1/9. Anaesthetic management for a left pneumonectomy in a child with bronchopleural fistula.The anaesthetic management of a left pneumonectomy in a 18-month-old girl with a bronchopleural fistula is described. An ordinary tracheal tube was slit at the bevel to ensure upper lobe ventilation on right endobronchial intubation. A combination of a bronchial blocker, endobronchial intubation with a slit tube, and nerve blocks for these manoeuvres was used. Pain relief by a thoracic epidural block ensured good physiotherapy and a comfortable postoperative period.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
2/9. Neuropathic pain syndrome as an occult manifestation of injury of the spinal cord after surgical repair of aortic coarctation.Injury to the spinal cord injury with paraplegia, is a rare complication of surgical repair of aortic coarctation recognized immediately post-operatively. We present the case of a 41-year-old male undergoing surgery for restenosis at the site of a repair. Intra-operatively, he suffered inadvertent injury to an intercostal arterial branch during isolation of the aorta below the graft. Over the following months, he developed unusual symptoms involving the legs and genitourinary tract which, only after extensive investigations, were attributed to ischemic damage to the spinal cord related to the surgery. We suspect that similar syndromes reflecting injury to the spinal cord injury may be unrecognized following surgical repair of coarctation.- - - - - - - - - - ranking = 0.11585485143349keywords = urinary (Clic here for more details about this article) |
3/9. Anesthetic management of acquired tracheoesophageal fistula: a brief report.IMPLICATIONS: tracheoesophageal fistula may be either a congenital lesion or an acquired condition, most often resulting from foreign body ingestion. Location of the lesion has implications for anesthetic management and single lung ventilation may be required to facilitate surgical repair. In pediatric patients, intentional mainstem intubation may be required.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
4/9. Prolonged duration of anesthesia in a patient with multiple sclerosis following paravertebral block.PURPOSE: To explore the possibility that the prolonged duration of anesthesia following paravertebral block was related to the presence of multiple sclerosis in a patient undergoing elective inguinal hernia repair. CLINICAL FEATURES: A healthy 33-yr-old female presented for elective inguinal hernia repair. The procedure was performed under general anesthesia and a paravertebral block was performed at the end of the procedure for postoperative pain relief, whilst the patient was still anesthetized. Upon recovering from general anesthesia it was noted that the patient had a flaccid paralysis of both lower extremities. She was also very nauseated and required antiemetics and vasopressors for hypotension. A differential diagnosis of subarachnoid, subdural or epidural spread was considered. The presence of an epidural hematoma was also considered. The block regressed very slowly with full return of function in 12.5 hr. The duration of action of the block was far longer than one would expect following spinal, epidural or subdural spread of a local anesthetic. urinary catheterization was performed electively to prevent urinary retention. The patient was discharged home late that evening. Prior to discharge she volunteered that she was being investigated for multiple sclerosis. One month later the diagnosis of multiple sclerosis was confirmed. CONCLUSION: In conclusion the extended duration of central neural blockade following paravertebral block, may have been related to an abnormal uptake of local anesthetics into the spinal cord in the presence of demyelination.- - - - - - - - - - ranking = 0.11585485143349keywords = urinary (Clic here for more details about this article) |
5/9. Prevention of the development of a vesicovaginal fistula.The cause of vesicovaginal fistulas after hysterectomy is not clearly understood. In an attempt to determine its cause, the records of 12 patients who had vesicovaginal fistula develop (after total abdominal hysterectomy) were compared with 12 consecutive patients who underwent total abdominal hysterectomy without fistula formation. Most of the patients who had vesicovaginal fistulas develop had excessive postoperative abdominal pain, distension or paralytic ileus, or both. hematuria and symptoms of irritability of the bladder were also noted in the fistula group and prolonged postoperative fever and increased white blood cell count occurred more often. In contrast, the postoperative course was uncomplicated in the nonfistula group. The clinical course observed in many of the patients with vesicovaginal fistulas suggests that the patients had an unrecognized injury to the bladder resulting in urinary extravasation. It is postulated that the fistula develops when the urinoma drains into the vaginal cuff which is dependent and usually not closed. It may be possible to abort the development of many vesicovaginal fistulas by early recognition and treatment of an unsuspected bladder injury. It is suggested that patients with severe abdominal pain, distension, paralytic ileus, hematuria or symptoms of severe irritability of the bladder after abdominal hysterectomy be investigated early for a possible bladder injury.- - - - - - - - - - ranking = 2.7158548514335keywords = fistula, urinary (Clic here for more details about this article) |
6/9. kidney stone removal: percutaneous versus surgical lithotomy.Percutaneous removal of most urinary tract calculi may be performed as a 1-stage effort with techniques and skills developed recently in the specialties of urology and radiology. Ultrasonic fragmentation of most calculi was done to permit their extraction. Percutaneous ultrasonic lithotripsy was performed on 250 consecutive (a single exception) patients bearing stones that required removal. Targeted calculi were removed successfully from 97 per cent of these patients. One patient required surgical lithotomy. The previous 100 patients with stones underwent surgical lithotomy with 96 per cent success. Complications of percutaneous ultrasonic lithotripsy appeared equitable with those of surgical lithotomy. Of the patients who underwent percutaneous ultrasonic lithotripsy 6 (6 per cent) required extended hospital days or additional procedures for management of complications. None of these patients required a surgical incision. anesthesia times were similar for both groups--average 159 plus or minus 4 (standard error) minutes for percutaneous ultrasonic lithotripsy and 193 plus or minus 8 minutes for surgical lithotomy. Hospital recovery days averaged 5.5 plus or minus 0.3 for percutaneous ultrasonic lithotripsy and 8.4 plus or minus 0.5 for surgical lithotomy (p less than 0.01). Associated costs averaged $7,203 plus or minus 55 for lithotripsy and $8,849 plus or minus 660 for lithotomy (p less than 0.01). The number of narcotic administrations per patient (days 1 to 5 postoperatively) averaged 9.88 plus or minus 0.70 for lithotripsy and 16.82 plus or minus 0.78 for lithotomy (p less than 0.01). The average patient who underwent percutaneous ultrasonic lithotripsy felt capable of full activity 2.0 plus or minus 0.2 weeks following stone removal, whereas no patient who underwent previous surgical lithotomy recalls a recovery period of less than 3 weeks (p less than 0.01). We believe that most upper urinary tract calculi may be removed cost-effectively with a percutaneous approach. Compared to surgical lithotomy, percutaneous ultrasonic lithotripsy may result in rapid convalescence with diminished pain.- - - - - - - - - - ranking = 0.23170970286698keywords = urinary (Clic here for more details about this article) |
7/9. Phantom urinary bladder pain--case report.Phantom urinary phenomena are a relatively rare disease entity. literature search has revealed only one case following cystectomy, seven cases following spinal cord injury and several other cases in hemodialysis patients. This report presents a case of painful phantom bladder following cystectomy for chronic kidney and urinary tract infection. Treatment was directed toward sensory hyperstimulation for suppression of the subjective experience of the painful phantom. Lumbar sympathetic blocks and transcutaneous electrical stimulation were used. Competent coping mechanisms were increased through relaxation training and assertiveness training to deal with a medical problem which has no standard solution. The patient's response to the Comprehensive Pain Control Program was excellent with an estimated 75% reduction in painful phantom perceptions. A brief discussion of the medical literature on the subject is presented.- - - - - - - - - - ranking = 0.69512910860094keywords = urinary (Clic here for more details about this article) |
8/9. The Rosen prosthesis: a bad experience.Between September 1977 and September 1980 we implanted 4 Rosen inflatable incontinence prostheses in 4 men with urinary incontinence. Twelve operations were necessary on these 4 patients to assure them to be continent during a total of 43 months. Because of the great number of complications we no longer use the Rosen prosthesis.- - - - - - - - - - ranking = 0.11585485143349keywords = urinary (Clic here for more details about this article) |
9/9. suction drain management of salivary fistulas.Salivary fistulas remain an unpleasant complication of upper aerodigestive tract surgery. To avoid a disastrous outcome such as carotid rupture, clinicians "medialize" (i.e., incise the skin flap in the anterior aspect of the neck and insert a Penrose drain) to divert fistula fluid from the carotid sheath and then perform laborious wound care. Meanwhile, patients endure the unpleasant odor, discomfort due to the wound dressing, occasional secondary surgical procedures, a lengthened hospital stay, and increased financial costs. In an effort to mitigate these problems, suction drains that had been placed at the time of the original surgical procedure were used as an alternative management technique. Out of a population of 118 reviewable patients who underwent standard or extended variations of supraglottic laryngectomy, partial laryngopharyngectomy, near-total laryngectomy, or total laryngectomy between 1988 and 1992, 16 patients appropriate for inclusion in this study developed postsurgical fistulas. Eight of these patients were treated with traditional medialization procedures, and the other 8 patients were treated with suction drainage. Comparison of the two groups revealed no significant difference with respect to complications or time to fistula closure. The advantages of simplified postsurgical care, less patient discomfort, reduced time demands on the clinician, and cost containment were noted for the group treated with suction drainage.- - - - - - - - - - ranking = 1.6keywords = fistula (Clic here for more details about this article) |