1/5. Aspiration: a possible severe complication in colonoscopy preparation of elderly people by orthograde intestine lavage.Total gut lavage is a widely recommended method in preparation for colonoscopy and there are almost no reports of severe complications in the literature. Application of orthograde lavage by a nasogastric tube may be necessary in disorientated patients, assisted by slight medical sedation, if necessary. Despite absolutely correct appliance of the method, a case of severe aspiration with subsequent hypoxemia and stroke in a senile female patient, suffering from a common hiatal hernia, is described.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
2/5. myotonia dystrophica and spinal surgery.Two cases of patients suffering from the congenital form of myotonia dystrophica under going spinal surgery are presented. Both patients had major complications, including cardiac arrhythmias, postoperative wound infection and more minor complications, such as sedation and opioid sensitivity. However, the most notable complication resulting in long-term morbidity was the deterioration of bulbar muscular function in one of the patients. This resulted in recurrent aspiration pneumonia and the need for a tracheostomy. This serious complication has not previously been reported following surgery.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
3/5. death from paraesophageal hiatus hernia: post-mortem assessment and forensic relevance.Hiatus hernias of the diaphragma are rarely recorded under forensic aspects. Their relevance is demonstrated by the case of an elderly lady who was suffering from severe abdominal pain after dinner. She vomited several times and died 4 days later. After a forgery of the notarial last will and testament was revealed, a post-mortem was performed and a paraesophageal hiatus hernia was detected. The toxicological investigation revealed high levels of pethidin, and a married couple, both of them medical doctors, responsible for the forgery of the last will was charged with murder. The pathogenetic reconstruction led to the conclusion that a mechanism of 'self-tamponing' was initiated on the grounds of a pre-existing paraesophageal hernia filled up by the last meal ingested. The blockage of the gastrointestinal passage way induced severe abdominal pain and permanent vomiting, furthermore resulting in hemorrhagic infarction and perigastritis. death from natural cause was finally appreciated by the court and the accused were acquitted. The post-mortem estimation of paraesophageal hiatus hernias is discussed, particularly, the necessity of an in situ preparation with separate incision of the translocated part and histological investigation. A synoptic expertise of clinicians, toxicologists and forensic pathologists is mandatory for estimating the relevance of high levels of analgesics.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
4/5. Use of cimetidine in esophageal atresia with lower tracheoesophageal fistula.pneumonia, in infants suffering from esophageal atresia with lower esophageal fistula, is usually caused by gastric reflux through the fistula, In order to abolish the acidity of the gastric content, cimetidine i.v. infusion was used during the first 12--48 hr after diagnosis, while treating the pneumonia. The amount of cimetidine required to induce achlorhydria was established by serial aspiration of gastric content, in infants and children with gastrostomies performed for various causes.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
5/5. Anaesthetic implications of long term diabetic complications.A case history in which a patient suffering from long-term diabetes mellitus underwent vascular surgery of a lower extremity is presented. Anaesthesia was commenced with an epidural anaesthesia, but due to insufficient analgesia combined with a high thoracal block general anaesthesia was added. The course was complicated because of cardiomyopathy, autonomic neuropathy, difficult laryngoscopy, aspiration of gastric content, and acute renal failure. Anaesthetic implications of long-term diabetes mellitus are discussed.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |