1/99. Extra-renal pseudoaneurysm: an uncommon complication following renal transplantation.Vascular complications are reported in a significant proportion of patients following renal transplantation and are a contributory cause of graft dysfunction. Of these, pseudoaneurysm formation is one of the least common. We present three patients in whom extra-renal transplant artery pseduoaneurysms arising from the surgical anastomosis between the external iliac and renal transplant artery were initially diagnosed with colour Doppler ultrasound, and outline their subsequent management.- - - - - - - - - - ranking = 1keywords = outline (Clic here for more details about this article) |
2/99. Anterolateral thigh fasciocutaneous flap in the difficult perineogenital reconstruction.A pedicled anterolateral thigh fasciocutaneous flap that was used to cover a complicated perineogenital defect after bilateral gracilis myocutaneous flap for perineal reconstruction is presented. The indications and advantages of this approach are outlined. This technique offers to the plastic surgeon and gynecologic oncologist a new option in the armamentarium for reconstruction of the perineum, and it offers the patient reduced donor-site morbidity.- - - - - - - - - - ranking = 1keywords = outline (Clic here for more details about this article) |
3/99. Cystic schwannomas of the jugular foramen: clinical and surgical remarks.OBJECTIVE: The goals of this report were to outline the clinical presentation, radiological characteristics, surgical techniques, postoperative morbidity, and long-term follow-up results for cystic jugular foramen (JF) schwannomas and to describe their differences, compared with solid schwannomas involving the JF. methods: A retrospective analysis of radiological studies and surgical records identified five primarily cystic tumors among 21 cases of JF schwannomas that had been surgically treated at our institution. RESULTS: Two types of cystic JF schwannomas were observed, i.e., Type 1 lesions, which are single large cysts with thin ring-like enhancement of the tumor wall, and Type 2 lesions, which are multiple cysts with very irregular, thick enhancement of the cyst wall. The most common symptoms were hearing loss, ataxia, and headaches. Total surgical removal could be performed in all cases. The immediate postoperative findings indicated hearing improvement in three cases. No deterioration of lower cranial nerve function was observed. All patients were independent in the immediate postoperative period and in the long-term follow-up period (Karnofsky Performance Scale score, 90). CONCLUSION: Surgical treatment of cystic JF schwannomas can be very demanding because of generally stronger adhesion of the tumor capsule to the surrounding structures, fragile tumor capsules, and difficulty in identification of the arachnoidal planes in some cases. Early identification of the arachnoidal planes without opening of the cyst and sharp dissection may be useful. Careful intradural opening of the JF should be performed to achieve total removal of the last tumor portion within the JF. A comparison of these lesions with solid schwannomas involving the JF indicated that cystic tumors affected a younger population, with less preoperative swallowing impairment (P < 0.05). The immediate postoperative course in both types of cystic JF schwannomas was usually better than for solid lesions, because of minor postoperative cranial nerve morbidity, especially involving lower cranial nerve function, in the latter cases. Long-term follow-up data failed to demonstrate any significant differences in final patient outcomes, however.- - - - - - - - - - ranking = 1keywords = outline (Clic here for more details about this article) |
4/99. Labyrinthine fistula: an unreported complication of the Grote prosthesis.OBJECTIVES: To alert the otological surgeon that labyrinthine fistula is a rare and avoidable complication of the Grote hydroxyapatite ceramic external auditory canal (EAC) prosthesis. The reasons for its causation and strategies to prevent its formation are discussed. STUDY DESIGN: Case study and retrospective review of the literature. methods: Labyrinthine fistula that occurred after the use of the Grote hydroxyapatite ceramic EAC prosthesis is presented. The literature is reviewed retrospectively for various methods of reconstruction of the EAC following canal wall down mastoidectomy. Strategies and principles are outlined to avoid complications associated with reconstruction of the mastoid and EAC. RESULTS: The Grote hydroxyapatite (HA) prosthesis is a reliable prosthesis for reconstruction of the external auditory canal (EAC) in the absence of a draining mastoid cavity or cholesteatoma and with adequate soft tissue cover. Contact of the medial end of the prosthesis with the lateral semicircular canal must be avoided. immobilization or rigid fixation and avoidance of infection are essential for optimal prosthesis stability and osseointegration. Covering the prosthesis with vascularized soft tissue appears to be important for the achievement of a successful reconstruction. CONCLUSION: The Grote prosthesis is safe and effective provided it does not contact the lateral semicircular canal, is stabilized, and covered by vesicular tissue, in the absence of infection.- - - - - - - - - - ranking = 1keywords = outline (Clic here for more details about this article) |
5/99. aquaporins and the surgeon: cautionary tales.Nephrogenic diabetes insipidus (NDI) presents an uncommon but formidable clinical challenge in the surgical patient. Two recent cases of NDI with differing aetiology are presented. These cases and a review of the literature illustrate well the diagnosis, fluid and electrolyte imbalances seen and the strategy of treatment required in the post-operative setting. The central role of the recently discovered aquaporin channels in this condition is briefly outlined. Nephrogenic diabetes insipidus has a diverse aetiology and many of the hazards of the condition are peculiar to the surgical setting. The importance of management in a high dependency environment is highlighted.- - - - - - - - - - ranking = 1keywords = outline (Clic here for more details about this article) |
6/99. Controlled tamponade of severe presacral venous hemorrhage: use of a breast implant sizer.hemorrhage from the presacral venous plexus is a potentially life-threatening complication of pelvic operations. The morbidity and mortality that stems from severe hemorrhage has led to the development of various hemostatic techniques. Although suture ligature, packing, and placement of tacks can be very effective, they can often be unsuccessful. When these conventional hemostatic techniques fail, alternative approaches are required. We describe the successful use of an expandable breast implant sizer and outline the practical, theoretical, and financial advantages of applying this technique when more conservative approaches have failed.- - - - - - - - - - ranking = 1keywords = outline (Clic here for more details about this article) |
7/99. Sticky eye, tricky diagnosis.BACKGROUND: Infective conjunctivitis is common and mostly responds well to supportive management and/or empiric antibiotic treatment. At times the differential diagnosis includes more serious conditions that potentially threaten vision. recurrence and treatment failures are relatively common. OBJECTIVE: To outline the usual clinical appearance of conjunctivitis and its management. To explore the clinical appearance (with the help of case studies) of conditions that have been mistaken for conjunctivitis, and to consider some of the conditions that may coexist that contribute to recurrence and nonresponsiveness. DISCUSSION: Empiric treatment for presumed bacterial conjunctivitis remains an appropriate course of action. Care must be taken in certain groups who are at high risk of complications. Careful review of the clinical appearance and consideration of other possible diagnoses is mandatory in nonresponding patients.- - - - - - - - - - ranking = 1keywords = outline (Clic here for more details about this article) |
8/99. Traumatic intracranial aneurysms complicating anterior skull base surgery.Traumatic cerebral aneurysm formation following closed head injury is uncommon, although well documented in the literature. Aneurysmal development following surgical procedures on the anterior skull base is extremely rare. This article reports successful neurosurgical management of 3 cases of anterior circulation aneurysms that developed following relatively straightforward rhinological procedures. These cases illustrate the vulnerability of the vessels of the anterior circle of willis; they also document the sites of penetration of the anterior skull base. As reported in the literature, most such aneurysms occur following transsphenoidal surgery. The clinical procedures, radiological follow-up, and the surgical management are outlined; three cases are utilized to illustrate this complication. The causes of such iatrogenic injury are discussed, with emphasis on strategies for the avoidance of such injuries.- - - - - - - - - - ranking = 1keywords = outline (Clic here for more details about this article) |
9/99. Aortic dissection immediately following division of a patient ductus arteriosus.A case of aortic dissection following division of a patent ductus arteriosus in a 20-years-old female is presented. The possibility of an idiopathic dilatation of the aorta or of preexisting medial abnormalities as predisposing factors besides the cross clamping of the aorta or of the ductus is outlined. The dissection was successfully treated transecting the abdominal aorta, contrary to the classical thoracic approach, and repairing the dissection of the distal end of the abdominal aorta interposing a graft between the divided ends.- - - - - - - - - - ranking = 1keywords = outline (Clic here for more details about this article) |
10/99. Unexpected complication of posterior canal occlusion surgery for benign paroxysmal positional vertigo.OBJECTIVE: The purpose of this report was to illustrate how an unusual complication of posterior canal occlusion surgery for benign paroxysmal positional vertigo (BPPV) may be recognized and prevented. recurrence of BPPV after occlusion surgery of the posterior semicircular canal has not previously been reported in the literature, to the authors' knowledge. Failure of occlusion not only permits the continued symptoms of BPPV but also burdens the patient with the additional morbidity of a fistula of the PSCC. The authors describe the successful treatment of a patient with recurrent and incapacitating BPPV after the failure of occlusion surgery of the posterior semicircular canal, when the patient was simultaneously crippled by the distressing morbidity of an iatrogenic fistula. DESIGN: Case report. SETTING: Tertiary care referral center. INTERVENTION: Surgical excision of the fistulous segment of the membranous posterior semicircular canal. OUTCOME MEASURES: The BPPV was resolved. The distressing symptom of a fistula was eliminated. Hearing was preserved. CONCLUSION: Failure to completely occlude the posterior semicircular canal during posterior canal occlusion surgery results in recurrence of BPPV and an iatrogenic fistula, both of which are preventable. The occurrence of such an event is described, its management is outlined, and some thoughts are offered about its prevention.- - - - - - - - - - ranking = 1keywords = outline (Clic here for more details about this article) |
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