1/6. Nursing a patient with a malodorous fungating non-healing wound.Mr Lunn, who is 59 years old, was admitted to hospital with an acute bowel obstruction secondary to an adenocarcinoma of the descending colon. During a laparotomy and colocolonic bypass Mr Lunn was found to have large plaques of cancer in the mesentery, omentum and liver, and a diagnosis of carcinomatosis was made. He declined treatment with chemotherapy. After discharge from hospital, Mr Lunn was referred to the district nursing team for assessment and nursing care of his surgical wound.- - - - - - - - - - ranking = 1keywords = obstruction (Clic here for more details about this article) |
2/6. Bronchial dehiscence associated with a large broncholith in a lung transplant recipient.A 63-year-old man who underwent single lung transplantation for advanced emphysema had a postoperative course complicated by asymptomatic bronchial dehiscence associated with a large broncholith. The stone eventually caused airway obstruction requiring partial fragmentation and incomplete extrication. We suggest that calcified nodes of significant size be removed at the time of surgery in the lung transplant recipient.- - - - - - - - - - ranking = 1keywords = obstruction (Clic here for more details about this article) |
3/6. Technique and complications of reconstruction of the pelvic floor with polyglactin mesh.A polyglactin mesh sling was used to reconstruct the pelvis in eight patients after colorectal or urologic resections in preparation for postoperative radiation therapy. There were three perioperative complications--a pelvic abscess requiring percutaneous drainage, a wound dehiscence and a herniation of the small intestine between the pelvic sidewall and mesh requiring small intestinal resection. There were two delayed complications, both partial small intestinal obstructions. One occurred just after the conclusion of radiation treatment and the other occurred five months after the conclusion of radiation therapy. Both obstructions responded to conservative management. None of the common acute radiation effects occurred during radiotherapy. One patient with delayed partial small intestinal obstruction had possible late radiation effects. The median follow-up period after radiation therapy was 12.5 months. Despite the complications described in this report, the use of a polyglactin mesh sling as an adjunct to resection of carcinoma of the pelvis has merit and should be studied further.- - - - - - - - - - ranking = 3keywords = obstruction (Clic here for more details about this article) |
4/6. Extraluminal compression of an aortic graft simulating recoarctation.Restenosis rarely develops after surgical correction of coarctation of the aorta in adults. Late morbidity is usually related to residual hypertension or progressive aortic valve disease. A patient in whom symptoms and signs of recurrent coarctation developed 19 years after initial graft repair is described. Dehiscence of the original silk suture line was found at operation. Extensive thrombus had produced graft compression. Milder hypertension persisted in the postoperative period despite relief of the aortic obstruction.- - - - - - - - - - ranking = 1keywords = obstruction (Clic here for more details about this article) |
5/6. Open peritoneal drainage as effective treatment of advanced peritonitis.In 13 patients with advanced peritonitis (postoperative suture line breakdown in eight and spontaneous intestinal perforation in five) treatment consisted of widely opening the peritoneal cavity and exposing the contaminated viscera. Eight of the patients underwent diverting enterostomy, and the remaining five underwent an additional drainage procedure to evacuate a residual collection. Clinical improvements were observed in all except one who died without favorable response. Some of the clinical manifestations indicative of organ failures subsided in nine of the ten patients. In five patients peritonitis subsided completely, whereas in another seven it was localized, leaving a fistula; in five of them reoperative closure of the abdominal wall and fistula was performed with one operative death. One patient developed a new enteric fistula from the previous anastomotic site that had been exposed after opening the abdominal wall. There was no intestinal obstruction or inreducible bowel pretrusion during the course of treatment. It was concluded that the open peritoneal drainage procedure, combined, if necessary, with diverting enterostomy, should be considered for advanced peritonitis causing grave systemic complications.- - - - - - - - - - ranking = 1keywords = obstruction (Clic here for more details about this article) |
6/6. Vascular lip enlargement: Part I. Hemangiomas--tenets of therapy.Vascular lesions involving the lips pose a difficult problem for both the surgeon and patient. Their removal by surgery may result in greater disfigurement and impairment than the original lesion. When nonsurgical modalities fail, using a well-planned strategy of sequential procedures can provide excellent results. Many hemangioma patients require judicious serial debulking of excess tissue mass, whereas enlargement from port-wine lesions may require direct aggressive surgery. Over a 10-year period, 38 patients underwent surgery for treatment of vascular lip enlargement. In 27 patients, the lip deformities were caused by hemangiomas. The remaining 11 patients had macrocheilia associated with port-wine vascular malformations. This paper specifically addresses hemangiomas of the lips, tenets for their removal, and reduction strategies. Of the 27 patients with hemangiomas involving the lips, 12 had had some form of previous treatment including corticosteroids (4 patients), embolization (3 patients), laser (3 patients), and interferon (2 patients). All 12 of these patients had unsatisfactory results. Specific tenets for the surgical management of these patients are presented. The distribution of the facial hemangiomas was as follows: 15 patients had isolated involvement of the upper lip, 7 lesions involved the lower lip alone and 5 involved both upper and lower lips. Additionally, 10 of these lesions involved the cheek(s), nose, or chin to some degree. Six patients experienced some form of functional impairment before our evaluation including difficulty with eating or drinking, visual obstruction, and psychosocial problems. All operations were performed following several principles established by the senior surgeon (B.M.Z.). By following the tenets presented in this report, he has achieved near-normal lip form, giving the patient marked improvement in appearance and function.- - - - - - - - - - ranking = 1keywords = obstruction (Clic here for more details about this article) |