ABSTRACT
The practice of laparoscopic liver surgery has developed gradually, and most liver resections seem currently feasible and safe for selected patients in centers where surgeons are experienced both in liver surgery and in laparoscopic surgery. However, further studies would be required, especially for long-term oncological results and for major hepatectomy follow-up, before laparoscopic hepatectomy becomes a common alternative to open liver surgeries. Laparoscopic major hepatectomy is a recent technique, due to its significant complexity. In this review, we showed that patients undergoing laparoscopic hepatectomy for liver metastases experienced decreased rates of overall and major postoperative complications without any compromise on long-term outcomes compared to patients treated by open resection.
Subject(s)
Hepatectomy , Laparoscopy , Liver Neoplasms/surgery , Hepatectomy/methods , Humans , Laparoscopy/methods , Liver Neoplasms/secondary , Minimally Invasive Surgical Procedures/methods , Neoplasm Metastasis , Treatment OutcomeABSTRACT
Intercostal artery pseudoaneurysm (IAP) is a rare entity and may complicate a percutaneous intervention through an intercostal space or follow thoracic trauma. Its rupture into the pleural space can give rise to haemothorax, which if untreated may lead to a retained haemothorax (RH). Traditionally both the IAP and the RH are managed by a thoracotomy. We report a patient who developed an IAP with haemothorax following a trauma. The diagnosis was established by computed tomography. The patient was treated by endovascular embolisation of the IAP followed by thoracoscopic decortications of the RH.
Subject(s)
Aneurysm, False/therapy , Embolization, Therapeutic , Hemothorax/surgery , Intercostal Muscles/blood supply , Thoracic Injuries/complications , Thoracoscopy , Wounds, Stab/complications , Aneurysm, False/diagnostic imaging , Aneurysm, False/etiology , Diabetes Complications , Embolization, Therapeutic/methods , Endovascular Procedures/methods , Follow-Up Studies , Hemothorax/diagnostic imaging , Hemothorax/etiology , Humans , Hypertension/complications , Male , Middle Aged , Risk Factors , Thoracic Injuries/etiology , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
We describe a patient who developed peritonitis and paralytic ileus due to a retained portion of the inflammed appendix following laparoscopic appendicectomy (LA). The details of the presentation and management are discussed along with a brief review of the unusual complications LA.
ABSTRACT
BACKGROUND AND OBJECTIVE: In cases of aspiration of gastric contents the risk of pneumonitis is dependent on the pH and volume of the gastric contents. Omeprazole and rantidine each decrease gastric volume and increase gastric pH. We evaluated the efficacy of preoperative administration of omeprazole (60 mg) or ranitidine (150 mg) in the prophylaxis of aspiration pneumonitis. METHODS: Data were obtained from 75 elective female surgical patients randomly allocated to one of three groups, who received either omeprazole 60 mg orally, or ranitidine 150 mg orally, or neither, on the evening prior to, and on the morning of, surgery. Gastric volume and pH was measured using blind aspiration. RESULTS: Both pH < 2.5 and volume > 25 mL were present in none of the patients in either the ranitidine or omeprazole groups, compared to 15 of 25 control patients (P < 0.0001). CONCLUSIONS: Preoperative oral administration of omeprazole (60 mg) or ranitidine (150 mg) reduced residual gastric content volume and increased pH > 2.5, possibly reducing the effects of pulmonary aspiration of gastric contents.
Subject(s)
Anti-Ulcer Agents/therapeutic use , Elective Surgical Procedures , Gastrointestinal Contents/drug effects , Omeprazole/therapeutic use , Ranitidine/therapeutic use , Administration, Oral , Adult , Anesthetics, Inhalation/administration & dosage , Anesthetics, Intravenous/administration & dosage , Anti-Ulcer Agents/administration & dosage , Female , Humans , Hydrogen-Ion Concentration , Intubation, Gastrointestinal/instrumentation , Isoflurane/administration & dosage , Middle Aged , Nitrous Oxide/administration & dosage , Omeprazole/administration & dosage , Pneumonia, Aspiration/prevention & control , Premedication , Ranitidine/administration & dosage , Statistics, Nonparametric , Thiopental/administration & dosageABSTRACT
OBJECTIVE: To determine the safety and efficiency of metered dose inhaler salbutamol delivered to the intubated rabbit. DESIGN: Prospective, comparative, five-group laboratory investigation. SETTING: Animal laboratory, Department of Nuclear Medicine. SUBJECTS: A total of 30 adult, anesthetized New Zealand White rabbits. INTERVENTIONS: Three groups of rabbits underwent tracheal intubation through a tracheostomy and received 5 puffs of 99mTcO4 salbutamol delivered at the elbow connector (group 1) or via a catheter with its distal tip positioned at the midpoint (group 2) or bevel of the endotracheal tube (group 3). No intervention was provided for the rabbits in the fourth group. A fifth group underwent tracheal intubation through the mouth and received salbutamol (5 puffs) delivered at the bevel of the endotracheal tube. MEASUREMENTS: Delivery efficiency was expressed as the ratio of radioactivity emitted from lungs and trachea to the total radioactivity of the administered dose. Histopathologic injury scores were assigned to each trachea or lung specimen. MAIN RESULTS: Delivery efficiency was 30 times greater in groups 3 and 5 (full catheter) than in group 1 (elbow). The injury scores were similar in all groups. CONCLUSION: We conclude that the increased efficiency obtained by administration of metered dose inhaler salbutamol at the distal tip of endotracheal tube is not necessarily associated with increased epithelial injury.