Laparoscopic placement of distal ventriculoperitoneal shunt catheters

2008 ◽  
Vol 2 (4) ◽  
pp. 282-285 ◽  
Author(s):  
Michael H. Handler ◽  
Brian Callahan
Keyword(s):  
Medical Records ◽  
Foreign Bodies ◽  
Senior Author ◽  
General Surgeon ◽  
Ventriculoperitoneal Shunts ◽  
First Choice ◽  
Early Failures ◽  
Abdominal Operations ◽  
General Surgeons ◽  
Choice Approach

Object Ventriculoperitoneal shunts (VPSs) are commonly placed into the peritoneal cavity via a small laparotomy or blindly by using a split trocar. Larger patients require larger incisions, and placement is made more difficult by previous abdominal operations and obesity. For general surgeons, laparoscopy has become the first-choice approach for abdominal procedures, using 1 or several very small incisions. The authors discuss their pediatric series of patients in whom laparoscopy was used to place distal shunt catheters. Methods The authors reviewed the medical records accrued over a 9-year period, noting VPS operations performed using laparoscopy. Complications, morbidity, and alterations of planned management were noted. Results One hundred thirty-seven VPS operations in 126 patients were identified, 92 performed by the senior author (M.H.H.) alone and 45 conducted with the assistance of a general surgeon. A second port was placed for lysis of adhesions or retrieval of old catheters in 7 cases. There were no immediate complications. The infection rate was 6.6%, comparable with the institutional norm (6.3%) over an 8-year period. There were 3 early failures due to abdominal malabsorption without infection. Five catheters later broke at the level where they were introduced into the abdomen due to shearing by the abdominal trocar. Conclusions Laparoscopic placement of distal VPS catheters is relatively safe and allows insertion via inconspicuous incisions. It can allow for inspection or lysis of adhesions and removal of foreign bodies, help determine if and where the abdomen can absorb shunt fluid, and make VPS surgery in the obese patient easier.

scholarly journals Trichobezoars in the practice of a pediatric surgeon

2021 ◽  
Vol 25 (2) ◽  
pp. 135-139
Author(s):  
R. V. Bocharov ◽  
Ya. V. Shikunova ◽  
G. V. Slyzovsky ◽  
V. G. Pogorelko ◽  
M. A. Zykova ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Medical Records ◽  
Foreign Bodies ◽  
Psychological Trauma ◽  
Postoperative Course ◽  
X Ray ◽  
First Case ◽  
History Of ◽  
Dense Hair ◽  
Hair Formation

Material and methods. A retrospective analysis of medical records of two children. Anamnestic, clinical, diagnostic and intraoperative findings were analyzed.Purpose. To describe cases of trichobezoars in children : occurrence, diagnostics and treatment.Results. In the first case, a girl, aged 5, often swallowed her own hair after a psychological trauma; and at the age of 15 she complained of hair loss and anemia. In the second case, a boy was chewing and swallowing his own hair for 6 months under the emotional stress. Two weeks before hospitalization he complained of abdominal pain. In both cases, there were no history of intestinal obstruction. At the fibroesophagogastroduodenoscopy, foreign bodies were visualized which were diagnosed as trichobezoars. X-ray diagnostics confirmed foreign bodies in both patients. Those bodies had the shape of the stomach and had an inhomogeneous porous structure. The patients were operated: laparotomy, gastrotomy with removal of dense hair formation. Postoperative course was uneventful.Conclusion. Psychological situations provoked in children the obsessive trichotillomania and trichophagia due to which large trichobezoars were formed in the stomach.

scholarly journals Occult Foreign Body Aspirations in Pediatric Patients: 20-years of Experience

2020 ◽  
Author(s):  
Bo Liu ◽  
Fengxia Ding ◽  
Yong An ◽  
Yonggang Li ◽  
Zhengxia Pan ◽  
...  
Keyword(s):  
Foreign Body ◽  
Medical Records ◽  
Foreign Bodies ◽  
Pediatric Patients ◽  
Previous History ◽  
Rigid Bronchoscopy ◽  
Diagnostic Difficulties ◽  
History Of ◽  
Male Patients ◽  
Symptoms And Signs

Abstract Background: The purpose of our study was to assess the frequency of occult foreign body aspiration (FBA) and to evaluate the diagnostic difficulties and therapeutic methods for these patients. Methods: Between May 2000 and May 2020, 3557 patients with the diagnosis of FBA were treated in our department. Thirty-five patients with occult FBA were included in this study. A retrospective analysis of medical records was performed. Results: Twenty-three male patients (65.7%) and 12 female patients (34.3%) were hospitalized due to occult FBA. The average age was 3.60 years (range 9 months-12 years). Most of the patients were younger than 3 years old (n=25, 71.4%). Coughing (n=35, 100%) and wheezing (n=18, 51.4%) were the main symptoms and signs. All the patients were found to have a FBA under the fiberoptic bronchoscope. The most common organic foreign bodies were peanuts (n=10) and the most common inorganic foreign bodies were pen caps (n=5). The extraction of foreign bodies under rigid bronchoscopy was applied successfully in 34 patients. Only one patient needed a surgical intervention. Conclusions: Occult FBA should always be considered in the differential diagnosis of chronic or recurrent respiratory diseases that are poorly explained, even in the absence of a previous history of aspiration.

Use of biologicals in dermatology – following the agreed path or going off-piste? A brief report

2021 ◽  
Vol 10 (3) ◽  
pp. 141-144
Author(s):  
Michael Wilcock ◽  
Andrew Pothecary
Keyword(s):  
Medical Records ◽  
Treatment Cost ◽  
Biological Therapy ◽  
Severe Psoriasis ◽  
Small Scale ◽  
First Line ◽  
First Choice ◽  
Biological Medicine ◽  
Reasons For Use ◽  
Local Guideline

Introduction: Biological medicines are used to treat a range of conditions according to National Institute for Health and Care Excellence (NICE) technology appraisals. The annual drug treatment cost per patient per year varies depending on various factors, including newer or older biological, and availability of a biosimilar. Our biologicals pathway for dermatology (moderate or severe psoriasis) listed less expensive older biologicals (including biosimilars) early on in the treatment choices and more recently approved (and generally more expensive) choices lower down the pathway. Objective: We aimed to identify which biologicals or selective immunosuppressants were used first line in adult patients with moderate or severe psoriasis, and ascertain if the reasons for use of treatments other than adalimumab were in accordance with the locally agreed pathway. Methods: Medical records were reviewed for a sample of patients prescribed biologicals during late 2019 and early 2020. We identified patients who had commenced any treatment. Contact was made with lead dermatology nurses if needed. Results: There were 33 patients commenced on a biological – 17 had newly started biological therapy and 16 had switched from a prior biological therapy to a new therapy. Of the 17 new patients, two commenced apremilast (biological contraindicated), 10 commenced adalimumab, and five commenced other biologicals. Of these five who commenced other biologicals, two were on guselkumab, two on ustekinumab, and one on certolizumab. In all five instances there was a valid reason for not using adalimumab as first choice though this was not always explicit in the multidisciplinary team (MDT) documentation. Discussion: Though the number of psoriasis patients (17) newly starting a biological medicine was relatively small, it was reassuring that for five of these who commenced a subcutaneous biological other than adalimumab, there was a valid reason for this choice, though not always explicit in the MDT letter, which Dermatology will ensure is clear for future decisions. Hence going ‘off-piste’ was deemed justified. Conclusion: This very small-scale study found that the local guideline was followed with patients commencing treatments other than biosimilar adalimumab for valid reasons.

Article Commentary: Soft Tissue Sarcoma of the Extremity and Trunk: Issues for the General Surgeon

2006 ◽  
Vol 72 (8) ◽  
pp. 665-671
Author(s):  
Gerame Wells ◽  
Robert C.G. Martin ◽  
Kelly M. Mcmasters ◽  
Charles R. Scoggins
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Current Literature ◽  
Medical Literature ◽  
Malignant Tumors ◽  
Soft Tissue Sarcomas ◽  
Heterogeneous Group ◽  
General Surgeon ◽  
Academic Interest ◽  
General Surgeons

Soft tissue sarcomas represent a heterogeneous group of malignant tumors that arise from mesenchymal tissues. The majority of these tumors arise on the extremity or trunk. Despite their rarity, soft tissue sarcomas continue to generate vigorous academic interest, and as a result, the ever-expanding medical literature dealing with sarcomas continues to grow. Many general surgeons will see few of these tumors during their careers, and a review of the current literature and how it applies to patients afflicted with soft tissue sarcoma of the extremity or trunk is warranted.

scholarly journals Safety of Laparoscopic Colorectal Surgery in a Low-Volume Setting: Review of Early and Late Outcome

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Robert C. Gandy ◽  
Christophe R. Berney
Keyword(s):  
Lymph Nodes ◽  
Case Series ◽  
Median Number ◽  
General Surgeon ◽  
Laparoscopic Technique ◽  
Advanced Laparoscopy ◽  
General Surgeons ◽  
Low Volume ◽  
Colorectal Resections ◽  
Laparoscopic Colorectal Resections

Background. There is increasing evidence suggesting that the laparoscopic technique is the treatment of choice for large bowel resection, including for malignancy. The purpose of the study was to assess whether general surgeons, with particular skills in advanced laparoscopy, can adequately provide safe laparoscopic colorectal resections in a low-volume setting.Methods. A retrospective review of prospectively collected case series of all laparoscopic colorectal resections performed under the care of a single general surgeon is presented. The primary endpoint was postoperative clinical outcome in terms of morbidity and mortality. Secondary endpoints were adequacy of surgical margins and number of lymph nodes harvested for colorectal cancer cases.Results. Seventy-three patients underwent 75 laparoscopic resections between March, 2003, and May, 2011. There was no elective mortality and the overall 30-day postoperative morbidity was 9.3%. Conversion and anastomotic leakage rates were both 1.3%, respectively. None of the malignant cases had positive margins and the median number of lymph nodes retrieved was 17.Conclusions. Our results support the view that general surgeons with advanced skills in minimally invasive surgery may safely perform laparoscopic colorectal resection in a low-volume setting in carefully selected patient cases.

Surgical density and its effect on esophageal cancer (EC) and gastric (GC) mortality.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 16-16
Author(s):  
M. Y. Ho ◽  
J. S. Albarrak ◽  
W. Y. Cheung
Keyword(s):  
Household Income ◽  
Population Level ◽  
Multimodality Treatment ◽  
General Surgeon ◽  
County Level ◽  
Median Household Income ◽  
Hospital Beds ◽  
Beta Coefficient ◽  
General Surgeons ◽  
The Impact

16 Background: Surgical resection plays an integral role in the multimodality treatment of patients with EC or GC. The distribution of thoracic and general surgeons at the county level varies widely across the US. The impact of the allocation of these surgeons on cancer outcomes is unclear. Our aims were to 1) examine the effect of surgeon density on EC or GC mortality, 2) compare the relative roles of thoracic and general surgeons on EC and GC outcomes and 3) determine other county characteristics associated with cancer mortality. Methods: Using county-level data from the Area Resources File, U.S. Census and National Cancer Institute, we constructed regression models to explore the effect of thoracic and general surgeon density on EC and GC mortality, respectively. Multivariate analyses controlled for incidence rate, county demographics (population aged 65+, proportion eligible for Medicare, education attainment, metropolitan vs. rural), socioeconomic factors (median household income) and healthcare resources (number of general practitioners, number of hospital beds). Results: In total, 332 and 402 counties were identified for EC and GC, respectively: mean EC/GC incidence = 5.29/6.83; mean EC/GC mortality=4.70/3.92; 91% were metropolitan and 9% were rural; mean thoracic and general surgeon densities were 10 and 63 per 100,000 people, respectively. When compared to counties with no thoracic surgeons, those with at least 1 thoracic surgeon had reduced EC mortality (beta coefficient -0.031). For GC, counties with 1 or more general surgeons also had decreased number of deaths (beta coefficient -0.095) when compared with those without any surgeons. While increasing the density of surgeons beyond 10 only yielded minimal improvements in EC mortality, it resulted in significant further reductions in GC mortality. Other county characteristics, such as increased number of hospital beds and higher median household income, were correlated with improved outcomes. Conclusions: Mortality from GC appears to be more susceptible to the benefits of increased surgeon density. For EC, a strategic policy of allocating health resources and distributing the workforce across counties will be best able to optimize outcomes at the population-level. No significant financial relationships to disclose.

Comparable Esophagectomy Outcomes by Surgeon Specialty: A NSQIP Analysis

2021 ◽  
pp. 000313482110651
Author(s):  
Diana S Hsu ◽  
Sora Ely ◽  
Rebecca C Gologorsky ◽  
Kara A Rothenberg ◽  
Kian C Banks ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
National Database ◽  
General Surgeon ◽  
Open Approach ◽  
American College Of Surgeons ◽  
Postoperative Leak ◽  
General Surgeons ◽  
Baseline Characteristics ◽  
Large National Database ◽  
Better Than

Background A few observational studies have found that outcomes after esophagectomies by thoracic surgeons are better than those by general surgeons. Methods Non-emergent esophagectomy cases were identified in the 2016-2017 American College of Surgeons NSQIP database. Associations between patient characteristics and outcomes by thoracic versus general surgeons were evaluated with univariate and multivariate logistic regression. Results Of 1,606 cases, 886 (55.2%) were performed by thoracic surgeons. Those patients differed from patients treated by general surgeons in race (other/unknown 19.3% vs 7.8%; P<.001) but not in other baseline characteristics (age, sex, BMI, and comorbidities). Thoracic surgeons performed an open approach more frequently (48.9% vs 30.8%, P<.001) and had operative times that were 30 minutes shorter (P<.001). General surgeons had lower rates of reoperation (11.8% vs 17.2%; P=.003) and were more likely to treat postoperative leak with interventional means (6.3% vs 3.4%, P=.01). Thoracic surgeons were more likely to treat postoperative leak with reoperation (5.9% vs 3.6%, P=.01). There were no other differences in univariate comparison of outcomes between the two groups, including leak, readmission, and death. General surgery specialty was associated with lower risk of reoperation. Our multivariable model also found no relationship between general surgeon and risk of any complication (odds ratio 1.10; 95% CI .86 to 1.42). Discussion In our large, national database study, we found that outcomes of esophagectomies by general surgeons were comparable with those by thoracic surgeons. General surgeons managed postoperative leaks differently than thoracic surgeons.

scholarly journals Application of cystourethroscopy during tracheobronchial foreign body removal in children

2018 ◽  
Vol 46 (9) ◽  
pp. 3741-3747
Author(s):  
Bifan Deng ◽  
Weiguang Tang ◽  
Feiqun Su ◽  
Hua Li ◽  
Wanqiang Lai ◽  
...  
Keyword(s):  
Medical Records ◽  
Foreign Bodies ◽  
Operation Time ◽  
Foreign Body Removal ◽  
Operational Risks ◽  
Removal Time ◽  
Tracheobronchial Foreign Body ◽  
Successful Removal ◽  
The Mean ◽  
Mean Time

Objective This study aimed to describe preliminary experiences associated with removal of tracheobronchial foreign bodies (TFBs) by cystourethroscopy (CU). Methods We performed a retrospective analysis of 127 paediatric cases of TFB removal by CU at our centre from January 2009 to August 2016. Data that were extracted from the medical records included age, sex, location and nature of the TFBs, operation time, and complications. Results All TFBs were successfully removed by CU. The mean time of the procedure was 3.38 ± 2.86 minutes. A total of 102 (80.31%) patients had successful removal of TFBs by CU during the initial trial, 19 (14.96%) were successfully treated in the second trial, and six (4.72%) required a third trial. Otolaryngologists with 2, 5, and 7 years of professional CU training showed a mean TFB removal time of 3.38 ± 2.13, 3.40 ± 3.60, and 3.37 ± 2.86 minutes, respectively. In the operations, oxygen saturation fell below 90% at an average occurrence of 0.39 times, but no patients showed a decrease below 85%. Only one patient experienced laryngeal oedema after the procedure. Conclusion CU is a useful technique and minimizes complications and operational risks during removal of paediatric TFBs.

scholarly journals Management of Head Injury by General Surgeons in a General Hospital

1970 ◽  
Vol 1 (1) ◽  
pp. 19-22
Author(s):  
P Ghimire ◽  
N Yogi ◽  
GB Acharya
Keyword(s):  
Head Injury ◽  
Glasgow Coma Scale ◽  
General Hospital ◽  
Regional Hospital ◽  
General Surgeon ◽  
Coma Scale ◽  
High Dependency ◽  
General Surgeons ◽  
Western Regional ◽  
Dedicated Team

Background: Head injury is one of the common causes of surgical admission in Western Regional Hospital, Pokhara, Nepal. With no neurosurgeons available, most of the cases are managed effectively with adequately trained general surgeons. The aim of the study is to study the epidemiology, incidence and pattern of head injury and their outcome in a setting of a general hospital where they were managed by general surgeons. Methods: This is a prospective analytical study of 1847 head injury patients. The study defines the patterns of head injury, their management by general surgeons and outcome in surgery ward, Western Regional Hospital, Pokhara for about five years (1999 to 2003). Results: Head injury comprised 15.5% (1847) of total admissions (11901) in surgery ward. Out of those, 80.5% (1487) were mild, 10.4% (192) moderate and 9% (168) severe head injury cases, based on Glasgow coma scale. Majority of cases (42.1%) were young adults between 21-40 years. 70% (1294) of cases were male and 30% (553) were female. 7.5% (138) cases were associated with skull fractures. Most of the cases showed good recovery. Only 2% required surgery; 3.7% were referred; 2.8% died and 0.8% left against advice. Conclusion: Most of the cases of head injury can be managed by general surgeon in a General Hospital provided basic facilities like high dependency unit, Intensive care unit and a dedicated team are available. Keywords: Glasgow Coma Scale; head injury; traumatic brain injury DOI: http://dx.doi.org/10.3126/njms.v1i1.5791   Nepal Journal of Medical Sciences. 2012; 1(1): 19-22

Carotid Endarterectomy With Primary Closure: Analysis of Outcomes and Review of the Literature

Neurosurgery ◽  
2011 ◽  
Vol 70 (3) ◽  
pp. 646-655 ◽  
Author(s):  
Georgios Zenonos ◽  
Ning Lin ◽  
Albert Kim ◽  
Jeong Eun Kim ◽  
Lance Governale ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Medical Records ◽  
Primary Closure ◽  
Medication Compliance ◽  
Senior Author ◽  
Careful Evaluation ◽  
Patch Angioplasty ◽  
St Elevation ◽  
Structured Questionnaire

Abstract Background: Despite abundant published support of patch angioplasty during carotid endarterectomy (CEA), primary closure is still widely used. The reasons underlying the persistence of primary closure are not quite evident in the literature. Objective: To present our experience with primary closure in CEA, and provide a rationale for its persistent wide use. Methods: Medical records of all patients undergoing CEA by the senior author (R.F.) were retrospectively reviewed. Follow-up was supplemented with a telephone interview and completion of a structured questionnaire. A review of the current literature was performed. Results: From 1998 to 2010, the senior author performed 111 CEAs. Average cross-clamp time was 33 ± 11 minutes. Postoperative complications included 1 non– ST-elevation myocardial infarction and 2 strokes. No deaths, cranial-nerve deficits, or acute reocclusions were observed. After a mean follow-up of 64.6 months (7170.6 case-months), there were 3 contralateral strokes and 7 deaths. There were no ipsilateral strokes or restenoses &gt;50%. Follow-up medication compliance was 94.6% for anti-platelet agents and 91.9% for statins. The outcomes of the current study were comparable to those of the available trials comparing patch angioplasty with primary closure. A careful evaluation of the literature revealed a number of reasons potentially explaining the persistent use of patch angioplasty. Conclusion: In conjunction with contemporary medical management, primary closure during CEA may yield results comparable or superior to patch angioplasty. Advantages of primary closure include shorter cross-clamp times and elimination of graft-specific complications.

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