ABSTRACT
We observed a patient who had central retinal artery occlusion with severely reduced visual acuity and characteristic retinal changes after cervical spine surgery under general anesthesia. In acute stage, visual acuity was slightly improved. But over course of several months, there was no improvement in visual acuity and central scotoma was remained. There were no evidences of hypotension or anemia during operation. The only presumptive cause was direct external ocular compression by horseshoe headrest. It is necessary to pay attention to eyes when prone positioning in the patients of cervical spine surgery.
Subject(s)
Humans , Anemia , Anesthesia, General , Blindness , Hypotension , Prone Position , Retinal Artery Occlusion , Retinaldehyde , Scotoma , Spine , Visual AcuityABSTRACT
Laparoscopic Burch operation is one of laparoscopic surgery for stress urinary incontinence. Subcutaneous emphysema and hypercarbia are potential complications of laparoscopic surgery, but are more likely to occur in extraperitoneal surgery than in intraperitoneal surgery, since insufflated CO2 can diffuse easily into the surrounding tissues. We report a patient in whom pneumomediastinum and extensive subcutaneous emphysema developed during laparoscopic Burch operation. Transient hypoxemia was also accompanied with hypercarbia. Possible mechanisms are presented, along with discussion of prompt diagnosis and treatment. For the management of laparoscopic extraperitoneal surgery, it is necessary to be careful with monitoring of CO2 insufflation pressure, routine examination and palpation of chest wall, use of N2O with caution, increase of ventilation to eliminate CO2, and excluding other causes of subcutaneous emphysema and hypercarbia.
Subject(s)
Humans , Hypoxia , Carbon Dioxide , Diagnosis , Insufflation , Laparoscopy , Mediastinal Emphysema , Palpation , Subcutaneous Emphysema , Thoracic Wall , Urinary Incontinence , VentilationABSTRACT
Local excision and axillary dissection followed by radiation therapy to the breast has been shown to achieve equivalent local control and survival as mastectomy in an prospective randomized trials. We analyzed 28 cases of early breast cancer in order to evaluate the therapeutic effects of conservative f surgery and definitive radiotherapy in the management of early breast cancer as possible alternative of simple mastectomy, retrospectively. Obtained results were as follows 1. Treatment related acute side reactions are more prominant in the case of chemoradiotherapy group than radiotherapy alone group. 2. There were no cases of primary, regional or systemic failures on the last follow up examination. 3. Cosmetic results after treatment were satisfactory in 26 cases out of 28 cases on the last follow up examination. 4. There were no demonstrable differences of tumor control and cosmetic results between the treatment groups. Although, these results suggested that definitive radiotherapy after local excision would be a possible and desirable alternative instead of total mastectomy in the management of early breast cancers, analyzed cases were too small and follow up period was too short to evaluate the therapeutic effect of primary radiotherapy after local excision, exactly.