Percutaneous endoluminal grafts for AAA repair in the catheterization laboratory

Background Percutaneous abdominal aortic aneurysm(AAA) repair has been previously described using the "preclose"technique and general endotrachial anesthesia (GA).     

Use of CO2 to move structures as an aid to percutaneous procedures

By injecting small amounts of CO2 through a needle, one can move bowel or bladder from the intended path of instruments during interventional procedures. The technique worked well in six of seven cases in the pelvis and retroperitoneum; it was not effective in the mediastinum or midabdomen (n = 6).     

Radiographic changes induced after cervical facet radiofrequency denervation

BACKGROUND CONTEXT: Paraspinal infections after zygapophyseal (facet) radiofrequency denervation (RFD) are a serious but rare complication of this procedure. We are aware of only one case report of an epidural abscess after facet joint injection. PURPOSE: To report post-procedure inflammatory changes after cervical facet RFD. STUDY DESIGN: Case report. PATIENT SAMPLE: A 35-year-old Caucasian female. METHODS: Retrospective case review. RESULTS: The patient underwent cervical RFD and was admitted to the hospital 7 days after her procedure with severe neck pain. Magnetic resonance imaging (MRI) with contrast revealed what appeared to be evidence of a paraspinal muscle abscess although blood tests were negative. She was treated with antibiotic therapy, yet she never developed systemic signs of infection. A follow-up MRI without contrast revealed no evidence of infection, and she was discharged home on hospital day 6. At her first follow-up visit, she was still experiencing scalp pain and paraspinal muscle spasm. During subsequent follow-up visits, she has continued to improve clinically without experiencing signs of infection. Another follow-up MRI 6 weeks after her discharge home revealed persistent minimal left paraspinal enhancement at C2-3, possibly representing post-procedure granulation tissue with no evidence of abscess. CONCLUSIONS: Post-procedural MRI findings after radiofrequency lesioning can resemble radiographic findings associated with a paraspinal abscess. Patients with radiographic findings consistent with abscess should only be treated if clinical signs or symptoms of systemic infection are present.     

外科手术中产生的烟气:仅仅是大量的热空气吗?

外科医生和手术室人员经常接触手术设备产生的烟气,病人也会暴露于烟气中,特别是腹腔镜手术中产生的烟气滞留于腹腔内这一密闭空间并被吸收.这些烟气是一种与香烟烟气相似的毒性物质,然而对这种毒性物质的影响还未引起足够重视.应该采取必要措施尽可能减少手术中烟气的不良影响.     

Calciphylaxis – a topical overview

'Calciphylaxis', a calcification syndrome associated with ischaemic cutaneous necrosis, is acquired naturally in humans in disease states. It is a life and limb-threatening complication, usually observed in patients with renal disease and secondary hyperparathyroidism, but known to occur in the absence of renal or parathyroid disease. The reported mortality rate, which ranges from 60-80%, relates to wound infection, sepsis and organ failure. It is a small-vessel vasculopathy, which is estimated to occur in about 4% of haemodialysis patients. Clinically, violaceous, reticulate areas of cutaneous necrosis and eschar may be evident, particularly in the extremities. In addition to the clinical picture, a raised calcium phosphorous product, an elevated parathyroid hormone level, radiographic evidence of vessel and soft-tissue calcification and the finding of mural calcification affecting small arteries and arterioles on histopathology help to confirm the diagnosis of this entity which generally has a poor prognosis. A high index of suspicion and an active multidisciplinary management approach, with rigorous attention to wound care and prevention of sepsis, are vital in the management of these patients. In this overview, we discuss the pathophysiology, clinical features and associations, risk factors, diagnosis and management issues relating to calciphylaxis.