1/4. role of hepatobiliary scintigraphy in the evaluation and management of post-cholecystectomy pain due to biliary dyskinesia.Imaging with technetium-99m analogs of imminodiacetic acid has been shown to be useful in the diagnosis of various hepatobiliary diseases. The biliary ductal dilatation is usually late response of obstruction. With the development of TC-99m IDA scintigraphy, however, the functional aberrations associated with obstruction can be detected prior to the development of ductal enlargement identifiable by US & CT. We report a case of post-cholecystectomy pain due to biliary dyskinesia diagnosed by 99m TC-HIDA hepatobiliary imaging.- - - - - - - - - - ranking = 1keywords = obstruction (Clic here for more details about this article) |
2/4. Rapid communication: laparoscopic Anderson-Hynes dismembered pyeloplasty using the da Vinci robot: technical considerations.PURPOSE: To present our initial experience with laparoscopic pyeloplasty utilizing the da Vinci robot for upper tract reconstruction. Case Report: A four-port transperitoneal approach was used in a 73-year-old man. The ureteropelvic (UPJ) obstruction was identified with a crossing vessel. After dismemberment of the UPJ, the renal pelvis was trimmed and reconstructed using the da Vinci robot. The total operative time was 5 hours; the time spent for reconstruction was 45 minutes. blood loss was <150 mL. The postoperative analgesic requirement was 8 mg of morphine and 25 mg of hydrocodone. There were no intraoperative or postoperative complications. CONCLUSION: The da Vinci robot can serve as a vital surgical tool during pyeloplasty with extensive reconstruction.- - - - - - - - - - ranking = 0.5keywords = obstruction (Clic here for more details about this article) |
3/4. A late post-vasectomy syndrome.A group of 20 surgical specimens in 18 patients with a previously unappreciated syndrome of unremitting epididymal pain and induration 5 to 7 years after vasectomy was collected during a 2-year interval. These symptoms uniformly were unresponsive to conservative measures, including empiric antibiotics. Total unilateral or bilateral epididymectomy and partial vasectomy led to complete relief of symptoms, usually within 24 hours. Pathological examination of the specimens revealed features consistent with sequelae of long-standing obstruction. Recognition of this late post-vasectomy syndrome, which represents a major complication of vasectomy, might be expected to increase as cohorts of vasectomized individuals age.- - - - - - - - - - ranking = 0.5keywords = obstruction (Clic here for more details about this article) |
4/4. glossopharyngeal nerve block for pain relief after pediatric tonsillectomy: retrospective analysis and two cases of life-threatening upper airway obstruction from an interrupted trial.A regional anesthetic technique formerly used in adults for tonsillectomy was adapted to provide posttonsillectomy pain relief in children. Injection of 3-10 mL of 0.25%-0.5% bupivacaine into each lateral pharyngeal space appeared to provide good postsurgical analgesia. A retrospective chart review failed to link the technique to airway-related complications. A prospective, randomized, double-blind, placebo-controlled trial comparing the analgesic effectiveness and postsurgical complications in patients undergoing tonsillectomy and receiving either bupivacaine or placebo was begun after institutional approval and informed consent. The study was terminated after eight children had been enrolled because two of four children receiving bupivacaine developed severe upper airway obstruction (UAO) after extubation of the trachea. We conclude that the volume and concentration of bupivacaine were sufficient to block the vagus nerves proximal to the take off of the recurrent laryngeal nerves and/or the hypoglossal nerves, resulting in severe UAO. The short distance between the hyoid and jugular foramen would predispose children and adults with a short neck to the development of this complication. In conclusion, bilateral local anesthetic injection into the lateral pharyngeal space may result in severe UAO and loss of protective reflexes.- - - - - - - - - - ranking = 2.5keywords = obstruction (Clic here for more details about this article) |