11/2622. A technique for reconstruction of the medial patellofemoral ligament.Additional medial patellofemoral ligament reconstruction was performed successfully on six consecutive patients with recurrent dislocation of the patella because of residual patellar instability after medial transfer of the tibial tubercle. A technique for medial patellofemoral ligament reconstruction is described, and complications and postoperative management are discussed. The reconstruction was performed using a double strand hamstring tendon graft in five patients and iliotibial allograft in one. Good stabilization of the patella was achieved in all six patients, resulting in improved confidence in higher levels of activity. The satisfactory outcome of additional medial patellofemoral ligament reconstruction suggests the possibility that the procedure may be part of the optional procedure in proximal realignment for recurrent dislocation of the patella.- - - - - - - - - - ranking = 1keywords = tube (Clic here for more details about this article) |
12/2622. splenic artery aneurysm and orthotopic liver transplantation.splenic artery aneurysms are a rare but potentially fatal complication after liver transplantation. We report three cases presenting in a 12-month period in adult patients who underwent transplantation for chronic liver disease. Doppler ultrasound of the splenic artery should be performed in all patients with cirrhosis and portal hypertension who are being assessed for liver transplantation. The aneurysm can be ligated at the time of transplantation.- - - - - - - - - - ranking = 2.0015955710366keywords = disease (Clic here for more details about this article) |
13/2622. Atypical mycobacterium infection with dermatological manifestation in a renal transplant recipient.In April 1997, a 58-year-old renal transplant recipient presented with abscess-like nodules in his left calf and on his right foot. Furuncular disease was suspected and the patient was treated with flucloxacillin. However, the lesions increased in size and became ulcerative. In the following 3 months, cultures of punctuated material, blood, and urine remained negative and gram stains did not reveal micro-organisms. In June 1997, acid-fast stains were positive. A diagnosis of a nontuberculous mycobacterium (NTM) infection was made and empirical antimycobacterial therapy was started. The combination of relatively minor symptoms with enlarged purulent lesions, causing severe morbidity, raises the possibility of NTM infection in the immunocompromised patient.- - - - - - - - - - ranking = 3.0015955710366keywords = disease, tube (Clic here for more details about this article) |
14/2622. diagnosis and management of primary hyperoxaluria type 1 in infancy.We report a case of a 6-month-old infant who presented with failure to thrive due to end-stage renal disease as a result of primary hyperoxaluria type 1. The infant was managed with a combined daily hemodialysis and peritoneal dialysis prescription in order to manage the total body oxalate burden. Medical management included oral pyridoxine, aggressive hydration and nutritional supplementation via an enteral feeding tube. At one year of age the infant underwent a combined liver/kidney transplantation with intra- and daily post-operative hemodialysis to prevent oxalate deposition in the newly transplanted organs. The post-operative course was complicated by gross hematuria and increased hyperoxaluria, requiring an increase in hydration and thiazide diuretics. This infant received a combination of dialysis modalities which was designed to lower the potential oxalate burden prior to transplantation. This case illustrates the difficulty in medical management of an infant pre- and post-combined liver/kidney transplantation.- - - - - - - - - - ranking = 3.0015955710366keywords = disease, tube (Clic here for more details about this article) |
15/2622. Development of a colocutaneous fistula in a patient with a large surface area burn.A 61 year old female sustained a large surface area burn, complicated by inhalation injury. One month before the incident, she had undergone a left hemicolectomy with colorectal anastomosis for diverticular disease. Due to the severity of her burns, multiple surgical debridement and skin grafting procedures were required, including a large fascial debridement of her flank and back. Her hospital course was complicated by recurrent episodes of pulmonary and systemic infection, as well as pre-existing malnutrition. Prior to her discharge to a rehabilitation center, stool began to drain from her left posterior flank. This complication represented a colonic fistula arising from the recent colon anastomosis. The fistula was managed nonoperatively and gradually closed. To our knowledge, this is the first report of a colocutaneous fistula spontaneously draining from the abdomen via the retroperitoneum in a burn victim, not related to direct thermal injury to the peritoneal cavity.- - - - - - - - - - ranking = 2.0015955710366keywords = disease (Clic here for more details about this article) |
16/2622. Bochdalek hernia in adulthood: a case report and review of recent literature.A 37-year-old Filipino woman presented with a post road-traffic accident fracture of dorsal spine 12. Chest radiograph revealed evidence of loops of small bowel in the left lung field. She admitted to symptoms of respiratory insufficiency since birth and treatment for tuberculosis in childhood. A pre-operative diagnosis of left traumatic diaphragmatic hernia was not confirmed at laparotomy which revealed typical left congenital Bochdalek hernia with smooth edges and herniation of small bowel and spleen into the left pleural cavity. Following reduction and repair of the hernia, the patient made an uneventful recovery. Chest radiograph remains normal till now, eight years post-operatively.- - - - - - - - - - ranking = 1keywords = tube (Clic here for more details about this article) |
17/2622. Postoperative pulmonary edema.BACKGROUND: Noncardiogenic pulmonary edema may be caused by upper airway obstruction due to laryngospasm after general anesthesia. This syndrome of "negative pressure pulmonary edema" is apparently well known among anesthesiologists but not by other medical specialists. methods: We reviewed the cases of seven patients who had acute pulmonary edema postoperatively. RESULTS: There was no evidence of fluid overload or occult cardiac disease, but upper airway obstruction was the most common etiology. Each patient responded quickly to therapy without complications. CONCLUSIONS: Of the seven patients with noncardiogenic postoperative pulmonary edema, at least three cases were associated with documented laryngospasm causing upper airway obstruction. This phenomenon has been reported infrequently in the medical literature and may be underdiagnosed. Immediate recognition and treatment of this syndrome are important. The prognosis for complete recovery is excellent.- - - - - - - - - - ranking = 2.0015955710366keywords = disease (Clic here for more details about this article) |
18/2622. Redo operations of Hirschsprung's disease.The purpose of this study was to specify the indications, applicability and final outcome of the redo definitive operations of Hirschsprung's disease. Between 1976-1993, 213 patients had undergone definitive operations of Hirschsprung's disease. In this series, 5 who required a redo pull-through operation were investigated. The redo pull-through operations were performed in 5 patients because of severe anastomotic stricture or total closure of the anastomotic site, recto-urethral fistula, anastomotic stricture, and enterocolitis due to anastomotic disruption. The initial definitive procedures were in 4 patients the Swenson operation and in one patient the Boley operation. As redo pull-through operations, the following were performed with success: in 3 patients, the Duhamel operation; and in 2 patients, the Swenson operation. The final outcome of the redo pull-through alterations were satisfactory and it can be suggested that one should not hesitate to perform a redo pull-through operation in selected Hirschsprung patients.- - - - - - - - - - ranking = 12.00957342622keywords = disease (Clic here for more details about this article) |
19/2622. The prevention of irreversible lung changes following reversible phrenic nerve paralysis.phrenic nerve paralysis frequently follows operations on the neck such as resection of a cervical or first rib. It all too often passes unrecognised or is incorrectly treated, leading to permanent lung damage which may be severe enough as to result in a functional pneumonectomy. This is particularly unfortunate since the phrenic nerve paralysis is usually temporary. Three case histories are described of reversible paralysis of the phrenic nerve in which, due to prompt diagnosis, the ensuing lung changes were either prevented or immediatley treated. Intermittent assisted respiration with a Monaghan respirator was used to provide nebulised inhalations of mesna several times a day. The method is applicable via a tracheostomy, an endotracheal tube or a simple mouthpiece. The latter is illustrated. The therapy is not hindered by immobilisation of the head and neck and the level of consciousness of the patients is of no importance. Many chest x-rays demonstrate the rapid clearing of the lungs achieved. All three patients were discharged with perfectly normal lungs.- - - - - - - - - - ranking = 1keywords = tube (Clic here for more details about this article) |
20/2622. Early postoperative esophageal obstruction caused by enteral feeding concretions in patients who have undergone laryngectomy.We report two cases of tube-feeding concretions causing esophageal obstruction in patients after laryngectomy. The cause of tube-feeding concretions is unknown at this time but probably involves esophageal stasis caused by esophageal dysmotility, protein precipitation by acidic gastric contents, tube damage, and concomitant use of sucralfate and other antacids. Although this is a rare complication of nasogastric feedings, the diagnosis should be entertained in cases in which postoperative esophageal obstruction is noted in head and neck surgical patients.- - - - - - - - - - ranking = 3keywords = tube (Clic here for more details about this article) |
| <- Previous || Next -> |