Pneumothorax revealed by postoperative computed tomography

We report a case of pneumothorax revealed by postoperative computed tomography. A 39-year-old obese woman (height 153 cm, weight 70 kg) with fractures of the radius, ulna, clavicle, and femur in a traffic accident, was scheduled for osteosynthesis. Anesthesia was induced with thiopental and maintained with 50% nitrous oxide in oxygen and sevoflurane. The Spo2 decreased from 99% to 94% during the surgery. Bilateral chest sounds were symmetrical. The Spo2 increased to 100% after discontinuation of nitrous oxide. Pneumothorax was not evident on a postoperative chest X-ray, but computed tomography of the chest demonstrated right-sided pneumothorax. An ECG electrode had overlapped the fractured rib on the preoperative chest X-ray.     

Acute cholecystitis in the early postoperative period

The authors observed 6 patients, who developed acute cholecystitis at day 2--5 after the operation. In 3 patients, an operation on the abdominal organs was performed, in 3--the urologic intervention. The leading symptoms of postoperative cholecystitis are the following: epigastric pain, stable intestinal paresis, high body temperature. The authors recommend a wide use of the ultrasound investigation of the abdominal cavity, and in its negative results, or in absence of the apparatus--laparoscopy. All the patients were reoperated. One patient died.     

Protean appearance of craniopharyngioma on computed tomography.

Craniopharyngiomas present a diverse appearance on computed tomography. Histological diagnosis is not always possible, but computed tomography is of great assistance in the delineation of the tumour as well as of the degree of associated hydrocephalus. Computed tomography also enables rapid non-invasive follow-up after surgery or radiotherapy, or both.     

Contrast-enhanced computed tomography scanning of the postoperative spine

A prospective study of contrast-enhanced computed tomography (CT) scanning was undertaken for 17 levels previously operated upon in the lumbosacral spine in 14 patients. All levels with prior operations were scanned before and after the administration of intravenous contrast medium. A standardized technique for contrast enhancement using high doses of intravenous contrast medium was employed and a specialized technique for measuring enhancement with corrections for scan artifacts was used. Results indicated that measurable contrast enhancement occurred in 16 of 17 postoperative scars up to 12 years after surgery. Enhanced scans provided more accurate delineation of the size and margins of postoperative scarring than precontrast scans. No instances of enhancement of normal disk or recurrent herniated disk were observed. In six instances recurrent herniated disks were predicted on the basis of contrast-enhanced CT scans and subsequently confirmed at reoperation. Contrast-enhanced CT scans meticulously performed appear to permit differentiation between scarring and disk herniation in patients with recurring symptoms after operations for lumbosacral disk disease.     

Comparison of biomaterials in the early postoperative period

Background: Laparoscopic hernia repair necessitates the use of biocompatible materials. A prospective, double-blind study was conducted to compare two different polypropylene meshes. Methods: The study included 40 men with primary inguinal hernia undergoing transabdominal preperitoneal polypropylene mesh repair. In 20 of these men, a monofile, heavy-weight, rigid mesh was implanted (group A), and in the remaining 20 men, a smooth, heavy-weight variant of polypropylene mesh was implanted (group B). Complications, pain development, inability to work, physical conditions, testicular volume, and blood circulation were documented. Results: Reconvalescence in group A was slower than in group B. In group A, the postoperative values of the visual scales for pain development were higher; inability to work was 7.3 days longer; urologic disorders were worse; activities of everyday life were more reduced; and SF-36 data showed a significant reduction of physical problems (p < 0.05). Conclusions: The polypropylene mesh variant seems to be more compatible with the human organism than conventional mesh. Not only the material, but also the structure seems to influence the comfort of the mesh.     

Anterior cervical myelopathy in the early postoperative period

Purpose

The onset of anterior cervical myelopathy in the early postoperative period is an unusual complication after cardiac surgery without extracorporeal circulation in which haemodynamic stability was maintained. We report a patient who developed anterior cervical myelopathy after cardiac surgery.

Clinical features

A 53-yr-old man with no serious associated medical problems underwent cardiac surgery without extracorporeal circulation to repair a ruptured left ventricle. Haemodynamic stability was maintained throughout the procedure but the patient developed flaccid paraparesis and dissociated sensory loss, three hours later Early recognition of the clinical picture and prompt initiation of steroid treatment facilitated a successful outcome. The definitive diagnosis was based on magnetic resonance findings days after surgery.

Conclusion

The onset or aggravation of neurological symptoms in the postoperative period may be avoided by thorough search for medullary pathology in the patient’s background and by using particular care when performing manoeuvres dunng the penoperative period, not only to ensure haemodynamic stability, thus preserving medullary perfusion, but also to avoid mechanical compression of a spinal segment.     

Acute gastroduodenal ulcers in the early postoperative period

Clinical observations of 146 surgical patients have confirmed high informative value of fibrogastroduodenoscopy which could reveal ulcerations in 69% of the patients examined and thus choose the adequate treatment. A thorough study of acid-forming function of the stomach as well as determination of activity of lysosomal enzymes of the gastric juice has shown that hyperacidic state of the mucosa and high activity of alcaline phosphatase of the gastric juice may be considered as risk factors of the formation of acute ulcers.     

Hyperglycemic syndrome at the early postoperative period

An analysis of treatment of 141 patients with hyperglycemic syndrome at the early postoperative period was made, which was 1.3% of all the patients operated on during this period. Inflammatory postoperative complications took place in 30 (21.3%) patients in the group of patients with hyperglycemic syndrome. It suggests that hyperglycemia at the early postoperative period should be considered not simply as criterion of a severe state, but also as a factor having a direct influence on the course of the pathological process. So, these patients should be given sugar-decreasing therapy with monitoring of the glucose level.