1/24. Symposium: Congenital anomalies of the middle ear. IV. Management of profuse perilymph leak.Profuse perilymph leak during an otological operation can be controlled by inserting an epidural teflon cannula into the lumbar subarachnoid space and draining away the excess spinal fluid. After about 100 cc is removed the perilymph leak stops, and the oval window can be sealed with a living seal, such as vein, and the operation completed. The catheter is left in the subarachnoid space for about four days, with a bottle on the distal end positioned to remove no more than 150 cc of spinal fluid per day. Results with two patients in which this maneuver was used to control profuse perilymph leak are reported.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
2/24. Interventional treatment of lateral tunnel dehiscence in a total cavopulmonary connection using a balloon expandable covered stent.In this paper we present a patient with dehiscence of an intra-atrial tunnel previously constructed during a total cavopulmonary connection procedure. We describe the use of a custom made covered stent to seal off the dehisced segment, and abolish the intra-cardiac shunting. We believe this is the first account of such a procedure being undertaken.- - - - - - - - - - ranking = 0.5keywords = seal (Clic here for more details about this article) |
3/24. Successful sealing of perforation of saphenous vein graft by coronary stent.Coronary artery perforation is a rare occurrence during angioplasty and could lead to major complications requiring emergency surgical intervention. We describe a case of perforation of a saphenous vein graft during stenting. The perforation was successfully sealed by a second coronary stent.- - - - - - - - - - ranking = 2.5keywords = seal (Clic here for more details about this article) |
4/24. Use of gelatin matrix to rapidly repair diaphragmatic injury during laparoscopy.Iatrogenic diaphragmatic injury during laparoscopy has necessitated intracorporeal suturing and occasionally thoracostomy tube placement. We describe a technique to repair the diaphragm quickly using a novel gelatin thrombin matrix. The matrix can be administered through a trocar or hand-assist device and can rapidly seal small injuries, obviating the need for formal suture repair. The presented case and technique should be considered in selected small diaphragmatic injuries.- - - - - - - - - - ranking = 0.5keywords = seal (Clic here for more details about this article) |
5/24. Migration of a bifurcated endovascular graft into an iliac aneurysm: endovascular salvage and future prevention--a case report.The FDA approval of endovascular grafts for the treatment of abdominal aortic aneurysms has been associated with a dramatic increase in the use of these devices. Major referral centers are reporting the treatment of 75% to 80% of their patients with infrarenal abdominal aortic aneurysms with endovascular devices. The large quantity of endovascular devices being used has produced a growing number of management issues that are often not predictable during the preoperative assessment. These issues require complex intraoperative decision making and innovative techniques for their management as reflected by the subsequent case report. An 82-year-old patient presented with a 7.8-cm abdominal aortic aneurysm. The aneurysm extended into the common iliac arteries bilaterally. The right common iliac artery was 6.5 cm and the left common iliac artery was 2.0 cm in maximal diameter. The preoperative work-up, including a computed tomography scan and arteriogram, suggested that he would be a potential candidate for endovascular repair. The plan was to extend the graft into the right external iliac artery after embolization of the right hypogastric artery and to seal the left limb in the ectatic left common iliac artery using an aortic extender cuff. During the endovascular repair of the aortoiliac aneurysms using the AneuRx bifurcated graft, the main device became dislodged from its infrarenal attachment site and migrated into the large right common iliac artery aneurysm with the iliac limb ending in the distal external iliac artery. A new bifurcated device was deployed from the left side to attempt an endovascular salvage of the difficult situation. The new graft was partially deployed down to the iliac limb. This allowed cannulation of the contralateral stump through the original endovascular graft that had migrated distally. The two grafts were connected with a long iliac limb. This allowed stabilization of the endovascular reconstruction by increasing its columnar strength. The deployment of the second bifurcated graft was completed and the central core with the runners removed safely without migration of the second bifurcated component. The reconstruction was completed with an aortic cuff in the left common iliac artery. The use of the aortic cuff was useful to preserve the left hypogastric artery. No intraoperative endoleak was noted. The patient did well and was discharged the day following the procedure. The follow-up computed tomography scan shows the abdominal aortic aneurysm excluded by the endovascular graft with a defunctionalized portion of one bifurcated graft within the right common iliac aneurysm. There is no evidence of endoleak and the abdominal aortic aneurysm had decreased in size at 6 months. This case demonstrates one of the unique management problems that may arise during endovascular graft placement. Events that initially would suggest failure of the endoluminal treatment may be corrected using advanced endovascular techniques by an experienced surgeon. However, there will be times that the prudent decision will be conversion to open repair. Only good clinical judgement and adequate training will prevent catastrophic outcomes.- - - - - - - - - - ranking = 0.5keywords = seal (Clic here for more details about this article) |
6/24. Iatrogenic aortic dissection during coronary intervention.Iatrogenic acute dissection of the ascending aorta following coronary angiography and percutaneous intervention is rare. Localized aortic dissections have been treated by sealing the entry with a coronary stent. Extensive dissections may require a surgical intervention. We describe a coronary dissection with retrograde extension to the ascending aorta that occurred during angioplasty of the right coronary artery. The extensive dissection, which was limited to the ascending aorta, was successfully treated by stenting of the right coronary artery and monitoring the aortic dissection by means of transesophageal echocardiography.- - - - - - - - - - ranking = 0.5keywords = seal (Clic here for more details about this article) |
7/24. Corneal bed perforation by laser ablation during laser in situ keratomileusis.A 34-year-old man was referred to our department with corneal perforation after multiple laser in situ keratomileusis procedures for myopia. corneal perforation occurred at the time of laser application during the fourth surgery, and the anterior chamber became completely flat. The perforation was sealed shortly thereafter and the corneal edema disappeared in 3 weeks, but there was an 86 microm forward shift of the cornea associated with an 8.0 diopter myopic shift during the subsequent 6 months. No further forward bulging of the cornea was observed. The refraction had stabilized up to 2 years postoperatively, but corneal irregular astigmatism limited the patient's best spectacle-corrected visual acuity.- - - - - - - - - - ranking = 0.5keywords = seal (Clic here for more details about this article) |
8/24. emergency treatment of tracheal tear during pharyngolaryngectomy.Longitudinal tracheal tear (of the trachealis muscle), an unusual but acknowledged complication of pharyngolaryngectomy, was encountered during a total pharyngo-oesophagolaryngectomy with gastric replacement. Due to serious ventilatory difficulties a rapid repair was required to obtain an airtight seal to allow continued mechanical ventilation. A reinforced polytetrafluoroethylene (PTFE) vascular graft was used as an intratracheal stent to seal the air leak. This technique proved effective and the tracheal defect had healed by the time the stent was removed 10 days later.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
9/24. Small-bowel obstruction due to Bezoar following pancreas transplantation with portal-enteric drainage: a case report.BACKGROUND: Despite recent improvements, surgical complications continue to occur frequently after pancreas transplantation, remaining the leading cause of early graft loss. Small-bowel obstruction, however, is exceedingly rare; it has not been associated with an enhanced risk of graft loss. methods: intestinal obstruction occurred 7 days after pancreas transplantation due to bezoar blockage at the level of the jejunojejunostomy of the Roux-en-Y loop, which had been constructed to drain the exocrine secretions of the pancreas graft. RESULTS: CT scan promptly identified the foreign body and greatly facilitated graft rescue before duodenal rupture or the development of graft pancreatitis. Nineteen months after repeat laparotomy the patient is alive with good pancreatic endocrine function. CONCLUSIONS: In cases of pancreas transplantation with enteric drainage, obstruction of the Roux-en-Y loop may create a totally sealed system that may lead to severe duodenal dilation and eventually to duodenal rupture or graft pancreatitis.- - - - - - - - - - ranking = 0.5keywords = seal (Clic here for more details about this article) |
10/24. Simple method to control a cerebrospinal fluid gusher during cochlear implant surgery.OBJECTIVE:: perilymph/cerebrospinal fluid gushers are reported at the time of cochleostomy during the performance of cochlear implant surgery. Anatomic conditions are discussed. Surgical methods of control with tissue seals have varied results. A simple technique using bone-waxed silk suture is described. patients:: Three patients with perilymph/cerebrospinal fluid gushers were encountered during cochlear implant surgery in the louisiana State University Cochlear Implant Project. A simple method for control of these leaks is described using lengths of bone-waxed silk suture. CONCLUSIONS:: This safe and rapid technique is a useful addition to the armamentarium of the cochlear implant surgeon.- - - - - - - - - - ranking = 0.5keywords = seal (Clic here for more details about this article) |
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