Current Issue : January - March Volume : 2012 Issue Number : 1 Articles : 5 Articles
A healthy 53 year old man developed profound cardiogenic shock following instillation of bupivacaine-lidocaine-epinephrine solution as a locoregional anesthetic for elective outpatient shoulder surgery. Intubation, resuscitation, and transfer to the nearby hospital were done: echocardiography showed profound biventricular dysfunction; cardiac catheterization showed normal coronary arteries. Despite placement of an intra-aortic balloon pump and intravenous vasoactive drugs, the patient remained in shock. Stabilization was achieved with emergent institution of cardiopulmonary bypass and placement of a temporary left ventricular assist device (LVAD). Twenty-four hours later, cardiac function normalized and the LVAD was removed. The patient was discharged five days later and remained with normal heart function in three-year follow-up....
End-tidal anaesthetic gas concentration monitoring during inhalation anaesthesia has become standard of care. Explorative study comparing the end-tidal anaesthetic gas measured by a new main-stream anaesthetic gas monitor (IRMA, Phasein, Stockholm, Sweden) as compared to standard Datex side-stream monitoring during routine low flow anaesthesia Day surgical centre in StockholmThirty two healthy, ASA 1-2, patients undergoing elective day case anaesthesia with low flow 0.2-0.5 L/min. Simultaneous recording of the end-tidal gas concentration during routine day case anaesthesia with low flow sevoflurane or desflurane anaesthesia. The new monitor was found to be clinically acceptable. The mean bias between IRMA and Datex measures -0.125 vol % (Ã?± 0.145, limits of agreement were -0.41 ââ?¬â?? 0.16). The new main stream gas monitor is clinically acceptable alternative for end-tidal anaesthetic gas monitoring during routine anaesthesia with low flow, 0.2-0.5 L/min....
Introduction: Several options are available for preserving fertility before cytotoxic treatment, including ovarian tissue cryopreservation. Most reported surgical techniques include electrocoagulation. Our hypothesis is that avoidance of electrocoagulation may decrease ovarian cortex injury during cryopreservation procedures.\r\nCase presentation: We report a laparoscopic technique of whole-ovary removal without coagulation using Endo-GIA forceps and clips. Laparoscopic ovariectomy was performed for cryopreservation in a 37-year-old Caucasian woman with breast cancer and for whom chemotherapy was planned. The procedure was completed quickly and without complication. This Endo-GIA procedure was of short duration with a short period of ischemia before freezing.\r\nConclusion: Laparoscopic ovariectomy using the Endo-GIA stapling device procedure without coagulation may diminish ovary injury before ovarian cryopreservation....
Objective: To create an ideal temporary skin substitute. Methods: Temporary skin\nsubstitute (Biobrane, AWBAT and AWBAT Plus) porosity, 3D matrix, and biochemical composition were evaluated for impact on healing wounds (pain, fluid accumulation, infection, and time to heal). Twenty-four Sprague-Dawley [H1a: (SD) CVF] rats were used to measure the histology of healed full-thickness wounds. Tissue culture methods were used to measure the influence of Immuno-10 on human dermal fibroblasts: proliferation, collagen, and alpha-smooth muscle actin. Results: In full-thickness wounds (rats), histological evidence suggests better reepithelialization ofwounds covered withAWBAT Plus than those with AWBAT. Tissue culture techniques revealed that key biological additives to AWBAT Plus stimulated human dermal fibroblast growth, collagen synthesis, and alpha-smooth muscle actin production. Human keratinocyte growth was also promoted\nby a key biological element in AWBAT Plus. Interestingly, human mesenchymal\nstem cells grew well on the AWBAT Plus membrane. Clinically, AWBAT Plus protected widely meshed autograft, which healed more uniformly and faster than cadaver allograft. Conclusion: AWBAT Plus shows a great promise as a major advancement in wound care....
INTRODUCTION: Although a skin- and nipple-sparing mastectomy technique offers distinct cosmetic and reconstructive advantages over traditional methods, partial skin flap and nipple necrosis remain a significant source of post-operative morbidity. Prior work has suggested that collateral thermal damage resulting from electrocautery use during skin flap development is a potential source of this complication. This report describes the case of a smoker with recurrent ductal carcinoma in situ (DCIS) who experienced significant unilateral skin necrosis following bilateral skin-sparing mastectomy while participating in a clinical trial examining mastectomy outcomes with two different surgical devices. This unexpected complication has implications for the choice of dissection devices in procedures requiring skin flap preservation.\r\n\r\nCASE PRESENTATION: The patient was a 61-year-old Caucasian woman who was a smoker with recurrent DCIS of her right breast. As part of the clinical trial, each breast was randomized to either the standard of care treatment group (a scalpel and a traditional electrosurgical device) or treatment with a novel, low thermal injury dissection device, allowing for a direct, internally controlled comparison of surgical outcomes. Post-operative follow-up at six days was unremarkable for both operative sites. At 16 days post-surgery, the patient presented with a significant wound necrosis in the mastectomy site randomized to the control study group. Following debridement and closure, this site progressively healed over 10 weeks. The contralateral mastectomy, randomized to the alternative device, healed normally.\r\n\r\nCONCLUSION: We hypothesize that thermal damage to the subcutaneous microvasculature during flap dissection may have contributed to this complication and that the use of a low thermal injury dissection device may be advantageous in select patients undergoing skin- and nipple-sparing mastectomy....
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