Assuntos
Acidentes de Trabalho , Explosões , Odontologia Legal , Incêndios , Humanos , Mar do Norte , PetróleoRESUMO
The cases of two children with giant nevi of the trunk that were excised and closed in early childhood are presented. Both had cosmetic and functional deformities and were treated by scar excision and skin grafting. The 2 cases demonstrate that excision and closure of giant nevi in young children should be discouraged, as it can result in distortion of surrounding structures.
Assuntos
Cicatriz/cirurgia , Nevo Pigmentado/cirurgia , Neoplasias Cutâneas/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Complicações Pós-Operatórias , Cirurgia Plástica , Retalhos CirúrgicosRESUMO
The closure of myelorachischisis defects has been difficult and at times complicated. Over the past 2 decades, the use of rotational advancement flaps has been increasingly popular, but can be attended by instances of skin ischemia and necrosis. The development of the myocutaneous and muscle flap concept has aided reconstructive surgery. Extensive experience with the useful latissimus dorsi flap with and without overlying skin has been obtained for the reconstruction of a variety of truncal defects. We describe the use of bilateral "reverse" latissimus dorsi muscle flaps based on the paraspinal perforators for the closure of myelorachischisis defects in two patients. Coverage was uneventful in both instances. A 2-year follow-up revealed no compromise of upper extremity function due to sacrifice of the latissimus dorsi muscles. We offer an approach to the problem of closure of large myelorachischisis defects: bilateral reverse latissimus dorsi muscle flaps and delayed skin coverage. This approach seems to offer a good muscle layer over the dural closure and to provide long-standing durable coverage without apparent compromise of upper extremity function.
Assuntos
Meningomielocele/cirurgia , Retalhos Cirúrgicos , Seguimentos , Humanos , Recém-Nascido , Masculino , MétodosRESUMO
Thyroidal secretion of 3,3',5'-triiodothyronine (reverse T3, rT3) and its control by TSH was assessed by measuring (1) arterio-venous hormone gradients in patients undergoing surgery, (2) changes of hormone concentrations after induction of anaesthesia, and (3) changes induced by TRH administration. In ten patients in whom thyroid activity was under TSH control (parathyroidectomy and non-toxic goitre) increased thyroid vein/carotid artery ratios (TV/CA) for rT3 (mean TV/CA ratio 2.53) were found when compared to six patients with non-toxic goitre on suppressive doses of T4 (mean TV/CA ratio, 1.27) (P less than 0.05). The mean calculated operative secretion rate of rT3 was 12.5 microgram/day but only 2.4 microgram/day in patients receiving T4. In thirteen patients undergoing elective surgery induction of anaesthesia significantly increased rT3 levels. In nine euthyroid adults intravenous TRH (200 microgram) increased peripheral venous rT3 levels between 3 h (P less than 0.005) and 8 h (P less than 0.05) after the injection. It is concluded that significant amounts of rT3 are secreted by the thyroid gland at operation and this is, in part, under TSH control.
Assuntos
Glândula Tireoide/metabolismo , Tireotropina/fisiologia , Tri-Iodotironina/metabolismo , Adulto , Idoso , Anestesia Geral , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Taxa Secretória/efeitos dos fármacos , Tireoidectomia , Tireotropina/farmacologia , Hormônio Liberador de Tireotropina , Tiroxina/sangue , Tiroxina/metabolismo , Tri-Iodotironina/sangueRESUMO
35S-methimazole (MMI), 35S-carbimazole or 35S-propylthiouracil (PTU) were given orally to fifty-five patients at various times up to 12 h before surgical thyroidectomy. The amount of 35S radioactivity and labelled drug in thyroid and plasma samples was measured. Intrathyroidal inhibition or organic binding of iodine by MMI, carbimazole and PTU was measured after intravenous administration of 131I, 132I or 125I-iodide. After administration of 35S-carbimazole or 35S-MMI the thyroid to serum (T/S) ratio of 35S radioactivity was greater in thyrotoxic glands than in non-toxic adenoma tissue. 35S-MMI was found in thyroid and plasma samples after administration of 35S-carbimazole. The T/S 35S-MMI was greater than 1 in most but not all patients. 35S radioactivity was also concentrated in the thyroid after administration of 35S-PTU. In thyrotoxic glands there was an 80% inhibition of iodine organification in patients receiving MMI and 60% for those receiving PTU. It is suggested that carbimazole and MMI can be given once or twice daily in some patients but PTU would be less suitable for this dose schedule.
Assuntos
Antitireóideos/metabolismo , Iodo/metabolismo , Glândula Tireoide/metabolismo , Carbimazol/sangue , Carbimazol/metabolismo , Ensaios Clínicos como Assunto , Feminino , Humanos , Masculino , Metimazol/sangue , Metimazol/metabolismo , Propiltiouracila/sangue , Propiltiouracila/metabolismo , Doenças da Glândula Tireoide/metabolismo , Fatores de TempoRESUMO
The records of 91 patients with vesicovaginal fistulas at the Ochsner Clinic between 1942 and 1974 were reviewed. The fistulas were managed in several ways: spontaneous closure, palliative operation, urinary diversion, transvesical repair, transvaginal repair, and a combined transvaginal-transvesical procedure. The latter had a 100% success rate in the eight patients in whom it was used. The technic of this procedure is described and the indications are expanded to include (1) large fistulas, (2) fistulas near the ureteral orifice, (3) if other abdominal or urologic surgery is being done, (4) if transvesical approach is being used, (5) previous failed attempts at correction, (6) difficulty of access by vaginal approach, and (7) fistulas resulting from transurethral resection of the bladder neck.
Assuntos
Fístula Vesicovaginal/cirurgia , Adolescente , Adulto , Feminino , Humanos , Métodos , Pessoa de Meia-Idade , Fístula Vesicovaginal/diagnóstico , Fístula Vesicovaginal/etiologiaRESUMO
PIP: The findings of a comparison between laparoscopy as an outpatient sterilization procedure on 270 patients in a Louisiana charity hospital with postpartum tubal ligation on 490 patients in a private hospital are presented. Multiparity was the most frequent indication in both groups of patients. Complications were within acceptable limits. Local anesthesia could be used for the laparoscopic procedure, and recently in the other group, ligation has been done immediately after delivery using the conduction anethesia given for delivery which eliminates giving additional anesthetic. Both procedures appear to be safe, practical, and acceptable methods of tubal sterilization.^ieng
Assuntos
Laparoscopia , Esterilização Tubária , Assistência Ambulatorial , Feminino , Humanos , Ligadura , Indigência Médica , Métodos , Período Pós-Parto , Gravidez , Esterilização Tubária/efeitos adversosAssuntos
Adenoma/metabolismo , Antitireóideos/metabolismo , Hipertireoidismo/metabolismo , Glândula Tireoide/metabolismo , Neoplasias da Glândula Tireoide/metabolismo , Carbimazol/metabolismo , Humanos , Iodetos/metabolismo , Metimazol/metabolismo , Propiltiouracila/metabolismo , Isótopos de EnxofreAssuntos
Antitireóideos/metabolismo , Imidazóis/metabolismo , Glândula Tireoide/metabolismo , Animais , Carbimazol/metabolismo , Cromatografia em Papel , Cromatografia em Camada Fina , Humanos , Masculino , Metimazol/metabolismo , Metiltiouracila/metabolismo , Propiltiouracila/metabolismo , Ratos , Isótopos de Enxofre , Tiouracila/metabolismo , Neoplasias da Glândula Tireoide/metabolismo , TireoidectomiaRESUMO
Ninety patients who had a recurrence of thyrotoxicosis after thyroidectomy have been reviewed. All 10 patients who had a second operation and 18 out of 20 patients treated with a full course of antithyroid drugs relapsed. These results differ greatly from the results of treatment of the first episode of thyrotoxicosis, whether by thyroidectomy or antithyroid drugs. Radioiodine is the treatment of choice in this group of patients, despite the high incidence of hypothyroidism.
Assuntos
Antitireóideos/uso terapêutico , Hipertireoidismo/terapia , Complicações Pós-Operatórias , Adulto , Idoso , Feminino , Seguimentos , Humanos , Hipertireoidismo/tratamento farmacológico , Hipertireoidismo/radioterapia , Hipertireoidismo/cirurgia , Hipotireoidismo/etiologia , Isótopos de Iodo/administração & dosagem , Masculino , Pessoa de Meia-Idade , Radioterapia/efeitos adversos , Testes de Função Tireóidea , TireoidectomiaRESUMO
One hundred and thirty patients who relapsed after a full course of treatment with antithyroid drugs have been reviewed. Of 22 patients receiving a second course of antithyroid drugs, 17 (77%) relapsed. In contrast, only 2 out of 44 patients treated by surgery relapsed and seven became hypothyroid. Nevertheless, local complications, in particular parathyroid insufficiency, were especially common in this group. Eighty patients received radioiodine, 11 (14%) requiring more than three doses before finally being rendered euthyroid. Postradiation hypothyroidism developed in 39 (49%) patients.