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The isolated circuit diathermy.

When using the conventional diathermy generator in surgery failure to apply the plate electrode can always present a serious risk of a thermoelectrical burn at any point where the patient makes contact with an earthed object on the operating table. The recent introduction of the earth-free (isolated circuit) diathermy should, under most conditions, provide complete protection against such risks. However, there are still certain circumstances under which even the isolated circuit may give rise to a thermoelectrical burn. Two such hypothetical examples are described; the sequences of events for these are fairly frequent occurrence.

Burns↗

Microcirculation of the epimyocardial layer of the rat heart: no recruitment after hypoxia.

1. In vivo microscopic studies of the microcirculation of the beating mammalian heart are accomplished by use of small needles connected to the operation table, restricting excessive movement of the cardiac surface. 2. Fluorescence microscopic techniques combined with a highly sensitive TV tape system, enable to determine microvascular diameters, intercapillary distances, as well as directions and velocities of capillary flow in the epimyocardial layer of the mammalian heart. 3. During acute hypoxia, no recruitment of previously resting capillaries could be observed. 4. The capillary flow pattern of the epimyocardial layer reveals a mixed countercurrent system.

Animals↗

[Single dynamic compression during osteosynthesis using plates].

Special plates for the osteosynthesis and instantaneous compression of bone fragments with a contractor are described. The construction of the plates makes it possible to perform the compression on the operating table. The longitudinal grooves aid in approaching the fragments during the treatment process and do not interfere with the physiological compression due to both -- the reflectory tonic muscular contraction and the effect of the dynamic compression upon the extremity under loading. The combination of the instantaneous and dynamic compression while using the immersion osteosynthesis was carried out on 45 cases of bone fractures and 38 cases of long tubular bones pseudoarthrosis.

Adolescent↗

Concomitant hysteroscopy and hysterography in Asherman's syndrome.

Intrauterine adhesions (IUA) (Asherman's syndrome) are a relatively frequent sequel of curettage and may cause fertility problems. Diagnosis is by hysterography, and hitherto treatment was by blind division or curettage. Lately hysteroscopic division has been introduced. A few weeks later re-hysterography is done to evaluate the results. A one-stage method is presented, in which hysteroscopic division of adhesions and immediate hysterography are done on the operating table. If some adhesions are still seen, repeat hysteroscopy and adhesionolysis re done, until the uterine cavity is restored to normal. A Lippes IUD is inserted for 2 months, with cyclic hormonal treatment, and the patient allowed subsequently to become pregnant. Fifty-six patients were treated in this manner and in 53 a regular cavity was obtained. Obstetric performance was improved from 31.9% to 64.9%, so that anatomical and functional results compare very favorably with previous reports that used other methods. This one-stage method offers a short and efficient treatment of IUA.

Female↗

Surgical management of hyperparathyroidism.

Twenty-one patients with hyperpara-thyroidism were studied to determine the outcome of surgical treatment by a variety of surgeons using a variety of techniques. Primary surgical treatment was excision of an adenoma in 11 patients with primary hyperparathyroidism. One patient (7%) had a true recurrence. One patient (7%) had persistent disease. Subtotal parathyroidectomies were carried out in three patients with primary diffuse hyperplasia and in five patients with chronic renal disease. Total parathyroidectomy and autotransplantation were performed in two more recent patients with chronic renal disease. Permanent hypoparathyroidism was not seen postoperatively in patients with primary hyperparathyroidism. Identification of all four glands at the operating table is essential. The low recurrence rate following selective excision of diseases parathyroid glands in this series suggests that the approach can be undertaken safely in most instances.

Adenoma↗

Comparative study of etomidate-alfentanil anesthesia with N2O/O2 or with air/O2.

Systolic, diastolic blood pressures, heart rate, glycaemia, blood gases and clinical status were studied preinduction, 10' after anesthesia induction and intubation, 3', 30', 60' and 90' after surgical incision, when awake on the operating table and 60' after awakening in 20 hysterectomy patients. Etomidate (0.3 mg/kg + continuous infusion), alfentanil (75 micrograms/kg + increments of 15 micrograms/kg) anesthesia was used with a N2O/O2 mixture (10 pt) or with air/O2 (10 pt), both at a FIO2 = 0.33. This technique gave a smooth induction and recovery. Cardiovascular changes were moderate. The additional dose of alfentanil was 5.25 +/- 0.65 mg in the N2O/O2 group and 6.45 +/- 0.85 mg in the air/O2 group. The incidence of vomiting was 15%. Statistical analysis of both groups indicated no major difference between the two types of anesthesia, for the cardiovascular, acid base data and glycaemia. This technique is a simple and effective way of anesthetising patients, but from a clinical point of view the etomidate/alfentanil anesthesia combined with N2O/O2 gives better results than when combined with air/O2.

Adjuvants, Anesthesia↗

Hypobaric spinal anesthesia in the operative management of orthopedic emergencies in geriatric patients.

Hypobaric spinal anesthesia was administered to 40 patients undergoing lower limb surgery. Twenty-nine of the patients were debilitated geriatric patients who presented with orthopedic emergencies, in most cases a fractured hip. Hypobaric spinal anesthesia was found to be a simple and safe procedure that provided adequate analgesia. Due to its inherent nature, hypobaric spinal anesthesia does not necessitate positioning of the patient on the injured, painful side (unlike hyperbaric spinal or epidural anesthesia) and, therefore, facilitates a smooth and painless transfer of the patient to the operating table. Complications encountered were similar to those following hyperbaric anesthesia.

Adult↗

Comparison between square-ended distraction rods and standard round-ended distraction rods in the treatment of thoracolumbar spinal injuries. A statistical analysis.

This is a retrospective clinical and roentgenographic study of two different types of instrumentation used in the treatment of thoracic and lumbar spinal fractures. Dual square-ended distraction rods contoured into lordosis produced improved results when compared with round-ended distraction rods in terms of both the degree of reduction obtained on the operating table and preventing recollapse of the fracture in the ensuing month. The importance of restoring lordosis was more apparent in the thoracolumbar junction and lumbar spine than in the thoracic region.

Adolescent↗

[Reconstructive valve surgery in congenital heart disease].

As part of various defects in congenital heart disease, valvular lesions are frequently encountered and remain as one of the difficult subjects. Recent advances in the management of valvular lesions and late results of repair and replacement were reported. In congenital aortic stenosis, most of patients have obtained satisfactory results with valvotomy, but some required reoperation with valve replacement even during childhood. In supracristed VSD associated with aortic regurgitation, late recurrence of regurgitation was found in some, but 70% of the patients showed free of diastolic murmur after 10 years. In tetralogy of Fallot, definitive repair of pulmonary valve was performed in last 5 years with composite patch with patient's own pericardium to reduce postoperative pulmonary regurgitation. Recently, pericardium is treated with glutaraldehyde on the operating table to prevent late shrinkage. As external conduit, homograft aorta, which had been utilized previously, showed good late results comparable to xenograft in terms of free from reoperation. Xenograft has been frequently utilized without significant late obstruction so far. In atrioventricular canal, endocardial cushion prosthesis technique has been utilized satisfactory with recent modification of the wings made by glutaraldehyde treated patient's own pericardium as well as in tetralogy.

Follow-Up Studies↗

Solitary parathyroid microadenoma.

In our experience with operations for primary hyperparathyroidism, a recurring problem centers on patients whose solitary adenomas are too small to be appreciated at the initial exploration. We have seen four patients with parathyroid microadenomas, which we define as lesions less than 6 mm in diameter in externally undeformed parathyroid glands. Two such patients were fortuitously cured at the initial exploration even though the operative findings were inconclusive. One, a 25-year-old man, underwent excision of an externally normal gland that contained a 3 by 2 by 2 mm microadenoma. He is eucalcemic since the operation. The other patient, a 70-year-old woman with hypercalcemia, responded to prednisone. She then underwent a neck exploration at which the diagnosis of sarcoidosis was confirmed by lymph node biopsy examination. A 4 by 2 by 2 mm parathyroid microadenoma was incidentally removed. The patient is normocalcemic receiving low-dose steroid treatment since the operation. In a third patient, a 34-year-old practical nurse, three explorations were needed to find a parathyroid gland, which was negative for adenoma on frozen-section microscopy. The solitary adenoma, 6 by 3 by 3 mm, was appreciated only on permanent sections. The majority of oxyphil microadenomas should be suspected to be nonfunctioning, as in a 59-year-old woman in whom the lesion coexisted with primary chief cell parathyroid hyperplasia. The hyperparathyroidism responded well to three and a half-gland resection. The 2 by 2 by 2 mm oxyphil adenoma was also removed. Solitary parathyroid adenomas can be subtle and small. Appraisal of parathyroid disease at the operating table is not always straightforward. As more patients with early hyperparathyroidism appear on routine calcium screening, we may expect to see increasing numbers of challenging solitary parathyroid microadenomas.

Adenoma↗

Intraoperative lymph scintigraphy during radical surgery for cervical cancer.

Intraoperative lymph scintigraphy during radical surgery for cervical cancer was developed in the course of a program covering three periods. During the last period technetium-99m antimony sulfide has been used to visualize pelvic lymph nodes. Surgery is done with a modified gamma camera serving as an operating table. This ensures intraoperative monitoring and greater thoroughness of lymphadenectomy. The introduction of the technique has improved the rate of total lymphadenectomies and has increased both the yields of involved nodes and the 3-yr survival rates.

Antimony↗

Torsion of normal uterine adnexa in childhood: case report.

A case of torsion of a normal right ovary and tube in an 8-year-old child is presented. True infarction of the adnexa can be prevented only by considering this diagnosis early in the course of right lower quadrant pain. It is recommended that a routine exploration of the pelvis be carried out in any patient explored for acute appendicitis in whom that diagnosis cannot be made at the operating table.

Adnexal Diseases↗

Effect of retrobulbar anesthesia on ocular tension.

To determine the effect of retrobulbar lidocaine, with or without epinephrine, on intraocular pressure, 50 patients admitted to hospital for cataract surgery were selected at random. By applanation tonometry the tension of each eye was measured when the patient was placed on the operating table and 4 minutes after the retrobulbar injection. The decrease in intraocular pressure 4 minutes after the injection was not significant, clinically or statistically, and probably resulted from relaxation of the extraocular muscles.

Adult↗

[Surgical treatment of essential varices and their recurrences].

On the ground of the experience matured in about 800 operations for varicose veins of the lower limb carried out in a period of time of 3 years and a half in the surgical department of the Valduce Hospital of Como, the authors want to bring a personal contribution on the study of some problems, still enough controversial, on the many diagnostic and curative modalities of the essential varices and their relapses. Taking this treatment as starting point, an important speech is open on the anatomic and clinic findings and pathogenesis of the varicose relapses by the light of the phlebographic researches carried out in patients affected of recidivous varices and verified, later on, at the operative table.

Humans↗

Chiari's osteotomy. A note on technique.

Direct joint distraction of the hip facilitates the performance of Chiari's osteotomy on a standard operating table as opposed to the classic procedure on the traction table. Some useful modifications of the original technique include a guide wire to control the direction of the osteotomy, insertion of an additional bone graft to provide better anterior coverage of the head, and internal fixation of the osteotomy.

Adolescent↗

Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases.

Intramedullary nailing was performed on 520 femoral fractures in 500 patients. The series included eighty-six open fractures and 261 comminuted fractures. Closed intramedullary nailing was used in 497 femora and open intramedullary nailing with cerclage wiring, in twenty-three. The union rate was 99.1 per cent. The range of motion of the knee at follow-up averaged 130 degrees. Complications included four infections (0.9 per cent). Shortening of more than two centimeters occurred in ten patients (2.0 per cent) and malrotation of more than 20 degrees was observed in twelve patients (2.3 per cent). After prompt emergency measures had been taken, routine treatment included strong preoperative traction followed by accurate positioning of the patient on the operating table; selection of the correct insertion point for a properly sized, prebent, flexible, bullet-tipped nail; and accurate reduction of the fracture. Careful rehabilitation of the patient also contributed to the excellence of the results.

Adolescent↗

[Egas Moniz, Wilhelm Löhr and cerebral angiography. An expedition into the discovery of the cerebral vessels].

25 years ago the Portuguese neurologist Egas Moniz (1874-1955), the founder of the cerebral angiography and Nobel Prize laureate of the year 1949, died in Lisbon. Narrow 15 years before his German partner and competitor Wilhelm Löhr (1889-1941), surgeon in Mageburg, died. Löhr was the first physician, who applied and extended the carotis angiography in Germany, to begin together with the neurologist Walter Jacobi (1889-1937). For many important reasons and informations in cerebral angioarchitectonics it is indebted to the achievement of Moniz and Löhr. On this occasion a ramble set out through the history of discovery of the brain vessels. Beginning in the antiquity (Herophilos, Galen) via the considerable anatomists in the 16th and 17th century. (Berengario, Vesal, Wepfer, Willis, Sylvius and others) to the discoveries and the specifications in the late 19th and 20th century it is shown, that in the research of cerebral vessels a change of guidance is performed in the first half of our century, from the classic morphologists of the "anatomists" at the operating table and at the X-ray screen, i.e. to the neurosurgeons, neurologists and radiologists. In this connection the present paper is not only an essay about the history of brain research but also a contribution to the history of neuroradio-diagnostics. Such excellent textbooks and atlases as Becher, Braus/Elze, Ferner/Kautzky, Krayenbühl/Yaşargil, Wolf-Heidegger and especially Ferner (1979) reflect the high level of evolution of the theoretical and applied neuroanatomy.

Brain↗

[Pancreatic injuries. Report on 42 cases (author's transl)].

Between 1975 and 1980, 42 pancreatic injuries have been managed, they represented 9.5 per cent of abdominal injuries. Nine patients received penetrating trauma and thirty three patients sustained blunt trauma, the majority of them was a road accident. Associated and concomitant injuries of abdominal organs were present in 81 per cent of cases with the pancreatic trauma. More than 66 per cent have multiple brain, thoraco, abdominal, and bones injuries. Thirty two patients have been treated before the sixth hour. The emergency surgical treatment has been conservative in twenty six patients and a primary resection has been performed in twelve patients, (with eleven partial pancreatectomy and one pancreatoduodenectomy). But four patients died on the operating table because they have extensive injuries to several abdominal organs. Postoperative complications were present in 66 per cent of cases. They obliged the drainage of abscesses, three distal pancreatectomy and one pancreatoduodenectomy. The global mortality is 31 per cent, the secondary mortality is 21.4 per cent. The authors conclude thanks to the study of this series and of literature that the frequency of pancreatic trauma increased, and that its gravity is directly related to the number of other organs damages, missed or delayed diagnostic and to an inappropriate emergency treatment, which let necrosis and infection making their deadly evolution.

Adolescent↗