A short wholly inside-out reversed vascular graft facilitating difficult aortic anastomosis

Aortic arch operations are sometimes very difficult because of their deep position, exposure limitation, and extensive involvement of the degenerative disease. We present a new technique derived from a modified elephant trunk technique to simplify some laborious situations.     

Epidural anaesthesia in paediatric surgery present status in the Hamilton general hospital

The use of epidural anaesthesia in paediatric surgery is presented as a continuation of the preliminary reports which were published in 1954 arid 1957. The technique of epidural block has been modified by the advent of Carbocaine and Nesacaine so that Xylocaine is no longer in a singular position. The introduction of the modified Wagner Point needle has added greatly to the safety and facility of epidural block. Continuous epidural anaesthesia has been used in prolonged serious abdominal operations A reply has been attempted to the criticism of paediatnc epidural anaesthesia Safety measures have been emphasized. The author believes that although epidural anaesthesia can hold a position in the practice of paediatnc anaesthesia, yet it should not be used unless all the members of the surgical team have confidence in its application     

New head fixation for the riechert stereotaxic system

The combined use of stereotaxic and microsurgical techniques makes it possible to minimize damage to critical nervous tissue during operations in subcortical regions. The Riechert stereotaxic system has been further modified. The patient's head is fixed in the new head ring with standard Mayfield pins. The headring is connected to a standard Mayfield clamp at symmetrical bearings at 0, 90, 180, and 270 degrees, which holds the head stable in any desired position and allows unhindered access to the cranial vault and skull base.     

妇科腹腔镜手术与体位有关的并发症及其防治

目的:探讨妇科腹腔镜手术与体位有关的并发症及其防治。方法:回顾性分析我院2003年3月至2005年5月122例妇科腹腔镜手术术中体位安置的体会。结果:均顺利完成手术,仅于腹腔镜手术开展初期出现术后肩部疼痛4例,神经损伤2例,体位性低血压2例。采取预防措施后90例手术未发生由于体位护理不当导致的术中、术后并发症及死亡病例。结论:术中合理安置患者体位,可有效减少与体位有关的并发症的发生。     

Anwendung der sitzenden Position in der Neurochirurgie Ergebnisse einer Umfrage aus 1998 in Deutschland

OBJECTIVES: This 1998 survey was carried out on the use of the sitting position for neurosurgical procedures in the posterior fossa and operations of the craniospinal and cervical spine region by the dorsal approach. In addition, anesthetic management of the sitting position and the compliance with recommendations of the Neuroanesthesia Study Group of the German Society of Anesthesiology and Intensive Care Medicine (DGAI) published in 1995 were investigated and compared to results of a 1995 survey. METHODS: A questionnaire was sent to 152 departments of anesthesiology in Germany providing anesthesia for neurosurgical procedures. 85 institutions (56%) responded to the survey, data from 78 hospitals were enrolled into the study. The sitting position was preferred for posterior fossa surgery by 45% of the neurosurgeons, for craniospinal operations by 35% and for cervical spine surgery by the dorsal approach by 39%. To 97% of the institutions the recommendations of the Neuroanesthesia Study Group of the DGAI were well known, 19% modified their anesthetic approach due to these recommendations. Recommendations of the Study Group on neuro-monitoring, in particular on the use of ultrasound (precordially or transoesophageally) for the detection of venous air embolism were followed by all institutions. 45% of the participants of the study preoperatively undertook diagnostic measures to preclude a probe-patent foramen ovale which predisposes the patient to paradoxical air embolism. CONCLUSIONS: The survey demonstrates that the use of the sitting position in German neurosurgery is still high when compared to other Western countries, but a tendency for decline over last 3 years can be observed from our data. In addition, our data appears to indicate a positive effect of the Study Group's recommendations on anesthetic management of the sitting position in neurosurgery.     

改良后外侧小切口在普胸手术中的应用

通过胸腔镜肺切除术的研究和临床应用，作者在３１１例普通外科手术中，采用改良的后外侧小切口。包括肺叶切除加淋巴结清扫１８６例，全肺切除术２３例，食管癌根治术２３例等。手术结果证实采用此切口避免切除或切断肋骨；避免大片胸壁肌肉的切断；明显地减少术后胸痛，肩关节活动障碍；减少出血和减少输血；大大缩短开、关胸时间。作者认为这是可行的切口，可以在开胸手术中广泛应用。     

Ist die Spinalanästhesie bei Eingriffen in Bauchlage ein empfehlenswertes Verfahren?

There is still controversy on the usefulness of spinal anesthesia for operations performed in the prone or jackknife position. There is about the risk of inadvertent increase of the sensomotory blockade with the patient in the prone position and the difficulty of managing consecutive cardiorespiratory complications or inducing general anesthesia in case of failures. This article reviews the current literature in terms of safety and effectiveness of spinal anesthesia for such operations. For lower-limb or perianal operations with limited extension and blood loss, performed in the prone position, spinal anesthesia seems to be a safe, effective and economic technique in patients without severe a cardiac history. Substantial knowledge about the onset time, fixation time, duration of sensomotory block and baricity of the applied local anesthetic is crucial in this setting. Obese patients are at risk for sudden extension of the block when turned into the prone position. Additional narcotics and sedatives should be avoided and continuous monitoring of hemodynamic and respiratory parameters, of the level of the blockade and vigilance of the patient is mandatory.     

Neurovascular lower extremity complications of the lithotomy position

The lithotomy position is commonly used during the performance of a variety of abdominal and pelvic operations. Previous publications reporting complications with these operations have been largely anecdotal. We report our experience with eight patients over the past four years who have suffered serious lower extremity complications following operations in which the lithotomy position was used. The average time in the lithotomy position for our patients was 7.4 hours (range: 3.7–12 hours). The mean interval between the original operation and the secondary operation to treat the lower extremity complication was 18.9 hours (range: 2–51 hours). The average hospital length of stay for these patients, 38.4 days (range: 11–119 days), was often prolonged as a direct result of their limb complication. Serious lower extremity complications may result from operations in which the lithotomy position is used. To prevent such complications, strict attention should be paid to the positioning of the limbs in the operating room and the time in the lithotomy position should be minimized. Perioperative monitoring of the lower extremity circulation and compartment pressures are essential in these patients since early detection and treatment of these complications is the only way to prevent permanent limb injury. Presented at the Fourteenth Annual Meeting of the Midwestern Vascular Surgical Society, September 14–15, 1990, Toledo, Ohio.     

Indications for the Bankart operation

This is a clinical and radiological follow-up on 61 patients operated upon between 1973 and 1983 according to the Bankart technique. In 84 per cent of all cases primary dislocation had taken place before the age of thirty. On an average 11 recurrent dislocations occurred before the operative procedure was performed. The radiological follow-up comprised X-rays in a.p. position with internal rotation of 60 degrees, in tangent plane according to Hermodsson as well as in dorsal tangent plane. In the modified score of Caroit and Cyprien 34 operations had excellent, 25 good, 2 moderate and 2 poor results (recurrent postoperative dislocation and deep infection). Neglecting those cases with severe deformation of the glenoid one can state that the Bankart technique offers fair results in the treatment of recurrent dislocation of the shoulder.     

Influence of maternal position during epidural labor analgesia

The influence of maternal position on the spread of local anesthetics in low concentration has not been well examined during epidural analgesia for labor. This study was designed to investigate the differences in sensory block, pain relief and incidence of supine hypotensive syndrome between parturients in the left lateral position and in a modified supine position. Sixty-seven parturients were randomly assigned to lie either in the left lateral position (n = 34) or in a modified supine position (n = 33), and received 0.125% bupivacaine 10 mL with epinephrine 1:800000 and sufentanil 7.5 microg. At 20 min parturients in the modified supine position turned to the left lateral position and a second investigator, unaware of the initial position, measured the extent of the sensory block at 20 and 30 min and just before a second epidural injection was requested. More dermatomes were blocked on the dependent side when the dose was injected in the left lateral position (at 20 and 30 min: P < 0.05; before the second epidural injection: P < 0.0005). In the modified supine position the incidence of bilaterally blocked dermatomes T10-L1 was greater at 20 and 30 min (P < 0.05) and the pain on a visual analogue scale was better at 30 min (P < 0.05). Three parturients in the modified supine position had signs and symptoms of supine hypotensive syndrome. We conclude that injecting in the modified supine position results in a more equal spread of local anesthetic and better pain relief.     

Pediatric cardiac surgery: an historical appreciation

Many of the early, classic pediatric cardiac surgical operations were named after their originators. Some of these continue to be performed in the original form, many in modified form and some are obsolete. The development of many of these important early operations is reviewed and they are placed in the context of their times.     

改良Hardinge小切口应用于髋关节置换术的解剖学及临床研究

[目的]通过尸体解剖确定臀上神经最下支(most inferior branch,MIB)的体表投影从而确定一个手术安全区域,依据这一解剖结果对Hardinge入路进行改良,并在临床中探讨改良入路的优势.[方法]解剖50具尸体双侧臀部(共计100侧),确定MIB的体表投影和手术安全区域.依据结果对Hardinge入路进行改良,并在3具尸体双侧臀部(共计6侧)上经改良Hardinge入路模拟手术,从而验证其安全性,然后应用于临床.[结果]MIB在体表的弧形投影线与股骨大转子外侧最凸点形成一解剖区域,内无重要血管神经分布,为手术安全区.依据安全区所改良的Hardinge入路模拟手术后,解剖均未发现MIB及其他明显神经血管损伤.临床应用26例,经10～28个月随访,平均18.6个月,术后患者均无神经损伤和外展肌力减弱的现象.[结论]MIB在体表的弧形投影线与股骨大转子外侧最凸点构成了一个手术安全区域,改良Hardinge入路在手术操作过程中均未超出此安全区域,不会损伤到MIB及其他重要神经血管,手术安全有效.     

Evaluation of efficacy and safety of optimized based on the ketamine modified neuroleptanalgesia during operations on the biliary tract and liver

A comparative analysis of efficacy and safety of the neuroleptanalgesia (NLA) and balanced general anesthesia during operations on the biliary tract and liver. Analysis of the results of comprehensive studies of hemodynamic, humoral homeostasis, liver function and clinical anesthesia showed that the optimized on the basis of ketamine modified NLA provides effective neurovegetative protection during operations on the organs of the hepatobiliary system, accompanied by obscure variations in the studied parameters. Traditional methods of the modified NLA is characterized by insufficient anesthesia, accompanied by pronounced physical inactivity circulation and a large number of "critical incidents".     

Collis gastroplasty: origin and evolution

In 1957 J. Leigh Collis published his innovative operation for treating the difficult problem of the irreducible hiatal hernia, esophagitis, and stricture. The design of the operation was based on the relatively primitive understanding of hiatal hernia and the newly emerging concept of reflux esophagitis. A variety of antireflux operations by different surgeons emerged over the years to follow. The original Collis gastroplasty has been subsequently modified with the addition of both partial and complete fundoplication procedures. The place of the modified Collis gastroplasty-fundoplication operations in today's approach to the problems of hiatal hernia and gastroesophageal reflux disease remains unsettled.     

Secondary reconstruction of the eye socket in a free flap transferred after complete excision of the orbit.

Reconstruction of the eye socket in a free flap transferred after complete excision for malignancy is difficult. Between 1980 and 2005 we secondarily reconstructed five eye sockets in free flaps after resection of cancer, cirsoid haemangioma, and the consequences of irradiation for retinoblastoma. Free flaps were used during the primary operations to cover the defects. The eye socket was then reconstructed during the secondary operations with a conventional skin graft in two cases, and with a skin graft using the modified Antia's method in three cases. All free flaps survived and all eye sockets accepted ocular prostheses. Three patients in particular, whose eye sockets were reconstructed using the modified Antia's method, had excellent results. Here we describe operations and problems related to secondary reconstruction of eye sockets in previously transferred free flaps after complete excision, and describe some typical cases.     

Secondary reconstruction of the eye socket in a free flap transferred after complete excision of the orbit

Reconstruction of the eye socket in a free flap transferred after complete excision for malignancy is difficult. Between 1980 and 2005 we secondarily reconstructed five eye sockets in free flaps after resection of cancer, cirsoid haemangioma, and the consequences of irradiation for retinoblastoma. Free flaps were used during the primary operations to cover the defects. The eye socket was then reconstructed during the secondary operations with a conventional skin graft in two cases, and with a skin graft using the modified Antia's method in three cases. All free flaps survived and all eye sockets accepted ocular prostheses. Three patients in particular, whose eye sockets were reconstructed using the modified Antia's method, had excellent results. Here we describe operations and problems related to secondary reconstruction of eye sockets in previously transferred free flaps after complete excision, and describe some typical cases.     

Intravenous fluid loading as prophylaxis for paradoxical air embolism

Paradoxical cerebral air embolism has been described in neurosurgical operations performed on patients in the seated position. This problem is thought to result most often from a probe-patent foramen ovale. It has been postulated that right atrial pressure exceeds left atrial pressure when paradoxical air embolism occurs. A study is described in which intravenous fluid loading is compared with routine fluid management in 20 patients undergoing neurosurgical operations in the seated position. In order to investigate if intravenous fluid loading would decrease the risk of paradoxical air embolism during neurosurgical operations on seated patients, 20 patients were assigned randomly to two groups: 10 patients received normal intravenous fluid replacement (1220 +/- 102 ml), and 10 received augmented fluid replacement (2800 +/- 400 ml). Right atrial and pulmonary capillary pressures were monitored for evidence of an interatrial pressure gradient that would force air emboli from the right atrium into the left atrium via a probe-patent foramen ovale. Four of 10 patients receiving routine fluid administration developed right atrial pressure greater than pulmonary capillary wedge pressure (and hence, indirectly, greater than left atrial pressure), whereas none of the 10 patients with augmented fluid loading developed this condition (p = 0.04). The authors conclude that augmented intravenous fluid loading may be effective in preventing systemic air embolism during neurosurgical operations performed on patients in the seated position.     

Surgical treatment of 4th degree frostbite of the extremities

The aim of the operative treatment of IV degree frostbite is not only to save the bone stump, but also to achieve its functional fitness after primary surgery or in future due to creation of favourable conditions for the following reconstructive operations. Dermo-plastic operations, both well-known and modified ones were used. The experience of the authors includes 347 patients.     

Vacuum-stiffened beanbag for cranial remodeling procedures in modified prone position. Technical note

In surgical correction of multiple-suture synostosis, placing the patient in the modified prone position permits access to the calvarium from the supraorbital ridge to the occipital bone below the transverse sinus. The modified prone position thereby enables surgeons to perform cranial remodeling procedures at one stage under direct vision, contributing to improved surgical results. However, no satisfactory head-frame for this position has been available. The authors report the successful use of a vinyl bag filled with styrofoam beads to achieve the modified prone position in young children. This widely available, economical device provides a safe, reliable means of positioning the child's head for cranial remodeling procedures.