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The structure set of an arbitrary space, the algebraic surgery exact sequence and the total surgery obstruction  [PDF]
Andrew Ranicki
Mathematics , 2001,
Abstract: An introduction to the applications of algebraic surgery to the structure theory of high-dimensional topological manifolds.
Total colectomy: Options in management of acute obstruction of the left-side colon  [PDF]
Vukovi? Milivoje,Moljevi? Neboj?a
Medicinski Pregled , 2008, DOI: 10.2298/mpns0802043v
Abstract: Introduction. Emergency colorectal surgery has been associated with a high morbidity and mortality rate. The current trend for the management of obstruction of left-sided colorectal carcinoma favours primary resection and anastomosis, as a safe and acceptable approach to selected patients. Method Retrospective review of 81 patients (46 male and 35 female, mean 64 years). Results Morbidity after emergency total colectomy was 21%, and mortality was 6%. There were 6 anastomotic complications (2 an-astomotic disruptions and 4 anastomotic leaks). Mean hospital stay was 13 days. 82% patients had adequate continence. Discussion: Traditional approach for left-sided colon obstruction is three-stage procedure (Bloch-Paul-Mikulicz). The idea of removing dilated colon proximal to an obstructing tumor is not new, since Lane suggested this option in 1914. In 1965 Hughes and Cuthberson described their experience with 12 patients. At the moment of laparotomy 20% patients had advanced malignant disease. The cumulative morbidity and mortality are high in three-stage procedure. Three-stage approach is associated with high permanent colostomy rate. One-stage resection with primary anastomosis of the obstructed left-sided colon is a safe alternative to staged procedures. Emergency radical resection can be safely performed in majority of patients with left-colon obstruction. Conclusions Total colectomy with anastomosis is a suitable procedure for treating left-sided colonic obstruction provided that pelvic floor is adequate. Total colectomy has low mortality, acceptable morbidity and good quality of life. The success of the surgery depends on the selection of patients. .
Principles of plastic surgery revisited  [cached]
Rana Roshani,Puri V,Baliarsing A
Indian Journal of Plastic Surgery , 2004,
Abstract: Since the first five basic principles of Plastic Surgery were stated by Ambroise Pare in 1564, and revised to thirty-three by Millard in 1986, the importance and application of these principles has not changed, although their application may vary from patient to patient. The very fact that these principles are applicable even today indicates the depth of understanding and foresightedness of those who formulated these principles. In spite of newer developments in plastic surgery, these principles have stood the test of time and have proved useful even today. This article discusses these principles and elucidates their relevance in the context of the practice of current plastic surgery.
Encountering Meckel's diverticulum in emergency surgery for ascaridial intestinal obstruction
Imtiaz Wani, Viliam ?nábel, Ghulam Naikoo, Shadab Wani, Muddasir Wani, Abid Amin, Tariq Sheikh, Fazal Q Parray, Rauf A Wani
World Journal of Emergency Surgery , 2010, DOI: 10.1186/1749-7922-5-15
Abstract: A retrospective case review study of 14 children who had surgical intervention for symptomatic intestinal ascariasis having the presence of concomitant Meckel's diverticulum was done. The study was done at SMHS Hospital Srinagar, Kashmir.A total of the 14 children who had ascaridial intestinal obstruction with concomitant presence of Meckel's diverticulum were studied. Age of children ranged from 4-12 years, male:female ratio was 1.8:1. Nine patients had asymptomatic Meckel's diverticulum, whereas 5 patients with symptomatic signs were found in the course of emergency surgery for ascaridial intestinal obstruction.Meckel's diverticulum in intestinal ascariasis may pursue silent course or may be accompanied with complications of the diverticulitis, perforation or the gangrene. Incidental finding of the Meckel's diverticulum in the intestinal ascariasis should have removal.Though ascaris infestation is usually asymptomatic, ascariasis-related intestinal complications can be seen children with a high intestinal roundworm load. Presence of massive roundworm infestation in children may lead to symptomatic Meckel's diverticulum. High burden of intestinal roundworms, propensity to wander, size of the worm and the characteristics of Meckel's diverticulum constitute prerequisite for complications of Meckel's diverticulum. Surgical complications associated with Ascaris lumbricoides infection can be diverticulitis, gangrene or the perforation in the Meckel's diverticulum. Preoperative diagnosis of Meckel's diverticulum is often difficult. Incidental diverticulectomies in asymptomatic Meckel's diverticulum are considered safer [1,2]. The work was designed to study findings of concomitant Meckel's diverticulum who had surgical intervention for ascaridial intestinal obstruction in children.A retrospective case review study of 14 children who had surgical intervention for symptomatic ascaridial intestinal obstruction with the presence of the concomitant Meckel's diverticulum, was d
Stent Implantation for Effective Treatment of Refractory Chylothorax due to Superior Vena Cava Obstruction as a Complication of Congenital Cardiac Surgery
Akiko Tamai, Clara Kurishima, Mitsuru Seki, Satoshi Masutani, Mio Taketazu and Hideaki Senzaki
Clinical Medicine Insights: Cardiology , 2012, DOI: 10.4137/CMC.S8687
Abstract: Chylothorax is a serious complication of congenital cardiac surgery and is significantly associated with increased morbidity and mortality. Central venous obstruction, which is often related to the insertion of central venous catheters for postoperative management, is known to be an important risk factor for treatment failure and mortality associated with this condition. We present the case of a 6-month-old girl with refractory chylothorax after surgical repair of tetralogy of Fallot. The chylous drainage continued for more than 2 months despite maximal conservative therapy (water restriction, total parenteral nutrition, and infusion of somatostatin and steroid) and surgical ligation of the thoracic duct. Subsequently, we observed stenosis of the superior vena cava (SVC) caused by large thrombi possibly associated with the prolonged use of central venous catheter placed in the internal jugular vein. Because transcatheter balloon dilation failed to relieve the stenosis, we performed stent implantation for the SVC and innominate vein. After the procedure, chylous drainage dramatically reduced, and the patient was discharged from the hospital. In conclusion, central venous obstruction due to thrombosis should be routinely examined when chylothorax is diagnosed and is resistant to conservative therapy after congenital heart surgery. Stent implantation can effectively relieve the venous obstruction and thus be a life-saving treatment option for this difficult condition.
A Survey of Etiology of Intestinal Obstruction in a Pediatric Surgery Center in Tehran
J Ahmadi,M Kalantari,H Nahvi,B Ashjaei
Iranian Journal of Pediatrics , 2005,
Abstract: Background: Intestinal obstruction is a common cause of abdominal surgery in pediatric age group. A delay in diagnosis and treatment of this disease can lead to serious complications. This study has been conducted to evaluate different causes of intestinal obstruction. Methods: 231 children were operated on intestinal obstruction. Prior to surgery all patients underwent a labarotory examination consisting of CBC, abdominal X–ray and, if necessary, gastrointestinal (GI) study with contrast media or CT-Scan and sonography. Final diagnosis was reached by surgical findings. Results: 231 children were operated due to intestinal obstruction. Among these, 128 cases, (55.4%) were male and 103 cases (44.6%) were female. The causes of intestinal obstruction were: Incarcerated hernia in 41 cases (17.7%), GI atresia in 38 cases (16.4%), malrotation in 32 cases (13.8%), anorectal malformation in 29 cases (12.5%) and benign or malignant masses inside or outside GI tract in 28 cases (12.1%). Conclusion: The most common causes of intestinal obstruction were: incarcerated hernia, GI atresia and malrotation.
Colonic stenting as bridge to surgery versus emergency surgery for management of acute left-sided malignant colonic obstruction: a multicenter randomized trial (Stent-in 2 study)
Jeanin E van Hooft, Willem A Bemelman, Ronald Breumelhof, Peter D Siersema, Philip M Kruyt, Klaas van der Linde, Roeland A Veenendaal, Marie-Louise Verhulst, Andreas W Marinelli, Josephus JGM Gerritsen, Anne-Marie van Berkel, Robin Timmer, Marina JAL Grubben, Pieter Scholten, Alfons AM Geraedts, Bas Oldenburg, Mirjam AG Sprangers, Patrick MM Bossuyt, Paul Fockens
BMC Surgery , 2007, DOI: 10.1186/1471-2482-7-12
Abstract: Patients with acute left-sided malignant colonic obstruction eligible for this study will be randomized to either emergency surgery (current standard treatment) or colonic stenting as bridge to elective surgery. Outcome measurements are effectiveness and costs of both strategies. Effectiveness will be evaluated in terms of quality of life, morbidity and mortality. Quality of life will be measured with standardized questionnaires (EORTC QLQ-C30, EORTC QLQ-CR38, EQ-5D and EQ-VAS). Morbidity is defined as every event leading to hospital admission or prolonging hospital stay. Mortality will be analyzed as total mortality as well as procedure-related mortality. The total costs of treatment will be evaluated by counting volumes and calculating unit prices. Including 120 patients on a 1:1 basis will have 80% power to detect an effect size of 0.5 on the EORTC QLQ-C30 global health scale, using a two group t-test with a 0.05 two-sided significance level. Differences in quality of life and morbidity will be analyzed using mixed-models repeated measures analysis of variance. Mortality will be compared using Kaplan-Meier curves and log-rank statistics.The Stent-in 2 study is a randomized controlled multicenter trial that will provide evidence whether or not colonic stenting as bridge to surgery is to be performed in patients with acute left-sided colonic obstruction.Current Controlled Trials ISRCTN46462267.Colorectal cancer is the second most common cancer in women and the third most common in men in the Netherlands [1]. The incidence in the Netherlands in 2003 was 9898 new cases, men and women were equally affected (Dutch Cancer Registry) [2]. Literature shows that between 7 and 29% of the patients present with a sub-total or total bowel obstruction [3,4].Conventionally these patients are treated with emergency surgery to restore luminal patency. These emergency operations, involving an unprepared and obstructed bowel, include a variety of procedures ranging from a loop colost
Large Bowel Obstruction Caused by Adhesions without Previous Abdominal Surgery: Two Case Reports
AA Munyika, E Muguti, D Muchuweti
East and Central African Journal of Surgery , 2012,
Abstract: Background: Large bowel obstruction is rarely caused by adhesions. To our knowledge, the few cases reported in literature are secondary to previous abdomino-pelvic surgery, and are in female patients. Case Reports: We report two cases of large bowel obstruction due to adhesions in males with no previous abdominal surgery. The first case was a 73 years old male previously well, who presented with a one week history of abdominal colicky pain with nausea. Initially this patient was thought to have symptomatic gallstones as a result of an ultrasound scan report. Consequently, a decision to take the patient for laparoscopic cholecystectomy was reached. Due to difficulties in achieving penumoperitoneum, a laparotomy was done; the patient was found to have a fibrous band across transverse colon causing obstruction. The second case was a 61 years old male, known diabetic and hypertensive, who presented with epigastric pain, nausea, vomiting and constipation. Abdominal X-rays demonstrated large bowel obstruction. At laparotomy, this patient was found to have adhesions causing sigmoid colon obstruction. Conclusion: In this paper, we demonstrate the rarity of large bowel obstruction secondary to adhesions especially in a virgin abdomen, emphasize the importance of good radiological expertise, and highlight the need to consider adhesions as a very rare but possible cause of large bowel obstruction.
The Relationship between Vessel Obstruction and Serum Total and Lipid-Bound Sialic Acid Levels in Patients with Coronary Heart Disease
Trakya Universitesi Tip Fakultesi Dergisi , 2002,
Abstract: Objectives: This study was designed to compare serum total and lipid-bound sialic acid levels obtained from patients with and without coronary obstruction. Patients and Methods: Serum total and lipid-bound sialic acid levels were determined in 42 patients (29 men, 13 women; mean age 58 years; range 32 to 75 years) with angiographically documented coronary obstruction and in 35 patients (22 men, 13 women; mean age 54 years; range 39 to 75 years) with no obstruction. Serum total and lipid-bound sialic acid levels were determined by the methods of Warren and Katopodis, respectively. The results were compared with the use of one-way ANOVA test. Results: Serum total and lipid-bound sialic acid levels were significantly higher in patients with coronary obstruction (81.01±10.10 mg/dl and 33.59±7.00 mg/dl, respectively) when compared with those of patients with no obstruction (65.18±10.23 mg/dl and 25.28±7.40 mg/dl, respectively) (p<0.001). Conclusion: The measurement of serum total and lipid-bound sialic acid levels may be useful in distinguishing between patients with and without coronary obstruction.
The Utility of Outcome Measures in Total Knee Replacement Surgery  [PDF]
Michelle M. Dowsey,Peter F. M. Choong
International Journal of Rheumatology , 2013, DOI: 10.1155/2013/506518
Abstract: Total knee replacement (TKR) is the mainstay of treatment for people with end-stage knee OA among suitably “fit” candidates. As a high cost, high volume procedure with a worldwide demand that continues to grow it has become increasingly popular to measure response to surgery. While the majority who undergo TKR report improvements in pain and function following surgery, a significant proportion of patients report dissatisfaction with surgery as a result of ongoing pain or poor function. Poor outcomes of TKR require care that imposes on already overburdened health systems. Accurate and meaningful capture and interpretation of outcome data are imperative for appropriate patient selection, informing those at risk, and for developing strategies to mitigate the risk of poor results and dissatisfaction. The ways in which TKR outcomes are captured and analysed, the level of follow-up, the types of outcome measures used, and the timing of their application vary considerably within the literature. With this in mind, we reviewed four of the most commonly used joint specific outcome measures in TKR. We report on the utility, strengths, and limitations of the Oxford knee score (OKS), knee injury and osteoarthritis outcome score (KOOS), Western Ontario and McMaster Universities osteoarthritis index (WOMAC), and knee society clinical rating system (KSS). 1. Background Total knee replacement is a major surgical procedure that requires multidisciplinary input prior to and after surgery to ensure the best possible outcome. Recovery from surgery is optimized with the inclusion of rehabilitation programs which are tailored to restore mobility and independence [1]. Time to recovery can vary following TKR, and most patients will report substantial gains between 3 and 6 months after surgery [2, 3]. Overall, a continuing pattern of improvement can be observed up to 12 months following surgery [4, 5]. While a majority of patients report improvements in pain and function following total knee replacement [6, 7], a substantial number of individuals do not meet the level of improvement expected at 12 months or more after surgery [8, 9]. A number of individual characteristics are known to influence pain and function after surgery [10]. Individual risk factors which impact on patient outcomes after TKR include age and gender [7, 11, 12], antecedent diagnosis [13], body mass index [14, 15], ethnicity [16], psychological distress [13, 17], baseline pain and functional disability [7, 13], comorbidity profile [10, 18], socioeconomic status [19], and radiographic osteoarthritis severity
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