Missed Inadvertent Gastrointestinal Injuries during Abdominal Operations: Characteristics, Diagnosis, and Treatment

2012 ◽  
Vol 78 (1) ◽  
pp. 46-50 ◽  
Author(s):  
Wisam Khoury ◽  
Subhi Abu-Abeid ◽  
Benjamen Person ◽  
Joseph M. Klausner ◽  
Yehuda Kariv
Keyword(s):  
Gastrointestinal Tract ◽  
Rare Complication ◽  
Laparoscopic Approach ◽  
Contrast Study ◽  
Abdominal Operations ◽  
Gastrointestinal Leak ◽  
The Mean ◽  
Type Of Injury ◽  
Selection Of Patients ◽  
Selection Of

Inadvertent gastrointestinal tract injuries (IGITI) during abdominal operations increase postoperative morbidity. Common mechanisms for this type of injury are not well-defined. The risk factors associated with an increase in missed IGITI during elective abdominal surgery and a possible strategy that may contribute to early diagnosis were not previously evaluated. Between 1998 and 2006, all the patients who underwent a subsequent laparotomy within 30 days of an index operation were identified. Patients reoperated for missed IGITI, defined as perforation at sites other than previous anastomosis or bowel repair, were collected. Data pertaining to patients, disease, and primary operations’ characteristics, as well as reoperation findings and outcomes were studied. Methods of diagnosis of perforation for each particular patient were assessed. Thirty-two patients (15 females, 17 males) underwent a second operation for gastrointestinal tract leak within 30 days of an index surgery due to missed IGITI. The mean age was 59.5 ± 18.2 years (range 21–87). The average time between the first and second operation was 5.3 ± 3.5 days (range 1–13). Adhesions (27 patients), previous operations (20 patients), and laparoscopic approach (13 patients) were the most commonly documented factors that may result in missed IGITI. Diagnosis of gastrointestinal leak due to missed IGITI was made clinically in 12 patients. Twenty patients underwent contrast study before reoperation. Careful selection of patients and type of surgery in addition to awareness of this rare complication may decrease the frequency of missed IGITI, lead to earlier diagnosis, and possibly improve outcomes.

Introduction of helical computed tomography affects patient selection for V/Q lung scan

2002 ◽  
Vol 41 (02) ◽  
pp. 91-94 ◽  
Author(s):  
G. Zettinig ◽  
S. Baudrexel ◽  
Th. Leitha
Keyword(s):  
Computed Tomography ◽  
Helical Computed Tomography ◽  
Lung Scan ◽  
The Mean ◽  
Low Probability ◽  
Selection For ◽  
Lung Scanning ◽  
Selection Of Patients ◽  
Selection Of

Summary Aim: Retrospective analysis for determination of the effect of helical computed tomography (HCT) on utilization of V/Q lung scanning to diagnose pulmonary embolism (PE) in a large general hospital. Methods: A total number of 2676 V/Q scans of in- and out-patients referred to our department between March 1992 and December 1998 and between April 1997 and December 1998 were analyzed by an identical group of nuclear physicians. Results: Neither the total number of annually performed V/Q scans (446 ± 135) nor the mean age of patients (56 years ± 17) changed significantly since the introduction of HCT. However, the referral pattern was different. The percentage of patients with high and intermediate probability for PE decreased significantly from 15.2% to 9.4% (p < 0.01) and from 10.2% to 7.3% (p < 0.05), respectively. Low probability scans significantly increased from 37.8% to 42.7% (p < 0.05). The percentage of normal scans did not change significantly, however, there was a highly significant increase summarizing patients with normal and low probability scans (74.6% to 83.3%; p < 0.01). Conclusion: The introduction of HCT affected the selection of patients referred for V/Q lung scanning since V/Q scanning was primarily used to exclude rather to confirm PE.

scholarly journals Cognitive Outcomes for Essential Tremor Patients Selected for Thalamic Deep Brain Stimulation Surgery Through Interdisciplinary Evaluations

2020 ◽  
Vol 14 ◽  
Author(s):  
Jacob D. Jones ◽  
Tatiana Orozco ◽  
Dawn Bowers ◽  
Wei Hu ◽  
Zakia Jabarkheel ◽  
...  
Keyword(s):  
Working Memory ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Verbal Memory ◽  
Significant Interaction ◽  
Cognitive Outcomes ◽  
The Mean ◽  
Selection Of Patients ◽  
Selection Of ◽  
Deep Brain

Objective: Deep brain stimulation (DBS) targeted to the ventral intermediate (VIM) nucleus of the thalamus is effective for motor symptoms in essential tremor (ET), but there is limited data on cognitive outcomes. We examined cognitive outcomes in a large cohort of ET DBS patients (pre-DBS and 1+ year after DBS).Methods: In a retrospective analysis, we used repeated-measures ANOVA testing to examine whether the age of tremor onset, age at DBS surgery, hemisphere side implanted with lead, unilateral vs. bilateral implantations, and presence of surgical complications influenced the cognitive outcomes. Neuropsychological outcomes of interest were verbal memory, executive functioning, working memory, language functioning, visuospatial functioning, and general cognitive function.Results: We identified 50 ET DBS patients; 29 (58%) males; the mean age of tremor onset was 35.84 (±21.50) years with a median age of 38 years. The mean age at DBS was 68.18 (±10.07) years. There were 37 unilateral 30 left, seven right, and 13 bilateral brain implantations. In the subgroup analysis, there was a significant interaction between assessment (pre vs. post) and age of tremor onset (&lt;38 vs. &gt;38 years); F(1,30) = 4.47; p = 0.043 for working memory. The post hoc testing found improvements for younger onset ET. Similarly, there was a significant interaction between assessment (pre vs. post) and complications vs. no complications subgroups; F(1,45) = 4.34; p = 0.043 for verbal memory with worsening scores seen for ET patients with complications. The remaining tests were not significant.Conclusion: In this large cohort of ET patients with (&gt;30% improvements), DBS was not accompanied by a significant decline in many cognitive domains. These outcomes were possibly related to the selection of patients with normal cognitive functioning before surgery, unilateral DBS implantations for the majority, and selection of patients with optimal response to DBS.

scholarly journals Training, Skills and Approach to Potentially Difficult Anaesthesia in General Practitioner Anaesthetists

1994 ◽  
Vol 22 (6) ◽  
pp. 706-709 ◽  
Author(s):  
R. W. Watts ◽  
M. Bassham
Keyword(s):  
General Practitioner ◽  
General Practitioners ◽  
Obstetric Anaesthesia ◽  
Disease States ◽  
Skeletal Myopathy ◽  
The Mean ◽  
Grade 3 ◽  
Safe Approach ◽  
Selection Of Patients ◽  
Selection Of

Seventy-six of the 92 practising South Australian rural general practitioner anaesthetists responded to a questionnaire on anaesthetic training, skills and approach to potentially difficult anaesthesia. The mean training period in anaesthesia was 7.5 months, 24% at registrar level. Eight per cent had no training, and 40% had 3 months or less. Thirty-three per cent trained exclusively overseas and 13% hold a Diploma in Anaesthesia. A total of 11,400 anaesthetics were performed by 76 general practitioners in 1992 at an average of 152 (range 2 to 1500). The mean visual analog “comfort score” in performing anaesthesia was 6.6 and correlated best with the number of procedures per year (r = 0.32, P = 0.03). Forty-six per cent of general practitioners provided anaesthesia for the 0 to 12 month age group, and only 35% had regional skills to use in obstetric anaesthesia. Patients classified as ASA grade 3 to 5, disease states such as unstable angina, severe asthma, and risk factors such as skeletal myopathy, were avoided by most general practitioners. The failed intubation rate was 50/10,000. The conclusion is that South Australian general practitioner anaesthetists exhibit a generally safe approach to selection of patients for anaesthesia, although in some instances the approach to potentially difficult anaesthesia should be more conservative.

Determination of enteroglucagon in plasma for detection of celiac disease in children.

1984 ◽  
Vol 30 (1) ◽  
pp. 77-80 ◽  
Author(s):  
A F Kilander ◽  
L Stenhammar ◽  
G Lindstedt ◽  
P A Lundberg
Keyword(s):  
Celiac Disease ◽  
Intestinal Biopsy ◽  
Gastrointestinal Disorders ◽  
Small Intestinal Biopsy ◽  
The Mean ◽  
Small Intestinal ◽  
Untreated Celiac Disease ◽  
Selection Of Patients ◽  
Selection Of

Abstract To evaluate the plasma enteroglucagon assay as a test for the detection of celiac disease, we have determined basal and postprandial concentrations of enteroglucagon in plasma of children who underwent small-intestinal biopsy because of suspected celiac disease. In the 14 children with untreated celiac disease both basal [81 (SD 33) pmol/L] and postprandial [129 (SD 26) pmol/L] concentrations of enteroglucagon were significantly higher (p less than 0.001) than in the 45 children with other gastrointestinal disorders [24 (SD 9) pmol/L, and 50 (SD 22) pmol/L, respectively] and in the 15 children without gastrointestinal disorders [14 (SD 10) pmol/L, and 35 (SD 8) pmol/L, respectively]. All children with celiac disease had either basal or postprandial plasma enteroglucagon concentrations exceeding the mean + 2 SD of the results for the children with other gastrointestinal disorders. Eight of 10 children with celiac disease in whom both concentrations were measured had increased values for both. In our study the sensitivity for detection of celiac disease was 100% and the specificity 97%. Evidently determination of plasma enteroglucagon concentration is effective in diagnosing celiac disease, thereby improving the selection of patients for small-intestinal biopsy.

scholarly journals THE RESULTS OF 600 TRANSANAL ENDOSCOPIC SURGERIES OF RECTAL ADENOMAS AND ADENOCARCINOMAS

2019 ◽  
Vol 18 (3(69)) ◽  
pp. 20-40
Author(s):  
E. A. Khomyakov ◽  
S. V. Chernyshov ◽  
E. G. Rybakov ◽  
O. A. Maynovskaya ◽  
Yu. A. Shelygin
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
R0 Resection ◽  
Safe Method ◽  
Mean Size ◽  
The Mean ◽  
Mean Time ◽  
Russian Medical ◽  
Selection Of Patients ◽  
Selection Of

AIM: transanal endomicrosurgery (TEM) is the method of choice for local excision of rectal cancer. The presented series of patients is collected prospectively and is the largest of the published in the Russian medical periodicals. PATIENTS AND METHODS: six-hundred patients [average age ±σ 59.8±9 (31-90) years old; 375/600 (62.5%) – women]with rectal adenomas and adenocarcinomas, who underwent TEM in 2011-2019. RESULTS: the mean size of the removed tumors was 3.4±1.5 cm (0.5-10.0). R0 resection was performed in 571/600 (95.2%) of the cases. The complication rate was 3.6% (22/600). Pathomorphological study of the removed specimens revealed adenoma in 450/600 (75.0%) patients, adenocarcinoma in 150/600 (25.0%) cases. The mean time of observation of patients with adenomas was 38.4±25.1 months, with adenocarcinomas – 33.4±23.8 months. The rate of local recurrence in adenomas was 4.5%. Loco-regional recurrence of adenocarcinoma pT1 after TEM was revealed in 6.8% of patients and 30% of pT2 patients without adjuvant treatment. CONCLUSION: TEM is an effective and safe method of treatment of rectal adenomas. With rectal cancer, a thorough selection of patients is required.

scholarly journals Endoprothesis of the Ankle Joint at Defeat by Tumours of Distal Part of Tibia

2011 ◽  
Vol 18 (4) ◽  
pp. 32-36
Author(s):  
V A Sokolovskiy ◽  
M D Aliev ◽  
Anatoliy Vladimirovich Sokolovskiy ◽  
P S Sergeev ◽  
V A Sokolovsky ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Ankle Joint ◽  
Functional Result ◽  
Tumor Resection ◽  
Distal Tibia ◽  
Reconstructive Operations ◽  
The Mean ◽  
Selection Of Patients ◽  
Selection Of

In a current of two years with 2008 for 2010, to six patients with primary malignant and aggressively benign bone tumors of the distal tibia executed six operations, in value of tumor resection with the subsequent reconstruction of defect by an ankle joint endoprosthesis. In group of patients there were five males and one female, with a mean age of 30 years. Among the treated patients 2 were with an osteosarcoma, 2 with Ewing's sarcoma and 2 with giant cell tumor. The mean duration of follow-up after the operation was 14,7 months (7 to 28). Reconstruction of the distal tibia defect was carried out using oncological modular endoprosthesis of the ankle joint. Common free of recurrence surviving during 2,4 years was 83%. Progressing of the primary disease is revealed in 50 % in the form of occurrence of the remote metastasis in lungs. A mean functional result assessed with the using of the MSTS system and consisted 75%. During the whole period of supervision no patient of six had complications such as periprosthesis infection, instability of a design of endoprosthesis or its fracture. At one patient with the diagnosis an osteosarcoma, through a floor of year after endoprosthesis, revealed a local recurrence during the spent of conservative treatment, in communication, with what amputation has been executed. For achievement of good clinical and functional result observance of indications to carrying out of reconstructive operations of area of an ankle joint, careful selection of patients taking into account effect on the spent conservative treatment is necessary.

Selection of patients for portal-systemic shunts

JAMA ◽  
1966 ◽  
Vol 196 (12) ◽  
pp. 1039-1044 ◽  
Author(s):  
R. E. Hermann
Keyword(s):  
Selection Of Patients ◽  
Selection Of

Perioperative acute internal carotid thrombosis after general surgery

2020 ◽  
Vol 99 (3) ◽  
pp. 136-140
Keyword(s):  
Cardiac Surgery ◽  
Internal Carotid ◽  
Right Hemicolectomy ◽  
Diagnostic Assessment ◽  
Left Carotid Artery ◽  
Perioperative Stroke ◽  
Internal Carotid Occlusion ◽  
Acute Brain Ischemia ◽  
Selection Of Patients ◽  
Selection Of

Introduction: The average incidence of perioperative stroke during major non-cardiac surgery is less than 1%, suggesting that it is rarely a major problem for the vast majority of patients. Methods: In our paper we present a 46-year-old patient undergoing acute right hemicolectomy who developed right-sided hemiparesis in the perioperative setting. Immediate CTAg examination showed an ischemic stroke in the left hemisphere as a result of left internal carotid thrombosis. A surgical procedure to recanalize the left carotid artery was performed 14 hours from the onset of neurological symptomatology and the neurological deficit gradually recovered fully. Conclusion: Our case report supports studies showing that a thorough diagnostic assessment allows the selection of patients who may benefit from urgent revascularization of acute internal carotid occlusion during the phase of acute brain ischemia.

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