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21/78. Laparoscopic diaphragmatic plication: long-term results of a novel surgical technique for postoperative phrenic nerve palsy.

    BACKGROUND: paralysis of the diaphragm is a severe complication of cardiothoracic surgery carrying significant morbidity and mortality. This study demonstrates a novel minimally invasive technique for treatment of phrenic nerve injuries presenting with symptomatic eventration of the diaphragm. It also presents long-term results of three patients treated with this operation. methods: Chest x-ray proved eventration of the left diaphragm in all patients. Two patients required treatment due to prolonged respirator therapy/assisted ventilation for 4 weeks after cardiac surgery. One patient suffered from progressive dyspnea caused by increasing left-sided diaphragmatic elevation and underwent surgery 2 years after cardiac surgery. In all cases, a minimally invasive abdominal approach was chosen. During surgery the dome of the diaphragm was pulled down via three percutaneously inserted retention stitches. This resulted in two or three folds of the diaphragm located within the abdomen. These diaphragmatic folds were subsequently tightened using 12 to 15 unresorbable sutures with extracorporally prepared knots. Surgical as well as long-term follow-up results are presented of all patients and a review of the current literature is provided. RESULTS: Mean operating time was 203 min; mean intraoperative blood loss was 130 ml. No major complications occurred during surgery or the postoperative period. At a median follow-up of 72 months no recurrence was observed. CONCLUSIONS: Laparoscopic diaphragmatic plication provides excellent relief of symptoms caused by diaphragmatic paralysis. There is no perioperative morbidity, and hospital stay is short. The laparoscopic approach, therefore, is an attractive surgical alternative for the treatment of phrenic nerve palsy and should be considered in all suitable patients.
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22/78. pituitary apoplexy occurring during large volume liposuction surgery.

    A 50-year-old woman developed headache and right-sided ophthalmoplegia upon awakening from general anesthesia after liposuction surgery on her abdomen, hips, and thighs. neuroimaging showed hemorrhage within a previously undiagnosed pituitary adenoma. The confirmatory surgical specimen contained areas of gross infarction and hemorrhage. The anesthesia record revealed intraoperative reduction of systolic blood pressure to 90 mm Hg for 30 minutes from a baseline of 120 mm Hg. This first reported case of pituitary apoplexy during liposuction surgery probably resulted from intraoperative hypotension attributed to a combination of general anesthesia, the use of subcutaneous lidocaine, sequestration of plasma in injured tissues, and blood loss.
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23/78. Epicardial electrode insertion by means of video-assisted thoracic surgery technique.

    BACKGROUND: The number of patients who depend on pacemaker (PM) insertion is steadily increasing. slovenia has two centers for PM insertion, in which 250 such procedures are performed every year. Thus, with regard to the number of procedures per year per million inhabitants, slovenia holds a middle position in the list of countries. METHOD: We report a patient with cardiomyopathy, complete A-V block (A-V block III) and permanent transvenous pacing lead replacements. The resulting thrombosis of the superior vena cava compelled us to insert an epicardial permanent pacing lead. Video-assisted thoracic surgery (VATS) technique was selected. RESULTS: Surgery was safe for the patient, of 40 minutes' duration, and with minimum blood loss. The postoperative course was devoid of complications, the patient's circulation was stable, and he was able to leave the hospital one week later. CONCLUSIONS: We believe that the choice of the thoracoscopic method of epicardial permanent pacing lead insertion is appropriate, and that the method is safe and promising as it broadens the indications for the VATS technique.
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24/78. The use of an overlay autogenous tissue (OAT) patch to control intra-operative haemorrhage of the spleen.

    BACKGROUND: During major abdomino-pelvic surgery, there is a risk of severe haemorrhage. When routine measures at haemostasis fail, the overlay autogenous tissue (OAT) patch may be useful to control bleeding. CASE: We present a case report of the use of the use of an OAT patch to control haemorrhage of the spleen incurred during tertiary cytoreduction. CONCLUSION: The OAT patch should be considered in situations where bleeding is unable to be controlled after routine measures have failed and in instances other than for vascular injury alone. This technique has implications for practice in a wide range of gynaecologic oncology surgery.
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ranking = 1.0721317934554
keywords = haemorrhage
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25/78. Surgical excision of sacral tumors assisted by occluding the abdominal aorta with a balloon dilation catheter: a report of 3 cases.

    STUDY DESIGN: A report of 3 cases of upper sacral tumors excised by occluding the abdominal aorta with a balloon dilation catheter (BDC). OBJECTIVE: To investigate the feasibilities of reducing intraoperative hemorrhage and improving the safety of surgical excision of sacral tumors assisted by occluding the abdominal aorta with a BDC. SUMMARY OF BACKGROUND DATA: Surgical excision of upper sacral tumors has been considered a high-risk and difficult operation, with multiple complications because of its massive and uncontrollable intraoperative hemorrhage. However, until now and to our knowledge, no report on resection of sacral tumors assisted by occluding the abdominal aorta with a BDC is available. methods: A BDC was used to occlude the abdominal aorta for 40-65 minutes in assisting with resection of upper sacral tumors in 3 cases. RESULTS: After the abdominal aorta was occluded, much less intraoperative hemorrhage was found, and the volume of blood loss was only 100-200 mL. This procedure assisted the surgeon in identifying clearly the surgical margin and sacral nerves surrounded by the tumors. In addition, intraoperative contamination was also minimized. The blood pressure remained stable during the operation. CONCLUSION: To occlude the abdominal aorta with a BDC may effectively reduce intraoperative hemorrhage, thus assisting the surgeon in the complete and safe resection of upper sacral tumors.
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26/78. Benefits and limitations of image guidance in the surgical treatment of intracranial dural arteriovenous fistulas.

    BACKGROUND: Despite major advances in endovascular embolization techniques, microsurgical resection remains a reliable and effective treatment modality for dural arteriovenous fistulas (DAVF). However, intraoperative detection of these lesions and identification of feeding arteries and draining veins can be challenging. In a series of 6 patients who were not candidates for definitive treatment by endovascular embolization we evaluated the benefits and limitations of computer-assisted image guidance for surgical ablation of DAVF. methods: Of the 6 patients, 5 presented with haemorrhage and one with seizures. diagnosis of DAVF was made by conventional angiography and dynamic contrast enhanced MR angiography (CE-MRA). All patients were surgically treated with the assistance of a 3D high resolution T1-weighted MR data set and time-of-flight MR angiography (MRA) obtained for neuronavigation. Registration was based on cranial fiducials and image-guided surgery was performed with the navigation system. FINDINGS: Four of the 6 patients suffered from DAVF draining into the superior sagittal sinus, one fistula drained into paracavernous veins adjacent to the superior petrosal sinus and one patient had a pial fistula draining in the straight sinus. DAVF diagnosed with conventional angiography could be located on CE-MRA and MRA prior to surgery. MRI and MRA images were combined on the neuronavigation workstation and DAVF were located intraoperatively by using a tracking device. In 4 out of 6 cases neuronavigation was used for direct intraoperative identification of DAVF. brain shift prevented direct tracking of pathological vessels in the other 2 cases, where navigation could only be used to assist craniotomy. Microsurgical dissection and coagulation of the fistulas led to complete cure in all patients as confirmed by angiography. CONCLUSIONS: neuronavigation may be used as an additional tool for microsurgical treatment of DAVF. However, in this small series of 6 cases, surgical procedures have not been substantially altered by the use of the neuronavigation system. Image guidance has been beneficial for the location of small, superficially located DAVF, whereas a navigated approach to deep-seated lesions was less accurate due to the familiar problem of brain shift and brain retraction during surgery.
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ranking = 0.17868863224257
keywords = haemorrhage
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27/78. Protein-Z-deficiency as a rare case of unexpected perioperative bleeding in a patient with spinal cord injury.

    STUDY DESIGN: Case report describing the management of repeated perioperative bleeding probably due to Protein-Z-deficiency in a post-traumatic paraplegic patient. OBJECTIVES: To describe the difficulty in diagnosing this rare form of hypocoagulability and the monitoring and substitution concept during three elective surgical interventions. SETTING: spinal cord Injury Center, Bergmannstrost, Halle, germany. CASE REPORT: A 19-year-old male suffering from a post-traumatic paraplegia sub Th8 (asia-A) since childhood had experienced two life-threatening intraoperative bleeding incidents before finally Protein-Z-deficiency as the underlying coagulation disorder was diagnosed. After substitution of 2000 IE PPSB (Beriplex P/N) a repeatedly postponed implantation of a sphincter-externus (Brindley-) stimulator could be performed without bleeding complications, and this was also true for two additional urological interventions 1 year later. Protein-Z levels were monitored before, during and after the operations. The preoperative application of between 1000 and 2000 IE PPSB was safe and sufficient to raise the patients' plasma Protein-Z level to almost normal and so prevent excessive intraoperative blood loss. CONCLUSION: In case of repeated bleeding tendency of unknown origin it is mandatory to look for rare causes of hypocoagulability such as Protein-Z-deficiency. We developed a substitution concept using a plasma concentrate with guaranteed Protein-Z amount (PPSB) allowing the safe performance of elective surgical interventions.
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28/78. Intraoperative ruptures of thoracic aortic aneurysms.

    Intraoperative rupture of thoracic aortic aneurysm is a severe complication which may have an adverse effect on the outcome of operation. Among all intraoperative aneurysmal ruptures the most difficult and uncontrolled are ruptures of aortic aneurysms in the presence of dissection and of false aortic aneurysm during repeat interventions in this area. At intraoperative aortic rupture the priority task of the surgical team consists in urgent attainment of maximal temporary hemostasis and an adequate replenishment of blood loss. Presented herein are two most demonstrative clinical cases of intraoperative aortic ruptures: of the ascending aorta during cannulation of the right atrium and of false aneurysm of the aortic isthmus, which developed after aortic isthmoplasty by dacron patch for coarctation where the posterolateral wall of aneurysm was visceral pleura of the left lung. The authors provide a detailed description of the treatment policy for the given condition. review the reported data pertaining to the problem under consideration.
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29/78. Laparoscopic repair of external iliac-artery transection during laparoscopic radical prostatectomy.

    BACKGROUND AND PURPOSE: Vascular injuries are the most common complication of pelvic lymph-node dissection. We report a case of total division of the external iliac artery and its immediate laparoscopic repair. methods: A 70-year-old man with a prostatic adenocarcinoma (Gleason Score 6) and serum prostate specific antigen concentration of 20 ng/mL had inadvertent external iliac-artery transection during pelvic lymphnode dissection secondary to the abnormal course and anatomy of the artery. Immediate laparoscopic repair was accomplished with a two-needle single-knot technique as is routinely used for the vesicourethral anastomosis. Thereafter, laparoscopic radical prostatectomy was completed. RESULTS: The reconstruction time was 37 minutes. There was no significant blood loss. There were no further intraoperative complications. Postrepair, the femoral pulse was intact, and follow-up duplex color ultrasonography showed good flow. The patient was disharged home on day 7, ambulant and asymptomatic. CONCLUSION: In controlled cicumstances, laparoscopic repair of external iliac-artery transection is feasible and represents a safe alternative to open surgery.
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30/78. Development of torsade de pointes caused by exacerbation of QT prolongation during clipping of cerebral artery aneurysm in a patient with subarachnoid haemorrhage.

    We report the case of a 79-yr-old woman with subarachnoid haemorrhage (SAH) in whom torsade de pointes (TdP) caused by worsening the QT prolongation occurred during clipping of cerebral artery aneurysm. This patient shows a potential risk of occurrence of life-threatening tachyarrhythmia, TdP by prolonging the QT interval during surgery in patients with SAH even with no additional factors that predispose to TdP. Therefore, a proper monitoring of the QT interval is necessary as a predictor of TdP. When ventricular tachyarrhythmia occurs, recognition of TdP is important because antiarrhythmic drug therapy for TdP is different from that for ventricular tachyarrhythmias that is not TdP.
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ranking = 0.89344316121283
keywords = haemorrhage
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