1/17. Hepatolithiasis (intrahepatic stone) during octreotide therapy for acromegaly: a case report.We report a case of hepatolithiasis (intrahepatic stone) complicated by gram-negative sepsis in a 37 year old male with acromegaly being treated with octreotide. As a child, he had suffered a traumatic injury to his liver requiring the surgical repair of a laceration. This is the first reported case of hepatolithiasis during octreotide therapy. gallstones and bile sludge are common side effects of octreotide therapy but rarely become symptomatic or require treatment. Hepatolithiasis is uncommon in western countries but is quite prevalent in East asia and is often associated with a predisposing condition that causes intrahepatic bile stasis (eg. bile duct stricture). In addition to its known effect on gallbladder stasis, octreotide alters bile acid composition and may thus hasten intrahepatic sludge and stone formation. Extra caution should be taken in using octreotide or its long-acting analog in patients otherwise predisposed to intrahepatic bile stasis.- - - - - - - - - - ranking = 1keywords = bile (Clic here for more details about this article) |
2/17. 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 = 0.41576200963963keywords = obstruction (Clic here for more details about this article) |
3/17. Massive pericardial effusion following a laparoscopic adjustable gastric banding.Laparoscopic adjustable gastric banding (LAGB) is currently the most common bariatric surgical procedure. The most frequent complications of LAGB surgery are pouch dilatation, gastric prolapse, band erosion, stoma obstruction and access-port problems. We report a rare life-threatening case of massive pericardial effusion as a complication of an infected Lap-Band. The management of this condition included subxiphoid pericardial window, removal of the band and later conversion to gastric bypass.- - - - - - - - - - ranking = 0.41576200963963keywords = obstruction (Clic here for more details about this article) |
4/17. Transmandibular K-wire in the management of airway obstruction in Pierre Robin sequence.The Pierre Robin sequence was first described by Pierre Robin in 1923 as a triad of micrognathia, U-shaped cleft palate, and glossoptosis. Although the problems associated with Pierre Robin sequence may be numerous, the most acute problem in affected newborns is upper airway obstruction. The causes of upper airway obstruction are heterogeneous, and treatment is controversial and may include a long stay in an intensive care setting. Most patients could be treated conservatively with prone/lateral positioning and close clinical observation. A more aggressive approach is to hold the tongue forward surgically by a lip-tongue adhesion (glossopexy) technique, and if all else fails, it might be necessary to perform a tracheostomy. The purpose of this article is to report an unconventional technique for the management of airway obstruction in Pierre Robin sequence. A transmandibular K-wire was used in two patients with Pierre Robin sequence to prevent airway obstruction. The author was not the surgeon who placed the K-wire, and in one of the patients, the K-wire was retained for 4 years before being removed by the author. Both patients had surgical intervention to manage the airway problem in the form of lip-tongue adhesion in addition to the transmandibular K-wire. In conclusion, the value of using a transmandibular K-wire in the two cases presented here could not be determined and was questionable.- - - - - - - - - - ranking = 3.326096077117keywords = obstruction (Clic here for more details about this article) |
5/17. Isolation of mycobacterium thermoresistibile following augmentation mammaplasty.This is the first case report of a mycobacterium thermoresistibile infection following augmentation mammaplasty and is the fourth human case report of M. thermoresistibile infection. Antimicrobial susceptibility results determined by a modified proportion method using a 3-day incubation were the same as those determined by the standard 3-week assay.- - - - - - - - - - ranking = 1.2keywords = bile (Clic here for more details about this article) |
6/17. Postcholecystectomy surgical site infection by salmonella enterica var. Weltevreden.BACKGROUND: Surgical site infections (SSI) are the most common complication of gastrointestinal surgery. The most common endogenous organisms encountered are the enteric pathogens. methods: We report a rare case of S. enterica var. Weltevreden as a cause of SSI after cholecystectomy and common bile duct exploration. Pertinent literature is reviewed. RESULTS: The infection was due to bile spillage and contamination during surgery. The organism was found to be sensitive only to imipenem, and the patient recovered following intravenous treatment with that carbapenem. CONCLUSIONS: This case illustrates the fact that cholecystectomy with bile spillage is a definite risk factor for SSI. Although controversial, isolation of the pathogen from the bile and the surgical site must be made to allow this rare pathogen to be identified. Appropriate antibiotic could then be directed against the pathogen.- - - - - - - - - - ranking = 0.8keywords = bile (Clic here for more details about this article) |
7/17. Two-dimensional echocardiographic findings in postoperative aortic suture line endarteritis.Infections occurring after aortic valve surgery, whether valvuloplasty or replacement, commonly affect the valve itself. However infection of the aortic suture line alone is extremely rare. Such cases with endarteritis can be diagnosed at autopsy or by angiocardiography. In this report a patient with a vegetation at the aortic suture line which was diagnosed by echocardiography is presented. By two-dimensional echocardiography, a very mobile and echo-dense mass protruding from the ascending aorta was observed on the recordings through the suprasternal notch. This diagnosis was surgically confirmed and the patient was treated.- - - - - - - - - - ranking = 0.2keywords = bile (Clic here for more details about this article) |
8/17. 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 = 1.2472860289189keywords = obstruction (Clic here for more details about this article) |
9/17. Long-standing indolent blastomycosis at internal opening of tracheostomy.An unusual case of long-standing endotracheal blastomycosis caused recurrent airway obstruction at a tracheostomy site.- - - - - - - - - - ranking = 0.41576200963963keywords = obstruction (Clic here for more details about this article) |
10/17. Postoperative wound infection associated with vibrio parahaemolyticus in a patient without exposure to seawater.This report describes a case of wound infection associated with vibrio parahaemolyticus. The patient had ingested steamed crabs 7 days before admission for surgical treatment of intestinal obstruction due to colon carcinoma. The Vibrio sp. was isolated from postoperative wound drainage as well as from stool. Recovery was uneventful.- - - - - - - - - - ranking = 0.41576200963963keywords = obstruction (Clic here for more details about this article) |
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