Montgomery T-tube: anesthetic management

The Montgomery T-tube is a device used as a combined tracheal stent and airway after laryngotracheoplasty. It is a valuable option in the management of upper and mid-tracheal lesions. Because its use is sporadic, many anesthesiologists may not be familiar with this device, and its anesthetic management may pose a challenge. Safe management of such patients requires careful planning. We describe different techniques of anaesthetic management in two cases of injuries to the throat, for which this tube was inserted as a tracheal stent.     

Pneumatosis intestinalis after laparoscopic appendectomy: case report and review of the literature

Pneumatosis intestinalis (PI) is the presence of intraluminal gas within the wall of the intestine. As a marker for bowel injury owing to mucosal injury, PI may herald a severe underlying disease process in patients without a significant medical history. In other cases, PI is a benign process, and expectant management is appropriate. Here, we present the first reported case of pneumatosis associated with postoperative abscess after appendectomy and its successful management. Then, we describe the pathophysiology of pneumatosis and review the literature regarding its origin and management.     

Paraplejía tardía transitoria tras reparación de aneurismas torácico y toracoabdominal

Thoracoabdominal aneurysm requires multidisciplinary management due to its complexity both in surgical technique and anesthetic considerations. One of the most feared postoperative complication is spinal cord ischemia. It can be presented as different clinical patterns, and its recovery may be partial or complete. The postoperative management of spinal cord ischemia is mainly based on techniques to increase spinal cord perfusion, above all, hemodynamic stability and cerebrospinal fluid drainage. We present two cases of delayed paraplegia after an open repair of a thoracoabdominal aneurysm and a descending thoracic aortic aneurysm repair using an endovascular stent graft. They both had a complete neurological recovery after cerebrospinal fluid drainage.     

脓胸——术后——复张性肺水肿

此案报告63岁老年女性患左侧脓胸,实施脓胸扩清术发生复张性肺水肿(reexpansion pulmonary edema,RPE)的诊疗过程.在给予患者限制液体入量、利尿及药物治疗后,患者病情得到稳定和改善.RPE是胸科手术少见的术后并发症,鉴于其突发性以及存在不同程度的低氧血症、低血压或休克,对其诊断和处理应引起麻醉医师的重视.     

脓胸——术后——复张性肺水肿

此案报告63岁老年女性患左侧脓胸,实施脓胸扩清术发生复张性肺水肿(reexpansion pulmonary edema,RPE)的诊疗过程.在给予患者限制液体入量、利尿及药物治疗后,患者病情得到稳定和改善.RPE是胸科手术少见的术后并发症,鉴于其突发性以及存在不同程度的低氧血症、低血压或休克,对其诊断和处理应引起麻醉医师的重视.     

The evolving role for surgery in the management of nonseminomatous testicular carcinoma

Summary Once the only therapy available for locoregional disease extension, the approriate role for surgical management by retroperitoneal lymphadenectomy (RPND) of nonseminomatous germ cell testicular cancer is now being redefined in an algorithm of management comprising several modalities. Nerve-sparing techniques for RPND have overcome a substantial hesitancy for its continued utilization. Its continued use in low stage disease provides both therapeutic and diagnostic benefit; its role in relation to surveillance protocols will be defined. For bulky disease, node dissection is best reserved after induction chemotherapy; the need for surgery after such chemotherapy will be reviewed.     

Ipsilateral proximal and flexion supracondylar humerus fracture with an associated olecranon fracture in a 4-year-old child: a case report

Isolated supracondylar fractures of the humerus are relatively common in children, often occurring after a fall on an outstretched hand. The combination of a supracondylar fracture with a proximal humerus fracture and olecranon fracture is a very rare occurrence and its optimal management is unclear. We report a child of 4 years of age who underwent fixation of these injuries with a good outcome. This case is reported for its rarity and its management. Complete diagnostic evaluation is imperative to avoid missed injuries and achieve satisfactory outcome.     

RECURRENT TRAUMATIC SPLENIC RUPTURE TWO YEARS AFTER NON-OPERATIVE TREATMENT OF SPLENIC TRAUMA

Non-operative and conservative surgical management are now the preferred methods of treatment for blunt splenic trauma in children and adults. These conservative strategies evolved as the risk of late septic complications following splenectomy for trauma became apparent. Although recurrent splenic trauma following conservative management of the ruptured spleen is rare, its surgical management may pose some difficult problems. We present a case in which a second episode of splenic trauma required surgery, two years after the successful non-operative management of the first splenic injury.     

Primary mediastinal seminoma

A case of primary mediastinal seminoma in a 25-year-old man is being presented in view of its rarity. The diagnosis was established only after thoracotomy and excision. Further management comprised irradiation and chemotherapy. Possible theories of aetiopathogenesis, clinical profile, staging, and management are discussed along with a brief review of literature.     

Recurrent transitional cell carcinoma in a scrotal abscess

We discuss a case of recurrent transitional cell carcinoma to the scrotum 5 years after cystectomy, along with its postoperative management and implications.     

Acute isolated volar dislocation of the distal radio-ulnar joint: Case report and literature review

The acute isolated distal radio-ulnar (DRU) dislocation is a rare traumatic pathology and no consensus concerning its management has been established. This case report describes an acute isolated volar DRU dislocation in a 26-year-old patient. The authors propose, based on this case and after an exhaustive review of the literature, a non-operative management for these isolated and non-complicated dislocations.     

Bilateral Chylothoraces Without Chyle Leakage After Left-Sided Neck Dissection for Thyroid Cancer: Report of Two Cases

Bilateral chylothorax is a rare complication of neck dissection, but it is potentially serious and sometimes life threatening. Because of the rarity of chylothorax, surgeons are unfamiliar with its early signs, which allow a prompt diagnosis and effective management. Most cases reported in the literature were associated with a concurrent external chyle leakage, which occurred either during or after surgery. We report two cases of bilateral chylothoraces without concurrent external chyle leakage, which occurred after left-sided neck dissections for thyroid cancer. We treated both patients successfully with conservative management.     

Hemodynamic resuscitation of the brain-dead organ donor and the potential role of vasopressin

The pathophysiological changes that occur after brain death lead to a progressive deterioration in organ function. The limited number of organs available for transplantation has increased interest in the use of marginal donors and highlighted the importance of appropriate donor management, particularly hemodynamic resuscitation. Although the use of vasopressin has an obvious role in the management of diabetes insipidus, its vasoactive properties are also of benefit in the management of the multiorgan donor.     

Late thrombosis of a drug-eluting coronary stent after antiplatelet therapy discontinuation

We reported the late thrombosis of a drug-eluting coronary stent related to discontinuation of antiplatelet therapy for venous surgery of the right leg more than half and a year after its implantation. After this acute myocardial infarction, a cardiac assistance device has to be used as a bridge to transplantation because of end stage ischaemic cardiopathy. Antiplatelet therapy management must be revisited for eluting stents, which can clot lately after its implantation.     

An unusual lesion on the chest wall

Osteoradionecrosis is an exceptional complication after the treatment of breast carcinoma. We report here a 63-year-old woman who presented with osteoradionecrosis of the sternum 17 years after initial treatment for breast cancer. Difficulty in diagnosing the lesion and its management is discussed.     

Endovascular management of abdominal aortic aneurysm: a critical analysis on the DREAM, EVAR 1 and EVAR 2 randomized controlled trials

Fourteen years after its introduction in clinical practice and being subject to a large and widespread utilization, the endovascular management of the abdominal aortic aneurysm was evaluated through controlled randomized trials, to assess its efficacy facing the conventional open surgery. The results of these trials, recently published in the international literature, are the subject of a critical analysis by the author, who concludes that they are so significantly important that will probably influence the future, the indications and the range of utilization of the endovascular management of the abdominal aortic aneurysm.     

Postthoracotomy pain management problems

Pain after thoracotomy is very severe, probably the most severe pain experienced after surgery. Thoracic epidural analgesia has greatly improved the pain experience and its consequences and has been considered the standard for pain management after thoracotomy. This view has been challenged recently by the use of paravertebral nerve blocks. Nevertheless, severe ipsilateral shoulder pain and the prevention of the postthoracotomy pain syndrome remain the most important challenges for management of postthoracotomy pain.     

Should vacuum-assisted closure therapy be routinely used for management of deep sternal wound infection after cardiac surgery?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether vacuum-assisted closure (VAC) should be routinely used for management of deep sternal wound infection after cardiac surgery. Altogether, 198 papers were identified using the reported search. A further three relevant papers were identified by hand searching reference lists. Thirteen papers represented the best evidence on the topic. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated. We conclude that VAC provides a viable and efficacious adjunctive method by which to treat postoperative wound infection after cardiac surgery. It is especially useful for managing sternal osteomyelitis in high-risk patients and is an attractive option as a first-line therapy in this group of patients. However, currently the evidence to endorse its routine use for management of deep sternal wound infection after cardiac surgery is weak. A randomised controlled trial comparing VAC therapy with the conventional treatment is mandatory to validate its safety, efficacy, and cost effectiveness as a routine first-line therapy for management of deep sternal wound infection after cardiac surgery.     

Intrathoracic gastrojejunostomy for gastric outlet obstruction after Ivor Lewis esophagogastrectomy

Gastric outlet obstruction after esophagogastrectomy with a drainage procedure is unusual, but when encountered, its management can be formidable. A Rous-en-Y intrathoracic gastrojejunostomy was created in a 74-year-old woman 2 years after Ivor Lewis esophagogastrectomy for benign disease to treat severe gastric outlet obstruction at the native pylorus.     

Double J catheter loop as consequence of endourologic procedure: case report

We present a report of a patient that had a iatrogenic double J catheter loop after endourology procedure (neumatic balloon dilatation of ureteral estenosis) as well as its therapeutic management.