Eosinophilic granuloma of stomach.
A case of eosinophilic granuloma presenting as a large benign gastric ulcer is reported. On operation table, the lesion was interpreted as malignant.
Adult↗
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[Stable tachycardia as a cause of heart failure].
The authors described a patient in whom the right vagus had been cut during removal of hormonally inactive chemodectoma in the bifurcation of the external and internal carotid arteries. Stable sinus and then atrial tachycardia (140-180 strokes per min.) developed on the operating table. Congestive cardiac insufficiency developed in 3 yrs. Treatment with diuretics cardiac glycosides was ineffective. Clinical and x-ray signs of cardiac insufficiency disappeared after atrial tachycardia was converted into atrial fibrillation with ventricular contractions up to 80 per min. A conclusion has been made that stable tachycardia causes the development of cardiac insufficiency.
Adult↗
[O.15 mg Intrathecal buprenorphine applied for postoperative analgesia. A clinical double-blind study].
In a double-blind, randomized study of 29 patients who underwent orthopedic procedures we studied the additional effect of intrathecal buprenorphine on isobaricpinal anesthesia and postoperative analgesia. The injections were 20 mg tetracaine (19 patients) or 20 mg tetracaine plus 0.15 mg buprenorphine (10 patients). In both groups the drugs were contained within a total volume of 4 ml cerebrospinal fluid. Progression and regression of the sensory blockade of spinal anesthesia were estimated with pinprick; the motor blockade was judged by the Bromage scheme. Postoperative pain was evaluated by the patients using an analogue scale after Scott and Huskisson. Arterial blood gases, respiratory rate, blood pressure, and heart rate were measured and other side-effects determined. Both groups were comparable in age, body weight, height and duration of operation (Table 1). The addition of buprenorphine elevated the sensory blockade by three segments both during spread and regression of anesthesia (Figs. 1, 2). Postoperative analgesia was better up to 8 h after injection (p less than 0.05), after 8 h pain levels were equal in test and control groups (Fig. 3). After buprenorphine patients became aware of pain sensation 13 h after injection; in the control group the pain-free interval lasted only 9 h (p greater than 0.05). There were no differences in the need for postoperative analgesics between both groups. The respiratory rate was lower during the whole period of observation (p less than 0.05). The mean values for PaCO2, pH and BE were similar in both groups (Fig. 4). PaO2 was elevated in the buprenorphine group. There was no essential alteration of blood pressure after buprenorphine. The pulse rate, however, was slightly diminished.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Anterior approach in total hip arthroplasty].
The anterior approach to the hip is first between the tensor muscle of fascia lata and the sartorius muscle, then laterally to the vastus externus. Desinsertion of the fascia lata from the ilium is necessary in only slightly more than one half of the cases, and it is always limited. Access to the capsule is wide and, provided one works on an orthopaedic operating table, the manoeuvres required to dislocate the joint and expose the femoral head and neck, then the cotyloid cavity, are simple. Closure is easy, and because the trochanter has not been sectioned, early rehabilitation is possible.
Hip↗
An expanded view of risk-group definition in differentiated thyroid carcinoma.
There continues to be controversy about every aspect of management of differentiated thyroid carcinoma. In an age-based risk group previously described, low-risk patients made up 62% of cases and had a death rate of only 1%. Recent reports from the Mayo Clinic have expanded the concept of the low-risk group to include 86% of all cases with a 2% death rate by utilizing several anatomic and pathologic criteria of risk. We offer here another multifactorial system for the identification of low-risk patients who made up 89.4% of all patient seen between 1961 and 1980 and who have a death rate of only 1.8%. The resultant high-risk group constitutes 11% of cases but carries a 46% mortality rate. The risk-group definition is completely clinical and is based on age, presence of distant metastases, and the size and extent of primary cancer. It can be used confidently at the operating table to select conservative surgical procedures in patients with negligible risk of death. Through the succeeding decades analyzed, from 1941 to 1980, the effectiveness of this clinical categorization has increased substantially in separating patients at high and low risk, so that a mortality rate ratio of 26:1 now exists between high- and low-risk groups, respectively.
Adult↗
Knee prop for knee surgery.
A simple, inexpensive, effective, sterilizable knee prop is described for use in the operating room. It allows placement of the knee in any position, using the operating table hydraulic mechanism in conjunction. It is small, compact, easily adjustable, and can be kept sterilized for easy access. Over thirty years of use have abundantly demonstrated its success.
Humans↗
Height, weight, and the spread of subarachnoid hyperbaric bupivacaine in the term parturient.
Using a standardized technique, spinal anesthesia was induced in 50 term parturients to study the correlation between patient height, weight, and body mass index (BMI) and the spread of sensory blockade. All patients received 12 mg hyperbaric bupivacaine while in the right lateral decubitus position on a horizontal operating table. Immediately after drug injection, the women were turned to the supine horizontal position with left uterine displacement. Fifteen minutes after drug injection, the level of analgesia to pinprick was measured. Linear regression analysis revealed no significant correlation between height (146-175 cm), weight (57.3-93.6 kg), or body mass index (21-38 kg/m2) and the spread of spinal anesthesia (T7-C8). It is concluded that, in term parturients, patient height, weight, or BMI does not significantly affect the spread of hyperbaric spinal anesthesia.
Anesthesia, Obstetrical↗
Using the Heffington frame in elective lumbar spinal surgery.
Numerous techniques and frames are available to position the patient on an operating table for elective lumbar spine surgery. We utilized the Heffington frame to position 27 patients with hips and knees flexed and abdomen free. This group was compared with those patients positioned prone during surgery. Our data indicate that average intraoperative blood loss is reduced by the use of such a frame, a finding that is attributable to maximal decompression of the abdomen. Complications related to the Heffington frame were not observed in our series of patients.
Adult↗
Renal failure with posttransplant renin-angiotensin mediated hypertension.
Ten days after receiving a kidney transplant, severe hypertension and renal failure developed in a patient with a previously functioning graft. Although moderate blood pressure control was achieved with dialysis and antihypertensive medications, the graft did not function well. A trial of sar-ala-angiotensin II (an angiotensin II antagonist) was associated with a dramatic fall in blood pressure. Subsequently, the patient's own two kidneys were removed, the blood pressure fell to normal on the operating table, and within days graft function improved. The possible explanation for the changes in graft function, including angiotensin II-mediated changes of glomerular filtration rate, are discussed.
Adult↗
Use of a low-profile thigh holder to facilitate high tibial osteotomy for varus gonarthrosis.
In the performance of a proximal tibial osteotomy, the maintenance of proper leg positioning on a standard operating table can be cumbersome. A low-profile thigh holder commonly used for arthroscopic knee surgery effectively positions the limb and simplifies the performance of high tibial osteotomy.
Humans↗
Almost total absence of the left ventricular myocardium with dextro-transposition of the great arteries.
The term parchment heart is used to describe partial to nearly complete loss of ventricular myocardium. We report the first case of transposition of the great arteries with almost total absence of left ventricular myocardium. The latter was not recognized and the child underwent Mustard's operation at four months of age. He died on the operating table. At necropsy, the left ventricular wall was 1 mm in thickness; microscopic examination revealed few myocardial fibers within edematous connective tissue.
Heart Defects, Congenital↗
New technique for repair of posterior left ventricular rupture.
A case is presented of posterior left ventricular rupture occurring from resection of intramyocardial calcification during mitral valve replacement. The laceration was obvious on the operating table with discontinuation of cardiopulmonary bypass, but attempts at simple closure with buttressd sutures were unsuccessful. The ventricular defect was repaired by insertion of a low-porosity Dacron graft. A saphenous vein bypass graft was also placed between the aorta and circumflex coronary artery.
Heart Rupture↗
[Repeated revascularization of the extremities in functional disorders of aortofemoral explants].
The article analyzes results of 95 operations in 71 patients with disturbed functions of the prosthesis implanted into the aorto-femoral segment. In thrombosis of the implanted prosthesis the authors prefer to fulfil thrombectomy with plasty of the distal anastomosis and the collateral with autotissues (a fragment of the vein or the non-functioning superficial femoral artery). Failure of thrombectomy from the prosthesis or recidivation of thrombus on the operative table should be considered as an indication for a substitution of the prosthesis. The results obtained in reoperations are very modest, but at present there is no alternative for an attempt to save not only the ischemic extremity but also the patient's life.
Aorta, Abdominal↗
Electrical fascicle identification as an adjunct to nerve repair.
In view of the tragic consequences of median nerve and/or ulnar nerve paralysis and the biologic problems inherent in nerve healing, it seems logical that the surgeon should make a serious effort to control those problems that lie within his or her power: to identify and align those principal sensory and motor pathways in the severed nerve ends. I find that this is feasible. For over 15 years, I have used the electrical fascicle identification method, repairing 49 major upper extremity nerves. (A single radial nerve case was lost to follow-up.) As with any new technique, problems have been identified: incomplete information and confusing information, both of which require careful interpretation and some knowledge of internal nerve topography. Other problems have included the occasional patient who awakens on the operating table, confused and apprehensive, requiring some patience by surgeon and anesthetist. Perhaps this latter group should be done under Bier block intravenous anesthesia, if they can be identified beforehand. I believe that the electrical fascicle identification technique is sufficiently useful that I do not like to repair a major nerve without it. When distal stump motor identification is not feasible because of time delay or other reason, then anatomic dissection is used to locate the motor fascicle (and also digital nerve sensory fascicles, if necessary). My results have been significantly better than in the era of standard epineurial nerve repair. The median nerve is not only the most important nerve in the upper extremity, but also the most elusive in which to restore intrinsic motor recovery. Yet, today, I am able to restore opponens-abductor motor function in more than 90 per cent of median nerve lacerations repaired using electrical fascicle identification. Ulnar nerve loss, with its profound motor weakness, is almost as devastating. The modest number of ulnar nerves repaired by electrical fascicle identification in this present study (20 cases) suggests that low-level injuries recover more rapidly (1 to 2 years) than did the standard epineurial sutures and also that two relatively high-level injuries near the elbow have shown surprisingly good intrinsic motor recovery--something that epineurial suture did not accomplish.
Adolescent↗
[Diagnosis and microsurgical treatment of discogenic lumbosacral radiculitis].
The literature data and the authors' experience in the treatment of 50 patients showed that the level and character of damage inflicted to the spinal cord roots by Schmorl's body can be determined with the precision necessary for performing a microsurgical intervention only on the basis of a diagnostic complex including scrupulous neurological, X-ray, and electrophysiological examination. The authors show the diagnostic value of studying the somatosensory evoked potentials in stimulation of the corresponding dermatomes (L4, L5 or S1), which reflect the primary side of the affection and, to a lesser degree, the level of Schmorl's body. The microsurgical techniques of exposing the spinal cord root compressed by Schmorl's body was carefully developed and described. Attention is focused on the necessity of using the appropriate microsurgical instruments and placing the patient in an adequate position on the operating table.
Adult↗
Major factors affecting cadaver renal transplant outcome in a single center.
In this center, 3 major factors have favorably improved cadaver renal allograft survival rates. The good risk recipient has been associated with a better graft survival and lower mortality. This factor cannot easily be controlled because of an increasing percentage of poor risk recipients awaiting transplantation in most major centers. Recipient blood transfusions administered both before transplantation and at the operating table have led to a better allograft survival in our center. Cadaver donor genotyping with haplotype matching of donor-recipient pairs has resulted in an improved graft survival. As sharing of kidneys between centers becomes more common, it is encouraging to note that one method of preservation is not superior to the other.
Blood Transfusion↗
Direct coronary surgery with saphenous vein bypass without either cardiopulmonary bypass or cardiac arrest.
From October, 1980 to April, 1983, 30 patients underwent direct coronary surgery without either cardiopulmonary bypass or cardiac arrest. Patients were selected according to the site of the lesion or the condition of the vessel, i.e. generally arteries with a good calibre (more than 1.5 mm), without big plaques in the anastomotic area and lesions limited to the left anterior descending, the diagonal or the right coronary arteries, independently from the clinical condition or state of left ventricular function. Eighteen had stable angina, 10 unstable angina, 2 post-myocardial infarction angina, and 4 had a severe concomitant disease. The operations performed were: 17 simple aorto-coronary bypasses, 11 double bypasses and 2 triple bypasses. When it was necessary to revascularize the diagonal or the left anterior descending artery, the operating table was rotated to the right, a gauze pack was applied posteriorly and the arteries were sutured with 6-0 or 7-0 prolene sutures. There were no deaths and no perioperative infarctions. It should be noted that to date this technique could be used only on 7% of our patients, but we consider this percentage could be increased in the future.
Aged↗
[EEG in brain tumors in childhood. Anatomo-clinical correlations].
The authors reviewed the electroencephalographic findings relevant to a casuistry of 136 cerebral tumours in paediatric age and correlated them with the anatomic site of the neoplasias, as checked on the operating table, and with clinical symptomatology. The casuistry, as concerns the site of the tumours, consists of 32 cases with a hemispheric localisation, 35 localized on the median line (suprasellar tumours, tumours of the 3rd ventricle, tumours of the basal nuclei and tumours of the pineal region) and 68 cases of tumours of the cerebellar fossa. E.E.G. proved normal in 9.3% of the patients with a hemispheric tumour, 17.1% of those with median tumours and in 23.1% of the tumours of the cerebellar fossa. 12.5% of the cases with a hemispheric tumour showed a general widespread alteration of the electroencephalogram, which was also traceable in 20% of the deep seated tumours and 13% of the subtentorial tumours. A focal E.E.G. finding with polymorphic delta waves was detected in 62.5% of the tumours with a hemispheric localisation, as compared to 14.2% of the deep seated and 28% of the subtentorial ones. Finally, in the three groups, intermittent slow waves were detected respectively in 46.8%, 51.4% and 72.4% of the cases. Related with clinical conditions, in the presence of endocranial hypertension, a clear prevalence of general widespread alteration and of intermittent activities were detected. The authors discuss the diagnostic value of each E.E.G. finding in cerebral tumours with particular attention to localizing value of focal polymorphic delta waves and to the meaning of intermittent slow waves which, in paediatric age, show a clear prevalence in the posterior cerebral areas.
Adolescent↗