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At least 793 records · Page 44Linked to original sources
PubMedDate not supplied

A simple lithotomy device for children.

BACKGROUND: The position of the patient is important for good access during surgery. The aim of this paper is to present a simple lithotomy device for children. METHOD: We present a simple easy-to-construct and affordable lithotomy device utilizing locally available materials for paediatricpatients. RESULTS: A simple, cheap and easy-to-construct lithotomy device for children has been used in our centre. It is also easy to sterilize and very durable. No complication has been noticed so far that is attributable to the lithotomy device. It has been used for Swenson's procedure for Hirschsprung's disease, and rectal biopsy. CONCLUSION: The affordability of the device will save hospital administrators and the country great cost while still being effective. The device is being recommended for use in developing countries where paediatric operating tables are not available.

Child↗
PubMedDate not supplied

Total quality management: care dealers vs. car dealers.

Let's turn our "flawed system into the Toyota City of world health care," proposes Fortune magazine. I shudder at the thought. Deming-Juran-type TQM procedures can help to ensure that cars and their drivers do not die on the road. Skillfully adapted for health care, these same procedures can help keep patients from dying on the operating table. These procedures can also respond to Fortune's indictment that the "U.S. medical system is as wasteful and managerially backward as Detroit before Henry Ford." However, people are not cars, and care dealers are not car dealers.

Empathy↗
PubMed1993

Doctors under the knife.

With Bill Clinton's new reforms only a month away, the health-care system is on the operating table--and the doctors are under the knife. Americans have a love-hate relationship with physicians: they like the care that doctors provide but hold them to blame for the nation's health-care mess. NEWSWEEK looks at how the culture of medicine may change, assesses doctors' fears--and examines the brave new world of HMOs.

American Medical Association↗
PubMed1997

Integration of behavioral medicine into general practice = better outcomes, lower costs.

Health care organizations save by looking beyond the basics of prescribing pills and taking to the operating table. Experts in behavioral medicine have developed six pathways to identify high-cost patients who may benefit from relaxation techniques and psychiatric counseling more than they can from biomedical care. Learn how to cut costs with formal behavioral medicine programs that are being instituted around the country.

Behavioral Medicine↗
PubMed1999

Anesthesia for ankylosing spondylitis patients undergoing transpedicle vertebrectomy.

BACKGROUND: Ankylosing Spondylitis (AS) patients present specific challenges to the anesthesiologists. Airway management, central venous access, positioning, neuraxial monitoring and protection as well as management of massive blood loss may prove to be difficult. We retrospectively reviewed the anesthetic management of consecutive AS patients who underwent transpedicle vertebrectomy (TPV). METHODS: To secure airway and administer anesthesia, we used awake fiberoptic endotracheal intubation. The central venous access was attempted through the infraclavicular approach. The positioning was made possible with modification of the operation table and padding. The neuraxial monitoring was done with both somatosensory evoked potentials (SSEPs) and the modified transcranial magnetic evoked potential (tcMMEP). The spinal cord protection was attempted with deliberate hypothermia. To prevent massive blood loss we did controlled hypotension, and autotransfusion. RESULTS: Fiberoptic endotracheal intubation was done smoothly in all cases except two. In one of these two cases, endotracheal intubation was successful only after cricothyroidectomy and retrograde intubation. In the other case antegrade stiff catheter guided intubation was attempted to overcome the acute angulation cause by fixed cervical flexion. Central venous access through infraclavicular approach was agreeable except one case of pneumothorax. Massive rapid blood loss during vertebral osteotomy, occurred in one patient with fall of the mean blood pressure to 20 mmHg and ventricular tachycardia for 10 min, during which all the SSEPs and tcMMEP activities disappeared. The patient recovered without sequelae. CONCLUSIONS: Although it is extremely challenging, with proper planning, anticipation of difficulties and meticulous work in airway management, central venous catheterization and positioning as well as prevention of neurological injury and massive bleeding, we successfully accomplished fine job of anesthesia for the AS patients presented for correction of severe kyphosis.

Adult↗
PubMedDate not supplied

Hepatic injuries: management and outcome.

A total of 52 patients with different grades of liver injuries were treated in a 1 year period: 32 patients had penetrating injuries and in 20 patients injuries resulted from blunt trauma. Blunt trauma victims were frequently associated with chest and head injuries and with skeletal fractures. A 4-fold incidence of associated intra-abdominal injuries was encountered in penetrating trauma victims. Blunt and gunshot victims commonly had severe grades of liver injuries (55% and 83.3%, respectively). Stab wounds caused simpler grades of injuries (86.7%). Suture hepatorraphy was the commonest procedure performed (57.7%).The other procedures applied to treat the injured liver were: selective ligation of the injured blood vessels (15.4%); packing (7.7%); and liver resection (3.8%). Two patients died on the operating table before any remedy was applied. The overall morbidity was 40.4%. The liver related complications constituted 17.3%. The total mortality was 13.5% and the liver related mortality was 9.6%.

Adult↗
PubMed1975

Low-output syndrome as a complication of open-heart surgery in 85 patients.

Low-output syndrome (LOS) was manifested after cardiopulmonary bypass in 33% of the patients undergoing mitral valve replacement in 12% of those submitted to aortic valve surgery, and in 16% of the patients on whom coronary artery bypass surgery was performed. It was also a frequent complication of multiple valve procedures, LOS was the commonest cause of hospital deaths after valve or coronary bypass surgery. The development and prognosis of LOS is dependent on several factors which may be related to the preoperative state, intraoperative events and postoperative treatment. Of these, one of the most important prognostic factors that emerged in this study was perfusion time. It was longest in the group of the 14 patients who died of myocardial failure on the operating table, shortest amongst the 28 patients who survived LOS, and of intermediate length for the 43 patients who died of LOS postoperatively. The differences between the groups were statistically significant. The mechanism of myocardial injury is reviewed. The incidence of various extracardiac complications increased during th postoperative course in proportion to the duration of LOS. Many of these complications resulted in a fatal outcome even when the patient was succesfully weaned from inotropic pharmacological support. There was more survivors in the group treated with dopamine than in the groups treated with isoproterenol or a combination of these drugs.

Adolescent↗
PubMedDate not supplied

Primary mediastinal hydatid cyst.

An unusual case of primary mediastinal echinococcosis in a young female presented with non-specific symptoms. On examination, she had signs of Horner's syndrome and mild superior vena cava compression. She was operated successfully. The final diagnosis could only be made on the operating table and confirmed by histopathology. Hydatid cyst in mediastinum is uncommon but because of surrounding vital structures and potential of its complete cure should be explored without delay.

Adult↗
PubMed1999

[Intraoperative indirect monitoring of electrocardiogram].

The electrocardiogram (ECG) is used as a standard monitoring method during anesthesia and operation. But during the operation of severely burnt patients, the electrodes for ECG cannot be placed on the ideal points for the standard limb leads. We tried the indirect monitoring of the ECG. We placed the electrodes on the sheet over the operating table, and connected the patient and the electrodes with water. By this way the ECG similar to the standard limb leads could be recorded. This method is useful for the patients, with such diseases as severe burn, severe atopic dermatitis and epidermolysis bullosa hereditaria.

Electrocardiography↗
PubMed1975

Reconstruction of cranial defects.

We have found that small defects, particularly those within the hairline, are easily reconstructed with methy methacrylate prepared at the operating table. Larger defects, especially in children and active adults, are benefited by autogenous bone grafts and we prefer split rib. When the fabrication facilities are available the preformed silicone implants offer much to the surgeon. They may be sculptured to correct difficult contour problems such as in the supraorbital or forehead region and are especially useful to fill in defects where the bone is present, but depressed. These three methods have many advantages over the metallic implants. There is little complaint of the implant being cold when the patient is exposed to cold weather and a very important fact is that these methods not only provide a radiolucent reconstruction, but also do not affect EEG examination.

Bone Transplantation↗
PubMed2000

[Fiber fasciotomy in Dupuytren's contracture].

42 patients with hand Dupuytren's contracture were operated. Transection of each finger scar cords was performed in transverse direction through 3-8 skin punctures from proximal portion to distal segment in the zone of middle phalanx base. In addition, complete finger extension was achieved on operating table. There were no recurrences in follow-up of 13 years.

Age Factors↗
PubMedDate not supplied

[The diagnostic and surgical characteristics of gunshot nonmagnetic intraocular fragments].

Results of treatment of 42 patients with a magnetic intraocular fragments (balls, pistons, capsules) are analyzed and indications for various surgical interventions for removal of fragments with the minimal injury for the eye are defined. The role of echo diagnosis (together with x-ray diagnosis and computer-aided tomography) in the selection of operative access to a foreign body and, specifically, echolocation on the operative table during surgery is shown. Combination of informative diagnostic methods with advanced surgical technologies helps save the organ and attain functional results in this extremely grave posttraumatic pathology.

Adolescent↗
PubMed1975

Abdominoplasty by the W technique.

The W abdominoplasty is an excellent esthetic operation (Figs. 7-12), based on several important principles. 1. The drawing of the W with its 3 angles gives 3 good landmarks for a symmetrical result. The mid-angle may be cut off by one to two cm at the time of closure, if it seems too sharp. 2. By making the incision inside the hairline, there is no increase in the height of the pubic hair. 3. By removing more tissues laterally than in the midline the traction on the flap is equalized, thus giving a nice draping on the hips. 4. The operation equalizes the wound edges and avoids producing skin folds. 5. Complete removal of the skin and fat between the umbilicus and the pubis is always possible if the operating table is put in a proper position for closure. No vertical scar has ever been necessary in our series. 6. The direction of the final scar, although different from the primary incision due to the traction, remains low-just above the inguinal fold and approximately in the same direction, in the area concealed by small bathing suits. 7. The maximum stretching of the abdominal skin favors a lasting result.

Abdomen↗
PubMed2000

[Incidence of complications of thyroid surgery].

BACKGROUND: Thyroid surgery presents a low incidence of complications. Death is certainly a rare, or even exceptional event. Hypoparathyroidism, above all if definitive, is the main complication of total thyroidectomy with percentages that very between 0 and 10% in the literature (average 2%). METHODS: The incidence of recurrent lesions varies between an improbable 0% to 8%, whereas lesions to the superior laryngeal nerve are relatively frequent, but often undervalued. Dysphagia, although always transient, presents a high risk of pneumonia ab ingestis and severe dehydration. Hemorrhage has an incidence of 0.1-3.8% and infection is reported in approximately 1% of cases. The permanent and recurrence nature of thyroid pathology in literature is between 5 and 11%, resulting from inadequate or sometimes useless surgery. Hypothyroidism is the logical consequence of total thyroidectomy. In the light of these data we have re-examined 300 operations involving thyroid pathology performed by the same team using the same method over the past 4 years (82% females, 18% males). 33% of the cases presented benign euthyroid nodular pathology, 27% hyperfunctioning benign nodular pathology, 2.6% Flajani-Basedow-Graves disease, 9% were adenomas, 7% were differentiated carcinomas, 2% anaplastic carcinomas and 0.7% medullary carcinomas. 99 extracapsular total loboisthmectomies, 135 total extracapsular thyroidectomies and 66 subtotal thyroidectomies were performed. RESULTS: The following complications were observed: 31/300 symptomatic hypocalcemias of which 25 were transient and 6 (2%) were definitive but easily controlled with treatment; 9 recurrent monoplegias out of 501 isolated recurrent forms of which 4 (0.8%) was permanent; 5/300 (1.7%) postoperative dysphagias associated with recurrent monoplegia in 4 cases. Damage to the external branch of the superior laryngeal nerve was suspected in 11/300 cases (3.7%). Postoperative hemorrhage occurred with an incidence of 1.3%, whereas the incidence of wound infection and serous collection was 1.7%. Moreover, persistent hyperthyroidism after subtotal bilateral thyroidectomy was observed secondary to toxic plurinodular struma. A case of paralysis of the right ulnar nerve, when the arm was adducted, was observed on the operating table, but regressed after about 4 months. Mortality was zero. CONCLUSIONS: Thyroid surgery is still hampered by a relatively low percentage of complications, which are probably still the result of various technical limitations, and it appears difficult to reduce these, let alone eliminate them completely.

Adolescent↗
PubMed2000

[Technical difficulties of microlaparotomy for cholecystectomy].

Microlaparotomy cholecystectomy (MLC) is an alternative for minimal invasive surgical interventions of the biliary tract. In Hungary over 7000 operations were performed in 21 surgical departments as at December 31. 1998 and numerous additional departments have indicated their demand for the initiation of the method. Every new surgical procedure requires a "learning curve" during the application of MLC, difficulties encountered with the surgical solution occurred in a 14-15% range. We studied difficulties noticed during micro-, minilaparotomy cholecystectomy in 2400 unselected cases from the adoption of the surgical method in our department until December 31, 1998. We grouped our findings into avoidable, and unavoidable difficulties. Circumstances that can present unavoidable difficulties include: the patient's abnormal change in build, surgical interventions that have to be performed on patients 8-10 days after obstructive cholecystitis, abnormal gallbladder not indicated during preoperative examination, as well as biliary tract variations. A considerable part of the difficulties can be avoided by MLC-desirable positioning of the patient on the operating table, appropriate choice of surgical incision site and method, satisfactory anaesthesia, the use of necessary instruments suitable for exposure and unobjectionable illumination of the surgical area, as well as the performance of cholecystectomy with required modifications per given circumstances. The concomitant 2.5-16% alternating conversion rate after minicholecystectomy is indicative of the importance of the use of instruments assuring adequate exposure and excellent illumination of the surgical area. During the practice in our department this occurrence was recorded in 0.29% with the use of the ROMICRO R-set.

Cholecystectomy↗
PubMed2001

Importance of correlating static and dynamic imaging studies in diagnosing degenerative lumbar spondylolisthesis.

Degenerative spondylolisthesis in the lumbar spine is due to long-standing segmental instability. A standing plain radiograph is commonly the only imaging study needed to establish the diagnosis. Translatory motion in spondylolisthesis is traditionally assessed with lateral flexion and extension radiographs. These dynamic studies often demonstrate a decrease in the slip percentage between the vertebral segments with extension and an increase with forward flexion. Some low-grade spondylolisthetic deformities reduce anatomically on the operating table after the administration of an anesthetic. We encountered one case in which there was complete reduction of an L4-5 grade I degenerative spondylolisthesis with positioning of a non-anesthetized patient in the supine position during a lumbosacral magnetic resonance imaging (MRI) scan. The patient's condition was originally misdiagnosed, as the spondylolisthesis was not identified on recumbent plain radiographs or on lumbosacral MRI. This case stresses the importance of correlating static and dynamic imaging studies in developing a treatment plan for patients with degenerative spondylolisthesis.

Female↗
PubMed2000

Rhabdomyolysis after a long-term thoracic surgery in right decubitus position.

We report a rare case who developed rhabdomyolysis associated with the use of the right decubitus position for 10 h during thoracotomy with lobectomy. It appears that an increasing of the compartment pressure may induce reperfusion injury of the ischemic muscle by prolonged compression of the gluteal and flank muscles against the operation table. Early recognition and aggressive treatment with intravenous fluid and diuresis may prevent the development of acute renal failure. Adequate prevention in high-risk patients, early diagnosis and aggressive treatment are the keys to a successful recovery.

Adult↗
PubMed2001

[Use of the modified Fogarty in acute occlusions of inverted venous graft. Technique proposal].

The acute thrombosis of inverted venous graft, although less frequent than of the alloplastic prosthesis graft, represents a problem for the vascular surgeon that on one hand wants to restore the flow and on the other to preserve, as much as possible, the integrity of the venous endothelium without damaging the valvular apparatus. The two objectives are not possible, using a traditional Fogarty balloon catheter: the introduction from the proximal anastomosis, the only possible way for the presence of the valves, requires that, for the removal of the thrombotic material, the instrument is drawn back in a contrary way with unavoidable damage of the valves. Such disadvantage is eliminated using a modified Fogarty catheter, that allows to introduce the instrument in cranio-caudal direction and to draw it back in the same way, with impossibility to stop into the bottom of the valvular border and with a minimal trauma of parietal and valvular endothelium. On the other hand, distal introduction of the traditional Fogarty catheter is difficult, if not impossible, due to the presence of the valves. The use of the Fogarty catheter from the top to the bottom of the graft is feasible after appropriate modifications of the traditional catheter that allow its introduction from the tail and to draw it back towards the periphery (with inflated balloon) according to the direction of the flow. Such modifications of the Fogarty catheter are easily feasible even on the operating table and they don't require particular devices. The technique is simple, does not require additional costs (this particular modified catheter can be, like the traditional, reusable) and allows the graft patency if the thrombosis cause is eliminated.

Acute Disease↗