RESUMO
Superior vena caval syndrome (SVCS) is a life-threatening medical emergency that is usually treated with high-dose irradiation. Previous attempts at surgical intervention have been disappointing. Recently, the authors have successfully treated a case of SVCS with a axillo-axillary and axillary to femoral venous bypass using an externally supported synthetic graft. This is an easy, safe, and rapid alternative for the emergent treatment of superior vena caval syndrome.
Assuntos
Veia Axilar/cirurgia , Prótese Vascular , Veia Femoral/cirurgia , Síndrome da Veia Cava Superior/cirurgia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
From January 1978 to December 1985, 22 parietal cell vagotomies for bleeding peptic ulcers were performed at the Charleston Area Medical Center. Twenty of these operations were done for acute bleeding with an overall complication rate of 27 per cent. There was only one operative mortality, and these results coincide with those of the world literature. Follow-up ranges from 1 month to 6 years with an average of 2 and one half years. Seventy-eight per cent of our patients had a good result defined as either Visick class I (ten patients) or Visick class II (four patients). All of the patients, with the exception of the one mortality, had control of the bleeding. Therefore, the authors believe parietal cell vagotomy should be considered in the treatment of acute bleeding peptic ulcer disease.
Assuntos
Úlcera Duodenal/cirurgia , Úlcera Péptica Hemorrágica/cirurgia , Vagotomia Gástrica Proximal , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Widespread acceptance of Limulus Amoebocyte Lysate testing in clinical situations has been elusive. The results obtained in this series of 38 patients seem to support the contention that the amylase-endotoxin complex can be of value in detecting rapidly and with reasonable sensitivity the presence of pancreatic injury and gastrointestinal perforations. A corrected WBC count appears to add diagnostic possibilities to the technique. Despite the promising evidence detailed in this paper, further studies are required to establish the true sensitivity/specificity of the test. Its validity and utility could be assessed rapidly if traumatologists who routinely perform lavage would utilize this method and report their findings.
Assuntos
Traumatismos Abdominais/diagnóstico , Amilases/análise , Líquido Ascítico/análise , Perfuração Intestinal/diagnóstico , Teste do Limulus , Irrigação Terapêutica , Sistema Digestório/lesões , Humanos , Contagem de Leucócitos , Pâncreas/lesõesRESUMO
In recent months, the technique of Laparoscopic Laser Cholecystectomy (LLC) was introduced at our institution. A small series is presented here involving 14 patients, seven of whom underwent LLC and seven in which a "mini-lap" cholecystectomy was performed. Symptomatic cholelithiasis was the indication for surgery in all cases, and operative cholangiograms were employed in 12 patients. Comparisons are made regarding length of hospitalization, recovery time and operative time. An improved recovery period is indeed demonstrated with LLC allowing return to normal activities and employment much sooner than with an open cholecystectomy. We suggest that, though some prudence and caution is advised, this appears to be a safe and feasible adjunct in the treatment of cholelithiasis.
Assuntos
Colecistectomia/métodos , Colelitíase/cirurgia , Laparoscopia/normas , Terapia a Laser/normas , Adulto , Idoso , Colelitíase/diagnóstico por imagem , Estudos de Avaliação como Assunto , Feminino , Humanos , Laparotomia , Masculino , Pessoa de Meia-Idade , RadiografiaRESUMO
Deep vein thrombosis (DVT) of the lower extremity during pregnancy is infrequent, but its complication, pulmonary embolism, remains an important cause of maternal mortality. To evaluate the best method of caring for patients with DVT, we reviewed the records of patients at the Charleston Area Medical Center from 1987-1992 who were treated for this condition. Twelve patients were treated with conventional continuous intravenous heparin for 7 days-10 days followed by subcutaneous heparin until 6 weeks-8 weeks after delivery. The other group consisted of nine patients who were treated with lower dose subcutaneous heparin for 7 days-10 days and maintained as the first group, but a Greenfield filter was inserted for patients with iliofemoral DVT. The patients who received low-dose heparin and Greenfield filters tended to do better than those who received high-dose conventional heparin treatment. However, since there were so few patients evaluated, further verification is needed.
Assuntos
Heparina/administração & dosagem , Complicações Hematológicas na Gravidez/tratamento farmacológico , Tromboflebite/tratamento farmacológico , Filtros de Veia Cava , Adulto , Terapia Combinada , Relação Dose-Resposta a Droga , Feminino , Humanos , Recém-Nascido , Infusões Intravenosas , Injeções Subcutâneas , Gravidez , Complicações Hematológicas na Gravidez/mortalidade , Embolia Pulmonar/mortalidade , Embolia Pulmonar/prevenção & controle , Taxa de Sobrevida , Tromboflebite/mortalidadeRESUMO
Gastrostomy can be a valuable adjunct to patient care, and percutaneous endoscopic gastrostomy is often considered the method of choice for gastrostomy placement. As with all surgical procedures, however, patient selection is important no matter how the gastrostomy is placed. In a retrospective review of 125 randomly selected patients having gastrostomy tube placement, there were certain groups of patients who received virtually no benefit from gastrostomy and may even have died sooner due to gastrostomy placement. The leading indication for gastrostomy placement was neurologic debilitation; the procedural mortality rate for these patients was 28%. However, patients with pulmonary cachexia or metastatic cachexia had much higher mortality rates: 90% and 37%, respectively. We believe patient selection has been imperfect and that certain patients should not have a gastrostomy tube. These patients suffer the moral indignation of persistent intervention and often die without receiving any real benefit.
Assuntos
Gastrostomia/mortalidade , Mortalidade Hospitalar , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Caquexia/etiologia , Caquexia/mortalidade , Caquexia/terapia , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/estatística & dados numéricos , Gastrostomia/efeitos adversos , Gastrostomia/estatística & dados numéricos , Hospitais Comunitários , Humanos , Pessoa de Meia-Idade , Neoplasias/mortalidade , Neoplasias/terapia , Doenças do Sistema Nervoso/mortalidade , Doenças do Sistema Nervoso/terapia , Estudos Retrospectivos , Análise de Sobrevida , Fatores de Tempo , West Virginia/epidemiologiaRESUMO
An endolaparoscopic technique to perform a proctopexy is reported. This procedure appears to be ideally suited for this approach and, furthermore, it can be performed safely and effectively. Long-term predictions of morbidity, mortality and recurrence rates cannot yet be made, but those parameters might not be different from what would be expected with the open approach.
Assuntos
Laparoscopia/métodos , Reto/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Prolapso Retal/cirurgia , Telas CirúrgicasRESUMO
We describe a method for performing laparoscopic staging laparotomy. We believe this minimally invasive approach can ease the transition between purely open and laparoscopic surgery, and it is applicable to a variety of intra-abdominal problems. The results are comparable to those of a standard staging laparotomy, with improvement in access morbidity and decreased hospitalization time.
Assuntos
Abdome/cirurgia , Laparoscopia/métodos , Laparotomia/métodos , Adulto , Feminino , Doença de Hodgkin/cirurgia , Humanos , Masculino , Esplenectomia/métodosRESUMO
A method of performing a laparoscopic splenectomy with the aide of intraabdominal manipulation is described. We believe that this is a versatile technique that compares quite favorably with a pure cannula approach. It is likely that this approach is safer because vascular control can readily be assured by the intraabdominal operator. It is also less costly because it is more rapid than a procedure done solely by cannula techniques. Moreover, it is reproducible by an experienced general surgeon. The results appear equal in terms of access morbidity and hospitalization time to those seen with a purely laparoscopic approach. Experience with 21 splenectomies is described and compared with 20 others performed by the traditional open approach.
Assuntos
Laparoscopia/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Esplenectomia/métodos , Adulto , Idoso , Feminino , Volume Expiratório Forçado , Mãos , Hospitalização , Humanos , Laparoscópios , Laparoscopia/efeitos adversos , Laparoscopia/economia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/economia , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Reprodutibilidade dos Testes , Estudos Retrospectivos , Esplenectomia/efeitos adversos , Esplenectomia/economia , Esplenectomia/instrumentação , Taxa de Sobrevida , Fatores de Tempo , Capacidade VitalRESUMO
The relatively new field of endoscopic surgery shows much promise and allows alternative treatment options. With increasing numbers of surgeons gaining experience with this technique, new approaches to old conditions are being reported. We present the case of a young female with partial small bowel obstruction secondary to an adhesive band; the condition was readily diagnosed using the laparoscope and treated. We show that in appropriate patient selection, this method is a viable and easily performed alternative to formal laparotomy.