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At least 919 records · Page 51Linked to original sources
PubMed1995

[Preliminary experience in prosthetic hernia surgery].

We reviewed 410 cases, 365 males and 45 females, mean age 64 years, of inguinal and femoral hernia, from 1/1/1991 to 31/12/1994, repaired with Lichtenstein and Trabucco techniques. Recurrent hernias repaired were 36 (8,8%). Local anesthesia was used in 82% and follow-up has ranged from 6 months to 4 years. The meshes used are made with a single layer of polipropylene and the Trabucco plugs T1 were made by hand at the operating table. In our experience these two techniques are simple, but is very important, before application of the mesh, a correct dissection of inguinal region. We made a complete excision of cremasteric fibers preservig, if possible, the genital branch of the genitofemoral nerve. The transversalis fascia is introflected and sutured in direct hernia repair or when there are a loss of tissues. The preliminary results obtained with the "tension free" hernioplasty are satisfying. The most important complications were 9 hematomas and an important and persistent inguinal neuralgia in 1 case. There were no recurrences, but we must considered the short follow-up period.

Adult↗
PubMed1996

[Pro-Shouldice: primary tension-free hernia repair--conditio sine qua non?].

Protagonists of laparoscopic hernia repair with mesh emphasize the tension-free repair as a main advantage. Thus, conventional techniques of hernia repair with tissue approximation and suture lines are questioned. Postulated advantages of the tension-free repair are less postoperative pain, shorter labour disability, less recurrences and less complications. The results of our own patients (primary hernia n = 2025, recurrent hernias n = 897) operated with the Shouldice technique were evaluated with regard to the postulated advantages of the tension-free repair. 95% of our patients were operated under local anesthesia. The amount of analgetic drugs/patient decreased from 45% first postoperative day to 20% second postoperative day. The individual judgement of pain with a visual analogue scale decreased to zero at the second postoperative day. Chronic groin pain persisted in 1.4% after primary hernia repair and 2.6% after repair of recurrent hernias in our patients. Mobilizing the patient from the operating table the postoperative hospital stay is 3,7 days after primary hernia and 6,7 days after recurrent hernia. The length of labour disability correlated significantly with the occupation. 90% of self-employees are back at work 3 weeks postoperatively while, in the group of employers, it lasts 8 weeks. 5-year follow-up reveals a recurrence rate of 1.3% after primary hernia and 3.1% after recurrent hernia. With the Shouldice repair the modern goals of hernia surgery are feasible. Therefore, a primary tension-free repair is not a "conditio sine qua non".

Anesthesia, Local↗
PubMed1997

[The spread of subarachnoid hyperbaric dibucaine in the term parturient].

To study the effect of patient's age, height, body mass index (BMI), site of injection, and volume injected on determining the spread of hyperbaric spinal anesthesia in the term parturient, we performed a retrospective analysis on 86 parturients who had received 0.3% hyperbaric dibucaine for cesarean section. All patients received subarachnoid injection of the drug in the left lateral decubitus position on a horizontal operating table. After the drug was injected, the final cephalad level of analgesia to pinprick was measured. Multiple regression analysis revealed that BMI and volume injected had relatively stronger relation with the spread of sensory analgesia, when compared to the others. However, neither of them was a significant determinant of the level of analgesia. In conclusion, patient's age, height, BMI, site of injection and volume injected were not significant determinants of hyperbaric dibucaine spinal anesthesia in the term parturient.

Anesthesia, Obstetrical↗
PubMed1996

[Penetrating wounds of the thorax].

From January 1989 to December 1993 at the Institute of Clinical Surgery of the University of Perugia, 5 patients were under observation for penetrating chest injuries. Two of them had show-wounds, one a slash, one a stabbing and slash and one a cutting blow. One of the patients with shot-wounds died on the operating table from a haemorrhage while the other was saved by surgery. One patient successfully underwent surgery for loss of tissue in the thorax walls. Another had a mini-thoracotomy plus lung suture which were successful. Finally, in the patient with a slash in the front region of the thorax and a slight pneumothorax, we inserted a chest thorax tube and so obtained a complete re-expansion of the lung. Total mortality was 20%. Surgical exploration of the thorax we believe is necessary wherever there is a risk of haemorrhage or possible lung damage requiring only surgery. According to many authors, video-thoracoscopy has the advantage of a reliable diagnosis and above all, enable us to repair lung wounds without opening the thorax. In one of our patients we could have avoided the mini-thoracotomy and used thoracoscopy to repair the lung damage.

Adult↗
PubMed1997

History of reconstruction after total gastrectomy.

Nearly a century has passed since Schlatter carried out the first successful total gastrectomy and antecolic end-to-side oesophagojejunostomy in 1897 in Zurich. Actually, fourteen years before, Conner attempted a total gastrectomy, but his patient died on the operating table. From the first success, a large number of different procedures have populated the worldwide literature, with a lot of papers reporting "original' techniques or data about the functional outcome.

Anastomosis, Roux-en-Y↗
PubMed1997

[Image-guided surgery for epilepsy].

Availability of a neuronavigation system for epilepsy surgery was reported, and its practical use was discussed. Four of nine patients with intractable epilepsy underwent surgical procedures using a neuronavigation system, Viewing wand, from November 1995 to August 1996, in our hospital. The ages of patients were between 9 to 46 years old. Three of them had temporal lobe epilepsy and one had generalized tonic seizures. One of the temporal lobe epilepsy cases had focal cortical dysplasia in the left posterior temporal lobe, and the other one showed that left hippocampal atrophy on MR images. The remaining two patient had no abnormality on MR images. All patients underwent video-EEG monitoring and habitual seizures were recorded at least three times. Ictal and/or interictal SPECT and neuropsychological testing were also performed. Electrocorticograms were recorded intraoperatively in all patients. Surgical procedures using the neuronavigation system were anterior temporal lobectomy, corpus callosotomy and lesionectomy of focal cortical dysplasia. A patient with temporal lobe epilepsy underwent implantation of depth electrodes under the neuronavigation. In temporal lobectomy, image-guided surgery helped to make a decision concerning the safely-resectable size of the lateral temporal cortex and hippocampus. The hippocampus was resected with minimum surgical damage and it made possible a complete histopathological examination. In corpus callosotomy, although it was not easy to confirm the length of the callosal section, the neuronavigation system enabled this to be done quickly. The real-time navigation showed the accurate operating position on three-dimensional images. The location of focal cortical dysplasia was often difficult to identify macroscopically. However, the location of the lesion can be projected to the skin surface under the neuronavigation system. The width of skin incision and craniotomy was able to be made smaller, and the surgery was able to be performed less invasively. The Viewing Wand system was accurate, reliable and easy to operate in these procedures. The navigating error was 2-5 mm. Using CT image data of 5 mm thickness the error was greater, although use of MR image data of 2 mm thickness resulted in relatively small error up to 2-3 mm. The first major factor of the error was the fiducial registration of the patient's head. While the registration was made more strictly with multiple fiducial points, the error was smaller. The second factor was movement of patient's head and/or the navigation arm. The arm and the head should be fixed tightly to the operating table, and it is better if they are fixed together with a supporting arm. The third factor was intraoperative brain shift caused by flow out of the cerebrospinal fluid or removal of mass lesions. This type of error is common in all navigation systems. However, it may be avoided making some real-time feedback system. With the Viewing Wand system, repetition of the intraoperative registration using intracranial anatomical structures reduces this type of error. On the other hand, there were some difficulties on stereotaxic procedures, such as implantation of depth electrodes, using the Viewing Wand. The error was larger than that recorded in other frame-based stereotaxic apparatus. This problem may be improved by a supporting system to fix the probe position. As a neuronavigation system can be widely applied to neurosurgical procedures, we consider that epilepsy and skull-base surgery are the best targets for it because of the minimum possible brain shift. We hope that accurate and less-invasive surgery using a neuronavigation system will contribute to a better outcome for epilepsy patients.

Adolescent↗
PubMed1997

[Time course of epidural pressure change under intraperitoneal insufflation during laparoscopic surgery].

The effect of intraperitoneal insufflation on epidural pressure (EPP) was studied in 10 patients undergoing laparoscopic cholecystectomy under general anesthesia. Epidural puncture was performed at T8/9 interspace. After placing an epidural catheter, EPP was recorded continuously using a pressure transducer. Ventilation was controlled to maintain PETCO2 at 30-35 mmHg. Intraperitoneal pressure was maintained at 8-12 mmHg by using CO2 gas insufflator. During EPP measurements, the patients were supine on a horizontal operating table and zero point was referred to the level of the external auditory meatus. ECG and direct BP were also monitored. Before anesthetic induction, the mean EPP was 15.5 +/- 2.0 mmHg. During the mechanical ventilation, EPP recordings showed two types of periodic waves: large and small. The large waves were observed in phase of positive pressure ventilation, and the small waves were synchronous with arterial pulsations. Intraperitoneal insufflation produced an immediate increase in EPP (19.8 +/- 4.2 mmHg after 1 min, 22.8 +/- 5.8 mmHg after 5 min). An immediate decrease in EPP to the baseline level was observed just after the release of intraperitoneal pressure. The results suggest that 1) EPP is positive and fluctuates with ventilation and arterial pulsations, 2) intraperitoneum insufflation produces an increase in EPP that lasts until the procedure is discontinued, and 3) increased intrathoracic and intraperitoneal pressures play a predominant role in producing the elevation of EPP.

Adult↗
PubMed1996

Orbitotomy facilitated by a mechanical retraction system.

A series of arms and retractors that attach to the operating table to aid the surgeon during orbitotomy and dacryocystorhinostomy is described. This enables the surgeon to consistently retract and expose orbital structures without assistance.

Dacryocystorhinostomy↗
PubMed1997

[The effect of prone position in spinal surgery on respiration and circulation].

The effects of position change on respiration and circulation of 42 patients during spinal operations were investigated in this study. The results showed that, if the patient was placed on the operation position following the administration of the anesthesia, the changes of respiration (f, VT, MV) and circulation (SBP, HR) were significant (P < 0.01, 0.05). On the contrary, if the patient was placed in the operation position and then started the anesthesia, the respiratory and circulatory changes were comparatively stable (P > 0.05). The authors concluded that: 1. for the cases undergoing spinal operations, it is advisable to place the patient in the operation position first and then start the anesthesia; 2. for the critical cases, a tolerable position should be adopted; 3. during the adjustment of the position of the patient, the clavicle and the ilium should be used as the fulcrum so as to avoid driect contact of the chest and abdoment with the operation table, thus to minimze interference on the respiratory and circulatory functions.

Adult↗
PubMed1997

Arterial to end-tidal carbon dioxide gradient and physiological dead space monitoring during general anaesthesia: effects of patients' position.

METHODS: One hundred and five ASA I-II patients, scheduled for elective surgical procedures were studied in order to evaluate the effect of different surgical postures on physiological pulmonary dead space (VDphys/ VT) and arterial to end-tidal carbon dioxide gradient [P(a-Et)CO2]. Patients were divided into four groups according to their position on the operating table: supine position (acting as control group, n = 33), 20 degree Trendelenburg position (n = 24), lateral position (n = 24) and prone position with convex saddle frame (n = 24). Physiologic dead space was measured using Enghoff modification of Bohr equation. Arterial CO2 partial pressure was measured by blood gas analysis and end tidal CO2 was measured by means of an infrared CO2 analyser. All measurements were performed 20 minutes after general anaesthesia induction, with patients mechanically ventilated by a constant inspiratory flow (TV = 8 ml kg-1, RR = 10-14, EIP = 10%) in order to reach a steady state end tidal CO2 ranging between 32 and 36 mmHg; afterwards surgery started. RESULTS: Arterial blood pressure showed a mean decrease of about 5-10% compared to baseline values, but no significant differences in arterial pressure decrease were found between the four groups. A significant VDphys/VT increase in postures other than supine was observed, unless it was statistically significant in lateral and prone position only; while P(a-Et)CO2 was higher in all postures compared to supine. Changes of intrapulmonary gas and blood distribution due to patients' posture are probably responsible for the observed physiologic dead space and CO2 gradient differences. CONCLUSIONS: In conclusion, the clinical practice of predicting PaCO2 from EtCO2 must be tempered by recognition of the potential magnitude of P(a-Et)CO2 gradient, which is higher than normal during general anaesthesia and further increased when positioning the patient other than supine.

Adult↗
PubMed1997

[Postoperative ulnar nerve palsy of the elbow].

Ulnar nerve neuropathy of the elbow is a recognized complication of surgery involving general anesthesia. In 13 patients, aged 21-76 years, ulnar nerve palsy developed at various times and of varying degrees of severity during the postoperative period. Diagnosis was based on clinical and electrophysiological findings. 3 patients had subclinical entrapment of the ulnar nerve. All were treated conservatively by rest, splinting and physical therapy: 10 improved slowly with time and 3 were operated on, but only 1 recovered fully. Preventive measures, such as proper positioning on the operative table, use of elbow pads, avoiding adduction of the arm, pronation of the forearm and prolonged elbow flexion, may reduce the incidence of ulnar nerve palsy. Unfortunately, treatment of established lesions has yielded mixed results.

Adult↗
PubMed1997

[Transesophageal echocardiography in cardiac anesthesiology].

Starting from 1995 in the 3rd Military Central Clinic Hospital by A. A. Vishnevskiĭ the staff specialists apply transesophageal echocardiography as intraoperative monitor when operating on heart. On their personal experience and literature information the authors prove that the method of intraoperative application of echocardiography in heart surgery is very effective. When operating on revascularization of myocardium, on correction or replacement of heart valve or foreign body removal, this method makes it possible to receive all necessary information on the functional and morphological changes in the heart right on the operation table. Transesophageal echocardiography proved itself as highly valuable for noninvasive evaluation of cardiovascular patients.

Anesthesia↗
PubMed1997

"Temporary prosthesis" of the fibrotic ring for relative insufficiency of the tricuspid valve.

BACKGROUND: De Vega type suturing dosage plasty is the intervention most widely used for relative insufficiency of the tricuspid valve (TV). In fact, this operation may be considered as an equivalent of prosthetic reconstruction of the fibrotic ring, shaping a fixed orifice for passage. Intrapulmonary pressure normalized as early as during the first months after surgery in patients with the mitral-tricuspid cardiac valvular disease. Under such conditions a rigid suture (prosthesis of the anulus) at the interface of the right atrium and ventricle is not physiological. METHODS: We used Maxon CV 2-0 (D+G) suture absorbable for 6 months. Xenopericardial pads were fixed at the edge of the suture. The pads were prepared by enzymatic and chemical processing. RESULTS: Operations were performed in 7 patients, the results were followed for up to 28 months. The size of the TV fibrotic ring was measured by transesophageal ultrasonography (Hewlett-Packard SONOS 1500; OMNIPLANE) on the operating table and for 2 years postoperation. No signs af tricuspid insufficiency were detected.

Heart Valve Prosthesis Implantation↗
PubMed1998

Organization and activity of the health service in the Croatian province of Lika in the first year of the war.

The aim of this report is to present the various aspects of the reorganization of the health service in the Croatian province of Lika during the first year, 1991-1992, of the war in Croatia. In the former Socialist Republic of Yugoslavia, the health service was completely in the hands of the state, and Croatia was not able to transform it in the first year of its independence. The paper documents the personnel, supplies, and equipment that the health service of Lika had at its disposal in the first year of the war, the division of the health service into the stationary and front-line medical corps, and the evacuation protocols developed to transfer surgical patients to the rear-area hospital. The response of the health service allowed for rapid and successful patient treatment, emphasized by the fact that the usual time elapsed between wounding and delivery of the patient to the operating table was less than 30 minutes. All surgeries, with the exception of those involving severe craniocerebral injuries, were performed in the war hospitals of Lika. After stabilization of their postoperative condition, generally within 30 minutes, patients were evacuated to the rear-area hospital in Rijeka, with artificial respiration. The distance by road from the war hospitals in Otocac and Gospić to the reararea hospital in Rijeka was 120 and 170 km, respectively. Collectively, the results of our work demonstrate that a nonmilitary health service can be transformed successfully and efficiently into a war medical service. Yet, we believe that this is possible only under the extreme conditions of a defensive war.

Croatia↗
PubMed1997

[Perforations of hepatic hydatid cysts].

Out of a total of 753 patients operated for liver echinococcosis, in 43 (5.71 per cent) various perforations are observed, namely: in the biliary apparatus, chest, abdominal cavity, gastrointestinal tract, subphrenic and subcutaneous tissue. Their incidence in bile ducts is the highest. The lethality is rather elevated with two patients dying on the operating table. In conclusion, proceeding from the severity of the complication emphasis is laid on the necessity of early diagnosis of the disease, before development of serious complications, successfully achieved in the last few years.

Aged↗
PubMed1998

[Laparoscopy in perforated gastroduodenal ulcers].

The authors have performed operations on 32 patients with perforated ulcers of the duodenum and 7 patients with perforated ulcers of the stomach. The diameter of the perforations was 2-8 mm. In 10 of the 39 patients the perforation defects could not be sutured by the laparoscopic method. The authors consider that of great significance for the decision to make laparoscopic operations was the diagnosis of peritonitis, size and localization of the perforation, the surgeon's experience with endoscopic operating. The technique of laparoscopic suturing the perforations is described. Special attention is paid to the special disposition of the surgeon and his assistant at the operating table.

Duodenal Ulcer↗
PubMed1998

[Special aspects of anesthesia in patients with epidermolysis bullosa based on a case example].

Epidermolysis bullosa hereditaria dystrophica (Hallopeau-Siemens) is a rare autosomal recessive disease characterized by extreme bullae formation of skin and mucosa. Typical dystrophic nails and flexion contractures of the joints can lead to deformities. Carious teeth and microstomia caused by scarred contractures of the lips are characteristic of the clinical picture. Depending on the form and severity of epidermolysis bullosa, the anaesthetic and surgical management requires careful planning to avoid unnecessary complications as a result of positioning, anaesthesia or surgery. In cooperation with the patient, optimal positioning on the operating table without pressure or tangential friction of the skin needs to be achieved. Wherever possible, surgical tape and adhesive electrodes should be avoided. Artificial respiration, intubation and monitoring must be adapted to the skin conditions of the patient. In particular the skin below the blood pressure cuff must be protected by adequate padding, and maximum intervals between measurements should be chosen. Nasal, oral, laryngeal and tracheal manipulations should be kept to a minimum for protection of the upper airway. Fibre optic intubation is to be preferred because of the possibility of microstomia and the need for simultaneous airway diagnosis. In addition, oro- or nasopharyngeal tubes and catheters should be avoided where possible. Depending on the course of surgery and anaesthesia, postoperative therapy in an intensive care unit should be considered.

Adult↗