False-positive computed tomographic findings in a series of 525 patients with acoustic neuromas

In our series of 525 patients operated on for acoustic neuroma, there were three false-positive computed tomography findings resulting in unnecessary surgery. The histories and results of laboratory investigations and surgery are presented. Discussion of the outcome had gadolinium-enhanced magnetic resonance imaging been performed is presented.     

Laparoscopic closure of mesenteric defects after Roux-en-Y gastric bypass

Two case reports are presented of incarcerated small-bowel internal hernias through mesenteric defects following Roux-en-Y gastric bypass surgery (one case each of open and laparoscopic). Both patients first presented to physicians unfamiliar with bariatric surgery complaining of vague, cramping midabdominal pain, and the correct diagnosis was not revealed until laparoscopic surgery was performed. Treatment then resulted in quick recoveries. This type of hernia can evade radiologic testing. Prompt clinical recognition and treatment is necessary to prevent small-bowel infarction.     

Anesthesia in a patient with chromosome 11;22 translocation: a case report and literature review

Chromosome 11;22 translocation is a rare genetic condition, which results in characteristic features some of which may present problems when these children require surgery and anesthesia. We describe a child with this chromosomal variant who presented for surgery and anesthesia. The case report and review of the literature is presented here.     

Wound problems in surgery for talipes equinovarus

The traditional treatment for talipes equinovarus (TEV) has been open surgery in many units around the world. The complication rates for primary corrective surgery are relatively small but may affect outcome significantly. The complications of surgery in relapsed TEV are more frequent than for primary surgery, and problems relating to wound healing present difficult challenges to the treating surgeon. An overview of the approaches to management of this still challenging condition are presented, and the factors involved in wound healing problems and strategies for their prevention and treatment are presented. In particular, the belated but rapid spread worldwide of the Ponseti nonoperative approach to treating talipes is the most important factor in reducing the rates of surgery and therefore the complications that may ensue.     

Urologic complications of hip arthroplasty

Significant intrapelvic injuries from routine hip surgery are rare but may result in long-term urologic morbidity. Two illustrative cases are presented with attention given to the close anatomic proximity of the intrapelvic structures to the hip joint and their potential for injury after hip surgery. A review of similar cases with their management is presented.     

Endovascular approach to treating secondary arterioureteral fistula

Two patients with the rare entity of arterio-ureteral fistula are presented. Both highlight the predisposing factors of radiation, major surgery in the region, history of vascular surgery and presence of double-J-stent. Both patients presented with the clinical sign of intermittent gross hematuria. Both patients were successfully treated by endovascular intervention using graft covered stent.     

Oncoplastic surgery of the breast: rationale and experience of 30 cases

A definition of oncoplastic surgery of the breast is presented, and its objectives and advantages over the usual conservative procedures are discussed. The oncological safety of these procedures are demonstrated, especially in surgery of larger tumors. Technical possibilities are discussed and a classification of the procedures presented. Data from 30 cases operated in our institution are depicted. The need for better training of the breast surgeon is discussed and the advantages of the same surgeon to perform the whole procedure presented.     

Aortic surgery in the presence of cholelithiasis. Should simultaneous cholecystectomy be performed?

From 1984 to 1987, a cholecystectomy for biliary lithiasis was carried out at the same time as aortic vascular surgery in 21 patients. Seventy six percent of patients presented an abdominal aortic aneurysm and 24% occlusive atherosclerosis. Thirty eight percent had previously presented symptoms related to biliary lithiasis. Biliary surgery was conducted after closure of the retroperitoneum. The gall bladder region was drained separately. The technique did not increase operative morbidity or mortality. Combined cholecystectomy and vascular surgery depends on two arguments. Firstly, patients with stones present a higher risk of post-operative cholecystitis. Secondly, a significant percentage of non-cholecystectomized patients will present with biliary symptomatology in the months following vascular surgery.     

The scleral yoke suture for anterior segment surgery

A safe effective method of global control during anterior segment surgery is presented. The method used in 1184 consecutive cases was the scleral yoke traction suture adapted from a method often used in strabismus surgery. The incidence of postoperative ptosis severe enough to require surgical correction is presented in that group as well as in a group of 591 consecutive cataract extractions utilizing the classic superior rectus traction surgery. The principle advantages of this method as compared to the classic superior rectus traction suture are pointed out, with emphasis on the reduction of postoperative ptosis.     

Endoluminal repair of aneurysms associated with coarctation

BACKGROUND: Late aneurysm formation is a well-recognized complication of surgery for aortic coarctation. Open surgery to repair these aneurysms is associated with significant morbidity and mortality. Endoluminal repair is an attractive alternative to open surgery. METHODS: Data were collected prospectively on consecutive patients who presented with aneurysms associated with coarctation RESULTS: Between June 1999 and October 2001, 5 patients underwent elective endoluminal repair for coarctation aneurysms. All procedures were technically successful and no patients died. Four patients previously had open surgery to repair aortic coarctation, and 1 presented with an aneurysm associated with a previously unrecognized coarctation. The median follow-up was 7 months (range, 3 to 29 months), and to date, all aneurysms remain excluded. CONCLUSIONS: Endoluminal repair is a promising alternative to redo open surgery for thoracic aneurysms associated with previous surgery for aortic coarctation. Long-term follow-up is required to assess the durability of the stent grafts.     

Endless story of a spinal column hydatid cyst disease: A case report

We describe a case of multifocal relapsing hydatid cyst following multilevel thoracic corpectomy and 360° instrumentation surgery. A 41-year-old male patient presented with cord compression and paraplegia due to a multiseptated cystic lesion at T10-11 level. The cyst was excised with a combined anterior and posterior approach and 360° stabilization was performed. The patient received albendazole for 1 year after the surgery.The patient presented with paraparesis 5 years after the surgery. Cystic lesions between C2-T1 and T10-11 were detected on the spinal MRI and the patient was operated with removal of the lesions on both levels and adjuvant local 20% hypertonic saline application. The patient received albendazole for the postoperative 6 months.After 3 months from the surgery, the patient’s paraparesis recovered. There was no recurrence after 2 years from the last surgery.     

Airway complication following functional endoscopic sinus surgery

Difficulty breathing after upper airway surgery requires immediate evaluation and treatment. We present a case of airway compromise after sinus surgery due to edema of the uvula. The patient was admitted for observation overnight and discharged the next day. A discussion of potential airway changes after sinonasal surgery is presented.     

Prostatic disease: H. Marberger,et al., Eds., Liss,New York, $22.50

A case of a broken pin from previous orthopedic hip surgery which perforated into the bladder is presented. A review of other urologic complications of orthopedic surgery are included.     

Profound bilateral deafness complicating aortic arch surgery

Hearing loss is a rare complication of cardiac surgery; bilateral profound deafness has never been reported in this setting. A 45-year-old male presented with profound bilateral sudden deafness following arch surgery and frozen elephant trunk. Patient’s presentation, surgery details and aetiological mechanisms are discussed.     

腹股沟疝日间手术患者护理模式的探讨与分析

目的探讨与分析日间手术治疗腹股沟疝患者的护理模式。 方法回顾性分析2017年1月至2019年1月,首都医科大学附属北京朝阳医院疝和腹壁外科就诊的3266例腹股沟疝日间手术患者。其中,儿童疝患者1111例（34.0%）,成人疝患者根据手术方式不同分为开放组和腹腔镜组。开放组患者1256例（38.46%）,腹腔镜组患者例899（27.54%）,记录全部患者围手术期护理的并发症与相应的处理对策。 结果所有患者手术过程顺利,儿童疝组围手术期出现尿浸湿伤口敷料24例（2.2%）,活动后出现伤口敷料脱落13例（1.2%）,急性疼痛21例（1.9%）;成人疝组围手术期出现排尿困难48例（2.2%）,急性疼痛69例（3.2%）,发热33例（1.5%）,体位性低血压12例（0.6%）,恶心呕吐20例（0.9%）;所有成人组患者围手术期出现特殊事件5例（0.2%）,术后转普通病房7例（0.3%）,夜间再次急诊就诊11例（0.5%）。所有患者随访期间均未出现伤口感染、液化等并发症。 结论在日间手术治疗腹股沟疝患者的围手术期中,良好的腹股沟疝日间手术护理模式,以及定期密切的随访,能显著提升临床治疗效率,有助于减少患者围手术期并发症的发生及早日康复。     

强直性脊柱炎胸腰椎后凸畸形患者行后路截骨矫形术气管及气管导管位置变化的临床观察

目的:观察经椎弓根截骨术（pedicle subtraction osteotomy, PSO）治疗强直性脊柱炎（ankylosing spondylitis, AS）胸腰椎后凸畸形患者手术前后门齿距气管隆突距离（length of incisors to carina, LIC）及气管隆突距气管导管尖端距离（leng...     

Regional anesthesia for ambulatory foot and ankle surgery

Regional anesthesia provides significant advantages for the patient and practitioner involved in ambulatory foot and ankle surgery. Reliable techniques for administering regional ankle blocks emphasizing their importance in the practice of ambulatory surgery are presented.     

Rapid preparation of a patient with pheochromocytoma with labetolol and magnesium sulfate

PURPOSE: To describe the rapid perioperative optimization and control of blood pressure in a young patient who presented with pheochromocytoma. He was non-compliant with phenoxybenzamine but insisted on early surgery. He was scheduled for laparoscopic resection of the tumour. CLINICAL FEATURES: This 32-yr-old man presented with uncontrolled hypertension for a few years for which he was treated with nifedipine. He subsequently defaulted follow-up. The patient presented again approximately three months from the day of surgery and was diagnosed to have a pheochromocytoma. The endocrinologist prescribed phenoxybenzamine and propanolol in addition to the nifedipine but the patient stopped taking both drugs six weeks prior to surgery due to their side effects. The patient was admitted the evening before surgery to the intensive care unit for rapid control of his blood pressure. Blood pressure was optimized with an infusion of labetolol and volume expansion titrated under central venous catheter and intraarterial blood pressure guidance throughout the night. On the morning of surgery, a magnesium sulfate infusion was started. The laparoscopic surgery proceeded uneventfully and the patient was hemodynamically stable. There were two transient periods of hypotension after induction and at removal of tumour respectively which were corrected with a brief adrenaline infusion. No adverse outcome was noted. CONCLUSION: This case highlights the possibility of a more rapid perioperative control of pheochromocytoma using high doses of labetolol and a magnesium sulfate infusion to achieve stable intraoperative hemodynamics during laparoscopic resection of pheochromocytoma.     

Multimodal intraoperative monitoring during surgery of spinal deformities in 217 patients

A prospective study was performed on 217 patients who received MIOM during corrective surgery of spinal deformities between March 2000 and December 2005. Aim is to determine the sensitivity and specificity of MIOM techniques used to monitor spinal cord and nerve root function during corrective spine surgery. MIOM is becoming an increasingly used method of monitoring function during corrective spine surgery. The combination of monitoring of ascending and descending pathways may provide more sensitive and specific results giving immediate feedback information regarding any neurological deficits during the operation. Intraoperative somatosensory spinal and cerebral evoked potentials combined with continuous EMG and motor evoked potentials of the spinal cord and muscles were evaluated and compared with postoperative clinical neurological changes. A total of 217 consecutive patients with spinal deformities of different aetiologies were monitored by means of MIOM during the surgical procedure. Out of which 201 patients presented true negative findings while one patient presented false negative and three patients presented false positive findings. Twelve patients presented true positive findings where neurological deficit after the operation was predicted. All neurological deficits in those 12 patients recovered completely. The sensitivity of MIOM applied during surgery of spinal deformities has been calculated of 92.3% and the specificity 98.5%. Based upon the results of this study MIOM is an effective method of monitoring the spinal cord and nerve root function during corrective surgery of spinal deformities and consequently improves postoperative results. The Wake-up test for surgical procedure of spinal deformities became obsolete in our institution.

     

Suture line ulcers after gastric surgery.

Four cases of suture line ulcers after gastric surgery caused by nonabsorbable suture material are presented. The literature is reviewed, and a plea ia made for the use of absorbable suture materials in gastrointestinal surgery.