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11/513. Paravesical granuloma after inguinal herniorrhaphy. Case report and review of the literature.

    Paravesical granuloma after herniorrhaphy is an unusual complication due to infected suture material and often mimics bladder or urachal malignancy. We present 3 cases of this disease and reviewed 21 previously reported cases. Our patients underwent hernial repair 2-7 years before examination and presented urinary symptoms. They were treated with antibiotics and underwent exploration of the inguinal wound infection but the symptoms did not resolve. En bloc excision and partial cystectomy were performed and resulted in complete resolution of the symptoms. It is important to consider paravesical granuloma in patients who had undergone herniorrhaphy in the differential diagnosis of bladder or urachal tumors.
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keywords = wound infection, wound
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12/513. Poststernotomy mediastinitis treated by rectus muscle flap plugging.

    The current standard treatment of mediastinitis following median sternotomy is radical sternal curettage and plugging of the anterior mediastinal dead space with muscle flap or omentum. This paper will report our experience with a pediculated flap of the rectus muscle after mediastinal irrigation and drainage. The patient was a 75-year-old man diagnosed as having aortic arch aneurysm. The patient underwent a total aortic arch replacement with the bovine-collagen sealed vascular prosthesis (Hemashield). As an early postoperative complication, he was diagnosed with mediastinitis which was the result of infection of the drainage fluid. Mediastinal curettage and plugging of the rectus muscle flap was successfully performed. Without recurrence of infection, the wound healed completely. We conclude that early curettage and rectus muscle flap plugging are the most effective treatment of the poststernotomy mediastinitis.
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ranking = 0.080117635105794
keywords = wound
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13/513. Reconstruction of irradiated postpneumonectomy empyema cavity with chain-link coupled microsurgical omental and TRAM flaps.

    We present the first case of complete hemithoracic reconstruction of an irradiated postpneumonectomy recurrent empyema cavity that was unresponsive to multiple conventional treatments. The procedure described used a chain-link of two coupled free flaps consisting of an omental and TRAM flap. A single abdominal donor site and single operative position are other advantages of this technique that provides sufficient volume to obviate the need for thoracoplasty even in the largest wounds.
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ranking = 0.080117635105794
keywords = wound
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14/513. Epithelial ingrowth in a corneal graft treated by laser in situ keratomileusis: light and electron microscopy.

    PURPOSE: To demonstrate progressive epithelial ingrowth histopathologically in a human cornea after laser in situ keratomileusis (LASIK) and review its pathophysiology. SETTING: Department of ophthalmology, Medical College of virginia Campus, virginia Commonwealth University, and the veterans Affairs Medical Center, Richmond, virginia, USA. methods: Tissue from a corneal transplant specimen was examined 6 weeks after LASIK by light and transmission electron microscopy. RESULTS: Epithelial ingrowth in the flap interface with connection to the surface corneal epithelium was evident on light microscopy. In areas without epithelial ingrowth, the flap interface was imperceptible. Electron microscopy revealed minimal disruption of the stromal collagenous lamellae. CONCLUSION: Progressive epithelial ingrowth occurred with a continuous sheet of epithelium to the flap edge. Location of epithelial ingrowth and cytokine epithelial-stromal interaction appear to be important factors in this complication. Histopathological changes in the cornea after LASIK are difficult to detect in areas with normal wound healing.
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ranking = 0.080117635105794
keywords = wound
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15/513. Penetrating craniocerebral injury from an underwater fishing harpoon.

    Weapon injuries other than gunshot wounds or low-velocity stab wounds to the head are extremely rare. We report the case of a 6-year-old girl who sustained a penetrating craniocerebral injury after being accidentally shot with an underwater fishing harpoon. This mechanism of injury seems to share characteristics of both high- and low-velocity projectiles. We discuss the management of this unusual injury in a child, remarking that foreign body removal in these cases must be carried out following the original direction of the projectile trajectory. We review the current literature on craniocerebral injuries caused by similar objects, especially those occurring in children.
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ranking = 0.16023527021159
keywords = wound
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16/513. Complications of surgical closure of tracheo-cutaneous fistula in pediatric patients - two case reports.

    Tracheocutaneous fistula is seen frequently in decannulated children and respiratory complications associated with primary surgical closure can be potentially fatal. cough is a precipitating factor for an air leak and we report two cases in which this occurred. A tracheotomy was performed on a 5-month-old girl for mechanical ventilation. Decannulation was successful at the first attempt. One year later, she presented with a persistent tracheo-cutaneous fistula. After surgical closure without drainage, she developed subcutaneous emphysema during a coughing episode. sutures were removed. A 9-month-old boy presented with oxygen-dependence after lung disease and a tracheotomy was performed for respiratory support. Decannulation was successful at the first attempt 6 months later. He developed a pneumomediastinum after surgical closure of a tracheo-cutaneous fistula. sutures were removed but replacement of a tracheotomy tube was required. In both cases the wounds were allowed to heal by secondary intention.
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ranking = 0.080117635105794
keywords = wound
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17/513. Scleral perforation after scleral buckling surgery for retinopathy of prematurity.

    Scleral perforation occurred as a result of using a silicone band during scleral buckling surgery for subtotal retinal detachment in retinopathy of prematurity (ROP). The patient was initially treated by cryotherapy and scleral buckling surgery for ROP, and was later referred due to a dark bluish mass in the superotemporal quadrant of the eyeball. After removing the overlying whitish membrane, uveal tissue prolapsed through the melted scleral wound (5 mm x 5 mm). A silicone encircling band had passed through the wound and was exposed subconjunctivally around the temporal and the inferior limbus. The band was removed and a scleral allograft was performed. After three years, follow up revealed the eyeball was slightly microphthalmic. Though scleral bucking surgery is helpful for the treatment of advanced ROP, a scleral perforation may develop as a disastrous complication.
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ranking = 0.16023527021159
keywords = wound
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18/513. Early experience with poly L-lactic acid bioabsorbable fixation system for paediatric craniosynostosis surgery. Report of 3 cases.

    OBJECTIVE: The authors describe early experience in the use of bioabsorbable fixation devices for cranial reconstruction of paediatric craniosynostosis patients. methods: Three patients, individually respectively presenting sagittal synostosis, metopic synostosis, and clover leaf skull deformity, underwent cranial reconstruction using poly L-lactic acid (PLLA) plates and screws. The patients ranged in age from 2 to 10 months at the time of surgery. The postoperative clinical follow-up ranged from 16 to 18 months. All patients showed satisfactory wound healing without signs of infection or local inflammation. The plates provided satisfactory fixation and were not palpable through the skin after 16 to 18 postoperative months. CONCLUSION: Our experience demonstrated the efficacy of PLLA bioabsorbable plates and screws for cranial reconstruction in cases of infant craniosynostosis. prospective studies and longer follow-up of a larger number of patients is desirable for confirmation of these findings.
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ranking = 0.080117635105794
keywords = wound
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19/513. fibrinolysis activation after operation of spermatic cord.

    The authors report a case of fibrinolytic haemorrhagic diathesis after operation of vas deferens carried out under epidural analgesia. attention is called to the diagnostic difficulties in the rare complication of these operations. Treatment of fibrinolytic haemorrhagic diathesis is discussed stressing the advantages of trasylol, which is a drug of choice in emergency states associated with bleeding from the surface of the wound when difficulties arise in carrying out full blood clotting tests.
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ranking = 0.080117635105794
keywords = wound
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20/513. Tamponade after open-heart surgery with percutaneous cardiopulmonary support.

    A 56-year-old man presented with late cardiac tamponade appearing on 9 postoperative day after weaning from percutaneous cardiopulmonary support. He had been referred to our hospital for congestive heart failure. He underwent aortic valve replacement and fell into postcardiotomy low output syndrome. He could not be weaned from extracorporeal circulation, and we had to use an intraaortic balloon pump and percutaneous cardiopulmonary support. On postoperative day 9, percutaneous cardiopulmonary support was successfully withdrawn without problems, but he showed signs of superior vena cava syndrome after the cannulas were removed. An echocardiogram also showed cardiac tamponade. When the wound was reopened, a lot of old clots had compressed the right atrium and, after clot removal, the patient's hemodynamic state improved markedly. It is important to be aware that percutaneous cardiopulmonary support may conceal hemodynamic deterioration due to cardiac tamponade and to take care that a patient does not experience hemodynamic deterioration after percutaneous cardiopulmonary support withdrawal.
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ranking = 0.080117635105794
keywords = wound
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