scholarly journals Vascular anatomical considerations in preparing colonic flaps to replace the oesophagus

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Amr Abdelhamid AbouZeid
Keyword(s):  
Postoperative Complications ◽  
Transverse Colon ◽  
Oesophageal Atresia ◽  
Single Case ◽  
Standard Technique ◽  
Pedicled Flap ◽  
Vascular Pedicle ◽  
Middle Segment ◽  
Essential Step ◽  
Rare Occasion

Abstract Background The colon is among the best options to substitute the oesophagus; it is well known for its durability and good function that makes it most suitable for paediatric patients. The steps of the procedure, postoperative complications, and outcome assessment were thoroughly discussed in previous reports. However, in this report, we have tried to focus on one basic and essential step of the operation, which is fashioning of the colonic flap used to substitute the oesophagus. Results The study included 50 consecutive paediatric cases who underwent colonic replacement of the oesophagus during the period 2010 through 2020. The indication for oesophageal replacement was either oesophageal atresia (27 cases) or corrosive strictures (23 cases). Our standard technique was using a middle segment of the colon (transverse colon) based on the left colic vessels (vascular pedicle) after ligation of middle colic vessels. Variations of the middle colic vessels were encountered that included single, double, or absent vessels. In a single case (2%), the middle colic vessels were multiple, short, and non-branching with interrupted continuity of marginal vessels at that point. In the latter situation, we had to use a different technique by fashioning a right colonic flap based on the middle colic vessels. Conclusion In colonic replacement of the oesophagus, preparing a pedicled flap from the transverse colon based on the left colic vessels was almost always feasible owing to the stable collateral marginal vessels. On a rare occasion, the marginal vessels were interrupted by disturbed anatomy of the middle colic vessels when we had to shift to another technique using a right colonic flap.

scholarly journals Clinical trial for comparison of clinical performance of I-Gel with LMA-proseal in elective surgeries

2020 ◽  
Vol 11 (4) ◽  
pp. 5350-5356
Author(s):  
Amit B. Kadam ◽  
Jamale P B
Keyword(s):  
Clinical Trial ◽  
Postoperative Complications ◽  
Lower Incidence ◽  
Clinical Performance ◽  
Standard Technique ◽  
Lower Airway ◽  
Postoperative Sore Throat ◽  
Clinically Significant ◽  
Sealing Pressure ◽  
Pressure Changes

The I-gel is genuinely interesting second era aviation route gadget with delicate gel like non inflatable sleeve. The objective of this study was to evaluate and compare the ease of insertion and number of insertion attempts, airway sealing pressure, and evaluation of device position and occurrence of complication. Total70 adult patients were allocated to either i-gel group or P-LMA group with 35patients in each group. Both i-gel and P- LMA were introduced with standard technique. The outcomes measured ease of insertion, number of insertion attempts, airway sealing pressure, changes, evaluation of device position and complications. the i-gel group the success rate at ease of insertion was greater (97% vs72% respectively;P=0.012). Airway sealing pressure was lesser (24.72±1.37 cmH2Ovs 30.09±2.64 cmH2O respectively; P=0.0003). The incidence of postoperative sore throat was lower (2.8% vs 25.7% respectively;P=0.01). Changes in parameters were not clinically significant. The i-gel is easier to insert than P-LMA however with a lower airway sealing pressure. It has a lower incidence of postoperative complications.

scholarly journals Risk Factors for Postoperative Complications after Percutaneous Nephrolithotomy

2018 ◽  
Vol 16 (1) ◽  
pp. 79-83 ◽  
Author(s):  
Robin Bahadur Basnet ◽  
Anil Shrestha ◽  
Parash Mani Shrestha ◽  
Bishwa Raj Joshi
Keyword(s):  
Postoperative Complications ◽  
Percutaneous Nephrolithotomy ◽  
Scoring System ◽  
Operative Time ◽  
Standard Technique ◽  
Diabetic Patients ◽  
Staghorn Calculi ◽  
Stone Burden ◽  
Major Complications ◽  
A Prospective Study

Background: To identify the perioperative factors associated with complications after percutaneous nephrolithotomy by classification of complications according to the modified Clavien scoring system and evaluation of the minor and major complications related to the procedure.Methods: A prospective study of all the percutaneous nephrolithotomy performed by standard technique within 1.5 years at Bir Hospital was made. Possible demographic, preoperative and intraoperative variables were included in the study and patients were followed up postoperatively for any complications. All complications were classified according to modified Clavien scoring system and analyzed to identify the prognostic variables.Results: Two hundred and forty six percutaneous nephrolithotomy done within the study period were analyzed. Although 41.06 % of the study population developed complications, only 9.35 % had major complications. Age, body mass index, gender, clinical presentation, history of previous surgery and ASA score did not correlate with complications. Diabetes was the only comorbidity associated (p = 0.0482). Preoperatively estimated stone burden (p = 0.0023), number of calyces involved by the stones (p = 0.0002), and presence of staghorn calculi were significantly associated with development of postoperative complications. Multiple tracts were required (p = 0.0151) and operative time was longer (p < 0001) in the patients who developed complications.Conclusions: Percutaneous nephrolithotomy has lesser complications. Diabetic patients are more prone to develop complications. Larger stone burden, involvement of multiple calyces by stones and staghorn calculi are associated with need of multiple tracts and longer operative time, thus predisposing to higher incidence of complications.

scholarly journals AN UNSUTURED MESENTERY DEFECT AFTER COLON GRAFT FORMATION IN ESOPHAGOPLASTY IN CHILDREN

2019 ◽  
Vol 23 (5) ◽  
pp. 238-242
Author(s):  
M. G. Chepurnoy ◽  
Gennady I. Chepurnoy ◽  
V. I. Averin ◽  
L. N. Nesteruk ◽  
Yu. M. Grinevich ◽  
...  
Keyword(s):  
Transverse Colon ◽  
Vascular Pedicle ◽  
Abdominal Complications ◽  
X Ray ◽  
The Right ◽  
Scar Contraction

Purpose. To decrease the number of complications at the intra-abdominal stage of total esophagoplasty in children by leaving a mesentery defect unsutured after the graft formation. Material and methods. 27 children with atresia (4) and scar contraction (23) of the esophagus had esophagoplasty with a colon left-side graft on a vascular pedicle including a. colicamed; a.colicasin and the arcade between the first sigmoid artery were ligated and cut. The graft was placed behind the sternum in the antiperistaltic position. A “window” in the mesentary of the transverse colon was left unsutured after the graft formation. Basic techniques for examination - X-ray and endoscopy. An anastomosis “end of the esophagus to the side of the colon graft” was always formed at the neck level. Results. Due to the unsutured mesentary of the transverse colon, surgeons avoided all intra-abdominal complications which may develop, if the mesentary is sutured. The right side of the colon remained intact ; neck-anastomosis fistulas were seen only in 2 (9%) patients.

scholarly journals COMPLICATIONS REQUIRING HOSPITAL MANAGEMENT AFTER BARIATRIC SURGERY

2015 ◽  
Vol 28 (suppl 1) ◽  
pp. 3-6 ◽  
Author(s):  
Aline WRZESINSKI ◽  
Jéssica Moraes CORRÊA ◽  
Tainiely Müller Barbosa FERNANDES ◽  
Letícia Fernandes MONTEIRO ◽  
Fabiana Schuelter TREVISOL ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Postoperative Complications ◽  
Hepatic Steatosis ◽  
Standard Technique ◽  
Female Gender ◽  
First Year ◽  
Frequent Complication ◽  
One Year

Background: The actual gold standard technique for obesity treatment is the Roux-en-Y gastric bypass. However, complications may occur and the surgeon must be prepared for them. Aim: To evaluate retrospectively the complications occurrence and associated factors in patients who underwent bariatric surgery. Methods: In this study, 469 medical charts were considered, from patients and from data collected during outpatient consultations. The variables considered were gender, age, height, pre-operatory BMI, pre-operatory weight, pre-operatory comorbidities, time of hospital stay, postoperative complications that demanded re-admission to the hospital and the time elapsed between the procedure and the complication. The patients' follow up was, at least, one year. Results: The incidence of postoperative complications that demanded a hospital care was 24,09%. The main comorbidity presented in this sample was hepatic steatosis. The comorbidity that was associated with the postoperative period was type 2 diabetes. There was a tendency for the female gender be related to the complications. The cholecystectomy was the most frequent complication. Complications occurred during the first year in 57,35%. Conclusion: The most frequent complication was the need to perform a cholecystectomy, where the most frequent comorbidity was hepatic steatosis. Over half the complications occurred during the first year postoperatively. Type 2 diabetes was associated with the occurrence of postoperative complications; women had the highest incidence; body mass index was not associated with the occurrence of complications.

scholarly journals Torsion of the Vascular Pedicle of A Wandering Spleen: An Unusual Cause of Intestinal Strangulation

2021 ◽  
Vol 2 (2) ◽  
pp. 13-15
Author(s):  
Zakarimanana Lucas ◽  
Ratsimarisolo Nathan ◽  
Rajaonarivony Maheriandrianina Fanambina Voahary ◽  
Ahmad Ahmad ◽  
Ravalisoa Marie Lydia Agnès
Keyword(s):  
Case Report ◽  
Intestinal Obstruction ◽  
Transverse Colon ◽  
Acute Intestinal Obstruction ◽  
Wandering Spleen ◽  
Vascular Pedicle ◽  
Common Complication ◽  
Ectopic Spleen ◽  
Intestinal Strangulation ◽  
Unusual Situation

Ectopic spleen is a rare splenic malformation. Apart from torsion of the vascular pedicle, a common complication, an ectopic spleen could be responsible of an acute intestinal obstruction. We report a case of an 8-year-old girl who presented an acute abdomen, following of the transverse colon strangulation by the torsion of the vascular pedicle of a wandering spleen. The patients benefited a surgical opening into the abdomen who has been confirmed the diagnosis and made a detorsion of the vascular pedicle of spleen with splenopexy.The interest of this case report lies on the rarity of a wandering spleen and on the unusual situation of transverse colon strangulation by the vascular pedicle of spleen.

Postoperative Complications Associated with the Choice of Reconstruction in Head and Neck Cancer: An Outcome Analysis of 4,712 Patients from the ACS-NSQIP Database

2021 ◽  
Author(s):  
Jacob Y. Katsnelson ◽  
Richard Tyrell ◽  
Murad J. Karadsheh ◽  
Ely Manstein ◽  
Brian Egleston ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Length Of Stay ◽  
Head And Neck ◽  
Free Flap ◽  
Hospital Readmission ◽  
Free Flaps ◽  
Pedicled Flap ◽  
Head And Neck Reconstruction ◽  
Pedicled Flaps ◽  
Neck Reconstruction

Abstract Background Microsurgical free flaps have largely supplanted pedicled flaps as the gold standard for head and neck cancer reconstruction. However, incidence of postoperative complications after accounting for patient comorbidities based on choice of reconstruction has not been well-defined in the literature in recent years. Methods Patients undergoing head and neck reconstruction were identified in the 2011–2016 ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database and stratified into groups by free flap, myocutaneous pedicled flap, and other reconstruction. Demographics were analyzed and covariates balanced using overlap propensity score-based weighting. Logistic regression was used for binary outcomes and Gamma generalized linear model was used for length of stay. Results A total of 4,712 patients met inclusion criteria out of which 1,297 patients (28%) underwent free flap, 208 patients (4%) pedicled flap, and 3,207 patients (68%) had other, or no reconstruction performed. After adjusting for patient and disease-specific factors, pedicled flap reconstruction was associated with a higher risk of deep vein thrombosis (odds ratio [OR] = 2.64, confidence interval [CI] 1.02–6.85, p = 0.045), sepsis (OR = 2.95, CI 1.52–5.71, p = 0.001), and infection (OR = 2.03, CI 1.39–2.96, p <0.001) compared with free flap reconstruction. Free flaps had the longest mean operative time compared with the other two groups (unadjusted 578 vs. 440 vs. 326, p <0.001). Pedicled flaps had a lower incidence of bleeding requiring transfusion (adjusted OR = 0.65, CI 0.50–0.85, p = 0.002), and lower incidence of prolonged mechanical ventilation (adjusted OR = 0.33, CI 0.12–0.92, p = 0.034) compared with free flaps. There was no difference in rates of reoperation, hospital readmission, or hospital length-of-stay between pedicled and free flaps. Conclusion Myocutaneous pedicled flaps are associated with higher overall short-term postoperative complications compared with free flaps in head and neck reconstruction, which demonstrate a more favorable morbidity profile without significantly impacting hospital readmission, reoperation, or length-of-stay.

The Analysis of Dislocations Using a Symmetry Criterion

1972 ◽  
Vol 30 ◽  
pp. 660-661
Author(s):  
J. C. Ingram ◽  
P. R. Strutt ◽  
Wen-Shian Tzeng
Keyword(s):  
Electron Beam ◽  
Electron Microscope ◽  
Displacement Field ◽  
Standard Technique ◽  
Residual Image ◽  
Symmetry Criterion

The invisibility criterion which is the standard technique for determining the nature of dislocations seen in the electron microscope can at times lead to erroneous results or at best cause confusion in many cases since the dislocation can still show a residual image if the term is non-zero, or if the edge and screw displacements are anisotropically coupled, or if the dislocation has a mixed character. The symmetry criterion discussed below can be used in conjunction with and in some cases supersede the invisibility criterion for obtaining a valid determination of the nature of the dislocation.The symmetry criterion is based upon the well-known fact that a dislocation, because of the symmetric nature of its displacement field, can show a symmetric image when the dislocation is correctly oriented with respect to the electron beam.

Stereo imaging in the shadow electron microscope

1978 ◽  
Vol 36 (1) ◽  
pp. 120-121
Author(s):  
W. C. T. Dowell
Keyword(s):  
Electron Microscopy ◽  
Electron Microscope ◽  
Convenient Method ◽  
Patent Application ◽  
Standard Technique ◽  
Stereo Imaging ◽  
Stereo Images ◽  
Specimen Height

Stereo imaging is not new to electron microscopy. Von Ardenne, who first published transmission pairs nearly forty hears ago, himself refers to a patent application by Ruska in 1934. In the early days of the electron microscope von Ardenne employed a pair of magnetic lenses to view untilted specimens but soon opted for the now standard technique of tilting the specimen with respect to the beam.In the shadow electron microscope stereo images can, of course, be obtained by tilting the specimen between micrographs. This obvious method suffers from the disadvantage that the magnification is very sensitive to small changes in specimen height which accompany tilting in the less sophisticated stages and it is also time consuming. A more convenient method is provided by horizontally displacing the specimen between micrographs. The specimen is not tilted and the technique is both simple and rapid, stereo pairs being obtained in less than thirty seconds.

Multislice calculations for quasi-periodic and non-periodic objects

1990 ◽  
Vol 48 (4) ◽  
pp. 138-139
Author(s):  
R. Herrera ◽  
A. Gómez
Keyword(s):  
Electron Diffraction ◽  
Computer Simulations ◽  
Periodic Table ◽  
Amorphous Materials ◽  
Space Group ◽  
Essential Step ◽  
Shape Effects ◽  
Atomic Scattering ◽  
Diffraction Patterns ◽  
Periodic Continuation

Computer simulations of electron diffraction patterns and images are an essential step in the process of structure and/or defect elucidation. So far most programs are designed to deal specifically with crystals, requiring frequently the space group as imput parameter. In such programs the deviations from perfect periodicity are dealt with by means of “periodic continuation”.However, for many applications involving amorphous materials, quasiperiodic materials or simply crystals with defects (including finite shape effects) it is convenient to have an algorithm capable of handling non-periodicity. Our program “HeGo” is an implementation of the well known multislice equations in which no periodicity assumption is made whatsoever. The salient features of our implementation are: 1) We made Gaussian fits to the atomic scattering factors for electrons covering the whole periodic table and the ranges [0-2]Å−1 and [2-6]Å−1.

Moving Forward Four Words at a Time: Effects of a Supplemental Preschool Vocabulary Intervention

2020 ◽  
Vol 51 (1) ◽  
pp. 165-175 ◽  
Author(s):  
Lindsey A. Peters-Sanders ◽  
Elizabeth S. Kelley ◽  
Christa Haring Biel ◽  
Keri Madsen ◽  
Xigrid Soto ◽  
...  
Keyword(s):  
Group Intervention ◽  
Single Case ◽  
Single Case Design ◽  
Vocabulary Intervention ◽  
Iterative Development ◽  
At Risk Children ◽  
Before And After ◽  
Child Friendly ◽  
Interactive Lessons ◽  
Case Design

Purpose This study evaluated the effects of an automated, small-group intervention designed to teach preschoolers challenging vocabulary words. Previous studies have provided evidence of efficacy. In this study, we evaluated the effects of the program after doubling the number of words taught from 2 to 4 words per book. Method Seventeen preschool children listened to 1 prerecorded book per week for 9 weeks. Each storybook had embedded, interactive lessons for 4 target vocabulary words. Each lesson provided repeated exposures to words and their definitions, child-friendly contexts, and multiple opportunities for children to respond verbally to instructional prompts. Participants were asked to define the weekly targeted vocabulary before and after intervention. A repeated acquisition single-case design was used to examine the effects of the books and embedded lessons on learning of target vocabulary words. Results Treatment effects were observed for all children across many of the books. Learning of at least 2 points (i.e., 1 word) was replicated for 74.5% of 149 books tested across the 17 participants. On average, children learned to define 47% of the target vocabulary words (17 out of 36). Conclusions Results support including 4 challenging words per book, as children learned substantially more words when 4 words were taught, in comparison to previous studies. Within an iterative development process, results of the current study take us 1 step closer to creating an optimal vocabulary intervention that supports the language development of at-risk children.

Sign in / Sign up

Export Citation Format

Share Document