1/89. The development of a pancreatic abscess, suppurative pylethrombosis, and multiple hepatic abscesses after a pancreatojejunostomy for chronic pancreatitis: report of a case.We present herein an autopsy case of 63-year-old Japanese man who died as a result of pancreatic abscess, suppurative pylethrombosis, and multiple liver abscesses that had developed 10 years after a pancreato- and cystojejunostomy with side-to-side anastomosis for chronic pancreatitis. Even after this operation, the patient had continued to consume excessive amounts of alcohol. He had first experienced back pain with leukocytosis 9 years after the operation, which relapsed the following year. Despite percutaneous transhepatic gallbladder drainage, his icterus had deteriorated into hepatic insufficiency. Computed tomographic scans of the abdomen had disclosed multiple liver abscesses. At autopsy, a pancreatic abscess and suppurative pylethrombosis as well as multiple liver abscesses were found. There have been few reported cases of such lethal complications developing after a pancreato- and cystojejunostomy for chronic pancreatitis. As the consumption of alcohol would have exacerbated the chronic pancreatitis, such patients should be strongly advised to abstain from drinking alcohol.- - - - - - - - - - ranking = 1keywords = sump (Clic here for more details about this article) |
2/89. classification and treatment of intercondyloid fractures of the humerus.The authors describe the satisfactory results obtained in sixteen intercondyloid fractures of the humerus, thirteen of which were treated surgically. The preference for surgical treatment in such fractures is based in the assumption that, as in all articular fractures, a good functional result can only be achieved if there is the most perfect possible reconstruction of the fragments and the joint surface. A classification is therefore suggested which is based not purely on anatomical criteria, but is also related to treatment and prognosis. The slendor nature of the distal end of the humerus and the danger of metal reaction call for the use of fixation devices that are efficient but slender, such as fine screws and crossed wires. The precise method of fixation is conditioned above all by the direction of the fracture lines. More solid fixation with early mobilisation can be achieved by compression screws, and less solid fixation with longer immobilisation is achieved by fixation with crossed Kirschner wires. Consequently, the more oblique types of fracture with fragments with long beaks that allow more stable fixation with compression screws have the more favourable prognosis. In the evaluation of results, the authors emphasize the importance of using parameters which take into account the functionally useful range of joint movement.- - - - - - - - - - ranking = 1keywords = sump (Clic here for more details about this article) |
3/89. Postoperative acalculous cholecystitis due to Torulopsis glabrata.Acute acalculous cholecystitis due to Torulopis glabrata, an opportunistic yeast, developed postoperatively in a 70-year-old man who had an extremely complicated course after resection of an abdominal aortic aneurysm. The infection first appeared as an acute surgical abdomen, three days after resumption of solid food intake subsequent to a prolonged ileus and after 31 days of parenteral hyperalimentation. The condition was successfully treated by cholecystostomy; at the time of writing, six months after cholecystostomy, there are no gastrointestinal symptoms.- - - - - - - - - - ranking = 1keywords = sump (Clic here for more details about this article) |
4/89. Pseudomonas osteomyelitis of the symphysis pubis after inguinal hernia repair.osteitis pubis (OP) is a term used to describe an entity characterised by severe pelvic pain, a wide-based gait and bony destruction of the margins of the pubic symphysis. It is usually assumed that OP is a non-infectious, self-limiting, relatively benign condition. Infectious osteomyelitis of the symphysis pubis (IOSP) is very unusual and the clinical presentation can resemble OP. IOSP following inguinal hernia repair is extremely rare. A case of IOSP caused by pseudomonas aeruginosa is described. We reiterate the assumption that IOSP can be misdiagnosed as OP.- - - - - - - - - - ranking = 1keywords = sump (Clic here for more details about this article) |
5/89. Intraarticular methyl methacrylate: a complication of hip surgery.Methyl methacrylate, used as a grout during hip arthroplasty, can inadvertently become lodged between acetabular and femoral components during surgery. After resumption of ambulation, crescentic fragments may extrude into the pseudocapsule. If mobile methyl methacrylate fragments lodge within the joint, late surgical failure may result because of methyl methacrylate's abrasive character. Two cases of total hip replacement and one case of femoral arthroplasty are reported in which intraarticular methyl methacrylate was identified retrospectively; all three patients remain asymptomatic at the time of the report.- - - - - - - - - - ranking = 1keywords = sump (Clic here for more details about this article) |
6/89. Presumptive delayed gas embolism after laparoscopic cholecystectomy.A 50-year-old woman, with a history of arterial hypertension treated with beta-blocker and Ca-antagonist, presented cardiac arrest 6 hours after elective laparoscopic cholecystectomy. During surgical intervention, arterial hypotension without any respiratory change was observed. dyspnea, asthenia and anxiety were the clinical signs appearing approximately 2 hours before cardiac arrest. After resuscitation, myocardial infarction, dissecting thoracic aortic aneurysm and major pulmonary thromboembolism were excluded. The signs of increased resistance to the right ventricular outflow and the relevant alteration of coagulation tests, lasting only a few hours, suggested venous gas embolism. Subsequently, the patient presented a cortical blindness, persisting at hospital discharge. The anesthetists should be aware about the complication that we observed after laparoscopic surgery. The least sign of cardiorespiratory instability appearing in the postoperative period must be taken into account and signal the need for increased monitoring.- - - - - - - - - - ranking = 4keywords = sump (Clic here for more details about this article) |
7/89. Identification of the asexual state of rhizopus species on histologic tissue sections in a patient with rhinocerebral mucormycosis.mucormycosis is an infection caused by a group of fungi in the order mucorales in the phylum Zygomycota. The most well-known form of this disease is rhinocerebral mucormycosis, which usually develops in diabetic or immunocompromised patients. The fungal hyphal elements are easily detected in biopsy specimens by direct or histologic examination. However, the confirmatory identification of the genus or species requires culture of the specimen. This article presents a case of rhinocerebral mucormycosis in which presumptive identification of the genus was made without microbiologic cultures and was based on the extraordinarily rare appearance of fungal sporangia and sporangiospores in histologic tissue sections. Identification of these structures allowed an early and accurate diagnosis of rhinocerebral invasive mucormycosis.- - - - - - - - - - ranking = 1keywords = sump (Clic here for more details about this article) |
8/89. Thrombolysis of prosthetic tricuspid valve thrombosis with human recombinant tissue plasminogen activator in an adolescent.Prosthetic heart valve thrombosis is associated with a high mortality. Traditionally, thrombectomy or valve replacement is performed. Thrombolysis offers a promising alternative to surgery. Usually, streptokinase and urokinase are the preferred agents for thrombolysis; however, human recombinant tissue plasminogen activator (rt-PA) is increasingly used. thrombosis of prosthetic valves in children and adolescents is rare and experience of thrombolysis for obstructed valves is limited. We report the successful lysis of a thrombosed prosthetic tricuspid valve in an adolescent using rt-PA. The outcome of our patient supports the assumption that rt-PA represents an adequate therapeutic option for thrombolysis of obstructed prosthetic heart valves in children and adolescents.- - - - - - - - - - ranking = 1keywords = sump (Clic here for more details about this article) |
9/89. Re-opened foramen ovale--a rare cause of postoperative dyspnea following pneumonectomy.dyspnea and hypoxemia are common postoperative problems following pneumonectomy. Platypnea, the increased dyspnea in the erect position relieved by assuming a prone position, has been reported as a result of right to left inter-atrial shunt. We report here on our experience with a patient who had severe platypnea with remarkable positional arterial desaturation following right pneumonectomy. After establishing the diagnosis with contrast-enhanced transesophageal echocardiography of the preoperatively undetected interatrial right-left shunt, cardiac surgery led to clinical improvement and resumption of platypnea. Given the rarity of the diagnosis, we think interatrial shunt, based on an open foramen ovale, should be taken into consideration when platypnea occurs in patients as a postoperative complication following lung surgery. Transesophageal echocardiography may be helpful in detecting patients with "anatomical closed but functional open" foramen ovale or genuine inter-atrial septal defect prior to lung surgery.- - - - - - - - - - ranking = 1keywords = sump (Clic here for more details about this article) |
10/89. Perioperative wheezing--a report of three cases.CLINICAL PICTURE: We describe 3 patients with perioperative wheezing, 2 of whom were treated with bronchodilators on the presumptive diagnosis of bronchospasm. TREATMENT AND OUTCOME: Subsequent clinical improvement occurred when it was recognised that the wheezing was due to upper airway obstruction and stridor, not bronchospasm and rhonchi, and appropriate treatment instituted.- - - - - - - - - - ranking = 1keywords = sump (Clic here for more details about this article) |
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