1/2. dissection in a right sided porcine-valved Dacron conduit.Seventeen years after corrective surgery for a double outlet right ventricle and pulmonary stenosis, a 30-year-old patient was admitted for reoperation for a critical stenosis of a porcine-valved Dacron conduit between the right ventricle and pulmonary artery. A residual ventricular septal defect was present. Induction of anaesthesia resulted in an inadequate pulmonary flow and uncontrollable ventricular arrhythmias. At autopsy the conduit showed a dissection between the conduit wall and the peel formation, leaving a residual lumen with a diameter of less than a third of the original. patients with a right sided bioprosthetic valved conduit must be evaluated regularly and operated before the stenosis becomes critical.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/2. Penile prostheses in the management of impotence in sickle cell disease.priapism lasting more than 24 h in adults with homozygous sickle cell disease usually results in impotence. The dense fibrosis of the corpora cavernosa which destroys the normal vascular erectile system of the penis also complicates insertion of penile prostheses. Our experience in 5 patients is reviewed. Sharp dissection and dilatation were necessary to form a tunnel for the prosthesis, which was more easily excavated anteriorly and posteriorly through a dorsal incision than for the length of the corpora through a traditional perineal-scrotal incision. Damage to the tunica was common and subsequent migration of the prosthesis necessitated an additional 11 procedures under general anaesthesia. Despite these technical difficulties, the procedure allowed satisfactory intercourse. The average interval between onset of impotence and implantation was 4 years. Early implantation before the dense fibrosis develops might give more satisfactory results.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |