1/145. Intra-operative enteroscopy for obscure gastrointestinal bleeding.Small bowel enteroscopy has been reported useful in the non-surgical evaluation of the small intestine in patients with obscure gastrointestinal bleeding but findings may be limited due to incomplete small bowel intubation and a lack of tip deflection. Intra-operative enteroscopy (IOE) is accepted as the ultimate diagnostic procedure for complete evaluation of the small bowel in these patients. Two patients with obscure gastrointestinal bleeding and deep anemia underwent IOE during surgical exploration. Angiodysplastic lesion with a diameter of 3 cm was found at jejunum in the first patient and segmental jejunal resection was performed. Enteroscopy showed red punctate lesions with a diameter of 1-3 mm located at proximal jejunum and extending to the ileum in the second patient. Total jejunal resection was performed. There was no recurrence of gastrointestinal bleeding during 36 months follow-up.- - - - - - - - - - ranking = 1keywords = gas (Clic here for more details about this article) |
2/145. A new technique for intraoperative enteroscopy using a 12-mm trocar.Intraoperative enteroscopy is a valuable method for localizing gastrointestinal bleeding of obscure origin. The insertion and manipulation of an endoscope through an enterotomy, however, may result in significant trauma to the intestinal wall, as well as contamination of the abdominal cavity. We have devised a new technique for the introduction of the endoscope that lessens trauma to the bowel wall and allows a complete enteroscopy with minimal contamination.- - - - - - - - - - ranking = 0.14285714285714keywords = gas (Clic here for more details about this article) |
3/145. Rapunzel syndrome--a case report.The gastric trichobezoars usually occur in young girls, often those with psychiatric disorders. Rarely these are known to extend from the stomach to the small intestine as a tail, when they are termed the Rapunzel syndrome. Until 1997, only 10 such cases have been reported in the literature. We report another case in which we could extract the trichobezoar by gastrotomy and enterotomy.- - - - - - - - - - ranking = 0.28571428571429keywords = gas (Clic here for more details about this article) |
4/145. Transient left vocal cord paralysis during laparoscopic surgery for an oesophageal hiatus hernia.A 45-year-old male, with symptoms of many years standing of gastro-oesophageal reflux disease, was subjected, under general anaesthesia, to laparoscopic fundoplication. Tracheal intubation yielded no problems but great difficulties were encountered during tube insertion into the oesophagus. After surgery, aphonia developed. Laryngological examination demonstrated paralysis of the left vocal cord. voice strength returned to the pre-operative status after 3 months, and laryngological examination confirmed normal mobility of both cords. The possible cause of the complication was damage to the left recurrent laryngeal nerve which occurred during insertion of the tube into the oesophagus. Gastro-oesophageal reflux disease causing 'acid laryngitis' can create conditions favouring this type of complication.- - - - - - - - - - ranking = 0.14285714285714keywords = gas (Clic here for more details about this article) |
5/145. Metastatic esophageal cancer leading to gastric perforation after repeat PEG placement.Various complications from percutaneous endoscopic gastrostomy have been reported. We describe a case of pneumoperitoneum after percutaneous endoscopic gastrostomy placement because of gastric wall weakening from malignant stomal seeding and, possibly, from chemoradiation.- - - - - - - - - - ranking = 1keywords = gas (Clic here for more details about this article) |
6/145. Possible venous argon gas embolism complicating argon gas enhanced coagulation during liver surgery.We report a case of a major venous argon embolism during argon beam coagulation of a liver biopsy. The essential signs were an abrupt reduction in end-tidal carbon dioxide partial pressure, in SpO2 and in systolic arterial pressure, at the time of coagulation. Spontaneous recovery was observed within 10 min. Precautions in respect of usage are highlighted.- - - - - - - - - - ranking = 1.1428571428571keywords = gas (Clic here for more details about this article) |
7/145. Severe aspiration pneumonia after surgery for reconstructed gastric tube cancer treated with extracorporeal life support.A 68-year-old man who had received resection for thoracic esophageal cancer 8 years ago, was operated on for the cancer of the reconstructed gastric tube. On the day of the operation, he accidentally swallowed gastric juice due to an obstruction in the reconstructed gastric tube. He suffered from acute hypoxic respiratory failure which could not be controlled with conventional therapy on postoperative day 1. Therefore, extracorporeal life support was employed at 3.0 L/min. extracorporeal flow for 11 days. Before extracorporeal life support data: PO2/FiO2 = 45, A-aDO2 = 600. During extracorporeal life support, the ventilator setting was pressure control (16 cmH2O) ventilation with a positive end expiratory pressure of 8 cmH2O, respiratory rate of 5 breaths/min., and FiO2 of 0.4. The patient was successfully weaned from extracorporeal life support and extubated on postoperative day 12. After extracorporeal life support data: PO2/FiO2 = 225, A-aDO2 = 465. We report on a successful weaning case from extracorporeal life support and discuss the efficacy these of regarding this patient.- - - - - - - - - - ranking = 1keywords = gas (Clic here for more details about this article) |
8/145. Surgical management of arteriosclerotic coronary artery aneurysm.A 60-year-old man suffered antero-septal myocardial infarction at the age of 56. coronary angiography demonstrated total occlusion of the left anterior descending artery and a large saccular aneurysm of the right coronary artery. Diffuse coronary ectasia was also shown in the right coronary artery adjacent to the aneurysm. Despite anticoagulant therapy, the aneurysm formed a thrombus and developed coronary artery stenosis distal to the aneurysm. ligation of the aneurysm and in situ gastroepiploic artery grafting were performed. Sudden heart failure was developed during skin closure. As this condition was considered to be graft hypoperfusion, supplemental saphenous vein grafting was placed. ligation is a simple, reliable technique to prevent future complications for a large saccular right coronary artery aneurysm, however, gastroepiploic artery might be an inappropriate bypass conduit for the ligated coronary artery with diffuse ectasia.- - - - - - - - - - ranking = 0.28571428571429keywords = gas (Clic here for more details about this article) |
9/145. Biochemical changes related to hypoxia during cerebral aneurysm surgery: combined microdialysis and tissue oxygen monitoring: case report.OBJECTIVE AND IMPORTANCE: The objective of this study was to monitor brain metabolism on-line during aneurysm surgery, by combining the use of a multiparameter (brain tissue oxygen, brain carbon dioxide, pH, and temperature) sensor with microdialysis (extracellular glucose, lactate, pyruvate, and glutamate). The case illustrates the potential value of these techniques by demonstrating the effects of adverse physiological events on brain metabolism and the ability to assist in both intraoperative and postoperative decision-making. CLINICAL PRESENTATION: A 41-year-old woman presented with a World Federation of Neurological Surgeons Grade I subarachnoid hemorrhage. Angiography revealed a basilar artery aneurysm that was not amenable to coiling, so the aneurysm was clipped. Before the craniotomy was performed, a multiparameter sensor and a microdialysis catheter were inserted to monitor brain metabolism. INTERVENTION: During the operation, the brain oxygen level decreased, in relation to biochemical changes, including the reduction of extracellular glucose and pyruvate and the elevation of lactate and glutamate. These changes were reversible. However, when the craniotomy was closed, a second decrease in brain oxygen occurred in association with brain swelling, which immediately prompted a postoperative computed tomographic scan. The scan demonstrated acute hydrocephalus, requiring external ventricular drainage. The patient made a full recovery. CONCLUSION: The monitoring techniques influenced clinical decision-making in the treatment of this patient. On-line measurement of brain tissue gases and extracellular chemistry has the potential to assist in the perioperative and postoperative management of patients undergoing complex cerebrovascular surgery and to establish the effects of intervention on brain homeostasis.- - - - - - - - - - ranking = 0.14285714285714keywords = gas (Clic here for more details about this article) |
10/145. Venous oxygen embolism due to hydrogen peroxide irrigation during posterior fossa surgery.Hazards of application of hydrogen peroxide to semiclosed space are well known. We present a case of suspected gas embolism following hydrogen peroxide irrigation of the surgical field during posterior fossa surgery in the prone position. Severe cardiovascular collapse occurred when the wound was irrigated with hydrogen peroxide solution. Generation of pressure gradient leads to absorption of a considerable amount of oxygen giving rise to features of venous gas embolism. Although the case was associated with an uneventful recovery, use of hydrogen peroxide for securing hemostasis should be avoided.- - - - - - - - - - ranking = 0.28571428571429keywords = gas (Clic here for more details about this article) |
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