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61.
62.
BACKGROUND: Paraplegia and peripheral nerve injuries may arise after general anaesthesia from many causes but are easily ascribed to central block if the latter has been used. CASE REPORT: A 56-yr-old woman, with Bechterev disease but otherwise healthy, was operated with left-sided thoracotomy to remove a tumour in the left lower lobe. She had an epidural catheter inserted in the mid-thoracic area before general anaesthesia was started. Bupivacaine 0.5% 5 ml was injected once and the infusion of bupivacaine 0.1% with 2 micrograms/ml fentanyl and 2 micrograms/ml adrenaline (5 ml/h) started at the end of surgery. The patient woke up with total paralysis in the lower limb and sensory analgesia at the level of T8, which remained unchanged at several observations. Laminectomy, performed 17 h after the primary operation, showed a large piece of a haemostatic sponge (Surgicel) compressing the spinal cord, which was then decompressed but the motor and sensory deficit remained virtually unchanged both then and a year later. CONCLUSIONS: This case shows--once again--that although central blocks may cause serious neurological complications and paraplegia, other causes are possible and have to be considered. However, all patients with an epidural catheter must be monitored for early signs and symptoms of an intraspinal process and the appropriate treatment has to be instituted instantly. 相似文献
63.
Anatomy and physiology of the male urethral sphincter and its preservation in prostatic surgery 总被引:2,自引:0,他引:2
Radical prostatectomy is commonly used in the management of localized prostate cancer. Urinary incontinence after prostatectomy
is of great concern to many patients. Improved understanding of the anatomy of the external urethral sphincter complex has
resulted in a statistically significant decrease in the incidence of postprostatectomy incontinence. Most recent anatomic
studies have described the external urethral sphincter complex as consisting of an intrinsic rhabdosphincter surrounding the
smooth musculature of the urethra and an extrinsic sphincter incorporating the levator ani muscle and the pelvic floor. Both
form a condensed striated muscle ring around the membranous urethra. Preservation of as much as possible of the normal anatomy
of the sphincter mechanism and its nerve supply results in an excellent return to continence after radical prostatectomy.
Received: 26 February 1999 / Accepted: 20 May 1999 相似文献
64.
Bhandari AK 《Indian journal of pediatrics》1996,63(5):609-613
Radiofrequency (RF) catheter ablation has ushered in a new era in the management of patients with symptomatic tachyarrhythmias.
By providing the ability to cure the underlying arrhythmic substrate, RF catheter ablation obviates the need for life-long
antiarrhythmic drugs. In the reported series, the success has been high and the complications have been infrequent and relatively
minor. Not unexpectedly, RF catheter ablation has become the treatment of choice for patients with symptomatic paroxysmal
tachyarrhythmias. The role of radiofrequency catheter ablation in infants and small children remains controversial, and awaits
a larger experience and longer follow-up data. 相似文献
65.
A psychophysiological evaluation of female urethral syndrome: Evidence for a muscular abnormality 总被引:4,自引:0,他引:4
A. M. Bernstein H. C. Philips W. Linden H. Fenster 《Journal of behavioral medicine》1992,15(3):299-312
This is a preliminary investigation into a recently defined urological disorder occurring in a subgroup of women with urethral syndrome suggestive of pelvic floor muscular (PFM) dysfunction. Symptoms include straining to void, urgency, frequency, hesitation, incontinence and/or retention, and subpubic pain. Finding neither bladder nor urological abnormalities, urologists may consider these women emotionally unstable without organic cause for their symptoms. However, their distress may be a consequence rather than a cause of their voiding problems. Sixteen female urological patients were matched with 16 asymptomatic controls to investigate PFM functioning, psychological status, and symptomatology. Results showed heterogeneity of symptomatology and little elevation of depression or anxiety when comparing patients with controls. Hypotheses of muscular abnormality were confirmed. Patients evidenced poor control over tensing and relaxing PFM, elevations of PFM activity under various conditions, and chronic pain as a prominent symptom. Treatment approaches specifically designed to address PFM dysfunction are discussed. 相似文献
66.
Embolization with “Ethibloc” of vascular tumors and arteriovenous malformations in the head and neck
Summary Ethibloc has been used almost exclusively until now for embolization of tumors and bleeding vessels in the liver and kidney. Unlike with Gelfoam-particles, there is no recanalization. The resorption occurs so slowly that there is no interference with the necrosis of the embolized tumor. Due to its low viscosity, it passes catheters with thin lumina and fills the capillary bed of the tumor without danger of reaching the venous vessels. In this paper we describe a new technic of percutaneous catheter-embolization with Ethibloc using a coaxial catheter which we believe enhances safety and effectiveness. It has been successfully used in five patients. In the meantime two more patients have been treated successfully.Presented in part at the 17th Annual Meeting of the German Society of Neuroradiology, 9–10 October 1981 in Tübingen, FRG. 相似文献
67.
T. Akagi K. Hashino Y. Maeno M. Ishii T. Sugimura T. Kawano H. Kato 《Pediatric cardiology》1997,18(1):61-63
Using a commercially available 5F deflectable radiofrequency catheter, we have succeeded in percutaneous valvotomy of an
imperforate pulmonary valve and consecutive balloon dilatation in a baby with pulmonary atresia and intact ventricular septum.
After the procedure, right ventricular systolic pressure fell from 125 mmHg to 65 mmHg, and right ventriculography demonstrated
anterograde blood flow into the pulmonary arteries. There were no major complications. Doppler echocardiography at 1 year
after the procedure demonstrated a pressure gradient across the pulmonary valve of 20 mmHg with mild pulmonary and tricuspid
regurgitations. 相似文献
68.
Augusto Ferrari MD Luigi Frigerio MD 《American journal of obstetrics and gynecology》1997,177(6):1426-1431
OBJECTIVE: We describe an alternative sling procedure that permits concomitant correction of urethral hypermobility and urinary incontinence through a single surgical exposure. STUDY DESIGN: Fifteen women with severe urinary stress incontinence and urethral hypermobility underwent a sling procedure by creation of a simple triangular patch from the anterior vaginal wall. RESULTS: The mean operative time for the vaginal sling procedure was 38 minutes (range 29 to 65 minutes) in addition to other operations. The mean postoperative hospital stay was 7.7 days (range 5 to 13 days) and all patients were routinely discharged with an indwelling Foley catheter. Spontaneous micturition occurred in 12 patients after a mean period of 25 days (range 13 to 36 days). In three cases long-term catheterization was necessary. By subjective and objective evaluations, all the patients were cured of their stress incontinence. CONCLUSION: The triangular vaginal patch with the single sutures on each side provides an alternative approach for bladder neck stabilization that may permit a more anatomic suspension of a hypermobile urethra.(Am J Obstet Gynecol 1997;177:31) 相似文献
69.
中心静脉置管在肿瘤内科的用途及价值探讨 总被引:9,自引:0,他引:9
目的探讨中心静脉置管在肿瘤内科的用途及其价值,以满足肿瘤内科给药的多种特殊需求.方法以一次性中心静脉导管经锁骨下穿刺置管于上腔静脉末端.结果中心静脉置管用于治疗20种中晚期癌症患者482例,13种特殊用药所需399例(82.8%);肺癌和肺部转移癌为增加肺部药物持续浓度130例(27.0%);外周静脉条件差难以顺利给药127例(26.3%);需长期输液24例(5.0%);为避免外周静脉化疗的痛苦、不便和静脉炎或曾发生静脉炎,患者要求13例(2.7%);外周静脉留置针失败后1例(0.2%).结论经锁骨下中心静脉置管在肿瘤内科用途甚广,可满足多种病种给药的多种特殊需求,既有助于提高疗效减轻副作用,又可避免外周静脉给药的痛苦和不便及其局部并发症,有助于改善患者生活质量,值得推广. 相似文献
70.
Percutaneous transcatheter embolization of splanchnic artery aneurysms is a minimally invasive and alternative therapy to
conventional surgical intervention. Due to a high-grade stenosis at the origin of the celiac trunk, a retrograde approach
to the celiac trunk pseudoaneurysm via the gastroduodenal artery was necessary. To prevent undesirable embolization into the
peripheral left gastric artery initial occlusion of the central portion of the left gastric artery was performed with microcoils
using a Tracker catheter. Complete occlusion of the celiac trunk itself and the short adjacent segments of the celiac artery
was achieved by using a mixture of N-butyl-2-cyanoacrylate and ethiodized oil as the embolizing agent.
Received: 22 June 1999; Revised: 7 September 1999; Accepted: 1 October 1999 相似文献