distinct population. Understanding their resource needs

  11. Emergency surgery pre-operative delays - realities and economic impacts.

    Science.gov (United States)

    O'Leary, D P; Beecher, S; McLaughlin, R

    2014-12-01

    A key principle of acute surgical service provision is the establishment of a distinct patient flow process and an emergency theatre. Time-to-theatre (TTT) is a key performance indicator of theatre efficiency. The combined impacts of an aging population, increasing demands and complexity associated with centralisation of emergency and oncology services has placed pressure on emergency theatre access. We examined our institution's experience with running a designated emergency theatre for acute surgical patients. A retrospective review of an electronic prospectively maintained database was performed between 1/1/12 and 31/12/13. A cost analysis was conducted to assess the economic impact of delayed TTT, with every 24hr delay incurring the cost of an additional overnight bed. Delays and the economic effects were assessed only after the first 24 h as an in-patient had elapsed. In total, 7041 procedures were performed. Overall mean TTT was 26 h, 2 min. There were significant differences between different age groups, with those aged under 16 year and over 65 having mean TTT at 6 h, 34 min (95% C.I. 0.51-2.15, p 65 years age group had a mean TTT of 23 h, 41 min which was significantly longer than the overall mean TTT Vascular and urological emergencies are significantly disadvantaged in competition with other services for a shared emergency theatre. The economic impact of delayed TTT was calculated at €7,116,000, or €9880/day of additional costs generated from delayed TTT over a 24 month period. One third of patients waited longer than 24 h for emergency surgery, with the elderly disproportionately represented in this group. Aside from the clinical risks of delayed and out of hours surgery, such practices incur significant additional costs. New strategies must be devised to ensure efficient access to emergency theatres, investment in such services is likely to be financially and clinically beneficial. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier

  12. Creation of an emergency surgery service concentrates resident training in general surgical procedures.

    Science.gov (United States)

    Ahmed, Hesham M; Gale, Stephen C; Tinti, Meredith S; Shiroff, Adam M; Macias, Aitor C; Rhodes, Stancie C; Defreese, Marissa A; Gracias, Vicente H

    2012-09-01

    Emergency general surgery (EGS) is increasingly being provided by academic trauma surgeons in an acute care surgery model. Our tertiary care hospital recently changed from a model where all staff surgeons (private, subspecialty academic, and trauma academic) were assigned EGS call to one in which an emergency surgery service (ESS), staffed by academic trauma faculty, cares for all EGS patients. In the previous model, many surgeries were "not covered" by residents because of work-hour restrictions, conflicting needs, or private surgeon preference. The ESS was separate from the trauma service. We hypothesize that by creating a separate ESS, residents can accumulate needed and concentrated operative experience in a well-supervised academic environment. A prospectively accrued EGS database was retrospectively queried for the 18-month period: July 2010 to June 2011. The Accreditation Council for Graduate Medical Education (ACGME) databases were queried for operative numbers for our residency program and for national resident data for 2 years before and after creating the ESS. The ACGME operative requirements were tabulated from online sources. ACGME requirements were compared with surgical cases performed. During the 18-month period, 816 ESS operations were performed. Of these, 307 (38%) were laparoscopy. Laparoscopic cholecystectomy and appendectomy were most common (138 and 145, respectively) plus 24 additional laparoscopic surgeries. Each resident performed, on average, 34 basic laparoscopic cases during their 2-month rotation, which is 56% of their ACGME basic laparoscopic requirement. A diverse mixture of 70 other general surgical operations was recorded for the remaining 509 surgical cases, including reoperative surgery, complex laparoscopy, multispecialty procedures, and seldom-performed operations such as surgery for perforated ulcer disease. Before the ESS, the classes of 2008 and 2009 reported that only 48% and 50% of cases were performed at the main academic

  13. Emergency Backwards Whipple for Bleeding: Formidable and Definitive Surgery

    Directory of Open Access Journals (Sweden)

    Cristian Lupascu

    2017-01-01

    Full Text Available Introduction. During the past decades, the safety of pancreatoduodenectomy has improved, with low mortality and reduced morbidity, particularly in centers with extensive experience. Emergency pancreatoduodenectomy is an uncommon event, for treatment of pancreaticoduodenal trauma, bleeding, or perforation. We herein present a single center experience concerning nontrauma emergency pancreatoduodenectomy for pancreaticoduodenal bleeding. Methods. From January 2007 to December 2015, from a population of 134 PD (70 males and 64 females, mean age 62.2, range 34–82, 5 patients (3.7%; 2 males and 3 females, mean age 64, range 57–70 underwent one-stage emergency pancreatoduodenectomy for uncontrollable nontrauma pancreaticoduodenal bleeding in our tertiary center. Results. All the 5 patients underwent a backwards Whipple with a morbidity of 60% and a mortality of 20% (1/5. The other 4 patients were recovered and discharged with a median postoperative length of stay of 17 days (range 14–23. Conclusion. Emergency pancreatoduodenectomy is a definitive life-saving procedure allowing for a rapid control of bleeding when other less invasive approaches (transcatheter arterial embolization or interventional endoscopy are exhausted, unavailable, or unsafe. It should be particularly considered in neoplastic disease and tailored by surgeons with a high level of experience in pancreatic surgery.

  14. Emergency Backwards Whipple for Bleeding: Formidable and Definitive Surgery.

    Science.gov (United States)

    Lupascu, Cristian; Trofin, Ana; Zabara, Mihai; Vornicu, Alexandra; Cadar, Ramona; Vlad, Nutu; Apopei, Oana; Grigorean, Valentin; Lupascu-Ursulescu, Corina

    2017-01-01

    During the past decades, the safety of pancreatoduodenectomy has improved, with low mortality and reduced morbidity, particularly in centers with extensive experience. Emergency pancreatoduodenectomy is an uncommon event, for treatment of pancreaticoduodenal trauma, bleeding, or perforation. We herein present a single center experience concerning nontrauma emergency pancreatoduodenectomy for pancreaticoduodenal bleeding. From January 2007 to December 2015, from a population of 134 PD (70 males and 64 females, mean age 62.2, range 34-82), 5 patients (3.7%; 2 males and 3 females, mean age 64, range 57-70) underwent one-stage emergency pancreatoduodenectomy for uncontrollable nontrauma pancreaticoduodenal bleeding in our tertiary center. All the 5 patients underwent a backwards Whipple with a morbidity of 60% and a mortality of 20% (1/5). The other 4 patients were recovered and discharged with a median postoperative length of stay of 17 days (range 14-23). Emergency pancreatoduodenectomy is a definitive life-saving procedure allowing for a rapid control of bleeding when other less invasive approaches (transcatheter arterial embolization or interventional endoscopy) are exhausted, unavailable, or unsafe. It should be particularly considered in neoplastic disease and tailored by surgeons with a high level of experience in pancreatic surgery.

  15. Emergency surgery on mentally impaired patients: standard in consenting

    Directory of Open Access Journals (Sweden)

    Mihai Paduraru

    2018-04-01

    Full Text Available Emergency surgery is often performed on the elderly and susceptible patients with significant comorbidities; as a consequence, the risk of death or severe complications are high. Consent for surgery is a fundamental part of medical practice, in line with legal obligations and ethical principles. Obtaining consent for emergency services (for surgical patients with chronic or acute mental incapacity, due to surgical pathology is particularly challenging, and meeting the standards requires an up-to-date understanding of legislation, professional body guidelines, and ethical or cultural aspects. The guidance related to consent requires physicians and other medical staff to work with patients according to the process of ‘supported decision-making’. Despite principles and guidelines that have been exhaustively established, the system is sometimes vulnerable in actual clinical practice. The combination of an ‘emergency’ setting and a patient without mental ‘capacity’ is a challenge between patient-centered and ‘paternalistic’ approaches, involving legislation and guidelines on ‘best interests’ of the patient.

  16. Emergency surgery for complicated colorectal cancer in central Brazil

    Directory of Open Access Journals (Sweden)

    Alex Caetano dos Santos

    2014-04-01

    Full Text Available Objective: to report clinical and pathological features of patients with colorectal cancer diagnosed during emergency abdominal surgery. Methods: records of 107 patients operated between 2006 and 2010 were reviewed. Results: there were 58 women and 49 men with mean age of 59.8 years. The most frequent symptoms were: abdominal pain (97.2%, no bowel movements (81.3%, vomiting (76.6%, and anorexia (40.2%. Patients were divided into five groups: obstructive acute abdomen (n = 68, obstructive acute perforation (n = 21, obstructive acute inflammation (n = 13, abdominal sepsis (n = 3, and severe gastrointestinal bleeding (n = 2. Tumors were located in the rectosigmoid (51.4%, transverse colon (19.6%, ascendent colon (12.1%, descendent colon (11.2%, and 5.6% of the cases presented association of two colon tumors (synchronic tumors. The surgical treatment was: tumor resection with colostomy (85%, tumor resection with primary anastomosis (10.3%, and colostomy without tumor resection (4.7%. Immediate mortality occurred in 33.4% of the patients. Bivariate analysis of sex, tumor location and stage showed no relation to death (p > 0.05%. Conclusions: colorectal cancer may be the cause of colon obstruction or perfuration in patients with nonspecific colonic complaints. Despite the high mortality rate, resection of tumor is feasible in most patients. Resumo: Objetivo: analisar os aspectos clinicos e patológicos de pacientes operados de cancer colorretal diagnosticados durante operações abdominais de urgencia. Métodos: foram estudados os prontuários de 107 pacientes operados entre 2006 e 2010. Resultados: Foram incluidos 58 mulheres e 49 homens com idade media de 59,8 anos. Os sintomas mais frequentes foram: dor abdominal (97,2%, parade de eliminação de gases e fezes (81,3%, vomitos (76,6% e anorexia (40,2%. Os pacientes foram divididos em cinco grupos: abdomen agudo obstrutivo (68, abdomen agudo perfurativo (21, abdomen agudo inflamatorio (13

  17. TMJ surgery following orthognathic surgery: A case series

    Directory of Open Access Journals (Sweden)

    C. Politis

    2018-06-01

    Full Text Available Orthognathic surgery may affect or cause temporomandibular joint (TMJ complaints. This study evaluated the need for TMJ surgery after orthognathic surgery.A retrospective cohort study was carried out on 630 consecutive patients undergoing at least a Le Fort I or bilateral sagittal split osteotomy (BSSO. The mean follow-up time was 2,3 years. Clinical, surgical and radiographic findings were collected.Ten of the 630 patients (1.6% had additional arthroscopic TMJ-surgery in one (9 or in both (1 joints because of internal derangement, resistant to conventional therapy. Only 4/10 patients had successful outcomes following arthroscopic surgery. One patient with unsuccessful outcome required multiple additional open TMJ-surgeries, all remaining ineffective to relieve pain and restricted mouth opening. If arthroscopy failed to relieve symptoms (5/10 patients, further conservative management was opted. Arthroscopy seemed effective mainly in patients without pre-existing TMJ complaints.A further five of the 630 patients (0.8% required more treatment because of bilateral postoperative condylar resorption, but none of them required TMJ-surgery.In contrast to patients with bilateral condylar resorption where the skeletal relapse remained the issue of concern, patients with internal derangement/osteoarthrosis exhibited major occlusal changes in one patient only (1/10, leaving the TMJ complaints as the main concern. Keywords: Sagittal split osteotomy, Le Fort I osteotomy, Orthognathic surgery, Condylar remodelling, Condylar resorption, Osteoarthrosis, Internal derangement, Relapse, Arthroscopy

  18. Emerging Applications of Bedside 3D Printing in Plastic Surgery

    Directory of Open Access Journals (Sweden)

    Michael P Chae

    2015-06-01

    Full Text Available Modern imaging techniques are an essential component of preoperative planning in plastic and reconstructive surgery. However, conventional modalities, including three-dimensional (3D reconstructions, are limited by their representation on 2D workstations. 3D printing has been embraced by early adopters to produce medical imaging-guided 3D printed biomodels that facilitate various aspects of clinical practice. The cost and size of 3D printers have rapidly decreased over the past decade in parallel with the expiration of key 3D printing patents. With increasing accessibility, investigators are now able to convert standard imaging data into Computer Aided Design (CAD files using various 3D reconstruction softwares and ultimately fabricate 3D models using 3D printing techniques, such as stereolithography (SLA, multijet modeling (MJM, selective laser sintering (SLS, binder jet technique (BJT, and fused deposition modeling (FDM. Significant improvements in clinical imaging and user-friendly 3D software have permitted computer-aided 3D modeling of anatomical structures and implants without out-sourcing in many cases. These developments offer immense potential for the application of 3D printing at the bedside for a variety of clinical applications. However, many clinicians have questioned whether the cost-to-benefit ratio justifies its ongoing use. In this review the existing uses of 3D printing in plastic surgery practice, spanning the spectrum from templates for facial transplantation surgery through to the formation of bespoke craniofacial implants to optimize post-operative aesthetics, are described. Furthermore, we discuss the potential of 3D printing to become an essential office-based tool in plastic surgery to assist in preoperative planning, patient and surgical trainee education, and the development of intraoperative guidance tools and patient-specific prosthetics in everyday surgical practice.

  19. Emerging Applications of Bedside 3D Printing in Plastic Surgery.

    Science.gov (United States)

    Chae, Michael P; Rozen, Warren M; McMenamin, Paul G; Findlay, Michael W; Spychal, Robert T; Hunter-Smith, David J

    2015-01-01

    Modern imaging techniques are an essential component of preoperative planning in plastic and reconstructive surgery. However, conventional modalities, including three-dimensional (3D) reconstructions, are limited by their representation on 2D workstations. 3D printing, also known as rapid prototyping or additive manufacturing, was once the province of industry to fabricate models from a computer-aided design (CAD) in a layer-by-layer manner. The early adopters in clinical practice have embraced the medical imaging-guided 3D-printed biomodels for their ability to provide tactile feedback and a superior appreciation of visuospatial relationship between anatomical structures. With increasing accessibility, investigators are able to convert standard imaging data into a CAD file using various 3D reconstruction softwares and ultimately fabricate 3D models using 3D printing techniques, such as stereolithography, multijet modeling, selective laser sintering, binder jet technique, and fused deposition modeling. However, many clinicians have questioned whether the cost-to-benefit ratio justifies its ongoing use. The cost and size of 3D printers have rapidly decreased over the past decade in parallel with the expiration of key 3D printing patents. Significant improvements in clinical imaging and user-friendly 3D software have permitted computer-aided 3D modeling of anatomical structures and implants without outsourcing in many cases. These developments offer immense potential for the application of 3D printing at the bedside for a variety of clinical applications. In this review, existing uses of 3D printing in plastic surgery practice spanning the spectrum from templates for facial transplantation surgery through to the formation of bespoke craniofacial implants to optimize post-operative esthetics are described. Furthermore, we discuss the potential of 3D printing to become an essential office-based tool in plastic surgery to assist in preoperative planning, developing

  20. Emerging Applications of Bedside 3D Printing in Plastic Surgery

    Science.gov (United States)

    Chae, Michael P.; Rozen, Warren M.; McMenamin, Paul G.; Findlay, Michael W.; Spychal, Robert T.; Hunter-Smith, David J.

    2015-01-01

    Modern imaging techniques are an essential component of preoperative planning in plastic and reconstructive surgery. However, conventional modalities, including three-dimensional (3D) reconstructions, are limited by their representation on 2D workstations. 3D printing, also known as rapid prototyping or additive manufacturing, was once the province of industry to fabricate models from a computer-aided design (CAD) in a layer-by-layer manner. The early adopters in clinical practice have embraced the medical imaging-guided 3D-printed biomodels for their ability to provide tactile feedback and a superior appreciation of visuospatial relationship between anatomical structures. With increasing accessibility, investigators are able to convert standard imaging data into a CAD file using various 3D reconstruction softwares and ultimately fabricate 3D models using 3D printing techniques, such as stereolithography, multijet modeling, selective laser sintering, binder jet technique, and fused deposition modeling. However, many clinicians have questioned whether the cost-to-benefit ratio justifies its ongoing use. The cost and size of 3D printers have rapidly decreased over the past decade in parallel with the expiration of key 3D printing patents. Significant improvements in clinical imaging and user-friendly 3D software have permitted computer-aided 3D modeling of anatomical structures and implants without outsourcing in many cases. These developments offer immense potential for the application of 3D printing at the bedside for a variety of clinical applications. In this review, existing uses of 3D printing in plastic surgery practice spanning the spectrum from templates for facial transplantation surgery through to the formation of bespoke craniofacial implants to optimize post-operative esthetics are described. Furthermore, we discuss the potential of 3D printing to become an essential office-based tool in plastic surgery to assist in preoperative planning, developing

  1. Anesthetic management of a pediatric patient with hypohidrotic ectodermal dysplasia undergoing emergency surgery.

    Science.gov (United States)

    Ahiskalioglu, Elif Oral; Ahiskalioglu, Ali; Firinci, Binali; Dostbil, Aysenur; Aksoy, Mehmet

    2015-01-01

    Ectodermal dysplasias are rare conditions with a triad of hypotrichosis, anodontia and anhidrosis. In literature review there have been only a few reports of anesthetic management of patients with ectodermal dysplasias. Hyperthermia is a very serious risk which may occur due to the defect of sweat glands. The present case involves a 10-year-old child with ectodermal dysplasia who presented with an acute abdomen and was considered for an emergency surgery. Our aim was to demonstrate the successful management of this case using a combination of general and epidural anesthesia. It is important for anesthesiologist to have information about this syndrome in case of emergency operations, since it can prevent serious complications and even save lives. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  2. Anesthetic management of a pediatric patient with hypohidrotic ectodermal dysplasia undergoing emergency surgery

    Directory of Open Access Journals (Sweden)

    Elif Oral Ahiskalioglu

    2015-11-01

    Full Text Available Ectodermal dysplasias are rare conditions with a triad of hypotrichosis, anodontia and anhidrosis. In literature review there have been only a few reports of anesthetic management of patients with ectodermal dysplasias. Hyperthermia is a very serious risk which may occur due to the defect of sweat glands. The present case involves a 10-year-old child with ectodermal dysplasia who presented with an acute abdomen and was considered for an emergency surgery. Our aim was to demonstrate the successful management of this case using a combination of general and epidural anesthesia. It is important for anesthesiologist to have information about this syndrome in case of emergency operations, since it can prevent serious complications and even save lives.

  3. Anesthetic management of a pediatric patient with hypohidrotic ectodermal dysplasia undergoing emergency surgery

    Directory of Open Access Journals (Sweden)

    Elif Oral Ahiskalioglu

    2015-12-01

    Full Text Available ABSTRACT Ectodermal dysplasias are rare conditions with a triad of hypotrichosis, anodontia and anhidrosis. In literature review there have been only a few reports of anesthetic management of patients with ectodermal dysplasias. Hyperthermia is a very serious risk which may occur due to the defect of sweat glands. The present case involves a 10-year-old child with ectodermal dysplasia who presented with an acute abdomen and was considered for an emergency surgery. Our aim was to demonstrate the successful management of this case using a combination of general and epidural anesthesia. It is important for anesthesiologist to have information about this syndrome in case of emergency operations, since it can prevent serious complications and even save lives.

  4. Venous Thromboembolism Prevention in Emergency General Surgery: A Review.

    Science.gov (United States)

    Murphy, Patrick B; Vogt, Kelly N; Lau, Brandyn D; Aboagye, Jonathan; Parry, Neil G; Streiff, Michael B; Haut, Elliott R

    2018-05-01

    Venous thromboembolism (VTE) is the most preventable cause of morbidity and mortality in US hospitals, and approximately 2.5% of emergency general surgery (EGS) patients will be diagnosed with a VTE event. Emergency general surgery patients are at increased risk of morbidity and mortality because of the nature of acute surgical conditions and the challenges related to prophylaxis. MEDLINE, Embase, and the Cochrane Database of Collected Reviews were searched from January 1, 1990, through December 31, 2015. Nearly all operatively and nonoperatively treated EGS patients have a moderate to high risk of developing a VTE, and individual risk should be assessed at admission. Pharmacologic prophylaxis in the form of unfractionated or low-molecular-weight heparin should be considered unless an absolute contraindication, such as bleeding, exists. Patients should receive the first dose at admission to the hospital, and administration should continue until discharge without missed doses. Certain patient populations, such as those with malignant tumors, may benefit from prolonged VTE prophylaxis after discharge. Mechanical prophylaxis should be considered in all patients, particularly if pharmacologic prophylaxis is contraindicated. Studies that specifically target improved adherence with VTE prophylaxis in EGS patients suggest that efficacy and quality improvement initiatives should be undertaken from a system and institutional perspective. Operatively and nonoperatively treated EGS patients are at a comparatively high risk of VTE. Despite gaps in existing literature with respect to this increasing patient population, successful best practices can be applied. Best practices include assessment of VTE risk, optimal prophylaxis, and physician, nurse, and patient education regarding the use of mechanical and pharmacologic VTE prophylaxis and institutional policies.

  5. Bilateral transversus abdominis plane block as a sole anesthetic technique in emergency surgery for perforative peritonitis in a high risk patient

    OpenAIRE

    Mishra, Lipi; Pani, Nibedita; Mishra, Debasis; Patel, Nupur

    2013-01-01

    Although transversus abdominis plane (TAP) block is an effective way of providing analgesia in post-operative abdominal surgery patients; however, it can be considered as an anesthetic technique in high-risk cases for surgery. We report a case of a geriatric female with chronic obstructive pulmonary disease in the respiratory failure, hypotension, posted in an emergency with old perforation leading to peritonitis. The surgery was successfully conducted under bilateral TAP block, which was use...

  6. Use of National Burden to Define Operative Emergency General Surgery.

    Science.gov (United States)

    Scott, John W; Olufajo, Olubode A; Brat, Gabriel A; Rose, John A; Zogg, Cheryl K; Haider, Adil H; Salim, Ali; Havens, Joaquim M

    2016-06-15

    Emergency general surgery (EGS) represents 11% of surgical admissions and 50% of surgical mortality in the United States. However, there is currently no established definition of the EGS procedures. To define a set of procedures accounting for at least 80% of the national burden of operative EGS. A retrospective review was conducted using data from the 2008-2011 National Inpatient Sample. Adults (age, ≥18 years) with primary EGS diagnoses consistent with the American Association for the Surgery of Trauma definition, admitted urgently or emergently, who underwent an operative procedure within 2 days of admission were included in the analyses. Procedures were ranked to account for national mortality and complication burden. Among ranked procedures, contributions to total EGS frequency, mortality, and hospital costs were assessed. The data query and analysis were performed between November 15, 2015, and February 16, 2016. Overall procedure frequency, in-hospital mortality, major complications, and inpatient costs calculated per 3-digit International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes. The study identified 421 476 patient encounters associated with operative EGS, weighted to represent 2.1 million nationally over the 4-year study period. The overall mortality rate was 1.23% (95% CI, 1.18%-1.28%), the complication rate was 15.0% (95% CI, 14.6%-15.3%), and mean cost per admission was $13 241 (95% CI, $12 957-$13 525). After ranking the 35 procedure groups by contribution to EGS mortality and morbidity burden, a final set of 7 operative EGS procedures were identified, which collectively accounted for 80.0% of procedures, 80.3% of deaths, 78.9% of complications, and 80.2% of inpatient costs nationwide. These 7 procedures included partial colectomy, small-bowel resection, cholecystectomy, operative management of peptic ulcer disease, lysis of peritoneal adhesions, appendectomy, and laparotomy. Only 7 procedures account

  7. Proceedings of resources for optimal care of acute care and emergency surgery consensus summit Donegal Ireland

    NARCIS (Netherlands)

    Sugrue, M.; Maier, R.; Moore, E. E.; Boermeester, M.; Catena, F.; Coccolini, F.; Leppaniemi, A.; Peitzman, A.; Velmahos, G.; Ansaloni, L.; Abu-Zidan, F.; Balfe, P.; Bendinelli, C.; Biffl, W.; Bowyer, M.; DeMoya, M.; de Waele, J.; di Saverio, S.; Drake, A.; Fraga, G. P.; Hallal, A.; Henry, C.; Hodgetts, T.; Hsee, L.; Huddart, S.; Kirkpatrick, A. W.; Kluger, Y.; Lawler, L.; Malangoni, M. A.; Malbrain, M.; MacMahon, P.; Mealy, K.; O'Kane, M.; Loughlin, P.; Paduraru, M.; Pearce, L.; Pereira, B. M.; Priyantha, A.; Sartelli, M.; Soreide, K.; Steele, C.; Thomas, S.; Vincent, J. L.; Woods, L.

    2017-01-01

    Background: Opportunities to improve emergency surgery outcomes exist through guided better practice and reduced variability. Few attempts have been made to define optimal care in emergency surgery, and few clinically derived key performance indicators (KPIs) have been published. A summit was

  8. General surgery 2.0: the emergence of acute care surgery in Canada

    Science.gov (United States)

    Hameed, S. Morad; Brenneman, Frederick D.; Ball, Chad G.; Pagliarello, Joe; Razek, Tarek; Parry, Neil; Widder, Sandy; Minor, Sam; Buczkowski, Andrzej; MacPherson, Cailan; Johner, Amanda; Jenkin, Dan; Wood, Leanne; McLoughlin, Karen; Anderson, Ian; Davey, Doug; Zabolotny, Brent; Saadia, Roger; Bracken, John; Nathens, Avery; Ahmed, Najma; Panton, Ormond; Warnock, Garth L.

    2010-01-01

    Over the past 5 years, there has been a groundswell of support in Canada for the development of organized, focused and multidisciplinary approaches to caring for acutely ill general surgical patients. Newly forged acute care surgery (ACS) services are beginning to provide prompt, evidence-based and goal-directed care to acutely ill general surgical patients who often present with a diverse range of complex pathologies and little or no pre- or postoperative planning. Through a team-based structure with attention to processes of care and information sharing, ACS services are well positioned to improve outcomes, while finding and developing efficiencies and reducing costs of surgical and emergency health care delivery. The ACS model also offers enhanced opportunities for surgical education for students, residents and practicing surgeons, and it will provide avenues to strengthen clinical and academic bonds between the community and academic surgical centres. In the near future, cooperation of ACS services from community and academic hospitals across the country will lead to the formation of systems of acute surgical care whose development will be informed by rigorous data collection and research and evidence-based quality-improvement initiatives. In an era of increasing subspecialization, ACS is a strong unifying force in general surgery and a platform for collective advocacy for an important patient population. PMID:20334738

  9. Day case inguinal hernia surgery in Nigerian children: Prospective ...

    African Journals Online (AJOL)

    required readmission into the hospital. Conclusion: Day case inguinal hernia surgery in children is safe and well accepted by patients and parents alike. Health institutions in which children with inguinal hernias still queue for long periods for space on the operation list need to adopt day case surgery for inguinal hernia in ...

  10. Are You Ready for Emergency Medical Services in Your Oral and Maxillofacial Surgery Office?

    Science.gov (United States)

    Rayner, Clive; Ragan, Michael R

    2018-05-01

    Efficient responses to emergencies in the oral and maxillofacial surgery office require preparation, communication, and thorough documentation of the event and response. The concept of team anesthesia is showcased with these efforts. Emergency medical services training and response times vary greatly. The oral and maxillofacial surgery office should be prepared to manage the patient for at least 15 minutes after making the call to 911. Patient outcomes are optimized when providers work together to manage and transport the patient. Oral and maxillofacial surgery offices should develop and rehearse emergency plans and coordinate these protocols with local Emergency medical services teams. Copyright © 2018 Elsevier Inc. All rights reserved.

  11. Regenerative periapical surgery: A case report

    Directory of Open Access Journals (Sweden)

    Sonam Bhandari

    2013-01-01

    Full Text Available Introduction: Periapical surgery is an important treatment alternative in the presence of a large periapical cyst. To achieve optimal healing and regeneration of the bone different bone substitutes can be used. Case Report: A 35 year old male patient reported with the soft diffuse swelling in anterior palatal region and drainings in us with 21 labially. He had a history of trauma 5 years back. The clinical and radiographic diagnosis of infected periapical cyst with 11,21; invasive cervical root resorption with 21 and internal root resorption with 11 was made. Endodontic treatment was performed with11,2 followed by periapical curettage. A picectomy and retrograde filling with white mineral trioxide aggregate (MTA was carried out with 11,21. The cervical resorption defect with 21 was restored with white MTA. Platelet rich fibrin (PRF was mixed with demineralised bone matrix (Osseograft and used as a regenerative biomaterial in the periapiacl defect. 14 months follow up shows satisfactory healing and regeneration of periapical region. Discussion: There is considerable clinical interest in using PRF alone or in combination with graft materials as it is a reservoir of many growth factors and have potential for accelerated soft-and hard tissue healing. PRF is a new generation of platelet concentrate, derived from patients own blood.

  12. Emergency surgery for lung cancer with abscess formation after transbronchial biopsy.

    Science.gov (United States)

    Takanashi, Yusuke; Miyashita, Koichi; Tajima, Shogo; Hayakawa, Takamitsu; Neyatani, Hiroshi; Funai, Kazuhito

    2017-03-01

    Abscess formation in lung cancer after transbronchial biopsy (TBB) is a rare complication with no standard consensus on a coping strategy or prophylaxis. We describe an instructive case of lung cancer which developed into an abscess after TBB. An 80-year-old man with poorly controlled diabetes mellitus underwent TBB for diagnosing a mass lesion in the left upper lobe. The TBB specimen confirmed a diagnosis of lung cancer, and he was scheduled for radical surgery. However, the tumour was revealed to have progressed into an enlarged abscess 24 days after TBB. Prompt use of meropenem failed to relieve the infection, hence we performed emergency left upper lobectomy. Poorly controlled diabetes mellitus was considered to be a risk for the formation of a tumour abscess after TBB. It was difficult to control the infection with conservative treatment using antibiotics; emergency surgical resection was considered to be the safest strategy for recovery.

  13. Emergency readmissions to paediatric surgery and urology: The impact of inappropriate coding.

    Science.gov (United States)

    Peeraully, R; Henderson, K; Davies, B

    2016-04-01

    Introduction In England, emergency readmissions within 30 days of hospital discharge after an elective admission are not reimbursed if they do not meet Payment by Results (PbR) exclusion criteria. However, coding errors could inappropriately penalise hospitals. We aimed to assess the accuracy of coding for emergency readmissions. Methods Emergency readmissions attributed to paediatric surgery and urology between September 2012 and August 2014 to our tertiary referral centre were retrospectively reviewed. Payment by Results (PbR) coding data were obtained from the hospital's Family Health Directorate. Clinical details were obtained from contemporaneous records. All readmissions were categorised as appropriately coded (postoperative or nonoperative) or inappropriately coded (planned surgical readmission, unrelated surgical admission, unrelated medical admission or coding error). Results Over the 24-month period, 241 patients were coded as 30-day readmissions, with 143 (59%) meeting the PbR exclusion criteria. Of the remaining 98 (41%) patients, 24 (25%) were inappropriately coded as emergency readmissions. These readmissions resulted in 352 extra bed days, of which 117 (33%) were attributable to inappropriately coded cases. Conclusions One-quarter of non-excluded emergency readmissions were inappropriately coded, accounting for one-third of additional bed days. As a stay on a paediatric ward costs up to £500 a day, the potential cost to our institution due to inappropriate readmission coding was over £50,000. Diagnoses and the reason for admission for each care episode should be accurately documented and coded, and readmission data should be reviewed at a senior clinician level.

  14. Anesthesia through an intraosseous line using an 18-gauge intravenous needle for emergency pediatric surgery.

    Science.gov (United States)

    Hamed, Riyadh Khudeir; Hartmans, Sharon; Gausche-Hill, Marianne

    2013-09-01

    To describe the success and complication rate of intraosseous (IO) access for delivery of anesthesia with the use of an 18-gauge (G) intravenous (IV) needle. Prospective study. Children's Welfare Teaching Hospital, Baghdad, Iraq. 300 critically ill infants and toddlers, age 3 weeks to 16 months, requiring emergency surgery for intra-abdominal or pelvic conditions, in whom peripheral or central access was not obtainable. Patients presented for surgery between 2007 and 2010. In 26 patients, the IO catheter was established when peripheral access was not obtained at the outset of surgery; in 4 patients standard peripheral vascular access failed during the surgical procedure and IO access was obtained. An 18-G IV needle was placed into the proximal tibia and attached to an extension set with a 3-way stopcock to deliver anesthesia. For 26 critically ill children and 4 other children, IV access failed during delivery of anesthesia; vascular access was successfully obtained within minutes in all 30 infants (100%) using the intraosseous route. Ninety percent (27/30) of patients awoke immediately postoperatively in good condition; 10% (3/30) went to the pediatric intensive care unit (PICU) for further care due to their critical preoperative condition. Complications associated with use of the IO route were considered minor (3/30 pts [10%]) and included extravasation of fluid in two cases and cellulitis in one. The IO route provided for rapid delivery of anesthesia, induction, and maintenance in this series of critically ill infants undergoing emergency surgery when other vascular access routes failed. Few complications were noted. Intraosseous access was achieved through a simple technique using an 18-gauge IV needle. © 2013 Elsevier Inc. All rights reserved.

  15. Surgery preceding orthodontics in bimaxillary cases

    Directory of Open Access Journals (Sweden)

    B Saravana Kumar

    2015-01-01

    Full Text Available Orthognathic surgery is performed to alter the shape of the jaws to increase the facial esthetic and improve the occlusions. Surgery prior orthodontics reduces the total length of the treatment of the patients, followed by orthodontics treatment. Advantages is positive outcome in short period of time. Surgical procedure includes Anterior Maxillary osteotomy and Anterior subapical mandibular osteotomy. Complication includes haemorrhage, paraesthesia, malunion of bone, etc.

  16. Emergency general surgery in a low-middle income health care setting: Determinants of outcomes.

    Science.gov (United States)

    Shah, Adil A; Latif, Asad; Zogg, Cheryl K; Zafar, Syed Nabeel; Riviello, Robert; Halim, Muhammad Sohail; Rehman, Zia; Haider, Adil H; Zafar, Hasnain

    2016-02-01

    Emergency general surgery (EGS) has emerged as an important component of frontline operative care. Efforts in high-income settings have described its burden but have yet to consider low- and middle-income health care settings in which emergent conditions represent a high proportion of operative need. The objective of this study was to describe the disease spectrum of EGS conditions and associated factors among patients presenting in a low-middle income context. March 2009-April 2014 discharge data from a university teaching hospital in South Asia were obtained for patients (≥16 years) with primary International Classification of Diseases, 9(th) revision, Clinical Modification diagnosis codes consistent with an EGS condition as defined by the American Association for the Surgery of Trauma. Outcomes included in-hospital mortality and occurrence of ≥1 major complication(s). Multivariable analyses were performed, adjusting for differences in demographic and case-mix factors. A total of 13,893 discharge records corresponded to EGS conditions. Average age was 47.2 years (±16.8, standard deviation), with a male preponderance (59.9%). The majority presented with admitting diagnoses of biliary disease (20.2%), followed by soft-tissue disorders (15.7%), hernias (14.9%), and colorectal disease (14.3%). Rates of death and complications were 2.7% and 6.6%, respectively; increasing age was an independent predictor of both. Patients in need of resuscitation (n = 225) had the greatest rates of mortality (72.9%) and complications (94.2%). This study takes an important step toward quantifying outcomes and complications of EGS, providing one of the first assessments of EGS conditions using American Association for the Surgery of Trauma definitions in a low-middle income health care setting. Further efforts in varied settings are needed to promote representative benchmarking worldwide. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Geriatric emergency general surgery: Survival and outcomes in a low-middle income country.

    Science.gov (United States)

    Shah, Adil A; Haider, Adil H; Riviello, Robert; Zogg, Cheryl K; Zafar, Syed Nabeel; Latif, Asad; Rios Diaz, Arturo J; Rehman, Zia; Zafar, Hasnain

    2015-08-01

    Geriatric patients remain largely unstudied in low-middle income health care settings. The purpose of this study was to compare the epidemiology and outcomes of older versus younger adults with emergency general surgical conditions in South Asia. Discharge data from March 2009 to April 2014 were obtained for all adult patients (≥16 years) with an International Classification of Diseases, 9th revision, Clinical Modification diagnosis codes consistent with an emergency general surgery condition as defined by the American Association for the Surgery of Trauma. Multivariable regression analyses compared patients >65 years of age with patients ≤65 years for differences in all-cause mortality, major complications, and duration of hospital stay. Models were adjusted for potential confounding owing to patient demographic and clinical case-mix data with propensity scores. We included 13,893 patients; patients >65 years constituted 15% (n = 2,123) of the cohort. Relative to younger patients, older adults were more likely to present with a number of emergency general surgery conditions, including gastrointestinal bleeding (odds ratio OR [95% CI], 2.63[1.99-3.46]), resuscitation (2.17 [1.67-2.80]), and peptic ulcer disease (2.09 [1.40-3.10]). They had an 89% greater risk-adjusted odds (1.89 [1.55-2.29]) of complications and a 63% greater odds (1.63 [1.21-2.20]) of mortality. Restricted to patients undergoing operative interventions, older adults had 95% greater odds (1.95 [1.29-2.94]) of complications and 117% greater odds (2.17 [1.62-2.91]) of mortality. Understanding unique needs of geriatric patients is critical to enhancing the management and prioritization of appropriate care in developing settings. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Bilateral transversus abdominis plane block as a sole anesthetic technique in emergency surgery for perforative peritonitis in a high risk patient

    Directory of Open Access Journals (Sweden)

    Lipi Mishra

    2013-01-01

    Full Text Available Although transversus abdominis plane (TAP block is an effective way of providing analgesia in post-operative abdominal surgery patients; however, it can be considered as an anesthetic technique in high-risk cases for surgery. We report a case of a geriatric female with chronic obstructive pulmonary disease in the respiratory failure, hypotension, posted in an emergency with old perforation leading to peritonitis. The surgery was successfully conducted under bilateral TAP block, which was used as a sole anesthetic technique. TAP block can be considered as an anesthetic technique for abdominal surgery in moribund patients.

  19. ED breast cases and other breast emergencies.

    Science.gov (United States)

    Khadem, Nasim; Reddy, Sravanthi; Lee, Sandy; Larsen, Linda; Walker, Daphne

    2016-02-01

    Patients with pathologic processes of the breast commonly present in the Emergency Department (ED). Familiarity with the imaging and management of the most common entities is essential for the radiologist. Additionally, it is important to understand the limitations of ED imaging and management in the acute setting and to recognize when referrals to a specialty breast center are necessary. The goal of this article is to review the clinical presentations, pathophysiology, imaging, and management of emergency breast cases and common breast pathology seen in the ED.

  20. Experiencing your own orthognathic surgery: A personal case report

    NARCIS (Netherlands)

    Mensink, Gertjan; Gooris, Peter; Mulder, Florine; Gooris-Kuipers, Christel; van Merkesteyn, Richard

    2015-01-01

    There has been much research on minimizing the side effects of orthognathic surgery. However, there are very few doctors and researchers who themselves have undergone this surgery. This case report describes the findings of a maxillofacial surgeon who underwent combined orthodontic and orthognathic

  1. Experiencing your own orthognathic surgery: a personal case report

    NARCIS (Netherlands)

    Mensink, G.; Gooris, P.; Mulder, F.; Gooris-Kuipers, C.; van Merkestyn, R.

    2015-01-01

    There has been much research on minimizing the side effects of orthognathic surgery. However, there are very few doctors and researchers who themselves have undergone this surgery. This case report describes the findings of a maxillofacial surgeon who underwent combined orthodontic and orthognathic

  2. Complications after orthognathic surgery: our experience on 423 cases.

    Science.gov (United States)

    Friscia, Marco; Sbordone, Carolina; Petrocelli, Marzia; Vaira, Luigi Angelo; Attanasi, Federica; Cassandro, Francesco Maria; Paternoster, Mariano; Iaconetta, Giorgio; Califano, Luigi

    2017-06-01

    Orthognathic surgery is widely used to correct dentofacial discrepancies. However, this procedure presents numerous possible complications. The aim of our study is to review intraoperative and postoperative complications related to orthognathic surgery based upon a 10-year period in the Maxillofacial Surgery Department of Federico II University of Naples. Medical records of 423 patients who undergone orthognathic surgery in a 10-year period were retrospectively analyzed and complications was noted. Statistical analysis was conduced in order to understand if the type of surgical procedure influenced complications rate. One hundred eighty-five complications in 143 (33.8%) of the 423 treated patients were reported. Complications detected were nerve injury (49 cases, 11.9%), infections (10 cases, 2.4%), complications related to fixation plates or screws (30 cases, 7.1%), bad split osteotomy (8 cases, 1.9%), secondary temporo-mandibular joint disorders (36 cases, 8.5%), dental injuries (21 cases, 5%), condilar resorption (2 cases, 0.5%), and necessity of a second-time surgery (24 cases, 5.7%). Serious complications seem to be quite rare in orthognathic surgery. Some of the surgical complications found are related to the surgeon experience and not strictly to the risks of the operation itself. Understanding potential complications allows the surgeon to guarantee safe care through early intervention and correctly inform the patient in the preoperative colloquy.

  3. 30-Day, 90-day and 1-year mortality after emergency colonic surgery

    DEFF Research Database (Denmark)

    Pedersen, T; Watt, S K; Tolstrup, M-B

    2017-01-01

    PURPOSE: Emergency surgery is an independent risk factor in colonic surgery resulting in high 30-day mortality. The primary aim of this study was to report 30-day, 90-day and 1-year mortality rates after emergency colonic surgery, and to report factors associated with 30-day, 90-day and 1-year...... mortality. Second, the aim was to report 30-day postoperative complications and their relation to in-hospital mortality. METHODS: All patients undergoing acute colonic surgery in the period from May 2009 to April 2013 at Copenhagen University Hospital Herlev, Denmark, were identified. Perioperative data...... postoperative deaths. CONCLUSION: Mortality and complication rates after emergency colonic surgery are high and associated with patient related risk factors that cannot be modified, but also treatment related outcomes that are modifiable. An increased focus on medical and other preventive measures should...

  4. Patients' experiences of postoperative intermediate care and standard surgical ward care after emergency abdominal surgery

    DEFF Research Database (Denmark)

    Thomsen, Thordis; Vester-Andersen, Morten; Nielsen, Martin Vedel

    2015-01-01

    AIMS AND OBJECTIVES: To elicit knowledge of patient experiences of postoperative intermediate care in an intensive care unit and standard postoperative care in a surgical ward after emergency abdominal surgery. BACKGROUND: Emergency abdominal surgery is common, but little is known about how patie......, intermediate care patients felt hindered in doing so by continuous monitoring of vital signs. RELEVANCE TO CLINICAL PRACTICE: Intermediate care may increase patient perceptions of quality and safety of care.......AIMS AND OBJECTIVES: To elicit knowledge of patient experiences of postoperative intermediate care in an intensive care unit and standard postoperative care in a surgical ward after emergency abdominal surgery. BACKGROUND: Emergency abdominal surgery is common, but little is known about how...... patients experience postoperative care. The patient population is generally older with multiple comorbidities, and the short-term postoperative mortality rate is 15-20%. Thus, vigilant surgeon and nursing attention is essential. The present study is a qualitative sub-study of a randomised trial evaluating...

  5. Comparison of maintenance, emergence and recovery characteristics of sevoflurane and desflurane in pediatric ambulatory surgery

    Directory of Open Access Journals (Sweden)

    Manish B Kotwani

    2017-01-01

    Conclusion: Desflurane provides faster emergence and recovery in comparison to sevoflurane when used for the maintenance of anesthesia through SGA in children. Both sevoflurane and desflurane can be safely used in children for lower abdominal surgeries.

  6. Orthognathic surgery during breast cancer treatment—A case report

    Directory of Open Access Journals (Sweden)

    Tsuyoshi Shimo

    2017-01-01

    Conclusion: We experienced a case in which breast cancer was found just before the orthognathic surgery; we performed a bimaxillary osteotomy, including follow-up tamoxifen administration, during breast cancer treatment.

  7. Routine hemoglobin electrophoresis for pediatric surgery day case ...

    African Journals Online (AJOL)

    2015-09-25

    Sep 25, 2015 ... 2016 Nigerian Journal of Clinical Practice | Published by Wolters Kluwer - Medknow ... surgery day case in at-risk populations: Suggested algorithm for screening .... HBE is a routine preoperative investigation before a surgical ...

  8. Laparoscopy in major abdominal emergency surgery seems to be a safe procedure

    DEFF Research Database (Denmark)

    Nielsen, Liv Bjerre Juul; Tengberg, Line Toft; Bay-Nielsen, Morten

    2017-01-01

    INTRODUCTION: Laparoscopy is well established in the majority of elective procedures in abdominal surgery. In contrast, it is primarily used in minor surgery such as appendectomy or cholecystectomy in the emergent setting. This study aimed to analyze the safety and effectiveness of a laparoscopic...

  9. Differences in emergency colorectal surgery in Medicaid and uninsured patients by hospital safety net status.

    Science.gov (United States)

    Bradley, Cathy J; Dahman, Bassam; Sabik, Lindsay M

    2015-02-01

    We examined whether safety net hospitals reduce the likelihood of emergency colorectal cancer (CRC) surgery in uninsured and Medicaid-insured patients. If these patients have better access to care through safety net providers, they should be less likely to undergo emergency resection relative to similar patients at non- safety net hospitals. Using population-based data, we estimated the relationship between safety net hospitals, patient insurance status, and emergency CRC surgery. We extracted inpatient admission data from the Virginia Health Information discharge database and matched them to the Virginia Cancer Registry for patients aged 21 to 64 years who underwent a CRC resection between January 1, 1999, and December 31, 2005 (n = 5488). We differentiated between medically defined emergencies and those that originated in the emergency department (ED). For each definition of emergency surgery, we estimated the linear probability models of the effects of being treated at a safety net hospital on the probability of having an emergency resection. Safety net hospitals reduce emergency surgeries among uninsured and Medicaid CRC patients. When defining an emergency resection as those that involved an ED visit, these patients were 15 to 20 percentage points less likely to have an emergency resection when treated in a safety net hospital. Our results suggest that these hospitals provide a benefit, most likely through the access they afford to timely and appropriate care, to uninsured and Medicaid-insured patients relative to hospitals without a safety net mission.

  10. Laparoscopic Bladder -Conserving Surgery: Case Series

    African Journals Online (AJOL)

    advantages of minimal access surgery, upholds quality of life, improves patient's body image and preserves function. Methods: We present our experience in .... of the bladder, reporting an operative time of 205 min with minimal blood loss and R0 resection margins. (1,13). One patient has required salvage chemotherapy.

  11. Mortality following emergency groin hernia surgery in Denmark

    DEFF Research Database (Denmark)

    Kjærgaard, Jesper; Bay-Nielsen, M; Kehlet, H

    2010-01-01

    The mortality following emergency groin hernia repair in Denmark is more than twice as high (7%) as in comparable countries. This article describes in detail the population that died following emergency herniotomy in order to identify aspects of care that may improve outcome.......The mortality following emergency groin hernia repair in Denmark is more than twice as high (7%) as in comparable countries. This article describes in detail the population that died following emergency herniotomy in order to identify aspects of care that may improve outcome....

  12. Prediction of Outcome After Emergency High-Risk Intra-abdominal Surgery Using the Surgical Apgar Score

    DEFF Research Database (Denmark)

    Cihoric, Mirjana; Toft Tengberg, Line; Bay-Nielsen, Morten

    2016-01-01

    BACKGROUND: With current literature quoting mortality rates up to 45%, emergency high-risk abdominal surgery has, compared with elective surgery, a significantly greater risk of death and major complications. The Surgical Apgar Score (SAS) is predictive of outcome in elective surgery, but has nev...... emergency high-risk abdominal surgery. Despite its predictive value, the SAS cannot in its current version be recommended as a standalone prognostic tool in an emergency setting....

  13. Single-port access laparoscopic surgery for rectal cancer: initial experience with 10 cases

    DEFF Research Database (Denmark)

    Bulut, Orhan; Nielsen, Claus B; Jespersen, Niels

    2011-01-01

    Single-port access laparoscopic surgery is emerging as a method to improve the morbidity and cosmetic benefits of conventional laparoscopic surgery and minimize the surgical trauma. However, the feasibility of this procedure in rectal surgery has not yet been determined.......Single-port access laparoscopic surgery is emerging as a method to improve the morbidity and cosmetic benefits of conventional laparoscopic surgery and minimize the surgical trauma. However, the feasibility of this procedure in rectal surgery has not yet been determined....

  14. Emergency abdominal surgery in Zaria, Nigeria | Ahmed | South ...

    African Journals Online (AJOL)

    Background. The causes of abdominal surgical emergencies in a particular setting may change because of alterations in demographic, socio-economic or geographical factors. We present the pattern, management and outcome of such emergencies in Zaria, Northern Nigeria. Methods. This is a retrospective review of ...

  15. Case-Cohort Studies: Design and Applicability to Hand Surgery.

    Science.gov (United States)

    Vojvodic, Miliana; Shafarenko, Mark; McCabe, Steven J

    2018-04-24

    Observational studies are common research strategies in hand surgery. The case-cohort design offers an efficient and resource-friendly method for risk assessment and outcomes analysis. Case-cohorts remain underrepresented in upper extremity research despite several practical and economic advantages over case-control studies. This report outlines the purpose, utility, and structure of the case-cohort design and offers a sample research question to demonstrate its value to risk estimation for adverse surgical outcomes. The application of well-designed case-cohort studies is advocated in an effort to improve the quality and quantity of observational research evidence in hand and upper extremity surgery. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  16. Complications of bariatric surgery: Presentation and emergency management.

    Science.gov (United States)

    Kassir, Radwan; Debs, Tarek; Blanc, Pierre; Gugenheim, Jean; Ben Amor, Imed; Boutet, Claire; Tiffet, Olivier

    2016-03-01

    The epidemic in obesity has led to an increase in number of so called bariatric procedures. Doctors are less comfortable managing an obese patient after bariatric surgery. Peri-operative mortality is less than 1%. The specific feature in the obese patient is that the classical signs of peritoneal irritation are never present as there is no abdominal wall and therefore no guarding or rigidity. Simple post-operative tachycardia in obese patients should be taken seriously as it is a WARNING SIGNAL. The most common complication after surgery is peritonitis due to anastomotic fistula formation. This occurs typically as an early complication within the first 10 days post-operatively and has an incidence of 1-6% after gastric bypass and 3-7% after sleeve gastrectomy. Post-operative malnutrition is extremely rare after restrictive surgery (ring, sleeve gastrectomy) although may occur after malabsorbative surgery (bypass, biliary pancreatic shunt) and is due to the restriction and change in absorption. Prophylactic cholecystectomy is not routinely carried out during the same procedure as the bypass. Superior mesenteric vein thrombosis after bariatric surgery is a diagnosis which should be considered in the presence of any postoperative abdominal pain. Initially a first etiological assessment is performed (measurement of antithrombin III and of protein C and protein S, testing for activated protein C resistance). If the least doubt is present, a medical or surgical consultation should be requested with a specialist practitioner in the management of obese patients as death rates increase with delayed diagnosis. Copyright © 2016 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  17. Ankle Fracture Surgery on a Pregnant Patient Complicated by Intraoperative Emergency Caesarian Section

    Directory of Open Access Journals (Sweden)

    Ran Schwarzkopf

    2013-01-01

    Full Text Available We report the case of a woman in the third trimester of pregnancy who sustained an ankle fracture dislocation that could not be adequately closed reduced. After discussions with the patient, her obstetrician, and the anesthesiologists, she was indicated for surgical fixation. A heart tone monitor was used to assess fetal health during the procedure. During surgical incision, the fetus went into distress, and an emergency caesarian section was performed. After delivery of the infant and abdominal closer, surgery was completed. Due to a cohesive team effort, both the patient and her infant had excellent outcomes. There are many important considerations in the surgical management of the pregnant patient with traumatic orthopaedic injuries. Of especial importance to the orthopaedic surgeon is the impact of patient positioning on uteroplacental blood flow. This report discusses factors that should be taken into account by any orthopaedist who plans to operate on a pregnant patient.

  18. Secondary Bleedings in Oral Surgery Emergency Service: A Cross-Sectional Study

    Directory of Open Access Journals (Sweden)

    Sebastian Igelbrink

    2018-01-01

    Full Text Available Introduction. Bleeding after dental surgery is still a common cause for emergency presentation in patients using anticoagulants. Our aim was to analyze pertinent characteristic features on the one hand and to bare existing problems in handling on the other. Materials and Methods. The study included 76 patients. We documented basic data, anticoagulant medication, type of surgery, and tooth socket sutures in respective patients. Results. The vast majority of patients took a coumarin derivative (41 and acetylsalicylic acid (27. Nine (12% of the patients had to be hospitalized due to ongoing bleeding despite local haemostyptic steps and/or circulatory dysregulation. Most patients could be successfully treated in outpatient settings. No statistically significant correlation between bleeding, level of INR value, number of extracted teeth, and sewed alveoli could be shown. Sixty-five percent of cases with tooth extractions did not have suture of tooth sockets. Eighty-seven percent of the patients denied being informed about possible self-treatment options by their surgeon/dentist, and none of the patients got presurgical-fabricated bandage plate(s. Conclusions. Patients taking coumarin derivative currently, furthermore, represent the biggest anticoagulant after-bleeding group in dentoalveolar surgery. The major part of after-bleedings (90% can be handled in an outpatient setting with simplest surgical interventions. Unfortunately, the biggest part of the patient collective got no suture, no prefabricated dental bandage plate(s, and no explanation by their dentist how to handle in case of after-bleeding. Therefore, dental practitioners should furthermore get enlightenment on how to prevent after-bleeding situations.

  19. Effect of intermediate care on mortality following emergency abdominal surgery. The InCare trial

    DEFF Research Database (Denmark)

    Vester-Andersen, Morten; Waldau, Tina; Wetterslev, Jørn

    2013-01-01

    ABSTRACT: BACKGROUND: Emergency abdominal surgery carries a 15% to 20% short-term mortality rate. Postoperative medical complications are strongly associated with increased mortality. Recent research suggests that timely recognition and effective management of complications may reduce mortality....... The aim of the present trial is to evaluate the effect of postoperative intermediate care following emergency major abdominal surgery in high-risk patients.Methods and design: The InCare trial is a randomised, parallel-group, non-blinded clinical trial with 1:1 allocation. Patients undergoing emergency...... laparotomy or laparoscopic surgery with a perioperative Acute Physiology and Chronic Health Evaluation II score of 10 or above, who are ready to be transferred to the surgical ward within 24 h of surgery are allocated to either intermediate care for 48 h, or surgical ward care. The primary outcome measure...

  20. Emerging Applications of Bedside 3D Printing in Plastic Surgery

    OpenAIRE

    Chae, Michael P.; Rozen, Warren M.; McMenamin, Paul G.; Findlay, Michael W.; Spychal, Robert T.; Hunter-Smith, David J.

    2015-01-01

    Modern imaging techniques are an essential component of preoperative planning in plastic and reconstructive surgery. However, conventional modalities, including three-dimensional (3D) reconstructions, are limited by their representation on 2D workstations. 3D printing, also known as rapid prototyping or additive manufacturing, was once the province of industry to fabricate models from a computer-aided design (CAD) in a layer-by-layer manner. The early adopters in clinical practice have embrac...

  1. Serratia marcescens endophthalmitis after pterygium surgery: a case report.

    Science.gov (United States)

    Yi, Myeong Yeon; Chung, Jin Kwon; Choi, Kyung Seek

    2017-11-02

    To report a case of Serratia marcescens endophthalmitis after pterygium surgery using the bare sclera technique with mitomycin C (MMC). A 69-year-old male patient underwent pterygium excision surgery using the bare sclera technique and 0.02% MMC. The patient presented with decreased visual acuity and pain from the day after the operation. Trans pars plana vitrectomy was performed and intravitreal antibiotics were administered. Cultures from the aqueous humor and intraocular lens were all positive for S. marcescens, which was sensitive to an empiric antibiotic regimen. The best corrected distant visual acuity, 1 month after treatment, was a finger count/50 cm, but the retinal layer structure and the vasculature were relatively well preserved. This is the first reported case of S. marcescens endophthalmitis after pterygium surgery. Endophthalmitis caused by S. marcescens has a devastating visual prognosis and may show a high clinical risk-benefit ratio for the application of MMC in pterygium surgery.

  2. Conservative cricoid surgery for chondrosarcoma: a case report.

    Science.gov (United States)

    Gaio, Elena; Maggiore, Giandomenico; Canesso, Alessandra; Artico, Riccardo

    2014-02-01

    We present the case of a 39-year-old man who presented with hoarseness and progressively worsening dyspnea. Findings on laryngoscopy and computed tomography strongly suggested the presence of a chondrosarcoma. The patient underwent open surgery for removal of the lesion with wide margins. Reconstruction was carried out with two segments of costal cartilage. Laryngeal chondrosarcomas are rare, malignant, usually well-differentiated neoplasms that should be treated with conservative surgery. Recurrences should be treated more aggressively.

  3. Non-emergency small bowel obstruction: assessment of CT findings that predict need for surgery

    Energy Technology Data Exchange (ETDEWEB)

    Deshmukh, Swati D.; Shin, David S.; Willmann, Juergen K.; Rosenberg, Jarrett; Shin, Lewis; Jeffrey, R.B. [Stanford University, School of Medicine, Department of Radiology, Stanford, CA (United States)

    2011-05-15

    To identify CT findings predictive of surgical management in non-emergency small bowel obstruction (SBO). Contrast-enhanced abdominal CT of 129 patients with non-emergency SBO were evaluated for small bowel luminal diameter, wall thickness, presence of the small bowel faeces sign (intraluminal particulate matter in a dilated small bowel) and length, transition point, submucosal oedema, mesenteric stranding, ascites and degree of obstruction (low grade partial, high grade partial and complete obstruction). Medical records were reviewed for age, gender, management and history of abdominal surgery, abdominal malignancy, or SBO. Statistical analyses were performed with Stata Release 9.2. Degree of obstruction was the only predictor of need for surgery. Whereas 18.0% of patients with low-grade partial obstruction (n = 50) underwent surgery, 32.5% of patients with high-grade partial obstruction (n = 77) and 100% of patients with complete obstruction (n = 2) required surgery (P = 0.004). The small bowel faeces sign was inversely predictive of surgery (P = 0.018). In non-emergency SBO patients with contrast-enhanced CT imaging, grade of obstruction predicts surgery, while the small bowel faeces sign inversely predicts need for surgery. (orig.)

  4. Emergency presentation of cystic lymphangioma of the colon: A case report and literature review

    Directory of Open Access Journals (Sweden)

    Luca Lepre

    2016-01-01

    Conclusion: The interest in our case lies in the relatively rare diagnosis of colon lymphangioma and how the cardinal sign was anemia, which may be due to the serosanguineous cystic contents of lymphangiomatosis from the internal bleeding and can cause fatal complications that require emergency surgery.

  5. [Suspension laryngoscopic surgery for laryngotracheal stenosis of 32 cases].

    Science.gov (United States)

    Wang, Chunyan; Qin, Yong; Xiao, Shuifang

    2014-08-01

    To investigate the efficacy of suspension laryngoscopic surgery for benign laryngotracheal stenosis (LTS). Thirty-two patients (aged from 5 to 70 years with a median of 36 years) with benign LTS were studied retrospectively who were treated by suspension laryngoscopic surgery with or without assistance of CO₂ Laser for LTS. Stents were placed in 17 cases. Among 32 patients, 13 cases were with LST in Cotton I, 8 cases in Cotton II, and 11 cases in Cotton III; 23 were with single level narrow, and 9 cases with multi-level narrow; the average narrow length was 1.3 cm and the average diameter at maximum stenosis was 0.5 cm; and 19 cases underwent tracheostomy before surgery. Follow-up period ranged from 1 to 18 years with median time of 10 years. Twenty-six patients (81.2%) were successfully decannulated with good airway patency and effective phonation. Six cases failed and 1 case of them was changed to open surgery. Among 17 cases with stent placement, 4 cases were applied additionally with T tube (effective rate of 50.0%), 1 case with laryngeal keel, 12 cases with stents alone (effective rate of 66.7%). Stent-related complications occurred in 2 cases. Patients with cotton I-II had a successful rate of 100% (21/21), while patients with Cotton III showed poor effectiveness (5/11), with a statistical significant difference between two groups (χ² = 14.098, P = 0.001). The patients with single level LTS were successfully treated by suspension laryngoscopic surgery with 100% successful rate (23/23), while the patients with multi-level LTS showed poor effectiveness (3/9), with a statistical significant difference between two groups (χ² = 18.872, P = 0.000) . Suspension laryngoscopic microsurgery can treat single level LTS with good results and also can be used as a pre-surgery in treatment of multi-level LTS with the virtue of minimal trauma and short recovery time. Application of stents can be helpful for suspension laryngoscope surgery for LST.

  6. Dexmedetomidine does not reduce emergence agitation in adults following orthognathic surgery.

    Science.gov (United States)

    Ham, S Y; Kim, J E; Park, C; Shin, M J; Shim, Y H

    2014-09-01

    Patients undergoing orthognathic surgery are at high risk of developing emergence agitation. We hypothesised that a single-dose of dexmedetomidine would reduce emergence agitation in adults with nasotracheal intubation after orthognathic surgery. Seventy adults (20-45 years old) undergoing orthognathic surgery were randomly assigned to two groups. Patients received intravenous dexmedetomidine 1 μg/kg (dex group) or normal saline (control group) for 10 min at the end of surgery. Remifentanil was infused at 0.02 μg/kg/min during emergence in both groups. The severity of emergence agitation was assessed with the Richmond agitation-sedation scale. Cough, haemodynamic and respiratory profiles, pain, and time to eye opening were evaluated. The incidence of emergence agitation was not different between dex group and control group (38% vs. 47%, P = 0.45). However, severe cough during emergence was reduced in the dex group (P = 0.04). Tachycardia during emergence and recovery phases was attenuated in the dex group. The verbal numeric rating of pain was lower in the dex group. There were no differences in respiratory rate between the two groups. Time to eye opening was prolonged in the dex group. The addition of a single dose of dexmedetomidine (1 μg/kg) to low-dose remifentanil infusion did not attenuate emergence agitation in intubated patients after orthognathic surgery compared with low-dose remifentanil infusion alone. However, single-dose dexmedetomidine suppressed coughing, haemodynamic changes, and pain during emergence and recovery phases, without respiratory depression. Delayed awakening might be associated with this treatment. © 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  7. Psychiatric Case Management in the Emergency Department.

    Science.gov (United States)

    Turner, Stephanie B; Stanton, Marietta P

    2015-01-01

    The care of the mentally ill has reached a real crisis in the United States. There were more than 6.4 million visits to emergency departments (EDs) in 2010, or about 5% of total visits, involved patients whose primary diagnosis was a mental health condition or substance abuse (). That is up 28% from just 4 years earlier, according to the latest figures available from the Agency for Healthcare Research and Quality in Rockville, MD. Using a method called scoping, the purpose of this article is to examine the range, extent, and evidence available regarding case management as an intervention in the ED to manage mental health patients, to determine whether there is sufficient quantity and quality of evidence on this topic to conduct a meta-analysis, and to identify relevant studies that balance comprehensiveness with reasonable limitations. One solution for ensuring that the costs are contained, efficiency is maintained, and quality outcomes are achieved is the placement of a case manager in the ED. According to , because the majority of hospital admissions come through the ED, it makes sense to have case managers located there to act as gatekeepers and ensure that patients who are admitted meet criteria and are placed in the proper bed with the proper status. From the scoping techniques implemented in this study, the authors came to the conclusion that case management has been and can be used to effectively treat mental health patients in the emergency room. A good number of patients with psych mental health issues are frequent visitors and repeat visitors. Case management has not been used very often as a strategy for managing patients through the ED or for follow-up after the visit. Hospitals that have developed a protocol for managing these patients outside the main patient flow have had successful results. Staff training and development on psych mental health issues have been helpful in the ED. While there are not a large number of studies available on this topic

  8. Propranolol reduces the anxiety associated with day case surgery.

    Science.gov (United States)

    Mealy, K; Ngeh, N; Gillen, P; Fitzpatrick, G; Keane, F B; Tanner, A

    1996-01-01

    To find out if propranolol, a non-cardioselective beta-blocker, can reduce the anxiety associated with day case surgery. Prospective randomized double blind trial. University hospital, Ireland. An unselected group of 53 patients undergoing day case surgery. Subjects randomised to receive either propranolol (10 mg) or placebo on the morning of operation. Blood pressure; pulse, anxiety, pain score and patient satisfaction. Mean (SD) Hospital Anxiety and Depression score was significantly lower in the propranolol group than in the control group (2.5 (0.7) compared with 4.6 (0.7), p anxiety.

  9. Delayed spinal extradural hematoma following thoracic spine surgery and resulting in paraplegia: a case report

    Directory of Open Access Journals (Sweden)

    Parthiban Chandra JKB

    2008-05-01

    Full Text Available Abstract Introduction Postoperative spinal extradural hematomas are rare. Most of the cases that have been reported occured within 3 days of surgery. Their occurrence in a delayed form, that is, more than 72 hours after surgery, is very rare. This case is being reported to enhance awareness of delayed postoperative spinal extradural hematomas. Case presentation We report a case of acute onset dorsal spinal extradural hematoma from a paraspinal muscular arterial bleed, producing paraplegia 72 hours following surgery for excision of a spinal cord tumor at T8 level. The triggering mechanism was an episode of violent twisting movement by the patient. Fresh blood in the postoperative drain tube provided suspicion of this complication. Emergency evacuation of the clot helped in regaining normal motor and sensory function. The need to avoid straining of the paraspinal muscles in the postoperative period is emphasized. Conclusion Most cases of postoperative spinal extradural hematomas occur as a result of venous bleeding. However, an arterial source of bleeding from paraspinal muscular branches causing extradural hematoma and subsequent neurological deficit is underreported. Undue straining of paraspinal muscles in the postoperative period after major spinal surgery should be avoided for at least a few days.

  10. The emergence of radiofrequency identification tags: applications in surgery.

    Science.gov (United States)

    Schwaitzberg, S D

    2006-08-01

    Radiofrequency identification (RFID) is a wireless method of automatic identification. Currently, RFID tags are emerging into our environment in many aspects of our lives. Applications are being developed in a variety of fields, including health care. Aspects of surgical care will lend themselves to this approach. This technology could provide large amounts of data that not only carry the promise of improving health care, but also may have an impact on personal aspects of our daily lives. Each of us must become familiar with the risks and benefits of RFID use.

  11. Increased mortality in the elderly after emergency abdominal surgery

    DEFF Research Database (Denmark)

    Svenningsen, Peter; Manoharan, Thukirtha; Foss, Nicolai B

    2014-01-01

    was a retrospective analysis of patient charts and perioperative documentation in an unselected consecutive cohort of 131 patients. Covariates for survival outcomes were evaluated in a multivariate analysis. No external funding and no competing interests were declared. The study was approved by The Danish Data...... within 30 days post-operatively. CONCLUSION: Acute admission and emergency laparotomy is associated with a very high mortality, especially in elderly patients. However, delay in the surgical treatment exceeding six hours is not associated with a higher mortality. There may be a considerable potential...

  12. Present status and problems of radionuclide studies in emergency cases

    International Nuclear Information System (INIS)

    Ogawa, Kiyoshi

    1983-01-01

    Scintigraphy is just right for diagnosing emergency cases due to its noninvasive and simple method, but emergency radionuclide studies have not become practical as a result of difficulty problems. Recently, nuclear medical devices have become easier to use in operations. It is become of this, that I have submitted this report regarding the problems of radionuclide studies in emergency cases. There were 101 cases (1.4 %) out of 7,310 cases for the year period Sept. 1981 - Aug. 1982. The studies consisted of 12 brain imaging cases, 9 plumonary imaging cases, 22 cardiac study cases (cardio-angiography cases 8, 99m-Tc-PYP myocardium imaging cases 12, 201-Tl myocardium imaging cases 2), 12 renal study cases, 11 G.I. blood loss cases, 35 peripheral angiography cases. In the near future, we will have to be ready to perform emergency radionuclide studies if the need arises. (author)

  13. The ACGME case log: General surgery resident experience in pediatric surgery

    Science.gov (United States)

    Gow, Kenneth W.; Drake, F. Thurston; Aarabi, Shahram; Waldhausen, John H.

    2014-01-01

    Background General surgery (GS) residents in ACGME programs log cases performed during their residency. We reviewed designated pediatric surgery (PS) cases to assess for changes in performed cases over time. Methods The ACGME case logs for graduating GS residents were reviewed from academic year (AY) 1989–1990 to 2010–2011 for designated pediatric cases. Overall and designated PS cases were analyzed. Data were combined into five blocks: Period I (AY1989–90 to AY1993–94), Period II (AY1994–95 to AY1998–99), Period III (AY1999–00 to AY2002–03), Period IV (AY2003–04 to AY2006–07), and Period V (AY2007–08 to AY2010–11). Periods IV and V were delineated by implementation of duty hour restrictions. Student t-tests compared averages among the time periods with significance at P < .05. Results Overall GS case load remained relatively stable. Of total cases, PS cases accounted for 5.4% in Period I and 3.7% in Period V. Designated pediatric cases declined for each period from an average of 47.7 in Period I to 33.8 in Period V. These changes are due to a decline in hernia repairs, which account for half of cases. All other cases contributed only minimally to the pediatric cases. The only laparoscopic cases in the database were anti-reflux procedures, which increased over time. Conclusions GS residents perform a diminishing number of designated PS cases. This decline occurred before the onset of work-hour restrictions. These changes have implications on the capabilities of the current graduating workforce. However, the case log does not reflect all cases trainees may be exposed to, so revision of this list is recommended. PMID:23932601

  14. The role of radionuclide studies in emergency cases

    International Nuclear Information System (INIS)

    Nishimura, Tsunehiko; Hayashida, Kohei; Uehara, Toshiisa

    1982-01-01

    Radionuclide studies have been performed popularly because of its noninvasive and simple method recently. In this study, we applied this technique for the evaluation of emergency cases in cardiovascular diseases. There were 93 cases (1.5%) out of 6163 cases, done during 1981. The subjects were 34 cases of cardiac studies (9 cases of sup(99m)Tc-PYP myocardial imaging, 12 cases of thallium myocardial imaging, 13 cases of cardioangiography), 23 cases of peripheral diseases (12 cases of peripheral angiography, 11 cases of venography), 16 cases of pulmonary imaging, 10 cases of renal studies (6 cases of renal angiography, 9 cases of renal imaging) and 5 cases of brain angiography. These studies were proven to be useful clinically for the evaluation of emergency cases and follow-up studies. In the near future, ''emergency radionuclide studies'' would be benefit for the high-risk patients noninvasively. (author)

  15. Geographic Diffusion and Implementation of Acute Care Surgery: An Uneven Solution to the National Emergency General Surgery Crisis.

    Science.gov (United States)

    Khubchandani, Jasmine A; Ingraham, Angela M; Daniel, Vijaya T; Ayturk, Didem; Kiefe, Catarina I; Santry, Heena P

    2018-02-01

    Owing to lack of adequate emergency care infrastructure and decline in general surgery workforce, the United States faces a crisis in access to emergency general surgery (EGS) care. Acute care surgery (ACS), an organized system of trauma, general surgery, and critical care, is a proposed solution; however, ACS diffusion remains poorly understood. To investigate geographic diffusion of ACS models of care and characterize the communities in which ACS implementation is lagging. A national survey on EGS practices was developed, tested, and administered at all 2811 US acute care hospitals providing EGS to adults between August 2015 and October 2015. Surgeons responsible for EGS coverage at these hospitals were approached. If these surgeons failed to respond to the initial survey implementation, secondary surgeons or chief medical officers at hospitals with only 1 general surgeon were approached. Survey responses on ACS implementation were linked with geocoded hospital data and national census data to determine geographic diffusion of and access to ACS. We measured the distribution of hospitals with ACS models of care vs those without over time (diffusion) and by US counties characterized by sociodemographic characteristics of county residents (access). Survey response rate was 60% (n = 1690); 272 responding hospitals had implemented ACS by 2015, steadily increasing from 34 in 2001 to 125 in 2010. Acute care surgery implementation has not been uniform. Rural regions have limited ACS access, with hospitals in counties with greater than the 75th percentile population having 5.4 times higher odds (95% CI, 1.66-7.35) of implementing ACS than hospitals in counties with less than 25th percentile population. Communities with greater percentages of adults without a college degree also have limited ACS access (OR, 3.43; 95% CI, 1.81-6.48). However, incorporating EGS into ACS models may be a potential equalizer for poor, black, and Hispanic communities. Understanding and

  16. Pediatric day case surgery: Experience from a tertiary health ...

    African Journals Online (AJOL)

    surgical service is in great demand in developing countries, and in-patient beds and surgical supplies are insufficient. Method: A ..... Day Case Surgery in Children in Ile-Ife, Nigeria-An Audit. ... as a clinical indicator for quality assurance.

  17. Use of a Combination of Regional and General Anesthesia during Emergency Thoracic Surgery

    Directory of Open Access Journals (Sweden)

    V. Kh. Sharipova

    2015-01-01

    Full Text Available Objective: to elaborate multimodal anesthetic regimens and to evaluate their efficiency during emergency thoracic surgeries for varying injuries. Subjects and methods. A total of 116 patients emergently admitted to the Republican Research Center for Emergency Medical Care for chest traumatic injuries were examined and divided into 3 groups according to the mode of anesthesia. Results. Perioperative multimodal anesthetic regimens for emergency thoracic surgery, which involved all components of the pathogenesis of pain, were elaborated. Conclusion. The combination of regional and general anesthesia contributes to the smooth course of an intra operative period with minimal hemodynamic stress and it is cost effective in decreasing the use of narcotic anal gesics in the intraoperative period. 

  18. Impact of Targeted Preoperative Optimization on Clinical Outcome in Emergency Abdominal Surgeries: A Prospective Randomized Trial.

    Science.gov (United States)

    Sethi, Ashish; Debbarma, Miltan; Narang, Neeraj; Saxena, Anudeep; Mahobia, Mamta; Tomar, Gaurav Singh

    2018-01-01

    Perforation peritonitis continues to be one of the most common surgical emergencies that need a surgical intervention most of the times. Anesthesiologists are invariably involved in managing such cases efficiently in perioperative period. The assessment and evaluation of Acute Physiology and Chronic Health Evaluation II (APACHE II) score at presentation and 24 h after goal-directed optimization, administration of empirical broad-spectrum antibiotics, and definitive source control postoperatively. Outcome assessment in terms of duration of hospital stay and mortality in with or without optimization was also measured. It is a prospective, randomized, double-blind controlled study in hospital setting. One hundred and one patients aged ≥18 years, of the American Society of Anesthesiologists physical Status I and II (E) with clinical diagnosis of perforation peritonitis posted for surgery were enrolled. Enrolled patients were randomly divided into two groups. Group A is optimized by goal-directed optimization protocol in the preoperative holding room by anesthesiology residents whereas in Group S, managed by surgery residents in the surgical wards without any fixed algorithm. The assessment of APACHE II score was done as a first step on admission and 24 h postoperatively. Duration of hospital stay and mortality in both the groups were also measured and compared. Categorical data are presented as frequency counts (percent) and compared using the Chi-square or Fisher's exact test. The statistical significance for categorical variables was determined by Chi-square analysis. For continuous variables, a two-sample t -test was applied. The mean APACHE II score on admission in case and control groups was comparable. Significant lowering of serial scores in case group was observed as compared to control group ( P = 0.02). There was a significant lowering of mean duration of hospital stay seen in case group (9.8 ± 1.7 days) as compared to control group ( P = 0

  19. [Usefulness of endovascular treatment for delayed massive epistaxis following endoscopic endonasal transsphenoidal surgery: a case report].

    Science.gov (United States)

    Oka, Tetsuo; Sugiu, Kenji; Ishida, Joji; Hishikawa, Tomohito; Ono, Shigeki; Tokunaga, Koji; Date, Isao

    2012-01-01

    We report here a case of massive nasal bleeding from the sphenopalatine artery three weeks after endonasal transsphenoidal surgery. This 66-year-old male suffered from massive nasal bleeding with the status of hypovolemic shock. Under general anesthesia, an emergent angiography revealed an extravasation from the sphenopalatine artery. Trans-arterial embolization using coil and n-butyl-cyanoacrylate (NBCA) was performed following the diagnostic angiography. Complete occlusion of the injured artery was achieved. The patient showed good recovery from general anesthesia. Delayed nasal bleeding after endonasal transsphenoidal surgery is a rare but important complication. The sphenopalatine artery and its branch are located in the hidden inferior lateral corner of the sphenoid sinus and may be injured during enlargement of the sphenoid opening. When massive delayed nasal bleeding follows transsphenoidal surgery and damage of the internal carotid artery has been ruled out, endovascular treatment of the external carotid artery should be considered.

  20. Medical emergencies in the dental surgery. Part 1: Preparation of the office and basic management.

    Science.gov (United States)

    Malamed, Stanley F

    2015-12-01

    Medical emergencies can and do happen in the dental surgery. In the 20- to 30-year practice lifetime of the typical dentist, he/she will encounter between five and seven emergency situations. Being prepared in advance of the emergency increases the likelihood of a successful outcome. PURPOSE OF THE PAPER: To prepare members of the dental office staff to be able to promptly recognize and efficiently manage those medical emergency situations that can occur in the dental office environment. Preparation of the dental office to promptly recognize and efficiently manage medical emergencies is predicated on successful implementation of the following four steps: basic life support for ALL members of the dental office staff; creation of a dental office emergency team; activation of emergency medial services (EMS) when indicated; and basic emergency drugs and equipment. The basic emergency algorithm (P->C->A->B->D) is designed for implementation in all emergency situations. Prompt implementation of the basic emergency management protocol can significantly increase the likelihood of a successful result when medical emergencies occur in the dental office environment.

  1. Surgical outcome and clinical profile of emergency versus elective cases of colorectal cancer in College of Medical Sciences, Nepal

    Directory of Open Access Journals (Sweden)

    Sujit Kumar

    2014-01-01

    Full Text Available Background: Patients who undergo emergency colorectal cancer surgery has poor outcome compared to elective surgery, both in terms of morbidity and mortality. Approximately 15 to 30% of colorectal cancers present as an emergency, most often as obstruction or perforation. Objective: To compare surgical outcome and clinical profiles of emergency and elective cases for colorectal cancer. Methods: Retrospective analysis of 34 cases who underwent surgery for colorectal cancer between December 2011 to January 2013was carried out and their surgical outcomes, clinical presentation, demographic profile were analyzed. Results: The total numbers of patients included in this study were 34. Out of which 52.94 %( n=18 were emergency cases and 47.05 %( n=16 were elective. Male female ratio was 3:1 in emergency cases and 2.6:1 in elective cases. Per rectal bleeding (56% and altered bowel habit (31.25% was predominant clinical presentation in elective cases whereas intestinal obstruction (55.55% and peritonitis (22.22% were predominant clinical presentation in emergency cases. In emergency cases most of the tumors were located in left side (77.77% and in elective cases rectum was common site (37.5%. Left hemicolectomy was the commonest surgery performed (72.22% in emergency set up. In elective cases, right hemicolectomy, left hemicolectomy, APR and LAR was done in 31.25%, 31.25%, 25% and 25% cases respectively. In the emergency group 11.11% (n=2 developed enterocutaneous fistula and early mortality within 30 days was observed in 5% (n=1 of emergency cases only. Conclusion: In emergency conditions, colorectal cancer presented with intestinal obstruction where as elective cases presented with per rectal bleeding and altered bowel habits. Compared with the elective patients, the emergency patients had higher rate of morbidity and mortality. Because of higher incidence of colorectal cancer in our institution, in all emergency cases who presents with features of

  2. Emerging risks and outcomes of blood transfusion in surgery.

    Science.gov (United States)

    Shander, Aryeh

    2004-01-01

    Prior to 1900, blood transfusions were fraught with danger and often caused more complications than the underlying disease. Discovery of the ABO compatibility system in the early twentieth century opened the modern era of blood transfusion, yet ABO incompatibility-as a result of clerical error-remains a significant threat to the recipient today. The risk of disease transmission now includes new and emerging agents, such as Trepanosoma cruzii and West Nile Virus (WNV), as well as other existing pathogens. Transfusion-related immunomodulation (TRIM) presents a further risk to recipient patients. Confounding these problems are shortages of safe blood and the accelerated rise in the cost of blood due to increased testing. Outcome data on transfusion therapy have not always been favorable, particularly in the areas of postoperative infection, systemic inflammatory response syndrome (SIRS), multiple organ failure (MOF), and mortality. Such data have generated extensive efforts to determine association versus underlying cause of post-transfusion complications. In addition, unprecedented global initiatives to minimize the use of allogeneic blood are on the way. Options may include, but are not limited to, the use of "blood substitutes," although validation of such products is still required. In the meantime, blood product conservation techniques should become part of routine transfusion medicine.

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

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Razeghinejad

    2016-09-01

    Full Text Available 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.

  4. [Medical negligence in surgery: 112 cases retrospective analysis].

    Science.gov (United States)

    Xiang, Jian; Chang, Lin; Wang, Xu; Zhang, Feng-Qin

    2013-06-01

    To explore the general characteristics of medical negligence in surgery in order to provide the reference for forensic practices. One hundred and twelve cases of medical negligence in surgical department were retrospectively analyzed in Fada Institute of Forensic Medicine and Science from 2008 to 2010. The common types of medical negligence cases in the surgery were improper operation procedure (28.57%), failure of consent (26.79%), and inadequate monitoring (22.32%). The results of complications included disability or functional impairment (61.61%), death (31.25%) and transient impairment with no obvious adverse reactions (7.14%). The most common roles played by the medical negligence cases were minor role (26.79%), equal role (19.64%), and slight role (14.29%). Significant attention should be paid to the operation procedure, consent, and monitoring. It should be cautious to not make assessment on involvement degree of medical negligence.

  5. Surgical management of acutely presenting gastrointestinal stromal tumors of the stomach among elderly: experience of an emergency surgery department.

    Science.gov (United States)

    Marano, Luigi; Arru, Giovanni Maria Antonio; Piras, Mario; Fiume, Stefania; Gemini, Sergio

    2014-01-01

    The incidence of gastrointestinal stromal tumors (GISTs), requiring often an emergency surgical management, is extremely rare among elderly. We aimed to present the experience of the Emergency Surgery Department, Brotzu Hospital, in the management of elderly patients with GIST related emergencies. This study was carried out on 12 patients with gastrointestinal stromal tumors who presented to in an emergency situation during the period from January 2010 to December 2013. All patients' data, clinical presentations, surgical procedures, complications, and survival data were collected and analyzed. Between 2010 and 2013, 12 patients (8 males and 4 females), with a mean age of 70 years (range: 65-79 years) were admitted with different emergency presentations of clinically and radiologically suspected GISTs. The incidence of proximal obstruction was 41.7% of all gastric GIST cases, resulting acute gastrointestinal bleeding and perforation in 41.7% and 16.6% respectively. The mean length of hospitalization was 9.1 ± 2.3 days and there were no posterative complications or mortalities. At a mean follow-up of 21 months, 11 patients (91.6%) were alive and disease free. Although GISTs are uncommon among elderly, their incidence is increasing especially in their emergency presentation and surgeon should be prepared to treat this condition following the principles of GIST surgery as stated by the GIST consensus conference. In conclusion our data demonstrate that age itself does not affect the outcome of surgical treatment of GISTs in emergency situation. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  6. Case review analysis of operating room decisions to cancel surgery.

    Science.gov (United States)

    Chang, Ju-Hsin; Chen, Ke-Wei; Chen, Kuen-Bao; Poon, Kin-Shing; Liu, Shih-Kai

    2014-07-23

    Cancellation of surgery close to scheduled time causes a waste of healthcare resources. The current study analyzes surgery cancellations occurring after the patient has been prepared for the operating room, in order to see whether improvements in the surgery planning process may reduce the number of cancellations. In a retrospective chart review of operating room surgery cancellations during the period from 2006 to 2011, cancellations were divided into the following categories: inadequate NPO; medical; surgical; system; airway; incomplete evaluation. The relative use of these reasons in relation to patient age and surgical department was then evaluated. Forty-one percent of cancellations were for other than medical reasons. Among these, 17.7% were due to incomplete evaluation, and 8.2% were due to family issues. Sixty seven percent of cancelled cases eventually received surgery. The relative use of individual reasons for cancellation varied with patient age and surgical department. The difference between cancellations before and after anesthesia was dependent on the causes of cancellation, but not age, sex, ASA status, or follow-up procedures required. Almost half of the cancellations were not due to medical reasons, and these cancellations could be reduced by better administrative and surgical planning and better communication with the patient and/or his family.

  7. Case report: Anesthesia management for emergency cesarean section in a patient with dwarfism.

    Science.gov (United States)

    Li, Xiaoxi; Duan, Hongjun; Zuo, Mingzhang

    2015-04-28

    Dwarfism is characterized by short stature. Pregnancy in women with dwarfism is uncommon and cesarean section is generally indicated for delivery. Patients with dwarfism are high-risk population for both general and regional anesthesia, let alone in an emergency surgery. In this case report we present a 27-year-old Chinese puerpera with dwarfism who underwent emergency cesarean section under combined spinal and epidural anesthesia. It is an original case report, which provides instructive significance for anesthesia management especially combined spinal and epidural anesthesia in this rare condition. There was only one former article that reported a puerpera who underwent combined spinal and epidural anesthesia for a selective cesarean section.

  8. Self-expandable metallic stent as a bridge to elective surgery versus emergency surgery for acute malignant colorectal obstruction.

    Science.gov (United States)

    Li, Zhi-Xiong; Wu, Xiao-Hua; Wu, Hai-yan; Chang, Wen-Ju; Chang, Xiu-juan; Yi, Tuo; Shi, Qiang; Chen, Jing-Wen; Feng, Qing-Yang; Zhu, De-Xiang; Wei, Ye; Zhong, Yun-Shi; Xu, Jian-Min

    2016-03-01

    The efficacy and safety of self-expandable metallic stents (SEMSs) as a bridge for patients with acute malignant colorectal obstructions (AMCOs) are still controversial. We conducted this study to evaluate the outcomes of patients with AMCOs treated by different strategies. From January 2010 to March 2014, a total of 171 patients with AMCOs from Zhongshan Hospital were retrospectively enrolled in this study. One hundred twenty patients successfully received stent placement followed by one-stage laparoscopic or open resection in the stent group, and 51 patients received emergency operations in the emergency group. The operation duration and postoperative hospital stay were significantly shorter in the stent group (114.51 ± 28.65 vs. 160.39 ± 58.94 min, P stent group also had significantly reduced intraoperative blood loss and the incidence of postoperative complications compared with the emergency group (61.00 ± 43.70 vs. 121.18 ± 85.90 ml, P stent group was significantly longer than that in the emergency group (53 vs. 41 months, P = 0.034). In subgroup analysis of stent group, the stent laparoscopy group had significantly decreased postoperative complications (P = 0.025), and similar long-term survival (P = 0.81). Stent placement as a bridge to surgery is a safe and feasible procedure and provides significant advantages in terms of short-term outcomes and favorable prognoses for patients with AMCOs. Laparoscopic surgery could be considered as an optimal treatment after stent placement.

  9. The financial burden of emergency general surgery: National estimates 2010 to 2060.

    Science.gov (United States)

    Ogola, Gerald O; Gale, Stephen C; Haider, Adil; Shafi, Shahid

    2015-09-01

    Adoption of the acute care surgery model has led to increasing volumes of emergency general surgery (EGS) patients at trauma centers. However, the financial burden of EGS services on trauma centers is unknown. This study estimates the current and future costs associated with EGS hospitalization nationwide. We applied the American Association for the Surgery of Trauma's DRG International Classification of Diseases-9th Rev. criteria for defining EGS to the 2010 National Inpatient Sample (NIS) data and identified adult EGS patients. Cost of hospitalization was obtained by converting reported charges to cost using the 2010 all-payer inpatient cost-to-charge ratio for all hospitals in the NIS database. Cost was modeled via a log-gamma model in a generalized linear mixed model to account for potential correlation in cost within states and hospitals in the NIS database. Patients' characteristics and hospital factors were included in the model as fixed effects, while state and hospital were included as random effects. The national incidence of EGS was calculated from NIS data, and the US Census Bureau population projections were used to estimate incidence for 2010 to 2060. Nationwide costs were obtained by multiplying projected incidences by estimated costs and reported in year 2010 US dollar value. Nationwide, there were 2,640,725 adult EGS hospitalizations in 2010. The national average adjusted cost per EGS hospitalization was $10,744 (95% confidence interval [CI], $10,615-$10,874); applying these cost data to the national EGS hospitalizations gave a total estimated cost of $28.37 billion (95% CI, $28.03-$28.72 billion). Older age groups accounted for greater proportions of the cost ($8.03 billion for age ≥ 75 years, compared with $1.08 billion for age 18-24 years). As the US population continues to both grow and age, EGS costs are projected to increase by 45% to $41.20 billion (95% CI, $40.70-$41.7 billion) by 2060. EGS constitutes a significant portion of US health

  10. Orthognathic Surgery: Planning and treatment with illustration on six cases

    International Nuclear Information System (INIS)

    AiRuhaimi, K; Nwoku, A. L; Shaikh, H. S

    1991-01-01

    Almost all conferences for plastic and maxillofacial surgery discuss reports on several methods of orthognathic surgery, planning, success results, and complications of the different procedures carried out to correct patient's soft and hard tissues frontal profiles and occlusal discrepancies. Various principles are involved in the diagnosis and treatment of facial deformities. However, the most important consideration, after all, is the final accepted aesthetic and functional requirements and stability of the moved segments. The objective of this paper is to give the basic principles of treatment planning for correcting facial discrepancies, surgical approach to different cases, and the methods to increase stability of the moved segments. Six cases are included to illustrate the different aspects of treatment planning, surgical management, and stabilization methods. (author)

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

    Science.gov (United States)

    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. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  12. Assessment of emergency general surgery care based on formally developed quality indicators.

    Science.gov (United States)

    Ingraham, Angela; Nathens, Avery; Peitzman, Andrew; Bode, Allison; Dorlac, Gina; Dorlac, Warren; Miller, Preston; Sadeghi, Mahsa; Wasserman, Deena D; Bilimoria, Karl

    2017-08-01

    Emergency general surgery outcomes vary widely across the United States. The utilization of quality indicators can reduce variation and assist providers in administering care aligned with established recommendations. Previous quality indicators have not focused on emergency general surgery patients. We identified indicators of high-quality emergency general surgery care and assessed patient- and hospital-level compliance with these indicators. We utilized a modified Delphi technique (RAND Appropriateness Methodology) to develop quality indicators. Through 2 rankings, an expert panel ranked potential quality indicators for validity. We then examined historic compliance with select quality indicators after 4 nonelective procedures (cholecystectomy, appendectomy, colectomy, small bowel resection) at 4 academic centers. Of 25 indicators rated as valid, 13 addressed patient-level quality and 12 addressed hospital-level quality. Adherence with 18 indicators was assessed. Compliance with performing a cholecystectomy for acute cholecystitis within 72 hours of symptom onset ranged from 45% to 76%. Compliance with surgery start times within 3 hours from the decision to operate for uncontained perforated viscus ranged from 20% to 100%. Compliance with exploration of patients with small bowel obstructions with ischemia/impending perforation within 3 hours of the decision to operate was 0% to 88%. For 3 quality indicators (auditing 30-day unplanned readmissions/operations for patients previously managed nonoperatively, monitoring time to source control for intra-abdominal infections, and having protocols for bypass/transfer), none of the hospitals were compliant. Developing indicators for providers to assess their performance provides a foundation for specific initiatives. Adherence to quality indicators may improve the quality of emergency general surgery care provided for which current outcomes are potentially modifiable. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. A comparative study of short- and medium-term outcomes comparing emergent surgery and stenting as a bridge to surgery in patients with acute malignant colonic obstruction.

    LENUS (Irish Health Repository)

    Kavanagh, Dara O

    2013-04-01

    The use of self-expanding metal stents as a bridge to surgery in the setting of malignant colorectal obstruction has been advocated as an acceptable alternative to emergency surgery. However, concerns about the safety of stenting have been raised following recent randomized studies.

  14. Bariatric Surgery for Adolescents with Type 2 Diabetes: an Emerging Therapeutic Strategy.

    Science.gov (United States)

    Stefater, M A; Inge, T H

    2017-08-01

    Type 2 diabetes (T2D) is a growing public health problem in youth, but conventional treatments are often insufficient to treat this disease and its comorbidities. We review evidence supporting an emerging role for bariatric surgery as a treatment for adolescent T2D. Paralleling what has been seen in adult patients, bariatric surgery dramatically improves glycemic control in patients with T2D. In fact, remission of T2D has been observed in as many as 95-100% of adolescents with diabetes after bariatric surgery, particularly vertical sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB) surgery. This striking outcome may be due to both weight-dependent- and weight-independent factors, and recent studies suggest that T2D-related comorbidities may also improve after surgery. Bariatric surgery including RYGB and VSG is a powerful therapeutic option for obese adolescents with T2D. Benefits must be weighed against risk for postoperative complications such as nutritional deficiencies, but earlier surgical intervention might lead to more complete metabolic remission in obese patients with T2D.

  15. Bilateral corneal denting after surgery under general anesthesia: A case report

    Directory of Open Access Journals (Sweden)

    Satsuki Obata

    2018-06-01

    Full Text Available Purpose: To report a case of temporary bilateral corneal denting in a patient who underwent cardiovascular surgery under general anesthesia. Observations: A 71-year-old male with no history of ophthalmological disease experienced bilateral corneal denting immediately after undergoing surgery for aneurysm of the thoracic aorta under general anesthesia. Anesthesia was induced with propofol and maintained with rocuronium bromide and remifentanil hydrochloride. The initial examination revealed significant denting on the surface of both the corneas and ocular hypotension. Visual evaluation could not be performed due to the patient's low level of consciousness resulting from delayed emergence from anesthesia. After applying tropicamide and phenylephrine ophthalmic solution for fundus examination, the ocular morphology improved. Ocular pressure was normal on the day after surgery, and creasing on the surface of the corneas had disappeared. Conclusions: and Importance: We experienced a patient with bilateral corneal denting following a cardiovascular surgery under general anesthesia. The dents could be attributed to augmentation of ocular hypotension using several types of anesthesia at relatively high doses. Keywords: General anesthesia, Cornea denting, Complication, Cardiovascular surgery

  16. Difficult airway management with bonfils fiberscope in case of emergency: acute abdomen with ileus.

    Science.gov (United States)

    Maldini, Branka; Novotny, Zdenko; Letica-Brnadić, Renata; Brkljacić, Ana; Bartolek, Dubravka

    2012-09-01

    This clinical report describes an emergency case of a 49-year-old man, ASA E III status, with clinical symptoms of acute abdomen and ileus, who was scheduled for urgent surgery. Predictors of difficult intubation (Mallampati test Class III, short thyro-mental (management decided on one attempt of Bonfils fiberoptic intubation as primary intervention and urgent tracheotomy, if needed, as secondary intervention. Immediately after assuming supine position on the operating table, the patient lost consciousness and cardiac arrest developed. Successful intubation with oxygenation was followed by cardiopulmonary resuscitation. Upon stabilization of the patient's vital functions, urgent surgery was performed. In the emergency case presented, we succeeded quickly to secure the airway with Bonfils fiberoptic intubation, which allowed for appropriate oxygenation and starting resuscitation. The high risk of the possible aspiration was avoided by timely provision of airway in the experienced anesthetist's hands.

  17. Accidental ovarian autograft after a laparoscopic surgery: case report.

    Science.gov (United States)

    Marconi, G; Quintana, R; Rueda-Leverone, N G; Vighi, S

    1997-08-01

    To report an autograft of ovarian tissue in the incision of the surgical trocar during laparoscopic surgery and to assess the potentiality of grafting of ovarian parenchyma in nonpelvic tissue in humans. A case report. Instituto de Fertilidad y Ginecología de Buenos Aires (IFER), Buenos Aires, Argentina. Infertile patient undergoing surgery due to an endometriotic cyst of the left ovary. Laparoscopic cystectomy. Accidental retention of a portion of the capsule and adjacent ovarian tissue of the endometrioma in SC cellular tissue. Months after surgery, a SC tumor was formed under the surgical incision. It was subsequently excised. Observation of tumor growth during menstrual cycles and ovulation induction; anatomopathologic study of the tissue after its extirpation. The tumor grew spontaneously in the periovulatory period and during treatments of ovulation induction. The anatomopathologic report of the tumor, removed 15 months after the first surgery, revealed functioning ovarian tissue with vessels of neoformation. This is the first description of autografted ovarian tissue in humans. We describe that the ovary can maintain its ovulatory function even in the absence of its pedicel. Also, we suggest that extirpation of surgical material through the incision of the trocar is not recommended, as the possibility of "sowing" or of autografts may occur.

  18. Endoscopy-guided vitreoretinal surgery following penetrating corneal injury: a case report

    Directory of Open Access Journals (Sweden)

    Motoko Kawashima

    2010-08-01

    Full Text Available Motoko Kawashima1, Shinichi Kawashima2, Murat Dogru1,3, Makoto Inoue4, Jun Shimazaki1,51Department of Ophthalmology, Tokyo Dental College, Chiba, Japan; 2Department of Ophthalmology, International University of Health and Welfare, Tokyo, Japan; 3Department of Ocular Surface and Visual Optics, Keio University School of Medicine, Tokyo, Japan; 4Kyorin Eye Center, Tokyo, Japan; 5Department of Ophthalmology, Keio University School of Medicine, Tokyo, JapanIntroduction: Severe ocular trauma requires emergency surgery, and a fresh corneal graft may not always be available. We describe a case of perforating eye injury with corneal ­opacity, suspected endophthalmitis, and an intraocular foreign body. The patient was successfully treated with a two-step procedure comprising endoscopy-guided vitrectomy followed by corneal transplantation. This surgical technique offers a good option to vitrectomy with simultaneous keratoplasty in emergency cases where no graft is immediately available and there is the ­possibility of infection due to the presence of a foreign body.Case presentation: A 55-year-old Japanese woman was referred to our hospital with a ­perforating corneal and lens injury sustained with a muddy ferrous rod. Primary corneal sutures and lensectomy were performed immediately. Vitreoretinal surgery was required due to ­suspected endophthalmitis, vitreous hemorrhage, retinal detachment, dialysis and necrosis of the peripheral retina. Instead of conventional vitrectomy, endoscopy-guided vitreous surgery was performed with the Solid Fiber Catheter AS-611 (FiberTech, Tokyo, Japan due to the presence of corneal opacity and the unavailability of a donor cornea. The retina was successfully attached with the aid of a silicon oil tamponade. Following removal of the silicon oil at 3 months after surgery, penetrating keratoplasty and intraocular lens implantation with ciliary sulcus suture fixation were performed. At 6 months after penetrating

  19. Variability of Arthroscopy Case Volume in Orthopaedic Surgery Residency.

    Science.gov (United States)

    Gil, Joseph A; Waryasz, Gregory R; Owens, Brett D; Daniels, Alan H

    2016-05-01

    To examine orthopaedic surgery case logs for arthroscopy case volume during residency training and to evaluate trends in case volume and variability over time. Publicly available Accreditation Council for Graduate Medical Education surgical case logs from 2007 to 2013 for orthopaedic surgery residency were assessed for variability and case volume trends in shoulder, elbow, wrist, hip, knee, and ankle arthroscopy. The national average number of procedures performed in each arthroscopy category reported was directly compared from 2009 to 2013. The 10th and 90th percentile arthroscopy case volume was compared between 2007 and 2013 for shoulder and knee arthroscopy procedures. Subsequently, the difference between the 10th and 90th percentile arthroscopy case volume in each category in 2007 was compared with the difference between the 10th and 90th percentile arthroscopy case volume in each category in 2013. From 2007 to 2013, shoulder arthroscopy procedures performed per resident increased by 43.1% (P = .0001); elbow arthroscopy procedures increased by 28.0% (P = .00612); wrist arthroscopy procedures increased by 8.6% (P = .05); hip arthroscopy procedures, which were first reported in 2012, increased by 588.9%; knee arthroscopy procedures increased by 8.5% (P = .0435); ankle arthroscopy increased by 27.6% (P = .00149). The difference in knee and shoulder arthroscopy volume between residents in the 10th and 90th percentile in 2007 and residents in the 10th and 90th percentile in 2013 was not significant (P > .05). There was a 3.66-fold difference in knee arthroscopy volume between residents in the 10th and 90th percentile in 2007, whereas the difference was 3.36-fold in 2013 (P = .70). There was a 5.86-fold difference in shoulder arthroscopy case volume between residents in the 10th and 90th percentile in 2007, whereas the difference was 4.96-fold in 2013 (P = .29). The volume of arthroscopy cases performed by graduating orthopaedic surgery residents has

  20. Results of emergency surgery in patients with Moschowitz's disease refractory to hematological treatment: is splenectomy always advisable?

    Science.gov (United States)

    Caronna, R; Cardi, M; Meloni, G; Mangioni, S; Spera, G; Benedetti, M; Frantellizzi, V; Layek, D; Catinelli, S; Schiratti, M; Chirletti, P

    2005-01-01

    Patients with thrombotic thrombocytopenic purpura (TTP), Moschowitz's disease, run a high risk of perioperative bleeding and need intensive hematologic support. In some patients, TTP is associated with cancer but the surgical role in these patients is still unclear. To illustrate the surgical problems and outcome we present the case histories of three patients with TTP observed in our emergency department. Two patients had TTP secondary to cancer and one patient with primary TTP (no evidence of neoplasia) had emergency operation for gastric hemorrhage, occlusion and TTP unresponsive to plasmapheresis. The first two patients who had not radical resection of cancer and no splenectomy, died for TTP complications. The third patient who underwent emergency splenectomy, had an uneventful postoperative course and TTP completely regressed. These case reports suggest that patients with TTP should be screened to rule out cancer. In patients with acute cancer-related complications emergency surgery should aim to resect the cancer. An associated splenectomy may increase the effectiveness of postoperative hematologic therapy.

  1. Emergency surgery due to complications during molecular targeted therapy in advanced gastrointestinal stromal tumors (GIST)

    International Nuclear Information System (INIS)

    Rutkowski, P.; Nowecki, Z. I.; Dziewirski, W.; Ruka, W.; Siedlecki, J. A.; Grzesiakowska, U.

    2010-01-01

    Aim. The aim of the study was to assess the frequency and results of disease/treatment-related emergency operations during molecular targeted therapy of advanced gastrointestinal stromal tumors (GISTs). Methods. We analyzed emergency operations in patients with metastatic/inoperable GISTs treated with 1 st -line imatinib - IM (group I: 232 patients; median follow-up time 31 months) and 2 nd -line sunitinib - SU (group II: 43 patients; median follow-up 13 months; 35 patients in trial A6181036) enrolled into the Polish Clinical GIST Registry. Results. In group I 3 patients (1.3%) underwent emergency surgery due to disease/treatment related complications: one due to bleeding from a ruptured liver tumor (1 month after IM onset) and two due to bowel perforation on the tumor with subsequent intraperitoneal abscess (both 2 months after IM onset). IM was restarted 5-8 days after surgery and no complications in wound healing were observed. In group II 4 patients (9.5%) underwent emergency operations due to disease/treatment related complications: three due to bowel perforations on the tumor (2 days, 20 days and 10 months after SU onset; 1 subsequent death) and one due to intraperitoneal bleeding from ruptured, necrotic tumor (3.5 months after SU start). SU was restarted 12-18 days after surgery and no complications in wound healing were observed. Conclusions. Emergency operations associated with disease or therapy during imatinib treatment of advanced GISTs are rare. The frequency of emergency operations during sunitinib therapy is considered to be higher than during first line therapy with imatinib which may be associated with more advanced and more resistant disease or to the direct mechanism of sunitinib action, i.e. combining cytotoxic and antiangiogenic activity and thus leading to dramatic tumor response. Molecular targeted therapy in GISTs should always be conducted in cooperation with an experienced surgeon. (authors)

  2. Clinicopathological analysis of colorectal cancer: a comparison between emergency and elective surgical cases.

    Science.gov (United States)

    Ghazi, Sam; Berg, Elisabeth; Lindblom, Annika; Lindforss, Ulrik

    2013-06-11

    Approximately 15 to 30% of colorectal cancers present as an emergency, most often as obstruction or perforation. Studies report poorer outcome for patients who undergo emergency compared with elective surgery, both for their initial hospital stay and their long-term survival. Advanced tumor pathology and tumors with unfavorable histologic features may provide the basis for the difference in outcome. The aim of this study was to compare the clinical and pathologic profiles of emergency and elective surgical cases for colorectal cancer, and relate these to gender, age group, tumor location, and family history of the disease. The main outcome measure was the difference in morphology between elective and emergency surgical cases. In total, 976 tumors from patients treated surgically for colorectal cancer between 2004 and 2006 in Stockholm County, Sweden (8 hospitals) were analyzed in the study. Seventeen morphological features were examined and compared with type of operation (elective or emergency), gender, age, tumor location, and family history of colorectal cancer by re-evaluating the histopathologic features of the tumors. In a univariate analysis, the following characteristics were found more frequently in emergency compared with elective cases: multiple tumors, higher American Joint Committee on Cancer (AJCC), tumor (T) and node (N) stage, peri-tumor lymphocytic reaction, high number of tumor-infiltrating lymphocytes, signet-ring cell mucinous carcinoma, desmoplastic stromal reaction, vascular and perineural invasion, and infiltrative tumor margin (Pemergency case generally show a more aggressive histopathologic profile and a more advanced stage than do elective cases. Essentially, no difference was seen in location, and therefore it is likely there would be no differences in macro-environment either. Our results could indicate that colorectal cancers needing emergency surgery belong to an inherently specific group with a different etiologic or genetic

  3. The laparoscopic approach in emergency surgery: A review of the literature

    Directory of Open Access Journals (Sweden)

    Ionut Negoi

    2018-01-01

    Full Text Available The role of laparoscopy in the acute care surgery had significantly increased during the latest years, both as a diagnostic and treatment method of all the upper or lower gastrointestinal pathologies. The objective of the present research is to review the current indications for laparoscopy in bdominal emergencies and to detail the benefits and complications associated with this approach. We have reviewed the relevant literature about this topic published between January 2005 and December 2017, using the PubMed/Medline and Web of Science Core Collection databases. According to the current evidence, we may conclude that the laparoscopic approach is an integral part of the emergency surgery for all the abdominal pathologies. Although laparoscopy requires specialized training and curricula, it brings all the benefits of minimal access in acute care arena.

  4. Emergency Cervical Cerclage: A Case Series

    Directory of Open Access Journals (Sweden)

    Arzu Doruk

    2011-06-01

    Full Text Available OBJECTIVE: To observe the effect of the emergency cervical cerclage on the duration of pregnancy in the patient with cervical insufficiency METHOD: Thirteen pregnant women between 22-28 th gestational age treated with emergency cerclage were included in the study. Mc Donald technic was perfomed to in all patients. RESULTS: Among the patients,7 women were delivered between 25-32th weeks, and 4 patients were followed beyond the 34th week. CONCLUSION: Ultrasonographic screening to determine cervical insufficiency among the patient in the risk group should be done at 14-20th weeks for the first time. Emergency cerclage can be considered in patient without contractions or chorioamnionitis, if there is any evidence of cervical dilatation at pelvic examination.

  5. Revision surgery due to magnet dislocation in cochlear implant patients: an emerging complication.

    Science.gov (United States)

    Hassepass, Frederike; Stabenau, Vanessa; Maier, Wolfgang; Arndt, Susan; Laszig, Roland; Beck, Rainer; Aschendorff, Antje

    2014-01-01

    To analyze the cause and effect of magnet dislocation in cochlear implant (CI) recipients requiring magnet revision surgery for treatment. Retrospective study. Tertiary referral center. Case reports from 1,706 CI recipients consecutively implanted from January 2000 to December 2011 were reviewed. The number of cases requiring magnet revision surgery was assessed. Revision surgery involving magnet removal or replacement was indicated in 1.23% (21/1,706), of all CI recipients. Magnet dislocation occurring during magnetic resonance tomography (MRI), at 1.5 Tesla (T), with the magnet in place and with the application of compression bandaging around the head, was the main cause for revision surgery in 47.62% (10/21) of the affected cases. All 10 cases were implanted with Cochlear Nucleus cochlear implants. These events occurred, despite adherence to current recommendations of the manufacturer. The present study underlines that MRI examination is the main cause of magnet dislocation. The use of compressive bandaging when using 1.5-T MRI does not eliminate the risk of magnet dislocation. Additional cautionary measures are for required for conditional MRI. We recommend X-ray examination after MRI to determine magnet dislocation and avoid major complications in all cases reporting pain during or after MRI. Additional research regarding silicon magnet pocket design for added retention is needed. Effective communication of guidelines for precautionary measures during MRI examination in CI patients is mandatory for all clinicians involved. MRI in CI recipients should be indicated with caution.

  6. Process mapping as a framework for performance improvement in emergency general surgery.

    Science.gov (United States)

    DeGirolamo, Kristin; D'Souza, Karan; Hall, William; Joos, Emilie; Garraway, Naisan; Sing, Chad Kim; McLaughlin, Patrick; Hameed, Morad

    2018-02-01

    Emergency general surgery conditions are often thought of as being too acute for the development of standardized approaches to quality improvement. However, process mapping, a concept that has been applied extensively in manufacturing quality improvement, is now being used in health care. The objective of this study was to create process maps for small bowel obstruction in an effort to identify potential areas for quality improvement. We used the American College of Surgeons Emergency General Surgery Quality Improvement Program pilot database to identify patients who received nonoperative or operative management of small bowel obstruction between March 2015 and March 2016. This database, patient charts and electronic health records were used to create process maps from the time of presentation to discharge. Eighty-eight patients with small bowel obstruction (33 operative; 55 nonoperative) were identified. Patients who received surgery had a complication rate of 32%. The processes of care from the time of presentation to the time of follow-up were highly elaborate and variable in terms of duration; however, the sequences of care were found to be consistent. We used data visualization strategies to identify bottlenecks in care, and they showed substantial variability in terms of operating room access. Variability in the operative care of small bowel obstruction is high and represents an important improvement opportunity in general surgery. Process mapping can identify common themes, even in acute care, and suggest specific performance improvement measures.

  7. Sarcopenia is a predictor of outcomes in very elderly patients undergoing emergency surgery.

    Science.gov (United States)

    Du, Yang; Karvellas, Constantine J; Baracos, Vickie; Williams, David C; Khadaroo, Rachel G

    2014-09-01

    With the increasing aging population, the number of very elderly patients (age ≥80 years) undergoing emergency operations is increasing. Evaluating patient-specific risk factors for postoperative morbidity and mortality in the acute care surgery setting is crucial to improving outcomes. We hypothesize that sarcopenia, a severe depletion of skeletal muscles, is a predictor of morbidity and mortality in very elderly patients undergoing emergency surgery. A total of 170 patients older than the age of 80 underwent emergency surgery between 2008 and 2010 at a tertiary care facility; 100 of these patients had abdominal computed tomography images within 30 days of the operation that were adequate for the assessment of sarcopenia. The impact of sarcopenia on the operative outcomes was evaluated using both univariate and multivariate analysis. The mean patient age was 84 years, with an in-hospital mortality of 18%. Sarcopenia was present in 73% of patients. More sarcopenic patients had postoperative complications (45% sarcopenic versus 15% nonsarcopenic, P = .005) and more died in hospital (23 vs 4%, P = .037). There were no differences in duration of stay or requirement for intensive care unit postoperatively. After we controlled for confounding factors, increasing skeletal muscle index (per incremental cm(2)/m(2)) was associated with decreased in-hospital mortality (odds ratio ∼0.834, 95% confidence interval 0.731-0.952, P = .007) in multivariate analysis. Sarcopenia was independently predictive of greater complication rates, discharge disposition, and in-hospital mortality in the very elderly emergency surgery population. Using sarcopenia as an objective tool to identify high-risk patients would be beneficial in developing tailored preventative strategies and potentially resource allocation in the future. Copyright © 2014 Mosby, Inc. All rights reserved.

  8. Type of incision does not predict abdominal wall outcome after emergency surgery for colonic anastomotic leakage

    DEFF Research Database (Denmark)

    Jensen, Kristian Kiim; Oma, Erling; Harling, Henrik

    2017-01-01

    for anastomotic leakage were included with a median follow-up of 5.4 years. Incisional hernia occurred in 41 of 227 (15.3%) patients undergoing midline incision compared with 14 of 81 (14.7%) following transverse incision, P = 1.00. After adjusting for confounders, there was no association between the type...... not predict abdominal wall outcome after emergency surgery for colonic anastomotic leakage....

  9. Bilateral postoperative maxillary cysts after orthognathic surgery: A case report

    International Nuclear Information System (INIS)

    Lee, Jung Hye; Huh, Kyung Hoe; Yi, Won Jin; Heo, Min Suk; Lee, Sam Sun; Choi, Soon Chul

    2014-01-01

    Postoperative maxillary cysts are locally aggressive lesions, usually developing as delayed complications many years after radical antral surgery. This report describes a case of bilateral postoperative maxillary cysts following orthognathic surgery performed approximately 21 years previously. The patient complained of stinging pain on her right cheek. Radiographic examination revealed low-attenuation lesions on both maxillary sinuses with discontinuously corticated margins without distinct expansion or bone destruction. The cysts were enucleated with the removal of metal plates and screws for pain relief. Histopathological examination confirmed the diagnosis of postoperative maxillary cysts lined by ciliated, pseudostratified columnar cells. The patient has remained asymptomatic thus far, and there was no evidence of local recurrence at 21 months of postoperative follow-up.

  10. Bilateral postoperative maxillary cysts after orthognathic surgery: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jung Hye; Huh, Kyung Hoe; Yi, Won Jin; Heo, Min Suk; Lee, Sam Sun; Choi, Soon Chul [Dept. of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul (Korea, Republic of)

    2014-12-15

    Postoperative maxillary cysts are locally aggressive lesions, usually developing as delayed complications many years after radical antral surgery. This report describes a case of bilateral postoperative maxillary cysts following orthognathic surgery performed approximately 21 years previously. The patient complained of stinging pain on her right cheek. Radiographic examination revealed low-attenuation lesions on both maxillary sinuses with discontinuously corticated margins without distinct expansion or bone destruction. The cysts were enucleated with the removal of metal plates and screws for pain relief. Histopathological examination confirmed the diagnosis of postoperative maxillary cysts lined by ciliated, pseudostratified columnar cells. The patient has remained asymptomatic thus far, and there was no evidence of local recurrence at 21 months of postoperative follow-up.

  11. 1950-nm diode laser-assisted microanastomoses (LAMA): an innovative surgical tool for hand surgery emergencies.

    Science.gov (United States)

    Leclère, Franck Marie; Schoofs, Michel; Vogt, Peter; Casoli, Vincent; Mordon, Serge

    2015-05-01

    Based on previous observations, the 1950-nm diode laser seems to be an ideal wavelength for laser microvascular anastomoses. The data presented here, part of a larger ongoing study, assess its use in emergency hand surgery. Between 2011 and 2014, 11 patients were operated on for hand trauma with laser-assisted microanastomoses (LAMA) and prospectively analysed. LAMA was performed with a 1950-nm diode laser after placement of equidistant stitches. For vessel size laser parameters were used: spot size 400 μm, five spots for each wall, power 125 mW, and arterial/venous fluence 100/90 J/cm(2) (spot duration 1/0.9 s). Mean operating time for arterial and venous microanastomoses was 7.3 ± 1.4 and 8.7 ± 1.0 min, respectively. Three anastomoses required a secondary laser application. Arterial and venous patency rates were 100 % at the time of surgery. The success rate for the 11 procedures assessed clinically and with the Doppler was 100 %. The technique is compared to the current literature. The 1950-nm LAMA is a reliable tool with excellent results in emergency hand surgery. The system is very compact and transportable for utilization in the emergency operating room.

  12. Emergency handling of radiation accident cases: firemen

    International Nuclear Information System (INIS)

    Procedures for the emergency handling of persons exposed to radiation or radioactive contamination are presented, with emphasis on information needed by firemen. The types of radiation accident patients that may be encountered are described and procedures for first aid, for preventing the spread of radioactive contamination, and for reporting the accident are outlined

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

    Science.gov (United States)

    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

  14. [Intra-anesthetic arterial hypotension in elderly patients during emergency surgery: what are the risk factors?

    Science.gov (United States)

    Boubacar Ba, El Hadji; Leye, Papa Alassane; Traoré, Mamadou Mour; Ndiaye, Pape Ibrahima; Gaye, Ibrahima; Bah, Mamadou Diawo; Fall, Mamadou Lamine; Diouf, Elisabeth

    2017-01-01

    Emergency anesthesia in elderly patients aged 65 years and older is complex. The occurrence of intraoperative incidents and arterial hypotension is conditioned by patients' initial health status and by the quality of intraoperative management. This study aimed to determine the incidence of intra-anesthetic arterial hypotension in elderly patients during emergency surgery and to assess the involvement of certain factors in its occurrence: age, sex, patient's history, ASA class, anesthetic technique. We conducted a retrospective descriptive and analytical study in the Emergency Surgery Department at the Aristide Le Dantec University Hospital from 1 March 2014 to 28 February 2015. We collected data from 210 patients out of 224 elderly patients aged 65 years and older undergoing emergency anesthesias (10.93%). Data of 101 men and 109 women were included in the analysis, of whom 64.3% had at least one defect. Patients' preoperative status was assessed using American Society of Anesthesiology (ASA) classification: 71% of patients were ASA class 1 and 2 and 29% were ASA class 3 and 4. Locoregional anesthesia was the most practiced anesthetic technique (56.7%). 28 patients (13.33%) had intra-anesthetic arterial hypotension, of whom 16 under general anesthesia and 12 under locoregional anesthesia. It was more frequent in patients with high ASA class and a little less frequent in patients with PAH and underlying heart disease. Arterial hypotension in elderly patients during emergency surgery exposes the subject to the risk of not negligible intraoperative hypotension, especially in patients with high ASA class. Prevention is based on adequate preoperative assessment and anesthetic management.

  15. Unplanned emergency department consultations and readmissions within 30 and 90 days of bariatric surgery.

    Science.gov (United States)

    Iskra, María P; Ramón, José M; Martínez-Serrano, Andrés; Serra, Carmen; Goday, Albert; Trillo, Lourdes; Lanzarini, Enrique; Pera, Manuel; Grande, Luis

    2018-04-01

    Hospital readmission is used as a measure of quality healthcare. The aim of this study was to determine the incidence, causes, and risk factors related to emergency consultations and readmissions within 30 and 90 days in patients undergoing laparoscopic gastric bypass and laparoscopic sleeve gastrectomy. Retrospective study of 429 patients operated on from January 2004 to July 2015 from a prospectively maintained database and electronic medical records. Demographic data, type of intervention, postoperative complications, length of hospital stay and records of emergency visits and readmissions were analyzed. Within the first 90 days postoperative, a total of 117 (27%) patients consulted the Emergency Department and 24 (6%) were readmitted. The most common reasons for emergency consultation were noninfectious problems related to the surgical wound (n=40, 34%) and abdominal pain (n=28, 24%), which was also the first cause of readmission (n=9, 37%). Postoperative complications, reintervention, associated surgery in the same operation and depression were risk factors for emergency consultation within the first 90 days of the postoperative period. Despite the high number of patients who visit the Emergency Department in the first 90 days of the postoperative period, few require readmission and none surgical reoperation. It is important to know the reasons for emergency consultation to establish preventive measures and improve the quality of care. Copyright © 2018 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. [Steinert myotonic dystrophy and blepharoptosis surgery: 9 case reports].

    Science.gov (United States)

    Karim, A; Schapiro, D; Morax, S

    2003-01-01

    Steinert myopathic dystrophy is a generalized, hereditary disease with bone, muscular, heart and ocular involvement. This is a retrospective study of nine patients with significant blepharoptosis due to Steinert disease, who were treated at the Adolphe de Rothschild Ophthalmology Foundation over a period of 5 years. Ptosis was symmetric and major in all cases with poor levator excursion. Severity criteria were an absence of the Bell phenomenon and diminished orbicularis tone. A frontalis suspension was performed in eight cases with intentional undercorrection. The outcome was favorable in all cases, 2 with a slight overcorrection underwent a second operation conclusion: Surgical treatment of ptosis in Steinert disease is difficult because of a risk of lagophthalmic, keratopathy due to the severity of the disease, an absence of the Bell phenomenon and ophthalmoplegia. This surgery must be undertaken with caution, most often using a frontalis suspension. Undercorrection must be systematic, with the single goal of freeing the pupil in the primary position.

  17. Refusal of Emergency Medical Treatment: Case Studies and Ethical Foundations.

    Science.gov (United States)

    Marco, Catherine A; Brenner, Jay M; Kraus, Chadd K; McGrath, Norine A; Derse, Arthur R

    2017-11-01

    Informed consent is an important component of emergency medical treatment. Most emergency department patients can provide informed consent for treatment upon arrival. Informed consent should also be obtained for emergency medical interventions that may entail significant risk. A related concept to informed consent is informed refusal of treatment. Patients may refuse emergency medical treatment during their evaluation and treatment. This article addresses important considerations for patients who refuse treatment, including case studies and discussion of definitions, epidemiology, assessment of decisional capacity, information delivery, medicolegal considerations, and alternative care plans. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  18. Emerging technologies in coloproctology: results of the Italian Society of Colorectal Surgery Logbook of Adverse Events.

    Science.gov (United States)

    Basso, L; Pescatori, M; La Torre, F; Destefano, I; Pulvirenti D'Urso, A; Infantino, A; Amato, A

    2013-04-01

    The aim of this paper is to present the results of the Italian Society of Colorectal Surgery [or Società Italiana di Chirurgia Colorettale (SICCR)] Logbook of adverse events (AE) occurring in relation to emerging technologies in coloproctology (ETCs), over a 3-year period. A total of 245 AE were reported (patients age: mean = 49.6 years, range = 20-75 years; gender: 155 = F, 90 = M). The "observations" originated from the same institution of the AEs in 44 cases (18.0%), while 201 patients (82.0%) had been operated on somewhere else. The three most reported ETCs were: Procedure for prolapsed haemorrhoids (PPH) (n = 120-48.9%), stapled transanal rectal resection (STARR (n = 96-39.2%), and transanal haemorrhoidal dearterialization (THD) (n = 11-4.5%). PPH, STARR, and THD together accounted for n = 227 (92.6%) observations. For the three main reported ETCs, the various AEs are listed. Chronic pain after PPH was 46/120 (38.3%), and after STARR of 21/96 (21.9%). The overall re-operation rate was n = 135 (55.1%) versus n = 110 (44.9%) no reoperation. In particular, for the three main reported ETCs, n = 68/120 (56.7%) following an AE after PPH, n = 47/94 (50.0%) following an AE after STARR, and n = 6/11 (54.5) following an AE post-THD. The various types of treatment to solve AE after each of the three most observed ETCs are reported in the text. Our results do not allow us to draw statistical conclusions; however, this was not the aim of our survey. ETCs are important, yet they are not without major risks. Manufacturers should help colorectal surgeons to convey the right message to patients.

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

    Directory of Open Access Journals (Sweden)

    Ahmet Göçmen

    2014-01-01

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

  20. Outcomes of hospitalized patients undergoing emergency general surgery remote from admission.

    Science.gov (United States)

    Sharoky, Catherine E; Bailey, Elizabeth A; Sellers, Morgan M; Kaufman, Elinore J; Sinnamon, Andrew J; Wirtalla, Christopher J; Holena, Daniel N; Kelz, Rachel R

    2017-09-01

    Emergency general surgery during hospitalization has not been well characterized. We examined emergency operations remote from admission to identify predictors of postoperative 30-day mortality, postoperative duration of stay >30 days, and complications. Patients >18 years in The American College of Surgeons National Surgical Quality Improvement Program (2011-2014) who had 1 of 7 emergency operations between hospital day 3-18 were included. Patients with operations >95th percentile after admission (>18 days; n = 581) were excluded. Exploratory laparotomy only (with no secondary procedure) represented either nontherapeutic or decompressive laparotomy. Multivariable logistic regression was used to identify predictors of study outcomes. Of 10,093 patients with emergency operations, most were elderly (median 66 years old [interquartile ratio: 53-77 years]), white, and female. Postoperative 30-day mortality was 12.6% (n = 1,275). Almost half the cohort (40.1%) had a complication. A small subset (6.8%) had postoperative duration of stay >30 days. Postoperative mortality after exploratory laparotomy only was particularly high (>40%). In multivariable analysis, an operation on hospital day 11-18 compared with day 3-6 was associated with death (odds ratio 1.6 [1.3-2.0]), postoperative duration of stay >30 days (odds ratio 2.0 [1.6-2.6]), and complications (odds ratio 1.5 [1.3-1.8]). Exploratory laparotomy only also was associated with death (odds ratio 5.4 [2.8-10.4]). Emergency general surgery performed during a hospitalization is associated with high morbidity and mortality. A longer hospital course before an emergency operation is a predictor of poor outcomes, as is undergoing exploratory laparotomy only. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Frailty as a predictor of mortality in the elderly emergency general surgery patient.

    Science.gov (United States)

    Goeteyn, Jens; Evans, Louis A; De Cleyn, Siem; Fauconnier, Sigrid; Damen, Caroline; Hewitt, Jonathan; Ceelen, Wim

    2017-12-01

    The number of surgical procedures performed in elderly and frail patients has greatly increased in the last decades. However, there is little research in the elderly emergency general surgery patient. The aim of this study was to assess the prevalence of frailty in the emergency general surgery population in Belgium. Secondly, we examined the length of hospital stay, readmission rate and mortality at 30 and 90 days. We conducted a prospective observational study at Ghent University Hospital. All patients older than 65 admitted to a general surgery ward from the emergency department were eligible for inclusion. Primary endpoint was mortality at 30 days. Secondary outcomes were mortality at 90 days, readmissions and length of stay. Cross-sectional observations were performed using the Fisher exact test, Mann-Whitney U-test, or one-way ANOVA. We performed a COX multivariable analysis to identify independent variables associated with mortality at 30 and 90 days as well as the readmission risk. Data were collected from 98 patients in a four-month period. 23.5% of patients were deemed frail. 79% of all patients underwent abdominal surgery. Univariate analyses showed that polypharmacy, multimorbidity, a history of falls, hearing impairment and urinary incontinence were statistically significantly different between the non-frail and the group. Frail patients showed a higher incidence for mortality within 30 days (9% versus 1.3% (p = .053)). There were no differences between the two groups for mortality at 90 days, readmission, length of stay and operation. Frailty was a predictor for mortality at 90 days (p= .025) (hazard ratio (HR) 10.83 (95%CI 1.34-87.4)). Operation (p= .084) (HR 0.16 (95%CI 0.16-1.29)) and the presence of chronic cardiac failure (p= .049) (HR 0.38 (95%CI 0.14-0.99)) were protective for mortality at 90 days. Frailty is a significant predictor for mortality for elderly patients undergoing emergency abdominal/general surgery. Level II therapeutic

  2. [Pediatric anesthesia emergence delirium after elective ambulatory surgery: etiology, risk factors and prevalence].

    Science.gov (United States)

    Gololobov, Alik; Todris, Liat; Berman, Yakov; Rosenberg-Gilad, Zipi; Schlaeffer, Pnina; Kenett, Ron; Ben-Jacob, Ron; Segal, Eran

    2015-04-01

    Emergence delirium (ED) is a common problem among children and adults recovering from general anesthesia after surgery. Its symptoms include psychomotor agitation, hallucinations, and aggressive behavior. The phenomenon, which is most probably an adverse effect of general anesthesia agents, harms the recovery process and endangers the physical safety of patients and their health. Ranging between 10% and 80%, the exact prevalence of ED is unknown, and the risk factors of the phenomenon are unclear. The aim of the current retrospective study was to determine the prevalence rate of ED in 3947 children recovering from general anesthesia after short elective ambulatory surgery, and to map the influence of various risk factors on this phenomenon. Data were collected using electronic medical records. ED severity was assessed using the Pediatric Anesthesia Emergence Delirium Scale. Results showed the prevalence of ED among children. ED was significantly correlated with patients' age, type of surgery and premedication. ED was not correlated with severity of pain, type of anesthesia or with patients' sex.

  3. Emergency pediatric surgery: Comparing the economic burden in specialized versus nonspecialized children's centers.

    Science.gov (United States)

    Kvasnovsky, Charlotte L; Lumpkins, Kimberly; Diaz, Jose J; Chun, Jeannie Y

    2018-05-01

    The American College of Surgeons has developed a verification program for children's surgery centers. Highly specialized hospitals may be verified as Level I, while those with fewer dedicated resources as Level II or Level III, respectively. We hypothesized that more specialized children's centers would utilize more resources. We performed a retrospective study of the Maryland Health Services Cost Review Commission (HSCRC) database from 2009 to 2013. We assessed total charge, length of stay (LOS), and charge per day for all inpatients with an emergency pediatric surgery diagnosis, controlling for severity of illness (SOI). Using published resources, we assigned theoretical level designations to each hospital. Two hospitals would qualify as Level 1 hospitals, with 4593 total emergency pediatric surgery admissions (38.5%) over the five-year study period. Charges were significantly higher for children treated at Level I hospitals (all P<0.0001). Across all SOI, children at Level I hospitals had significantly longer LOS (all P<0.0001). Hospitals defined as Level II and Level III provided the majority of care and were able to do so with shorter hospitalizations and lower charges, regardless of SOI. As care shifts towards specialized centers, this charge differential may have significant impact on future health care costs. Level III Cost Effectiveness Study. Copyright © 2018 Elsevier Inc. All rights reserved.

  4. Current and emerging basic science concepts in bone biology: implications in craniofacial surgery.

    Science.gov (United States)

    Oppenheimer, Adam J; Mesa, John; Buchman, Steven R

    2012-01-01

    Ongoing research in bone biology has brought cutting-edge technologies into everyday use in craniofacial surgery. Nonetheless, when osseous defects of the craniomaxillofacial skeleton are encountered, autogenous bone grafting remains the criterion standard for reconstruction. Accordingly, the core principles of bone graft physiology continue to be of paramount importance. Bone grafts, however, are not a panacea; donor site morbidity and operative risk are among the limitations of autologous bone graft harvest. Bone graft survival is impaired when irradiation, contamination, and impaired vascularity are encountered. Although the dura can induce calvarial ossification in children younger than 2 years, the repair of critical-size defects in the pediatric population may be hindered by inadequate bone graft donor volume. The novel and emerging field of bone tissue engineering holds great promise as a limitless source of autogenous bone. Three core constituents of bone tissue engineering have been established: scaffolds, signals, and cells. Blood supply is the sine qua non of these components, which are used both individually and concertedly in regenerative craniofacial surgery. The discerning craniofacial surgeon must determine the proper use for these bone graft alternatives, while understanding their concomitant risks. This article presents a review of contemporary and emerging concepts in bone biology and their implications in craniofacial surgery. Current practices, areas of controversy, and near-term future applications are emphasized.

  5. Teaching case studies on emergency evacuation : final report

    Science.gov (United States)

    2011-02-15

    Through the development of four Harvard Kennedy School case studies, this project explored the policy and institutional dimensions of emergency evacuation planning and implementation in two major metropolitan areas Houston and New Orleans. By pro...

  6. Esophageal perforation associated with cervical spine surgery: Report of two cases and review of the literature

    NARCIS (Netherlands)

    Vrouenraets, B. C.; Been, H. D.; Brouwer-Mladin, R.; Bruno, M.; van Lanschot, J. J. B.

    2004-01-01

    Background/Aims: Esophageal perforation after anterior cervical spine surgery is a rare complication with various clinical presentations and treatments. Methods: Two cases of esophageal perforation after anterior cervical spine surgery are described, one occurring in the immediate postoperative

  7. A Historic Case of Cardiac Surgery in Pregnancy

    Directory of Open Access Journals (Sweden)

    Said Benlamkaddem

    2016-01-01

    Full Text Available 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.

  8. Sarcopenia increases risk of long-term mortality in elderly patients undergoing emergency abdominal surgery.

    Science.gov (United States)

    Rangel, Erika L; Rios-Diaz, Arturo J; Uyeda, Jennifer W; Castillo-Angeles, Manuel; Cooper, Zara; Olufajo, Olubode A; Salim, Ali; Sodickson, Aaron D

    2017-12-01

    Frailty is associated with poor surgical outcomes in elderly patients but is difficult to measure in the emergency setting. Sarcopenia, or the loss of lean muscle mass, is a surrogate for frailty and can be measured using cross-sectional imaging. We sought to determine the impact of sarcopenia on 1-year mortality after emergency abdominal surgery in elderly patients. Sarcopenia was assessed in patients 70 years or older who underwent emergency abdominal surgery at a single hospital from 2006 to 2011. Average bilateral psoas muscle cross-sectional area at L3, normalized for height (Total Psoas Index [TPI]), was calculated using computed tomography. Sarcopenia was defined as TPI in the lowest sex-specific quartile. Primary outcome was mortality at 1 year. Secondary outcomes were in-hospital mortality and mortality at 30, 90, and 180 days. The association of sarcopenia with mortality was assessed using Cox proportional hazards regression and model performance judged using Harrell's C-statistic. Two hundred ninety-seven of 390 emergency abdominal surgery patients had preoperative imaging and height. The median age was 79 years, and 1-year mortality was 32%. Sarcopenic and nonsarcopenic patients were comparable in age, sex, race, comorbidities, American Society of Anesthesiologists classification, procedure urgency and type, operative severity, and need for discharge to a nursing facility. Sarcopenic patients had lower body mass index, greater need for intensive care, and longer hospital length of stay (p Sarcopenia was independently associated with increased in-hospital mortality (risk ratio, 2.6; 95% confidence interval [CI], 1.6-3.7) and mortality at 30 days (hazard ratio [HR], 3.7; 95% CI, 1.9-7.4), 90 days (HR, 3.3; 95% CI, 1.8-6.0), 180 days (HR, 2.5; 95% CI, 1.4-4.4), and 1 year (HR, 2.4; 95% CI, 1.4-3.9). Sarcopenia is associated with increased risk of mortality over 1 year in elderly patients undergoing emergency abdominal surgery. Sarcopenia defined by TPI is

  9. IAEA assistance services in the case of emergency

    International Nuclear Information System (INIS)

    Ouvrard, R.

    1991-01-01

    This paper provides a general outline of the convention on Early Notification of a Nuclear Accident and of the convention on Assistance in the case of a Nuclear Accident or Radiological Emergency. The purpose of these 2 conventions is to support and improve international cooperation in case of a nuclear accident or a radiological emergency involving transfrontier contamination and to provide the necessary legal framework for cooperation and assistance (4 figs) [fr

  10. Forensic Emergency Medicine - Six-Year Experience of 13823 Cases in a University Emergency Department

    OpenAIRE

    DEMİRCAN, Ahmet; KELEŞ, Ayfer; GÜRBÜZ, Neslihan; BİLDİK, Fikret

    2008-01-01

    Aims: Clinical forensic medicine deals with cases involving both the legal and medical aspects of patient care, such as motor vehicle trauma or poisoning. In this study, we aimed to draw attention to the forensic issues by retrospective investigation of 13823 emergency cases and to share our experiences on this topic. Materials and Methods: This retrospective study was conducted in a university Emergency Department (ED) in Ankara, Turkey. The data were collected from official hospital polic...

  11. Management of adult recurrent respiratory papillomatosis with oral acyclovir following micro laryngeal surgery: a case series.

    Science.gov (United States)

    Chaturvedi, Jagdish; Sreenivas, V; Hemanth, V; Nandakumar, R

    2014-01-01

    To demonstrate the role of oral acyclovir in monthly regimes after microdebrider assisted excision in 3 patients with adult recurrent respiratory papillomatosis (ARRP). Three patients with ARRP who presented to a tertiary referral hospital in stridor were initially treated with a tracheostomy in order to secure airway. On further evaluation by videolaryngoscopy extensive bilateral laryngeal papillomatosis was noted with history of similar conditions in the past for which they were repeatedly operated. They were admitted and underwent Microlaryngeal surgery and laryngeal microdebrider assisted surgery under general anesthesia. Post operatively a course of oral acyclovir at 800 mg/5 times/day for 5 days was administered. On repeat assessment with videolaryngoscopy at monthly intervals a complete remission of the disease was noted with no residual disease at the end of 1 year in 2 cases. One case had a recurrence. Renal parameters were monitored periodically. It may be concluded that the action of anti viral drugs at regular intervals in addition to a short course of oral steroids lead to rapid recovery and prevented latent virus activation within the laryngo tracheal system hence maintaining long term improvement. This can avoid multiple laryngeal surgeries, repeated respiratory emergencies and risk for malignant transformation in the future thereby reducing morbidity and effect on quality of life.

  12. Five Vessel Coronary Arter Bypass Graft Surgery in a Case with Familial Hypercholesterolemia

    Directory of Open Access Journals (Sweden)

    Sureyya Talay

    2014-08-01

    Full Text Available We report a case of a rare and sypmtomatic familyal hypercholesterolemia case with an end-point of coronary artery bypass surgery at the age of 16. Patient was evaluated at the emergency department with chest pain and discomfort. Physical examination were within normal limits. The electrocardiogram showed a normal sinus rhythm for 108/ min. Arterial blood pressure was 90/60 mmHg. Lungs and heart were clear to auscultation. Patient was under treatment with a prior diagnosis of familial hypercholesterolemia (FH for one year by daily 40 mgs rosuvastatine. A coronary artery angiography was performed for chest pain. Multivessel coronary artery disease was diagnosed with a total occlusion of left anterior descending artery. Transthoracic echocardiography presented a left ventricular (LV ejection fraction 50%, LV diameters 44/26 mm, aneurysm formation at interatrial septum and mild dyskinesia of anterior wall. Thus, a five vessel emergent coronary artery graft bypass surgery was performed at this early age. FH is with a severe elevation in total cholesterol (TC and low density lipoprotein cholesterol (LDL in an autosomal dominant characteristic disorder that approximately occurs in 1 per 500 persons by its heterozygous form. FH is most certainly associated with premature coronary artery disease (CAD with catasthrophic early age results. [Cukurova Med J 2014; 39(4.000: 872-875

  13. Recurrent sigmoid volvulus - early resection may obviate later emergency surgery and reduce morbidity and mortality.

    LENUS (Irish Health Repository)

    Larkin, J O

    2012-01-31

    INTRODUCTION: Acute sigmoid volvulus is a well recognised cause of acute large bowel obstruction. PATIENTS AND METHODS: We reviewed our unit\\'s experience with non-operative and operative management of this condition. A total of 27 patients were treated for acute sigmoid volvulus between 1996 and 2006. In total, there were 62 separate hospital admissions. RESULTS: Eleven patients were managed with colonoscopic decompression alone. The overall mortality rate for non-operative management was 36.4% (4 of 11 patients). Fifteen patients had operative management (five semi-elective following decompression, 10 emergency). There was no mortality in the semi-elective cohort and one in the emergency surgery group. The overall mortality for surgery was 6% (1 of 15). Five of the seven patients managed with colonoscopic decompression alone who survived were subsequently re-admitted with sigmoid volvulus (a 71.4% recurrence rate). The six deaths in our overall series each occurred in patients with established gangrene of the bowel. With early surgical intervention before the onset of gangrene, however, good outcomes may be achieved, even in patients apparently unsuitable for elective surgery. Eight of the 15 operatively managed patients were considered to be ASA (American Society of Anesthesiologists) grade 4. There was no postoperative mortality in this group. CONCLUSIONS: Given the high rate of recurrence of sigmoid volvulus after initial successful non-operative management and the attendant risks of mortality from gangrenous bowel developing with a subsequent volvulus, it is our contention that all patients should be considered for definitive surgery after initial colonoscopic decompression, irrespective of the ASA score.

  14. CORPORATE GOVERNANCE REGULATION IN EMERGING COUNTRIES. CASE OF ROMANIA

    Directory of Open Access Journals (Sweden)

    Claudiu George BOCEAN

    2010-01-01

    Full Text Available Most of the literature on corporate governance emphasizes that firms should be run in the interests of shareholders. This is a suitable objective function when markets are perfect and complete. In many emerging economies this is not the case: markets are imperfect and incomplete. Corporate governance issues are especially important in emerging countries, since these countries do not have the long-established financial institution infrastructure to deal with corporate governance issues. This paper discusses how emerging countries are dealing with corporate governance issues and the extra obstacles they have to overcome due to a lack of regulations. Romanian case study is examined.

  15. The Impact of Specialty on Cases Performed During Hand Surgery Fellowship Training.

    Science.gov (United States)

    Silvestre, Jason; Upton, Joseph; Chang, Benjamin; Steinberg, David R

    2018-03-07

    Hand surgery fellowship programs in the United States are predominately sponsored by departments or divisions of orthopaedic surgery or plastic surgery. This study compares the operative experiences of hand surgery fellows graduating from orthopaedic or plastic surgery hand surgery fellowships. Operative case logs of 3 cohorts of hand surgery fellows graduating during the academic years of 2012-2013, 2013-2014, and 2014-2015 were analyzed. The median case volumes were compared by specialty via Mann-Whitney U tests. An arbitrary 1,000% change between the 90th and 10th percentiles of fellows was used as a threshold to highlight case categories with substantial variability. In this study, 413 orthopaedic hand surgery fellows (87%) and 62 plastic surgery hand surgery fellows (13%) were included. Plastic surgery fellows reported more cases in the following categories: wound closure with graft; wound reconstruction with flap; vascular repair, reconstruction, replantation, or microvascular; closed treatment of fracture or dislocation; nerve injury; and congenital (p < 0.05). Orthopaedic surgery fellows reported more cases in the following categories: wound irrigation and debridement fasciotomy or wound preparation; hand reconstruction or releases; wrist reconstruction, releases, or arthrodesis; forearm, elbow, or shoulder reconstruction or releases; hand fractures, dislocation, or ligament injury; wrist fractures or dislocations; forearm and proximal fractures or dislocations; miscellaneous insertion or removal of devices; shoulder arthroscopy, elbow arthroscopy, and wrist arthroscopy; decompression of tendon sheath, synovectomy, or ganglions; nerve decompression; Dupuytren; and tumor or osteomyelitis (p < 0.05). Plastic surgery fellows reported substantial variability for 12 case categories (range, 1,024% to 2,880%). Orthopaedic surgery fellows reported substantial variability for 9 case categories (range, 1,110% to 9,700%). Orthopaedic and plastic hand surgery

  16. Perioperative factors predicting poor outcome in elderly patients following emergency general surgery: a multivariate regression analysis

    Science.gov (United States)

    Lees, Mackenzie C.; Merani, Shaheed; Tauh, Keerit; Khadaroo, Rachel G.

    2015-01-01

    Background Older adults (≥ 65 yr) are the fastest growing population and are presenting in increasing numbers for acute surgical care. Emergency surgery is frequently life threatening for older patients. Our objective was to identify predictors of mortality and poor outcome among elderly patients undergoing emergency general surgery. Methods We conducted a retrospective cohort study of patients aged 65–80 years undergoing emergency general surgery between 2009 and 2010 at a tertiary care centre. Demographics, comorbidities, in-hospital complications, mortality and disposition characteristics of patients were collected. Logistic regression analysis was used to identify covariate-adjusted predictors of in-hospital mortality and discharge of patients home. Results Our analysis included 257 patients with a mean age of 72 years; 52% were men. In-hospital mortality was 12%. Mortality was associated with patients who had higher American Society of Anesthesiologists (ASA) class (odds ratio [OR] 3.85, 95% confidence interval [CI] 1.43–10.33, p = 0.008) and in-hospital complications (OR 1.93, 95% CI 1.32–2.83, p = 0.001). Nearly two-thirds of patients discharged home were younger (OR 0.92, 95% CI 0.85–0.99, p = 0.036), had lower ASA class (OR 0.45, 95% CI 0.27–0.74, p = 0.002) and fewer in-hospital complications (OR 0.69, 95% CI 0.53–0.90, p = 0.007). Conclusion American Society of Anesthesiologists class and in-hospital complications are perioperative predictors of mortality and disposition in the older surgical population. Understanding the predictors of poor outcome and the importance of preventing in-hospital complications in older patients will have important clinical utility in terms of preoperative counselling, improving health care and discharging patients home. PMID:26204143

  17. Social media in plastic surgery practices: emerging trends in North America.

    Science.gov (United States)

    Wheeler, Chad K; Said, Hakim; Prucz, Roni; Rodrich, Rod J; Mathes, David W

    2011-05-01

    Social media is a common term for web-based applications that offer a way to disseminate information to a targeted audience in real time. In the current market, many businesses are utilizing it to communicate with clients. Although the field of plastic surgery is constantly changing in response to innovative technologies introduced into the specialty, the utilization of social media in plastic surgery practices is currently unclear. The authors evaluate the current attitudes and practices of aesthetic surgeons to emerging social media technology and compare these to attitudes about more traditional modes of communication. A 19-question web-based survey was disseminated by e-mail to all board-certified or board-eligible American plastic surgeons (n = 4817). Respondents were asked to answer questions on three topics: (1) their use of social media in their personal and professional lives, (2) their various forms of practice marketing, and (3) their demographic information. There were 1000 responses (20.8%). Results showed that 28.2% of respondents used social media in their practice, while 46.7% used it in their personal life. Most plastic surgeons managed their social media themselves or through a staff member. The majority of respondents who used social media in their practice claimed that their efforts were directed toward patient referrals. The typical plastic surgery practice that used social media was a solo practice in a large city with a focus on cosmetic surgery. Local competition of plastic surgeons did not correlate with social media use. Most plastic surgeons (88%) advertised, but the form of marketing varied. The most common forms included websites, print, and search engine optimization, but other modalities, such as television, radio, and billboards, were still utilized. Social media represents a new avenue that many plastic surgeons are utilizing, although with trepidation. As social media becomes commonplace in society, its role in plastic surgery

  18. Emergency surgery for lung cancer with abscess formation after transbronchial biopsy

    OpenAIRE

    Takanashi, Yusuke; Miyashita, Koichi; Tajima, Shogo; Hayakawa, Takamitsu; Neyatani, Hiroshi; Funai, Kazuhito

    2017-01-01

    Abscess formation in lung cancer after transbronchial biopsy (TBB) is a rare complication with no standard consensus on a coping strategy or prophylaxis. We describe an instructive case of lung cancer which developed into an abscess after TBB. An 80?year?old man with poorly controlled diabetes mellitus underwent TBB for diagnosing a mass lesion in the left upper lobe. The TBB specimen confirmed a diagnosis of lung cancer, and he was scheduled for radical surgery. However, the tumour was revea...

  19. Introduction of a fresh cadaver laboratory during the surgery clerkship improves emergency technical skills.

    Science.gov (United States)

    Nematollahi, Saman; Kaplan, Stephen J; Knapp, Christopher M; Ho, Hang; Alvarado, Jared; Viscusi, Rebecca; Adamas-Rappaport, William

    2015-08-01

    Student acquisition of technical skills during the clinical years of medical school has been steadily declining. To address this issue, the authors instituted a fresh cadaver-based Emergency Surgical Skills Laboratory (ESSL). Sixty-three medical students rotating through the third-year surgery clerkship participated in a 2-hour, fresh cadaver-based ESSL conducted during the first 2 days of the clerkship. The authors evaluated students utilizing both surgical skills and written examination before the ESSL and at 4 weeks post ESSL. Students demonstrated a mean improvement of 64% (±11) (P cadaver laboratory is an effective method to provide proficiency in emergency technical skills not acquired during the clinical years of medical school. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Effects of Ramadan on Forensic Cases Presenting to Emergency Service

    Directory of Open Access Journals (Sweden)

    F. Sarı Doğan

    2015-06-01

    Full Text Available The term "forensic case" is defined as disruption of physical and/or mental health of an individual due to external factors. Forensic cases are most frequently encountered in emergency services. Ramadan, the ninth month of Islamic calendar, is a month of fasting throughout which Muslims from all around the world worship by observing fasting. There are many studies focusing on the effects of fasting on health. The purpose of this study is to examine the effects of Ramadan on forensic cases presenting to emergency service.

  1. Defining our destiny: trainee working group consensus statement on the future of emergency surgery training in the United Kingdom.

    Science.gov (United States)

    Sharrock, A E; Gokani, V J; Harries, R L; Pearce, L; Smith, S R; Ali, O; Chu, H; Dubois, A; Ferguson, H; Humm, G; Marsden, M; Nepogodiev, D; Venn, M; Singh, S; Swain, C; Kirkby-Bott, J

    2015-01-01

    The United Kingdom National Health Service treats both elective and emergency patients and seeks to provide high quality care, free at the point of delivery. Equal numbers of emergency and elective general surgical procedures are performed, yet surgical training prioritisation and organisation of NHS institutions is predicated upon elective care. The increasing ratio of emergency general surgery consultant posts compared to traditional sub-specialities has yet to be addressed. How should the capability gap be bridged to equip motivated, skilled surgeons of the future to deliver a high standard of emergency surgical care? The aim was to address both training requirements for the acquisition of necessary emergency general surgery skills, and the formation of job plans for trainee and consultant posts to meet the current and future requirements of the NHS. Twenty nine trainees and a consultant emergency general surgeon convened as a Working Group at The Association of Surgeons in Training Conference, 2015, to generate a united consensus statement to the training requirement and delivery of emergency general surgery provision by future general surgeons. Unscheduled general surgical care provision, emergency general surgery, trauma competence, training to meet NHS requirements, consultant job planning and future training challenges arose as key themes. Recommendations have been made from these themes in light of published evidence. Careful workforce planning, education, training and fellowship opportunities will provide well-trained enthusiastic individuals to meet public and societal need.

  2. Cataract surgery in Knobloch syndrome: a case report

    Directory of Open Access Journals (Sweden)

    Bongiovanni CS

    2011-06-01

    Full Text Available Carmen Sílvia Bongiovanni1, Carla Cristina Serra Ferreira1, Ana Paula Silvério Rodrigues1, João Borges Fortes Filho2, Márcia Beatriz Tartarella11Department of Ophthalmology, Congenital Cataract Section, Medical School, Federal University of São Paulo, São Paulo; 2Department of Ophthalmology, Medical School, Federal University of Rio Grande do Sul, Porto Alegre, BrazilAbstract: Knobloch syndrome is an autosomal recessive disorder associated with early-onset ocular abnormalities and central nervous system malformations. Ocular abnormalities are usually severe, and include high myopia, vitreoretinal degeneration, retinal detachment, macular abnormalities, and cataract. The most frequent systemic changes are midline malformations of the brain, ventricular dilation, and occipital encephalocele. Cognitive delay may occur. We report a case of cataract in a child with Knobloch syndrome. Cataract surgery and follow-up are described.Keywords: Knobloch syndrome, cataract, phacoemulsification, vitreous, right eye, left eye, genetic

  3. Association of Bariatric Surgery With Risk of Infectious Diseases: A Self-Controlled Case Series Analysis.

    Science.gov (United States)

    Goto, Tadahiro; Hirayama, Atsushi; Faridi, Mohammad Kamal; Camargo, Carlos A; Hasegawa, Kohei

    2017-10-15

    Although emerging data demonstrate that obesity is a risk factor for infectious diseases, no study has investigated the relationship of bariatric surgery with the risk of infectious diseases among obese adults. We conducted a self-controlled case series analysis using data from the State Emergency Department Database and State Inpatient Database of 3 US states (California, Florida, and Nebraska) from 2005 through 2011. We included obese adults who underwent bariatric surgery as an instrument of weight reduction. Primary outcomes were emergency department (ED) visit or hospitalization for skin and soft-tissue infection (SSTI), respiratory infection, intra-abdominal infection, or urinary tract infection (UTI). Among 56277 obese adults who underwent bariatric surgery, compared to presurgery months 13-24 as the reference period, the risk of ED visit or hospitalization in the 0- to 12-month postsurgery period decreased significantly for SSTI (aOR, 0.85 [95% confidence interval {CI}, .76-.95]) and respiratory infection (aOR, 0.82 [95% CI, .75-.90]) and remained significantly low in the 13- to 24-month postsurgery period (aORs, 0.77 [95% CI, .68-.86] and 0.75 [95% CI, .68-.82], respectively). By contrast, the risk increased significantly in the 0- to 12-month postsurgery period for intra-abdominal infection (aOR, 2.09 [95% CI, 1.78-2.46]) and UTI (aOR, 1.93 [95% CI, 1.74-2.15]) and remained high in the 13- to 24-month postsurgery period (aORs, 1.29 [95% CI, 1.09-1.54] and 1.31 [95% CI, 1.17-1.47], respectively). We found a divergent risk pattern in the risk of 4 common infectious diseases after bariatric surgery. The risk of SSTI and respiratory infection decreased after bariatric surgery whereas that of intra-abdominal infection and UTI increased. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

  4. The Australian litigation landscape - oral and maxillofacial surgery and general dentistry (oral surgery procedures): an analysis of litigation cases.

    Science.gov (United States)

    Badenoch-Jones, E K; White, B P; Lynham, A J

    2016-09-01

    There are persistent concerns about litigation in the dental and medical professions. These concerns arise in a setting where general dentists are more frequently undertaking a wider range of oral surgery procedures, potentially increasing legal risk. Judicial cases dealing with medical negligence in the fields of general dentistry (oral surgery procedure) and oral and maxillofacial surgery were located using the three main legal databases. Relevant cases were analysed to determine the procedures involved, the patients' claims of injury, findings of negligence and damages awarded. A thematic analysis of the cases was undertaken to determine trends. Fifteen cases over a 20-year period were located across almost all Australian jurisdictions (eight cases involved general dentists; seven cases involved oral and maxillofacial surgeons). Eleven of the 15 cases involved determinations of whether or not the practitioner had failed in their duty of care; negligence was found in six cases. Eleven of the 15 cases related to molar extractions (eight specifically to third molar). Dental and medical practitioners wanting to manage legal risk should have regard to circumstances arising in judicial cases. Adequate warning of risks is critical, as is offering referral in appropriate cases. Preoperative radiographs, good medical records and processes to ensure appropriate follow-up are also important. © 2015 Australian Dental Association.

  5. Surgery for lung adenocarcinoma with smokers’ polycythemia: a case report

    Science.gov (United States)

    2013-01-01

    Background Smoking is a cause of cancer and polycythemia. Therefore, surgeons who treat patients with cancer may also encounter patients with polycythemia. However, few cases of surgical patients with polycythemia have been reported; in particular, a surgical case involving smokers’ polycythemia has never been reported. We herein report a patient with lung cancer and smokers’ polycythemia who successfully underwent lobectomy with control of hematocrit based on a modified formula in the perioperative period. Case presentation A 67-year-old man underwent abdominoperineal resection for rectal carcinoma in June 2008. A ground glass opacity had been identified in the upper lobe of the right lung and was gradually enlarging. In March 2012, bronchoscopic cytology for investigation of the mass revealed non-small cell lung cancer, suggesting primary lung non-small cell carcinoma (T1bN0M0, Stage IA). When he was referred to our hospital for surgery, his complete blood count showed a red blood cell level of 6.50×106/μL, hemoglobin of 21.0 g/dL, and hematocrit of 60.1%. The hematologists’ diagnosis was secondary polycythemia due to heavy smoking (smokers’ polycythemia) because the white blood cell and platelet counts were within normal limits and the erythropoietin was not increased. We calculated the appropriate phlebotomy and infusion volumes based on a formula that we modified. After 550 g of blood was phlebotomized to reduce the hematocrit to approximately 55%, video-assisted right lung upper lobectomy with lymph node dissection was performed in April 2012. The hematocrit was maintained at polycythemia who underwent right upper lobectomy for adenocarcinoma. The findings in this case report are meaningful for surgeons treating cancer patients because there are few reports discussing the perioperative care of surgical patients with polycythemia. PMID:23374961

  6. Surgery for lung adenocarcinoma with smokers’ polycythemia: a case report

    Directory of Open Access Journals (Sweden)

    Sugiura Yasoo

    2013-02-01

    Full Text Available Abstract Background Smoking is a cause of cancer and polycythemia. Therefore, surgeons who treat patients with cancer may also encounter patients with polycythemia. However, few cases of surgical patients with polycythemia have been reported; in particular, a surgical case involving smokers’ polycythemia has never been reported. We herein report a patient with lung cancer and smokers’ polycythemia who successfully underwent lobectomy with control of hematocrit based on a modified formula in the perioperative period. Case presentation A 67-year-old man underwent abdominoperineal resection for rectal carcinoma in June 2008. A ground glass opacity had been identified in the upper lobe of the right lung and was gradually enlarging. In March 2012, bronchoscopic cytology for investigation of the mass revealed non-small cell lung cancer, suggesting primary lung non-small cell carcinoma (T1bN0M0, Stage IA. When he was referred to our hospital for surgery, his complete blood count showed a red blood cell level of 6.50×106/μL, hemoglobin of 21.0 g/dL, and hematocrit of 60.1%. The hematologists’ diagnosis was secondary polycythemia due to heavy smoking (smokers’ polycythemia because the white blood cell and platelet counts were within normal limits and the erythropoietin was not increased. We calculated the appropriate phlebotomy and infusion volumes based on a formula that we modified. After 550 g of blood was phlebotomized to reduce the hematocrit to approximately 55%, video-assisted right lung upper lobectomy with lymph node dissection was performed in April 2012. The hematocrit was maintained at Conclusion We experienced a patient with smokers’ polycythemia who underwent right upper lobectomy for adenocarcinoma. The findings in this case report are meaningful for surgeons treating cancer patients because there are few reports discussing the perioperative care of surgical patients with polycythemia.

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

    Science.gov (United States)

    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.

  8. Thyroid emergencies following radioiodine therapy - Two case reports

    International Nuclear Information System (INIS)

    Tasmine, Sufia; Haque, Fatema Sultana; Karim, M. A.

    2002-01-01

    Thyrotoxicosis and well differentiated thyroid carcinomas are the two most common pathological conditions where radioiodine is used. Patients with well differentiated thyroid carcinomas are the candidates for post operative radio iodine therapy. It is currently the most popular and frequently used method of treatment. Its use is safe and cost effective. The results are usually eventless but in some exceptional cases emergencies that occurred after administration of I-131. One emergency occurred after I-131 administration for Graves' disease and the second case happened after therapeutic application of I-131 for treatment of local recurrences of thyroid cancer.(author)

  9. Emergency mitral valve replacement and cesarean section in parturients: Two case reports

    Directory of Open Access Journals (Sweden)

    P S Nagaraja

    2016-01-01

    Full Text Available Cardiac surgery during pregnancy using cardiopulmonary bypass has a maternal mortality rate (MMR of about 3-15%. Cardiopulmonary bypass, in addition, alters placental perfusion, which can increase infant mortality. Here, we report two cases of parturients with severe mitral stenosis, who developed acute mitral regurgitation (MR after percutaneous transluminal mitral commissurotomy (PTMC due to anterior mitral leaflet tear. They were posted for emergency mitral valve replacement (MVR followed by cesarean section. Altering the routine cardiopulmonary bypass and anesthesia protocol resulted in a favorable maternal and fetal outcome.

  10. The horror of wrong-site surgery continues: report of two cases in a regional trauma centre in Nigeria.

    Science.gov (United States)

    Nwosu, Arinze

    2015-01-01

    Wrong- site surgeries are iatrogenic errors encountered in the course of surgical patient management. Despite the 'never do harm' pledge in the 'Hippocratic Oath' drafted in 5(th) century BC, man is after all human, with this limitation manifesting in the physician's art despite his best intention. Beyond the catastrophic consequences of wrong- site surgery on the patient and surgeon, and the opprobrium on the art of medicine, the incidents have come to be regarded as a quality-of-care indicator. Orthopaedic surgery is a specialty with a preponderance of this phenomenon and the attendant medico-legal issues relating to malpractice claims. Consequently the specialty had pioneered institutional initiatives at preventing these 'friendly-fires'. Awareness and implementation of these initiatives however remain low in many parts of the world, hampered by a culture of denial and shame. This report presents two cases of wrong-site surgery following trauma from road-traffic accident. The first case was a closed reduction of the 'wrong' dislocated hip in the trauma/emergency unit under the care of senior residents, while the second case was attempted wrong-site surgery on the right leg in a patient with fracture of the left tibia, in conjunction with bilateral femoral fracture and right radio-ulnar fracture; by an experienced Chief Consultant Orthopaedic Surgeon operating elective list. Both are orthopaedic cases, each with some trauma to both lower extremeties. Neither of the cases was formally mentioned anywhere in clinical discourse in the hospital, much less a formal report or audit. There was no formal, institutionalized process to prevent wrong-site surgery in the health institution and this could have been largely responsible for these incidents. An open, mandatory process of reporting such incidents for relevant audit and awareness is necessary, as a mechanism for prevention rather than blame or punishment.

  11. Networks dynamics in the case of emerging technologies

    Energy Technology Data Exchange (ETDEWEB)

    Rotolo, D

    2016-07-01

    This research in progress aims at increasing our understanding of how collaborative networks form, evolve and are configured in the case of emerging technologies. The architecture of the relationships among the variety of organisational actors involved in the emergence process exerts a significant influence in shaping technological change in certain directions rather than others, especially in the early stage of emergence. As a result, socially optimal or desirable technological trajectories may be ‘opportunistically’ rejected. Our empirical analysis is based on a case-study of an emerging medical technology, namely ‘microneedles’. On the basis of co-authorship data reported in 1,943 publications on the topic from 1990 to 2014, longitudinal collaboration (co-authorship) networks were built at two levels: affiliation and author. We examined the dynamics of co-authorship networks by building on recent methodological advancements in network analysis, i.e. Exponential Random Graph Models (ERGMs). These models enable us to make statistical inferences about on the extent to which a network configuration occurs more than could be expected by chance and to identify which social mechanisms may be shaping the network in certain configurations. The findings of the statistical analyses (currently in progress) combined with the qualitative understanding of the case will increase our understanding of which mechanisms are more likely to drive the network dynamics in the case of emerging technologies. These include evidence of the extent to which the likelihood of forming, maintaining, or terminating ties among actors (authors or affiliations) is affected by actors’ covariates such as types of organisations, diversity/specialisation of the research undertaken, and status. These findings have potential to provide important inputs for policymaking process in the case of emerging technologies. (Author)

  12. Networks dynamics in the case of emerging technologies

    International Nuclear Information System (INIS)

    Rotolo, D

    2016-01-01

    This research in progress aims at increasing our understanding of how collaborative networks form, evolve and are configured in the case of emerging technologies. The architecture of the relationships among the variety of organisational actors involved in the emergence process exerts a significant influence in shaping technological change in certain directions rather than others, especially in the early stage of emergence. As a result, socially optimal or desirable technological trajectories may be ‘opportunistically’ rejected. Our empirical analysis is based on a case-study of an emerging medical technology, namely ‘microneedles’. On the basis of co-authorship data reported in 1,943 publications on the topic from 1990 to 2014, longitudinal collaboration (co-authorship) networks were built at two levels: affiliation and author. We examined the dynamics of co-authorship networks by building on recent methodological advancements in network analysis, i.e. Exponential Random Graph Models (ERGMs). These models enable us to make statistical inferences about on the extent to which a network configuration occurs more than could be expected by chance and to identify which social mechanisms may be shaping the network in certain configurations. The findings of the statistical analyses (currently in progress) combined with the qualitative understanding of the case will increase our understanding of which mechanisms are more likely to drive the network dynamics in the case of emerging technologies. These include evidence of the extent to which the likelihood of forming, maintaining, or terminating ties among actors (authors or affiliations) is affected by actors’ covariates such as types of organisations, diversity/specialisation of the research undertaken, and status. These findings have potential to provide important inputs for policymaking process in the case of emerging technologies. (Author)

  13. Safety and Feasibility of a Ketamine Package to Support Emergency and Essential Surgery in Kenya when No Anesthetist is Available: An Analysis of 1216 Consecutive Operative Procedures.

    Science.gov (United States)

    Burke, Thomas F; Suarez, Sebastian; Sessler, Daniel I; Senay, Ayla; Yusufali, Taha; Masaki, Charles; Guha, Moytrayee; Rogo, Debora; Jani, Pankaj; Nelson, Brett D; Rogo, Khama

    2017-12-01

    Lack of access to emergency and essential surgery is widespread in low- and middle-income countries. Scarce anesthesia services contribute to this unmet need. The aim of this study was to evaluate the safety and feasibility of the Every Second Matters for Emergency and Essential Surgery-Ketamine (ESM-Ketamine) package for emergency and essential procedures when no anesthetist was available. From November 2013 to September 2017, the ESM-Ketamine package was used for patients requiring emergency or life-improving surgeries in fifteen selected facilities across Kenya when no anesthetist was available. A mixed-methods approach was used to assess safety and feasibility of the ESM-Ketamine package, including demand, acceptability, and practicality. The primary outcome was ketamine-related adverse events. Key-informant interviews captured perceptions of providers, hospital administrators, and surgeons/proceduralists. Non-anesthetist mid-level providers used ESM-Ketamine for 1216 surgical procedures across the fifteen study facilities. The median ketamine dose was 2.1 mg/kg. Brief (30 s) oxygen desaturations occurred in seven patients (0.6%). There were 157 (13%) reported cases of hallucinations and agitation which were treated with diazepam. All patients recovered uneventfully, and no ketamine-related deaths were reported. Twenty-seven key-informant interviews showed strong support for the program with four main themes: financial considerations, provision of services, staff impact, and scaling considerations. The ESM-Ketamine package appears safe and feasible and is capable of expanding access to emergency and essential surgeries in rural Kenya when no anesthetist is available.

  14. Randomized multicentre feasibility trial of intermediate care versus standard ward care after emergency abdominal surgery (InCare trial)

    DEFF Research Database (Denmark)

    Vester-Andersen, M; Waldau, T; Wetterslev, J

    2015-01-01

    BACKGROUND: Emergency abdominal surgery carries a considerable risk of death and postoperative complications. Early detection and timely management of complications may reduce mortality. The aim was to evaluate the effect and feasibility of intermediate care compared with standard ward care...... ward within 24 h of emergency abdominal surgery. Participants were randomized to either intermediate care or standard surgical ward care after surgery. The primary outcome was 30-day mortality. RESULTS: In total, 286 patients were included in the modified intention-to-treat analysis. The trial...... was terminated after the interim analysis owing to slow recruitment and a lower than expected mortality rate. Eleven (7·6 per cent) of 144 patients assigned to intermediate care and 12 (8·5 per cent) of 142 patients assigned to ward care died within 30 days of surgery (odds ratio 0·91, 95 per cent c.i. 0·38 to 2...

  15. Risks of cardiovascular adverse events and death in patients with previous stroke undergoing emergency noncardiac, nonintracranial surgery

    DEFF Research Database (Denmark)

    Christiansen, Mia N.; Andersson, Charlotte; Gislason, Gunnar H.

    2017-01-01

    Background: The outcomes of emergent noncardiac, nonintracranial surgery in patients with previous stroke remain unknown. Methods: All emergency surgeries performed in Denmark (2005 to 2011) were analyzed according to time elapsed between previous ischemic stroke and surgery. The risks of 30-day...... mortality and major adverse cardiovascular events were estimated as odds ratios (ORs) and 95% CIs using adjusted logistic regression models in a priori defined groups (reference was no previous stroke). In patients undergoing surgery immediately (within 1 to 3 days) or early after stroke (within 4 to 14...... and general anesthesia less frequent in patients with previous stroke (all P Risks of major adverse cardiovascular events and mortality were high for patients with stroke less than 3 months (20.7 and 16.4% events; OR = 4.71 [95% CI, 4.18 to 5.32] and 1.65 [95% CI, 1.45 to 1.88]), and remained...

  16. Surgery for lung adenocarcinoma with smokers' polycythemia: a case report.

    Science.gov (United States)

    Sugiura, Yasoo; Nemoto, Etsuo; Shinoda, Hiromi; Nakamura, Naoya; Kaseda, Shizuka

    2013-02-01

    Smoking is a cause of cancer and polycythemia. Therefore, surgeons who treat patients with cancer may also encounter patients with polycythemia. However, few cases of surgical patients with polycythemia have been reported; in particular, a surgical case involving smokers' polycythemia has never been reported. We herein report a patient with lung cancer and smokers' polycythemia who successfully underwent lobectomy with control of hematocrit based on a modified formula in the perioperative period. A 67-year-old man underwent abdominoperineal resection for rectal carcinoma in June 2008. A ground glass opacity had been identified in the upper lobe of the right lung and was gradually enlarging. In March 2012, bronchoscopic cytology for investigation of the mass revealed non-small cell lung cancer, suggesting primary lung non-small cell carcinoma (T1bN0M0, Stage IA). When he was referred to our hospital for surgery, his complete blood count showed a red blood cell level of 6.50×106/μL, hemoglobin of 21.0 g/dL, and hematocrit of 60.1%. The hematologists' diagnosis was secondary polycythemia due to heavy smoking (smokers' polycythemia) because the white blood cell and platelet counts were within normal limits and the erythropoietin was not increased. We calculated the appropriate phlebotomy and infusion volumes based on a formula that we modified. After 550 g of blood was phlebotomized to reduce the hematocrit to approximately 55%, video-assisted right lung upper lobectomy with lymph node dissection was performed in April 2012. The hematocrit was maintained at polycythemia who underwent right upper lobectomy for adenocarcinoma. The findings in this case report are meaningful for surgeons treating cancer patients because there are few reports discussing the perioperative care of surgical patients with polycythemia.

  17. Increased Authenticity in Practical Assessment Using Emergency Case OSCE Stations

    Science.gov (United States)

    Ruesseler, Miriam; Weinlich, Michael; Byhahn, Christian; Muller, Michael P.; Junger, Jana; Marzi, Ingo; Walcher, Felix

    2010-01-01

    In case of an emergency, a fast and structured patient management is crucial for patient's outcome. The competencies needed should be acquired and assessed during medical education. The objective structured clinical examination (OSCE) is a valid and reliable assessment format to evaluate practical skills. However, traditional OSCE stations examine…

  18. Case Study – Idling Reduction Technologies for Emergency Service Vehicles

    Energy Technology Data Exchange (ETDEWEB)

    Laughlin, Michael [Argonne National Lab. (ANL), Argonne, IL (United States); Owens, Russell J. [Argonne National Lab. (ANL), Argonne, IL (United States)

    2016-01-01

    This case study explores the use of idle reduction technologies (IRTs) on emergency service vehicles in police, fire, and ambulance applications. Various commercially available IRT systems and approaches can decrease, or ultimately eliminate, engine idling. Fleets will thus save money on fuel, and will also decrease their criteria pollutant emissions, greenhouse gas emissions, and noise.

  19. Case scheduling preferences of one Surgeon's cataract surgery patients.

    Science.gov (United States)

    Dexter, Franklin; Birchansky, Lee; Bernstein, James M; Wachtel, Ruth E

    2009-02-01

    The increase in the number of operating rooms nationwide in the United States may reflect preferences of patients for scheduling of outpatient surgery. Yet, little is known of the importance that patients place on scheduling convenience and flexibility. Fifty cataract surgery patients seen by a surgeon at his main office during a 6-mo period responded to a marketing survey. All the patients had Medicare insurance and supplemental insurance permitting surgery at any facility. A telephone questionnaire included four vignettes describing different choices in the scheduling of cataract surgery. Respondents were asked how far they would be willing to travel for one option instead of another. For example, "Your surgery will be on Thursday in three weeks at 2 pm. You can drink water until 9 am. You arrive at 10 am, because your surgery might start early. If you travel farther, you would arrive at 8 am for 9 am surgery." The median (50th percentile) additional travel time was 60 min (lower 95% confidence bound >or=52 min) for each of four options: to receive care on a day chosen by the patient instead of assigned by the physician, to receive care at a single site instead of both the surgeon's office and a surgery center at a different location, to combine the examination and the surgery into a single visit instead of two visits, and to have surgery in the morning instead of the afternoon. The patients of this ophthalmologist placed a high value on convenience and flexibility in scheduling their surgery. In general, this would be achievable only if many operating rooms were available each morning.

  20. First case report of retroperitoneal metastasis of fascioliasis after surgery

    Science.gov (United States)

    Wang, Jun-Ke; Ma, Wen-Jie; Lu, Qiang; Zheng, Er-Liang; Yang, Qin; Hu, Hai-Jie; Liu, Fei; Li, Quan-Sheng; Li, Fu-Yu

    2017-01-01

    Abstract Rationale: Fascioliasis is a rare cause of liver abscesses, and its clinical course consists of hepatic phase and biliary phase. Patient concerns: We describe a 58-year-old female patient who presented with a 2-month history of intermittent fever and abdominal pain. An abdominal computed tomography (CT) revealed confluent low-density lesions in the liver. Complete surgical resection of these abscesses was performed, and postoperative pathological examination and serological tests confirmed a diagnosis of fascioliasis. However, 4 months after the surgery, follow-up CT revealed a lesion in the retroperitoneal area. Meanwhile, ultrasonography-guided percutaneous needle biopsy of the retroperitoneal lesion was performed, and a parasitic infection was suspected. Diagnoses: Retroperitoneal metastasis of hepatic phase fascioliasis. Interventions: The patient received parasitic resistance treatment with triclabendazole at a dose of 10 mg/kg/d for 2 consecutive days. Outcomes: After 2 courses of triclabendazole therapy, the retroperitoneal metastasis regressed to a minor lesion. Lessons: To the best of our knowledge, this is the first case report of retroperitoneal metastasis of fascioliasis, aimed at helping recognize the clinical features and treatment options of this rare disease. PMID:29390366

  1. First case report of retroperitoneal metastasis of fascioliasis after surgery.

    Science.gov (United States)

    Wang, Jun-Ke; Ma, Wen-Jie; Lu, Qiang; Zheng, Er-Liang; Yang, Qin; Hu, Hai-Jie; Liu, Fei; Li, Quan-Sheng; Li, Fu-Yu

    2017-12-01

    Fascioliasis is a rare cause of liver abscesses, and its clinical course consists of hepatic phase and biliary phase. We describe a 58-year-old female patient who presented with a 2-month history of intermittent fever and abdominal pain. An abdominal computed tomography (CT) revealed confluent low-density lesions in the liver. Complete surgical resection of these abscesses was performed, and postoperative pathological examination and serological tests confirmed a diagnosis of fascioliasis. However, 4 months after the surgery, follow-up CT revealed a lesion in the retroperitoneal area. Meanwhile, ultrasonography-guided percutaneous needle biopsy of the retroperitoneal lesion was performed, and a parasitic infection was suspected. Retroperitoneal metastasis of hepatic phase fascioliasis. The patient received parasitic resistance treatment with triclabendazole at a dose of 10 mg/kg/d for 2 consecutive days. After 2 courses of triclabendazole therapy, the retroperitoneal metastasis regressed to a minor lesion. To the best of our knowledge, this is the first case report of retroperitoneal metastasis of fascioliasis, aimed at helping recognize the clinical features and treatment options of this rare disease. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

  2. Readmission and overstay after day case nasal surgery

    Directory of Open Access Journals (Sweden)

    McCormack David

    2004-10-01

    Full Text Available Abstract Background A readmission is classified as a patient necessitating readmission to hospital due to a post-operative complication following discharge. An overstay however, is classified as a patient having to stay longer than the planned duration in hospital (not having been discharged in the interim due to a post-operative complication. This study aims to investigate patient-related factors that predispose to readmission or overstay and thus make recommendations to decrease the likelihood of readmission or overstay. Method In this retrospective study 312 'day-case nasal procedures', were selected from a total cohort of 4274 ENT patients over a 17-month period. This sub-group was investigated for a range of demographic factors including, age, gender and ethnicity with regards to their relationship to readmission rates and overstay frequency and duration. Results The rates were 2.88% and 9.62% for readmission and overstay respectively. The total number of days spent in hospital as a result of readmission was 27. Epistaxis was the leading cause for readmission/overstay (28.9% followed by high levels of post-operative pain preventing them from being discharged (23.7%. All procedures in this study had readmission rates that were below those recommended in the guidelines set by the Royal College of Surgeons of England. Women overstayed significantly longer (t = 1.65, p Conclusions Suitable candidates for day-case ENT surgery highlighted by this study include healthy individuals between the ages of 20 and 60. Operating in the morning would increase the immediate post-operative recovery time, which may reduce the numbers of patients who complain of high levels of pain at the time of discharge. Procedures such as septorhinoplasty being performed routinely in the ambulatory setting require additional research into more effective methods of pain control. Standards need to be improved so that the causes of overstay and readmission are clearly

  3. H1N1 infection in emergency surgery: A cautionary tale.

    LENUS (Irish Health Repository)

    Galbraith, J G

    2010-01-01

    Pandemic 2009 influenza A H1N1 has spread rapidly since its first report in Mexico in March 2009. This is the first influenza pandemic in over 40 years and it atypically affects previously healthy young adults, with higher rates of morbidity and mortality. The medical literature has been inundated with reports of H1N1 infection, the majority found in critical care and internal medicine journals with a relative paucity in the surgical literature. Despite this, it remains an important entity that can impact greatly on acute surgical emergencies. We present a case of previously healthy 31-year-old male who underwent open appendectomy. His post-operative recovery was complicated by acute respiratory distress syndrome secondary to H1N1 infection. This case report highlights the impact that H1N1 virus can have on acute surgical emergencies and how it can complicate the post-operative course.

  4. Portal venous gas detected on computed tomography in emergency situations: surgery is still necessary.

    Science.gov (United States)

    Monneuse, Olivier; Pilleul, Frank; Barth, Xavier; Gruner, Laurent; Allaouchiche, Bernard; Valette, Pierre-Jean; Tissot, E

    2007-05-01

    Portal venous gas (PVG) has been reported to be associated with lethal surgical diagnosis. Recent studies tend to confirm the clinical significance of gas in the portal vein; however, some patients are managed without surgical treatment. The aim of this study was to assess both the diagnoses and the treatment of patients with PVG in an emergency surgical setting. We performed a retrospective chart review of 15 patients with PVG in the emergency setting detected by computed tomography (CT) between July 1999 and July 2004. Characteristics assessed included age, sex, clinical presentation, first CT diagnosis of both PVG and the underlying pathology, American Society of Anesthesiologists (ASA) score, surgical findings, final clinical diagnosis, duration of hospitalization, and evolution of the illness/mortality. All patients were examined one month after operation. This series of 5 women and 10 men ranged in age from 38 to 90 years at the time they underwent emergency surgical treatment. The mean preoperative ASA score was 4.20. Computed tomography diagnosed the underlying pathology in all cases: bowel obstruction (4 cases), bowel necrosis (9 cases), and diffuse peritonitis (2 cases). The mean length of hospital stay was 12.4 days. The mortality rate was 46.6%; (7 patients). A wide range of pathologies can generate PVG. Computed tomography can detect both the presence of gas and the underlying pathology. In emergency situations, all the diagnosed causal pathologies required a surgical procedure without delay. We report that the prognosis was related to the pathology itself and was not influenced by the presence of PVG.

  5. Intraocular Lens Dislocation after Cataract Surgery in Tambolaka, Southwest Sumba, Indonesia: A Case Report

    OpenAIRE

    Ratna Sitompul

    2018-01-01

    Intraocular lens (IOL) dislocation is a rare complication of cataract extraction requiring prompt surgery. This case report aims to raise awareness of such cases and the importance of post-surgery follow-up. A 58-year-old female patient was found with anterior IOL dislocation a week after phacoemulsification surgery in her right eye. Visual acuity of the right eye was 1/60 with ciliary injection and IOL dislocation to the anterior chamber of the right eye. The patient underwent surgery of the...

  6. Salmonella enterica serovar Enteritidis brain abscess mimicking meningitis after surgery for glioblastoma multiforme: a case report and review of the literature

    OpenAIRE

    Luciani, L?a; Dubourg, Gr?gory; Graillon, Thomas; Honnorat, Estelle; Lepidi, Hubert; Drancourt, Michel; Seng, Piseth; Stein, Andreas

    2016-01-01

    Background Salmonella brain abscess associated with brain tumor is rare. Only 11 cases have been reported to date. Here we report a case of brain abscess caused by Salmonella enterica serovar Enteritidis mimicking post-surgical meningitis in a patient with glioblastoma multiforme. Case presentation A 60-year-old Algerian woman was admitted through an emergency department for a 4-day history of headache, nausea and vomiting, and behavioral disorders. Surgery for cerebral tumor excision was per...

  7. Assessing written communication during interhospital transfers of emergency general surgery patients.

    Science.gov (United States)

    Harl, Felicity N R; Saucke, Megan C; Greenberg, Caprice C; Ingraham, Angela M

    2017-06-15

    Poor communication causes fragmented care. Studies of transitions of care within a hospital and on discharge suggest significant communication deficits. Communication during transfers between hospitals has not been well studied. We assessed the written communication provided during interhospital transfers of emergency general surgery patients. We hypothesized that patients are transferred with incomplete documentation from referring facilities. We performed a retrospective review of written communication provided during interhospital transfers to our emergency department (ED) from referring EDs for emergency general surgical evaluation between January 1, 2014 and January 1, 2016. Elements of written communication were abstracted from referring facility documents scanned into the medical record using a standardized abstraction protocol. Descriptive statistics summarized the information communicated. A total of 129 patients met inclusion criteria. 87.6% (n = 113) of charts contained referring hospital documents. 42.5% (n = 48) were missing history and physicals. Diagnoses were missing in 9.7% (n = 11). Ninety-one computed tomography scans were performed; among 70 with reads, final reads were absent for 70.0% (n = 49). 45 ultrasounds and x-rays were performed; among 27 with reads, final reads were missing for 80.0% (n = 36). Reasons for transfer were missing in 18.6% (n = 21). Referring hospital physicians outside the ED were consulted in 32.7% (n = 37); consultants' notes were absent in 89.2% (n = 33). In 12.4% (n = 14), referring documents arrived after the patient's ED arrival and were not part of the original documentation provided. This study documents that information important to patient care is often missing in the written communication provided during interhospital transfers. This gap affords a foundation for standardizing provider communication during interhospital transfers. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Pre-operative risk scores for the prediction of outcome in elderly people who require emergency surgery

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    Bates Tom

    2007-06-01

    Full Text Available Abstract Background The decision on whether to operate on a sick elderly person with an intra-abdominal emergency is one of the most difficult in general surgery. A predictive risk-score would be of great value in this situation. Methods A Medline search was performed to identify those predictive risk-scores relevant to sick elderly patients in whom emergency surgery might be life-saving. Results Many of the risk scores for surgical patients include the operative findings or require tests which are not available in the acute situation. Most of the relevant studies include younger patients and elective surgery. The Glasgow Aneurysm Score and Hardman Index are specific to ruptured aortic aneurysm while the Boey Score and the Hacetteppe Score are specific to perforated peptic ulcer. The Reiss Index and Fitness Score can be used pre-operatively if the elements of the score can be completed in time. The ASA score, which includes a significant element of subjective clinical judgement, can be augmented with factors such as age and urgency of surgery but no test has a negative predictive value sufficient to recommend against surgical intervention without clinical input. Conclusion Risk scores may be helpful in sick elderly patients needing emergency abdominal surgery but an experienced clinical opinion is still essential.

  9. Comparing the Quality and Complications of Tube Thoracostomy by Emergency Medicine and Surgery Residents; a Cohort Study

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    Parvin Kashani

    2017-01-01

    Full Text Available Introduction: Tube thoracostomy complications depend on the operator’s skill, patients’ general condition and the place in which the procedure is done. The present study aimed to compare the quality and complications of tube thoracostomy carried out by emergency medicine residents (EMRs and surgery residents (SRs.Methods: This cohort study was conducted on 18-60 years old trauma patients in need of tube thoracostomy presenting to two academic emergency departments. Quality of tube placement and its subsequent complications until tube removal were compared between SRs and EMRs using SPSS 20.Results: 72 patients with the mean age of 37.1±14.1 years were studied (86.1% male. 23 (63.8% cases were complicated in SRs and 22 (61.1% cases in EMRs group (total= 62.5%. Chest drain dislodgement (22.2% in SRs vs. 22.2% EMRs; p>0.99, drainage failure (19.4% in SRs vs. 16.7% EMRs; p=0.50, and surgical site infection (11.1% in SRs vs. 19.4% EMRs; p=0.25 were among the most common observed complications. The overall odds ratio of complication development was 0.89 (95% CI: 0.35-2.25, p = 0.814 for SRs and 1.12 (95% CI: 0.28-4.53, p = 0.867 for EMRs.Conclusion: The findings of the present study showed no significant difference between SRs and EMRs regarding quality of tube thoracostomy placement and its subsequent complications for trauma patients. The rate of complications were interestingly high (>60% for both groups.

  10. Ostomy-related complications after emergent abdominal surgery: a 2-year follow-up study.

    Science.gov (United States)

    Lindholm, Elisabet; Persson, Eva; Carlsson, Eva; Hallén, Anne-Marie; Fingren, Jeanette; Berndtsson, Ina

    2013-01-01

    The aim of this study was to prospectively evaluate ostomy-related complications and describe ostomy configuration in patients undergoing acute abdominal surgery. The study sample comprised 144 patients with a median age of 67 years (IOR: 53.5-78 years) who underwent an intestinal ostomy as part of an acute abdominal surgical procedure. The research setting was the surgical and gynecological clinics at the Sahlgrenska University Hospital in Gothenburg, Sweden. Ostomy configuration, diameter, height, and the presence of stomal and peristomal complications were assessed by a WOC nurse 1 to 2 times while in hospital, once at the ostomy outpatient clinic 2 weeks after discharge, and at 3, 6, 12, and 24 months following ostomy creation. The types of ostomies evaluated were end colostomy (58%), end ileostomy (18%), loop ileostomy (17%), and loop colostomy (7%). Most stomal or peristomal complications occurred within 1 year after surgery (31 of 57; 54.4%). Necrosis, separation, and stenosis were most common in patients with an end colostomy. Peristomal skin complications occurred in 45% of subjects during the first 6 months after surgery. The ostomy's diameter decreased significantly during the hospital course and over the first 2 weeks following hospital discharge in patients with end colostomy (Postomy had peristomal skin problems ranging between 21% and 57% over this time period. The frequency of using a pouching system that incorporated convexity was highest in the case of loop ileostomy, used in 67% at 6 months. During the first 2 weeks after discharge, the physical configuration of the ostomy evolves and the pouching system must be frequently adjusted by a WOC nurse. Stomal and peristomal complications are prevalent during the first 2 postoperative years and especially during the first 6 months.

  11. Cataract surgery in a case of carotid cavernous fistula

    Science.gov (United States)

    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

  12. Monitoring equine visceral pain with a composite pain scale score and correlation with survival after emergency gastrointestinal surgery

    NARCIS (Netherlands)

    van Loon, Johannes P A M; Jonckheer-Sheehy, Valerie S M; Back, Willem; van Weeren, René; Hellebrekers, Ludo J; Back, Wim

    Recognition and management of equine pain have been studied extensively in recent decades and this has led to significant advances. However, there is still room for improvement in the ability to identify and treat pain in horses that have undergone emergency gastrointestinal surgery. This study

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

    Science.gov (United States)

    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…

  14. Adverse events and readmissions after day-case urological surgery

    Directory of Open Access Journals (Sweden)

    Alvaro Paez

    2007-06-01

    Full Text Available OBJECTIVE: The literature lacks of studies on postoperative outcomes after urological ambulatory surgery. Our study aims to identify parameters associated with postoperative complications within 30 days after ambulatory urological surgery. MATERIALS AND METHODS: Adjusted and unadjusted comparisons between clinical features and postoperative outcome (complicated and uncomplicated. RESULTS: Postoperative course was complicated in 5% of the patients. Discharge schedule was not completed in 1.1% while unplanned visits resulted in admission in 0.5%. Multivariate analyses could only confirm the independent effect of type of anesthesia and diagnosis-related group (DRG relative weight. CONCLUSIONS: Ambulatory urological surgery can be safe in terms of postoperative complications. In the present study surgery under general anesthesia, or a higher DRG relative weight procedure, increased the risk of complications compared to surgery under regional or local anesthesia or lower DRG relative weight operations. Patients scheduled for general anesthesia or undergoing complex urological procedures should be warned about an increased risk of postoperative incidents and/or readmission.

  15. Strategies to improve the outcome of emergency surgery for perforated peptic ulcer.

    Science.gov (United States)

    Søreide, K; Thorsen, K; Søreide, J A

    2014-01-01

    Perforated peptic ulcer (PPU) is a common surgical emergency that carries high mortality and morbidity rates. Globally, one-quarter of a million people die from peptic ulcer disease each year. Strategies to improve outcomes are needed. PubMed was searched for evidence related to the surgical treatment of patients with PPU. The clinical registries of trials were examined for other available or ongoing studies. Randomized clinical trials (RCTs), systematic reviews and meta-analyses were preferred. Deaths from peptic ulcer disease eclipse those of several other common emergencies. The reported incidence of PPU is 3.8-14 per 100,000 and the mortality rate is 10-25 per cent. The possibility of non-operative management has been assessed in one small RCT of 83 patients, with success in 29 (73 per cent) of 40, and only in patients aged less than 70 years. Adherence to a perioperative sepsis protocol decreased mortality in a cohort study, with a relative risk (RR) reduction of 0.63 (95 per cent confidence interval (c.i.) 0.41 to 0.97). Based on meta-analysis of three RCTs (315 patients), laparoscopic and open surgery for PPU are equivalent, but patient selection remains a challenge. Eradication of Helicobacter pylori after surgical repair of PPI reduces both the short-term (RR 2.97, 95 per cent c.i. 1.06 to 8.29) and 1-year (RR 1.49, 1.10 to 2.03) risk of ulcer recurrence. Mortality and morbidity from PPU can be reduced by adherence to perioperative strategies. © 2013 BJS Society Ltd. Published by John Wiley & Sons Ltd.

  16. Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery.

    Science.gov (United States)

    Bala, Miklosh; Kashuk, Jeffry; Moore, Ernest E; Kluger, Yoram; Biffl, Walter; Gomes, Carlos Augusto; Ben-Ishay, Offir; Rubinstein, Chen; Balogh, Zsolt J; Civil, Ian; Coccolini, Federico; Leppaniemi, Ari; Peitzman, Andrew; Ansaloni, Luca; Sugrue, Michael; Sartelli, Massimo; Di Saverio, Salomone; Fraga, Gustavo P; Catena, Fausto

    2017-01-01

    Acute mesenteric ischemia (AMI) is typically defined as a group of diseases characterized by an interruption of the blood supply to varying portions of the small intestine, leading to ischemia and secondary inflammatory changes. If untreated, this process will eventuate in life threatening intestinal necrosis. The incidence is low, estimated at 0.09-0.2% of all acute surgical admissions. Therefore, although the entity is an uncommon cause of abdominal pain, diligence is always required because if untreated, mortality has consistently been reported in the range of 50%. Early diagnosis and timely surgical intervention are the cornerstones of modern treatment and are essential to reduce the high mortality associated with this entity. The advent of endovascular approaches in parallel with modern imaging techniques may provide new options. Thus, we believe that a current position paper from World Society of Emergency Surgery (WSES) is warranted, in order to put forth the most recent and practical recommendations for diagnosis and treatment of AMI. This review will address the concepts of AMI with the aim of focusing on specific areas where early diagnosis and management hold the strongest potential for improving outcomes in this disease process. Some of the key points include the prompt use of CT angiography to establish the diagnosis, evaluation of the potential for revascularization to re-establish blood flow to ischemic bowel, resection of necrotic intestine, and use of damage control techniques when appropriate to allow for re-assessment of bowel viability prior to definitive anastomosis and abdominal closure.

  17. Fluorescence-guided surgery and intervention - An AAPM emerging technology blue paper.

    Science.gov (United States)

    Pogue, Brian W; Zhu, Timothy C; Ntziachristos, Vasilis; Paulsen, Keith D; Wilson, Brian C; Pfefer, Joshua; Nordstrom, Robert J; Litorja, Maritoni; Wabnitz, Heidrun; Chen, Yu; Gioux, Sylvain; Tromberg, Bruce J; Yodh, Arjun G

    2018-04-10

    Fluorescence-guided surgery (FGS) and other interventions are rapidly evolving as a class of technologically driven interventional approaches in which many surgical specialties visualize fluorescent molecular tracers or biomarkers through associated cameras or oculars to guide clinical decisions on pathological lesion detection and excision/ablation. The technology has been commercialized for some specific applications, but also presents technical challenges unique to optical imaging that could confound the utility of some interventional procedures where real-time decisions must be made. Accordingly, the AAPM has initiated the publication of this Blue Paper of The Emerging Technology Working Group (TETAWG) and the creation of a Task Group from the Therapy Physics Committee within the Treatment Delivery Subcommittee. In describing the relevant issues, this document outlines the key parameters, stakeholders, impacts, and outcomes of clinical FGS technology and its applications. The presentation is not intended to be conclusive, but rather to inform the field of medical physics and stimulate the discussions needed in the field with respect to a seemingly low-risk imaging technology that has high potential for significant therapeutic impact. This AAPM Task Group is working toward consensus around guidelines and standards for advancing the field safely and effectively. © 2018 American Association of Physicists in Medicine.

  18. A national review of the frequency of minimally invasive surgery among general surgery residents: assessment of ACGME case logs during 2 decades of general surgery resident training.

    Science.gov (United States)

    Richards, Morgan K; McAteer, Jarod P; Drake, F Thurston; Goldin, Adam B; Khandelwal, Saurabh; Gow, Kenneth W

    2015-02-01

    Minimally invasive surgery (MIS) has created a shift in how many surgical diseases are treated. Examining the effect on resident operative experience provides valuable insight into trends that may be useful for restructuring the requirements of resident training. To evaluate changes in general surgery resident operative experience regarding MIS. Retrospective review of the frequency of MIS relative to open operations among general surgery residents using the Accreditation Council for Graduate Medical Education case logs for academic years 1993-1994 through 2011-2012. General surgery residency training among accredited programs in the United States. We analyzed the difference in the mean number of MIS techniques and corresponding open procedures across training periods using 2-tailed t tests with statistical significance set at P surgery has an increasingly prominent role in contemporary surgical therapy for many common diseases. The open approach, however, still predominates in all but 5 procedures. Residents today must become efficient at performing multiple techniques for a single procedure, which demands a broader skill set than in the past.

  19. Computer-assisted surgery in orthopedic oncology : Technique, indications, and a descriptive study of 130 cases

    NARCIS (Netherlands)

    Gerbers, Jasper G.; Stevens, Martin; Ploegmakers, Joris J. W.; Bulstra, Sjoerd K.; Jutte, Paul C.

    2014-01-01

    Background and purpose - In orthopedic oncology, computerassisted surgery (CAS) can be considered an alternative to fluoroscopy and direct measurement for orientation, planning, and margin control. However, only small case series reporting specific applications have been published. We therefore

  20. Colonic stenting as bridge to surgery versus emergency surgery for management of acute left-sided malignant colonic obstruction: a multicenter randomized trial (Stent-in 2 study

    Directory of Open Access Journals (Sweden)

    Scholten Pieter

    2007-07-01

    Full Text Available Abstract Background Acute left-sided colonic obstruction is most often caused by malignancy and the surgical treatment is associated with a high mortality and morbidity rate. Moreover, these operated patients end up with a temporary or permanent stoma. Initial insertion of an enteral stent to decompress the obstructed colon, allowing for surgery to be performed electively, is gaining popularity. In uncontrolled studies stent placement before elective surgery has been suggested to decrease mortality, morbidity and number of colostomies. However stent perforation can lead to peritoneal tumor spill, changing a potentially curable disease in an incurable one. Therefore it is of paramount importance to compare the outcomes of colonic stenting followed by elective surgery with emergency surgery for the management of acute left-sided malignant colonic obstruction in a randomized multicenter fashion. Methods/design Patients with acute left-sided malignant colonic obstruction eligible for this study will be randomized to either emergency surgery (current standard treatment or colonic stenting as bridge to elective surgery. Outcome measurements are effectiveness and costs of both strategies. Effectiveness will be evaluated in terms of quality of life, morbidity and mortality. Quality of life will be measured with standardized questionnaires (EORTC QLQ-C30, EORTC QLQ-CR38, EQ-5D and EQ-VAS. Morbidity is defined as every event leading to hospital admission or prolonging hospital stay. Mortality will be analyzed as total mortality as well as procedure-related mortality. The total costs of treatment will be evaluated by counting volumes and calculating unit prices. Including 120 patients on a 1:1 basis will have 80% power to detect an effect size of 0.5 on the EORTC QLQ-C30 global health scale, using a two group t-test with a 0.05 two-sided significance level. Differences in quality of life and morbidity will be analyzed using mixed-models repeated measures

  1. Evaluation of the Effect of a Preoperative Single Dose of Gabapentin on Emergence Agitation in Patients Undergoing Breast Cancer Surgery

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    Simin Azemati

    2013-10-01

    Full Text Available Background: Emergence agitation is a transient confusional state that usuallyoccurs within 10 to 30 minutes of recovery from general anesthesia. It may lead to seriousconsequences and increasing hospital costs. This study evaluates the effect of gabapentinon emergence agitation in patients undergoing breast cancer surgery.Methods: This randomized, double blind controlled trial enrolled 100 femalepatients with American Society of Anesthesiologists' classifications I and II who werecandidates for breast cancer surgery. Patients were randomly assigned into two groups(n=50 that received either oral gabapentin 600 mg or placebo. Induction andmaintenance of anesthesia were similar in both groups. At the end of surgery, patient'sagitation score, pain score, and presence of nausea or vomiting were reported. In theward, the presence of headache or dizziness was checked during the first 8 h. Mann-Whitney test was used for comparison of agitation and pain scores between two groups.Chi-square test was used for comparing occurrence of nausea, vomiting and qualitative.The qualitative demographic variable and t-test compared quantitative demographicvariables.Results: There was a significantly lower incidence of emergence agitation in thegabapentin group before (P<0.001 and after (P=0.029 extubation. There weresignificantly lower mean agitation scores before (P<001 and after (P=0.006 extubationand in the pain score (P=0.005 in the gabapentin group. The need for remifentanilinfusion (P<0.05 during surgery was significantly lower in the gabapentin groupcompared with the placebo group. Occurrence of nausea and vomiting and gabapentinside effects that included headache or dizziness did not significantly differ between twogroups (P=0.126, P=1, P=0.629 respectively.Conclusion: Gabapentin not only decreased postoperative pain but also effectivelyreduced emergence agitation without any significant side effects in patients undergoingbreast cancer surgery.

  2. Case mix classification and a benchmark set for surgery scheduling

    NARCIS (Netherlands)

    Leeftink, Gréanne; Hans, Erwin W.

    Numerous benchmark sets exist for combinatorial optimization problems. However, in healthcare scheduling, only a few benchmark sets are known, mainly focused on nurse rostering. One of the most studied topics in the healthcare scheduling literature is surgery scheduling, for which there is no widely

  3. Esophageal Perforation Following Anterior Cervical Spine Surgery: Case Report and Review of the Literature

    OpenAIRE

    Hershman, Stuart H.; Kunkle, William A.; Kelly, Michael P.; Buchowski, Jacob M.; Ray, Wilson Z.; Bumpass, David B.; Gum, Jeffrey L.; Peters, Colleen M.; Singhatanadgige, Weerasak; Kim, Jin Young; Smith, Zachary A.; Hsu, Wellington K.; Nassr, Ahmad; Currier, Bradford L.; Rahman, Ra?Kerry K.

    2017-01-01

    Study Design: Multicenter retrospective case series and review of the literature. Objective: To determine the rate of esophageal perforations following anterior cervical spine surgery. Methods: As part of an AOSpine series on rare complications, a retrospective cohort study was conducted among 21 high-volume surgical centers to identify esophageal perforations following anterior cervical spine surgery. Staff at each center abstracted data from patients? charts and created case report forms fo...

  4. Coronary artery surgery in a man with achondroplasia: a case report

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    Daskalopoulos Marios E

    2010-10-01

    Full Text Available Abstract Introduction Achondroplasia is a musculoskeletal disorder associated with short stature. Despite an estimated prevalence of 1:25,000 in the general population, there is little literature concerning the diagnostic and treatment challenges faced by doctors dealing with a heart operation on a patient with this condition. Case presentation We present the case of a 41-year-old Caucasian man of Greek ethnicity with achondroplasia, who underwent bypass heart surgery. Conclusions The surgery was successful and did not present particular difficulties, showing that heart surgery can be safely performed on people with achondroplasia.

  5. A case for the expansion of day surgery.

    Science.gov (United States)

    Ogg, T; Heath, P; Brownlie, G

    1989-12-01

    The efficiency of the National Health Service (NHS) is currently under scrutiny and the problems faced by the surgical services include a shortage of financial resources, fewer beds, poor nursing recruitment and rising waiting lists. During 1984-1988 a purpose built, separate 12-bedded day surgery unit at Addenbrooke's Hospital, Cambridge operated upon 13,000 patients, with a readmission rate of less than 1%. Senior medical staff are involved and the overall surgical waiting list has been reduced by 40.9%. Nurse recruitment has been excellent, and the community medical and nursing services have not been overburdened. The results detailed in this paper suggest that day surgery deserves special consideration as one acceptable solution to some of the current NHS problems.

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

    OpenAIRE

    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 t...

  7. Anaesthetic Management for Cataract Surgery in VACTERL Syndrome Case Report

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    Sonal S Khatavkar

    2009-01-01

    Full Text Available Eight year old girl, weighing 14 kg with VACTERL syndrome V: Vertebral anomalies, A: Anal malformation, C: Cardiovascular defect, TE: Tracheal and esophageal malformation, R:Renal agenesis, L: Limb anomalies., underwent cataract surgery under general anaesthesia. She had multiple congenital anomalies like esophageal atresia, imperfo-rate anus (corrected, single kidney& radial aplasia. Anticipating problems of gastro-esophageal reflux& chronic renal failure, successful management was done.

  8. Supratentorial hematoma during infratentorial surgery: A short series of three cases

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    Sandeep Mohindra

    2012-01-01

    Full Text Available Distant site hematoma formation may complicate an otherwise uneventful surgery. The authors describe three cases of such unexpected complications, while operating upon infratentorial lesions in prone position. Pathophysiology behind such complications and changes in intraoperative monitoring is discussed, along with all the previously reported cases. Of the three cases, there was one death, while rest of the two cases made eventless recovery. Meticulous hemostasis, isolation of operative site, avoidance of cerebrospinal fluid over-drainage during surgery may prevent such a complication. Careful interpretation of vital-monitoring may indicate the occurrence of such a complication.

  9. Plastic surgery in chest wall reconstruction: relevant aspects - case series

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    Diogo Franco

    Full Text Available Objective: to discuss the participation of Plastic Surgery in the reconstruction of the chest wall, highlighting relevant aspects of interdisciplinaryness. Methods: we analyzed charts from 20 patients who underwent extensive resection of the thoracic integument, between 2000 and 2014, recording the indication of resection, the extent and depth of the raw areas, types of reconstructions performed and complications. Results: among the 20 patients, averaging 55 years old, five were males and 15 females. They resections were: one squamous cell carcinoma, two basal cell carcinomas, five chondrosarcomas and 12 breast tumors. The extent of the bloody areas ranged from 4x9 cm to 25x40 cm. In 12 patients the resection included the muscular plane. In the remaining eight, the tumor removal achieved a total wall thickness. For reconstruction we used: one muscular flap associated with skin grafting, nine flaps and ten regional fasciocutaneous flaps. Two patients undergoing reconstruction with fasciocutaneous flaps had partially suffering of the flap, solved with employment of a myocutaneous flap. The other patients displayed no complications with the techniques used, requiring only one surgery. Conclusion: the proper assessment of local tissues and flaps available for reconstruction, in addition to the successful integration of Plastic Surgery with the specialties involved in the treatment, enable extensive resections of the chest wall and reconstructions that provide patient recovery.

  10. The case for restraint in spinal surgery: does quality management have a role to play?

    Science.gov (United States)

    Deyo, Richard A; Mirza, Sohail K

    2009-08-01

    Most quality improvement efforts in surgery have focused on the technical quality of care provided, rather than whether the care was indicated, or could have been provided with a safer procedure. Because risk is inherent in any procedure, reducing the number of unnecessary operations is an important issue in patient safety. In the case of lumbar spine surgery, several lines of evidence suggest that, in at least some locations, there may be excessively high surgery rates. This evidence comes from international comparisons of surgical rates; study of small area variations within countries; increasing surgical rates in the absence of new indications; comparisons of surgical outcomes between geographic areas with high or low surgical rates; expert opinion; the preferences of well-informed patients; and increasing rates of repeat surgery. From a population perspective, reducing unnecessary surgery may have a greater impact on complication rates than improving the technical quality of surgery that is performed. Evidence suggests this may be true for coronary bypass surgery in the US and hysterectomy rates in Canada. Though similar studies have not been done for spine surgery, wide geographic variations in surgical rates suggest that this could be the case for spine surgery as well. We suggest that monitoring geographic variations in surgery rates may become an important aspect of quality improvement, and that rates of repeat surgery may bear special attention. Patient registries can help in this regard, if they are very complete and rigorously maintained. They can provide data on surgical rates; offer post-marketing surveillance for new surgical devices and techniques; and help to identify patient subgroups that may benefit most from certain procedures.

  11. Pleural Effusion Resultant after Upper Abdominal Surgery: Analysis of 47 Cases

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    Ufuk Cobanoglu

    2011-09-01

    Full Text Available Postoperative pulmonary complications, following upper abdominal surgery, occur at a rate which is higher, than lower abdominal surgery. One of these complications is pleural effusion. In this study, the frequency and causes of pleural effusions and the changes of the blood gas values and pulmonary functions of the patients with pleural effusions, occured after upper abdominal surgery are discussed in the accompaniment of the literature. Material and Methods:148 patients to whom upper adominal surgery is performed and in 47 of these patients pleural effusion is developed (31.75% , were examined restrospectivitely. Preoperative and postoperative pulmonary function tests (PFT and arterial blood gas (ABG results and the blood proteins, albumin values were recorded. The anesthesia type, the surgery properties, involving type of surgery and the surgical incision were determined. Results:Pleural effusion is detected bilaterally in 8 patients (17:02, at the rightside in 21 patients (44.69% ,and at the left side in 18 patients (38.29%.The 40.42% (19 cases of the patients who has pleural effusion in the postoperative period, had liver and gallbladder surgery, the %23.41 (11 Cases had spleen and pancreas surgery and the %36.17 (17 cases had the  other surgical procedures.Conclusions: While the upper abdominal surgery, impairment of the integrity of the diaphragm‘s peritoneum that covers the abdominal cavity where there is a highliquid pressure, may cause the liquid transition to the pleural space that has a negative pressure. Hypoalbuminemia and hipoproteinemia, that will occur due to the changes of oral intake and diet regulation in the postoperative period, may cause a reason for the pleural effusion. For this reason, doctors who performed these surgery procedures, should not ignore this complication, in the period of postoperative follow-ups of the patients.

  12. Socioeconomic factors and mortality in emergency general surgery: trends over a 20-year period.

    Science.gov (United States)

    Armenia, Sarah J; Pentakota, Sri Ram; Merchant, Aziz M

    2017-05-15

    Socioeconomic factors such as race, insurance, and income quartiles have been identified as independent risk factors in emergency general surgery (EGS), but this impact has not been studied over time. We sought to identify trends in disparities in EGS-related operative mortality over a 20-y period. The National Inpatient Sample was used to identify patient encounters coded for EGS in 1993, 2003, and 2013. Logistic regression models were used to examine the adjusted relationship between race, primary payer status, and median income quartiles and in-hospital mortality after adjusting for patients' age, gender, Elixhauser comorbidity score, and hospital region, size, and location-cum-teaching status. We identified 391,040 patient encounters. In 1993, Black race was associated with higher odds of in-hospital mortality (odds ratio [95% confidence interval]: 1.35 [1.20-1.53]) than White race, although this difference dissipated in subsequent years. Medicare, Medicaid, and underinsured patients had a higher odds of mortality than those with private insurance for the entire 20-y period; only the disparity in the underinsured decreased over time (1993, 1.63 [1.35-1.98]; 2013, 1.41 [1.20-1.67]). In 2003 (1.23 [1.10-1.38]) and 2013 (1.23 [1.11-1.37]), patients from the lowest income quartile were more likely to die after EGS than patients from the highest income quartile. Socioeconomic disparities in EGS-related operative morality followed inconsistent trends. Over time, while gaps in in-hospital mortality among Blacks and Whites have narrowed, disparities among patients belonging to lowest income quartile have worsened. Medicare and Medicaid beneficiaries continued to experience higher odds of in-hospital mortality relative to those with private insurance. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Outcome after emergency surgery without angiography in patients with intracerebral haemorrhage after aneurysm rupture

    DEFF Research Database (Denmark)

    Bergdal, Ove; Springborg, Jacob; Hauerberg, John

    2009-01-01

    BACKGROUND: Patients with large intracerebral haematomas (ICH) from aneurysm rupture often present in a poor clinical condition and have a poor prognosis. Time delay for preoperative angiography might in some cases be unappealing. We evaluated the outcome after immediate haematoma removal...... and aneurysm occlusion without preoperative angiography. METHODS: We retrospectively identified 13 consecutive patients. We recorded clinical data and evaluated mortality and morbidity with the Glasgow Outcome Score (GOS) and Telephone Interview of Cognitive Status (TICS). FINDINGS: At follow up seven...... of thirteen patients had favourable outcome assessed by GOS. Three patients had severe disability and three patients died. None of the survived patients interviewed had impaired cognition. CONCLUSIONS: In patients presented in a critical state with aneurysmal ICH, emergency haematoma removal and aneurysm...

  14. A Case Study on Idiopathic Orbital Pseudotumor: Surgery and ...

    African Journals Online (AJOL)

    This is a case study of five isolated orbital nerve inflammatory pseudotumor cases ... Optic disk edema was observed by ophthalmoscopy. ... The patients on clinical examination were found to have protrusion, reduced visual acuity of the right ...

  15. In Situ Surgery: Is It Safe ? (Experience with 60 cases)

    African Journals Online (AJOL)

    xp

    potentiality of line disconnection or endotracheal tube dislodgement. ... insertion of intrapertioneal drain in one case ,the ... closure with intraperitoneal drainage , this case needed later ... conservative measures were undertaken till complete.

  16. Audit of day case surgery in LAUTECH teaching hospital, Osogbo ...

    African Journals Online (AJOL)

    Background/ method: A retrospective study of all patients operated as day-case at the Ladoke Akintola University Teaching Hospital Osogbo over a period of 14 months (October 2000 to November 2001) was carried out. Results: Seventy-six patients were operated as day-cases within the study period, but 74 case notes ...

  17. Epicrania fugax: 19 cases of an emerging headache.

    Science.gov (United States)

    Cuadrado, María Luz; Ordás, Carlos M; Sánchez-Lizcano, María; Casas-Limón, Javier; Matías-Guiu, Jordi A; García-García, María Eugenia; Fernández-Matarrubia, Marta; Barahona-Hernando, Raúl; Porta-Etessam, Jesús

    2013-05-01

    Epicrania fugax (EF) is a primary headache of recent description. We aimed to report 19 new cases of EF, and thus contribute to the characterization of this emerging headache. EF is characterized by painful paroxysms starting in a particular area of the head, and rapidly radiating forwards or backwards through the territories of different nerves. The pain is felt in quick motion along a lineal or zigzag trajectory. To date, 47 cases have been published, 34 with forward EF and 13 with backward EF. We performed a descriptive study of all EF cases attending our Headache Unit from April 2010 to December 2012. Demographic and clinical data were recorded with a structured questionnaire. Overall, there were 12 women and 7 men. Mean age at onset was 51.7 ± 16.2. Fourteen patients had forward EF, while 5 patients had backward EF. Painful paroxysms lasted 1-4 seconds. Pain intensity was usually moderate or severe, and pain quality was mostly electric. Four patients had ocular autonomic accompaniments. Pain frequency was extremely variable, and 7 patients identified some triggers. Between attacks, 13 patients had some pain or tenderness in the stemming area. Thirteen patients required therapy for their pain. Neuromodulators, indomethacin, anesthetic blockades, and steroid injections were used in different cases, with partial or complete response. EF appears as a distinct headache syndrome and could be eventually included in future editions of the International Classification of Headache Disorders. © 2013 American Headache Society.

  18. Gingival recontouring by provisional implant restoration for optimal emergence profile: report of two cases.

    Science.gov (United States)

    Son, Mee-Kyoung; Jang, Hyun-Seon

    2011-12-01

    The emergence profile concept of an implant restoration is one of the most important factors for the esthetics and health of peri-implant soft tissue. This paper reports on two cases of gingival recontouring by the fabrication of a provisional implant restoration to produce an optimal emergence profile of a definitive implant restoration. After the second surgery, a preliminary impression was taken to make a soft tissue working cast. A provisional crown was fabricated on the model. The soft tissue around the implant fixture on the model was trimmed with a laboratory scalpel to produce the scalloped gingival form. Light curing composite resin was added to fill the space between the provisional crown base and trimmed gingiva. After 4 to 6 weeks, the final impression was taken to make a definitive implant restoration, where the soft tissue and tooth form were in harmony with the adjacent tooth. At the first insertion of the provisional restoration, gum bleaching revealed gingival pressure. Four to six weeks after placing the provisional restoration, the gum reformed with harmony between the peri-implant gingiva and adjacent dentition. Gingival recontouring with a provisional implant restoration is a non-surgical and non-procedure-sensitive method. The implant restoration with the optimal emergence profile is expected to provide superior esthetic and functional results.

  19. The quality of research synthesis in surgery: the case of laparoscopic surgery for colorectal cancer

    Directory of Open Access Journals (Sweden)

    Martel Guillaume

    2012-02-01

    Full Text Available Abstract Background Several systematic reviews and meta-analyses populate the literature on the effectiveness of laparoscopic surgery for colorectal cancer. The utility of this body of work is unclear. The objective of this study was to synthesize all such systematic reviews in terms of clinical effectiveness, to appraise their quality, and to determine whether areas of duplication exist across reviews. Methods Systematic reviews comparing laparoscopic and open surgery for colorectal cancer were identified using a comprehensive search protocol (1991 to 2008. The primary outcome was overall survival. The methodological quality of reviews was appraised using the Assessment of Multiple Systematic Reviews (AMSTAR instrument. Abstraction and quality appraisal was carried out by two independent reviewers. Reviews were synthesized, and outcomes were compared qualitatively. A citation analysis was carried out using simple matrices to assess the comprehensiveness of each review. Results In total, 27 reviews were included; 13 reviews included only randomized controlled trials. Rectal cancer was addressed exclusively by four reviews. There was significant overlap between review purposes, populations and, outcomes. The mean AMSTAR score (out of 11 was 5.8 (95% CI: 4.6 to 7.0. Overall survival was evaluated by ten reviews, none of which found a significant difference. Three reviews provided a selective meta-analysis of time-to-event data. Previously published systematic reviews were poorly and highly selectively referenced (mean citation ratio 0.16, 95% CI: 0.093 to 0.22. Previously published trials were not comprehensively identified and cited (mean citation ratio 0.56, 95% CI: 0.46 to 0.65. Conclusions Numerous overlapping systematic reviews of laparoscopic and open surgery for colorectal cancer exist in the literature. Despite variable methods and quality, survival outcomes are congruent across reviews. A duplication of research efforts appears to exist

  20. [Characteristics of emergency poisoning cases in elderly versus younger patients].

    Science.gov (United States)

    Supervía Caparrós, August; Pallàs Villaronga, Oriol; Clemente Rodríguez, Carlos; Aranda Cárdenas, María Dolores; Pi-Figueras Valls, María; Cirera Lorenzo, Isabel

    2017-10-01

    To compare cases of poisoning according to age to detect differences in frequency of visits to the emergency department, patient characteristics, case management, and immediate outcome in terms of related mortality. Descriptive study of a retrospective series of patients who visited a university hospital emergency department for treatment of poisoning between 2009 and 2014. We collected patient characteristics and data related to the event, case management, and poisoning-related death. Patients were grouped according to age (cut-off 65 y). Of a total of 3847 poisoning episodes, 341 (8.9%) were in patients aged 65 years or older. The percentage of women among these older patients (61.3%) was greater than among younger patients (36.3%; P<.001). Poisoning was accidental in older patients more often than younger ones (64.4% vs 9.5%, respectively; P<.001), occurred more often in the home (82.1% vs 37%, P<.001), and more often required active treatment (73.3% vs 57.4%; P<.001) and admission to hospital (21.4% vs 7.3%, P<.001). The related mortality rate was also higher in the older patients (2.1% vs 0.1% in younger patients, P<.001). The percentage of poisonings in patients aged 65 years or older is not negligible. Poisoning in patients of advanced age tends to be accidental and take place in the home. Older patients more often require active treatment and hospital admission; poisoning-related death is more common in older patients than younger ones.

  1. Delayed cerebrospinal fluid leakage 10 years after transsphenoidal surgery and gamma knife surgery. Case report

    International Nuclear Information System (INIS)

    Ogawa, Yoshikazu; Tominaga, Teiji

    2007-01-01

    A 38-year-old woman presented with repeated episodes of meningitis. She had undergone transsphenoidal tumor removal followed by gamma knife irradiation in 1994. Complete remission was achieved. Intermittent cerebrospinal fluid (CSF) leakage began in 2004, and transsphenoidal surgery was performed for direct repair of the skull base defect. Operative findings showed that the sellar floor was uncovered, and CSF continuously escaped through the cyanoacrylate polymer framework of the previous repair. Reconstruction used autologous muscle pieces and cyanoacrylate polymer adhesive. The CSF leakage was presumably due to delayed radiation damage to the mucous membrane of the skull base. Several methods for reconstruction of the sellar floor have been proposed, which all rely on tissue regeneration including the arachnoid, dura mater, and mucus membrane of the sphenoidal sinus. Preservation of the arachnoid membrane and minimizing removal of the mucous membrane are essential, especially if postoperative irradiation is anticipated. (author)

  2. Strategic laparoscopic surgery for improved cosmesis in general and bariatric surgery: analysis of initial 127 cases.

    Science.gov (United States)

    Nguyen, Ninh T; Smith, Brian R; Reavis, Kevin M; Nguyen, Xuan-Mai T; Nguyen, Brian; Stamos, Michael J

    2012-05-01

    Strategic laparoscopic surgery for improved cosmesis (SLIC) is a less invasive surgical approach than conventional laparoscopic surgery. The aim of this study was to examine the feasibility and safety of SLIC for general and bariatric surgical operations. Additionally, we compared the outcomes of laparoscopic sleeve gastrectomy with those performed by the SLIC technique. In an academic medical center, from April 2008 to December 2010, 127 patients underwent SLIC procedures: 38 SLIC cholecystectomy, 56 SLIC gastric banding, 26 SLIC sleeve gastrectomy, 1 SLIC gastrojejunostomy, and 6 SLIC appendectomy. SLIC sleeve gastrectomy was initially performed through a single 4.0-cm supraumbilical incision with extraction of the gastric specimen through the same incision. The technique evolved to laparoscopic incisions that were all placed within the umbilicus and suprapubic region. There were no 30-day or in-hospital mortalities or 30-day re-admissions or re-operations. For SLIC cholecystectomy, gastric banding, appendectomy, and gastrojejunostomy, conversion to conventional laparoscopy occurred in 5.3%, 5.4%, 0%, and 0%, respectively; there were no major or minor postoperative complications. For SLIC sleeve gastrectomy, there were no significant differences in mean operative time and length of hospital stay compared with laparoscopic sleeve gastrectomy; 1 (3.8%) of 26 SLIC patients required conversion to five-port laparoscopy. There were no major complications. Minor complications occurred in 7.7% in the SLIC sleeve group versus 8.3% in the laparoscopic sleeve group. SLIC in general and bariatric operations is technically feasible, safe, and associated with a low rate of conversion to conventional laparoscopy. Compared with laparoscopic sleeve gastrectomy, SLIC sleeve gastrectomy can be performed without a prolonged operative time with comparable perioperative outcomes.

  3. Coping with regional variations: the case of surgery in Denmark

    DEFF Research Database (Denmark)

    Andersen, T F; Blais, R; Bredesen, J

    1988-01-01

    This article examines some of the key research and policy issues that are emerging as a result of recent analyses of regional variations in health care. The article presents a historical background to this important new field of health services' research, and indicates, using some Danish examples...

  4. Emergency aortic valve replacement and Caesarian section in a primigravida with severe aortic stenosis: a case report.

    Science.gov (United States)

    Kochhar, Puneet K; Zutshi, V; Shamsunder, S; Batra, S; Ghosh, P

    2011-01-01

    Congenital bicuspid aortic valve with severe aortic stenosis (AS) is a rare condition (3-6% of patients with congenital heart disease). Pregnancy in these patients carries a high risk of maternal and fetal mortality. With advancing gestational age, these women may develop cardiac failure due to increased cardiorespiratory requirements. When medical therapy proves insufficient, cardiac surgery becomes mandatory to save the patient's life. Balloon valvuloplasty is only palliative treatment, the duration of benefit being only 6 months. Valve replacement is thus recommended. Cardiopulmonary bypass (CPB) surgery with valve replacement has been reported to carry a lower risk of maternal mortality (1.5-13%) but a very high fetal risk (16-40%). This paper reports the case of a 30-year-old primigravida with severe AS with bicuspid aortic valve and pulmonary congestion clinically uncontrolled, in whom CPB surgery and aortic valve replacement was performed as an emergency procedure, along with a lower segment Caesarian section. The outcome of unrelieved severe symptomatic AS in pregnancy is poor. Multidisciplinary management is important to avoid deterioration in cardiac performance in parturients with severe AS. CPB during pregnancy carries a high risk to the fetus. Therefore, open heart surgery during pregnancy should be advised only in extreme emergencies (ie, heart failure refractory to conventional therapy).

  5. Adolescent Idiopathic Scoliosis – case report of a patient with clinical deterioration after surgery

    Directory of Open Access Journals (Sweden)

    Weiss Hans-Rudolf

    2007-12-01

    Full Text Available Abstract Background Although there is no evidence that the long-term effects of scoliosis surgery are superior to the long-term effects of Adolescent Idiopathic Scoliosis (AIS itself, patients can fear the consequences of not under going this surgery due to incorrect or insufficient information. The main indication for surgical treatment in patients with AIS, is cosmetic. However spinal surgery may, along with other negative side effects, actually cause postoperative clinical deterioration. This complication of surgery has not yet been described in international literature. Case presentation A 15-year old female patient originally presenting with a well-compensated double curve pattern scoliosis. The patient was advised to undergo surgery due to the long-term negative impact of signs and symptoms of scoliosis upon her health. The patient agreed to surgery, which was performed in one of Germanys leading centres for spinal surgery. The thoracolumbar curve was corrected and fused, while the thoracic curve, clearly showing wedged vertebrae, defined as structural scoliosis, remained untreated. This operation left the patient with an unbalanced appearance, with radiological and clinical imbalance to the right. The clinical appearance of the patient though clearly deteriorated post-surgery. Furthermore, the wedged disc space below the fusion area indicates future problems with possible destabilisation accompanied probably by low back pain. Conclusion Scoliosis surgery for patients with AIS is mainly indicated for cosmetic or psychological reasons. Therefore the treatment leading to the best possible clinical appearance and balance has to be chosen. Patients should be informed that surgery will not necessarily improve their health status. Clinical deterioration after surgery may occur, and such information is crucial for an adequate informed consent.

  6. Suicidal Ideation and Behaviours Among Adolescents Receiving Bariatric Surgery: A Case-Control Study.

    Science.gov (United States)

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

    2015-11-01

    This study examined the prevalence and correlates of suicidal ideation and behaviour (SI/B) among adolescents receiving bariatric surgery. Charts of 206 adolescents receiving bariatric surgery were reviewed. Cases with SI/B (current/lifetime reported at baseline or event occurring in the programme n = 31, 15%) were case matched on gender, age and surgery type to 31 adolescents reporting current or past psychiatric treatment and 31 adolescents denying lifetime SI/B or psychiatric treatment. Before surgery, adolescents with SI/B reported significantly lower total levels of health-related quality of life (p = 0.01) and greater depressive symptoms (p = 0.004) in comparison with candidates who never received psychiatric treatment. No significant differences were found between groups for the change in depressive symptoms or body mass index following surgery. As in studies of adults, a notable subset of adolescents receiving bariatric surgery indicated pre-operative or post-operative SI/B. It is critical that clinicians evaluate and monitor adolescent patients undergoing bariatric surgery for risk of SI/B. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.

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

    Science.gov (United States)

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

    2015-01-01

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

  8. The effect of expedited rotator cuff surgery in injured workers: a case-control study.

    Science.gov (United States)

    Razmjou, Helen; Lincoln, Sandra; Boljanovic, Dragana; Gallay, Stephen; Henry, Patrick; Richards, Robin R; Holtby, Richard

    2017-07-01

    Expediting rotator cuff surgery is expected to facilitate recovery and return to work in injured workers. This case-control study examined the effect of expedited rotator cuff surgery on recovery and work status in injured workers. Injured workers who had undergone an expedited rotator cuff surgery funded by parallel-pay insurance (study group) were compared with workers who had used the public health insurance (control group) while adjusting for sex, age, severity of pathology, and follow-up period. Disability was measured by the American Shoulder and Elbow Surgeons (ASES) Standardized Assessment Form score. The percentage of patients who exceeded the minimal clinically important difference of 17 points in the ASES was calculated. The study group waited less time to have surgery than the control group (P workers who underwent expedited rotator cuff surgery reported less disability and had a more successful return to work after surgery than injured workers who waited longer for specialist assessment and surgery within the public health system. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  9. Perioperative visual loss with non-ocular surgery: Case report and review of literature

    Directory of Open Access Journals (Sweden)

    Nidhi Pandey

    2014-01-01

    Full Text Available Perioperative visual loss (POVL, a rare but devastating complication, has been reported after spine, cardiac, and head-neck surgeries.The various causes include ischemic optic neuropathy, central or branch retinal artery occlusion, and cortical blindness. The contributory factors described are microvascular diseases and intraoperative hemodynamic compromise. However, the exact association of these factors with post-operative blindness has not yet been confirmed. A case of POVL with caesarian section surgery is being presented. The visual loss occurred due to a combined occlusion of central retinal artery and vein.The causes, presentation, and risk factors of POVL after non-ocular surgery are being discussed.

  10. Hematological Disorders following Gastric Bypass Surgery: Emerging Concepts of the Interplay between Nutritional Deficiency and Inflammation

    Directory of Open Access Journals (Sweden)

    Mingyi Chen

    2013-01-01

    Full Text Available Obesity and the associated metabolic syndrome are among the most common and detrimental metabolic diseases of the modern era, affecting over 50% of the adult population in the United States. Surgeries designed to promote weight loss, known as bariatric surgery, typically involve a gastric bypass procedure and have shown high success rates for treating morbid obesity. However, following gastric bypass surgery, many patients develop chronic anemia, most commonly due to iron deficiency. Deficiencies of vitamins B1, B12, folate, A, K, D, and E and copper have also been reported after surgery. Copper deficiency can cause hematological abnormalities with or without neurological complications. Despite oral supplementation and normal serum concentrations of iron, copper, folate, and vitamin B12, some patients present with persistent anemia after surgery. The evaluation of hematologic disorders after gastric bypass surgery must take into account issues unique to the postsurgery setting that influence the development of anemia and other cytopenias. In this paper, the clinical characteristics and differential diagnosis of the hematological disorders associated with gastric bypass surgery are reviewed, and the underlying molecular mechanisms are discussed.

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

    Science.gov (United States)

    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.

  12. Measuring strategy in case of a nuclear emergency situation

    International Nuclear Information System (INIS)

    Bieringer, J.; Bieringer, P.

    2003-01-01

    In the case of a nuclear emergency situation there are other demands -compared to normal operation - of kind, availability in time and volume of information providing the description of the radiological situation and allowing the recommendation of countermeasures in time. These requirements depend on the different phases of the emergency situation and the intense operation, respectively. In the first phase e. g. even before the radioactive release starts, information from the nuclear power plant is needed besides weather forecasts, trajectories and prognoses about the expected external dose and the contamination. In addition fast available results from dose rate measurements and information about the radionuclide spectrum are necessary. The aim is to get an overview about the actual radiological situation and its possible development in time in order to introduce countermeasures, where necessary. In the second phase, short time after the distribution of the radioactive substances has stopped, measurements according to Paragraph 3 of the precautionary radiation protection law (StrVG) are of primary interest, especially the determination of the contamination of human food and animal feed. In this phase after the end of the deposition process, where the spectrum of the deposited radionuclides is known, the behaviour of the external dose as a function of time can be well predicted. In the third phase, this means weeks after the emergency situation, the measurements are used to observe the activity concentrations in different media on a long time scale. In the beginning (phase one and two) the availability of information in time is of great importance. With increasing time this shifts more and more to the diversity of the analysed media. (orig.)

  13. [150 cases of vedio-laparoscopic gynecologic surgery].

    Science.gov (United States)

    Liu, Y; Hui, N

    1994-04-01

    From September 1992 to September 1993, 150 patients aged 15-68 years underwent laparoscopic gynecologic surgery. These patients included 63 patients with acute abdominal diseases (46 had ectopic pregnancy, 9 rupture of ovary, and 8 torsion of ovarian cyst), which consisted of 90% of total patients with acute abdomen in corresponding period, 63 patients with mass of adnexa, which made up 72% of total patients with ovarian tumors, and 24 patients with uterine diseases. We successfully performed laparoscopic salpingostomy, fallotomy, removal of ovarian cyst, oophorosalpingectomy, myomectomy and laparoscopy assisted vaginal hysterectomy (LAVH) with 2-4 puncture technic after general anesthesia. The largest ovarian tumor and the enlarged uterus were 14 and 16 cm in diameter respectively. Four patients had laparotomy because of severe pelvic adhesions and the laparotomy rate was about 2.6%. The procedure lasted 20-240 minutes and bleeding was less than 200ml. No major surgical complication was encountered.

  14. Emergency surgery and Limitation of therapeutic effort in relation to neurologic deterioration in elderly patients – a survey of European surgeons

    Directory of Open Access Journals (Sweden)

    Mihai Păduraru

    2017-10-01

    Full Text Available Background. In emergency surgery, a very heterogeneous approach is required in the decision making process, especially when considering the patient’s postoperative quality of life as well as medical, ethical, and legal factors. In some cases, the presence of an Advance Directive (AD form may potentially help resolve the surgeon’s dilemma. Objectives. The primary objective of this survey was to investigate the opinions of surgeons across a representative cross-section of European countries regarding the decision making process using a specific case scenario so as to identify similarities and differences in practice. A secondary objective was to identify the possibility of establishing a more uniform approach and best practice. Method. A survey was conducted of surgeons from a range of European countries. Questionnaires were designed to obtain an overview of decision making in relation to the Limitation of Therapeutic Effort (LTE using a specific case study and the level of awareness and practical use of ADs. Surveys were distributed via email to the members of the ESTES (European Society for Trauma and Emergency Surgery and AEC (Association of Spanish surgeons, with voluntary, anonymous participation. Conclusions. Clear and additional support in the form of legal and ethical guidance with clinical protocols for surgical practice in such case scenarios is necessary. Wider use of ADs, together with education about their role and support for patients and relatives, would benefit the type of patient described in our scenario. A multidisciplinary team should play a more active role in decision making in order to avoid surgical procedures that are potentially futile. The concepts of LTE and Quality of life need a broader understanding among surgeons as well as more consistent application.

  15. Surgery first in orthognathic surgery: what have we learned? A comprehensive workflow based on 45 consecutive cases.

    Science.gov (United States)

    Hernández-Alfaro, Federico; Guijarro-Martínez, Raquel; Peiró-Guijarro, María A

    2014-02-01

    In some patients, "surgery first" (SF) may represent a reasonable approach for the expedited correction of a maxillofacial deformity. Based on the prospective evaluation of a large sample, this article provides a specific orthodontic and surgical protocol, discusses the benefits and limitations of this approach, and updates its indications. Forty-five patients were managed with an SF approach. Selected cases presented symmetrical skeletal malocclusions with no need for extractions or surgically assisted rapid palatal expansion. Periodontal or temporomandibular joint problems and management by an orthodontist without experience in orthognathic surgery were considered exclusion criteria. Virtual treatment planning included a 3-dimensional orthodontic setup. Standard orthognathic osteotomies were followed by buccal interdental corticotomies to amplify the regional acceleratory phenomenon. Miniscrews were placed for postoperative skeletal stabilization. Orthodontic treatment began 2 weeks after surgery. Archwires were changed every 2 to 3 weeks. At 12-month follow-up, patient satisfaction and orthodontist satisfaction were evaluated on a visual analog scale of 1 to 10. Descriptive statistics were computed for all study variables. The studied sample consisted of 27 women and 18 men (mean age, 23.5 yr). The main motivation for treatment was the wish to improve facial esthetics. Bimaxillary surgery was the most common procedure. Mean duration of orthodontic treatment was 37.8 weeks, with an average of 22 orthodontic appointments. Mean patient and orthodontist satisfaction scores were 9.4 (range, 8 to 10) and 9.7 (range, 8 to 10), respectively. The SF approach significantly shortens total treatment time and is very favorably valued by patients and orthodontists. Nevertheless, careful patient selection, precise treatment planning, and fluent bidirectional feedback between the surgeon and the orthodontist are mandatory. Copyright © 2014 American Association of Oral and

  16. Improving Emergency Attendance and Mortality – The Case for Unit ...

    African Journals Online (AJOL)

    BACKGROUND: Emergency attendance and mortality which are reliable indicators of quality of care, have been of concern to many health institutions. Different models are being proposed to improve emergency outcomes in different parts of the world. A model to separate a single emergency Unit into multiple emergency ...

  17. A Case of Pseudoaneurysm of the Internal Carotid Artery Following Endoscopic Endonasal Pituitary Surgery: Endovascular Treatment with Flow-Diverting Stent Implantation

    Directory of Open Access Journals (Sweden)

    Ali Karadag

    2017-10-01

    Full Text Available Internal carotid artery (ICA pseudoaneurysm is a rare complication of endoscopic endonasal surgery occurring in 0.4–1.1% of cases. Pseudoaneurysms can subsequently result in other complications, such as subarachnoid hemorrhage, epistaxis, and caroticocavernous fistula with resultant death or permanent neurologic deficit. In this case, we illustrate endovascular treatment with a flow-diverting stent for an ICA pseudoaneurysm after endoscopic endonasal surgery for a pituitary adenoma in a 56-year-old male. Surgery was complicated by excessive intraoperative bleeding and emergent CT angiography confirmed an iatrogenic pseudoaneurysm on the anteromedial surface of the ICA. The pseudoaneurysm was treated endovascularly with flow-diverting stent implantation only. Follow-up CT angiography after three months demonstrated occlusion of the pseudoaneurysm.

  18. Ecballium Elaterium Poisoning in Pediatric Emergency Service: A Case Report

    Directory of Open Access Journals (Sweden)

    Sinem Sarı Gökay

    2018-01-01

    Full Text Available Background Ecballium elaterium is the only species belonging to the genus Ecballium of Cucurbitaceae family. It is native to the Mediterranean region. Despite its side effects, E. elaterium has still been being used as an alternative treatment agent for sinusitis, cirrhosis, rheumatic diseases and hemorrhoids for its anti-inflammatory and cathartic actions. Herein we discuss a pediatric case showing gastrointestinal side effects after ingesting E. elaterium. Case Report: A six-year-old boy admitted to Çukurova University Medical Faculty Pediatric Emergency Department, Turkey, for vomiting one hour after ingesting a green plant which he had tasted to satisfy his curiosity. Physical examination, vital signs and laboratory tests revealed normal. The ingested plant was defined to be E. elaterium. Maintenance fluid infusion, 1 mg/kg ranitidine and sucralfate medications were commenced. During the follow-up, the patient developed numbness of the tongue and hyper-salivation, without any signs of uvular edema or other system findings. Further follow-up showed stable vital signs within the normal range with no additional complications. The patient was sent home with the cure and recommendations. Discussion: The plants and herbs that are used as agents of alternative or complementary medicine may as well be accidentally or curiously taken by children leading to unwanted intoxication cases. Pre-encounter actions to prevent such cases are as important as any post-exposure clinical interventions to impede the unwanted consequences. One such measure might be a more intensive public information policy underscoring the fact that plants have the potential to be noxious and may cause serious side effects and even death.

  19. Comparison between sevoflurane and desflurane on emergence and recovery characteristics of children undergoing surgery for spinal dysraphism

    Directory of Open Access Journals (Sweden)

    Priyanka Gupta

    2015-01-01

    Full Text Available Background and Aims: Rapid recovery is desirable after neurosurgery as it enables early post-operative neurological evaluation and prompt management of complications. Studies have been rare comparing the recovery characteristics in paediatric neurosurgical patients. Hence, this study was carried out to compare the effect of sevoflurane and desflurane anaesthesia on emergence and extubation in children undergoing spinal surgery. Methods: Sixty children, aged 1-12 years, undergoing elective surgery for lumbo-sacral spinal dysraphism were enrolled. Anaesthesia was induced with sevoflurane using a face mask. The children were then randomised to receive either sevoflurane or desflurane with oxygen and nitrous oxide, fentanyl (1 μg/kg/h and rocuronium. The anaesthetic depth was guided by bispectral index (BIS ® monitoring with a target BIS ® between 45 and 55. Perioperative data with regard to demographic profile, haemodynamics, emergence and extubation times, modified Aldrete score (MAS, pain (objective pain score, agitation (Cole′s agitation score, time to first analgesic and complications, thereof, were recorded. Statistical analysis was done using STATA 11.2 (StataCorp., College Station, TX, USA and data are presented as median (range or mean ± standard deviation. Results: The demographic profile, haemodynamics, MAS, pain and agitation scores and time to first analgesic were comparable in between the two groups (P > 0.05. The emergence time was shorter in desflurane group (2.75 [0.85-12] min as compared to sevoflurane (8 [2.5-14] min (P < 0.0001. The extubation time was also shorter in desflurane group (3 [0.8-10] min as compared to the sevoflurane group (5.5 [1.2-14] min (P = 0.0003. Conclusion: Desflurane provided earlier tracheal extubation and emergence as compared to sevoflurane in children undergoing surgery for lumbo-sacral spinal dysraphism.

  20. Esophageal Perforation Following Anterior Cervical Spine Surgery: Case Report and Review of the Literature.

    Science.gov (United States)

    Hershman, Stuart H; Kunkle, William A; Kelly, Michael P; Buchowski, Jacob M; Ray, Wilson Z; Bumpass, David B; Gum, Jeffrey L; Peters, Colleen M; Singhatanadgige, Weerasak; Kim, Jin Young; Smith, Zachary A; Hsu, Wellington K; Nassr, Ahmad; Currier, Bradford L; Rahman, Ra'Kerry K; Isaacs, Robert E; Smith, Justin S; Shaffrey, Christopher; Thompson, Sara E; Wang, Jeffrey C; Lord, Elizabeth L; Buser, Zorica; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

    2017-04-01

    Multicenter retrospective case series and review of the literature. To determine the rate of esophageal perforations following anterior cervical spine surgery. As part of an AOSpine series on rare complications, a retrospective cohort study was conducted among 21 high-volume surgical centers to identify esophageal perforations following anterior cervical spine surgery. Staff at each center abstracted data from patients' charts and created case report forms for each event identified. Case report forms were then sent to the AOSpine North America Clinical Research Network Methodological Core for data processing and analysis. The records of 9591 patients who underwent anterior cervical spine surgery were reviewed. Two (0.02%) were found to have esophageal perforations following anterior cervical spine surgery. Both cases were detected and treated in the acute postoperative period. One patient was successfully treated with primary repair and debridement. One patient underwent multiple debridement attempts and expired. Esophageal perforation following anterior cervical spine surgery is a relatively rare occurrence. Prompt recognition and treatment of these injuries is critical to minimizing morbidity and mortality.

  1. Evaluation of Cases with Rabies Risk Presenting to Emergency Department

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    Fevzi Yilmaz

    2013-10-01

    Full Text Available Aim: All around the world 10-12 million people/year receive rabies prophylaxis. Rabies is an acute fatal central nervous system viral enfection. The virus can infect all warm-blooded animals and almost in all cases the enfection results with fatal encephalitis. The aim of this study is to determine the demographic characteristics of cases with rabies risk exposures and behind this to emphasise the significance of cooperation between the institutions to perform effective and accurate treatment. Material and Method: This study was performed with retrospective analysis of 1429 cases who attended to Emergency Department of Diyarbakir Goverment Hospital between January 2007-2010 for animal bites and exposures with the risk of rabies. Statistical analysis of data was performed SPSS V16 pocket programme. Data were defined as frequency and %. For statistical analysis Chi-Square and Fischer exact test was used. A value of P<0.05 was accepted statistically significant. Results: A total of 1055 (73.8% were male, 374 (26.2% were female and the mean age was 21.75 ± 16.9 (6 months-87 years. The major group in children was 6-11 years old and 651 (% 45.5 of the cases attended to hospital were under 18 years old. The vast majority (39.3% in adults were between 19-49 years. In our study 808 (56.5% of the cases  were bitten, 597 (41.8% of the cases  were scrabbled by the animal and 24 (1.7%of them  had indirect contact with the animal Both of them were taken into prophylactic vaccination programme (p<0.05. The vast majority of animal bites were dog (67%  and cat (28%. 3 doses of Human diploid cell vaccine-HDCV were administered to 1001 (70% of the patients and 5 doses to 428 (30% of patients. Human rabies immune globulin-HRIG were administered to 475 (33,3% of the patients in addition to vaccine. Discussion:  In our region rabies risk exposure is an important public health problem. Public oriented education should be given about attending to health care

  2. EVALUATION OF SUICIDE ATTEMPT CASES ADMITTED TO EMERGENCY DEPARTMENT

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    Hamit Sirri Keten

    2015-06-01

    Material and Methods: A total of 70 attempted suicide cases admitted to Emergency Department of Kahramanmaras Sutcu imam University Medical Faculty Hospital between 01.03.2012 and 01.03.2013 examined retrospectively. Results: Among the 70 patients included in the study, 26 (37.1% were male and 44 (62.9% were female with a mean age of 26.3+/-11.2 years. Of all, 10 (14.3% cases were reported to have one or more previous suicide attempts. Investigation of methods of suicide revealed that 64 (91.4% used medication or toxic substance ingestion, 5 (7.1% stabbing, and 1 (1.4% preferred hanging as suicide method. All of those of preferred stabbing as a means of suicide were males. Conclusion: In order to tackle suicidal attempts author suggests that collective preventive policies should be developed by local governments, non-governmental organizations and health care providers. [J Contemp Med 2015; 5(2.000: 102-105

  3. radiation dosimetry in cases of normal and emergency situations

    International Nuclear Information System (INIS)

    Morsi, T.M.

    2010-01-01

    The use of radioactive materials in various fields of medicine, industry, agriculture and researches has been increasing steadily during the last few decades. A lot of radiation sources, radiopharmaceuticals, labeled compounds and other radioactive materials are sold and used throughout the world each year. Historically, accidents have occurred during the production, transport and use of radioactive materials. If an accident does occur, it is necessary to cope with it as soon as possible in order to control radiological human exposures and contamination of the environment and to restore normal conditions. Examination of individuals that deal with radioactive isotopes should be carried out in cases of nuclear medicine units, and in other applications including radiotherapy unit and gamma irradiation facility. Identification of the feasibility and efficiency of the counting detectors of internal and external radiation dosimetry, and preparedness in normal and emergency situations are included in the present work. Furthermore, this study also deals with the use of thermoluminescent dosimeters for radiation dose estimation for applications of gamma irradiation, and cobalt-60 treatment unit. Hence, operator dose can be estimated in case of malfunction or stuck of the radioactive source. Three methods were used to measure the radiation dose: (1) TL dosimeters with Harshaw (TLD- 4000) reader were used for measurement of external exposures. (2) FASTSCAN and (3) ACUUSCAN II whole body counters were used for measurement of internal exposures.

  4. Prevention of Cerebral Embolism Progression by Emergency Surgery of the Left Atrial Myxoma

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    Syuichi Tetsuka

    2015-01-01

    Full Text Available A 21-year-old woman developed left hemiparesis during work and was hospitalized. Her National Institutes of Health Stroke Scale score was 4. Hyperintense areas in the left basal ganglia, corona radiata, and cortex of the temporal lobe were found by brain diffusion-weighted magnetic resonance imaging, indicating acute cerebral infarction. Echocardiography showed a giant mass of diameter 7 × 4 cm in the left atrium. Therefore, she was diagnosed with cerebral embolism due to a left atrial myxoma. Currently, thrombolytic therapy may continue to be effective because the embolic source may be composed of tumor tissue itself. In case of atrial myxoma, we considered that the use of tPA as emergency treatment in all patients with infarction by atrial myxoma may be questioned. Thus, cardiac tumor extraction was performed the next day after hospitalization without thrombolytic therapy. The excised myxoma measured 7 × 6 × 4 cm. The patient recovered and her neurological symptoms also improved. Furthermore, her National Institutes of Health Stroke Scale score improved to 0. Thirteen days after admission, the patient was discharged from our hospital. Cardiac myxoma is often associated with a high risk of embolic episodes, which emphasizes the need for prompt surgical excision as soon as the diagnosis is confirmed.

  5. Robinsoniella peoriensis infection following surgery for scoliosis: a case report

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    Cassir Nadim

    2012-06-01

    Full Text Available Abstract Introduction Robinsoniella peoriensis was recently identified as a Gram-positive, spore-forming, anaerobic bacillus originally isolated from swine manure storage pits. Seven isolates have been subsequently reported from human sources. Case presentation We report the case of an infection caused by R. peoriensis in a 45-year-old Caucasian woman after posterior instrumentation correction of idiopathic thoracolumbar scoliosis. The identification was made by culture of samples inoculated onto blood agar and chocolate agar and was confirmed by 16 S ribosomal ribonucleic acid gene sequencing. Conclusions We discuss similar cases suggesting that R. peoriensis is responsible for health care-associated infections with the colonic flora as a potential source of infection.

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

    Science.gov (United States)

    Dhanoa, Amreeta; Singh, Vivek A; Shanmugam, Rukmanikanthan; Rajendram, Raja

    2010-11-08

    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.

  7. Use of piezosurgery device in management of oral surgery complications: clincal case and clinical experience report.

    Science.gov (United States)

    Sammartino, G; Riccitiello, F; Trosino, O; Marenzi, G; Cioffi, A; Mortellaro, C

    2012-05-01

    The root displacement into the maxillary sinus could be a complication of oral surgery in the upper jaw. In these cases, the root removal is needed in order to avoid the occurrence of sinus pathologies. Piezosurgery techniques could assure a safer management of such complications, because of the clear surgical visibility and the selective ability of cut. The aim of this article is to present a case of oral surgery complication (root displacement in the right maxillary sinus), in which piezosurgery technique helped for a correct and safe clinical management, allowing to reduce the soft tissue damage.

  8. An occasional diagnosis of myasthenia gravis - a focus on thymus during cardiac surgery: a case report

    Directory of Open Access Journals (Sweden)

    Dainese Luca

    2009-10-01

    Full Text Available Abstract Background Myasthenia gravis, an uncommon autoimmune syndrome, is commonly associated with thymus abnormalities. Thymomatous myasthenia gravis is considered to have worst prognosis and thymectomy can reverse symptoms if precociously performed. Case report We describe a case of a patient who underwent mitral valve repair and was found to have an occasional thymomatous mass during the surgery. A total thymectomy was performed concomitantly to the mitral valve repair. Conclusion The diagnosis of thymomatous myasthenia gravis was confirmed postoperatively. Following the surgery this patient was strictly monitored and at 1-year follow-up a complete stable remission had been successfully achieved.

  9. Future of uniportal video-assisted thoracoscopic surgery-emerging technology.

    Science.gov (United States)

    Li, Zheng; Ng, Calvin S H

    2016-03-01

    Uniportal VATS poses unique difficulties to the surgeon, mainly as a consequence of operating through a small single incision. The instruments in uniportal VATS have limited movement through the small incision. In addition, the approach to the surgical operating site is unidirectional, which may restrict vision and retraction, and unavoidably suffers from instrument fencing. Recent thoracoscopic technology in the form of a wide variable angled lens has to some extent improved these shortcomings. The development of an extendable flexible thoracoscope and wireless steerable endoscope (WSE) systems can further improve the visualization for surgery and reduce or even remove fencing between endoscope and instruments. New single incision access platforms both derived from Natural orifice transluminal endoscopic surgery (NOTES) and robotic surgery approaches are on the horizon. These may allow uniportal VATS to be performed through an even smaller ultra-minimally invasive incision, with improved vision, more freedom of movement of the instruments and greater precision. However, a number of problems remain to be resolved, including provision of a stable platform and payload, applied force limitations and equipment sterilization. Advances in uniportal VATS major lung resection techniques have not only challenged the surgeon to acquire new skills and knowledge, but at the same time have rekindled the collaborative spirit between industry and clinician in developing novel equipment and technology to push the boundaries of minimally invasive surgery. These technological improvements and innovations may improve operating efficiency and safety during uniportal VATS surgery.

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

    Science.gov (United States)

    Son, Hee-Won; Park, Se-Hun; Cho, Hyun-Oh; Shin, Yong-Joon; Son, Jang-Ho

    2016-10-01

    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.

  11. [Staged transcranial and transsphenoidal surgery for giant pituitary adenomas: a retrospective study of 21 cases].

    Science.gov (United States)

    Liao, D Y; Liu, Z Y; Zhang, J; Ren, Q Q; Liu, X Y; Xu, J G

    2018-05-08

    Objective: To investigate the effect of the second-stage transcranial and transsphenoidal approach for giant pituitary tumors. Methods: A retrospective review of 21 patients, who had undergone the transcranial surgery and then transsphenoidal surgery for giant pituitary adenomas from 2012 to 2015 in the neurosurgery department of West China Hospital, was performed. Visual findings, endocrine presentation, complications, and tumor types were collected. All data were based on clinical feature, MRI, and follow-up. Results: Among the 21 cases, gross total resection of tumor was achieved in 7 of all patients, subtotal in 11, and partial in 3. No intracranial hemorrhage or death occurred postoperatively. Postoperative infectionoccurred in one patient and cerebrospinal fluid leakage occurred in 3 patients. Four patients recovered after treatment. Conclusion: According to the clinical feature and MRI, it is safe and effective to choose the transcranial surgery and then transsphenoidal surgery for specific giant pituitary adenomas, which can improve treatment effects and reduce postoperative complications.

  12. Robotic surgery

    Science.gov (United States)

    ... with this type of surgery give it some advantages over standard endoscopic techniques. The surgeon can make ... Elsevier Saunders; 2015:chap 87. Muller CL, Fried GM. Emerging technology in surgery: Informatics, electronics, robotics. In: ...

  13. Retrospective analysis of oral and maxillofacial surgery cases in a ...

    African Journals Online (AJOL)

    Method: This was a retrospective study conducted at the Oral Dental Health Centre, Akure, Ondo state, Nigeria covering the period September, 2000 and April, 2004. ... Conclusion: A wide variety of cases were seen but socioeconomic, human resource and infrastructural problems limited the scope of practice. Keywords: ...

  14. Information for nuclear emergency response: a case study based on ANGRA nuclear power plant emergency simulation exercises

    International Nuclear Information System (INIS)

    Carvalho, Paulo V.R. de

    2008-01-01

    Full text: Current nuclear emergency management procedures do not always satisfactorily address issues related to the information availability and to how people in emergency control centres use this information to respond to an nuclear accident. The lack of an adequate and prompt information may lead to a response that can be very different from what authorities recommend and thus create confusion, mistrust, and widespread uncertainty. This is a potentially serious problem for emergency planners. An adequate and prompt access to relevant information is a critical requirement that emergency teams face while they work towards reducing the undesired consequences of the emergency. There are three basic types of knowledge according to a conceptual framework developed to deal with emergency response: Previous Personal, Previous and, Current Contextual knowledge. Most decisions in emergency control centres require a dynamic combination of all types of knowledge, particularly the current contextual that comes from the emergency settings, including all information about the activities of other emergency teams. The aim of this paper is to describe the concepts and the structure of a system that aims at storing and disseminating the previous formal and contextual knowledge to help teams make the correct decisions during the evolution of an emergency. The elicitation of critical requirements are provided by a case study based on Cognitive Work Analysis and Naturalistic Decision Making methods, applied to a nuclear emergency response simulation. The framework and a prototype system were tested in a controlled experiment. The paper reports the results of this experiment. (author)

  15. Dexmedetomidine versus labetalol infusions for controlling emergence hypertension in cranial surgeries for supratentorial tumors

    Directory of Open Access Journals (Sweden)

    Tarek Ahmed Mostafa Radwan

    2016-10-01

    Conclusion: Both dexmedetomidine and labetalol had favorable effects on hemodynamics at time of emergence from anesthesia in comparison with control group without prolongation of the time of extubation.

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

    Science.gov (United States)

    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.

  17. Fulminant mediastinitis after goiter recurrence surgery: a case report

    Directory of Open Access Journals (Sweden)

    Mittag-Bonsch Martina

    2010-11-01

    Full Text Available Abstract Introduction Necrotizing soft tissue infection is a life-threatening disease characterized by rapid progressive inflammation and necrosis of the subcutaneous and deep fascia with or without involvement of the adjacent muscles. Case presentation We report the case of a 62-year-old Caucasian woman with goiter recurrence who underwent a right-sided hemithyroidectomy. Postoperatively, she developed fulminant mediastinitis caused by group A β-hemolytic streptococcus and septic shock. Our patient survived this rare life-threatening complication. Conclusions Initial atypical postoperative symptoms, such as personality changes or an unstable circulatory system, should lead a practitioner to consider the possibility of this severe complication and to begin therapy immediately.

  18. Endovascular treatment with a stent-graft for internal carotid artery laceration during trans sphenoidal surgery: a case report

    International Nuclear Information System (INIS)

    Choe, Eun Hwa; Ko, Ji Ho; Lee, Tae Hong; Rho, Myung Ho

    2008-01-01

    An internal carotid artery (ICA) tear during or after trans-sphenoidal surgery (TSS) is rare but may cause potentially lethal complications. A 23-year-old female patient visited our hospital for treatment of a Rathke's cleft cyst. The patient had massive hemorrhage during surgery and angiography performed after surgery showed laceration of the cavernous ICA. We successfully controlled the hemorrhage with emergency placement of an endovascular stent-graft

  19. Orthognathic Surgery in Patients With Congenital Myopathies and Congenital Muscular Dystrophies: Case Series and Review of the Literature.

    Science.gov (United States)

    Bezak, Brett J; Arce, Kevin A; Jacob, Adam; Van Ess, James

    2016-03-01

    This case series examined preoperative findings and the surgical, anesthetic, and postoperative management of 6 patients with congenital myopathies (CMs) and congenital muscular dystrophies (CMDs) treated at a tertiary medical institution with orthognathic surgery over 15 years to describe pertinent considerations for performing orthognathic surgery in these complex patients. According to the institutional review board-approved protocol, chart records were reviewed for all orthognathic surgical patients with a clinical, genetic, or muscle biopsy-proved diagnosis of CM or CMD. Six patients (5 male, 1 female) qualified, and they were treated by 4 surgeons in the division of oral and maxillofacial surgery from 1992 through 2007. Average age was 19.5 years at the time of orthognathic surgery. Five patients had Class III malocclusions and 1 patient had Class II malocclusion. All 6 patients had apertognathia with lip incompetence. Nasoendotracheal intubation with a difficulty of 0/3 (0=easiest, 3=most difficult) was performed in all cases. Routine induction and maintenance anesthetics, including halogenated agents and nondepolarizing muscle relaxants, were administered without malignant hyperthermia. All 6 patients underwent Le Fort level osteotomies; 4 also had mandibular setback surgery with or without balancing mandibular inferior border osteotomies. Five patients required planned intensive care unit care postoperatively (average, 18.4 days; range, 4 to 65 days). Postoperative respiratory complications resulting in major blood oxygen desaturations occurred in 5 patients; 4 of these patients required reintubation during emergency code response. Five patients required extended postoperative intubation (average, 4.2 days; range, 3 to 6 days) and ventilatory support. Average hospital length of stay was 21.8 days (range, 6 to 75 days). Average postoperative follow-up interval was 29.8 weeks (range, 6 to 128 weeks). Patients with CMs or CMDs often have characteristic

  20. A case of disseminated hydatid disease by surgery involving multiple organs

    Directory of Open Access Journals (Sweden)

    Asli Tanrivermis Sayit

    2014-09-01

    Full Text Available Hydatid disease is the most common parasitic infection in the world, and is caused by the parasite Echinococcus granulosus. The most common site of this disease is the liver (75%, followed by the lungs, kidney, bones, and brain. Multiple abdominal organ and peritoneal involvement can also be seen in some cases. The dissemination of hydatid cyst disease can develop spontaneously or secondary to trauma or surgery. Here, we present the case of a 69-year-old man with multiple cyst hydatidosis, who underwent surgery for acute appendicitis approximately 20 years previously. Computed tomography of the abdomen shows the multiple active and inactive cystic lesions in the liver, spleen, right kidney, and mesentery. This patient required surgery several times, as well as medical treatment, after the rupture of a mesenteric hydatid cyst during the appendectomy. Combined anthelmintic treatment was recommended to the patient who refused further surgical treatment.

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

    Directory of Open Access Journals (Sweden)

    M.R. Ramesh Babu

    2013-01-01

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

  2. Guillain–Barré Syndrome after Coronary Artery Bypass Graft Surgery:a Case Report

    Directory of Open Access Journals (Sweden)

    Manouchehr Hekmat

    2016-01-01

    Full Text Available Guillain-Barre syndrome is a neurologic disorder that may appear after infection or major surgery.  Guillian-Barre 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- Barre 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.

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

    Science.gov (United States)

    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.

  4. Eye Emergencies

    Science.gov (United States)

    ... The Marfan Foundation Marfan & Related Disorders What is Marfan Syndrome? What are Related Disorders? What are the Signs? ... Emergencies Eye Emergencies Lung Emergencies Surgeries Eye Emergencies Marfan syndrome significantly increases your risk of retinal detachment, a ...

  5. Exposure in emergency general surgery in a time-based residency ...

    African Journals Online (AJOL)

    Objective: This paper aimed to characterize the resident exposure to acute general surgical conditions during a three-months rotation in a general surgical unit. Setting: The Department of Surgery, University of Nairobi and Kenyatta National Referral and Teaching Hospital in Nairobi. MethodS: Four residents (in their first to ...

  6. Comparison of Emergency Medicine Malpractice Cases Involving Residents to Non-Resident Cases.

    Science.gov (United States)

    Gurley, Kiersten L; Grossman, Shamai A; Janes, Margaret; Yu-Moe, C Winnie; Song, Ellen; Tibbles, Carrie D; Shapiro, Nathan I; Rosen, Carlo L

    2018-04-17

    Data are lacking on how emergency medicine (EM) malpractice cases with resident involvement differs from cases that do not name a resident. To compare malpractice case characteristics in cases where a resident is involved (resident case) to cases that do not involve a resident (non-resident case) and to determine factors that contribute to malpractice cases utilizing EM as a model for malpractice claims across other medical specialties. We used data from the Controlled Risk Insurance Company (CRICO) Strategies' division Comparative Benchmarking System (CBS) to analyze open and closed EM cases asserted from 2009-2013. The CBS database is a national repository that contains professional liability data on > 400 hospitals and > 165,000 physicians, representing over 30% of all malpractice cases in the U.S (> 350,000 claims). We compared cases naming residents (either alone or in combination with an attending) to those that did not involve a resident (non-resident cohort). We reported the case statistics, allegation categories, severity scores, procedural data, final diagnoses and contributing factors. Fisher's exact test or t-test was used for comparisons (alpha set at 0.05). Eight hundred and forty-five EM cases were identified of which 732 (87%) did not name a resident (non-resident cases), while 113 (13%) included a resident (resident cases) (Figure 1). There were higher total incurred losses for non-resident cases (Table 1). The most frequent allegation categories in both cohorts were "Failure or Delay in Diagnosis/Misdiagnosis" and "Medical Treatment" (non-surgical procedures or treatment regimens i.e. central line placement). Allegation categories of Safety and Security, Patient Monitoring, Hospital Policy and Procedure and Breach of Confidentiality were found in the non-resident cases. Resident cases incurred lower payments on average ($51,163 vs. $156,212 per case). Sixty six percent (75) of resident vs 57% (415) of non-resident cases were high severity claims

  7. Microperforated Hymen Presenting Spontaneous Pregnancy with Cesarean Delivery and Hymenotomy Surgery: A Case Report

    Directory of Open Access Journals (Sweden)

    Brikene Elshani

    2018-03-01

    CONCLUSIONS: This case study suggests that even though as microperforated hymen surgery in puberty can permit pregnancy and intervention with cesarean section and hymenotomy is a good option to reduce the resulting perioperative complications which indirectly affect the increase of the fertilisation and improvement of later sexual life.

  8. Taylor Approach of Spinal Anaesthesia in a case of Ankylosing Spondylitis for Hip Fracture Surgery

    Directory of Open Access Journals (Sweden)

    Urmila Palaria

    2011-11-01

    Full Text Available Ankylosing Spondylitis (AS is a chronic inflammatory rheumatic disease primarily affecting the axial joints manifesting as stiffnesss of the spine. Patient with ankylosing spondylitis is a challenge to anaesthesiologists in terms of airway management and neuraxial blocks. Modified paramedian approach (Taylor approach of spinal anaesthesia can be used as an alternative to technically difficult cases in patients undergoing lower limb surgeries.

  9. Radio-guided surgery in differentiated thyroid cancer: report of four cases

    International Nuclear Information System (INIS)

    Kallel, F.; Hamza, F.; Charfeddine, S.; Guermazi, F.; Ghorbel, A.

    2009-01-01

    Radio-guided surgery is a technique using the ability of a tumour tissue to uptake a radiopharmaceutical, in order, to facilitate its location with an intraoperative gamma probe. This technique was first used in the detection of recurrent thyroid cancer. We present our experience in this indication in four cases which were followed in our department. (authors)

  10. Competence assessment in minors, illustrated by the case of bariatric surgery for morbidly obese children

    NARCIS (Netherlands)

    Bolt, L.L.E.; Summeren van, M

    Clinicians have to assess children's competence frequently. In order to do justice to children who are competent to make decisions and to protect incompetent children, valid assessment is essential. We address this issue by using bariatric surgery for morbidly obese minors as a case study. Our

  11. Drainage or Packing of the Sella? Transsphenoidal Surgery for Primary Pituitary Abscess: Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Soichi Oya

    2009-01-01

    Full Text Available The detailed surgical procedure of the transsphenoidal surgery for pituitary abscess has scarcely been described previously because it is a very rare clinical entity. The authors reported two cases of primary pituitary abscess. In case 1, the anterior wall of the sella turcica was reconstructed with the vomer bone after irrigating the abscess cavity, but the sella was not packed by fat for fear of the persistent infection by devascularized tissues. This led to the postoperative meningocele, the cerebrospinal fluid leak, and bacterial meningitis despite the successful abscess drainage. In case 2, tight sellar packing and reconstruction of the sellar wall were performed to avoid these postoperative complications, which resulted in complete drainage and uneventful postoperative course. Although accumulation of more cases is obviously needed to establish the definitive surgical technique in pituitary abscess surgery, our experience might suggest that packing of the sella is not impeditive for postoperative sufficient drainage.

  12. Meningeal hemangiopericytoma treated with surgery and radiation therapy -case report-

    International Nuclear Information System (INIS)

    Jang, Ji Young; Oh, Yoon Kyeong

    2006-01-01

    Meningeal hemangiopericytoma (HPC) is an uncommon dura-based tumor and can recur not only locally but also distantly in the neural axis or extraneural sites. We report our experience of radiation therapy, one preoperative and one elective postoperative, in two patients with meningeal HPC and reviewed the role of radiation therapy. A 41-year-old man (Case 1) presented with a 3-month history of headache and right hemiparesis. The mass was nearly unresectable at the first and second operation and diagnosed as meningeal HPC. Preoperative radiation therapy was given with a total dose of 55.8 Gy/31 fractions to the large residual mass of left frontoparietal area. Follow-up computerized tomography (CT) showed marked regression of tumor after radiation therapy. The third operation was performed to remove the residual tumor at 6 months after the radiation therapy and a 2 x 2 cm sized tumor was encountered. The mass was totally removed. The serial follow-up CT showed no evidence of recurrence and he is alive without distant metastasis for 4 years and 10 months after the first operation. A 45-year-old woman (Case 2) presented with suddenly developed headache and visual impairment. Tumor mass occupying right frontal lobe was removed with the preoperative diagnosis of meningioma. It was totally removed with attached sagittal sinus and diagnosed as meningeal HPC. Elective postoperative radiation therapy was performed to reduce local recurrence with a total dose of 54 Gy/30 fractions to the involved area of right frontal lobe. She is alive for 5 years maintaining normal activity without local recurrence and distant metastasis

  13. Meningeal hemangiopericytoma treated with surgery and radiation therapy -case report-

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Ji Young; Oh, Yoon Kyeong [College of Medicine, Chosun University, Gwangju (Korea, Republic of)

    2006-06-15

    Meningeal hemangiopericytoma (HPC) is an uncommon dura-based tumor and can recur not only locally but also distantly in the neural axis or extraneural sites. We report our experience of radiation therapy, one preoperative and one elective postoperative, in two patients with meningeal HPC and reviewed the role of radiation therapy. A 41-year-old man (Case 1) presented with a 3-month history of headache and right hemiparesis. The mass was nearly unresectable at the first and second operation and diagnosed as meningeal HPC. Preoperative radiation therapy was given with a total dose of 55.8 Gy/31 fractions to the large residual mass of left frontoparietal area. Follow-up computerized tomography (CT) showed marked regression of tumor after radiation therapy. The third operation was performed to remove the residual tumor at 6 months after the radiation therapy and a 2 x 2 cm sized tumor was encountered. The mass was totally removed. The serial follow-up CT showed no evidence of recurrence and he is alive without distant metastasis for 4 years and 10 months after the first operation. A 45-year-old woman (Case 2) presented with suddenly developed headache and visual impairment. Tumor mass occupying right frontal lobe was removed with the preoperative diagnosis of meningioma. It was totally removed with attached sagittal sinus and diagnosed as meningeal HPC. Elective postoperative radiation therapy was performed to reduce local recurrence with a total dose of 54 Gy/30 fractions to the involved area of right frontal lobe. She is alive for 5 years maintaining normal activity without local recurrence and distant metastasis.

  14. Fibrolipoma of the lip treated by diode laser surgery: A case report

    Directory of Open Access Journals (Sweden)

    Capodiferro Saverio

    2008-09-01

    Full Text Available Abstract Introduction Several neoplasms of the adipose tissue can involve the soft tissues of the head and neck region. These neoplasms are mainly treated surgically and an accurate histological examination is mandatory for a precise diagnosis. Case presentation We report a case of fibrolipoma involving the lower lip of a 43-year-old man, which was successfully treated by diode laser surgery. This approach allowed adequate resection of the neoplasm with minimal damage to the adjacent tissues, thus reducing post-surgical scarring. Conclusion Diode laser surgery for the treatment of benign lesions of the oral mucosa appears to be a convenient alternative to conventional blade surgery and has proved to be effective for the excision of fibrolipoma of the lip. The possibility of avoiding direct suture after excision is surely helpful when aesthetic areas, such as the lip, are surgically treated. For these reasons, and also considering the lower histological alteration of the specimen obtained with diode laser surgery if adequately used, the diode laser is undoubtedly a good alternative to conventional surgery.

  15. Maternal and perinatal outcomes after bariatric surgery: a case control study.

    Science.gov (United States)

    de Alencar Costa, Laura Arrais Sydrião; Araujo Júnior, Edward; de Lucena Feitosa, Francisco Edson; Dos Santos, Andréa Cavalcante; Moura Júnior, Luiz Gonzaga; Costa Carvalho, Francisco Herlânio

    2016-05-01

    To compare the results of maternal and perinatal pregnancies of obese women after bariatric surgery. A retrospective cross-sectional study was carried out on 63 women who had undergone bariatric surgery and 73 obese women (control). Demographic data, the characteristics of the bariatric surgery, and the maternal and perinatal results were evaluated. The Student's t-test and chi-square test (χ2) were used to compare the groups. The gestational complications of the prevalence of gestational diabetes mellitus, anemia, and preeclampsia were analyzed using simple and multivariate logistical regression and odd ratios (OD) with their respective confidence intervals (CI) of 95%. The average body mass index (BMI) at the 1st prenatal appointment of the control group was 34.6±3.3 kg/m2 and that of the post-surgical group was 26.5±4.2 kg/m2. The Roux-en-Y Gastric Bypass was used in 100% of cases; no complications were observed during or after the surgeries. The average weight loss in patients with a prior bariatric surgery was statistically significant (P=0.000). The average weight at birth of the control group was significantly higher than in the post-bariatric surgery group (P=0.017). The women who had a prior bariatric surgery had a higher chance of anemia (OR=3.5; CI 95%: 1.5-8.3) and a reduced chance of macrosomia (OR=0.2; CI 95%:0.1-0.5), and prematurity (OR=0.3; CI 95%:0.1-0.7). Those women who had been submitted to bariatric surgery presented better maternal and perinatal results when compared to obese women.

  16. Autologous Cricoid Cartilage as a Graft for Airway Reconstruction in an Emergent Technique - A Case Report

    Directory of Open Access Journals (Sweden)

    Farzad Izadi

    2016-03-01

    Full Text Available Introduction: Laryngotracheal stenosis can be caused after traumatic injuries to the neck from the subglottic larynx to the trachea. Patients with laryngotracheal stenosis often need a tracheotomy and occasionally may become tracheotomy dependent. Different procedures have been described for the management of these lesions. Management options include techniques of endoscopic dilation, laser resection, laryngo-fissure, and an innovative array of plastic reconstructions with or without the use of stents.   Case Report:This paper presents airway reconstruction in a young patient with severe subglottic stenosis due to a blunt trauma to the neck, who was treated using particles of an autologous fractured cricoid cartilage as the source for airway augmentation. An incision was made in the anterior midline of the cricoid lamina and deepened through the scar tissue to the posterior cricoid lamina. Then two lateral incisions (right & left were made in the cricoid lamina and fractured cartilage particles and the scar tissue were removed via these two lateral incisions. The mucosal lining at the right and left of the midline incision, after debulking, were sutured to a lateral position. Thereafter three cartilage particles were used to reconstruct the anterior cricoid lamina and augment the lumen.   Conclusion:  It is worth to mention that an autologus cartilage graft can be used for certain cases with traumatic airway stenosis. Further follow up and more patients are needed to approve this method of reconstructive surgery in emergent situations.

  17. A review of eleven cases of tuberculosis presenting as sternal wound abscess after open heart surgery.

    Science.gov (United States)

    Tabaja, Hussam; Hajar, Zeina; Kanj, Souha S

    2017-10-01

    Sternal wound infection with Mycobacterium tuberculosis is an uncommon yet highly challenging disease that can be quite insidious with various presentations. We hereby provide a review of 10 cases in current literature and describe an additional case which illustrates the difficulties associated with diagnosis. We used PubMed and Google search engine to search the literature for all published papers reporting on cases of sternal M. tuberculosis infections post open-heart surgeries. A total of 11 cases were presented, including a case of our own. The majority were males and were exposed to endemic areas. The average age was 59.6 ± 15.5 years. Coronary artery bypass surgery accounted for 73% of procedures and the average time to symptoms onset was 12.2 ± 16.6 months. Diabetes was the most reported non-cardiac comorbidity. Presenting symptoms varied and only 5 patients had other organs involved. Blood tests and radiographic studies were neither sensitive nor specific. M. tuberculosis culture on debrided tissues was the most sensitive test but often forgotten initially. Diagnostic delay was seen in almost all cases, often leading to unnecessary courses of antibiotics and aggressive surgical interventions. Finally, all patients responded well to anti-tuberculosis treatment, with reported treatment duration ranging from 9 to 12 months. M. tuberculosis infection of the sternum should be suspected in late-onset sternal wound infections post open-heart surgery especially when the course is chronic and indolent.

  18. Emerging role of functional brain MRI in low-grade glioma surgery

    DEFF Research Database (Denmark)

    Friismose, Ancuta; Traise, Peter; Markovic, Ljubo

    Learning objectives 1. To describe the use of functional MRI (fMRI) in cranial surgery planning for patients with low-grade gliomas (LGG). 2. To show the increasing importance of fMRI in the clinical setting. Background LGG include brain tumors classified by the World Health Organization as grade I...... be used to map eloquent cortex areas, thus minimizing postoperative deficits and improving surgical performance. Findings and procedure details Patients diagnosed with low-grade gliomas located in eloquent brain areas undergo fMRI prior to surgery. The exams are performed on a 3T MR system (Achieva TX....... Language comprehension and visual tasks can be added to visualize Wernicke’s area or the visual cortex. Diffusion tensor imaging (DTI) is used to map nerve tract course relative to the tumour. Conclusion FMRI has proven its clinical utility in locating eloquent brain areas with relation to tumor site...

  19. Emergency general surgery in Rwandan district hospitals: a cross-sectional study of spectrum, management, and patient outcomes.

    Science.gov (United States)

    Mpirimbanyi, Christophe; Nyirimodoka, Alexandre; Lin, Yihan; Hedt-Gauthier, Bethany L; Odhiambo, Jackline; Nkurunziza, Theoneste; Havens, Joaquim M; Omondi, Jack; Rwamasirabo, Emile; Ntirenganya, Faustin; Toma, Gabriel; Mubiligi, Joel; Bayitondere, Scheilla; Riviello, Robert

    2017-12-01

    Management of emergency general surgical conditions remains a challenge in rural sub-Saharan Africa due to issues such as insufficient human capacity and infrastructure. This study describes the burden of emergency general surgical conditions and the ability to provide care for these conditions at three rural district hospitals in Rwanda. This retrospective cross-sectional study included all patients presenting to Butaro, Kirehe and Rwinkwavu District Hospitals between January 1st 2015 and December 31st 2015 with emergency general surgical conditions, defined as non-traumatic, non-obstetric acute care surgical conditions. We describe patient demographics, clinical characteristics, management and outcomes. In 2015, 356 patients presented with emergency general surgical conditions. The majority were male (57.2%) and adults aged 15-60 years (54.5%). The most common diagnostic group was soft tissue infections (71.6%), followed by acute abdominal conditions (14.3%). The median length of symptoms prior to diagnosis differed significantly by diagnosis type (p operated on at the district hospital, either by a general surgeon or general practitioner. Patients were more likely to receive surgery if they presented to a hospital with a general surgeon compared to a hospital with only general practitioners (75% vs 43%, p operation in a hospital with a general surgeon as opposed to a general practitioner. This provides evidence to support increasing the surgical workforce in district hospitals in order to increase surgical availability for patients.

  20. Salmonella enterica serovar Enteritidis brain abscess mimicking meningitis after surgery for glioblastoma multiforme: a case report and review of the literature.

    Science.gov (United States)

    Luciani, Léa; Dubourg, Grégory; Graillon, Thomas; Honnorat, Estelle; Lepidi, Hubert; Drancourt, Michel; Seng, Piseth; Stein, Andreas

    2016-07-07

    Salmonella brain abscess associated with brain tumor is rare. Only 11 cases have been reported to date. Here we report a case of brain abscess caused by Salmonella enterica serovar Enteritidis mimicking post-surgical meningitis in a patient with glioblastoma multiforme. A 60-year-old Algerian woman was admitted through an emergency department for a 4-day history of headache, nausea and vomiting, and behavioral disorders. Surgery for cerebral tumor excision was performed and histopathological analysis revealed glioblastoma multiforme. On the seventh day post-surgery, she presented a sudden neurological deterioration with a meningeal syndrome, confusion, and fever of 39.8°C. Her cerebrospinal fluid sample and blood cultures were positive for S. enterica Enteritidis. She was treated with ceftriaxone and ciprofloxacin. On the 17th day post-surgery, she presented a new neurological disorder and purulent discharge from the surgical wound. Brain computed tomography revealed a large cerebral abscess located at the operative site. Surgical drainage of the abscess was performed and microbial cultures of surgical deep samples were positive for the same S. enterica Enteritidis isolate. She recovered and was discharged 6 weeks after admission. In this case report, a brain abscess was initially diagnosed as Salmonella post-surgical meningitis before the imaging diagnosis of the brain abscess. The diagnosis of brain abscess should be considered in all cases of non-typhoidal Salmonella meningitis after surgery for brain tumor. Surgical brain abscess drainage followed by prolonged antibiotic treatment remains a major therapeutic option.

  1. Day case shoulder surgery: satisfactory pain control without regional anaesthesia. A prospective analysis of a perioperative protocol.

    LENUS (Irish Health Repository)

    Daruwalla, Z J

    2009-03-01

    Pain control is an issue which may limit patients\\' acceptance of day case shoulder surgery. This study prospectively examined the outcome of a protocol for day case shoulder surgery to determine if satisfactory pain relief could be achieved without regional anaesthesia.

  2. Analysis of lawsuit cases in the Department of Surgery in Korea

    Science.gov (United States)

    Jung, Ji Yun; Kim, So Yoon; Kim, Dong Gyu; Kim, Choong Bai; Chi, Kyong-Choun; Kang, Won Kyung

    2018-01-01

    Purpose The aim of this study is to prepare medical staff in order to prevent medical malpractice litigation through analysis of litigation cases related to the department of surgery in Korea. Methods A total of 94 litigation cases related to the department of surgery, where a certain amount of payment was ordered to the defendant between 2005 through 2010, were analyzed. We examined time of occurrence, amount claimed and awarded in damages, plaintiff claims, and court opinion. Results An average of 3.2 years was spent from the date of the incident occurring to the end of the litigation procedures. The average amount awarded in judgments for damages was 59,708,983 ± 67,307,264 (range, 1,700,000–365,201,482) Korean won. Cases were found involving the following opinion of the court: violation of duty of care (49 cases), violation of informed consent (7 cases), violation of duty of care and informed consent (5 cases), and settlement, reconciliation, and others (32 cases). By analyzing defendants' negligence in court opinions, diagnosis (30.8%) was the most common, followed by post-operation management (27.7%). Conclusion Physicians have to conduct treatment and surgery based on exact diagnosis and be careful to observe patients' conditions and symptoms after surgery. It is essential to identify the current status and characteristics of medical litigation for reducing further litigation and improving patient safety. In order to create a safe medical environment, national efforts should be made not only by individuals but also at the national level. PMID:29520344

  3. Imaging CT findings in cases of subdural hematoma after cardiovascular surgery. Initial signs of SDH

    Energy Technology Data Exchange (ETDEWEB)

    Maruyama, Michiyuki; Kuriyama, Yoshihiro; Sawada, Tohru; Ogawa, Makoto; Kaneko, Takaji; Sakamoto, Akira; Kawazoe, Kouhei; Fujita, Tsuyoshi; Omae, Teruo

    1987-12-01

    A characteristic initial sign of CT findings, as seen in cases of subdural hematoma (SDH) after cardiovascular surgery, was reported. Central-nervous-system (CNS) complications after cardiovascular surgery have been thought to be due mainly to the ischemic brain damage caused by both reduced cerebral perfusion pressure and microembolism during extracorporeal circulation. However, we observed 8 cases of SDH in 39 patients suffering from major CNS complications after cardiovascular surgery. In view of these experiences, SDH was thought to be one of the most significant factors causing CNS complications after cardiovascular surgery. In the sequential CT scans of 8 cases of SDH, four exhibited a typical, small, spotty high-density area in the early period of SDH. The clinical courses of these four patients were relatively acute or subacute, and the initial small high-density area progressed to definite SDH findings in that region in the follow-up CT. These initial findings of CT scans were regarded as ''initial signs of SDH-ISS-''. Although there have been many reports concerning the sequential CT changes in SDH, there has been no report describing the above-mentioned finding. It was emphasized that ''ISS'' is of great importance in the early management for SDH.

  4. [Effect of dexmedetomidine on emergence agitation after general anesthesia in children undergoing odontotherapy in day-surgery operating room].

    Science.gov (United States)

    Lin, Luo; Yueming, Zhang; Meisheng, Li; Jiexue, Wang; Yang, Ji

    2017-12-01

    To study the effectiveness of dexmedetomidine used for general anesthesia maintenance in children undergoing odontotherapy in day-surgery operating room in reducing the incidence of emergence agitation (EA). Eighty children undergoing odontotherapy and under general anesthesia in day-surgery operating room were randomized into two groups, group A (n=40) and group B (n=40). Each patient in group A was administered with a bolus dose of dexmedetomidine (1.0 μg·kg⁻¹, saline diluted to 10 mL) pump-infused after intubation and a maintenance dose of 0.1-0.4 mL·(kg·h)⁻¹ followed-up until 45 min before the end of operation. Each patient in group B was administered with a bolus dose of normal saline 10 mL pump-infused after intubation and maintenance dose of 0.1-0.4 mL·(kg·h)⁻¹ followed-up until 45 min before the end of operation. Gender, age, weight, physical status according to the American Society of Anesthesiologists, perioperative heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO₂), sufentanil dosage, duration of surgery, time of extubation, time of regaining consciousness, and time to reach modified Aldrete's score≥12 were recorded. Behavior in postanesthesia care unit was rated on the four-point agitation scale. Compared with group B, decreases were observed in HR and MAP at the beginning of operation, in 10 and 30 min, 1 and 2 h after the beginning of operation, and after extubation of group A (Pgeneral anesthesia maintenance in children undergoing odontotherapy in day-surgery operating room, dexmedetomidine results in low incidence of EA during recovery and more stable vital signs.

  5. Off-site emergency response plans in case of technological catastrophes: the case Angra dos Reis

    International Nuclear Information System (INIS)

    Souza Junior, M.D. de.

    1990-04-01

    In the first part of the thesis a discussion of the technical, operational and methodological features of the current practices for emergency planning in case of a nuclear fallout. Based on this general reference is possible to evaluate the features in the natural and social environment of Angra dos Reis that probably will obstruct the application of the protective countermeasures to the public. These critical points are enhanced to permit the discussion of a methodological approach that is supposed to be suitable to the reality of Angra dos Reis. The approach was developed specifically to this region and was introduced as a part of the general emergency off-site plan to the Central Nuclear Almirante Alvaro Alberto (CNAAA). Starting from this experience will be possible to enlarge this approach in a further research, in order to study this potential hazards of other industrial plants. (author)

  6. Business continuity management in emerging markets: the case of Jordan.

    Science.gov (United States)

    Sawalha, Ihab H; Anchor, John R

    2012-01-01

    Despite their considerable growth in last few decades, emerging markets (EM) face numerous risks that have the potential to slow down or obstruct their development. Three main issues are discussed in this paper: first, the risks facing organisations operating in emerging markets and Jordan in particular; secondly, the role of business continuity management (BCM) in emerging markets; and thirdly, potential factors that underpin the role of BCM in emerging markets. These issues are significant, as they represent the role of BCM in highly dynamic and fast changing business environments. The paper provides a discussion of the significance of BCM in reducing or preventing risks facing organisations operating in emerging markets, especially those in Jordan.

  7. [Surgery for intractable epilepsy in a patient with encephalocele of the temporal lobe: a case report].

    Science.gov (United States)

    Semenov, M S; Belyakova-Bodina, A I; Murtazina, A F; Brutyan, A G; Golovteev, A L; Aziatskaya, G A; Samoylov, A S; Zabelin, M V; Udalov, Yu D

    We describe a case of surgical treatment of intractable temporal epilepsy in a female patient with congenital middle cranial fossa encephalocele. We present clinical-anamnestic and neuroimaging data as well as the microscopic and macroscopic pictures of encephalocele. We analyze outcomes of surgery for this pathology, which have been reported in the literature. To date, there have been a few articles on this subject in the domestic literature. The development of neuroimaging techniques and a growing number of verified encephalocele cases promote the widespread use of surgery for treatment of intractable epilepsy. Congenital encephalocele should be considered in the differential diagnosis of intractable temporal epilepsy, and, if verified, surgical treatment is the method of choice in most cases.

  8. Pattern of adult psychiatric emergency cases presenting at a ...

    African Journals Online (AJOL)

    , current episode manic without psychotic symptoms constituted 17.2% of the cases, while 9.4% were cases of Mental and Behavioural Disorder due to Psychoactive Substance Use. Other cases included depressive illness, mania and delirium.

  9. Left Transperitoneal Adrenalectomy with a Laparoendoscopic Single-Site Surgery Combined Technique: Initial Case Reports

    Directory of Open Access Journals (Sweden)

    Yasuhiro Sumino

    2011-01-01

    Full Text Available Laparoendoscopic single-site surgery (LESS is a step toward the development of minimally invasive surgery. It is initially difficult for surgeons with limited experience to perform the surgery. We describe two cases of left adrenalectomy with a LESS combined with the addition of an accessory port. After a 2.5-cm skin incision was made at the level of the paraumbilicus to insert the primary 12-mm trocar for the laparoscope, a 5-mm nonbladed trocar was placed through the skin incision side-by-side with the primary trocar. A second 3-mm nonbladed trocar was then placed along the anterior axillary line; a multichannel trocar was not used as a single port. Both adrenalectomies were completed successfully. In patients with a minor adrenal tumor, a combined technique using LESS and an additional port is easier than LESS alone and may, therefore, be a bridge between the conventional laparoscopic approach and LESS.

  10. Virtual reality in the treatment of body image disturbances after bariatric surgery: a clinical case.

    Science.gov (United States)

    Riva, Giuseppe; Cárdenas-López, Georgina; Duran, Ximena; Torres-Villalobos, Gonzalo M; Gaggioli, Andrea

    2012-01-01

    Bariatric surgery is an operation on the stomach and/or intestines that helps patients with extreme obesity to lose weight. Even if bariatric surgery, compared with traditional obesity treatment, is more effective in reducing BMI, this approach does not achieve equal results in every patient. More, following bariatric surgery common problems are body image dissatisfaction and body disparagement: there is a significant difference between the weight loss clinicians consider successful (50% of excess weight) and the weight loss potential patients expect to achieve (at least 67% of the excess weight). The paper discusses the possible role of virtual reality (VR) in addressing this problem within an integrated treatment approach. More, the clinical case of a female bariatric patient who experienced body dissatisfaction even after a 30% body weight loss and a 62% excess body weight loss, is presented and discussed.

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

    Science.gov (United States)

    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 B 1 ) 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. Copyright © 2016 by the American Academy of Pediatrics.

  12. Single-incision video-assisted thoracoscopic evaluation and emergent surgery for severe lung and chest wall injury after thoracic trauma in a water park.

    Science.gov (United States)

    Sesma, Julio; Alvarez, Melodie; Lirio, Francisco; Galvez, Carlos; Galiana, Maria; Baschwitz, Benno; Fornes, Francisca; Bolufer, Sergio

    2017-08-01

    Thoracic trauma is a challenging situation with potential severe chest wall and intrathoracic organ injuries. We present a case of emergent surgery in a 23-year-old man with hemorrhagic shock due to massive lung and chest wall injury after thoracic trauma in a water slide. We performed a SI-VATS approach in order to define intrathoracic and chest wall injuries, and once checked the extension of the chest wall injury, we added a middle size thoracotomy just over the affected area in order to stabilize rib fractures with Judet plates, that had caused massive laceration in left lower lobe (LLL) and injured the pericardium causing myocardical tear. After checking bronchial and vascular viability of LLL we suggested a lung parenchyma preserving technique with PTFE protected pulmonary primary suture in order to avoid a lobectomy. Chest tubes were removed on 3 rd postoperative day and patient was discharged on 14 th postoperative day. He has already recovered his normal activity 6 months after surgery.

  13. Congenital craniopharyngioma treated by radical surgery: case report and review of the literature.

    Science.gov (United States)

    Kageji, Teruyoshi; Miyamoto, Takeshi; Kotani, Yumiko; Kaji, Tsuyoshi; Bando, Yoshimi; Mizobuchi, Yoshifumi; Nakajima, Kohei; Nagahiro, Shinji

    2017-02-01

    Craniopharyngiomas are 5-10 % of all pediatric tumors, but are seldomly encountered in the perinatal period. Only seven instances of a truly antenatal diagnosis of a congenital craniopharyngioma that subsequently underwent radical surgery have been reported. We present the case of a patient who received the diagnosis of a suprasellar tumor during the prenatal period and received radical surgery. We report a case of a neonatal craniopharyngioma treated surgically. The pregnancy progressed uneventfully until a routine ultrasound at 37 weeks of gestation showed a 15 × 15 mm high echoic mass in the center of the fetal head. Neonatal Gd-enhanced T1-weighted MRI at 5 days of life showed a homogenously enhanced mass (16×22×15 mm) in the sellar and suprasellar lesion. As the tumor showed rapid growth at the 3rd month of life, the patient underwent a surgical treatment and the mass was totally removed. Three years later, the physical and mental development of the patient was normal, and Gd-MRI studies showed no tumor recurrence. The present case is the eighth case of a truly antenatal diagnosis of a craniopharyngioma that underwent successful radical surgery. Craniopharyngioma is a benign tumor and thought to be a slow growing tumor in childhood. The results of radical surgery were very poor, and the mortality and morbidity rates were high in the previous reports due to the huge size of tumor at operation. The present case demonstrated the rapid growth in short interval of Gd-MRI. This is the first report of tumor kinetics of congenital craniopharyngioma with previous reports. The calculated tumor doubling time in our case was 37 days.

  14. Fatal antiphospholipid syndrome following endoscopic transnasal-transsphenoidal surgery for a pituitary tumor: A case report.

    Science.gov (United States)

    Li, Chiao-Zhu; Li, Chiao-Ching; Hsieh, Chih-Chuan; Lin, Meng-Chi; Hueng, Dueng-Yuan; Liu, Feng-Chen; Chen, Yuan-Hao

    2017-01-01

    The fatal type of antiphospholipid syndrome is a rare but life-threating condition. It may be triggered by surgery or infection. Endoscopic transnasal-transsphenoidal surgery is a common procedure for pituitary tumor. We report a catastrophic case of a young woman died of fatal antiphospholipid syndrome following endoscopic transnasal-transsphenoidal surgery. A 31-year-old woman of a history of stroke received endoscopic transnasal-transsphenoidal surgery for a pituitary tumor. The whole procedure was smooth. However, the patient suffered from acute delirium on postoperative day 4. Then, her consciousness became comatose state rapidly with dilatation of pupils. Urgent magnetic resonance imaging of brain demonstrated multiple acute lacunar infarcts. The positive antiphosphoipid antibody and severe thrombocytopenia were also noted. Fatal antiphospholipid syndrome was diagnosed. Plasma exchange, corticosteroids, anticoagulant agent were prescribed. The hemodynamic condition was gradually stable. However, the consciousness was still in deep coma. The patient died of organ donation 2 months later. If patients have a history of cerebral stroke in their early life, such as a young stroke, the APS and higher risk of developing fatal APS after major surgery should be considered. The optimal management of APS remains controversial. The best treatment strategies are only early diagnosis and aggressive therapies combing of anticoagulant, corticosteroid, and plasma exchange. The intravenous immunoglobulin is prescribed for patients with refractory APS.

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

    Directory of Open Access Journals (Sweden)

    Seok-Kwun Kim

    2015-11-01

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

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

    Science.gov (United States)

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

    2016-08-01

    Rocuronium is the agent most frequently involved in perioperative anaphylaxis, and sugammadex has also been known to induce anaphylactic reactions. We describe a case of successive anaphylactic episodes that seemed to be induced by clinical doses of rocuronium and sugammadex. The patient was a 19-year-old woman who had a medical history of asthma, but no history of surgery. She had been injured in a fall, and several surgeries were scheduled for multiple bone fractures. At the first surgery under general anesthesia, she developed anaphylaxis 5 min after sugammadex administration. A second general anesthesia for treatment of calcaneal fracture was induced uneventfully without neuromuscular blockade after 10 days. A third general anesthesia was scheduled to reinforce the spinal column 12 days after the first surgery. She developed anaphylaxis 8 min after rocuronium administration. The level of plasma histamine was elevated, but serum tryptase level remained normal. This surgery was canceled and rescheduled without use of a neuromuscular blockade. Skin tests were performed in a later investigation. The patient showed positive results on intradermal tests for sugammadex and rocuronium, supporting a diagnosis of allergic reactions to both drugs. Clinicians must be aware that anaphylactic reactions can be induced by both sugammadex and rocuronium. Copyright © 2016 Elsevier Inc. All rights reserved.

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

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    Bougioukas Ioannis

    2010-08-01

    Full Text Available Abstract Kartagener syndrome consists of congenital bronchiectasis, sinusitis, and total situs inversus in half of the patients. A patient diagnosed with Kartagener syndrome was reffered 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.

  18. The Misconception of Case-Control Studies in the Plastic Surgery Literature: A Literature Audit.

    Science.gov (United States)

    Hatchell, Alexandra C; Farrokhyar, Forough; Choi, Matthew

    2017-06-01

    Case-control study designs are commonly used. However, many published case-control studies are not true case-controls and are in fact mislabeled. The purpose of this study was to identify all case-control studies published in the top three plastic surgery journals over the past 10 years, assess which were truly case-control studies, clarify the actual design of the articles, and address common misconceptions. MEDLINE, Embase, and Web of Science databases were searched for case-control studies in the three highest-impact factor plastic surgery journals (2005 to 2015). Two independent reviewers screened the resulting titles, abstracts, and methods, if applicable, to identify articles labeled as case-control studies. These articles were appraised and classified as true case-control studies or non-case-control studies. The authors found 28 articles labeled as case-control studies. However, only six of these articles (21 percent) were truly case-control designs. Of the 22 incorrectly labeled studies, one (5 percent) was a randomized controlled trial, three (14 percent) were nonrandomized trials, two (9 percent) were prospective comparative cohort designs, 14 (64 percent) were retrospective comparative cohort designs, and two (9 percent) were cross-sectional designs. The mislabeling was worse in recent years, despite increases in evidence-based medicine awareness. The majority of published case-control studies are not in fact case-control studies. This misunderstanding is worsening with time. Most of these studies are actually comparative cohort designs. However, some studies are truly clinical trials and thus a higher level of evidence than originally proposed.

  19. Preoperative intestinal stent decompression with primary laparoscopic surgery to treat left-sided colorectal cancer with obstruction: a report of 21 cases

    International Nuclear Information System (INIS)

    Zheng, Chao; Wu, Yu-Lian; Li, Qing

    2013-01-01

    This work aimed to study the safety and efficacy of preoperative intestinal stent decompression combined with laparoscopic surgery to treat left-sided colorectal cancer with obstruction (LCCO). Retrospective analysis was conducted on data obtained from 21 LCCO patients admitted to The First Affiliated Hospital of Zhejiang Chinese Medicine University during March 2008 and December 2011. To remove the intestinal obstruction, preoperative intestinal stent placement under colonoscopic guidance was performed. Approximately 7 to 10 days after the operation, laparoscopic radical surgery of colorectal cancer was conducted. Among the 21 cases studied, laparoscopic surgery was successful in 20 patients. Emergent laparotomy was conducted in one patient because of tumor invasion in the ureter. The duration of the operation ranged from 180 to 320 min, and the average time was 220 min. The recovery time for bowel function ranged from 2 to 5 days with an average time of 3 days. Postoperative infection of the incision occurred in one case. No anastomotic leakage was observed in any of the cases. Preoperative intestinal stent decompression, combined with primary stage laparoscopic surgery, is a safe and effective method for the treatment of LCCO

  20. Late-onset superior mesenteric artery syndrome four years following scoliosis surgery – a case report

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    Abol Oyoun Nariman

    2015-01-01

    Full Text Available Background: Superior mesenteric artery (SMA syndrome has been reported as an uncommon condition of external vascular compression of the SMA particularly after rapid weight loss, body casts, or after corrective surgery for spinal deformities, usually within the first few weeks after surgery. Methods: This is a retrospective report of a case of a non-verbal autistic female patient who started to develop SMA syndrome at the age of 16, 4 years after posterior spinal fusion surgery for scoliosis. She was treated conservatively by increasing oral caloric intake, which resulted in increased body weight and relief of symptoms. Results: Seen at 10 years’ follow up, the patient is doing well, and is functional within the limits of her suboptimal cognitive and verbal conditions. She maintains good trunk balance with solid spinal fusion and intact instrumentation at latest follow up. Conclusion: Spinal surgeons should maintain a high index of suspicion for diagnosis of SMA syndrome even years after scoliosis surgery, especially for patients with communication problems, like the case we present here. Appropriate conservative measures can succeed in relieving the symptoms, increasing body weight, and preventing complications including the risk of death.

  1. Complications of Methylene Blue Dye in Breast Surgery: Case Reports and Review of the Literature

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    FJ Reyes, MB Noelck, C Valentino, L Grasso-LeBeau, JE Lang

    2011-01-01

    Full Text Available Introduction: Methylene blue dye has been used worldwide successfully with few complications in breast surgery. We present two different complications involving methylene blue: 1 skin and parenchymal necrosis when dye was injected in a subdermal fashion and 2 Mycoplasma infection caused by contaminated methylene blue in breast reduction surgery.Methods: We present two cases seen at the University of Arizona during 2008 and referred to a breast surgeon for management. We evaluated and managed complications of methylene blue dye injected by 2 referring surgeons for different indications. A review of the literature was performed.Results: The first case is a 67 year old female diagnosed with infiltrating ductal carcinoma of the left breast for which she was treated by her initial surgeon with left segmental mastectomy and sentinel node biopsy. The operating surgeon injected methylene blue in a subareolar subdermal fashion (distant from the primary tumor; unfortunately the patient suffered skin and breast necrosis requiring multiple surgical debridements and finally achieving delayed primary closure. The second case is a 45 year old female with infiltrating lobular carcinoma with a history of Mycoplasma infection secondary to methylene blue injected for breast reduction surgery. She required multiple debridements and had granulomas masquerading as cancer on MRI that confounded her extent of disease.Conclusions: The use of methylene blue dye in breast surgery is not without risk. In both cases methylene blue was responsible for complications requiring surgical debridement for local wound problems. In each case severe necrosis and infection were present. Methylene blue may cause not only significant morbidity, but may also produce cosmetically unsatisfactory results.

  2. Guidelenines in the management of obstructing cancer of the left colon: consensus conference of the world society of emergency surgery (WSES) and peritoneum and surgery (PnS) society

    Science.gov (United States)

    2010-01-01

    Background Obstructive left colon carcinoma (OLCC) is a challenging matter in terms of obstruction release as well of oncological issues. Several options are available and no guidelines are established. The paper aims to generate evidenced based recommendations on management of OLCC. Methods The PubMed and Cochrane Library databases were queried for publications focusing on OLCC published prior to April 2010. A extensive retrieval, analyses, and grading of the literature was undertaken. The findings of the research were presented and largely discussed among panellist and audience at the Consensus Conference of the World Society of Emergency Surgery (WSES) and Peritoneum and Surgery (PnS) Society held in Bologna July 2010. Comparisons of techniques are presented and final committee recommendation are enounced. Results Hartmann's procedure should be preferred to loop colostomy (Grade 2B). Hartmann's procedure offers no survival benefit compared to segmental colonic resection with primary anastomosis (Grade 2C+); Hartmann's procedure should be considered in patients with high surgical risk (Grade 2C). Total colectomy and segmental colectomy with intraoperative colonic irrigation are associated with same mortality/morbidity, however total colectomy is associated with higher rates impaired bowel function (Grade 1A). Segmental resection and primary anastomosis either with manual decompression or intraoperative colonic irrigation are associated with same mortality/morbidity rate (Grade 1A). In palliation stent placement is associated with similar mortality/morbidity rates and shorter hospital stay (Grade 2B). Stents as a bridge to surgery seems associated with lower mortality rate, shorter hospital stay, and a lower colostomy formation rate (Grade 1B). Conclusions Loop colostomy and staged procedure should be adopted in case of dramatic scenario, when neoadjuvant therapy could be expected. Hartmann's procedure should be performed in case of high risk of anastomotic

  3. Guidelenines in the management of obstructing cancer of the left colon: consensus conference of the world society of emergency surgery (WSES and peritoneum and surgery (PnS society

    Directory of Open Access Journals (Sweden)

    Pinna Antonio D

    2010-12-01

    Full Text Available Abstract Background Obstructive left colon carcinoma (OLCC is a challenging matter in terms of obstruction release as well of oncological issues. Several options are available and no guidelines are established. The paper aims to generate evidenced based recommendations on management of OLCC. Methods The PubMed and Cochrane Library databases were queried for publications focusing on OLCC published prior to April 2010. A extensive retrieval, analyses, and grading of the literature was undertaken. The findings of the research were presented and largely discussed among panellist and audience at the Consensus Conference of the World Society of Emergency Surgery (WSES and Peritoneum and Surgery (PnS Society held in Bologna July 2010. Comparisons of techniques are presented and final committee recommendation are enounced. Results Hartmann's procedure should be preferred to loop colostomy (Grade 2B. Hartmann's procedure offers no survival benefit compared to segmental colonic resection with primary anastomosis (Grade 2C+; Hartmann's procedure should be considered in patients with high surgical risk (Grade 2C. Total colectomy and segmental colectomy with intraoperative colonic irrigation are associated with same mortality/morbidity, however total colectomy is associated with higher rates impaired bowel function (Grade 1A. Segmental resection and primary anastomosis either with manual decompression or intraoperative colonic irrigation are associated with same mortality/morbidity rate (Grade 1A. In palliation stent placement is associated with similar mortality/morbidity rates and shorter hospital stay (Grade 2B. Stents as a bridge to surgery seems associated with lower mortality rate, shorter hospital stay, and a lower colostomy formation rate (Grade 1B. Conclusions Loop colostomy and staged procedure should be adopted in case of dramatic scenario, when neoadjuvant therapy could be expected. Hartmann's procedure should be performed in case of high risk of

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

    Science.gov (United States)

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

    2016-07-27

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

  5. The general surgery chief resident operative experience: 23 years of national ACGME case logs.

    Science.gov (United States)

    Drake, Frederick Thurston; Horvath, Karen D; Goldin, Adam B; Gow, Kenneth W

    2013-09-01

    The chief resident (CR) year is a pivotal experience in surgical training. Changes in case volume and diversity may impact the educational quality of this important year. To evaluate changes in operative experience for general surgery CRs. Review of Accreditation Council for Graduate Medical Education case logs from 1989-1990 through 2011-2012 divided into 5 periods. Graduates in period 3 were the last to train with unrestricted work hours; those in period 4 were part of a transition period and trained under both systems; and those in period 5 trained fully under the 80-hour work week. Diversity of cases was assessed based on Accreditation Council for Graduate Medical Education defined categories. Total cases and defined categories were evaluated for changes over time. The average total CR case numbers have fallen (271 in period 1 vs 242 in period 5, P surgery training may be jeopardized by reduced case diversity. Chief resident cases are crucial in surgical training and educators should consider these findings as surgical training evolves.

  6. Retroperitoneal abscess after transanal minimally invasive surgery: case report and review of literature

    Directory of Open Access Journals (Sweden)

    Aaron Raney

    2017-10-01

    Full Text Available Abscesses are a rare complication of transanal minimally invasive surgery and transanal endoscopic micro surgery. Reported cases have been in the rectal and pre-sacral areas and have been managed with either antibiotics alone or in conjunction with laparotomy and diverting colostomy. We report a case of a large retroperitoneal abscess following a Transanal minimally invasive surgery full thickness rectal polyp excision. The patient was successfully managed conservatively with antibiotics and a percutaneous drain. Retroperitoneal infection should be included in a differential diagnosis following a Transanal minimally invasive surgery procedure as the presentation can be insidious and timely intervention is needed to prevent further morbidity. Resumo: Os abscessos são uma complicação rara da cirurgia de ressecção transanal minimamente invasiva (TAMIS e da micro cirurgia endoscópica transanal (TEMS. Os casos notificados foram nas áreas rectal e pré-sacral e foram administrados com antibióticos isoladamente ou em conjunto com laparotomia e desvio de colostomia. Relatamos um caso de grande abscesso retroperitoneal após uma excisão de pólipo retal de espessura total TAMIS. O paciente foi tratado com sucesso com a administração de antibióticos e drenagem percutânea. Para prevenir mais morbidade é necessária incluir a infecção retroperitoneal no diagnostico diferencial após um procedimento TAMIS onde a apresentação pode ser insidiosa e a intervenção atempada. Keywords: Colorectal surgery, Transanal minimally invasive surgery (TAMIS, Retroperitoneal abscess, Natural orifice transluminal endoscopic surgery (NOTES, Single-site laparoscopic surgery (SILS, Surgical oncology, Palavras-chave: Cirurgia colorretal, Cirurgia de ressecção transanal minimamente invasiva (TAMIS, Abscesso retroperitoneal, Cirurgia endoscópica transluminal de orifício natural (NOTES, Cirurgia laparoscópica de único local (SILS, Oncologia cirúrgica

  7. Cirurgia cardíaca de emergência para ressecção de mixoma atrial esquerdo Cardiac surgery of emergency for resection of left atrial myxoma

    Directory of Open Access Journals (Sweden)

    Antônio Augusto Ramalho Motta

    2008-06-01

    Full Text Available É descrito caso de paciente do sexo feminino que apresentava manifestações pulmonares e sistêmicas inespecíficas há vários meses, as quais resultaram em várias internações hospitalares com a hipótese diagnóstica de fibrose pulmonar. Estudo ecocardiográfico evidenciou a presença de grande mixoma pediculado no átrio esquerdo, que prolapsava, através da valva mitral, para o ventrículo esquerdo. Em condições clínicas bastante desfavoráveis, a paciente foi encaminhada ao nosso Serviço para tratamento cirúrgico, evoluindo durante o preparo pré-operatório com edema agudo pulmonar e instabilidade hemodinâmica, sendo submetida a cirurgia de emergência, com sucesso, para ressecção da tumoração. A paciente encontra-se assintomática.We report case of a female patient who during months presented pulmonary manifestation associated with nonspecific systemic symptoms resulting in several hospitalizations with the diagnostic hypothesis of pulmonary fibrosis. The echocardiographic study showed a great pedunculated left atrial myxoma prolapsing through the mitral valve for the left ventricle. In quite unfavorable clinical conditions the patient was sent to our Service for surgical treatment, evolving during the preparation for surgery with acute pulmonary edema and hemodinamic instability being submitted to a successfully surgery of emergency for resection of the tumor. The patient is asymptomatic.

  8. Local Helioseismology of Emerging Active Regions: A Case Study

    Science.gov (United States)

    Kosovichev, Alexander G.; Zhao, Junwei; Ilonidis, Stathis

    2018-04-01

    Local helioseismology provides a unique opportunity to investigate the subsurface structure and dynamics of active regions and their effect on the large-scale flows and global circulation of the Sun. We use measurements of plasma flows in the upper convection zone, provided by the Time-Distance Helioseismology Pipeline developed for analysis of solar oscillation data obtained by Helioseismic and Magnetic Imager (HMI) on Solar Dynamics Observatory (SDO), to investigate the subsurface dynamics of emerging active region NOAA 11726. The active region emergence was detected in deep layers of the convection zone about 12 hours before the first bipolar magnetic structure appeared on the surface, and 2 days before the emergence of most of the magnetic flux. The speed of emergence determined by tracking the flow divergence with depth is about 1.4 km/s, very close to the emergence speed in the deep layers. As the emerging magnetic flux becomes concentrated in sunspots local converging flows are observed beneath the forming sunspots. These flows are most prominent in the depth range 1-3 Mm, and remain converging after the formation process is completed. On the larger scale converging flows around active region appear as a diversion of the zonal shearing flows towards the active region, accompanied by formation of a large-scale vortex structure. This process occurs when a substantial amount of the magnetic flux emerged on the surface, and the converging flow pattern remains stable during the following evolution of the active region. The Carrington synoptic flow maps show that the large-scale subsurface inflows are typical for active regions. In the deeper layers (10-13 Mm) the flows become diverging, and surprisingly strong beneath some active regions. In addition, the synoptic maps reveal a complex evolving pattern of large-scale flows on the scale much larger than supergranulation

  9. The effect of ketamine on the separation anxiety and emergence agitation in children undergoing brief ophthalmic surgery under desflurane general anesthesia

    OpenAIRE

    Jeong, Won Ju; Kim, Woon Young; Moon, Man Gook; Min, Doo Jae; Lee, Yoon Sook; Kim, Jae Hwan; Park, Young Cheol

    2012-01-01

    Background Emergence agitation (EA) frequently occurs after desflurane anesthesia in children. Ketamine, because of its sedative and analgesic properties, might be useful for the management of separation anxiety and EA. We investigated the preventive effect of ketamine on separation anxiety and EA after desflurane anesthesia in children for brief ophthalmic surgery. Methods Sixty children, ranging in age from 2-8 years old, undergoing brief ophthalmic surgery were randomly allocated to one of...

  10. Transverse colon volvulus in neurologicaly imparied patient as an emergency surgical condition: A case report

    Directory of Open Access Journals (Sweden)

    Miličković Maja

    2017-01-01

    Full Text Available Introduction. Transverse colon volvulus is an uncommon cause of bowel obstruction in general. Predisposing factors are mental retardation, dysmotility disorders, chronic constipation and congenital megacolon. Case report. We presented transverse colon volvulus in a 16-year-old boy with cerebral palsy. Chronic constipation in neurologicaly impaired patient was a risk factor predisposing to volvulus. The patient was admitted to the hospital with enormous abdominal distension and acute respiratory insufficiency. A boy was emergently taken to the operating room for exploratory laparotomy. During the surgery, a 360º clockwise volvulus of the transverse colon was found. After reduction of volvulus, an enormous transverse colon was resected and colostomy was formed. In the postoperative period, despite the good functioning of stoma and intraabdominal normotension, numerous and long lasting respiratory problems developed. The patient was discharged from our institution after 8 months. Conclusion. Though very rare in pediatric group, the possibility of a transverse colon volvulus must be considered in the differential diagnosis of acute large bowel obstruction.

  11. Safe introduction of new procedures and emerging technologies in surgery: education, credentialing, and privileging.

    Science.gov (United States)

    Sachdeva, Ajit K; Russell, Thomas R

    2007-08-01

    Ongoing horizon scanning is needed to identify new procedures and emerging technologies that should be evaluated for introduction into surgical practice. Following evidence-based evaluation, if a new modality is found ready for adoption in practice, surgeons need education in the safe and effective use of the new modality. The educational experience should include structured teaching and learning, verification of new knowledge and skills, preceptoring or proctoring, and monitoring of outcomes. Credentialing and privileging to perform a new procedure or use an emerging technology should be based on evaluation of knowledge and skills and outcomes of surgical care, and not merely on the numbers of procedures performed. Education of the surgical team is also essential. The entire process involving education, verification of knowledge and skills, credentialing, and privileging must be transparent. Patients need to play a central role in making informed decisions regarding their care that involves use of a new procedure or an emerging technology, and they should participate actively in their perioperative care.

  12. Examinations on cases of surgery for radiation-induced disorders of large intestine

    Energy Technology Data Exchange (ETDEWEB)

    Shiba, Tadaaki [Toho Univ., Tokyo (Japan). School of Medicine

    1996-11-01

    Author`s experience of surgery for radiation colitis was examined and discussed on the primary disease, radiation dose, major symptoms, surgical techniques, results and post-operative complication. Patients were 1 male and 21 females of the average age of 59.5 y. The primary diseases were bladder cancer for the male and uterine cancer for the females. The radiation dose ranged from 35-120 Gy and was 63.4 Gy in a mean. The symptoms for surgery were 14 ileuses, 4 intestinal hemorrhages, 1 perforation and 3 burrows. Colostomy was performed for 18 cases; enterostomy, 2; anastomosis, 1; and enterectomy, 1, which resulted in improvement of symptoms in 5 cases, 0, 1 and 1, respectively. The author concluded that radiation colitis should be treated preventively. (K.H.)

  13. Obesity and contraception: metabolic changes, risk of thromboembolism, use of emergency contraceptives, and role of bariatric surgery.

    Science.gov (United States)

    Gurney, E P; Murthy, A S

    2013-06-01

    Rates of obesity are increasing worldwide. Due to the medical consequences of obesity, routine health care like family planning becomes complicated. Conflicting data exists regarding efficacy of hormonal contraceptives in obese women, while little data on efficacy of emergency contraception in obese women exists. Much of what is available suggests lower serum hormonal levels in obese women with little effect on ovulation inhibition. Contraceptive steroids can cause a number of deteriorating metabolic changes, particularly in obese women; whether these changes are clinically significant is unknown. Venous thromboembolic risk is increased with both obesity and use of hormonal contraceptives; however the question remains if the risk is additive or multiplicative. Bariatric surgery can lead to digestive changes which may affect absorption of contraceptive hormones. While long acting reversible contraceptives may be the best option in the post operative obese patient, little data, beyond a simple recommendation to avoid pregnancy for at least one year, exists to help guide appropriate contraceptive choice.

  14. Patient Decision-Making About Emergency and Planned Stoma Surgery for IBD: A Qualitative Exploration of Patient and Clinician Perspectives.

    Science.gov (United States)

    Dibley, Lesley; Czuber-Dochan, Wladyslawa; Wade, Tiffany; Duncan, Julie; Burch, Jennie; Warusavitarne, Janindra; Norton, Christine; Artom, Micol; O'Sullivan, Liam; Verjee, Azmina; Cann, Denise

    2018-01-18

    Many inflammatory bowel disease (IBD) patients worry about stoma-forming surgery (SFS), sometimes enduring poor bowel-related quality of life to avoid it. Anticipation of SFS and whether expectations match experience is underreported. This qualitative study explored influences on patients' SFS decision-making and compared preoperative concerns with postoperative outcomes. We purposively recruited participants with IBD from UK hospital outpatient and community sources, and IBD clinicians from public hospitals. Four focus groups, 29 semistructured patient participant interviews, and 18 clinician interviews were audio recorded, transcribed, and analysed thematically. Participants had a current temporary, recently-reversed, or permanent stoma, or were stoma naive. Four themes emerged: Preoperative concerns and expectations, Patient decision-making, Surgery and recovery, and Long-term outcomes. Participants and clinicians agreed about most preoperative concerns, that outcomes were often better than expected, and support from others with a stoma is beneficial. Patient decision-making involves multiple factors, including disease status. Some clinicians avoid discussing SFS, and the phrase 'last resort' can bias patient perceptions; others recommend early discussion, increasing dialogue when medical management becomes ineffective. The postoperative period is particularly challenging for patients. Stoma acceptance is influenced by personal perceptions and pre- and postoperative clinical and social support. Patients need balanced information on all treatment options, including surgery, from an early stage. Early multidisciplinary team dialogue about SFS, and contact with others living well with a stoma, could enable informed decision-making. Life with a stoma is often better than anticipated, improving quality of life and control. Ongoing specialist nursing support aids recovery and adjustment. © 2018 Crohn’s & Colitis Foundation of America. Published by Oxford University

  15. The Association of Frailty With Outcomes and Resource Use After Emergency General Surgery: A Population-Based Cohort Study.

    Science.gov (United States)

    McIsaac, Daniel I; Moloo, Husein; Bryson, Gregory L; van Walraven, Carl

    2017-05-01

    Older patients undergoing emergency general surgery (EGS) experience high rates of postoperative morbidity and mortality. Studies focused primarily on elective surgery indicate that frailty is an important predictor of adverse outcomes in older surgical patients. The population-level effect of frailty on EGS is poorly described. Therefore, our objective was to measure the association of preoperative frailty with outcomes in a population of older patients undergoing EGS. We created a population-based cohort study using linked administrative data in Ontario, Canada, that included community-dwelling individuals aged >65 years having EGS. Our main exposure was preoperative frailty, as defined by the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnoses indicator. The Adjusted Clinical Groups frailty-defining diagnoses indicator is a binary variable that uses 12 clusters of frailty-defining diagnoses. Our main outcome measures were 1-year all-cause mortality (primary), intensive care unit admission, length of stay, institutional discharge, and costs of care (secondary). Of 77,184 patients, 19,779 (25.6%) were frail. Death within 1 year occurred in 6626 (33.5%) frail patients compared with 11,366 (19.8%) nonfrail patients. After adjustment for sociodemographic and surgical confounders, this resulted in a hazard ratio of 1.29 (95% confidence interval [CI] 1.25-1.33). The risk of death for frail patients varied significantly across the postoperative period and was particularly high immediately after surgery (hazard ratio on postoperative day 1 = 23.1, 95% CI 22.3-24.1). Frailty was adversely associated with all secondary outcomes, including a 5.82-fold increase in the adjusted odds of institutional discharge (95% CI 5.53-6.12). After EGS, frailty is associated with increased rates of mortality, institutional discharge, and resource use. Strategies that might improve perioperative outcomes in frail EGS patients need to be developed and tested.

  16. Bariatric surgery in individuals with severe cognitive impairment: report of two cases

    Directory of Open Access Journals (Sweden)

    Everton Cazzo

    2017-04-01

    Full Text Available ABSTRACT CONTEXT: Bariatric surgery has become the gold-standard treatment for refractory morbid obesity. Obesity is frequently associated with certain syndromes that include coexisting cognitive deficits. However, the outcomes from bariatric surgery in this group of individuals remain incompletely determined. CASE REPORT: A 25-year-old male with Prader-Willi syndrome, whose intelligence quotient (IQ was 54, was admitted with a body mass index (BMI of 55 kg/m2, associated with glucose intolerance. He underwent the Scopinaro procedure for biliopancreatic diversion, with uneventful postoperative evolution, and presented a 55% loss of excess weight one year after the surgery, with resolution of glucose intolerance, and without any manifestation of protein-calorie malnutrition. A 28-year-old male with Down syndrome, whose IQ was 68, was admitted with BMI of 41.5 kg/m2, associated with hypertension. He underwent Roux-en-Y gastric bypass, with uneventful postoperative evolution. He presented a 90% loss of excess weight one year after the surgery, with resolution of the hypertension. CONCLUSION: Bariatric surgery among individuals with intellectual impairment is a controversial topic. There is a tendency among these individuals to present significant weight loss and comorbidity control, but less than what is observed in the general obese population. The severity of the intellectual impairment may be taken into consideration in the decision-making process regarding the most appropriate surgical technique. Bariatric surgery is feasible and safe among these individuals, but further research is necessary to deepen these observations.

  17. Bilateral Video-Assisted Thoracoscopic Surgery Resection for Multiple Mediastinal Myelolipoma: Report of a Case

    OpenAIRE

    Nakagawa, Masatoshi; Kohno, Tadasu; Mun, Mingyon; Yoshiya, Tomoharu

    2014-01-01

    Myelolipoma in the mediastinum is an extremely rare entity. In this report, we present the case of a 79-year-old asymptomatic man who had three bilateral paravertebral mediastinal tumors. The three tumors were resected simultaneously using bilateral three-port video-assisted thoracoscopic surgery (VATS). There has been no evidence of recurrence within four years after the operation. Multiple bilateral mediastinal myelolipomas are extremely rare. There are no reports in the English literature ...

  18. Tegmen Tympani Defect and Brain Herniation Secondary to Mastoid Surgery: Case Presentation

    Directory of Open Access Journals (Sweden)

    Oguz Kadir Egilmez

    2014-01-01

    Full Text Available Brain herniation into the middle ear is very rarely seen. In addition to reasons like congenital factors, trauma, and infection, tegmen defect may develop as a result of iatrogenic events secondary to chronic otitis media surgery with or without cholesteatoma. Since it may cause life-threatening complications, patients must be evaluated and monitored for tegmen defect. In this paper, diagnosis and treatment of a brain herniation case due to iatrogenic tegmen defect were described along with relevant literature.

  19. Proximal mandibular nerve block using electrolocation in 10 dogs undergoing mandibular surgery: a case series report.

    OpenAIRE

    Ravasio, Giuliano; D'Urso, Elisa Silvia; Macchioni, Chiara; Stefanello, Damiano

    2016-01-01

    Peripheral nerve block performed using electrical stimulation (i.e. electrolocation) is widely used for perioperative pain management during several surgical procedures in dogs (Campoy 2008), but few data are reported concerning its application to invasive maxillofacial surgery (Carotenuto et al 2011). The aim of this case series report is to evaluate the efficacy of proximal mandibular nerve block (PMNB) in perioperative pain management in dogs undergoing mandibulectomy. Ten dogs of various ...

  20. CLINICAL EVALUATION OF PREOPERATIVE SKIN PREPARATION WITH AQUEOUS POVIDONE IODINE ONLY AND IN COMBINATION WITH ALCHOLIC CHLORHEXIDINE IN PATIENTS UNDERGOING ELECTIVE AND EMERGENCY SURGERIES

    Directory of Open Access Journals (Sweden)

    Latchu

    2015-10-01

    Full Text Available INTRODUCTION: Many techniques are there for skin preparation before surgery, the commonest being initial scrub with antiseptic soap solution, followed by painting the prepared area with antiseptic paint solution. But degerming of the skin can be done with antiseptics us ed for less than one minute which is as effective as five minute scrub with germicidal soap solution followed by painting with antiseptics . AIMS AND OBJECTIVES : 1. To evaluate the efficacy of povidone iodine alone and antiseptic agent containing alcoholic chlorhexidine with povidone iodine in preoperative skin preparation by taking swab culture. 2. To compare the rate of postoperative wound infection in both the groups . METHODS: STUDY DESIGN: Comparative study conducted on 100 patients in two groups. STUDY SETTING: Sri Venkateswara Medical College Tirupathi SOURCE OF DATA: 100 Patients (50 in each Group undergoing elective and emergency surgery admitted in the Department of General Surgery in S.V.R.R. Government General Hospital, Tirupati from 2013 to 2014. INCLUSION CRITERIA: 1. Patients undergoing elective & emergency surgery in department of general surgery. 2. Patients with no focus of infection anywhere on the body. 3. Patients irrespective of their age and sex. 4. Patients neither immunocompromised nor on any long term steroids. 5. Patients undergoing mes h repair of hernia are also included. EXCLUSION CRITERIA: 1. Immuno compromised patients and patients on long term steroids. 2. Patients with septicemia. 3. Patients suffering from malignancies or undergoing chemotherapy or radiation therapy. 4. Contaminat ed surgeries in which viscus was opened were excluded from the study. 5. Patients with co - morbid medical conditions like diabetes, hypertension etc. METHOD OF COLLECTION OF DATA: In each case preoperatively, detailed history was taken and routine investiga tions like haemoglobin, total count, differential count, ESR, RBS and chest X - ray, ultrasound were done to

  1. [Emergent Caesarean Section in a Patient with a Mediastinal Tumor and Von Recklinghausen Disease: A Case Report].

    Science.gov (United States)

    Owada, Mayuko; Inomata, Shinichi; Danmura, Masato; Yamada, Kumiko; Tanaka, Makoto

    2016-06-01

    It is rare to encounter a pregnant patient with a mediastinal tumor, and if the tumor size increases as the pregnancy progresses, this increase can cause complications such as airway constriction and vascular occlusion. We report a case of a pregnant patient diagnosed with von Recklinghausen disease at the age of seven and diagnosed with a mediastinal tumors just after her present admission. The impending suffocation progressed and fetal heart rate decreased during her hospitalization. Her trachea was intubated and she was moved to an operating room for an emergent cesarean section under general anesthesia. With this rapid response, we could rescue both patient and infant. If the size of mediastinal tumor increases as pregnancy progresses, the tumor will cause suffocation by airway compression from the outside, in addition to specific airway edema on the inward side. The present case demonstrates that appropriate desisoins must be made for airway manegement and initiation of surgery.

  2. Evaluation of Head Trauma Cases in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Alim Cokuk

    2013-02-01

    Full Text Available Aim: In this study, we aimed to determine the epidemiological characteristics, morbidity and mortality rates of patients admitted to the emergency department with head trauma. Material and Methods: In this study, ambulatory and hospitalized patients over the age of 18 brought to the Emergency Department because of head trauma between 01.12.2009 - 31.12.2010 were analyzed retrospectively. Patient data were recorded to standard data entry form. SPSS 17.0 package program was used for statistical analysis of data. The statistical significance level of all tests was p <0.05. Results: 5200 patients were included in this study. The average age of the patients was 39.97 ± 16.66 years. 4682'si patients (90 % were discharged from the emergency department. The most common reason for admission to the emergency department was falls (41.81 % in the discharged patients. 518 (10 % patients were hospitalized. Gender of these patients was 110 female (21:24% and 408 male (78.76%. 256 patients (48.35% were injured as a result of a traffic accident. 201(38.8% of the cerebral CT were reported as normal and 89 (17.2% of the cerebral CT were reported as traumatic subarachnoid hemorrhage (SAH in hospitalized patients. The fracture of lumbar spine (12 % was detected as an additional pathological disease in patients. 75 patients hospitalized because of head trauma (14.5% had died (1.44 % of all patients. Cervical spine fracture was the most common (14 patients, 18.68 % additional pathology in patients who died. Thoracic trauma was detected as the second most common (13 patients, 17.33 % additional pathology. Conclusion: Most of the patients admitted to the emergency department with head injury had a minor trauma. Patients can be discharged from the emergency department after a thorough physical examination and simple medical intervention. Most of the head injury patients admitted to hospital were male. The most common reason of the patients with head injury admitted to

  3. How to Manage Public Information in Case of Nuclear Emergency

    International Nuclear Information System (INIS)

    Caldarovic, O.

    2000-01-01

    In the paper the problem of efficient, adequate and full information and education of the population as one of the most important aspects of nuclear emergency situations si discussed. It is shown that information and education in these situation must follow major principles of democratic information, that all decisions must be made in advance and in full co-ordination as well as with a full responsibility of the development of the situation. Furthermore, effective information is seen as a missing link in different nuclear emergency situation so far. A model of effective information is discussed and proposed. (author)

  4. Crude versus case-mix-adjusted control charts for safety monitoring in thyroid surgery.

    Science.gov (United States)

    Duclos, Antoine; Voirin, Nicolas; Touzet, Sandrine; Soardo, Pietro; Schott, Anne-Marie; Colin, Cyrille; Peix, Jean-Louis; Lifante, Jean-Christophe

    2010-12-01

    Patient-safety monitoring based on health-outcome indicators can lead to misinterpretation of changes in case mix. This study aimed to compare the detection of indicator variations between crude and case-mix-adjusted control charts using data from thyroid surgeries. The study population included each patient who underwent thyroid surgery in a teaching hospital from January 2006 to May 2008. Patient safety was monitored according to two indicators, which are immediately recognisable postoperative complications: recurrent laryngeal nerve palsy and hypocalcaemia. Each indicator was plotted monthly on a p-control chart using exact limits. The weighted κ statistic was calculated to measure the agreement between crude and case-mix-adjusted control charts. We evaluated the outcomes of 1405 thyroidectomies. The overall proportions of immediate recurrent laryngeal nerve palsy and hypocalcaemia were 7.4% and 20.5%, respectively. The proportion of agreement in the detection of indicator variations between the crude and case-mix-adjusted p-charts was 95% (95% CI 85% to 99%). The strength of the agreement was κ = 0.76 (95% CI 0.54 to 0.98). The single special cause of variation that occurred was only detected by the case-mix-adjusted p-chart. There was good agreement in the detection of indicator variations between crude and case-mix-adjusted p-charts. The joint use of crude and adjusted charts seems to be a reasonable approach to increase the accuracy of interpretation of variations in outcome indicators.

  5. Treatment of hematomas after anterior cervical spine surgery: A retrospective study of 15 cases.

    Science.gov (United States)

    Miao, Weiliang; Ma, Xiaojun; Liang, Deyong; Sun, Yu

    2018-05-04

    Postoperative hematoma is a rare and dangerous complication of cervical spine surgery. The aim of this study was to investigate the incidence and related factors of postoperative hematoma, and to report on 15 cases at our institution over a 6-year period. Fifteen cases of postoperative hematoma were retrospectively identified. We investigated their neurological outcomes, characteristics, and surgical data, and identified risk factors associated with postoperative (PO) hematoma. Patients with hematoma were compared to those with no hematoma, in order to identify risk factors. Retropharyngeal hematomas developed in seven cases and epidural hematomas in eight. The total incidence of postoperative hematoma was 1.2%: 0.5% retropharyngeal hematomas and 0.6% spinal epidural hematomas. At time of onset, the severity of paralysis was assessed as grade B in one case, grade C in six cases, and grade D in eight cases. Risk factors for PO hematoma were: (1) presence of ossification of the posterior longitudinal ligament (OPLL) (Phematoma group and non-hematoma group (P>0.05). Precise preoperative preparation and systematic evaluation are central to successful management of PO hematoma after anterior cervical surgery. Risk factors for PO hematoma include multilevel decompression, OPLL, higher BMI, and longer operation time. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

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

    Science.gov (United States)

    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

  7. A Case of Bariatric Surgery-related Wernicke-Korsakoff Syndrome with Persisting Anterograde Amnesia.

    Science.gov (United States)

    Gasquoine, Philip Gerard

    2017-08-01

    To describe the theoretical and clinical implications of the neuropsychological evaluation of a case of bariatric surgery-related Wernicke-Korsakoff syndrome. The patient was a 37-year old, female, bilingual, bachelor's degree educated, Mexican American public relations consultant without preexisting psychiatric, neurological, or substance abuse history. Recovery from laparoscopic sleeve gastrectomy surgery for morbid obesity was complicated by intraabdominal abscess, multibacterial infection, and prolonged nausea and vomiting. About 15 weeks post-surgery she was diagnosed with Wernicke's encephalopathy. She had a positive response to thiamine supplement but was left with persisting self-reported memory problems that were confirmed by family members. Multiple neuroimaging studies were all normal. A neuropsychological evaluation at 14 months post-surgery revealed anterograde amnesia for verbal and visual-perceptual material. There was no clear period of temporally graded retrograde amnesia. Scores on tests of visual-perceptual, language, fine motor, and executive functions were unimpaired. She had awareness of her neurocognitive impairment, but did not exhibit emotional distress. Follow-up neuropsychological evaluation at 17 months showed a similar neurocognitive profile with increased emotional distress. Her preserved executive functioning is theoretically important as it supports arguments that such impairment in alcohol use-related Korsakoff syndrome derives from the toxic effects of the prolonged misuse of alcohol and not vitamin deficiency. From a clinical perspective, neuropsychological evaluation of thiamine treated, bariatric surgery-related, Wernicke's encephalopathy cases is indicated if there is suspicion of residual memory impairment. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  8. Xanthomatous Hypophysitis Presenting with Diabetes Insipidus Completely Cured Through Transsphenoidal Surgery: Case Report and Literature Review.

    Science.gov (United States)

    Lin, Wei; Gao, Lu; Guo, Xiaopeng; Wang, Wenze; Xing, Bing

    2017-08-01

    Xanthomatous hypophysitis (XH) is extremely rare. Only 27 cases have been reported in the literature. No XH patient presenting with diabetes insipidus (DI) has been completely cured through surgery. Here, we describe the first XH case of a DI patient whose pituitary function was normalized postoperatively, without hormone replacement therapy. A 41-year-old woman suffered from polydipsia, DI, headache, and breast discharge. Laboratory investigation revealed hyperprolactinemia. Pituitary magnetic resonance imaging showed a 2.0-cm × 1.4-cm × 1.6-cm lesion that demonstrated heterogeneous intensity on T1-weighted imaging and peripheral ring enhancement following contrast; the lesion was totally removed through transsphenoidal surgery. Histopathologic and immunohistochemical examinations confirmed the diagnosis of XH. At the 4- and 15-month follow-up visits, all pituitary-related hormones were normal, and the patient was not taking medication. A repeat pituitary magnetic resonance imaging showed no evidence of recurrence. To the best of our knowledge, this case is the first documented occurrence of XH with DI completely cured through surgery. If XH is suspected, total surgical resection of the lesion is recommended and normal pituitary tissue should be carefully protected intraoperatively. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Lung Emergencies

    Science.gov (United States)

    ... The Marfan Foundation Marfan & Related Disorders What is Marfan Syndrome? What are Related Disorders? What are the Signs? ... Emergencies Lung Emergencies Surgeries Lung Emergencies People with Marfan syndrome can be at increased risk of sudden lung ...

  10. Congenital Heart Surgery Case Mix Across North American Centers and Impact on Performance Assessment.

    Science.gov (United States)

    Pasquali, Sara K; Wallace, Amelia S; Gaynor, J William; Jacobs, Marshall L; O'Brien, Sean M; Hill, Kevin D; Gaies, Michael G; Romano, Jennifer C; Shahian, David M; Mayer, John E; Jacobs, Jeffrey P

    2016-11-01

    Performance assessment in congenital heart surgery is challenging due to the wide heterogeneity of disease. We describe current case mix across centers, evaluate methodology inclusive of all cardiac operations versus the more homogeneous subset of Society of Thoracic Surgeons benchmark operations, and describe implications regarding performance assessment. Centers (n = 119) participating in the Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 through 2014) were included. Index operation type and frequency across centers were described. Center performance (risk-adjusted operative mortality) was evaluated and classified when including the benchmark versus all eligible operations. Overall, 207 types of operations were performed during the study period (112,140 total cases). Few operations were performed across all centers; only 25% were performed at least once by 75% or more of centers. There was 7.9-fold variation across centers in the proportion of total cases comprising high-complexity cases (STAT 5). In contrast, the benchmark operations made up 36% of cases, and all but 2 were performed by at least 90% of centers. When evaluating performance based on benchmark versus all operations, 15% of centers changed performance classification; 85% remained unchanged. Benchmark versus all operation methodology was associated with lower power, with 35% versus 78% of centers meeting sample size thresholds. There is wide variation in congenital heart surgery case mix across centers. Metrics based on benchmark versus all operations are associated with strengths (less heterogeneity) and weaknesses (lower power), and lead to differing performance classification for some centers. These findings have implications for ongoing efforts to optimize performance assessment, including choice of target population and appropriate interpretation of reported metrics. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  11. Improving Emergency Attendance and Mortality – The Case for Unit ...

    African Journals Online (AJOL)

    METHODS: The study compared the outcomes (attendance and mortality) in a Single Emergency Model (SEM) with a USM, over a two-year period. Two groups of patients were studied - the SEM phase comprising 809 patients, and the USM phase comprising 3,505 patients. Data on patients' attendance and mortality in the ...

  12. Effectiveness of Comprehensive Geriatric Assessment-Based Intervention to Reduce Frequent Emergency Department Visits: A Report of Four Cases

    Directory of Open Access Journals (Sweden)

    Mei-Chen Liao

    2012-06-01

    Full Text Available A small number of clustered visits by emergency department frequent users (EDFUs may over-consume emergency care resources. We report the effectiveness of comprehensive geriatric assessment (CGA-based multidisciplinary team (MDT care for four EDFUs, in reducing ED visits. Case 1 had visited the ED twice/month due to chest discomfort. Her ED visits were significantly reduced to 0.2 visits/month following CGA-based MDT care. Case 2 had failed back surgery syndrome and bipolar disorder. His ED visit was reduced from 2.8 visits to 0.8 visits/month following CGA-based MDT intervention. Case 3 had chronic obstructive pulmonary disease, heart failure, and urinary incontinence, with a urinary catheter in place. He made 31 ED visits (5.1 visits/month before his lung cancer and depression were discovered by CGA. He died 2 months later. Case 4 made 27 ED visits (2.7 visits/month due to dizziness. His problems of early dementia and neglect were identified by CGA, and he visited the ED only once following MDT intervention. In conclusion, CGA-based MDT intervention successfully reduced ED visits among these EDFUs, but further investigation is needed to evaluate the effectiveness of geriatric services in the ED.

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

    Directory of Open Access Journals (Sweden)

    Narayan H Gandedkar

    2016-01-01

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

  14. Uptake of cataract surgery in Sava Region, Madagascar: role of cataract case finders in acceptance of cataract surgery.

    Science.gov (United States)

    Razafinimpanana, Narivony; Nkumbe, Henry; Courtright, Paul; Lewallen, Susan

    2012-04-01

    The number of people coming for cataract surgery in Madagascar remains low and most ophthalmologists could do many more surgeries than currently done. Knowing why people identified with cataract do not accept surgery will help to design programs that use existing resources more effectively. The study was carried out in Sava Region of Madagascar. People with blinding (acceptance were proximity to hospital (people from Sambava district were twice as likely to present as people from more distant districts) and perceived price of transport and food (being higher for people not accepting). The actual price of surgery was not the main barrier to acceptance of surgery; instead it appears that distance to the hospital and the willingness to pay are important predictors. Strategies to improve uptake need to be revised in order to ensure that people have access to and use cataract surgical services.

  15. Surgery with radioguided location of a liver metastasis of melanoma choroid: case report

    International Nuclear Information System (INIS)

    Moreno, Marcelo; Miranda, Mario Henrique Furlanetto

    2015-01-01

    Introduction: The use of radioguided occult lesion localization prior to surgical excision is increasing, mainly due to the development of new probes and the use of PET-CT. Case report: A 70-year-old male who presented with a metastatic lesion in his liver from a choroidal melanoma. This was located using PET-CT and subsequently located with a low-energy intraoperative gamma probe during the laparotomy. Conclusion: The present case shows that it is possible to excise a hepatic metastasis utilizing the principles of radioguided surgery, even in centers without access to high energy probes. (author)

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

    Directory of Open Access Journals (Sweden)

    Ameri Ebrahim

    2009-06-01

    Full Text Available Abstract 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.

  17. C5 Palsy After Cervical Spine Surgery: A Multicenter Retrospective Review of 59 Cases.

    Science.gov (United States)

    Thompson, Sara E; Smith, Zachary A; Hsu, Wellington K; Nassr, Ahmad; Mroz, Thomas E; Fish, David E; Wang, Jeffrey C; Fehlings, Michael G; Tannoury, Chadi A; Tannoury, Tony; Tortolani, P Justin; Traynelis, Vincent C; Gokaslan, Ziya; Hilibrand, Alan S; Isaacs, Robert E; Mummaneni, Praveen V; Chou, Dean; Qureshi, Sheeraz A; Cho, Samuel K; Baird, Evan O; Sasso, Rick C; Arnold, Paul M; Buser, Zorica; Bydon, Mohamad; Clarke, Michelle J; De Giacomo, Anthony F; Derakhshan, Adeeb; Jobse, Bruce; Lord, Elizabeth L; Lubelski, Daniel; Massicotte, Eric M; Steinmetz, Michael P; Smith, Gabriel A; Pace, Jonathan; Corriveau, Mark; Lee, Sungho; Cha, Peter I; Chatterjee, Dhananjay; Gee, Erica L; Mayer, Erik N; McBride, Owen J; Roe, Allison K; Yanez, Marisa Y; Stroh, D Alex; Than, Khoi D; Riew, K Daniel

    2017-04-01

    A multicenter, retrospective review of C5 palsy after cervical spine surgery. Postoperative C5 palsy is a known complication of cervical decompressive spinal surgery. The goal of this study was to review the incidence, patient characteristics, and outcome of C5 palsy in patients undergoing cervical spine surgery. We conducted a multicenter, retrospective review of 13 946 patients across 21 centers who received cervical spine surgery (levels C2 to C7) between January 1, 2005, and December 31, 2011, inclusive. P values were calculated using 2-sample t test for continuous variables and χ 2 tests or Fisher exact tests for categorical variables. Of the 13 946 cases reviewed, 59 patients experienced a postoperative C5 palsy. The incidence rate across the 21 sites ranged from 0% to 2.5%. At most recent follow-up, 32 patients reported complete resolution of symptoms (54.2%), 15 had symptoms resolve with residual effects (25.4%), 10 patients did not recover (17.0%), and 2 were lost to follow-up (3.4%). C5 palsy occurred in all surgical approaches and across a variety of diagnoses. The majority of patients had full recovery or recovery with residual effects. This study represents the largest series of North American patients reviewed to date.

  18. Radioguided surgery with MIBI in brain tumors: on the subject of a case

    International Nuclear Information System (INIS)

    Martín Escuela, Juan Miguel

    2016-01-01

    Many efforts are directed towards better intraoperative detection and delimitation of brain tumors, in order to achieve better resection. A recent technique, implemented is radioguided surgery in which the tumor tissue is marked with a radiotracer (MIBI) and through the use of a probe and / or gamma camera to differentiate it from healthy brain tissue, in vivo, in the surgery room. : Evaluate the feasibility of radioguided surgery and optimize the procedures with the purpose of developing a clinical protocol for the reception of brain tumors. MATERIALS AND METHODS: A patient with a high grade glioma was submitted to MIBI, confirming that gamma camera facilitated the intraoperative detection of the tumor and indicated a small piece of residual tumor that was subsequently resected, Achieving total resection of the lesion. Conclusion: Radio-guided surgery with MIBI, showed, in this case, that it is a safe and reliable technique, not only for the detection and delimitation of brain tumors, but also for confirmation of presence or absence of residual tumor, facilitating total resection of the lesion.

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

    Directory of Open Access Journals (Sweden)

    Dincer Aktuerk

    2016-01-01

    Full Text Available 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 pCO 2 , 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.

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

    Science.gov (United States)

    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.

  1. Robot-assisted surgery: an emerging platform for human neuroscience research

    Directory of Open Access Journals (Sweden)

    Anthony Michael Jarc

    2015-06-01

    Full Text Available Classic studies in human sensorimotor control use simplified tasks to uncover fundamental control strategies employed by the nervous system. Such simple tasks are critical for isolating specific features of motor, sensory, or cognitive processes, and for inferring causality between these features and observed behavioral changes. However, it remains unclear how these theories translate to complex sensorimotor tasks or to natural behaviors. Part of the difficulty in performing such experiments has been the lack of appropriate tools for measuring complex motor skills in real-world contexts. Robot-assisted surgery (RAS provides an opportunity to overcome these challenges by enabling unobtrusive measurements of user behavior. In addition, a continuum of tasks with varying complexity – from simple tasks such as those in classic studies to highly complex tasks such as a surgical procedure – can be studied using RAS platforms. Finally, RAS includes a diverse participant population of inexperienced users all the way to expert surgeons. In this perspective, we illustrate how the characteristics of RAS systems make them compelling platforms to extend many theories in human neuroscience, as well as, to develop new theories altogether.

  2. Ventricular tachycardia during arthroscopic shoulder surgery: a report of two cases.

    Science.gov (United States)

    Cho, Seung Hyun; Yi, Jin Woong; Kwack, Yoon Ho; Park, Sung Wook; Kim, Mi Kyeong; Rhee, Yong Girl

    2010-03-01

    We routinely have performed arthroscopic shoulder surgery under general anesthesia in the beach chair position using epinephrine (0.33 mg/L) saline irrigation. At a 2-week interval, two patients, a 19-year-old man scheduled to undergo an arthroscopic Bankart repair for left traumatic anterior instability and a 49-year-old woman scheduled for an arthroscopic rotator cuff repair for a left rotator cuff tear, were resuscitated by chest compression and defibrillation due to a sudden developed cardiogenic shock following ventricular tachycardia at the time of arthroscopic shoulder surgery. They were transferred to the intensive care unit because their emergent echocardiogram showed significantly decreased cardiac functions. They were fully recovered and then discharged. Epinephrine was considered to be the cause of ventricular tachycardia because the two patients showed no anaphylactic reaction to drugs or symptoms of air embolism related to the beach chair position. In addition, according to our observation of epinephrine flow patterns, it was more likely that highly concentrated epinephrine was rapidly infused into the body. This complication is very rare. However, thorough understanding of the side effects and their development of epinephrine during arthroscopic shoulder surgery should neither be overemphasized nor disregarded.

  3. Managing hip fracture and lower limb surgery in the emergency setting: Potential role of non-vitamin K antagonist oral anticoagulants.

    Science.gov (United States)

    Fisher, William

    2017-06-01

    Trauma, immobilization, and subsequent surgery of the hip and lower limb are associated with a high risk of developing venous thrombo-embolism (VTE). Individuals undergoing hip fracture surgery (HFS) have the highest rates of VTE among orthopedic surgery and trauma patients. The risk of VTE depends on the type and location of the lower limb injury. Current international guidelines recommend routine pharmacological thromboprophylaxis based on treatment with heparins, fondaparinux, dose-adjusted vitamin K antagonists and acetylsalicylic acid for patients undergoing emergency HFS; however, not all guidelines recommend pharmacological prophylaxis for patients with lower limb injuries. Non-vitamin K antagonist oral anticoagulants (NOACs) are indicated for VTE prevention after elective hip or knee replacement surgery, but at present are not widely recommended for other orthopedic indications despite their advantages over conventional anticoagulants and promising real-world evidence. In patients undergoing HFS or lower limb surgery, decisions on whether to anticoagulate and the most appropriate anti-coagulation strategy can be guided by weighing the risk of thromboprophylaxis against the benefit in relation to each patient's medical history and age. In addition, the nature and location of the fracture, operating times and times before fracture fixation should be considered. The current review discusses the need for anticoagulation in patients undergoing emergency HFS or lower limb surgery together with the current guidelines and available evidence on the use of NOACs in this setting. Appropriate thromboprophylactic strategies and practical advice on the peri-operative management of patients who present to the Emergency Department on a NOAC before emergency surgery are further outlined.

  4. Parotitis after epidural anesthesia in plastic surgery: report of three cases.

    Science.gov (United States)

    Rosique, Marina Junqueira Ferreira; Rosique, Rodrigo Gouvea; Costa, Ilson Rosique; Lara, Brunno Rosique; Figueiredo, Jozé Luiz Ferrari; Ribeiro, Davidson Gomes Barbosa

    2013-08-01

    Acute swelling of the parotid glands after general anesthesia has become known as anesthesia mumps. Its cause is unknown. Only one case of postsurgical parotitis without general anesthesia is reported. This report describes three cases in this setting after plastic surgery. A 37-year-old women underwent breast surgery and abdominoplasty with a dual thoracic/lumbar epidural block (bupivacaine 0.5 %). The operative time totaled almost 6 h. Subsequently, 4 h after surgery, the patient experienced painless bilateral parotid swelling without palpable crepitus. The edema resolved completely within 12 h under clinical observation and parenteral hydration. A 45-year-old patient received subglandular breast implants and body contouring with liposuction, all with the patient under a dual thoracic/lumbar epidural block with 0.5 % marcaine. The total surgical time was 5 h. Subsequently, 3 h after surgery, the patient experienced a similar clinical presentation. The problem resolved completely in 36 h with clinical observation and parenteral hydration. CASE 3: A 30-year-old patient received a subglandular breast implant and underwent liposuction of the outer thighs using a dual thoracic/lumbar epidural block with lidocaine 1 %. The duration of surgery was 1 h. Subsequently, 5 h postoperatively, the patient experienced a similar clinical presentation. Dexamethasone and parenteral hydration were administered. The problem resolved completely in 48 h without sequelae. The occurrence of parotitis in patients undergoing surgery under epidural anesthesia is a novel situation, which increases the range of possible etiologies for this little known condition. Dehydration leading to transient parotid secretion obstruction may play a significant role. Further reports of parotitis occurring in the regional anesthesia setting are expected to help elucidate its pathophysiology. This journal requires that authors assign a level of evidence to each article. For a full description of

  5. Development and evaluation of standardized narrative cases depicting the general surgery professionalism milestones.

    Science.gov (United States)

    Rawlings, Arthur; Knox, Aaron D C; Park, Yoon Soo; Reddy, Shalini; Williams, Sarah R; Issa, Nabil; Jameel, Abid; Tekian, Ara

    2015-08-01

    Residency programs now are required to use educational milestones, which has led to the need for new methods of assessment. The literature suggests that narrative cases are a promising tool to track residents' progress. This study demonstrates the process for developing and evaluating narrative cases representing the five levels of the professionalism milestones. In 2013, the authors identified 28 behaviors in the Accreditation Council for Graduate Medical Education general surgery professionalism milestones. They modified previously published narrative cases to fit these behaviors. To evaluate the quality of these cases, the authors developed a 28-item, five-point scale instrument, which 29 interdisciplinary faculty completed. The authors compared the faculty ratings by narrative case and specialty with the authors' initial rankings of the cases by milestone level. They used t tests and analysis of variance to compare mean scores across specialties. The authors developed 10 narrative cases, 2 for each of the 5 milestone levels. Each case contained at least 20 of the 28 behaviors identified in the milestones. Mean faculty ratings matched the milestone levels. Reliability was good (G coefficient = 0.86, phi coefficient = 0.85), indicating consistency in raters' ability to determine the proper milestone level for each case. The authors demonstrate a process for using specialty-specific milestones to develop narrative cases that map to a spectrum of professionalism behaviors. This process can be applied to other competencies and specialties to facilitate faculty awareness of resident performance descriptors and provide a frame of reference for milestones assessment.

  6. Emergency surgery for obstructing colonic cancer: a comparison between right-sided and left-sided lesions.

    Science.gov (United States)

    Faucheron, J-L; Paquette, B; Trilling, B; Heyd, B; Koch, S; Mantion, G

    2018-02-01

    Few studies compare management and outcomes of obstructive colonic cancer, depending on the tumor site. We aim to evaluate the differences in patient characteristics, tumor characteristics, and outcomes of emergency surgery for obstructive right-sided versus left-sided colonic cancers. Between 2000 and 2009, 71 consecutive patients had an emergency colectomy following strict and clear definition of obstruction in a single institution. We retrospectively analyzed pre, per, and postoperative data that were prospectively collected. There were 31 and 40 patients in the right and left group, respectively. Patients aged over 80 were more frequent in the right group (p = 0.03). At operation, ileocecal valve was less often competent in the right group (p = 0.03). The one-stage strategy was more frequent in the right group (p = 0.008). Patients in the right group had a higher rate of nodes invasion (p = 0.04). One- and two-year mortality rate in the right group had a tendency to be higher. Patients presenting with a right obstructive colonic cancer are older, have a more advanced locoregional disease, and are more often treated in a one-stage strategy than patients with a left obstructive tumor.

  7. EMERGING BUSINESSES: THE SOUTH AFRICAN WINE INDUSTRY CASE

    OpenAIRE

    Weatherspoon, Dave D.; Alade, Julius A.; Danley, Cheryl

    1999-01-01

    Emerging economies such as South Africa, only a few years out of apartheid, have been feeling the strains of socio-political change. While South Africa has experienced political reform, economic reform and access are slow to come. Currently, South Africa is the 7th largest producer of wine in the world. Although this industry is impressive, the apartheid era production practices have caused primarily the European consumers and media to be vocal about this issue. However, this concern has spre...

  8. Selected acoustic characteristics of emerging esophageal speech: Case study

    Directory of Open Access Journals (Sweden)

    Glenn Binder

    1978-11-01

    Full Text Available The development of esophageal speech was examined in a laryngectomee subject to observe the emergence of selected acoustic characteristics, and their relation to listener intelligibility ratings. Over a two-and-a-half  month period, the data from  five recording sessions was used for spectrographic and perceptual (listener analysis. There was evidence to suggest a fairly reliable correlation between emerging acoustic characteristics and increasing perceptual ratings. Acoustic factors coincident with increased intelligibility ratings appeared related to two dimensions: firstly, the increasing pseudoglottic control over esophageal air release; secondly the presence of  a mechanism of  pharyngeal compression. Increased pseudoglottic control manifested  in a reduction of  tracheo-esophageal turbulence, and a more efficient  burping mode of  vibration with clearer formant structure. Spectrographic evidence of  a fundamental  frequency  did not emerge. These dimensions appeared to have potential diagnostic and therapeutic value, rendering an analysis of  the patient's developing vocal performance  more explicit for  both clinician and patient.

  9. Adjustable selective maxillary expansion combined with maxillomandibular surgery: A case report.

    Science.gov (United States)

    Leyder, Patrick; Altounian, Gérard; Chardain, Jacques; Quilichini, Julien

    2015-09-01

    Surgically assisted rapid maxillary expansion (SARME) is usually considered the gold standard for maxillary transverse expansion in adults. However, a second surgical procedure is needed in cases of associated sagittal or vertical discrepancies. We describe the use of two new innovative devices for the correction of discrepancies in all dimensions during a single surgical procedure, thus reducing treatment duration. We report the case of a 21-year-old female patient, referred to our department for skeletal Class III malocclusion associated with right-side laterognathism and transverse maxillary deficiency. The patient underwent one-stage surgery, using sliding osteosynthesis plates and an adjustable bone-borne distractor. Pre-surgical orthodontics consisted in leveling and aligning the mandibular arch; maxillary leveling was initiated 3 months before surgery. Postoperative palatal distraction combined with orthodontic finishing enabled complete correction of dental and bony discrepancies after 3 months. In our experience, treatment of transverse, sagittal and vertical discrepancies has been possible in a single surgical procedure, using two innovative techniques: sliding osteosynthesis and an adjustable bone distractor. Two years post-surgery, the correction is stable in all dimensions. Copyright © 2015. Published by Elsevier Masson SAS.

  10. Intraoperative Magnetic Resonance Imaging in Skull Base Surgery: A Review of 71 Consecutive Cases.

    Science.gov (United States)

    Ashour, Ramsey; Reintjes, Stephen; Park, Michael S; Sivakanthan, Sananthan; van Loveren, Harry; Agazzi, Siviero

    2016-09-01

    Although intraoperative magnetic resonance imaging (iMRI) increasingly is used during glioma resection, its role in skull base surgery has not been well documented. In this study, we evaluate our experience with iMRI for skull base surgery. Medical records were reviewed retrospectively on all neurosurgical cases performed at our institution in the IMRIS iMRI suite between April 2014 and July 2015. During the study period, the iMRI suite was used for 71 skull base tumors. iMRI was performed in 23 of 71 cases. Additional tumor resection was pursued after scanning in 7 of 23 patients. There was a significant difference in procedure length between the scanned versus nonscanned groups, and this was likely attributable to a greater proportion of petroclival meningiomas in the scanned group. Further analyses revealed significant increases in procedure length for the following scanned subgroups: anterolateral approach, anterolateral and petroclival lesion locations, and meningiomas. The rate of non-neurologic complications was significantly greater in the scanned group, particularly for patients with tumors >3 cm. Despite the unique challenges associated with skull base tumor surgery, iMRI can be safely obtained while adding a modest although not prohibitive amount of time to the procedure. The immediate evidence of residual tumor with a patient still in position to have additional resection may influence the surgeon to alter the surgical plan and attempt further resection in a critical area. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Emergency Evacuation Simulation for Radiological Emergency; A Case Study of Gijang

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Gyu M.; Na, Kyoungseok; Jeong, Jae Jun; Ahn, Seokyoung; Park, Seonghee [Pusan National Univ., Busan (Korea, Republic of)

    2014-05-15

    The recent nuclear reactor accident at Fukushima caused the residents at Gijang to be concerned about the safety of their local nuclear plants. The nuclear reactor-related accidents is very rare but may cause the serious consequences and last for significant period. Especially, Gijang is located next to Busan, at which most population is concentrated. Hence, the effective and efficient emergency evacuation plan cannot be overemphasized in addition to well-designed nuclear disaster prevention measures. The central government has studied the safety issues of nuclear plants and developed the prevention systems. However, the local government also needs their emergency evacuation plan for its residents, considering its geographical and local factors such as various modes of transportations, transportation and shelters systems. The disasters related to nuclear power plants is rare but their influence is considerable. Therefore, while maintaining the safe facilities, the disaster preparedness cannot be overemphasized. An agent-based emergency evacuation simulation tool has been developed and tested for Gijang area.

  12. Case-mix study of single incision laparoscopic surgery (SILS) vs. Conventional laparoscopic surgery in colonic cancer resections

    DEFF Research Database (Denmark)

    Mynster, Tommie; Wille-Jørgensen, Peer

    2013-01-01

    of administrations or amount of opioids were seen. Conclusion. With reservation of a small study group we find SILS is like worthy to CLS in colorectal cancer surgery and a benefit in postoperative recovery and pain is possible, but has to be investigated in larger randomised studies.......Single incision laparoscopic surgery (SILS) may be even less invasive to a patient than conventional laparoscopic surgery (CLS). Aim of the study of the applicability of the procedure, the first 1½ year of experiences and comparison with CLS for colonic cancer resections Material and methods. Since...

  13. Perioperative risk assessment in robotic general surgery: lessons learned from 884 cases at a single institution.

    Science.gov (United States)

    Buchs, Nicolas C; Addeo, Pietro; Bianco, Francesco M; Gorodner, Veronica; Ayloo, Subhashini M; Elli, Enrique F; Oberholzer, José; Benedetti, Enrico; Giulianotti, Pier C

    2012-08-01

    To assess factors associated with morbidity and mortality following the use of robotics in general surgery. Case series. University of Illinois at Chicago. Eight hundred eighty-four consecutive patients who underwent a robotic procedure in our institution between April 2007 and July 2010. Perioperative morbidity and mortality. During the study period, 884 patients underwent a robotic procedure. The conversion rate was 2%, the mortality rate was 0.5%, and the overall postoperative morbidity rate was 16.7%. The reoperation rate was 2.4%. Mean length of stay was 4.5 days (range, 0.2-113 days). In univariate analysis, several factors were associated with increased morbidity and included either patient-related (cardiovascular and renal comorbidities, American Society of Anesthesiologists score ≥ 3, body mass index [calculated as weight in kilograms divided by height in meters squared] surgery, malignant disease, body mass index of less than 30, hypertension, and transfusion were factors significantly associated with a higher risk for complications. American Society of Anesthesiologists score of 3 or greater, age 70 years or older, cardiovascular comorbidity, and blood loss of 500 mL or more were also associated with increased risk for mortality. Use of the robotic approach for general surgery can be achieved safely with low morbidity and mortality. Several risk factors have been identified as independent causes for higher morbidity and mortality. These can be used to identify patients at risk before and during the surgery and, in the future, to develop a scoring system for the use of robotic general surgery

  14. Emergence from anesthesia in children undergoing ambulatory surgery- a comparison between propofol and sevoflurane using single anesthetic technique

    International Nuclear Information System (INIS)

    Pasha, A.K.; Kazi, W.A.; Farhat, K

    2013-01-01

    statistically significant. Conclusion: VIMA with sevoflurane provided quicker emergence and early recovery compared with TIVA with propofol, in children undergoing ambulatory surgery. (author)

  15. Tracheostomy Tube Ignition During Microlaryngeal Surgery Using Diode Laser: A Case Report

    Directory of Open Access Journals (Sweden)

    Hsun-Mo Wang

    2006-04-01

    Full Text Available Ignition of the tracheal tube during laser microlaryngeal surgery under general anesthesia is an uncommon complication with potentially serious consequences. We present here a case of a patient with glottic stenosis following endotracheal intubation, who experienced this potentially catastrophic combustion during endoscopic arytenoidectomy, using a diode laser under general anesthesia via 60% FiO2, with an airway fire occurring at the tracheostomy tube and causing tubal damage and obstruction. The anesthetic connecting tube was immediately disconnected and the tracheostomy tube replaced. No adverse consequences to this patient's upper airway were noted during follow-up visits. Higher oxygen concentrations, the presence of combustibles, and the narrowness of the surgical field during endolaryngeal diode laser surgery are risk factors for airway fires.

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

    Science.gov (United States)

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

    2015-11-01

    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.

  17. Two-Stage Surgery for a Large Cervical Dumbbell Tumour in Neurofibromatosis 1: A Case Report

    Directory of Open Access Journals (Sweden)

    Mohd Ariff S

    2011-11-01

    Full Text Available Spinal neurofibromas occur sporadically and typically occur in association with neurofibromatosis 1. Patients afflicted with neurofibromatosis 1 usually present with involvement of several nerve roots. This report describes the case of a 14- year-old child with a large intraspinal, but extradural tumour with paraspinal extension, dumbbell neurofibroma of the cervical region extending from the C2 to C4 vertebrae. The lesions were readily detected by MR imaging and were successfully resected in a two-stage surgery. The time interval between the first and second surgery was one month. We provide a brief review of the literature regarding various surgical approaches, emphasising the utility of anterior and posterior approaches.

  18. Reasons for Cancellation of Cases on the Day of Surgery-A Prospective Study

    Directory of Open Access Journals (Sweden)

    Rakesh Garg

    2009-01-01

    We believe that many of the on-the-day surgery cancellations of elective surgery were potentially avoidable. We observed that cancellations due to lack of theatre time were not only a scheduling problem but were mainly caused by surgeons underestimating the timeneeded for the operation. The requirement of the instruments necessary for scheduled surgical listshould be discussed a day prior to planned OR list and arranged. The non-availability of the surgeon should be informed in time so that another case is substituted in that slot. All patients who have met PACU discharge criteria must be discharged promptly to prevent delay in shifting out of the operated patient. Day care patients should be counseled adequately to report on time. Computerized scheduling should be utilized to create a realistic elective schedule. Audit should be carried out at regular intervals to find out the effective functioning of the operation theatre.

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

    Directory of Open Access Journals (Sweden)

    Takatoshi Kobayashi

    2017-01-01

    Full Text Available 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.

  20. Laparoscopic versus robotic surgery for hepatocellular carcinoma: the first 46 consecutive cases.

    Science.gov (United States)

    Magistri, Paolo; Tarantino, Giuseppe; Guidetti, Cristiano; Assirati, Giacomo; Olivieri, Tiziana; Ballarin, Roberto; Coratti, Andrea; Di Benedetto, Fabrizio

    2017-09-01

    Hepatocellular carcinoma has a growing incidence worldwide, and represents a leading cause of death in patients with cirrhosis. Nowadays, minimally invasive approaches are spreading in every field of surgery and in liver surgery as well. We retrospectively reviewed demographics, clinical, and pathologic characteristics and short-term outcomes of patients who had undergone minimally invasive resections for hepatocellular carcinoma at our institution between June 2012 and May 2016. No significant differences in demographics and comorbidities were found between patients in the laparoscopic (n = 24) and robotic (n = 22) groups, except for the rates of cirrhotic patients (91.7% and 68.2%, respectively, P = 0.046). Perioperative data analysis showed that the operative time (mean, 211 and 318 min, respectively, P robotic-assisted resections were related to less Clavien I-II postoperative complications (22 cases versus 13 cases; P = 0.03). As regards resection margins, the two groups were similar with no statistically significant differences in rates of disease-free resection margins. A modern hepatobiliary center should offer both open and minimally invasive approaches to liver disease to provide the best care for each patient, according to the individual comorbidities, risk factors, and personal quality of life expectations. Our results show that the robotic approach is a reliable tool for accurate oncologic surgery, comparable to the laparoscopic approach. Robotic surgery also allows the surgeon to safely approach liver segments that are difficult to resect in laparoscopy, namely segments I-VII-VIII. Copyright © 2017 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2013-09-01

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

  2. Atlantoaxial rotatory fixation as a rare complication from head positioning in otologic surgery: Report of two cases in young children

    OpenAIRE

    Sakaida, Hiroshi; Akeda, Koji; Sudo, Akihiro; Takeuchi, Kazuhiko

    2017-01-01

    Background Atlantoaxial rotatory fixation is a condition in which the first and second vertebrae of the cervical spine become interlocked in a rotated position. This condition can result in serious consequences and thus have a significant impact on patients, especially when diagnosis and treatment are delayed. Some cases of atlantoaxial rotatory fixation have been described in association with otologic surgery or plastic surgery involving the ear. We present the cases of two pediatric patient...

  3. TESTING INFORMATIONAL EFFICIENCY: THE CASE OF U.E. AND BRIC EMERGENT MARKETS

    OpenAIRE

    OPREAN Camelia

    2012-01-01

    Empirical finance has brought together a considerable number of studies in determining the market efficiency in terms of information in the case of an emerging financial market. Conflicting results have been generated by these researches in efficient market hypothesis (EMH), so efficiency tests in the emerging financial markets are rarely definitive in reaching a conclusion about the existence of informational efficiency. This paper tests weak-form market efficiency of eight emerging markets:...

  4. The approach of prehospital health care personnel working at emergency stations towards forensic cases

    OpenAIRE

    Ozlem Asci; Guleser Hazar; Isa Sercan

    2015-01-01

    Objectives: The objective of this study is to determine the states of health care personnel, working at 112 emergency stations in the province of Artvin, to encounter with regarding forensic cases and determine their practices aimed at recognizing, protecting, and reporting the evidences that may affect the forensic process. Materials and methods: This descriptive study was conducted with nurses and emergency medicine technicians working at 112 emergency stations in Artvin between January 201...

  5. Association of bariatric surgery with risk of acute care use for hypertension-related disease in obese adults: population-based self-controlled case series study.

    Science.gov (United States)

    Shimada, Yuichi J; Tsugawa, Yusuke; Iso, Hiroyasu; Brown, David F M; Hasegawa, Kohei

    2017-08-23

    Hypertension carries a large societal burden. Obesity is known as a risk factor for hypertension. However, little is known as to whether weight loss interventions reduce the risk of hypertension-related adverse events, such as acute care use (emergency department [ED] visit and/or unplanned hospitalization). We used bariatric surgery as an instrument for investigating the effect of large weight reduction on the risk of acute care use for hypertension-related disease in obese adults with hypertension. We performed a self-controlled case series study of obese patients with hypertension who underwent bariatric surgery using population-based ED and inpatient databases that recorded every bariatric surgery, ED visit, and hospitalization in three states (California, Florida, and Nebraska) from 2005 to 2011. The primary outcome was acute care use for hypertension-related disease. We used conditional logistic regression to compare each patient's risk of the outcome event during sequential 12-month periods, using pre-surgery months 13-24 as the reference period. We identified 980 obese patients with hypertension who underwent bariatric surgery. The median age was 48 years (interquartile range, 40-56 years), 74% were female, and 55% were non-Hispanic white. During the reference period, 17.8% (95% confidence interval [CI], 15.4-20.2%) had a primary outcome event. The risk remained unchanged in the subsequent 12-month pre-surgery period (18.2% [95% CI, 15.7-20.6%]; adjusted odds ratio [aOR] 1.02 [95% CI, 0.83-1.27]; P = 0.83). In the first 12-month period after bariatric surgery, the risk significantly decreased (10.5% [8.6-12.4%]; aOR 0.58 [95% CI, 0.45-0.74]; P bariatric surgery (12.9% [95% CI, 10.8-15.0%]; aOR 0.71 [95% CI, 0.57-0.90]; P = 0.005). By contrast, there was no significant reduction in the risk among obese patients who underwent non-bariatric surgery (i.e., cholecystectomy, hysterectomy, spinal fusion, or mastectomy). In this population-based study of

  6. Thigh infection and subcutaneous emphysema: an emergency, review of literature and case discussion.

    LENUS (Irish Health Repository)

    Thakral, R

    2011-06-01

    Thigh infection associated with local emphysematous signs on presentation to the emergency room should alert the medical staff at once of potential complication associated with it. The infection may be associated with underlying bowel pathology and has a high mortality rate. Hence, emergency treatment should be instituted. We discuss a case with this uncommon presentation, treatment administered and relevant literature.

  7. An Anesthetist’s Experience and the Incidence of Critical Cases in Ambulatory Surgery

    Directory of Open Access Journals (Sweden)

    R. V. Bolshedvorov

    2009-01-01

    Full Text Available Objective: to evaluate the impact of experience on the quality of anesthesia in ambulatory surgery. Materials and methods. The authors undertook a study of the role of experience and specialization on the occurrence of complications in ambulatory anesthesia care. By using the internal audit and calculating the frequency of critical cases, they examined the results of the work of two groups of anesthetists: 1 medical beginners after 2-year adjunct practice and 2 one-day hospital specialists having an at least 7-year practice length. Results. In the beginner group, the number of critical cases per operation was twice higher than that in the experienced specialists. The paper shows the detrimental pattern of the residual principle in selecting anesthetists for work at a one-day hospital and provides evidence that specialization is required in the area under discussion. Key words: ambulatory anesthesiology, role of an anesthetist’s experience, critical cases.

  8. Sevoflurane-emergence agitation: Effect of supplementary low-dose oral ketamine premedication in preschool children undergoing dental surgery

    Directory of Open Access Journals (Sweden)

    Khattab Ahmed

    2009-01-01

    : Adding a low dose of oral ketamine to midazolam-based oral premedication in preschool children undergoing dental surgery reduced sevoflurane-related emergence agitation without delaying discharge.

  9. Social Enterprise Emergence from Social Movement Activism: The Fairphone Case

    NARCIS (Netherlands)

    A.O.P. Akemu (Ona); G.M. Whiteman (Gail); S.P. Kennedy (Steve)

    2016-01-01

    textabstractEffectuation theory invests agency - intention and purposeful enactment - for new venture creation in the entrepreneurial actor(s). Based on the results of a 15-month in-depth longitudinal case study of Amsterdam-based social enterprise Fairphone, we argue that effectual entrepreneurial

  10. The approach of prehospital health care personnel working at emergency stations towards forensic cases.

    Science.gov (United States)

    Asci, Ozlem; Hazar, Guleser; Sercan, Isa

    2015-09-01

    The objective of this study is to determine the states of health care personnel, working at 112 emergency stations in the province of Artvin, to encounter with regarding forensic cases and determine their practices aimed at recognizing, protecting, and reporting the evidences that may affect the forensic process. This descriptive study was conducted with nurses and emergency medicine technicians working at 112 emergency stations in Artvin between January 2013 and February 2014. Of 141 health personnel that constituted sample of the study, 48.9% were nurses, 9.9% emergency medicine technicians, and 41.1% ambulance and emergency care technicians. The rate of feeling sufficient in coping with forensic cases and incidents was 20.6%. There was a lower rate of receiving education about the approach towards forensic cases (15.6%). In the study, the frequency of encountering with at least one forensic case was 88.7%. Traffic accidents (72.5%), suicides (41.5%) and assaults (41.5%) were among the most frequent reasons of forensic cases. The practices of nurses were more successful in woundings by firearms compared to other health personnel (p forensic cases. The personnel with higher educational level and nurses have more successful practices in forensic cases. Health personnel have approaches that may negatively affect the solution of forensic cases.

  11. [Two cases of retinal detachment following laser in Situ keratomileusis repaired by scleral buckling surgery].

    Science.gov (United States)

    Onguchi, Tatsuya; Eshita, Tadahiko; Mita, Shinji; Ishida, Susumu; Shinoda, Kei; Kitamura, Shizuaki; Kawashima, Shinichi; Inoue, Makoto; Oguchi, Yoshihisa; Toda, Ikuko; Kato, Naoko

    2002-02-01

    As laser in situ keratomileusis (LASIK) becomes the treatment of choice in the field of refractive surgery, postoperative rhegmatogenous retinal detachment has also begun to occur. However, since it has not been reported yet here in Japan, we report two cases of retinal detachment following LASIK with suggestions based on our experience. A 34-year-old male(Case 1) and a 26-year-old male(Case 2) suffered from retinal detachment one month and eight months after LASIK, respectively. Contributing retinal breaks were a horseshoe tear in Case 1 and atrophic holes in the lattice degeneration in Case 2. Each patient underwent partial scleral buckling with no intraoperative complication, resulting in successful retinal reattachment. Postoperatively, myopic changes developed and persisted one month in Case 1 and several months in Case 2. Great attention should be paid to the possibility of postoperative myopia after a repair of retinal detachment following LASIK. Thus, we stress the necessity of close cooperation between LASIK surgeons and vitreoretinal surgeons to settle the matter.

  12. Emergency treatment of violent trauma: clinical cases and surgical treatment of penetrating thoracoabdominal, perineal and anorectal trauma.

    Science.gov (United States)

    Zuccon, William; Paternollo, Roberto; Del Re, Luca; Cordovana, Andrea; De Murtas, Giovanni; Gaverini, Giacomo; Baffa, Giulia; Lunghi, Claudio

    2013-01-01

    The authors analyse clinical cases of penetrating thoracic, abdominal, perineal and anorectal injury and describe the traumatic event and type of lesion, the principles of surgical treatment, the complication rate and follow up. In the last 24 months, we analyzed 10 consecutive cases of penetrating thoracic and abdominal wounds [stab wound (n=7), with evisceration (n=4), gunshot wound (n=1)], and penetrating perineal and anorectal wounds (impalement n=4). In addition, we report an unusual case of neck injury from a stab wound. All the patients underwent emergency surgery for the lesions reported. In 7 cases of perforating vulnerant thoracoabdominal trauma from stab wounds there was hemoperitoneum due to bleeding from the abdominal wall (n=3), the omentum (n=1), the vena cava (n=1) and the liver (n=2). Evisceration of the omentum was observed in 4 cases. In 2 cases laparoscopy was performed. In one case laparotomy and thoracoscopy was performed. In a patient with an abdominoperineal gunshot wound, exploration was extraperitoneal. The 4 cases of perineal and anorectal impalement were treated with primary reconstruction, while in one case a laparotomy was needed to suture the rectum and fashion a temporary colostomy. In one case of anorectal injury rehabilitation resulted in a gradual improvement of fecal continence, while in the patient with the colostomy follow up at 2 months was scheduled to plan colostomy closure. Based on the our clinical experience and the literature, in penetrating abdominal trauma laparotomy may be required if patients are hemodynamically unstable (or in hemorrhagic shock), in patients with evisceration and peritonitis, or for exploration of penetrating thoracoabdominal and epigastric lesions. In anterior injuries of the abdominal wall from gunshot or stab wounds, laparotomy is indicated when there is peritoneal violation and significant intraperitoneal damage. In patients with actively bleeding wounds of the abdominal wall muscles minimal

  13. Open-heart surgery using a centrifugal pump: a case of hereditary spherocytosis.

    Science.gov (United States)

    Matsuzaki, Yuichi; Tomioka, Hideyuki; Saso, Masaki; Azuma, Takashi; Saito, Satoshi; Aomi, Shigeyuki; Yamazaki, Kenji

    2016-08-26

    Hereditary spherocytosis is a genetic, frequently familial hemolytic blood disease characterized by varying degrees of hemolytic anemia, splenomegaly, and jaundice. There are few reports on adult open-heart surgery for patients with hereditary spherocytosis. We report a rare case of an adult open-heart surgery associated with hereditary spherocytosis. A 63-year-old man was admitted for congestive heart failure due to bicuspid aortic valve, aortic valve regurgitation, and sinus of subaortic aneurysm. The family history, the microscopic findings of the blood smear, and the characteristic osmotic fragility confirmed the diagnosis of hereditary spherocytosis. Furthermore, splenectomy had not been undertaken preoperatively. The patient underwent a successful operation by means of a centrifugal pump. Haptoglobin was used during the cardiopulmonary bypass, and a biological valve was selected to prevent hemolysis. No significant hemolysis occurred intraoperatively or postoperatively. There are no previous reports of patients with hereditary spherocytosis, and bicuspid aortic valve. We have successfully performed an adult open-heart surgery using a centrifugal pump in an adult patient suffering from hereditary spherocytosis and bicuspid aortic valve.

  14. Do online reviews diminish physician authority? The case of cosmetic surgery in the U.S.

    Science.gov (United States)

    Menon, Alka V

    2017-05-01

    This article analyzes the substance and perception of online physician reviews, which are qualitative and quantitative assessments of physicians written and shared by patients, in the case of U.S. cosmetic surgery. Like other cash-pay medical specialties, cosmetic surgery is elective and paid for largely out of pocket, with patients having latitude in their choice of surgeon. Drawing on qualitative data from interviews, observations of an American Society of Aesthetic Plastic Surgery professional meeting, and online reviews from the platforms RealSelf and Yelp, I identify two interdependent contributors to physician authority: reputation and expertise. I argue that surgeons see reviews overwhelmingly as a threat to their reputation, even as actual review content often positively reinforces physician expertise and enhances physician reputation. I show that most online reviews linked to interview participants are positive, according considerable deference to surgeons. Reviews add patients' embodied and consumer expertise as a circumscribed supplement to surgeons' technical expertise. Moreover, reviews change the doctor-patient relationship by putting it on display for a larger audience of prospective patients, enabling patients and review platforms to affect physician reputation. Surgeons report changing how they practice to establish and maintain their reputations. This research demonstrates how physician authority in medical consumerist contexts is a product of reputation as well as expertise. Consumerism changes the doctor-patient relationship and makes surgeons feel diminished authority by dint of their reputational vulnerability to online reviews. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Case Report: Emergency awake craniotomy for cerebral abscess in a patient with unrepaired cyanotic congenital heart disease [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Corinne D’Antico

    2016-10-01

    Full Text Available We report the case of a 39-year-old male with complex cyanotic congenital heart disease undergoing emergency craniotomy for a cerebral abscess. Maintenance of intraoperative hemodynamic stability and adequate tissue oxygenation during anesthesia may be challenging in patients with cyanotic congenital heart disease. In this case, we decided to perform the surgery as an awake craniotomy after interdisciplinary consensus. We discuss general aspects of anesthetic management during awake craniotomy and specific concerns in the perioperative care of patients with congenital heart disease.

  16. Case Report: Emergency awake craniotomy for cerebral abscess in a patient with unrepaired cyanotic congenital heart disease [version 2; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Corinne D’Antico

    2017-02-01

    Full Text Available We report the case of a 39-year-old male with complex cyanotic congenital heart disease undergoing emergency craniotomy for a cerebral abscess. Maintenance of intraoperative hemodynamic stability and adequate tissue oxygenation during anesthesia may be challenging in patients with cyanotic congenital heart disease. In this case, we decided to perform the surgery as an awake craniotomy after interdisciplinary consensus. We discuss general aspects of anesthetic management during awake craniotomy and specific concerns in the perioperative care of patients with congenital heart disease.

  17. [Surgery of grown up congenital heart disease. About 540 cases].

    Science.gov (United States)

    Haddad, A; Bourezak, R; Aouiche, M; Ait Mohand, R; Hamzaoui, A; Bourezak, S E

    2015-09-01

    With advances in recent decades in the field of congenital heart disease both for imaging in medical therapy, a large number of heart disease is diagnosed before birth. Many of them benefit from surgery and reach adulthood, they do not require further action. Some of them develop later in their lives other problems requiring reoperation in adulthood. This sparked the birth of a subspecialty within the department of congenital heart disease: GUCH Unit "grown up congenital heart disease". In developing countries, little heart are detected in childhood, a minority of them are operated and very few reach adulthood or with minor heart disease or become advanced enough then inoperable. Only part may still take advantage of surgery at this age. The aim of our study is to describe the spectrum and characteristics of congenital heart disease in adulthood in Algiers a center of cardiovascular surgery. A retrospective descriptive study of patients aged 15 and above operated for congenital heart defects between 1995 and 2011. Five hundred and forty patients aged 15 to 76years (29±10 years), including 314 women and 226 men are operated congenital heart defects between 1995 and 2011. The left-right shunts represent two thirds of heart disease, represented mainly (50%) by the atrial septal defect. Barriers to the ejection of the left heart represent one forth of cases with a predominance of subvalvular aortic stenosis. We find the native heart whose survival is considered exceptional in adulthood in the absence of surgery, such as tetralogy of Fallot, aortopulmonary windows wide, double outlet right ventricle and atrioventricular canal that take advantage of always surgery. The results are encouraging with low perioperative mortality (2%). The approach of congenital heart disease in developing countries is different from that of developed countries. Efforts need to be made in early detection and monitoring of congenital heart disease and improve access to surgery centers

  18. [Renal oncocytoma in the single kidney after previous surgery of renal carcinoma. Apropos of 2 cases].

    Science.gov (United States)

    Veneroni, L; Canclini, L; Berti, G L; Giola, V; Leidi, G L; Maccaroni, A; Raimoldi, A; Sironi, M; Assi, A; Bacchioni, A M

    1997-12-01

    Renal oncocytoma is a neoplasm which rarely occurs in patients with solitary kidney, the other being absent because of a previous nephrectomy performed for renal cancer. We present two case reports and a literature review. We have studied some important problems such as the histogenesis, the potential for malignancy, the diagnosis, the treatment and the follow up. The high incidence of coexistence of renal oncocytoma and renal cell carcinoma has important clinical implications. We would like to emphasize the importance of preoperatory FNAB, nephron sparing surgery and very careful follow up.

  19. Bilateral Video-Assisted Thoracoscopic Surgery Resection for Multiple Mediastinal Myelolipoma: Report of a Case

    Science.gov (United States)

    Kohno, Tadasu; Mun, Mingyon; Yoshiya, Tomoharu

    2014-01-01

    Myelolipoma in the mediastinum is an extremely rare entity. In this report, we present the case of a 79-year-old asymptomatic man who had three bilateral paravertebral mediastinal tumors. The three tumors were resected simultaneously using bilateral three-port video-assisted thoracoscopic surgery (VATS). There has been no evidence of recurrence within four years after the operation. Multiple bilateral mediastinal myelolipomas are extremely rare. There are no reports in the English literature of multiple bilateral thoracic myelolipomas that were resected simultaneously using bilateral VATS. We also present characteristic features of myelolipomas, which are helpful for diagnosis. PMID:24782978

  20. A case of severe ankylosing spondylitis posted for hip replacement surgery

    Directory of Open Access Journals (Sweden)

    Nalini Kotekar

    2007-01-01

    Full Text Available A 50-year-old male patient with history of ankylosing spondylitis (AS for 30 years presented for hip replacement surgery. Airway management in ankylosing spondylitis patients presents the most serious array of intubation and airway hazards imagin-able, which is secondary to decrease in cervical spine mobility and possible temporo-mandibular joint disease. Literatures support definitive airway management and many authors consider regional anaesthesia to be contraindicated. The reasons cited include inability to gain neuraxial access and the need for urgent airway control in case of complication of regional anaesthesia.

  1. Bilateral pneumothorax with extensive subcutaneous emphysema manifested during third molar surgery. A case report.

    Science.gov (United States)

    Sekine, J; Irie, A; Dotsu, H; Inokuchi, T

    2000-10-01

    This report describes a case of bilateral pneumothorax with extensive subcutaneous emphysema in a 45-year-old man that occurred during surgery to extract the left lower third molar, performed with the use of an air turbine dental handpiece. Computed tomographic scanning showed severe subcutaneous emphysema extending bilaterally from the cervicofacial region and the deep anatomic spaces (including the pterygomandibular, parapharyngeal, retropharyngeal, and deep temporal spaces) to the anterior wall of the chest. Furthermore, bilateral pneumothorax and pneumomediastinum were present. In our patient, air dissection was probably caused by pressurized air being forced through the operating site into the surrounding connective tissue.

  2. Inpatient magnetic resonance cholangiopancreatography: does it increase the efficiency in emergency hepatopancreaticobiliary surgery services?

    Science.gov (United States)

    Milburn, J A; Bailey, J A; Dunn, Wk; Cameron, I C; Gomez, D S

    2017-04-01

    INTRODUCTION Magnetic resonance cholangiopancreatography (MRCP) is commonly used to evaluate the biliary tree, although indications for patients who require inpatient imaging are not fully defined. The aim of this study was to evaluate inpatient MRCP performed on surgical patients and to devise a treatment pathway for these patients. MATERIAL AND METHODS All adult inpatient MRCP examinations between January 2012 and December 2013 were reviewed. Demographic, clinical and radiological data were collated. RESULTS During the study period, 271 inpatient MRCP were requested, of which 234 examinations were included. The majority of patients were female (n=140) and the median age was 63 years (range 16-93 years). Surgical admissions accounted for 171 (73%) of cases. Indications for inpatient MRCP include gallstone-related complications (n=173; 74%), malignant process (n=17; 7%) and other indications (n=44; 19%). Overall, inpatient MRCP led to further inpatient interventions in 22% (gallstone group, n=32, 18%; patients with malignancy, n=8, 47%; other indications, n=12, 27%). The median duration of inpatient MRCP from request to examination was 2 days (range 0-15 days) and median reporting after examination was 1 day (range 0-14 days). DISCUSSION AND CONCLUSION Improved access and timely reporting of iMRCP may reduce length of hospital stay. Inpatient MRCP also led to further inpatient interventions, in particular, in patients with malignancy.

  3. Bulky mesonephric adenocarcinoma of the uterine cervix treated with neoadjuvant chemotherapy and radical surgery: report of the first case.

    Science.gov (United States)

    Ditto, Antonino; Martinelli, Fabio; Bogani, Giorgio; Gasparri, Maria L; Donato, Violante Di; Paolini, Biagio; Carcangiu, Maria L; Lorusso, Domenica; Raspagliesi, Francesco

    2016-11-11

    Malignant mesonephric adenocarcinoma of the uterine cervix is a rare occurrence with few cases described in the literature. Although surgery seems to be effective in the treatment of early-stage tumor, no cases describing outcomes of locally advanced stage are available. We report the first case of a patient with International Federation of Obstetrics and Gynecologists stage IIB mesonephric adenocarcinoma undergoing neoadjuvant chemotherapy and radical surgery. Despite the inherent limitation of a single description of a case, our experience supports the utilization of neoadjuvant chemotherapy in patients with malignant mesonephric adenocarcinoma of the uterine cervix. Further prospective multi-institutional studies are needed.

  4. A procalcitonin-based algorithm to guide antibiotic therapy in secondary peritonitis following emergency surgery: a prospective study with propensity score matching analysis.

    Science.gov (United States)

    Huang, Ting-Shuo; Huang, Shie-Shian; Shyu, Yu-Chiau; Lee, Chun-Hui; Jwo, Shyh-Chuan; Chen, Pei-Jer; Chen, Huang-Yang

    2014-01-01

    Procalcitonin (PCT)-based algorithms have been used to guide antibiotic therapy in several clinical settings. However, evidence supporting PCT-based algorithms for secondary peritonitis after emergency surgery is scanty. In this study, we aimed to investigate whether a PCT-based algorithm could safely reduce antibiotic exposure in this population. From April 2012 to March 2013, patients that had secondary peritonitis diagnosed at the emergency department and underwent emergency surgery were screened for eligibility. PCT levels were obtained pre-operatively, on post-operative days 1, 3, 5, and 7, and on subsequent days if needed. Antibiotics were discontinued if PCT was Advanced age, coexisting pulmonary diseases, and higher severity of illness were significantly associated with longer durations of antibiotic use. The PCT-based algorithm safely reduces antibiotic exposure in this study. Further randomized trials are needed to confirm our findings and incorporate cost-effectiveness analysis. Australian New Zealand Clinical Trials Registry ACTRN12612000601831.

  5. Comparative adequacy of surgery and radiation therapy in 175 T2 glottic carcinomas: 116 cases treated with surgery and 59 with radiation therapy

    International Nuclear Information System (INIS)

    Cellai, E.; Olmi, P.; Chiavacci, A.; Fallai, C.; Aulisi, L.; Bottai, G.A.; De Meester, W.

    1991-01-01

    The results were analyzed of 175 patients with glottic squamous cell carcinomas who were treated with curative purposes (1970-1986). Overall 10-year local control rates were 74% for the surgical series and 69% for the cases treated by radiation therapy. After salvage therapy 10-year survival rates were 83% and 76% respectively. The analysis of the results showed no statistically significant difference. In the group treated by radical surgery 80% local control was observed, versus 66% in the cases treated with conservative surgery. 10-year survival rate was higher in the latter group (89% versus 81%) because of better results of salvage therapy: 7 of 10 recurrences were salvaged with the second treatment. Several prognostic factors were evaluated-i.e., T extent, anterior commissure involvement, subglottic invasion, vocal cord mobility impairment, and ventricular involvement. Anterior commissure involvement was the main factor affecting out-come in the surgical series: in the presence of this factor, 64% 10-year local control was observed versus 85% in the patients without commissure involvement. This factor proved more important in the patients treated with conservative surgery (10-year control: 42 versus 88%) than in those undergoing radical surgery (78% versus 85%). Anterior commissure involvement and the number of involved subsites were found to worsen prognosis in the serial treated by radiation therapy: cases with anterior commissure involvement had 59% 10-year local control versus 83%. The cases with a deeper spread had 60% local control versus 75%. Vocal cord mobility impairment was a less important prognosis factor in both series. Our results suggest radiation therapy as a valuable method in a treatment of the small T2 laryngeal cancers which are not suitable for conservative surgery

  6. Spontaneous HIT syndrome post-knee replacement surgery with delayed recovery of thrombocytopenia: a case report and literature review.

    Science.gov (United States)

    Poudel, Dilli Ram; Ghimire, Sushil; Dhital, Rashmi; Forman, Daniel A; Warkentin, Theodore E

    2017-09-01

    associated with seroreversion to a negative SRA (documented at POD151). Our literature review identified joint replacement surgery, specifically knee replacement, to be a relatively common trigger of spontaneous HIT syndrome. Further, including our patient case, 5 of 7 patients with spontaneous HIT syndrome post-orthopedic surgery who received treatment with argatroban developed new and/or progressive lower-limb DVT or recurrent PE despite anticoagulation with this parenteral direct thrombin inhibitor, suggesting that this patient population is at high risk of breakthrough thrombotic events despite treatment with this HIT treatment-approved anticoagulant. Our case also illustrates successful outcome with rivaroxaban for treatment of spontaneous HIT syndrome, consistent with emerging literature supporting safety and efficacy of direct oral anticoagulant therapy for treatment of acute HIT.

  7. Comparison of open and laparoscopic pyeloplasty in ureteropelvic junction obstruction surgery: report of 49 cases.

    Science.gov (United States)

    Umari, Paolo; Lissiani, Andrea; Trombetta, Carlo; Belgrano, Emanuele

    2011-12-01

    This study aimed to evaluate laparoscopic dismembered pyeloplasty compared with open surgery and to determine whether the morbidity and outcome rates are different in each of these techniques. We report our 10-year experience with open and laparoscopic pyeloplasty at one istitution. From February 1999 to October 2010, 49 patients with ureteropelvic junction obstruction were assigned into two groups. 25 patients underwent open surgical pyeloplasty (period 1999-2010) and 24 underwent laparoscopic pyeloplasty (period 2004-2010). 25 patients undergoing open pyeloplasty had a retroperitoneal flank approach. Of the 24 laparoscopic cases 18 had a transperitoneal retrocolic access, 1 had a transperitoneal transmesocolic access and 5 had a retroperitoneal access. In all 49 cases an Anderson-Hynes dismembered pyeloplasty was used. We retrospectively compared the operative time, hospital stay, perioperative complications and follow-up of the two groups. Clinical symptoms were assessed before and after surgery, subjectively. Patients dermographic data were similar between the two groups with mean age of 42 years (range 6-78) and with a male/female ratio of 1:1.45. A crossing vessel could be identified in 37.5% (9/24) with laparoscopy vs. 32% (8/25) in open surgery. Compared with open procedures, laparoscopic procedures were associated with a longer mean operating time (274 vs 143 min), a shorter mean hospital stay (9.9 vs 15.8 day) and the perioperative complication rates were 16.7% for laparoscopic pyeloplasties and 20% for open pyeloplasties. The success rates were 90.5% for laparoscopy and 90.9% for open surgery. Average follow-up was 40.9 month for the laparoscopic group and 72.3 month for the open group. Failed procedures showed no improvement in loin pain or obstruction. The efficacy (in term of success rate and perioperative complications) of laparoscopic pyeloplasty is comparable to that of open pyeloplasty, with shorter mean hospital stay and better cosmetic results

  8. Early results of robotically assisted mitral valve surgery: Analysis of the first 1000 cases.

    Science.gov (United States)

    Gillinov, A Marc; Mihaljevic, Tomislav; Javadikasgari, Hoda; Suri, Rakesh M; Mick, Stephanie L; Navia, José L; Desai, Milind Y; Bonatti, Johannes; Khosravi, Mitra; Idrees, Jay J; Lowry, Ashley M; Blackstone, Eugene H; Svensson, Lars G

    2018-01-01

    The study objective was to assess the technical and process improvement and clinical outcomes of robotic mitral valve surgery by examining the first 1000 cases performed in a tertiary care center. We reviewed the first 1000 patients (mean age, 56 ± 10 years) undergoing robotic primary mitral valve surgery, including concomitant procedures (n = 185), from January 2006 to November 2013. Mitral valve disease cause was degenerative (n = 960, 96%), endocarditis (n = 26, 2.6%), rheumatic (n = 10, 1.0%), ischemic (n = 3, 0.3%), and fibroelastoma (n = 1, 0.1%). All procedures were performed via right chest access with femoral perfusion for cardiopulmonary bypass. Mitral valve repair was attempted in 997 patients (2 planned replacements and 1 resection of fibroelastoma), 992 (99.5%) of whom underwent valve repair, and 5 (0.5%) of whom underwent valve replacement. Intraoperative postrepair echocardiography showed that 99.7% of patients receiving repair (989/992) left the operating room with no or mild mitral regurgitation, and predischarge echocardiography showed that mitral regurgitation remained mild or less in 97.9% of patients (915/935). There was 1 hospital death (0.1%), and 14 patients (1.4%) experienced a stroke; stroke risk declined from 2% in the first 500 patients to 0.8% in the second 500 patients. Over the course of the experience, myocardial ischemic and cardiopulmonary bypass times (P < .0001), transfusion (P = .003), and intensive care unit and postoperative lengths of stay (P < .05) decreased. Robotic mitral valve surgery is associated with a high likelihood of valve repair and low operative mortality and morbidity. The combination of algorithm-driven patient selection and increased experience enhanced clinical outcomes and procedural efficiency. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2016-10-01

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

  10. Unrecognized anterior compartment syndrome following ankle fracture surgery: a case report.

    Science.gov (United States)

    Seyahi, Aksel; Uludag, Serkan; Akman, Senol; Demirhan, Mehmet

    2009-01-01

    A 35-year-old male sustained a lateral malleolar fracture while playing football. The fracture was treated by open reduction and internal fixation with a tourniquet. The next day, the patient returned with pain and swelling of the ankle and was admitted again to the hospital with a suspected diagnosis of cellulitis. Ten hours later, the patient developed the symptoms of anterior compartment syndrome. Emergency open fasciotomy of the anterior compartment was performed. The retrospective analysis of the patient's history was suggestive of a predisposition to an exercise-induced compartment syndrome. We think that exertional increase of the compartmental pressure before the injury and the tourniquet used during surgery contributed together to the development of compartment syndrome. Physicians should be vigilant in identifying the features of compartment syndrome when managing patients injured during a sporting activity.

  11. [Sixteen Cases of Colon Stenting as a Bridge to Surgery(BTS)for Obstructive Colorectal Cancer].

    Science.gov (United States)

    Otsuka, Ryo; Saito, Shuji; Hirayama, Ryouichi; Miura, Yasuaki; Sasaki, Kazunori; Miyajima, Ayako; Kuwamoto, Nobutsuna; Kataoka, Ryoko; Shindo, Yukito; Fujita, Rikiya

    2017-11-01

    Colonic stent insertion is widely used as a bridge to surgery(BTS)for obstructive colorectal cancer. Stenting can shorten hospitalization and decrease complication and colostomy rates in comparison with emergency surgery. We investigated patients who underwent colonic stent insertion for BTS in our hospital. Sixteen patients(8 men, 8 women) with a colorectal obstruction score of 0 or 1 who underwent colonic stent insertion as a BTS between April 2015 and April 2017 period were investigated. Mean patient age was 68.2(45-94)years. Technical success was obtained in all patients, and clinical success in 14(87%). Total colonoscopy was possible via stent in 10 patients. Nine patients were temporarily discharged from the hospital, and median time to operation was 18(2-43)days. Laparoscopic resection was performed in 14 patients, and anastomotic leakage was a postoperative complication in 1 patient. Colostomy was performed in only 1 patient with anastomotic leakage. Good results were obtained with careful patient selection and safe colonic stent insertion.

  12. Canada as the emerging energy superpower : testing the case

    International Nuclear Information System (INIS)

    Hester, A.

    2007-10-01

    The need for forward-thinking energy sector policies that promote Canada as a leader in the responsible and effective management of energy resources was discussed. This paper proposed a set of strategies and policy options designed to ensure that Canada becomes an energy superpower with the ability to control access to supplies and leverage energy resources in order to extend its sphere of political influence. The historical evolution of energy provision was examined in order to better define the criteria needed to attain energy superpower status. The paper also examined current global energy markets and provided a summary of Canada's current energy industry. The impact of the oil sands industry on the Canadian economy was also discussed. It was concluded that although Canada does not qualify as an energy super-power, the energy sector will play an important role in Canada's future. The implementation of forward-thinking policies may mean that Canada will emerge as a superpower in the future. 42 refs

  13. Portfolio selection between rational and behavioral theories emergent markets case

    Directory of Open Access Journals (Sweden)

    Bouri Abdelfatteh

    2012-08-01

    Full Text Available The aim of this paper is to explore the determinants of Portfolio Choice under the investors, professionals and academics’ perception. We introduce an approach based on cognitive mapping technique with a series of semi-directive interviews. Among a sample of 30 Tunisian individuals, we propose tow different frameworks: a mean-variance framework and a behavioral framework. Each framework is oriented to capture the effect of some concepts as proposed by the mean-variance portfolio theory and the behavioral portfolio theory on the portfolio choice decision. The originality of this research paper is guaranteed since it traits the behavioral portfolio choice in emergent markets. In the best of our knowledge this is the first study in the Tunisian context that explores such area of research. Ours results show that the Tunisian investors behave as it prescribed by the behavioral portfolio theory. They use some concepts proposed by the rational mean-variance theory of portfolio choice but they are affected by their emotions and some others cognitive bias when constructing and managing they portfolio of assets.

  14. Emergency bypass post percutaneous atrial ablation: a case report.

    LENUS (Irish Health Repository)

    Hargrove, M

    2010-11-01

    A 34-year-old male undergoing percutaneous atrial ablation procedure for paroxysmal fibrillation required emergency sternotomy for cardiac tamponade. The patient had been anticoagulated and had received plavix and aspirin prior to and during the ablation procedure. Seven units of red cell concentrate had been transfused in the cardiac catherisation laboratory. On arrival in theatre, the patient was hypotensive, but was awake on induction of anaesthesia. No recordable blood pressure with non-invasive monitoring was observed. A sternotomy was immediately performed and, on evacuation of the pericardium, a bleeding site was not visible. The patient was commenced on cardiopulmonary bypass. Bleeding site was identified and the defect closed. The patient was weaned from cardiopulmonary bypass with minimal inotropic support and made an uneventful recovery. Bypass time was 38 minutes. A literature review showed a 1% incidence of post-ablation bleeding(1). The incidence of reverting to bypass for such an event has not been reported previously. During these procedures, it might be wise to have the cardiothoracic team notified while atrial ablation procedures are being performed in the cardiac catheterization laboratory.

  15. Prevention and management of intraoperative crisis in VATS and open chest surgery: how to avoid emergency conversion.

    Science.gov (United States)

    Safdie, Fernando M; Sanchez, Manuel Villa; Sarkaria, Inderpal S

    2017-01-01

    Video assisted thoracic surgery (VATS) has become a routinely utilized approach to complex procedures of the chest, such as pulmonary resection. It has been associated with decreased postoperative pain, shorter length of stay and lower incidence of complications such as pneumonia. Limitations to this modality may include limited exposure, lack of tactile feedback, and a two-dimensional view of the surgical field. Furthermore, the lack of an open incision may incur technical challenges in preventing and controlling operative misadventures leading to major hemorrhage or other intraoperative emergencies. While these events may occur in the best of circumstances, prevention strategies are the primary means of avoiding these injuries. Unplanned conversions for major intraoperative bleeding or airway injury during general thoracic surgical procedures are relatively rare and often can be avoided with careful preoperative planning, review of relevant imaging, and meticulous surgical technique. When these events occur, a pre-planned, methodical response with initial control of bleeding, assessment of injury, and appropriate repair and/or salvage procedures are necessary to maximize outcomes. The surgeon should be well versed in injury-specific incisions and approaches to maximize adequate exposure and when feasible, allow completion of the index operation. Decisions to continue with a minimally invasive approach should consider the comfort and experience level of the surgeon with these techniques, and the relative benefit gained against the risk incurred to the patient. These algorithms may be expected to shift in the future with increasing sophistication and capabilities of minimally invasive technologies and approaches.

  16. Association between elevated pre-operative glycosylated hemoglobin and post-operative infections after non-emergent surgery.

    Science.gov (United States)

    Blankush, Joseph M; Leitman, I Michael; Soleiman, Aron; Tran, Trung

    2016-09-01

    A chronic state of impaired glucose metabolism affects multiple components of the immune system, possibly leading to an increased incidence of post-operative infections. Such infections increase morbidity, length of stay, and overall cost. This study evaluates the correlation between elevated pre-operative glycosylated hemoglobin (HbA1c) and post-operative infections. Adult patients undergoing non-emergent procedures across all surgical subspecialties from January 2010 to July 2014 had a preoperative HbA1c measured as part of their routine pre-surgical assessment. 2200 patient charts (1100 operative infection (superficial surgical site infection, deep wound/surgical space abscess, pneumonia, and/or urinary tract infection as defined by Centers for Disease Control criteria) within 30 days of surgery. Patients with HbA1c infection rate (3.8% in the HbA1c infection. Elevated HbA1c was, however, predictive of significantly increased risk of post-operative infection when associated with increased age (≥81 years of age) or dirty wounds. The risk factors of post-operative infection are multiple and likely synergistic. While pre-operative HbA1c level is not independently associated with risk of post-operative infection, there are scenarios and patient subgroups where pre-operative HbA1c is useful in predicting an increased risk of infectious complications in the post-operative period.

  17. A three-arm (laparoscopic, hand-assisted, and robotic) matched-case analysis of intraoperative and postoperative outcomes in minimally invasive colorectal surgery.

    Science.gov (United States)

    Patel, Chirag B; Ragupathi, Madhu; Ramos-Valadez, Diego I; Haas, Eric M

    2011-02-01

    Robotic-assisted laparoscopic surgery is an emerging modality in the field of minimally invasive colorectal surgery. However, there is a dearth of data comparing outcomes with other minimally invasive techniques. We present a 3-arm (conventional, hand-assisted, and robotic) matched-case analysis of intraoperative and short-term outcomes in patients undergoing minimally invasive colorectal procedures. Between August 2008 and October 2009, 70 robotic cases of the rectum and rectosigmoid were performed. Thirty of these were organized into triplets with conventional and hand-assisted cases based on the following 6 matching criteria: 1) surgeon; 2) sex; 3) body mass index; 4) operative procedure; 5) pathology; and 6) history of neoadjuvant therapy in malignant cases. Demographics, intraoperative parameters, and postoperative outcomes were assessed. Pathological outcomes were analyzed in malignant cases. Data were stratified by postoperative diagnosis and operative procedure. There was no significant difference in intraoperative complications, estimated blood loss (126.1 ± 98.5 mL overall), or postoperative morbidity and mortality among the groups. Robotic technique required longer operative time compared with conventional laparoscopic (P hand-assisted (P robotic approach results in short-term outcomes comparable to conventional and hand-assisted laparoscopic approaches for benign and malignant diseases of the rectum and rectosigmoid. With 3-dimensional visualization, additional freedom of motion, and improved ergonomics, this enabling technology may play an important role when performing colorectal procedures involving the pelvic anatomy.

  18. Effect of intermediate care on mortality following emergency abdominal surgery. The InCare trial: study protocol, rationale and feasibility of a randomised multicentre trial

    Directory of Open Access Journals (Sweden)

    Vester-Andersen Morten

    2013-02-01

    Full Text Available Abstract Background Emergency abdominal surgery carries a 15% to 20% short-term mortality rate. Postoperative medical complications are strongly associated with increased mortality. Recent research suggests that timely recognition and effective management of complications may reduce mortality. The aim of the present trial is to evaluate the effect of postoperative intermediate care following emergency major abdominal surgery in high-risk patients. Methods and design The InCare trial is a randomised, parallel-group, non-blinded clinical trial with 1:1 allocation. Patients undergoing emergency laparotomy or laparoscopic surgery with a perioperative Acute Physiology and Chronic Health Evaluation II score of 10 or above, who are ready to be transferred to the surgical ward within 24 h of surgery are allocated to either intermediate care for 48 h, or surgical ward care. The primary outcome measure is all-cause 30-day mortality. We aim to enrol 400 patients in seven Danish hospitals. The sample size allows us to detect or refute a 34% relative risk reduction of mortality with 80% power. Discussion This trial evaluates the benefits and possible harm of intermediate care. The results may potentially influence the survival of many high-risk surgical patients. As a pioneer trial in the area, it will provide important data on the feasibility of future large-scale randomised clinical trials evaluating different levels of postoperative care. Trial registration Clinicaltrials.gov identifier: NCT01209663

  19. Postpartum psychiatric emergency visits: a nested case-control study.

    Science.gov (United States)

    Barker, Lucy Church; Kurdyak, Paul; Fung, Kinwah; Matheson, Flora I; Vigod, Simone

    2016-12-01

    Mental health conditions are one of the most common reasons for postpartum emergency department (ED) visits. Characteristics of women using the ED and their mental health service use before presentation are unknown. We characterized all women in Ontario, Canada (2006-2012), who delivered a live born infant and had a psychiatric ED visit within 1 year postpartum (n = 8728). We compared those whose ED visit was the first physician mental health contact since delivery to those who had accessed mental health services on specific indicators of marginalization hypothesized to be associated with lower likelihood of mental health contact prior to the ED visit. For 60.4 % of women, this was the first physician mental health contact since delivery. The majority were presenting with a mood or anxiety disorder, and only 13.6 % required hospital admission. These women were more likely to have material deprivation and residential instability than women with contact (Q5 vs. Q1 aORs 1.30, 95 % CI 1.12-1.50; 1.17, 95 % CI 1.01-1.36), to live in rural vs. urban areas (aOR 1.58, 95 % CI 1.38-1.80), and to be low vs. high income quintile (aOR 1.18, 95 % CI 1.01-1.38). The frequent use of ED services as the first point of contact for mental health concerns suggests that interventions to improve timely and equitable access to effective outpatient postpartum mental health care are needed. Marginalized women are at particularly high risk of not having accessed outpatient services prior to an ED visit, and therefore, future research and interventions will specifically need to consider the needs of this group.

  20. Reasons and results of endoscopic surgery for prolactinomas: 142 surgical cases.

    Science.gov (United States)

    Akin, Safak; Isikay, Ilkay; Soylemezoglu, Figen; Yucel, Taskin; Gurlek, Alper; Berker, Mustafa

    2016-05-01

    We report herein a retrospective analysis of the results of 142 consecutive prolactinoma cases operated upon using an endoscopic endonasal trans-sphenoidal approach over a period of 6 years. Medical records of 142 cases were analysed with respect to indications for surgery, duration of hospital stay, early remission rates, failures and recurrence rates during a median follow-up of 36 months. On the basis of magnetic resonance imaging (MRI) data, 19 patients (13.4 %) had microadenoma, 113 (79.6 %) had macroadenoma, and the remaining 10 (7.0 %) had giant adenomas. Cavernous sinus invasion was identified in 25 patients by MRI and confirmed during surgery. Atypical adenoma was diagnosed in 16 patients. Sparsely granulated prolactin adenoma was identified in 99 patients (69.7 %). Our results demonstrate that male sex and higher preoperative prolactin levels are independent factors predicting persistent disease. The post-surgical complications are as follows: 2.8 % patients had meningitis, 2.1 % patients had postoperative cerebrospinal fluid leak and 2.1 % patients had panhypopituitarism. At the end of follow-up, 74.6 % patients went into remission. During follow-up period, five patients who had initial remission developed recurrence. Our series together with literature data suggest that an endoscopic endonasal trans-sphenoidal approach in the treatment of proloctinomas has a favourable rate of remission. According to the findings of this study, endoscopic endonasal trans-sphenoidal surgery might be an appropriate therapy choice for patients with prolactinoma who could not have been managed with recommended therapeutic modalities.

  1. Postoperative visual loss due to conversion disorder after spine surgery: a case report

    Directory of Open Access Journals (Sweden)

    Dailson Mamede Bezerra

    Full Text Available Abstract Background and objective Patients undergoing spinal surgeries may develop postoperative visual loss. We present a case of total bilateral visual loss in a patient who, despite having clinical and surgical risk factors for organic lesion, evolved with visual disturbance due to conversion disorder. Case report A male patient, 39 years old, 71 kg, 1.72 m, ASA I, admitted to undergo fusion and discectomy at L4-L5 and L5-S1. Venoclysis, cardioscopy, oximetry, NIBP; induction with remifentanil, propofol and rocuronium; intubation with ETT (8.0 mm followed by capnography and urinary catheterization for diuresis. Maintenance with full target-controlled intravenous anesthesia. During fixation and laminectomy, the patient developed severe bleeding and hypovolemic shock. After 30 min, hemostasis and hemodynamic stability was achieved with infusion of norepinephrine, volume expansion, and blood products. In the ICU, the patient developed mental confusion, weakness in the limbs, and bilateral visual loss. It was not possible to identify clinical, laboratory or image findings of organic lesion. He evolved with episodes of anxiety, emotional lability, and language impairment; the hypothesis of conversion syndrome with visual component was raised after psychiatric evaluation. The patient had complete resolution of symptoms after visual education and introduction of low doses of antipsychotic, antidepressant, and benzodiazepine. Other symptoms also regressed, and the patient was discharged 12 days after surgery. After 60 days, the patient had no more symptoms. Conclusions Conversion disorders may have different signs and symptoms of non-organic origin,including visual component. It is noteworthy that the occurrence of this type of visual dysfunc-tion in the postoperative period of spinal surgery is a rare event and should be remembered asa differential diagnosis.

  2. "Skip the infection, get the injection": a case study in emergency preparedness education.

    Science.gov (United States)

    Adams, Lavonne M; Canclini, Sharon B; Frable, Pamela Jean

    2015-01-01

    The frequency of natural and manmade disasters along with increasing potential for public health emergencies emphasizes the need for emergency preparedness education. Because nurses are the largest group of health professionals to meet the needs of those affected by disasters and public health emergencies, schools of nursing need to prepare graduates who are knowledgeable about disaster and public health emergency management. The use of core competencies may be a means to ensure consistent application of best practices in disaster health care. The next step in competency development involves validation through evidence. Through documentation and dissemination of their experiences with emergency preparedness education, schools of nursing can provide supportive evidence to aid in competency development. The purpose of this paper is present a case study of an ongoing and evolving public health nursing education project consistent with disaster health care and emergency preparedness competencies. Copyright © 2014 Elsevier Ltd. All rights reserved.

  3. Multicystic peritoneal mesothelioma after fertility-sparing surgery for an ovarian tumor of borderline malignancy: A case report

    Directory of Open Access Journals (Sweden)

    Hidetaka Nomura

    2015-02-01

    Full Text Available We report a case of a 19-year-old woman with multicystic peritoneal mesothelioma (MCPM who had previously undergone left adnexectomy due to an ovarian tumor of borderline malignancy at the age of 17 years. Follow-up imaging studies after adnexectomy revealed multiple cystic lesions of increasing size and number, suggesting recurrence of the tumor. Diagnostic laparoscopic surgery was performed, and the cystic lesion was pathologically determined to be MCPM. To our knowledge, this is the first report of MCPM diagnosed and successfully treated by laparoscopic surgery during the course of follow-up for an ovarian tumor. It is important to recognize that MCPM can occur in patients who have previously undergone abdominal surgery, and laparoscopic surgery is recommended for patients of reproductive age, because of the potential risk of infertility associated with extensive pelvic surgery.

  4. Malignant neuroleptic syndrome following deep brain stimulation surgery: a case report

    Directory of Open Access Journals (Sweden)

    Stavrinou Lampis C

    2011-06-01

    Full Text Available Abstract Background The neuroleptic malignant syndrome is an uncommon but dangerous complication characterized by hyperthermia, autonomic dysfunction, altered mental state, hemodynamic dysregulation, elevated serum creatine kinase, and rigor. It is most often caused by an adverse reaction to anti-psychotic drugs or abrupt discontinuation of neuroleptic or anti-parkinsonian agents. To the best of our knowledge, it has never been reported following the common practice of discontinuation of anti-parkinsonian drugs during the pre-operative preparation for deep brain stimulation surgery for Parkinson's disease. Case presentation We present the first case of neuroleptic malignant syndrome associated with discontinuation of anti-parkinsonian medication prior to deep brain stimulation surgery in a 54-year-old Caucasian man. Conclusion The characteristic neuroleptic malignant syndrome symptoms can be attributed to other, more common causes associated with deep brain stimulation treatment for Parkinson's disease, thus requiring a high index of clinical suspicion to timely establish the correct diagnosis. As more centers become eligible to perform deep brain stimulation, neurologists and neurosurgeons alike should be aware of this potentially fatal complication. Timely activation of the deep brain stimulation system may be important in accelerating the patient's recovery.

  5. Microperforated Hymen Presenting Spontaneous Pregnancy with Cesarean Delivery and Hymenotomy Surgery: A Case Report.

    Science.gov (United States)

    Elshani, Brikene; Arifi, Heroid; Daci, Armond

    2018-03-15

    Female genital tract anomalies including imperforate hymen affect sexual life and fertility. In the present case, we describe a pregnant woman diagnosed with imperforate hymen which never had penetrative vaginal sex. A 27-year-old married patient with 2 months of amenorrhea presented in a clinic without any other complications. Her history of difficult intercourse and prolonged menstrual flow were reported, and subsequent vaginal examination confirmed the diagnosis of imperforate hymen even though she claims to made pinhole surgery in hymen during puberty. Her urine pregnancy test was positive, and an ultrasound examination revealed 8.3 weeks pregnant. The pregnancy was followed up to 39.5 weeks when she entered in cesarean delivery in urgency. Due to perioperative complications in our study, a concomitant hymenotomy was successfully performed. The patient was discharged with the baby, and vaginal anatomy was restored. This case study suggests that even though as microperforated hymen surgery in puberty can permit pregnancy and intervention with cesarean section and hymenotomy is a good option to reduce the resulting perioperative complications which indirectly affect the increase of the fertilisation and improvement of later sexual life.

  6. Combined spinal epidural anesthesia during colon surgery in a high-risk patient: case report.

    Science.gov (United States)

    Imbelloni, Luiz Eduardo; Fornasari, Marcos; Fialho, José Carlos

    2009-01-01

    Combined spinal epidural anesthesia (CSEA) has advantages over single injection epidural or subarachnoid blockades. The objective of this report was to present a case in which segmental subarachnoid block can be an effective technique for gastrointestinal surgery with spontaneous respiration. Patient with physical status ASA III, with diabetes mellitus type II, hypertension, and chronic obstructive pulmonary disease was scheduled for resection of a right colon tumor. Combined spinal epidural block was performed in the T5-T6 space and 8 mg of 0.5% isobaric bupivacaine with 50 microg of morphine were injected in the subarachnoid space. The epidural catheter (20G) was introduced four centimeters in the cephalad direction. Sedation was achieved with fractionated doses of 1 mg of midazolam (total of 6 mg). A bolus of 25 mg of 0.5% bupivacaine was administered through the catheter two hours after the subarachnoid block. Vasopressors and atropine were not used. This case provides evidence that segmental spinal block can be the anesthetic technique used in gastrointestinal surgeries with spontaneous respiration.

  7. Avascular necrosis of the femoral head at 2 years after pertrochanteric fracture surgery: Case report.

    Science.gov (United States)

    Deleanu, Bogdan; Prejbeanu, Radu; Vermesan, Dinu; Honcea, Lucian; Mioc, Mihail Lazar; Tsiridis, Eleftherios; Predescu, Vlad

    2016-02-01

    The avascular necrosis of the femoral head represents the death of bone tissue due to the lack of blood supply. The disease has a progressive evolution and left untreated leads to femoral head collapse and severe arthritis. We present a case of a pertrochanteric fracture which has been successfully operated with a dynamic interlocking trochanteric gamma nail on the right hip. At 2 years after surgery the patient developed an incipient avascular necrosis of the femoral head. Despite the good positioning of the implant, we considered that the source of the pain was an intolerance of the implant, and thus we removed it. After implant removal, the patient was kept under observation and conservative treatment, to prevent further damage to the right hip and allow the healing to occur. At 6 months after the gamma nail was removed the X-rays revealed advanced avascular necrosis of the femoral head and secondary osteoarthritis on the right hip. The patient underwent surgery with an uncemented total hip arthroplasty. There are a few discussions regarding the avascular necrosis of the femoral head. These discussions may include the predisposing risk factors, the treatment of choice and the postoperative complications. The avascular necrosis of the femoral head is a complication of pertrochanteric fractures that can not be foreseen or avoided. The optimal treatment in these cases is uncemented total hip arthroplasty.

  8. Prefigurative politics and emergent communitarian spaces: The case of Portugal

    Directory of Open Access Journals (Sweden)

    Mónica Catarina-Soares

    2017-09-01

    Full Text Available Prefiguration has become in the last years an important and powerful conceptualisation to understand the place–based constructions developed by different actors while attempting to create in their own interactions and in the way they organise their lives the kind of society they envision more respectful of inclusion, diversity and non-oppression. Concretely, this paper is focused on how the establishment of communitarian relations is of paramount importance to prefigurative politics. To this end, we will explore the concrete case of Portugal wherein an ever-growing number of communitarian projects (namely social centres, ecovillages and economic solidary networks have been developed both in urban and country sides of the country in the last years. Implications for contemporary ideas on everyday struggle are discussed in the end.

  9. Delayed radiation necrosis 7 years after gamma knife surgery for arteriovenous malformation. Two case reports

    International Nuclear Information System (INIS)

    Oyoshi, Tatsuki; Yatsushiro, Kazutaka; Arita, Kazunori; Hirahara, Kazuho; Uetsuhara, Koichi

    2010-01-01

    A 44-year-old woman and a 55-year-old woman were treated with gamma knife surgery (GKS) for occipital arteriovenous malformation (AVM). Angiography confirmed complete nidus obliterations 2 years after GKS. However, both patients complained of chronic headache and visual symptoms from around 7 years after GKS. Magnetic resonance imaging showed round masses with or without cystic change surrounded by large areas of brain edema. Angiography also showed complete obliteration of AVM at this time. Extended corticosteroid treatment failed to control the edema. Both patients underwent total surgical removal of the mass. Visual disturbance and chronic headache improved postoperatively and the brain edema rapidly subsided. The histological diagnosis was radiation necrosis in both cases, attributed to the low conformity index and large 12-Gy volume due to usage of a large collimator for GKS. These cases of delayed radiation necrosis after GKS suggest that surgical removal of necrotic lesions is necessary for radiation necrosis intractable to medical treatment. (author)

  10. Response of pulmonary artery intimal sarcoma to surgery, radiotherapy and chemotherapy: a case report

    Directory of Open Access Journals (Sweden)

    Long Hong-qing

    2008-06-01

    Full Text Available Abstract Introduction Pulmonary artery intimal sarcoma is a rare disease with no characteristic symptoms. It is difficult to diagnose early and is frequently misdiagnosed as a pulmonary embolism. Case presentation Here we report a case of pulmonary artery intimal sarcoma in a 54-year-old woman presenting with complaints of shortness of breath on exertion. Echocardiography and a computed tomography scan showed that the right pulmonary artery trunk was blocked by a low-density mass. The patient was diagnosed with pulmonary artery intimal sarcoma by pathology and a complete mass resection was performed. After experiencing 10 months of disease-free survival, she was re-admitted because of the recurrence and metastasis of the tumor. Radiotherapy and chemotherapy were performed; however, only limited success was achieved. The patient died 15 months after the initial onset of symptoms. Conclusion Some patients with intimal sarcoma of the pulmonary artery can benefit from radiotherapy and chemotherapy as well as surgery.

  11. Intestinal volvulus following laparoscopic surgery: a literature review and case report.

    Science.gov (United States)

    Ferguson, Louise; Higgs, Zoe; Brown, Sylvia; McCarter, Douglas; McKay, Colin

    2008-06-01

    Since its introduction in the early 1990s, the laparoscopic cholecystectomy has become the standard surgical intervention for cholelithiasis. The laparoscopic technique is being used in an increasing number of abdominal procedures. Intestinal volvulus is a rare complication of laparoscopic procedures, such as the laparoscopic cholecystectomy. A review of the literature revealed 12 reports of this complication occurring without a clear cause. Etiologic factors that have been postulated include congenital malrotation, previous surgery, and intraoperative factors, such as pneumoperitoneum, mobilization of the bowel, and patient position. In this paper, we review the literature for this rare complication and report on a case of cecal bascule (a type of cecal volvulus) occurring following the laparoscopic cholecystectomy. Of the 12 prior reports of intestinal volvulus following laparoscopic procedures, 8 of these followed the laparoscopic cholecystectomy, of which two were cecal volvulae. This is the first reported case of a cecal bascule occurring following the laparoscopic cholecystectomy.

  12. Telemedicine using an image transfer system in the treatment of neurosurgical emergent cases

    International Nuclear Information System (INIS)

    Saito, Atsushi; Numagami, Yoshihiro; Kamiyama, Hironaga; Furuno, Yuuichi; Nishimura, Shinjitsu; Nishijima, Michiharu

    2007-01-01

    Our department is located in the Tsugaru district, which is famous for heavy snow fall, and the small number of neurosurgeon centers in the urban areas leads to an inadequate distribution of neurosurgeons for patients in this region. Such geographical and social constraints have made it difficult to offer sufficient neurosurgical care to all patients in the region. We describe the usefulness of a telemedicine triage system using an image transfer system in the treatment of neurosurgical emergent cases. Image transfer systems have been installed at our hospital and 11 regional hospitals in the Tsugaru district, and have been utilized for teleconsultation regarding neurosurgical patients via transferred computed tomography images since 1989. Consultations regarding 2,858 cases were directed to our department between 1989 and 2006, including 1,615 cases of stroke, 869 cases of head trauma, 97 cases of brain tumor, and 277 cases with other disorders. 84% of subarachnoid hemorrhage cases and 22% of head trauma cases needed emergent transfer. The state of consciousness in intracerebral hemorrhage, and the state of consciousness and time of consultation in head trauma were statistically significant factors for emergent transfer. The presert telemedicine triage system was useful for ensuring correct diagnosis and appropriate primary neurosurgical care in the regional hospitals without neurosurgical units, resulting in a reinforcement of the relationships among the regional hospitals and the efficient transfer of emergent neurosurgical patients. (author)

  13. Atlantoaxial rotatory fixation as a rare complication from head positioning in otologic surgery: Report of two cases in young children.

    Science.gov (United States)

    Sakaida, Hiroshi; Akeda, Koji; Sudo, Akihiro; Takeuchi, Kazuhiko

    2017-01-01

    Atlantoaxial rotatory fixation is a condition in which the first and second vertebrae of the cervical spine become interlocked in a rotated position. This condition can result in serious consequences and thus have a significant impact on patients, especially when diagnosis and treatment are delayed. Some cases of atlantoaxial rotatory fixation have been described in association with otologic surgery or plastic surgery involving the ear. We present the cases of two pediatric patients who developed atlantoaxial rotatory fixation following otologic surgery and we review the relevant literature. One patient was a 7-year-old boy who underwent tympanoplasty for cholesteatoma. The other patient was a 5-year-old girl with profound sensorineural hearing loss who underwent cochlear implantation. Both patients developed atlantoaxial rotatory fixation on the day after surgery, and they were treated conservatively. Our literature search using relevant terms identified 12 similar published cases. Thus, a total of 14 patients, including our 2 patients, were evaluated. Most of the patients were children and typically they complained of painful torticollis and exhibited a characteristic posture called the "cock-robin" position on the day after surgery. Mostly, the direction of torticollis was opposite to the side of surgery. Most of the patients received conservative treatment alone, but three underwent surgical treatment. The correlation between the direction of torticollis and the side of surgery suggests that rotation of the head during surgery has an impact on development of postoperative atlantoaxial rotatory fixation. Thus, children undergoing otologic surgery are thought to be at a risk of postoperative atlantoaxial rotatory fixation. Although rare, the surgical team needs to be aware of this adverse event and pay close attention to this possibility throughout the perioperative period. Perioperative management should include informed consent, preoperative assessment of the

  14. [A clinical experience of continuous warm blood cardioplegia in two cases of repeat aortic valve surgery].

    Science.gov (United States)

    Nagaoka, H; In-nami, R; Watanabe, M; Funakoshi, N; Hirooka, K; Fujiwara, A

    1992-11-01

    The continuous warm blood cardioplegia (CWBC) was used for myocardial protection during aortic cross clamping in two cases of repeat aortic valve operations with good results. Case 1: A 46-year-old man, who underwent an aortic valve replacement because of the rheumatic aortic regurgitation (AR) in 1978, have suffered from orthopnea due to para-prosthetic valvular regurgitation since 1983. He was revealed to have bi-ventricular hypertrophy with myocardial damage on ECG, EF 0.27 on UCG, PCWP 20 mmHg and severe AR on cardiac catheterization. Case 2: A 43-year-old man, who had an aortic valvuloplasty for the non-rheumatic incompetency in 1981, have had a recurrent regurgitation, resulting in left ventricular hypertrophy accompanied by chest pain. Both cases were reoperated upon, having aortic valve replacement with mechanical prosthetic valves through the re-median sternotomy, utilizing CWBC with good recovery. CWBC provides an ideal circumstances for myocardial oxygen utilization during aortic cross clamping and moreover a benefit that needs not the wide dissection of the heart in a redo case because it has no need of topical cooling and ventricular defibrillation following aortic declamping. In conclusion, CWBC is very useful in a repeat aortic valve surgery.

  15. Inventory of nuclear materials in case of emergency

    International Nuclear Information System (INIS)

    Portugal, J.L.; Zanetti, S.

    2001-01-01

    The crisis situations for nuclear materials in nuclear facilities are provided for in the French regulation, as the decree of 12 May 1981 specifies that 'In any circumstance, the Ministry of Industry can order a physical inventory of the materials and its comparison with the accountancy records'. Such an inventory can be ordered in facilities holding category I nuclear materials, in case of a theft for example. The operators must be able to establish quickly if the stolen materials come from their facility. To test the organization set at the operators and competent authority levels respectively, five exercises of increasing complexity have already been carried out. These exercises have permitted the validation of procedures, composition of the various crisis centers, methodology for such an inventory and use of protected communication means. The authority crisis center includes members of the competent Authority and it's technical support body: staff members of the IPSN. It is in charge of the national managing of the operations, in relation with one or several site crisis centers. The site crisis center is the interface between the authorities and the facility crisis center. The operations of inventory are carried out from the roughest checking to the finest ones. To be efficient during the first hours of the crisis, the authority crisis center must have data bases at the disposal of its experts, containing information about physical protection and accountancy of the nuclear materials detained by the site and the relevant facilities. (authors)

  16. Reminder: call 74444 also in case of a medical emergency

    CERN Multimedia

    2005-01-01

    What happened? A CERN colleague, suffering from heart trouble, went to the ‘infirmary' on the Prévessin site for medical aid. He was unaware that the ‘infirmary' was in fact no such thing, but the office of the French medical officer, and, on top of that, it was closed. He therefore took his own car and went to the CERN Fire Station on the Meyrin site (building 65). The firemen and the CERN infirmary took care of him and requested a helicopter transport to the Geneva cantonal hospital, where he received medical treatment.   What do we learn from this event?   You can call the CERN internal number 74444 also in case of serious and acute illness, not only in the event of an accident, pollution, fire, etc.   Professional aid (ambulance firemen and medical assistance, if needed) will be provided.   The CERN Fire station is located in building 65, on ‘Route Einstein', the first road on your right when you enter CERN entrance B on the Meyrin site. It is open permanently, 24 hours per day, 7 days per we...

  17. Myxedema coma: A case report of pediatric emergency care.

    Science.gov (United States)

    Zhu, Yueniu; Qiu, Wenjuan; Deng, Mengyan; Zhu, Xiaodong

    2017-05-01

    Myxedema coma (MC) is extremely rare but lethal in pediatric patients with hypothyroidism leading to altered mental status and hypothermia. But there is no clinical guideline for such cases. A 6-year-old Chinese girl presented with coma and hypothermia preceded by pneumonia. Her lab results were: free thyroxin (T4) 4.18 pmol/L and thyroid-stimulating hormone (TSH) > 150 μIU/mL with extremely elevated anti-thyroid peroxidase (TPO-Ab) and anti-thyroglobulin. Pneumonia, mild pleural, and pericardial effusion were seen on computed tomographic (CT) scan. MC, autoimmune hypothyroidism, pneumonia and sepsis were diagnosed. Gastric levothyroxine, intravenous dexamethasone and antibiotics were administered. Her consciousness was restored and temperature returned to normal 2 days after starting levothyroxine. She was discharged two weeks later. MC is rare but may be the initial presentation in pediatric patients with prolonged untreated hypothyroidism. Autoimmune thyroiditis could cause hypothyroidism in children. MC should be suspected in pediatric patients with altered mental status, hypothermia and cardiovascular instability. Treatment with 100 mg/m of gastric levothyroxine is an option for pediatric patients with MC.

  18. Medical Adhesive-Related Skin Injury Following Emergent Appendectomy: A Case Study of MARSI and Missed Opportunities in Nursing Care.

    Science.gov (United States)

    Britt, Sylvia E; Coles, Karen M; Polson, Shannon S

    The potential for skin damage from adhesive products is documented in the literature. Nevertheless, health care providers continue to lack understanding of the impact and seriousness of skin injury associated with use of tapes or other adhesive devices when applied to a patient with a history or hypersensitivity or allergy to adhesives. A 67-year-old woman with a history of tape allergy underwent emergency appendectomy. Initial removal of an adhesive bandage placed over the surgical incision revealed medical adhesive-related skin injury (MARSI). The largest of the 3 wounds was a Class III skin tear based on the Payne-Martin Classification System. It measured (L) 4.4 cm × (W) 1.8 cm × (D) 0.3 cm and required 3 months to heal. Experiences with this case revealed the need for evidence-based practice innovations to prevent physical, emotional, and economic cost resulting from MARSI. We recommend early identification and careful documentation of susceptibility to MARSI prior to surgery and implementation of consensus-based recommendations for prevention of MARSI as advocated by the MARSI consensus group when preparing patients for surgery and treating wounds.

  19. Functional surgery of the temporomandibular joint with conscious sedation for "closed lock" using eminectomy as a treatment: a case series.

    LENUS (Irish Health Repository)

    Stassen, Leo F

    2011-06-01

    The purpose of this case series study was to evaluate the advantages and disadvantages of using local anesthesia and conscious sedation (CS) rather than general anesthesia (GA) for performing functional surgery on patients suffering from temporomandibular joint (TMJ) closed lock, using the eminectomy procedure. Performing this procedure using CS allows functional assessment of the TMJ meniscus at the time of surgery. The objectives of this study were to determine if this surgery is possible under CS, to determine the benefits of being able to see the meniscus in action, and to investigate the patients\\' acceptability for this form of anesthesia.

  20. Radiotherapy after surgery to dermato-fibrosarcoma protuberans of large dimension. Review of the literature and case report

    International Nuclear Information System (INIS)

    Bastos, Erika Malheiros; Santos, Ivan Dunshee de Abranches Oliveira; Ferreira, Lydia Masako; Paiva, Geruza Rezende; Brunstein, Flavia; Lima, Alessandra Haddad de; Segreto, Roberto

    2004-01-01

    Dermato-fibrosarcoma protuberans is a low incidence skin neoplasia of difficult management due to its high recurrence rate. Usual treatment consists of a large resection, some times causing functional and aesthetics impairment, and despite these efforts, published data point to a recurrence rate of 11% to 53%. Recently, radiotherapy has been used modifying the unreal course of this tumor, decreasing drastically the recurrence rate when compared to surgery only. We reviewed these treatment modalities and related three cases of large recurrent tumors treated in our plastic surgery department with surgery and adjuvant radiotherapy, without recurrences after 2 years follow up. (author)

  1. Cytoreductive surgery with a hyperthermic intraperitoneal chemotherapy program: Safe after 40 cases, but only controlled after 140 cases.

    Science.gov (United States)

    Voron, T; Eveno, C; Jouvin, I; Beaugerie, A; Lo Dico, R; Dagois, S; Soyer, P; Pocard, M

    2015-12-01

    Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC), used to treat peritoneal surface malignancies (PSM), is a complex procedure with significant major morbidity (MM). To investigate the learning curve (LC) of CRS with HIPEC in a new specialized surgical unit with a fully trained senior surgeon and individualize the variables associated with morbidity and oncological results. A total of 290 consecutive patients with PSM were included. Complete CRS with HIPEC was performed in 204 patients. A risk-adjusted sequential probability ratio test was used to assess the LC on the basis of rates of incomplete cytoreduction (IC) and MM. Complete CRS, MM, and mortality rates were 70.4%, 30.4%, and 2.5%, respectively. Tumor histotype, a high peritoneal cancer index (PCI) and the invaded region were the major independent risk factors for IC, whereas previous surgery, high PCI, stomia realization and blood transfusion were predictors of MM. RA-SPRT showed that 140 and 40 cases were needed to achieve the lowest risk of IC and MM, respectively. CRS with HIPEC to treat PSM has a steep LC. Drastic selection has to be made at the beginning, excluding high PCI, rare peritoneal disease and patients previously operated on. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. [Assessment of a transfusion emergent risk: the case of HEV].

    Science.gov (United States)

    Pillonel, J; Gallian, P; Sommen, C; Couturier, E; Piquet, Y; Djoudi, R; Laperche, S

    2014-11-01

    The risk assessment for blood transfusion is an essential step that must precede any screening strategy of a pathogen transmitted by transfusion. After several cases of HEV transmission by transfusion in France, a risk assessment for this virus was performed. We used a method based on the prevalence of HEV-RNA in plasmas collected for the preparation of SD-plasma. To estimate the rate of HEV-RNA positive among all blood donations, data on SD-plasma were adjusted on the following HEV risk factors: gender, age group and region of residence. We assumed that HEV risk factors were the same in plasma donors and whole blood donors. Among 57,101 plasma donations tested for HEV-RNA in 2013, 24 were positive (crude rate of 4.2 per 10,000 donations). After adjustment, the total number of HEV-RNA positive blood donations was estimated at 788, accounting for a rate of 2.65 per 10,000 donations (95% CI: 1.6-3.7) or 1 in 3800 donations (1 in 6,200-1 in 2,700). This rate was 12 times higher in men than in women, increased with age, and varied according to region of residence. The risk of blood donation contamination by HEV has been estimated to be 1 in 3800 donations in 2013. An essential input is still missing to assess now the risk in recipients: the minimum infectious dose. Furthermore, the risk in recipients has to be analyzed according to characteristics of transfused patients: presence of anti-HEV immunity, existence of chronic liver disease or immunodeficiency. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  3. [Clinical analysis of patients with tuberculosis admitted on an emergency cases].

    Science.gov (United States)

    Okada, Toru; Shibuya, Yasuhiro; Saito, Hitoshi; Enomoto, Tatsuji; Nakamura, Seiichi

    2008-08-01

    A retrospective study was made of 75 patients with tuberculosis and tuberculous pleurisy who received medical care in our hospital from 2002 through 2006. Of the 75 patients, 9 were admitted as tertiary emergency cases, and 12 patients were admitted by ambulance as secondary emergency cases. We studied the reason for their emergency medical admission, and the process of diagnosing 21 patients as tuberculosis. In some cases, the reasons for emergency admission were cardiorespiratory arrest, loss of consciousness, and injury resulting from a traffic accident, not common symptoms of tuberculosis such as dyspnea, hemoptysis and bloody sputum. Chest radiographic findings of most patients showed tuberculosis, and other cases were likely to be diagnosed as tuberculosis from their medical history or back-ground such as being homeless, previous tuberculosis, and receiving for therapy of tuberculosis. It was not so difficult to diagnose our cases as tuberculosis, nevertheless we may have an unconscious patient with normal chest radiograph. These data suggest that any patients visiting the emergency room may possibly have tuberculosis even if they are without respiratory symptoms.

  4. A unique approach to quantifying the changing workload and case mix in laparoscopic colorectal surgery.

    Science.gov (United States)

    Shah, P R; Gupta, V; Haray, P N

    2011-03-01

    Laparoscopic colorectal surgery includes a range of operations with differing technical difficulty, and traditional parameters, such as conversion and complication rates, may not be sensitive enough to assess the complexity of these procedures. This study aims to define a reproducible and reliable tool for quantifying the total workload and the complexity of the case mix. This is a review of a single surgeon's 10-year experience. The intermediate equivalent value scoring system was used to code complexity of cases. To assess changes in the workload and case mix, the period has been divided into five phases. Three hundred and forty-nine laparoscopic operations were performed, of which there were 264 (75.6%) resections. The overall conversion rate was 17.8%, with progressive improvement over the phases. Complex major operation (CMO), as defined in the British United Provident Association (BUPA) schedule of procedures, accounted for 35% of the workload. In spite of similar numbers of cases in each phase, there was a steady increase in the workload score, correlating with the increasing complexity of the case mix. There was no significant difference in the conversion and complications rates between CMO and non-CMO. The paradoxical increase in the mean operating time with increasing experience corresponded to the progressive increase in the workload score, reflecting the increasing complexity of the case mix. This article establishes a reliable and reproducible tool for quantifying the total laparoscopic colorectal workload of an individual surgeon or of an entire department, while at the same time providing a measure of the complexity of the case mix. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.

  5. Impaired alcohol metabolism after gastric bypass surgery: a case-crossover trial.

    Science.gov (United States)

    Woodard, Gavitt A; Downey, John; Hernandez-Boussard, Tina; Morton, John M

    2011-02-01

    Severe obesity remains the leading public health crisis of the industrialized world, with bariatric surgery the only effective and enduring treatment. Poor psychological adjustment has been occasionally reported postoperatively. In addition, evidence suggests that patients can metabolize alcohol differently after gastric bypass. Preoperatively and at 3 and 6 months postoperatively, 19 Roux-en-Y gastric bypass (RYGB) patients' breath alcohol content (BAC) was measured every 5 minutes after drinking 5 oz red wine to determine peak BAC and time until sober in a case-crossover design preoperatively and at 6 months postoperatively. Patients reported symptoms experienced when intoxicated and answered a questionnaire of drinking habits. The peak BAC in patients after RYGB was considerably higher at 3 months (0.059%) and 6 months (0.088%) postoperatively than matched preoperative levels (0.024%). Patients also took considerably more time to return to sober at 3 months (61 minutes) and 6 months (88 minutes) than preoperatively (49 minutes). Postoperative intoxication was associated with lower levels of diaphoresis, flushing, and hyperactivity and higher levels of dizziness, warmth, and double vision. Postoperative patients reported drinking considerably less alcohol, fewer preferred beer, and more preferred wine than before surgery. This is the first study to match preoperative and postoperative alcohol metabolism in gastric bypass patients. Post-RYGB patients have much higher peak BAC after ingesting alcohol and require more time to become sober. Patients who drink alcohol after gastric bypass surgery should exercise caution. Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  6. [Postoperative visual loss due to conversion disorder after spine surgery: a case report].

    Science.gov (United States)

    Bezerra, Dailson Mamede; Bezerra, Eglantine Mamede; Silva Junior, Antonio Jorge; Amorim, Marco Aurélio Soares; Miranda, Denismar Borges de

    Patients undergoing spinal surgeries may develop postoperative visual loss. We present a case of total bilateral visual loss in a patient who, despite having clinical and surgical risk factors for organic lesion, evolved with visual disturbance due to conversion disorder. A male patient, 39 years old, 71kg, 1.72 m, ASA I, admitted to undergo fusion and discectomy at L4-L5 and L5-S1. Venoclysis, cardioscopy, oximetry, NIBP; induction with remifentanil, propofol and rocuronium; intubation with ETT (8.0mm) followed by capnography and urinary catheterization for diuresis. Maintenance with full target-controlled intravenous anesthesia. During fixation and laminectomy, the patient developed severe bleeding and hypovolemic shock. After 30minutes, hemostasis and hemodynamic stability was achieved with infusion of norepinephrine, volume expansion, and blood products. In the ICU, the patient developed mental confusion, weakness in the limbs, and bilateral visual loss. It was not possible to identify clinical, laboratory or image findings of organic lesion. He evolved with episodes of anxiety, emotional lability, and language impairment; the hypothesis of conversion syndrome with visual component was raised after psychiatric evaluation. The patient had complete resolution of symptoms after visual education and introduction of low doses of antipsychotic, antidepressant, and benzodiazepine. Other symptoms also regressed, and the patient was discharged 12 days after surgery. After 60 days, the patient had no more symptoms. Conversion disorders may have different signs and symptoms of non-organic origin, including visual component. It is noteworthy that the occurrence of this type of visual dysfunction in the postoperative period of spinal surgery is a rare event and should be remembered as a differential diagnosis. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  7. Emergency Response Program Designing Based On Case Study ERP Regulations In Ilam Gas Refinery

    Directory of Open Access Journals (Sweden)

    Mehdi Tahmasbi

    2015-08-01

    Full Text Available The study of Emergency response plan designing is one of the most important prevention approaches in crisis management. This study aims to design emergency response plan based on case study ERP regulations in Ilam gas refinery. On the basis of risk assessment and identification techniques such as HAZOP and FMEA in Ilam gas refinery the risks have been prioritized and then according to this prioritization the design of possible scenarios which have the highest rate of occurrence and the highest level of damage has been separated. Possible scenarios were simulated with PHAST software. Then emergency response program has been designed for the special mode or similar cases. According to the internal emergency response plan for Ilam gas refinery and predictable conditions of the process special instructions should be considered at the time of the incident to suffer the least damage on people and environment in the shortest time possible.

  8. Factors associated with one step surgery in case of non-palpable breast cancer

    International Nuclear Information System (INIS)

    Schaefer, Fritz K.; Eden, I.; Schaefer, P.J.; Peter, D.; Jonat, W.; Heller, M.; Schreer, I.

    2007-01-01

    Purpose: To examine factors associated with one step surgery in case of non-palpable breast cancer. Materials and methods: Clinical data of 152 consecutively diagnosed patients with breast cancer were analyzed retrospectively. Preoperative diagnostic findings were divided in subgroups: mammographically visible mass/microcalcifications/sonographically visible mass/sonographically visible architectural distortion. Correlation between tumor-size, radiologic tumor morphology, quality of localization and number of operation was evulated. For localization exact wire position was defined less than 3 mm apart from the lesion. Results: One hundred and thirty-six patients attempted breast conservation and underwent preoperative tumor localization. Fourteen of 16 patients had mastectomy without preoperative localization. Average tumor size was 12 mm for one-operation, and 17 mm for re-operation. Significant correlation (p < 0.001) was found between one operation and masses visible in mammograms (55/62 (89%) patients) or sonography (53/64 (83%) patients). Significant correlation was found (p < 0.001) between more re-operation and microcalcifications in mammograms (33/89 (37% patients). In 123/138 (89%) cases wire position was central, in 15/138 (11%) cases distance was maximally 10 mm. No significant correlation was found between number of operation and wire position. Re-operation was required in 38 cases. Conclusion: Mammographically or sonographically visible mass, small size of tumors, preoperative percutaneous biopsy and exact preoperative localization are important for a single step procedure for definite surgical treatment, that we found in 74% of the patients

  9. Surgery for two cases with markedly impaired QOL(Quality of Life) of radiation enterocolitis

    International Nuclear Information System (INIS)

    Shiba, Tadaaki; Tanishima, Satoru; Sato, Masahiko; Yanagisawa, Terumasa; Yoshino, Masaaki; Takatsuka, Jun

    1996-01-01

    Two cases of radiation enterocolitis with markedly impaired QOL for a long period were reported. Case 1: A 61 years old female. She received 60 Gy irradiation post hysterectomy and ovariectomy due to uterine cancer at the age of 39 y. She suffered from fecal incontinence and anal pain at 58 y, was diagnosed to have radiation colitis. She was hospitalized due to neurosis, anal pain and hypertension at 59 y. She received nephrostomy due to hydronephrosis and ureterostenosis at 60 y, and colostomy and ileal conduit formation due to anal pain and dyschezia. Case 2: A 70 years old female who received 60 Gy irradiation post surgery similar to case 1 at the age of 61 y. She suffered from ileus, intestinal retention and hydronephrosis thereafter. She was hospitalized due to metastasis of the cancer to sacred bone, and received further 40 Gy radiation therapy at the age of 65 y. Up to the present, she received several operations such as ileostomy, nephrostomy and hemorrhoids excision. It is important for surgeons to understand the actual QOL of patients with radiation enterocolitis. (K.H.)

  10. Ventriculoscopic surgery for arachnoid cysts in the lateral ventricle: a comparative study of 21 consecutive cases

    Science.gov (United States)

    Shou, Xuefei; Zhao, Yao; Li, Shiqi; Wang, Yongfei

    2015-01-01

    Objective: To evaluate neuronavigation-guided ventriculoscopic technique in the treatment of arachnoid cysts in the lateral ventricle. Methods: Between January 2008 to November 2011, twenty-one neuronavigationguided ventriculoscopic surgery were performed for the treatment of symptomatic arachnoid cysts in 21 patients (14 male and 7 female patients, mean age 24.1 years [ranged 1.5-61 years]) Clinical presentations varied from headache, vomiting, hemiparesis and seizure. The trajectory of ventriculoscopy was dynamically monitored and guided in real time by neuronavigation system. Cysts fenestrations were performed in fourteen cases, and cysts resection in seven cases, respectively. All patients were prospectively had a regular follow-up. Results: After operation, all patients achieved symptom resolution without surgical mortality and morbidity. Aseptic meningitis was noted in four cases with cyst resection, and all recovered quickly without advanced treatments. However, a later ependymal adhesion, occurred in one case during follow-up period. Conclusion: The combination of ventriculoscopy and neuronavigation is an accurate, effective and safe approach for the treatment of the patients with arachnoid cysts in the lateral ventricle, especially, for overcoming the topographic variation caused by intraventricular pathologies. Cystoventriculostomy is the best choice. PMID:26885002

  11. Surgery for two cases with markedly impaired QOL(Quality of Life) of radiation enterocolitis

    Energy Technology Data Exchange (ETDEWEB)

    Shiba, Tadaaki; Tanishima, Satoru; Sato, Masahiko; Yanagisawa, Terumasa; Yoshino, Masaaki; Takatsuka, Jun [Toho Univ., Tokyo (Japan). School of Medicine

    1996-10-01

    Two cases of radiation enterocolitis with markedly impaired QOL for a long period were reported. Case 1: A 61 years old female. She received 60 Gy irradiation post hysterectomy and ovariectomy due to uterine cancer at the age of 39 y. She suffered from fecal incontinence and anal pain at 58 y, was diagnosed to have radiation colitis. She was hospitalized due to neurosis, anal pain and hypertension at 59 y. She received nephrostomy due to hydronephrosis and ureterostenosis at 60 y, and colostomy and ileal conduit formation due to anal pain and dyschezia. Case 2: A 70 years old female who received 60 Gy irradiation post surgery similar to case 1 at the age of 61 y. She suffered from ileus, intestinal retention and hydronephrosis thereafter. She was hospitalized due to metastasis of the cancer to sacred bone, and received further 40 Gy radiation therapy at the age of 65 y. Up to the present, she received several operations such as ileostomy, nephrostomy and hemorrhoids excision. It is important for surgeons to understand the actual QOL of patients with radiation enterocolitis. (K.H.)

  12. A comparative study on lecture based versus case based education on teaching general surgery to medical students

    Directory of Open Access Journals (Sweden)

    M. Moazeni Bistegani

    2013-06-01

    Full Text Available Introduction : various methods of teaching have different learning outcomes. Using a combination of teaching and training methods of training may boost education. This study compared lecture based and case based teaching as a combined approach in learning general surgery by medical students. Methods: This study was a quasi-experimental performed on two consecutive groups of 33 and 36 students who were studying general surgery course. The two styles of teaching were lecture-based and real case teaching methods. The final exam included twenty multiple choice questions. The mean scores of each group of students were collected and analyzed accordingly with descriptive tests, Fisher’s test and T-test. Results: The mean final mark of students' who received real case based education was 16.8/20 ± 1.8 and for the lecture group was 12.7± 1.7. There was a significant difference between the two groups (P <0.0001. In both groups, there were significant differences in the mean scores of questions with taxonomy two and three, but not in the questions with taxonomy one. Students' evaluation score of the teacher of the real case group increased by 1.7/20 (8.7% in the case based group compared to the lecture group. Conclusions: Case based teaching of general surgery led to a better outcome and students were more satisfied. It is recommended that case based education of surgery be encouraged.

  13. First year experience of robotic-assisted laparoscopic surgery with 153 cases in a general surgery department: indications, technique and results.

    Science.gov (United States)

    Tomulescu, V; Stănciulea, O; Bălescu, I; Vasile, S; Tudor, St; Gheorghe, C; Vasilescu, C; Popescu, I

    2009-01-01

    Robotic surgery was developed in response to the limitations and drawbacks of laparoscopic surgery. Since 1997 when the first robotic procedure was performed various papers pointed the advantages of robotic-assisted laparoscopic surgery, this technique is now a reality and it will probably become the surgery of the future. The aim of this paper is to present our preliminary experience with the three-arms "da Vinci S surgical system", to assess the feasibility of this technique in various abdominal and thoracic procedures and to point out the advantages of the robotic approach for each type of procedure. Between 18 January 2008 and 18 January 2009 153 patients (66 men and 87 women; mean age 48,02 years, range 6 to 84 years) underwent robotic-assisted surgical procedures in our institution; we performed 129 abdominal and 24 thoracic procedures, as follows: one cholecystectomy, 14 myotomies with Dor fundoplication, one gastroenteroanastomosis for unresectable antral gastric cancer, one transthoracic esophagectomy, 14 gastrectomies, one polypectomy through gastrotomy, 22 splenectomies,7 partial spleen resections, 22 thymectomy, 6 Nissen fundoplications, one Toupet fundoplication, one choledocho-duodeno-anastomosis, one drainage for pancreatic abscess, one distal pancreatectomy, one hepatic cyst fenestration, 7 hepatic resections, 29 colonic and rectal resections, 5 adrenalectomies, 12 total radical hysterectomies and pelvic lymphadenectomy, 3 hysterectomies with bilateral adnexectomy for uterine fibroma, one unilateral adnexectomy, and 2 cases of cervico-mediastinal goitre resection. 147 procedures were robotics completed , whereas 6 procedures were converted to open surgery due to the extent of the lesion. Average operating room time was 171 minutes (range 60 to 600 minutes, Median length of stay was 8,6 days (range 2 to 48 days). One system malfunctions was registered. Post-operatory complications occurred in 14 cases. There were no deaths. Our preliminary experience

  14. Pseudologia Fantastica in the Emergency Department: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Robyn Thom

    2017-01-01

    Full Text Available Psychiatrists commonly encounter deception in the emergency department. This article presents the case of a patient who presents to the emergency department with an unusual and elaborate web of deceptions along multiple themes including feigning medical illness, multiple losses, and grandiose academic and athletic achievements. We review the clinical characteristics of pseudologia fantastica and discuss how this patient’s constellation of malingering, factitious disorder, and personality disorder suggests this diagnosis.

  15. Convention on assistance in the case of a nuclear accident or radiological emergency

    International Nuclear Information System (INIS)

    1986-11-01

    The full text of the Convention on Assistance in the Case of a Nuclear Accident or Radiological Emergency adopted by the General Conference at its special session from 24-26 September 1986 is presented. It is stipulated that the States Parties shall cooperate between themselves and with the Agency to facilitate prompt assistance in the event of a nuclear accident or radiological emergency to minimize its consequences and to protect life, the property and the environment from the effects of radioactive releases

  16. Posttraumatic stress disorder: a special case of emergence delirium and anesthetic alternatives.

    Science.gov (United States)

    Shoum, Steven M

    2014-09-01

    Two anesthesia cases are presented involving patients with a history of posttraumatic stress disorder (PTSD). The first patient experienced a prolonged dangerous flashback during emergence. In the second patient, after a thorough review of PTSD and the anesthesia literature, emergence was uneventful. A history of PTSD should be considered a risk factor in the assessment of every patient and anesthetic management designed to best avoid serious and potentially harmful reactions.

  17. Malignant neuroleptic syndrome following deep brain stimulation surgery: a case report.

    Science.gov (United States)

    Themistocleous, Marios S; Boviatsis, Efstathios J; Stavrinou, Lampis C; Stathis, Pantelis; Sakas, Damianos E

    2011-06-29

    The neuroleptic malignant syndrome is an uncommon but dangerous complication characterized by hyperthermia, autonomic dysfunction, altered mental state, hemodynamic dysregulation, elevated serum creatine kinase, and rigor. It is most often caused by an adverse reaction to anti-psychotic drugs or abrupt discontinuation of neuroleptic or anti-parkinsonian agents. To the best of our knowledge, it has never been reported following the common practice of discontinuation of anti-parkinsonian drugs during the pre-operative preparation for deep brain stimulation surgery for Parkinson's disease. We present the first case of neuroleptic malignant syndrome associated with discontinuation of anti-parkinsonian medication prior to deep brain stimulation surgery in a 54-year-old Caucasian man. The characteristic neuroleptic malignant syndrome symptoms can be attributed to other, more common causes associated with deep brain stimulation treatment for Parkinson's disease, thus requiring a high index of clinical suspicion to timely establish the correct diagnosis. As more centers become eligible to perform deep brain stimulation, neurologists and neurosurgeons alike should be aware of this potentially fatal complication. Timely activation of the deep brain stimulation system may be important in accelerating the patient's recovery.

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

    Science.gov (United States)

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

    2016-01-01

    We present a case of allergic reaction to patent blue in a patient who underwent excision of sentinel lymph node associated with segmental breast resection. About 20minutes after the dye injection, the patient developed hypotension (BP=70×30mmHg) associated with increased heart frequency. The patient was treated successfully with decreased inspired fraction of inhaled anesthetic and fluid replacement. At the end of the procedure, she presented with bluish urticarial - like plaques on the head, neck, upper limbs, and trunk; hydrocortisone was then used. The patient recovered uneventfully and was discharged from the PACU two hours after the end of surgery without skin changes, and was discharged from hospital on the morning after surgery. The incidence of allergic reactions with the use of patent blue is far superior to the hypersensitivity reactions seen with anesthetic and adjuvant drugs. Therefore, the anesthesiologist must be aware of cardiovascular instability associated with skin changes during the use of patent blue, for early diagnosis and appropriate treatment of this hypersensitivity reaction to this dye. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

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

    Science.gov (United States)

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

    2016-01-01

    We present a case of allergic reaction to patent blue in a patient who underwent excision of sentinel lymph node associated with segmental breast resection. About 20min after the dye injection, the patient developed hypotension (BP=70×30mmHg) associated with increased heart frequency. The patient was treated successfully with decreased inspired fraction of inhaled anesthetic and fluid replacement. At the end of the procedure, she presented with bluish urticarial-like plaques on the head, neck, upper limbs, and trunk; hydrocortisone was then used. The patient recovered uneventfully and was discharged from the PACU 2h after the end of surgery without skin changes, and was discharged from hospital on the morning after surgery. The incidence of allergic reactions with the use of patent blue is far superior to the hypersensitivity reactions seen with anesthetic and adjuvant drugs. Therefore, the anesthesiologist must be aware of cardiovascular instability associated with skin changes during the use of patent blue, for early diagnosis and appropriate treatment of this hypersensitivity reaction to this dye. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  20. The efficacy of preopoerative instruction in reducing anxiety following gyneoncological surgery: a case control study

    Directory of Open Access Journals (Sweden)

    Gungor Tayfun

    2011-04-01

    Full Text Available Abstract Background This is a quasi-experimental case control research focusing on the impact of systematic preoperative instruction on the level of postoperative anxiety in gyneoncologic patients. The population studied consists of the gyneoncologic surgery patients admitted to the Gynecologic Oncology Service at Zekai Tahir Burak Gynecology Training and Research Hospital from May to September 2010. Patients and methods Through a random sampling, 60 patients were recruited in each group. The study group was given a systematic preoperative instruction while the control group was given routine nursing care. Patients were interviewed in the postoperative period and anxiety was measured. The data-collecting tool consisted of the Individual Information Form and the State-Trait Anxiety Inventory. The collected data were analyzed by using the SPSS Program to find the frequency, the percentage, the mean and the standard variables, and the hypothesis was tested with Chi-square, variance, and t-independent test. Results It was found that the incidence rates from the post-operative anxiety score of the study group were lower than those of the control group (p Conclusions Results of this study suggest that preoperative instruction programs aiming at informing gyneoncologic surgery patients at the preoperative stage should be organized in hospitals and have an essential role.

  1. [Drainage of amoebic liver abscess by single incision laparoscopic surgery. Report of a case].

    Science.gov (United States)

    Telich-Tarriba, José Eduardo; Parrao-Alcántara, Iris Jocelyn; Montes-Hernández, Jesús Manuel; Vega-Pérez, Jesús

    2015-01-01

    Single incision laparoscopic surgery has increased recently due to successful results, achieved in several procedures. The aim of the present work is to present the first case in which single incision laparoscopy is used for the drainage of an amoebic liver abscess. A 44-year-old man presented with intense right upper quadrant pain, generalised jaundice, tachycardia, fever, hepatomegaly and a positive Murphy's sign. Laboratory results revealed an increased plasma bilirubin, elevated alkaline phosphatase and transaminases, leucocytosis, negative viral panel for hepatitis, and positive antibodies against Entamoeba histolytica. On an abdominal computed tomography a 15 × 12.1 cm hypodense lesion was observed in the patient's liver, identified as an amoebic liver abscess. Analgesics and antibiotics were started and subsequently the patient was submitted to laparoscopic drainage of the abscess using a single port approach. Drainage and irrigation of the abscess was performed. Four days later the patient was discharged without complications. Management of amoebic liver abscess is focused on the elimination of the infectious agent and obliteration of the abscess cavity in order to prevent its complications, especially rupture. Laparoscopic surgery has proved to be a safe and effective way to manage this entity. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  2. A case of postirradiation angiosarcoma developed in the residual breast after breast-conserving surgery

    International Nuclear Information System (INIS)

    Nomura, Shinji; Okazaki, Yoshikazu; Fujii, Masakazu; Akiyama, Norio; Tomozawa, Naofumi; Morishige, Ichiro

    2008-01-01

    The patient was a 50-year-old woman who had undergone breast-conserving surgery for right breast cancer (C area, Bp+Ax, T2N0M0, Stage I, and scirrhous carcinoma), followed by irradiation at a total dose of 50 Gy in 1998. When 6 years 5 months had elapsed after the operation, redness and induration developed in the A area of the right breast. A biopsy via wedge resection was performed and the histopathological diagnosis was angiosarcoma. We could not rule out a possibility of positive surgical stump, and performed additional resection+skin grafting. No sarcoma remnant was demonstrated in the material resected additionally, but 2 years later, the patient experienced recurrence. Thus mastectomy+extended resection of the full thickness of the skin+skin grafting were performed. Postirradiation sarcoma involving the skin and vessels is a rare entity and occurs in 0.03-0.8% of all cases after radiation therapy. It metastasizes to the distant organs in an early stage and carries poor prognosis. No standard therapy for the disease has been established as yet. Early detection and extended resection are considered to contribute to an improvement of the prognosis. This paper deals with such a rare entity as postirradiation angiosarcoma developed in the residual breast after breast-conserving surgery. (author)

  3. Descending aortic injury by a thoracic pedicle screw during posterior reconstructive surgery: a case report.

    Science.gov (United States)

    Watanabe, Kei; Yamazaki, Akiyoshi; Hirano, Toru; Izumi, Tomohiro; Sano, Atsuki; Morita, Osamu; Kikuchi, Ren; Ito, Takui

    2010-09-15

    Case report. To describe an iatrogenic aortic injury by pedicle screw instrumentation during posterior reconstructive surgery of spinal deformity. Iatrogenic major vascular injuries during anterior instrumentation procedures have been reported by several authors, but there have been few reports regarding iatrogenic major vascular injuries during posterior instrumentation procedures. A 57-year-old woman with thoracolumbar kyphosis due to osteoporotic T12 vertebral fracture underwent posterior correction and fusion (T10-L2), using segmental pedicle screw construct concomitant with T12 pedicle subtraction osteotomy. Postoperative routine plain radiographs and computed tomography myelography demonstrated a misplaced left T10 pedicle screw, which was in contact with the posteromedial aspect of the thoracic aorta, and suspected penetration of the aortic wall. The patient underwent removal of the pedicle screw, and repair of the penetrated aortic wall through a simultaneous anterior-posterior approach. The patient tolerated the procedure well without neurologic sequelae, and was discharged several days after removal of a left tube thoracostomy. Plain radiographs demonstrated solid fusion at the osteotomy site and no loosening of hardware. Preoperative neurologic symptoms improved completely at 18-months follow-up. Use of pedicle screw instrumentation has the potential to cause major vascular injury during posterior spinal surgery, and measures to prevent this complication must be taken. Timely diagnosis and treatment are essential to prevent both early and delayed complications and death.

  4. EMTALA and patients with psychiatric emergencies: a review of relevant case law.

    Science.gov (United States)

    Lindor, Rachel A; Campbell, Ronna L; Pines, Jesse M; Melin, Gabrielle J; Schipper, Agnes M; Goyal, Deepi G; Sadosty, Annie T

    2014-11-01

    Emergency department (ED) care for patients with psychiatric complaints has become increasingly challenging given recent nationwide declines in available inpatient psychiatric beds. This creates pressure to manage psychiatric patients in the ED or as outpatients and may place providers and institutions at risk for liability under the Emergency Medical Treatment and Labor Act (EMTALA). We describe the patient characteristics, disposition, and legal outcomes of EMTALA cases involving patients with psychiatric complaints. Jury verdicts, settlements, and other litigation involving alleged EMTALA violations related to psychiatric patients between the law's enactment in 1986 and the end of 2012 were collected from 3 legal databases (Westlaw, Lexis, and Bloomberg Law). Details about the patient characteristics, disposition, and reasons for litigation were independently abstracted by 2 trained reviewers onto a standardized data form. Thirty-three relevant cases were identified. Two cases were decided in favor of the plaintiffs, 4 cases were settled, 10 cases had an unknown outcome, and 17 were decided in favor of the defendant institutions. Most patients in these 33 cases were men, had past psychiatric diagnoses, were not evaluated by a psychiatrist, and eventually committed or attempted suicide. The most frequently successful defense used by institutions was to demonstrate that their providers used a standard screening examination and did not detect an emergency medical condition that required stabilization. Lawsuits involving alleged EMTALA violations in the care of ED patients with psychiatric complaints are uncommon and rarely successful. Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  5. Mobile Unit and Its Role in the Case of Nuclear Emergencies

    International Nuclear Information System (INIS)

    Franic, Z.

    1998-01-01

    Emergency response mobile units play a significant role in the case of nuclear emergencies. The functioning and practice of such teams depend on the nature and phase of the nuclear emergency. In the acute phase, several teams with good navigational and communication abilities performing simple measurements can provide essential data for characterization of plume location and its magnitude. Therefore, such activities are complemental with the network of telemetric radiation monitors. However, in the late phase of an accident, in order to gather reliable data needed for utilization of remedial and recovery measures, a better equipped mobile units are necessary. (author)

  6. Legislative framework on establishing emergency response plan in the case of a nuclear accident

    International Nuclear Information System (INIS)

    Novosel, N.; Valcic, I.; Biscan, R.

    2000-01-01

    To give an overview of the legislative framework, which defined emergency planning in Croatia in the case of a nuclear accident, it's necessary to look at all international recommendations and obligations and the national legislation, acts and regulations. It has to be emphasized that Croatia signed three international conventions in this field, and by that took over some responsibilities and obligations. Beside that, it is also in Croatian interest to follow the recommendations of international institutions such as International Atomic Energy Agency (IAEA standards and technical documents). On the other hand, national legislation in this field consists of several laws, which cover nuclear safety measures, governmental organization, natural disasters and acts (decree, decisions) of responsible authority for emergency planning in the case of a nuclear accident (Ministry of Economy). This paper presents an overview of the international and Croatian legislation which influenced the emergency planning in the case of a nuclear accident. (author)

  7. Photorefractive keratectomy after cataract surgery in uncommon cases: long-term results

    Directory of Open Access Journals (Sweden)

    Anna Maria Roszkowska

    2018-04-01

    Full Text Available AIM: To evaluate the efficacy and safety of the excimer laser correction of the residual refractive errors after cataract extraction with intraocular lens (IOL implantation in uncommon cases. METHODS: Totally 24 patients with high residual refractive error after cataract surgery with IOL implantation were examined. Twenty-two patients had a history of phacoemulsification and IOL implantation, and two had extra-capsular cataract extraction with IOL implantation. Detailed examination of preoperative medical records was done to explain the origin of the post-cataract refractive errors. All patients underwent photorefractire keratectomy (PRK enhancement. The mean outcome measures were refraction, uncorretted visual acuity (UCVA, best corrected visual acuity (BCVA and corneal transparency and follow up ranged from 1 to 8y. RESULTS: The principal causes of residual ametropia was inexact IOL calculation in abnormal eyes with high myopia and congenital lens abnormalities, followed by corneal astigmatism both suture induced and preexisting. After cataract surgery and before the laser enhancement the mean spherical equivalent (SE was -0.56±3 D ranging from -4.62 to +2.25 D in high myopic patients, instead it was -1±1.73 D ranging from -3.25 to +3.75 D in the astigmatic eyes, with a mean cylinder of -3.75±0 ranging from -3 to +5.50 D. After laser refractive surgery the mean SE was 0.1±0.73, ranging from -0.50 to +1.50 in the myopic group, and it was -0.50±0.57 ranging from -1.25 to +0.50 in astigmatic patients, with a mean cylinder of -0.25±0.75. In myopic patients the mean UCVA and BCVA were 0.038±0.072 logMAR and 0.018±0.04 respectively, both ranging from 0.10 to 0.0. In astigmatic patients, the mean UCVA and BCVA were 0.213±0.132 and 0.00±0.0 respectively, UCVA ranging from 0.50 to 0.22 and BCVA was 0.00. All patients presented normal corneal transparency. No ocular hypertension was detected and no corneal haze was observed. All registered

  8. [Aortic infective endocarditis: Value of surgery. About 48 cases].

    Science.gov (United States)

    Tribak, M; Konaté, M; Elhassani, A; Mahfoudi, L; Jaabari, I; Elkenassi, F; Boutayeb, A; Lachhab, F; Filal, J; Maghraoui, A; Bensouda, A; Marmade, L; Moughil, S

    2016-02-01

    Infective endocarditis (IE) is a serious disease whose prognosis depends on early management. Aortic location is characterized by its evolution toward myocardial failure and the high number of complications reasons for early surgery. To compare the short- and mid-terms results of surgery for aortic infective endocarditis (IE) in the active phase and the healed phase. We analyzed retrospectively the data of 48 consecutive patients operated for aortic infective endocarditis between January 2000 and January 2012. The data on operative mortality, morbidity and major cardiovascular events (mortality, recurrent endocarditis, reintervention, and stroke) were analyzed. Twenty-three patients (48%) underwent surgery during the active phase (group I), 19 on native and 4 on prosthetic valves, and 25 patients (52%) were operated during healed endocarditis (group II) only on native valve. Mean age was 39 years (12-81) with a male predominance (83%). Rheumatic valvular disease was the main etiology of underlying valvular disease in both groups (85%). The clinical feature was dominated by signs of cardiogenic shock in group I and dyspnea exertion stage III-IV NYHA in group II. Streptococcus and Staphylococcus germs were most frequently encountered. Indication for surgery was heart failure in group I, it was related to the symptoms, the severity of valvular disease and its impact on the left ventricle in group II. An aortic valve replacement with a mechanical prosthesis was performed in the majority of cases (83%). Postoperative mortality concerned only one patient in group I. Twenty-one patients (44%) were followed for a mean of 30 months (1-72). One patient in group II died following cerebral hemorrhagic stroke related to accident with vitamin K antagonist. In both groups, there was an improvement in the functional class. No recurrence of endocarditis was noted in both groups during follow-up. The prognosis of infective endocarditis of the aortic valve is severe due to the fast

  9. Flurbiprofen Axetil Enhances Analgesic Effects of Sufentanil and Attenuates Postoperative Emergence Agitation and Systemic Proinflammation in Patients Undergoing Tangential Excision Surgery

    Directory of Open Access Journals (Sweden)

    Wujun Geng

    2015-01-01

    Full Text Available Objective. Our present study tested whether flurbiprofen axetil could reduce perioperative sufentanil consumption and provide postoperative analgesia with decrease in emergency agitation and systemic proinflammatory cytokines release. Methods. Ninety patients undergoing tangential excision surgery were randomly assigned to three groups: (1 preoperative dose of 100 mg flurbiprofen axetil and a postoperative dose of 2 μg/kg sufentanil and 10 mL placebo by patient-controlled analgesia (PCA pump, (2 preoperative dose of 100 mg flurbiprofen axetil and a postoperative dose of 2 μg/kg sufentanil and 100 mg flurbiprofen axetil by PCA pump, and (3 10 mL placebo and a postoperative dose of 2 μg/kg sufentanil and 10 mL placebo by PCA pump. Results. Preoperative administration of flurbiprofen axetil decreased postoperative tramadol consumption and the visual analog scale at 4, 6, 12, and 24 h after surgery, which were further decreased by postoperative administration of flurbiprofen axetil. Furthermore, flurbiprofen axetil attenuated emergency agitation score and Ramsay score at 0, 5, and 10 min after extubation and reduced the TNF-α and interleukin- (IL- 6 levels at 24 and 48 h after the operation. Conclusion. Flurbiprofen axetil enhances analgesic effects of sufentanil and attenuates emergence agitation and systemic proinflammation in patients undergoing tangential excision surgery.

  10. Flurbiprofen Axetil Enhances Analgesic Effects of Sufentanil and Attenuates Postoperative Emergence Agitation and Systemic Proinflammation in Patients Undergoing Tangential Excision Surgery.

    Science.gov (United States)

    Geng, Wujun; Hong, Wandong; Wang, Junlu; Dai, Qinxue; Mo, Yunchang; Shi, Kejian; Sun, Jiehao; Qin, Jinling; Li, Mei; Tang, Hongli

    2015-01-01

    Our present study tested whether flurbiprofen axetil could reduce perioperative sufentanil consumption and provide postoperative analgesia with decrease in emergency agitation and systemic proinflammatory cytokines release. Ninety patients undergoing tangential excision surgery were randomly assigned to three groups: (1) preoperative dose of 100 mg flurbiprofen axetil and a postoperative dose of 2 μg/kg sufentanil and 10 mL placebo by patient-controlled analgesia (PCA) pump, (2) preoperative dose of 100 mg flurbiprofen axetil and a postoperative dose of 2 μg/kg sufentanil and 100 mg flurbiprofen axetil by PCA pump, and (3) 10 mL placebo and a postoperative dose of 2 μg/kg sufentanil and 10 mL placebo by PCA pump. Preoperative administration of flurbiprofen axetil decreased postoperative tramadol consumption and the visual analog scale at 4, 6, 12, and 24 h after surgery, which were further decreased by postoperative administration of flurbiprofen axetil. Furthermore, flurbiprofen axetil attenuated emergency agitation score and Ramsay score at 0, 5, and 10 min after extubation and reduced the TNF-α and interleukin- (IL-) 6 levels at 24 and 48 h after the operation. Flurbiprofen axetil enhances analgesic effects of sufentanil and attenuates emergence agitation and systemic proinflammation in patients undergoing tangential excision surgery.

  11. Emergency surgery data and documentation reporting forms for sudden-onset humanitarian crises, natural disasters and the existing burden of surgical disease.

    Science.gov (United States)

    Burkle, Frederick M; Nickerson, Jason W; von Schreeb, Johan; Redmond, Anthony D; McQueen, Kelly A; Norton, Ian; Roy, Nobhojit

    2012-12-01

    Following large-scale disasters and major complex emergencies, especially in resource-poor settings, emergency surgery is practiced by Foreign Medical Teams (FMTs) sent by governmental and non-governmental organizations (NGOs). These surgical experiences have not yielded an appropriate standardized collection of data and reporting to meet standards required by national authorities, the World Health Organization, and the Inter-Agency Standing Committee's Global Health Cluster. Utilizing the 2011 International Data Collection guidelines for surgery initiated by Médecins Sans Frontières, the authors of this paper developed an individual patient-centric form and an International Standard Reporting Template for Surgical Care to record data for victims of a disaster as well as the co-existing burden of surgical disease within the affected community. The data includes surgical patient outcomes and perioperative mortality, along with referrals for rehabilitation, mental health and psychosocial care. The purpose of the standard data format is fourfold: (1) to ensure that all surgical providers, especially from indigenous first responder teams and others performing emergency surgery, from national and international (Foreign) medical teams, contribute relevant and purposeful reporting; (2) to provide universally acceptable forms that meet the minimal needs of both national authorities and the Health Cluster; (3) to increase transparency and accountability, contributing to improved humanitarian coordination; and (4) to facilitate a comprehensive review of services provided to those affected by the crisis.

  12. Are “knife and fork” good enough for day case surgery of resistant tennis elbow?

    Science.gov (United States)

    Govindaswamy, Raja; Elbouni, Tariq; Chambler, Andrew F. W.

    2008-01-01

    This observational retrospective study was performed on 22 consecutive patients treated surgically in a day surgery unit for resistant tennis elbow to ascertain the effectiveness of the “knife and fork” procedure. All patients had an unfavourable response to nonsurgical treatment lasting at least six months. A simple and inexpensive “knife and fork” technique yielded excellent results in 90.5% of patients and a high percentage (95.2%) of satisfied patients at an average follow-up of two years. There were no fair or poor results and no complications. We conclude that the “knife and fork” technique is a simple and dependable day case procedure. In the present National Health Service (NHS) era of tariff and “payment by results”, this approach is more cost effective than an arthroscopic alternative. PMID:19096844

  13. A primary intestinal lymphangiectasia patient diagnosed by capsule endoscopy and confirmed at surgery: a case report.

    Science.gov (United States)

    Fang, You-Hong; Zhang, Bing-Ling; Wu, Jia-Guo; Chen, Chun-Xiao

    2007-04-21

    Intestinal lymphangiectasia (IL) is a rare disease characterized by dilated lymphatic vessles in the intestinal wall and small bowel mesentery which induce loss of protein and lymphocytes into bowel lumen. Because it most often occurs in the intestine and cannot be detected by upper gastroendoscopy or colonoscopy, and the value of common image examinations such as X-ray and computerized tomography (CT) are limited, the diagnosis of IL is difficult, usually needing the help of surgery. Capsule endoscopy is useful in diagnosing intestinal diseases, such as IL. We here report a case of IL in a female patient who was admitted for the complaint of recurrent edema accompanied with diarrhea and abdominal pain over the last twenty years, and aggravated ten days ago. She was diagnosed by M2A capsule endoscopy as a primary IL and confirmed by surgical and pathological examination.

  14. Complex Regional Pain Syndrome (CRPS Type II After Carpal Tunnel Release Surgery: Case Report

    Directory of Open Access Journals (Sweden)

    Hakan Tunç

    2010-08-01

    Full Text Available Summary Complex regional pain syndrome is a chronic syndrome characterised with dystrophic changes and neurovascular disordes of bone and skin of extremities. The most common etiological factors are trauma, ischemic heart disease, cerebral lesions, servical region disorders, infections, and surgical treatments. Carpal tunnel syndrome is the most common compressive neuropaty of the upper extremity. There are various surgical and conservative alternatives in the treatment of carpal tunnel syndrome. Complex regional pain syndrome has been reported as a complication of surgical carpal tunnel release in 2-5% of patients. In this case report clinical characteristics and rehabilitation outcomes of a patient with complex regional pain syndrome after carpal tunnel release surgery is presented. (Osteoporoz Dünyasından 2010;16:41-3

  15. Digital Workflow for Computer-Guided Implant Surgery in Edentulous Patients: A Case Report.

    Science.gov (United States)

    Oh, Ji-Hyeon; An, Xueyin; Jeong, Seung-Mi; Choi, Byung-Ho

    2017-12-01

    The purpose of this article was to describe a fully digital workflow used to perform computer-guided flapless implant placement in an edentulous patient without the use of conventional impressions, models, or a radiographic guide. Digital data for the workflow were acquired using an intraoral scanner and cone-beam computed tomography (CBCT). The image fusion of the intraoral scan data and CBCT data was performed by matching resin markers placed in the patient's mouth. The definitive digital data were used to design a prosthetically driven implant position, surgical template, and computer-aided design and computer-aided manufacturing fabricated fixed dental prosthesis. The authors believe this is the first published case describing such a technique in computer-guided flapless implant surgery for edentulous patients. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Surgery for acoustic neurinoma treated by gamma-knife radiosurgery. A case report

    Energy Technology Data Exchange (ETDEWEB)

    Tokuda, Kentaro; Inamura, Takanori; Uesaka, Toshio; Matsushima, Toshio; Fukui, Masashi [Kyushu Univ., Fukuoka (Japan). Graduate School of Medical Science; Kenai, Hiroyuki; Karashima, Atushi

    2001-08-01

    A 52-year-old woman had a history of left hearing loss for 5 years. An acoustic neurinoma with 3.2 cm in diameter was diagnosed and treated with gamma-knife radiosurgery (19 Gy of marginal dose) 1 year and 4 months ago. She developed headache, nausea, and visual disturbance 1 month prior to admission. Slight left facial palsy appeared after radiosurgery. Magnetic resonance imaging demonstrated the tumor with central necrosis in the left cerebellopontine angle cistern, increasing in size to 3.5 cm in diameter, and hydrocephalus. Tumor removal was performed incompletely, because of the fibrous appearance of the tumor and severe adherence with the surrounding cerebellar tissue. Facial palsy did not worsen after surgery. Since the hydrocephalus was not resolved, a right ventriculo-peritoneal shunt was inserted. The clinical course in this case suggests that tumor removal followed by radiosurgery was an approximately effective treatment for large acoustic neurinoma. (author)

  17. A Case of Fatal Malignant Hyperthermia During Pes Equinovarus Surgery in a Child

    Directory of Open Access Journals (Sweden)

    Ümüt Altuğ

    2018-04-01

    Full Text Available Malignant hyperthermia (MH is a genetic syndrome characterized by hyperthermia, tachycardia, acidosis, and muscle rigidity, often triggered by depolarizing muscle relaxants such as volatile anesthetics and/or succinylcholine. MH usually develops following anesthesia induction, but may occur during and after a surgical intervention. A 4.5-year-old boy was admitted to the pediatric intensive care unit considering MH due to persistent fever, tachycardia and end-tidal carbon dioxide elevation which developed during pes equinovarus surgery. In the follow-up, hypercapnia, fever and refractory metabolic acidosis recurred. Despite the administration of dantrolene sodium and supportive treatments, the patient died. This case is presented to remind the possibility of MH which may be fatal in patients receiving general anesthesia and to emphasize the follow-up and treatment of the patients with MH in pediatric intensive care unit.

  18. Presurgical EEG-fMRI in a complex clinical case with seizure recurrence after epilepsy surgery

    Science.gov (United States)

    Zhang, Jing; Liu, Qingzhu; Mei, Shanshan; Zhang, Xiaoming; Wang, Xiaofei; Liu, Weifang; Chen, Hui; Xia, Hong; Zhou, Zhen; Li, Yunlin

    2013-01-01

    Epilepsy surgery has improved over the last decade, but non-seizure-free outcome remains at 10%–40% in temporal lobe epilepsy (TLE) and 40%–60% in extratemporal lobe epilepsy (ETLE). This paper reports a complex multifocal case. With a normal magnetic resonance imaging (MRI) result and nonlocalizing electroencephalography (EEG) findings (bilateral TLE and ETLE, with more interictal epileptiform discharges [IEDs] in the right frontal and temporal regions), a presurgical EEG-functional MRI (fMRI) was performed before the intraoperative intracranial EEG (icEEG) monitoring (icEEG with right hemispheric coverage). Our previous EEG-fMRI analysis results (IEDs in the left hemisphere alone) were contradictory to the EEG and icEEG findings (IEDs in the right frontal and temporal regions). Thus, the EEG-fMRI data were reanalyzed with newly identified IED onsets and different fMRI model options. The reanalyzed EEG-fMRI findings were largely concordant with those of EEG and icEEG, and the failure of our previous EEG-fMRI analysis may lie in the inaccurate identification of IEDs and wrong usage of model options. The right frontal and temporal regions were resected in surgery, and dual pathology (hippocampus sclerosis and focal cortical dysplasia in the extrahippocampal region) was found. The patient became seizure-free for 3 months, but his seizures restarted after antiepileptic drugs (AEDs) were stopped. The seizures were not well controlled after resuming AEDs. Postsurgical EEGs indicated that ictal spikes in the right frontal and temporal regions reduced, while those in the left hemisphere became prominent. This case suggested that (1) EEG-fMRI is valuable in presurgical evaluation, but requires caution; and (2) the intact seizure focus in the remaining brain may cause the non-seizure-free outcome. PMID:23926432

  19. COMPLICATION AND VISUAL OUTCOME OF SMALL INCISION CATARACT SURGERY IN REACH IN CAMP CASES

    Directory of Open Access Journals (Sweden)

    Rajendra Kumar Behera

    2018-01-01

    Full Text Available BACKGROUND Cataract is the principal cause of blindness in India accounting for 62.6%. This problem can be tackled, and the backlog of cataract blind can be reduced by large scale cataract operations in reach in camps at Base Hospital approach for good visual outcome with lesser complications. MATERIALS AND METHODS In this retrospective study, 2400 cataract patients with vision less than 6/60 underwent uncomplicated sutureless small incision cataract surgery with intraocular lens implantation. Postoperative complication and visual acuity was recorded. RESULTS The most common operative complications were Descemet detachment (0.75%, posterior capsule rent with IOL implant (0.58% and premature entry (0.25%. Immediate postoperative complications were mainly corneal oedema (1.16%, severe iritis (1.5% and hyphema (0.5%. Late postoperative complications were iritis (0.69%, persistent corneal oedema (0.43% and papillary capture (0.17%. Majority (48.71% had visual acuity 6/9 on first followup in 45th day followed by visual acuity of 6/12 on 38.44% of cases. 71.23% of cases had astigmatism below -1.5 D cylinder at 90 degrees. CONCLUSION The overall vision-threatening complications after cataract surgery in the Base Hospital are low. Our study reflects the efficacy of Base Hospital approach in terms of visual and surgical outcome as an important aspect from the public health point of view, which can help in clearing the cataract backlog in developing countries like India.

  20. Importance of preoperative imaging in acetabular revision surgery - a case report.

    Science.gov (United States)

    Schmitz, Hc; Egidy, Cc; Al-Khateeb, H; Cárdenas, G; Gehrke, T; Kendoff, D

    2012-01-01

    Acetabular defects, particularly as a result of protrusion of acetabular components into the hemipelvis, may cause serious complications during revision procedures as a result of iatrogenic injury to surrounding anatomical structures. In these challenging cases, we advocate the utilisation of preoperative three dimensional imaging. MRI and CT- imaging offer superior understanding of the three-dimensional quality of bony defects and the relationship of implants to important anatomical structures. Appropriate preoperative planning may also prevent major complications during the removal of the pre-existing hardware, prior to re-implantation of implants. Potential complications include injury of nerves, blood vessels and other intrapelvic structures.In our case, a major bony defect of the acetabulum was a result of the protrusion of an implanted reinforcement ring. A preoperative, contrast-enhanced CT scan showed that the urethra was in close proximity to the hook of the reinforcement ring.The preoperative imaging aided in identifying and understanding the potential complications that could occur intraoperatively. Additionally, it delineated the intact anatomic structures prior to surgery, which could have medico-legal implications.The importance of preoperative imaging and the existing literature is discussed within this case description.

  1. Presurgical EEG-fMRI in a complex clinical case with seizure recurrence after epilepsy surgery

    Directory of Open Access Journals (Sweden)

    Zhang J

    2013-07-01

    Full Text Available Jing Zhang,1 Qingzhu Liu,2 Shanshan Mei,2 Xiaoming Zhang,2 Xiaofei Wang,2 Weifang Liu,1 Hui Chen,1 Hong Xia,1 Zhen Zhou,1 Yunlin Li2 1School of Biomedical Engineering, Capital Medical University, Beijing, People's Republic of China; 2Department of Functional Neurology and Neurosurgery, Beijing Haidian Hospital, Beijing, People's Republic of China Abstract: Epilepsy surgery has improved over the last decade, but non-seizure-free outcome remains at 10%–40% in temporal lobe epilepsy (TLE and 40%–60% in extratemporal lobe epilepsy (ETLE. This paper reports a complex multifocal case. With a normal magnetic resonance imaging (MRI result and nonlocalizing electroencephalography (EEG findings (bilateral TLE and ETLE, with more interictal epileptiform discharges [IEDs] in the right frontal and temporal regions, a presurgical EEG-functional MRI (fMRI was performed before the intraoperative intracranial EEG (icEEG monitoring (icEEG with right hemispheric coverage. Our previous EEG-fMRI analysis results (IEDs in the left hemisphere alone were contradictory to the EEG and icEEG findings (IEDs in the right frontal and temporal regions. Thus, the EEG-fMRI data were reanalyzed with newly identified IED onsets and different fMRI model options. The reanalyzed EEG-fMRI findings were largely concordant with those of EEG and icEEG, and the failure of our previous EEG-fMRI analysis may lie in the inaccurate identification of IEDs and wrong usage of model options. The right frontal and temporal regions were resected in surgery, and dual pathology (hippocampus sclerosis and focal cortical dysplasia in the extrahippocampal region was found. The patient became seizure-free for 3 months, but his seizures restarted after antiepileptic drugs (AEDs were stopped. The seizures were not well controlled after resuming AEDs. Postsurgical EEGs indicated that ictal spikes in the right frontal and temporal regions reduced, while those in the left hemisphere became prominent

  2. Four Cases of Postoperative Pneumothorax Among 2814 Consecutive Laparoscopic Gynecologic Surgeries: A Possible Correlation Between Postoperative Pneumothorax and Endometriosis.

    Science.gov (United States)

    Hirata, Tetsuya; Nakazawa, Akari; Fukuda, Shinya; Hirota, Yasushi; Izumi, Gentaro; Takamura, Masashi; Harada, Miyuki; Koga, Kaori; Wada-Hiraike, Osamu; Fujii, Tomoyuki; Osuga, Yutaka

    2015-01-01

    To evaluate the frequency of pneumothorax after laparoscopic surgery and to identify possible correlations to endometriosis. Retrospective review. Tokyo University Hospital between 2006 and 2013. Four patients among a total of 2814 patients with a postoperative pneumothorax. Laparoscopic surgery for gynecologic benign disease. The main outcome was the clinical frequency and characteristics of the patients with postoperative pneumothorax. We observed 4 (0.14%) cases of postoperative pneumothorax after laparoscopic surgery, all of whom were diagnosed with endometriomas and developed a right-sided pneumothorax. The incidence of postoperative pneumothorax in 1097 patients with endometriomas was 0.36%, which was significantly higher than those without endometriomas. The presence of endometrioma should be considered a risk factor for postoperative pneumothorax in gynecologic laparoscopic surgery. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

  3. A STUDY ON CORNEAL ASTIGMATISM IN PTERYGIUM CASES BEFORE AND AFTER SURGERY

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    Kalanchiarani S

    2018-02-01

    Full Text Available BACKGROUND Pterygium is a common degenerative condition seen in the Indian subcontinent. One of the indications for pterygium excision is visual impairment due to astigmatism. Several mechanisms