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At least 307 records · Page 17Linked to original sources
PubMed1996

How Prepared is Prepared Enough?

A 17-year-old female was in the final stage in treatment of right unilateral cleft lip and palate. She had undergone a number of previous surgeries. Hearing and speech were good on evaluation, and her social and family situation were deemed excellent. After preparatory orthodontics she underwent a Lefort I maxillary advancement. Surgery was successful and she was admitted into postoperative recovery. However, the lack of adequate preoperative preparation caused traumatic reaction from the patient and her parents: anxiety over appearance, crying, refusal of oral fluids and oral care, refusal of analgesia, and refusal to mobilize. The patience and persistence of hospital staff slowly overcame all adversities and the patient moved on to full and successful recovery, but this case prompted changes in preoperative procedures and involvement of patients and their families in postoperative meal selection, planing, and preparation.

Journal Article↗
PubMed1999

Delayed sequelae of hydrochloric acid ingestion.

Hydrochloric acid is the active ingredient in common toilet bowl cleaner agents used in Thailand but it is occasionally abused for suicidal attempts by ingestion. Clinicopathological description caused by this agent has rarely been mentioned in the literature. We reported three cases of gastric outlet obstruction. Two of these cases were initially treated in provincial hospitals by gastric lavages. No clinical symptoms relating to ingestion and swallowing were present in the early period after ingestion but patients developed vomitting and cachexia a few months later. Among these three cases, pylorus and antrum were the most common sites of injury. All cases were gastrectomized and pathological findings of the resected specimens showed mucosal ulceration, submucosal fibrosis, thickening of muscularis mucosae, and eosinophilic infiltrations. Most cases in the literature had preoperative jejunostomy preformed but our cases did not have such a preoperative procedure. The outcomes of all cases were considered good and no postoperative complication was found. This presentation is aimed to stimulate physicians to be aware of delayed complications of hydrochloric acid ingestion and long term follow-up is required even though the initial symptoms of the patients were minimal.

Adolescent↗
PubMed1999

[The management in vascular trauma of extremities].

Between 1990-1998 in the Department of Vascular Surgery, Medical Academy in Wrocław, 104 patients were operated due to artery trauma: 28 women, 76 men. Mean age was 37 years. In 58 cases acute ischaemia occurred, in 46--haemorrhage. Preoperative procedure consisted of preparation and diagnostics, in some cases angiography. Predominantly autogenous material was used for artery reconstruction. In 25 cases prosthetic grafts were implanted. In 53 patients (79.1%) good results were obtained, complications occurred in 14 cases (20.9%).

Acute Disease↗
PubMed2000

Neuroendovascular management of intracranial and spinal tumors.

The benefits of preoperative embolization have been known and reported on since the 1970s. With embolization of hypervascular tumors, surgical morbidity can be reduced with decreasing blood loss, thereby shortening operating time, and the chances for complete resection are increased. Superselective catheterization of feeding vessels close to a tumor of the CNS and head and neck is possible, resulting in more effective embolization. Endovascular management with embolization is now standard preoperative procedure. This article discusses the processes of neuroendovascular management of hypervascular intracranial and spinal tumors.

Angiography↗
PubMed1999

Combined modality therapy of rectal cancers.

Rectal cancer accounts for about 10% of new cancer cases each year. It strikes men and women at nearly the same rate, generally in the range of 50-80 years of age, with rising incidence with age. Despite simple screening procedures rectal cancer is often advanced when discovered. Current trends in the management of cancer have focused on organ preservation and improved quality of life without compromising the overall survival. During the last decade substantial progress has been made in treatment modalities: new and improved radiation techniques (conformal radiotherapy, altered fractionation, brachytherapy), chemotherapy (protracted infusion, use of radiosensitizers) and development of surgical procedures-enabling safer postoperative irradiation. In patients with advanced/unresectable disease aggressive combined chemoradiation can be added prior to surgery to downstage the tumour and increase the proportion treated with anal-rectal-sparing procedures. Preoperative chemoradiation therapy regimens are as safe and tolerable as the standard postoperative treatment. In this presentation indications for preoperative radiochemotherapy will be discussed in detail, together with treatment-related side effects, prognostic parameters, tumour response and outcome. Different irradiation settings and chemotherapy schedules are described. In patients with primary resectable disease (mainly Dukes C) several prospective randomised trials have shown less local recurrence with postoperative combined modality therapy.

Antineoplastic Agents↗
PubMed2000

[Renal cell carcinoma in a horseshoe kidney with abdominal aortic aneurysm: a case report].

We herein report a case of renal cell carcinoma in a horseshoe kidney with an abdominal aortic aneurysm in a 69-year-old man. Radiological examinations showed a left renal tumor, horseshoe kidney and abdominal aortic aneurysm. We performed a left radical nephrectomy with the division of the isthmus and artificial graft through an abdominal transperitoneal approach. Histological findings revealed clear cell type renal cell carcinoma without invasion of the capsule or renal pelvis. Only 31 cases of renal cell carcinoma in a horseshoe kidney have been reported in Japan, and our case is the 32nd. No case with abdominal aortic aneurysm has been reported previously. We assume that abdominal aortic aneurysm was associated with renal cell carcinoma by chance in the horseshoe kidney in this case. The arterial and venous supplies vary from case to case. We emphasize that arteriography and venography are very important preoperative procedures.

Aged↗
PubMed2000

[Implantation of iliosacral screws. Simulation of optimal placement by 3-dimensional X-ray computed tomography].

PURPOSE OF THE STUDY: Percutaneous iliosacral screws are used advantageously to fix unstable pelvic girdle avoiding the morbidity of open access for conventional screw fixation. The insertion technique must be precise due to the risk of injury to the lumbosacral nerve trunk, the cauda equina roots, and the first sacral nerve. We undertook a study of the implantation site of iliosacral screws looking for a means of standardizing the drilling procedure on the basis of 3D computed tomography (CT) data. MATERIAL AND METHODS: A CT series with 3D reconstruction was performed on 11 pelvis bones. We retained pelvis parameters and characterized the axis and narrow zone of the sacral wing. The insertion routes of 6.5 mm cancelous bone screws were simulated: two iliosacral routes fixing S1, and two iliosacroiliac routes fixing S1 and S2. The values of the pelvic parameters and the positions of the screws were compared with the Spearman correlation test and graphic regression. RESULTS: The pelvic incidence was a mean 47 degrees. The length of the sacral wing was a mean 73 mm. The narrow zone of the wing was 47 mm from the lateral iliac fossa. In the narrow zone, the wing section showed an oval shape: 22 mm largest diameter, 11 mm smallest diameter. The wing was oriented 84 degrees in the paracoronal plane perpendicular to the plane of the sacral plate, 67 degrees in the para-axial plane parallel to the sacral plate, and 37 degrees in the sagittal plane of the subject. The length of the upper S1 screw was a mean 80 mm. This upper screw was inclined 89 degrees in the para-coronal plant, 61 degrees in the para-axial plane and 28 degrees in the sagittal plane. The length of the lower S1 screw as a mean 80 mm. This lower screw was inclined 74 degrees in the para-coronal plane, 91 degrees in the para-axial plane and 110 degrees in the sagittal plane. The fixation screws could be inserted in 12 out of 22 cases. Correlations were found with height of the subject, length of the wing and the screw, and screw inclination. The inclination of the upper S1 screw in the para-coronal plane was correlated with the larger diameter of the sacral wing. DISCUSSION: The pelvis parameters measured were comparable with data in the literature. The very small dimensions of the narrow zone dictate a very precise drilling for the narrow zone. This narrow zone determines the inclination of the screw insertion. In the sagittal plane the standard deviation was very large making it impossible to interpret the data. The route of the upper screw runs obliquely forward in the plane parallel to the sacral plate. The lower screw runs upwardly in the plane perpendicular to the sacral plate. It does not appear possible to insert fixation screws in a routine procedure. Preoperative assessment would be necessary before percutaneous insertion. CONCLUSION: The 3D CT reconstructions of the sacral wing can be used to determine the precise optimal position of the two iliosacral screws. The principle orientations can be deducted from the plane of the sacral plate. Approximate indications can help reduce operative time and exposure to irradiation (patient and surgeon). Percutaneous iliosacroiliac screw fixation cannot be proposed for all patients.

Adult↗
PubMed2001

[Imaging of intraductal papillary mucinous tumor of the pancreas: literature review].

Intraductal papillary-mucinous tumor (IPMT) is defined as a syndrome consisting of dilatation of the main pancreatic duct and/or branch ducts associated with mucin overproduction. The purpose was to evaluate the usefulness of different imaging techniques (CT, EUS, ERCP) for determination of tumor invasion and pancreatic extension. Diagnosis often is delayed because it is confused with chronic pancreatitis or cystic neoplasms of the pancreas. It is difficult to rule out invasive malignancy. MRCP can be an essential imaging modality because it is a non-invasive technique. Intraductal ultrasound or pancreatoscopy could become in the future an additional useful preoperative procedure. A high frequency of invasive carcinoma in patients operated for pancreatic IPMT is observed. Surgical resection should be extended until a normal tissue margin is encountered.

Adenocarcinoma, Mucinous↗
PubMed2001

[Dynamic pedobarography in postoperative evaluation of pes cavovarus].

PURPOSE OF THE STUDY: Pes cavovarus is a complex deformity of the forefoot, the midfoot and the hindfoot, frequently of neuropathologic etiology. The goals of surgical interventions consist of anatomical and functional correction of the foot deformity by soft tissue and bony procedures. Preoperative planning and postoperative assessment are based on clinical and radiographic examination. The present study was undertaken to find out if pedobarographic outcomes correlate with those postoperative results and if the dynamic pedobarography provides useful information in the functional evaluation of cavovarus feet. MATERIAL AND METHODS: Sixteen patients with cavovarus foot deformity (mean age 32.8 years, range 17-56) with a total of 21 feet were examined before and after surgery. The average follow-up time was 24 months (range 6-50). The study protocol included physical examination, angle measurements on weightbearing radiographs and dynamic pedobarography. The patients performed five trials at self-selected speed for each foot. The amount of correlation was established between: plantar peak pressure pattern and patient's subjective functional result, the evidence of callosities and increased peak pressures in forefoot and midfoot regions of interest, the change of calcaneal pitch or Hibbs' angle (first metatarsal - calcaneal axis) and the midfoot contact area. RESULTS: The patient's functional opinion and pedobarographic improvement of peak pressures correlated in 7 feet, the patients estimated the result better in 13 feet and worse in 1 foot. In 4 regions of interest callosities and increased peak pressures occurred together in 69% of the cases, in 15.5% callosities were observed without augmented peak pressures and in 15.5% increased peak pressures were measured without evidence of callosities. No correlation was found between radiographic and pedobarographic parameters which describe a reduction of the cavus deformity: calcaneal pitch angle and midfoot contact area (Pearson correlation coefficient r=- 0.36), Hibbs' angle and midfoot contact area (r=0.55), although all parameters changed significantly (p=0.001). DISCUSSION AND CONCLUSION: Pre- and postoperative assessment of the cavovarus foot is mainly based on static methods such as clinical and radiographic evaluation. The results of this study demonstrate that the dynamic measurement of plantar peak pressures and contact area offers limited information about functional and anatomical improvement after surgery. Patients with severe deformities and muscular discoordination have difficulties walking consistently on the platform at each trial and severe decrease of plantar contact area makes the exact positioning of the masks difficult, which leads to problems with standardised measurements. In this context, the dynamic pedobarography cannot be used as a profitable diagnostic tool which provides an objective measurement that can add a dynamic component to a clinical or radiographic examination.

Adolescent↗
PubMed1998

Stereolithography: a historical review and indications for use in the management of trauma.

BACKGROUND: Stereolithography (SL) is a new adjunct for treatment planning in complex maxillofacial trauma. It uses an argon/ion laser to polymerize acrylic resin models of reformatted computerized tomographic radiographs. SL provides superior anatomical detail and translucency, and it can be sterilized and transported to the operative field, if necessary. DISCUSSION: A review of the historical development of SL technology is presented, along with three clinical cases, showing the advantages of SL models in the treatment of patients with complex maxillofacial trauma. CONCLUSION: SL technology provides superior understanding of anatomic relationships, the ability to perform presurgical simulation of the proposed procedure, preoperative adaptation of biomaterials, decreased time in the operating room and associated patient morbidity, and improved residency training and patient education. The primary disadvantages of SL are availability and cost.

Acrylic Resins↗
PubMed2002

Nitric oxide: platelet protectant properties during cardiopulmonary bypass/ECMO.

Postoperative bleeding is a major complication in patients who have been placed on extracorporeal circulatory support for various cardiac procedures (1). The increase in hemorrhage is well documented and is associated with various factors, which include, high-dose systemic heparinization, thrombocytopenia, and impaired platelet function. Platelets activate when exposed to the large foreign surface of the extracorpeal circuit, with the largest area being the oxygenator. Despite adequate heparinization, platelet levels continue to decrease. This aggregation phenomenon has also been extensively studied, and it cannot be attributed to the use of aminocarproic acid, aprotinin, propofol, or amicar (2). Other factors found to be unrelated include, the brand or type of oxygenator, the use of heparin coatings (3), activated clotting time (ACT) levels while on bypass, the operative procedure, preoperative medications, or the types of anesthetic agents used (2). Therefore, it may be beneficial to add nitric oxide to the sweep gas to decrease platelet loss, platelet damage, postoperative bleeding, and lessening the need for post-operative blood transfusions.

Cardiopulmonary Bypass↗
PubMed2003

Nonfacial laser rejuvenation.

With continuing developments in laser rejuvenation of nonfacial skin, dermatology nurses and support staff need to stay abreast of procedural, preoperative, and postoperative aspects of new therapies.

Cosmetic Techniques↗
PubMed1992

[Doppler color flow imaging for demonstrating changes in portal hemodynamic after Hassab procedure].

Doppler color flow imaging (DCFI) was used to observe portal hemodynamic changes in 40 patients with portal hypertension after Hassab procedure. Preoperative portal blood flow was hepatopetal in all patients, and in 30 of them gastric coronary vein was shown, with the hepatofugal blood flow of 235.32 +/- 56.24 ml/min, and the velocity of 8.62 +/- 2.33 cm/sec. Postoperatively, the gastric coronary vein was interrupted in 27 patients, the portal blood flow was significantly increased from 742.62 +/- 141.73 ml/min to 986.82 +/- 134.58 ml/min (P < 0.01) and the velocity was increased from 10.14 +/- 2.13 cm/sec to 13.41 +/- 1.91 cm/sec (P < 0.01). The results showed that the operation can stop abnormal blood flow in the gastrosplenic region and enhance liver perfusion. DCFI is useful for postoperative follow-up and observing portal hemodynamic changes.

Adult↗
PubMed1992

[Endosonography: progress in the diagnosis of endocrine pancreatic tumors].

Diagnostic procedures for secreting endocrine pancreatic tumors comprise biochemical tests, CT scans, conventional abdominal sonography, angiography and occasionally MR imaging and isotope scans. Due to their small size, insulinomas and gastrinomas, the most common of these tumors, elude these diagnostic procedures. Preoperative sonography and CT scans were negative in over 60%, angiograms in 35% of the patients. The example of a patient with insulinoma demonstrates that in the future endosonography will offer itself as an accurate method with little risk.

Aged↗
PubMed2004

[Short-term effect of percutaneous transluminal coronary angioplasty with stent implantation in treating myocardial infarction with severe pump failure].

OBJECTIVE: To evaluate the short-term therapeutic effect of percutaneous transluminal coronary angioplasty (PTCA) with stent implantation in the treatment of myocardial infarction with severe pump failure. METHODS: The clinical data of 73 patients receiving PTCA and stent implantation for myocardial infarction with severity pump failure were analyzed and grouped according the occurrence of complications, degree of the vascular lesions and the complexity of the surgical procedures. Preoperative and postoperative ventricular ejection fractions (LVEF) were compared in each case. RESULTS: The degree of vascular lesions and surgical complexity were not shown to relate to the occurrence of the complications. Except in cases complicated by chronic renal dysfunction, significant improvement was achieved in the patients 7 d after the operation (P<0.05), regardless of different degrees of vascular lesions and surgical complexity. CONCLUSION: PTCA with stent implantation is effective to improve the short-term cardiac function of patients with myocardial infarction and severe pump failure.

Adult↗
PubMedDate not supplied

Surgery for hepatocellular carcinoma with tumor thrombus extending into the right atrium: report of a successful resection without the use of cardiopulmonary bypass.

Hepatocellular carcinomas, of which the tumor thrombus extends into the right atrium via the inferior vena cava, may soon cause fatal complications. Only surgery can be an effective treatment. This procedure usually needs the aid of cardiopulmonary bypass. We recently experienced a successful surgery to remove thrombus combined with hepatectomy. Reporting the detailed technique, both associated diagnosis and intraoperative management are discussed herein. We were able to perform hepatectomy of tumor thrombus in the right atrium without the use of cardiopulmonary bypass or veno-venous bypass. The tumor thrombus was removed from the right atrium into the suprahepatic inferior vena cava by reducing the liver on the tail side. And after total hepatic vascular exclusion was achieved, the intracaval tumor thrombus and the right lobe of the liver were removed en bloc. The operation took 545 minutes and the total hepatic vascular exclusion period was 32 minutes. The postoperative course was uneventful. There are some key points for this procedure. Preoperative or intraoperative US is essential in judging whether tumor thrombus can be removed from the right atrium into the inferior vena cava by reducing the liver or not. Test clamping of the inferior vena cava prior to total hepatic vascular exclusion will enable us to judge whether veno-venous bypass during total hepatic vascular exclusion is needed or not. Surgery without the use of cardiopulmonary bypass is safe and can be minimally invasive when it is performed with a reliable diagnosis and technique.

Carcinoma, Hepatocellular↗
PubMed2005

Laparoscopic radical nephrectomy in renal cell carcinoma.

Historically, the only surgical option for removal of a renal mass was through a large incision in the abdomen. Recently, many urologists have adopted new innovations in the removal of renal masses including laparoscopic radical nephrectomy. The laparoscopic approach to radical nephrectomy has been associated with improved patient outcomes including decreased pain, shorter hospital stay, rapid recovery, and improved aesthetic cosmetic appearance. Laparoscopic radical nephrectomy may be performed in three different types of surgical procedures including laparoscopic hand-assisted radical nephrectomy, transperitoneal radical nephrectomy, and retroperitoneal radical nephrectomy. Understanding the procedure, preoperative instructions, and recovery will assist nurses in counseling patients considering laparoscopic radical nephrectomy.

Aftercare↗
PubMed2005

[Percutaneous vertebroplasty].

Percutaneous vertebroplasty is a therapeutic, interventional radiologic procedure originally developed in France by Galibert, Deramond et al. (1987). The technique consists of the percutaneous puncture of the affected vertebral body, followed by injection of bone cement into a vertebral body for the relief of pain, and the strengthening of the bone. The procedure was used initially to treat aggressive hemangiomas, but it then was extended to the treatment of osteolytic metastases, multiple myeloma and osteoporotic compression fractures refractory to medical therapy. In this article we review the current techniques, indications for this procedure, preoperative and postoperative evaluations.

Bone Cements↗