1/35. Treatment of iatrogenic previable premature rupture of membranes with intra-amniotic injection of platelets and cryoprecipitate (amniopatch): preliminary experience.OBJECTIVE: Our aim was to describe the treatment of iatrogenic previable premature rupture of membranes with the intra-amniotic injection of platelets and cryoprecipitate (amniopatch). STUDY DESIGN: patients with iatrogenic previable premature rupture of membranes and without evidence of intra-amniotic infection underwent transabdominal intra-amniotic injection of platelets and cryoprecipitate through a 22-gauge needle. The study was approved by the Institutional review Board of St Joseph's Hospital in Tampa, florida, and all patients gave written informed consent. RESULTS: Seven patients with iatrogenic preterm premature rupture of membranes underwent placement of an amniopatch. Membrane sealing was verifiable in 6 of 7 patients. Three patients had iatrogenic preterm premature rupture of membranes after operative fetoscopy, 3 cases were after genetic amniocentesis, and 1 was after diagnostic fetoscopy. Three pregnancies progressed well, with restoration of the amniotic fluid volume and no further leakage. Two patients had unexplained fetal death despite successful sealing. One case of bladder outlet obstruction had no further leakage, but oligohydramnios persisted and did not allow unequivocal documentation of sealing. One patient miscarried from twin-twin transfusion, but the amniotic cavity was sealed. CONCLUSIONS: Iatrogenic preterm premature rupture of membranes can be treated effectively with an amniopatch. The technique is simple and does not require knowledge of the exact location of the defect. Unexpected fetal death from the procedure may be attributable to vasoactive effects of platelets or indigo carmine. Although the appropriate dose of platelets and cryoprecipitate needs to be established, the amniopatch may mean that iatrogenic preterm premature rupture of membranes no longer needs to be considered a devastating complication of pregnancy.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
2/35. Atherosclerotic disruption of the aortic arch during coronary artery bypass operation.A 70-year-old-man presented with a symptomatic three vessel coronary artery disease and was scheduled for myocardial revascularization. During extracorporeal circulation an intrathoracal bleeding occurred and aortic rupture was suspected. An iatrogenic plaque rupture in the concavity of the aortic arch was found due to cannulation attempts. The aortic arch was grafted in the so-called elephant trunk technique. Thereafter bypass grafts were anastomosed to the stenosed coronary arteries. The patient was discharged from hospital after 2 weeks in good condition.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
3/35. Iatrogenic acute subdural hematoma due to drainage catheter.BACKGROUND: Insertion of a catheter for drainage of a cavity is a routine step in many surgical practices. In neurosurgery, catheters are commonly placed in the subdural, subgaleal, or epidural spaces to prevent haematoma formation. CASE DESCRIPTION: We present three cases of iatrogenic acute subdural hematoma. These were all related to the drainage catheters. In the first case, a subgaleal redivac suction catheter was used after craniotomy for brain abscess. The other two patients had ordinary ventricular catheters placed in the subdural space after burr hole drainage of chronic subdural hematoma. The drainage catheter was removed on postoperative day 5 in the first case and two days after the initial operation in the other two cases. Shortly after the removal of the drains, the conditions of the patients deteriorated rapidly due to the development of acute subdural hematoma. CONCLUSION: Although they are extremely uncommon, life-threatening complications related to a drainage catheter are a real possibility. Therefore, the procedure should not be taken lightly.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
4/35. Delayed recognition of inadvertent gut injury during laparoscopy.Bowel injuries, which may occur as a result of the insertion of an insufflation needle or trocar, are a rare complication of laparoscopy. They are generally recognized either immediately or a few days after the operation. We present a case of laparoscopic perforation of the small intestine in a patient who had undergone previous pelvic surgery for an ovarian carcinoma. On ultrasound (US), the patient had multiple hepatic lesions resembling hepatic metastases. To confirm the diagnosis, laparoscopy with guided liver biopsy was performed on the grounds that this procedure is regarded as more appropriate than CT- or US-guided hepatic biopsy. Veress needle and trocar insertion were performed at a proper distance from the abdominal scar. However, the abdominal cavity was not visible after the trocar's insertion due to the unexpected presence of adhesions. This precluded the continuation of the procedure. In the following days, the patient experienced only mild abdominal discomfort. However, 2 weeks after laparoscopy, the patient presented signs of peritoneal reaction and underwent laparotomy. Adhesion-fixing jejunal loops to the anterior abdominal wall were discovered at the site of the trocar puncture. Moreover, two hiatuses of these loops were observed and sutured. The follow-up was uneventful. As this case illustrates, laparoscopic bowel injuries remain an unpredictable event. Recognition of this complication may occur several days after the procedure, as the tamponating effect of adhesions on the jejunal hiatus delays the involvement of the peritoneum.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
5/35. Pseudoaneurysm of the lingual artery secondary to tonsillectomy treated with selective embolization.False aneurysm may occur from trauma to the floor of the mouth, including iatrogenic trauma from surgical procedures. This report will present a case of a pseudoaneurysm of the lingual artery following tonsillectomy. Development of lingual artery pseudoaneurysms can occur within a few hours following tonsillectomy. angiography provides the diagnosis, and endovascular intervention is an efficient alternative to surgery for treatment of such aneurysm with low morbidity. Endovascular embolization with platinum coils is an effective means of controlling bleeding and avoiding surgical intervention.- - - - - - - - - - ranking = 0.090117570203014keywords = mouth (Clic here for more details about this article) |
6/35. Myospherulosis complicating cortical block grafting: a case report.BACKGROUND: Myospherulosis of the oral cavity is an inflammatory, granulomatous lesion historically associated with the use of petrolatum-based antibiotic ointment placed in third molar extraction sites to prevent postoperative infection. methods: A case of bilateral myospherulosis is presented, in which large lesions complicated the procurement of a cortical block graft used to prepare a mandibular molar edentulous space for implant placement. By obtaining the block graft from a more lateral location on the mandible, an adequate graft was procured and was successfully grafted into an atrophic edentulous ridge. RESULTS: The cortical block graft was successfully incorporated by the recipient site, which received a wide-body, threaded dental implant 6 months later. Healing was uncomplicated, and a functional implant-supported restoration was successfully achieved. CONCLUSIONS: Myospherulosis, though rare today, may present a significant obstacle to the procurement of cortical block grafts. In this case, thorough debridement of the material resulted in subsequent healing of the myospherulosis defect, but prevented procurement of the cortical graft from the planned site. The dimension and volume of the neighboring cortical bone were adequate, and the augmented edentulous space was subsequently restored with a functional endosseous implant. The success seen in these 2 sites would seem to confirm the assumption that size and location of myospherulosis defects are critical factors in obtaining a successful clinical result in implant patients.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
7/35. Thoracoscopic repair of instrumental perforation of the oesophagus: first report.BACKGROUND: Perforation of the oesophagus is a life-threatening condition requiring early recognition and repair to prevent mediastinitis and death. Primary closure with mediastinal drainage is recognised as the treatment of choice for patients presenting within 24 hours. Many are frail, however, and unsuitable for major surgery. AIM: To report the first case of thoracoscopic repair of the oesophagus for oesophageal perforation following instrumentation. methods: Flexible endoscopy revealed a 10cm perforation in the right lower oesophagus. With the gastroscope in the oesophagus, four thoracoports were introduced. Using suction and irrigation, the pleural cavity was suctioned free of debris and a 10cm longitudinal tear of the right lateral aspect of the oesophagus was repaired using interrupted polyglactin sutures through all layers. RESULTS: The patient tolerated the procedure well and made an uncomplicated recovery. CONCLUSION: The uncomplicated recovery of this frail patient without need for blood transfusions or assisted ventilation supports the notion that the thoracoscopic approach may have significant advantages. With increased experience and technical refinements there should be less reluctance to refer these patients for earlier definitive surgical repair.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
8/35. Successfully treated case of cervical abscess and mediastinitis due to esophageal perforation after gastrointestinal endoscopy.Perforations of the esophagus are uncommon complications of flexible gastrointestinal endoscopy. Perforations after endoscopy are likely to occur in the cervical esophagus, where fiber insertion is difficult anatomically. The diagnosis should be made as soon as possible, because mediastinitis and sepsis frequently develop following esophageal perforations. The surgical strategies are dependent on the location of the perforations and the condition of the patients. For a successful outcome, surgery is a preferred treatment for most perforation cases, and non-operative treatment, such as antibiotics, parental nutrition, and no food intake by mouth, should be applied carefully.- - - - - - - - - - ranking = 0.090117570203014keywords = mouth (Clic here for more details about this article) |
9/35. Sonographic detection of a malpositioned feeding tube causing esophageal perforation in a neonate.We report a case of esophageal perforation caused by a malpositioned feeding tube in a neonate of extremely low birth weight, 632 g. The infant had respiratory distress, which increased rapidly when he was 6 days old. radiography revealed right-sided hydrothorax that had not been evident a day earlier but no sign of a perforated esophagus. We performed sonography, which revealed fluid in the right pleural cavity and extra-esophageal placement of the feeding tube. Analysis of a fluid specimen obtained on thoracocentesis indicated that the fluid was feeding formula. The feeding tube's misplacement was confirmed sonographically by injecting a small amount of sterile distilled water into the tube and visualizing its entry into the pleural cavity. The feeding tube was removed, and antimicrobial agents were administered. When the infant was 15 days old, feeding resumed through another tube, the placement of which was verified radiographically. The infant was discharged when he was 118 days old with no severe complications, although he had mild chronic lung disease. Because radiography did not reveal the tube's misplacement in this case, we believe that the use of sonography can contribute to an early diagnosis of esophageal perforation in such cases.- - - - - - - - - - ranking = 2keywords = cavity (Clic here for more details about this article) |
10/35. Nasogastric tube misplacement into eustachian tube.Paediatric nasogastric tube placement can occasionally be difficult to perform. A unique case in a child is described where the tip of the nasogastric tube managed to travel via the eustachian tube through the attic and into the mastoid cavity of the middle ear. To the best of the authors' knowledge, this has never been reported in the literature before.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
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