Avulsion of the Ischial Tuberosity in a Young Soccer Player: Six Years Follow-Up

In this case a seventeen-years-old male soccer player, who sustained an injury while playing football, diagnosed as ischial tuberosity avulsion was reported. Following six-months of a conservative rehabilitation program, the athlete returned to his sports’ activities. Six years along he had no complaints and his athletic performance was not deteriorated. In this case report diagnosis, treatment and six-years follow-up results were discussed.Key Words: Apophysis, avulsion, ischial tuberosity, soccer     

Lesser Tuberosity Avulsions in Adolescents

Background

Subscapularis tendon avulsions of the lesser tuberosity are relatively rare and often missed acutely and their characteristic appearance is frequently not recognized or is misinterpreted for an osteochondroma or a neoplastic process.

Questions/Purposes

This report reviews our experience with six adolescents who had subscapularis tendon avulsions of the lesser tuberosity.

Methods

Six male adolescents (12–15 years) presented with shoulder pain following history of trauma during amateur sport. Clinical notes including range of motion, strength tests, and pain assessment were reviewed along with imaging studies pre- and post treatment. Treatment consisted of either surgical or conservative measures.

Results

Two of the six patients had a large avulsion that simulated an exostosis of the proximal humerus that was misdiagnosed as an osteochondroma at two different outside institutions. All six cases were diagnosed with subscapularis tendon avulsion of the lesser tuberosity following clinical and imaging evaluation at our institution. Five of the patients underwent surgical repair and fixation of the tendon and the lesser tuberosity with suture anchors. One patient was treated conservatively. All patients had a good outcome with recovery of full shoulder strength and motion upon follow-up.

Conclusion

Clinicians should have a high index of suspicion of lesser tuberosity avulsions in adolescents who present with loss of internal rotation and anterior shoulder pain following traumatic injuries. In addition, an osseous fragment or exostosis along the inferomedial humeral head should suggest a subscapularis tendon avulsion and also should not be confused with an osteochondroma or a neoplastic process.     

Bilateral double osteotomy in severe torsional malalignment syndrome: 16 years follow-up

Background

Torsional malalignment syndrome (TMS) is a well defined condition consisting of a combination of femoral antetorsion and tibial lateral torsion. The axis of knee motion is medially rotated. This may lead to patellofemoral malalignment with an increased Q angle and chondromalacia, patellar subluxation and dislocation. Conservative management is recommended in all but the most rare and severest cases. In these cases deformity correction requires osteotomies at two levels per limb.

Materials and methods

From 1987 to 2002 in our institution three patients underwent double femoral and tibial osteotomy for TMS bilateral correction (12 osteotomies). All patients were reviewed at mean follow-up of 16 years.

Results

At final follow-up no patients reported persistence of knee or hip pain. At clinical examination both lower limbs showed a normal axis and a normal patella anterior position. Pre-operative femoral version measurement showed an average hip internal rotation of 81.5° (range 80°–85°) and average hip external rotation of 27.2° (10°–40°). Thigh–foot angle measurement showed an average value of 38.6° (32°–45°). At final follow-up femoral version measurement showed an average hip internal rotation of 49° (range 45°–55°) and average hip internal rotation of 44.3° (20°–48°) (Figs. 1, 2, 3, 4, 5, 6). Thigh–foot angles measurement showed an average value of 21.6° (18°–24°) outward.

Conclusion

We recommend a clinical, radiographical and CT scan evaluation of all torsional deformity. In cases of significant deformity, internally rotating the tibia alone is not sufficient. Ipsilateral outward femoral and inward tibial osteotomies are our current recommendation for TMS, both performed at the same surgical setting.     

Totally Laparoscopic Anatomical Hepatectomy Exposing the Major Hepatic Veins from the Root Side: a Case of the Right Anterior Sectorectomy (with Video)

Laparoscopic hepatectomy has rapidly evolved recently; 1–5 however, laparoscopic anatomical hepatectomy has yet to become widely used, although anatomical hepatectomy is ideal, especially for curative treatment of hepatocellular carcinoma, and is widely accepted via open approach. 6–10 This is because good-experienced skills, for example, exposing Glissonean pedicles and hepatic veins on the cutting plane, are required in order to perform anatomical hepatectomy via a pure laparoscopic approach. We obtained good results for various totally laparoscopic anatomical hepatectomies using the standardized techniques. We exposed the major hepatic veins from the root side by utilizing the unique view from the caudal side in the laparoscopic approach, and moved CUSA from the root side toward the peripheral side to avoid splitting the bifurcation of the hepatic vein. 11–13 We performed totally laparoscopic anatomical hepatectomy for 47 patients from August, 2008, to December, 2012 (Table 1). In most types of anatomical hepatectomy, the mean blood loss was <500 ml. Conversion to open surgery was required in two patients. Postoperative complications were prolonged ascites in two, peroneal palsy in two, and biloma in one. Mortality was zero. The embedded video demonstrates totally laparoscopic right anterior sectorectomy. In conclusion, our standardized techniques make laparoscopic anatomical hepatectomy more feasible.

Avulsion of the ischial apophysis. The case for open reduction and internal fixation

We report three cases of avulsion of the ischial tuberosity with marked chronic disability after delay in diagnosis and non-union of the fracture. All were treated by open reduction and internal fixation with return to full function, allowing in one case, athletic performances of Olympic standard. We also report one patient with an acute apophyseal avulsion treated by early reduction and internal fixation with restoration of full function.     

Primary adenocarcinoma of the urinary bladder: a single site analysis of 21 cases

Purpose

To investigate whether there is a difference between urachal and non-urachal adenocarcinomas in terms of patient survival and to determine the significant prognostic factors.

Methods

Thirty-four patients with histologically proven adenocarcinoma of the urinary bladder were treated at Huashan hospital between 1999 and 2010. 13 cases were excluded, including 12 patients with metastatic involvement from gastrointestinal or reproductive tracts and one without follow-up data after the initial consultation. Life tables, Kaplan–Meier, Cox regression analysis and log-rank test were used.

Results

The difference between patients with urachal adenocarcinoma and patients with non-urachal adenocarcinoma was not statistically significant using the Kaplan–Meier estimates (P = 0.0763). Clinical stage had a significant influence on survival (P = 0.0320, Fig. 2). Patients with surgical resection including partial and radical cystectomy did not have a better prognosis (P = 0.7992, Fig. 3). However, the difference is statistically significant between patients who received partial cystectomy and patients who received radical cystectomy (P = 0.0123, Fig. 4).

Conclusion

Survival of Patients with adenocarcinoma is correlated with clinical stage. Patients with urachal adenocarcinoma and non-urachal adenocarcinoma may have similar survival outcome. Tumor stage was a highly significant predictor of outcome (P = 0.0320). Surgical resection seems to be more important than chemotherapy in the cases of adenocarcinoma of the urinary bladder. We are in favor of radical cystectomy for all patients.     

Internal Pancreatic Stent Causing Irreversible Dilatation of Pancreatic Duct

A 28-year-old woman underwent a pylorus preserving Whipple procedure for pancreatic serous cystadenoma located on the head of the pancreas. During the operation, an internal stent (7F silastic catheter, 9 cm in length) was placed within the pancreatic duct in the area of pancreaticojejunal end-to-end Dunking type anastomosis to prevent development of fistula. The stent was positioned so that one third of its length would lie into the pancreatic duct, and it was anchored to the periductal pancreatic tissue with only one rapidly absorbable chromic suture. Leakage from the anastomosis was not observed, and she was discharged without any complaint. Early postoperative abdominal CT examination revealed that the stent was retained within the normal caliber pancreatic duct (Fig. 1a). Six months after the operation, she began to complain to epigastric pain triggered by the meals. The laboratory analysis was normal, particularly liver biochemical tests and serum amylase. The internal pancreatic stent within the dilated pancreatic duct was detected by an additional CT examination (Fig. 1b). The stent was removed endoscopically at the third attempt. The pain was resolved after its removal. Control CT examination which was taken at the 18th month after removal of the stent showed dilatation of the pancreatic duct (Fig. 2a). The patient remained free of any complaint, although regressed pancreatic duct dilatation has persisted over 4 years of follow-up (Fig. 2b).     

Pilot Study to Evaluate Feasibility of Image-Guided Breast-Conserving Therapy in the Advanced Multimodal Image-Guided Operating (AMIGO) Suite

Background

The rate of reexcision in breast-conserving surgery remains high, leading to delay in initiation of adjuvant therapy, increased cost, increased complications, and negative psychological impact to the patient.1 ^– 3 We initiated a phase 1 clinical trial to determine the feasibility of the use of intraoperative magnetic resonance imaging (MRI) to assess margins in the advanced multimodal image-guided operating (AMIGO) suite.

Methods

All patients received contrast-enhanced three-dimensional MRI while under general anesthesia in the supine position, followed by standard BCT with or without wire guidance and sentinel node biopsy. Additional margin reexcision was performed of suspicious margins and correlated to final pathology (Fig. 1). Feasibility was assessed via two components: demonstration of safety and sterility and acceptable duration of the operation and imaging; and adequacy of intraoperative MRI imaging for interpretation and its comparison to final pathology. Fig. 1

Schema of AMIGO trial     

Unusual presentation of sciatica in a 14-year-old girl

The sciatic nerve can be compressed by a variety of causes, while intervertebral disc herniation is the most common cause of sciatica [Surg. Neurol. 46 (1996) 14], other documented causes include, infection, neoplasm, degenerative disease of a spine, congenital anomalies and traumatic posterior hip dislocation [BMJ 287 (1983) 157]. Sciatic neuropathy in children is uncommon. We present an unusual case of sciatic nerve compression in a 14-year-old-girl that was caused by an avulsion fracture of the ischial tuberosity. The compression was relieved by surgical excision of the avulsed ischial tuberosity.     

Giant Fibroadenoma Masquerading as Cystosarcoma Phylloides in an Elderly Lady—A Case Report and Review of Literature

Cavernous haemangioma is a rare disorder of the spleen with fewer than 100 cases reported [1]. Spleen may have an unusual degree of mobility and occupy an atypical location in less than 0.2 % of all the patients [2] Wandering spleen has been associated with incomplete fusion or even absence of gastrosplenic and lienorenal ligaments [3]. A 36-year-old woman presented with a six-month history of pain in the left hypochondrium and a massive splenomegaly. Ultrasonography, Doppler studies, and computed tomography were performed. Ultrasonography showed a large heterogeneous solid cystic mass, measuring 11.2 cm × 10.6 cm, located in the pelvis. Thin soft tissue connecting this mass to spleen noticed. Spleen was malrotated & in left lumbar fossa. Doppler studies shows prominent vessels at the periphery of the mass with high velocity external flow and scanty vascularity at the centre, probably suggesting haemangioma. Contrast-enhanced computed tomography (CECT) of the abdomen showed spleen in left lumbar region with a large heterogeneous, predominantly cystic mass lesion measuring 11.2 x 10.6 cm seen arising from diaphragmatic surface of lower pole of the spleen (Fig. 1), findings were suggestive of wandering spleen with a haemangioma or a hydatid cyst. The patient was explored by a left para-median incision under general anaesthesia. Peroperatively, there was a malrotated enlarged spleen with a large solid lesion confined to the lower half of the spleen (Fig. 2). Gastrosplenic ligament was not visualized. Total splenectomy was done after ligating the splenic artery as the main splenic artery was supplying the mass.     

Reattachment of an avulsed distal biceps tendon in athletes

Refixation of the ruptured distal biceps tendon to the radial tuberosity in a two-incision technique restores power and function. Between 1995 and 1999 a refixation of the ruptured distal biceps brachii tendon on the tuberositas radii was performed in four athletes (three gymnasts and one American football player) using a two-incision-technique according to Boyd and Anderson (J Bone Joint Surg 43A:1041–1043, 1961) modified by Bourne and Morrey (Clin Orthop 271:143–148, 1991). The average age at surgery was 36 (23–48) years. The patients were followed up with a clinical examination and a questionnaire at an average of 82 (70–108) months postoperative. Flexion, extension and pronation was normal in all patients, although two patients had a reduction of forearm supination of 10° on the operated side. On a visual analogue scale, a subjective 5–10% reduction of forearm-flexion strength was reported by three patients. No decrease of flexion- or supination-strength was observed upon clinical examination. The subjective rating of the overall clinical outcome was “excellent” in three and “good” in one patient. Three patients rated “excellent” and one patient “good” according to the criteria of Rantanen and Orava (Am J Sports Med 27:128–132, 1999). We conclude that power and function can be restored through a refixation of the ruptured distal biceps tendon to the radial tuberosity in a two-incision technique. We recommend the method in athletes.     

Anatomical study of the proximal origin of hamstring muscles

Purpose

It is relatively well accepted that the long head of the biceps femoris and the semitendinosus both originate from the ischial tuberosity as a common tendon. However, it is also widely known that the biceps femoris is consistently injured more than the semitendinosus. The purpose of this study was to examine the origins of the hamstring muscles, to find an anatomic basis for diagnosis and treatment of injuries of the posterior thigh regions.

Materials and methods

Twenty-eight hips of fourteen adult Japanese cadavers were used in this study. In twenty hips of ten cadavers, the positional relationships among the origins on the ischial tuberosity were examined. In eight hips of four cadavers, histological examination of the origins of the hamstrings was also performed.

Results

The origin of the long head of the biceps femoris adjoined that of the semitendinosus. In the proximal regions of these muscles, the long head consisted of the tendinous part; however, the semitendinosus mainly consisted of the muscular part. Some of the fibers of the biceps tendon extended to fuse with the sacrotuberous ligament. The semimembranosus muscle broadly originated from the lateral surface of the ischial tuberosity.

Conclusion

The origins of the long head of the biceps femoris and the semitendinosus are found to be almost independent, and the tendon of the long head is partly fused with the sacrotuberous ligament. The high incidence of injuries to the long head of the biceps femoris could be explained by these anatomical configurations.     

Anal precancers: a challenge for surgeons and pathologists

Background: Precancerous changes in the anal area are diagnosed with increasing frequency in the Western world and represent a challenge for surgeons and pathologists. Methods: Review of literature based on Medline-search dated June 1994 and own literature register comprising 3100 articles on anal anatomy and pathology and related subjects. Results: Precancerous changes are oftenpart of a multicentric anogenital neoplasia and considerable evidence links them to venereal diseases. Symptoms are vague but risk groups can be identified. A rather conservative surgical approach seems justified, but close follow-up is necessary. Conclusions: A close collaboration between clinicians and pathologists is mandatory in treating precancerous changes. A recommendable procedure for this is outlined.     

Traumatic avulsion of the tuberosity of the ischium

The apophysis of the ischial tuberosity usually becomes united with the hipbone by 25 years of age. The highest incidence of avulsion in this region occurs between 15 and 17 years in young active persons. Apophysitis should be differentiated from apophyseolysis or an avulsion fracture of the ischial tuberosity. Apophysitis may be associated with chronic excessive sports activities in young men and women and is manifested by pain in the region involved. Its presence is confirmed by radiographic findings. The patient with an avulsion fracture of the ischial tuberosity reports an injurious event, usually a sudden movement during sports activities, associated with immediate pain. The diagnosis is again confirmed by radiology. Apophysitis is treated conservatively with no resulting problems. The poor healing of an avulsion fracture may result in chronic complaints, particularly painful sitting. This condition is treated by resection of the fractured apophysis. The authors describe the case of a 28-year-old man who complained of experiencing pain when sitting. At 20 years of age, he suffered an avulsion fracture of the ischial tuberosity that was treated conservatively. He was examined at our department and an unhealed fracture of the ischial tuberosity was diagnosed by radiology and computed tomography. The separated bony fragment was removed and the patient was followed up to 1 year. He remained free from any complaints. An avulsion fracture of the ischial tuberosity is an injury rarely reported in our as well as foreign literature. The available case reports are discussed.     

Complications in Brief: Quadriceps and Patellar Tendon Tears

Effective treatment of knee extensor mechanism disruptions requires prompt diagnosis and thoughtful decision-making with surgical and nonsurgical approaches. When surgery is chosen, excellent surgical technique can result in excellent outcomes. Complications and failures arise from missed or delayed diagnoses and from technical problems in the operating room. In particular, inappropriate surgical timing (especially late surgery), misplaced patellar drill holes, and failure to address concomitant injuries can result in complications seen when repairing a patellar or quadriceps tendon tear. We review the complications that can occur during treatment of these injuries (Table 1).

Multidisciplinary validation study of the da Vinci Skills Simulator: educational tool and assessment device

Despite the increased dexterity and precision of robotic surgery, like any new surgical technology it is still associated with a learning curve that can impact patient outcomes. The use of surgical simulators outside of the operating room, in a low-stakes environment, has been shown to shorten such learning curves. We present a multidisciplinary validation study of a robotic surgery simulator, the da Vinci^® Skills Simulator (dVSS). Trainees and attending faculty from the University of Toronto, Departments of Surgery and Obstetrics and Gynecology (ObGyn), were recruited to participate in this validation study. All participants completed seven different exercises on the dVSS (Camera Targeting 1, Peg Board 1, Peg Board 2, Ring Walk 2, Match Board 1, Thread the Rings, Suture Sponge 1) and, using the da Vinci S Robot (dVR), completed two standardized skill tasks (Ring Transfer, Needle Passing). Participants were categorized as novice robotic surgeon (NRS) and experienced robotic surgeon (ERS) based on the number of robotic cases performed. Statistical analysis was conducted using independent T test and non-parametric Spearman’s correlation. A total of 53 participants were included in the study: 27 urology, 13 ObGyn, and 13 thoracic surgery (Table 1). Most participants (89 %) either had no prior console experience or had performed <10 robotic cases, while one (2 %) had performed 10–20 cases and five (9 %) had performed ≥20 robotic surgeries. The dVSS demonstrated excellent face and content validity and 97 and 86 % of participants agreed that it was useful for residency training and post-graduate training, respectively. The dVSS also demonstrated construct validity, with NRS performing significantly worse than ERS on most exercises with respect to overall score, time to completion, economy of motion, and errors (Table 2). Excellent concurrent validity was also demonstrated as dVSS scores for most exercises correlated with performance of the two standardized skill tasks using the dVR (Table 3). This multidisciplinary validation study of the dVSS provides excellent face, content, construct, and concurrent validity evidence, which supports its integrated use in a comprehensive robotic surgery training program, both as an educational tool and potentially as an assessment device.

Caecum perforation after renal transplantation: a case report and review of literature

Gastrointestinal (GI) complication used to be the second most common complication in renal transplant patients after infection (Bardaxoglou et al. in Transpl Int 6(3):148–152, 1993). Review of transplant registry reveals that GI complication is no longer the second most common type of complication after renal transplant, but that it is still a common cause of significant amount of deaths in renal transplant recipients (De Bartolomeis et al. in Transpl Proc 37(6):2504–2506, 2005). In a study of 1,515 adults with severe GI complication after renal transplant, Sarkio et al. (Transpl Int 17(9):505–510, 2004) reported that gastroduodenal ulcers followed by colon perforation were the two biggest groups of GI complications during the first year after renal transplantation. Colonic perforation is estimated to occur in about 1 % of all cases of renal transplant patients, and it does predispose to potentially fatal complication. About 50 % of all colonic perforation is due to complication of acute inflammation of diverticular disease (Bardaxoglou et al. in Transpl Int 6(3):148–152, 1993; Guice et al. in Am J Surg 138(1):43–48, 1979; Koneru et al. in Arch Surg 125(5):610–613, 1990; Coccolini et al. in Transpl Proc 41(4):1189–1190, 2009). This is particularly so because these patients were previously exposed to uremia before transplantation which alters their protein metabolism hence interfering with tissue healing there after (Carson et al. in Ann Surg 188(1):109–113, 1978). GI complications including colon perforation after renal transplantation have effect on a patient’s long-term survival (Gil-Vernet et al. in Transpl Proc 39(7):2190–2193, 2007). Despite this, the role of renal transplantation medication compared to anatomic anomaly in GI complication has been equivocal.     

Laparoscopic Versus Open Reversal of a Hartmann Procedure: A Single-Center Study

Purpose

Re-anastomosis after a Hartmann procedure is associated with a higher morbidity and mortality than other elective colorectal operations. The goal of this comparative study was to evaluate whether laparoscopic reversal is a justified operative approach, although the initial operation is most often an emergency laparotomy.

Methods

A retrospective analysis was conducted on data collected on all 70 patients who underwent laparoscopic and open reversal of a Hartmann procedure at the Department of Surgery, University of Schleswig–Holstein, Campus Lübeck, between January 1999 and December 2011. Together with general demographic data, the analysis included the indication for the initial Hartmann procedure, time to reversal, intraoperative findings, the choice of operative method, operating time, postoperative pain control, return of normal bowel function, length of hospital stay, and peri- and postoperative morbidity and mortality.

Results

In most patients, the Hartmann procedure was performed after a perforated sigmoid diverticulitis. We were not able to find any statistically significant differences with respect to gender, body mass index (BMI) and American Society of Anesthesiologists classification between the laparoscopic group (LG) (N = 24 patients) and the open group (OG) (N = 46). In the LG, patients were significantly younger (p = 0.019). The median operating time was 210 min (75–245) in the LG, which was significantly longer than in the OG (166 min; 66–230). The statistical analysis of the duration of postoperative analgesic therapy (LG 7 days [6–10]; OG 12 days [6–30] ), return to normal diet (LG 3 days [2–6]; OG 4 days [2–10] ), return of normal bowel function (LG 3 days [2–4]; OG 4 days [2–9] ) and length of hospital stay (LOS) (LG 10 days [8–13]; OG 15 days [8–163]) detected significant differences in advantage for the LG. Unplanned return to theatre during index admission was only necessary in the OG (N = 7, 15.2 %). With a median follow-up of 8 months (range 1–20), we observed a comparable number of minor complications in both groups but a significantly higher number of major complications in the OG (N = 27, 58.7 %) (p = 0.001). Conversion occurred in three cases (12.5 %). There was no mortality in either of the two groups.

Conclusions

This study was able to demonstrate the feasibility of the laparoscopic approach. In terms of postoperative results it should be seen as equivalent to the open procedure. However, the laparoscopic approach requires profound surgical expertise. The indication should be made after a careful risk/benefit analysis for each individual patient.     

Radical but Conservative Liver Resection for Large Centrally Located Hepatocellular Carcinoma: The Mini Upper-Transversal Hepatectomy

Background

In patients with hepatocellular carcinoma (HCC) in a diseased liver, surgery should be offered in a parenchyma-sparing fashion. This approach seems unfeasible for large and deeply located lesions. Ultrasound study of the tumor-vessel relationship and hepatic inflow and outflow opens new technical solutions: herein is described a new operation based on this approach.1 ^– 3

Methods

A 69-year-old man with a large centrally located HCC (Barcelona Clinic Liver Cancer stage C) underwent surgery. The HCC was located in segments 7, 8, and part of 5, extensively compressing and dislodging the anterior (P5–8) and posterior (P6–7) Glissonean pedicles at their origin. The lesion involved the right hepatic vein (RHV) and was in contact with the middle hepatic vein at the caval confluence. An inferior RHV (IRHV) was preoperatively evident.

Results

After a J-shaped thoracophrenolaparotomy, the liver exploration with the aid of intraoperative ultrasound confirmed the tumoral contact without vascular invasion with P5–8 and P6–7 and disclosed multiple communicating veins between the middle hepatic vein and RHV, warranting with the IRHV the segment 5–6 outflows. A resection of segments 7 and 8 with RHV resection, together with complete tumor detachment from P5–8 and P6–7, was performed. The specimen was removed combining the crush-clamping method for the parenchyma division and a peeling-off technique by means of blunt scissor dissection for the tumor vessel detachment. The postoperative course was uneventful. The patient was alive without recurrence at 12 months after surgery.

Conclusions

This video is the first live demonstration of the previously reported radical but conservative policy, adding to the latter the technical solutions provided by detection of accessory veins such as the IRHV and communicating veins.1 ^– 4     

Transcutaneous P_{CO_2 } monitors are more accurate than end-tidal P_{CO_2 } monitors

Purpose

The accuracy of monitors for measuring transcutaneous $ P_{CO_2 } $ (Tc $ P_{CO_2 } $ ), end-tidal $ P_{CO_2 } $ (Et $ P_{CO_2 } $ ), and nasal Et $ P_{CO_2 } $ was evaluated.

Methods

The measuring devices included a Tc $ P_{CO_2 } $ monitor (TCM3; Radiometer Trading), an Et $ P_{CO_2 } $ monitor (Ultima; Datex-Ohmeda), and a nasal Et $ P_{CO_2 } $ monitor (TG-920P; Nihon Kohden). The sensor electrode of the TCM3 Tc $ P_{CO_2 } $ monitor was applied to the skin of the subject’s upper arm. A sampling tube attached to the proximal end of the tracheal tube was connected to the Ultima Et $ P_{CO_2 } $ monitor. The miniature sensor of the TG-920P nasal Et $ P_{CO_2 } $ monitor was attached to the nostril. The values obtained were compared with direct measurements of arterial $ P_{CO_2 } $ ( $ Pa_{CO_2 } $ ) obtained by means of an ABL700 blood gas analyzer (Radiometer Trading) in surgically treated patients. The means ± 2 SD of the differences between variables were calculated.

Results

The Tc $ P_{CO_2 } $ monitor (0.19 ± 4.8 mmHg, mean ± 2-SD) was more accurate than the Et $ P_{CO_2 } $ monitor (?4.4 ± 6.5 mmHg, mean ± 2-SD) in patients receiving artificial ventilation via an endotracheal tube and the Tc $ P_{CO_2 } $ monitor was also more accurate than the nasal Et $ P_{CO_2 } $ monitor (?6.3 ± 9.8 mmHg, bias ± 2-SD) in patients breathing spontaneously.

Conclusion

We found that the Tc $ P_{CO_2 } $ monitor was more accurate than the Et $ P_{CO_2 } $ or nasal Et $ P_{CO_2 } $ monitor in surgically treated patients.