Management of rectal stump leak following emergency Hartmann's procedure / Gerenciamento do vazamento do coto retal após o procedimento de emergência de Hartmann

ABSTRACT We report on the management of three cases of rectal stump leak and sepsis following urgent Hartmann's procedure for perforated sigmoid diverticulitis or large bowel obstruction. Two patients had significant risk factors for poor tissue healing. All patients developed features of sepsis and computer tomography scans demonstrated rectal stump leak with adjacent collections. All patients required reoperation for drainage and washout of abscess. An intraperitoneal catheter system was introduced together with drains in order to continue on the ward until tract was formed. There was no mortality and minimal morbidity. The key to management of rectal stump leak is the early and aggressive drainage of the associated collection and continued irrigation of the stump.

RESUMO Relatamos o tratamento de três casos de vazamento de coto retal e sepse após o procedimento de urgente de Hartmann para diverticulite sigmoide perfurada ou obstrução do intestino grosso. Dois pacientes apresentaram fatores de risco significativos para uma má cicatrização tecidual. Todos os pacientes desenvolveram características de sepse e tomografia computadorizada demonstraram vazamento de coto retal com coleções adjacentes. Todos os pacientes necessitaram de reoperação para drenagem e lavagem do abscesso. Um sistema de cateter intraperitoneal foi introduzido junto com os drenos para continuar na enfermaria até a formação do trato. Não houve mortalidade e morbidade mínima. A chave para o gerenciamento do vazamento de coto retal é a drenagem precoce e agressiva da coleta associada e a irrigação contínua do coto.

Fatal pulmonary embolism after middle ear surgery: a case report

Pulmonary thromboembolism is a complication of underlying venous thrombosis. Factors contributing to thrombus formation include venous stasis, hypercoagulable state, immobilisation, surgery and pregnancy. Authors present the challenges authors faced in diagnosing pulmonary embolism in a post-operative patient. 35-year-old female with complaint of decreased hearing for 2 years along with tinnitus and giddiness was admitted for stapedectomy. She also gave history of dyspnoea and pedal oedema one month back for which she was hospitalized and underwent investigations which were normal. Patient was discharged as her clinical symptoms improved. On postoperative day 5, she developed sudden dyspnoea after getting up and walking a few steps. Dyspnoea along with falling saturation and bradycardia progressed to cardiopulmonary arrest. Intensive care was started. Bilateral lower limb venous doppler showed deep venous thrombosis. Clinical diagnosis of pulmonary embolism was made, and patient was lysed with Tenecteplase 30 mg. Echocardiography showed signs of resolution of embolism after lysis, but gradually patient deteriorated and developed cardiogenic shock. Intra-aortic balloon pump was inserted via right femoral artery and inotropic support was continued. However, patient’s condition worsened, and she developed cardiopulmonary arrest the next day and could not be revived. Prevention of pulmonary embolism is a major clinical problem for which prophylactic measures like early ambulation in post-operative periods, elastic stockings, graduated compressive stockings for bed ridden patients and preventive anticoagulation therapy in high risk patients should be considered.

A Rare Case of Left Ventricular Outflow Tract Obstruction 18 Years after a Mechanical Mitral Valve Replacement

Background: Left ventricular outflow tract (LVOT) obstruction is a serious complication that can occur after various mitral-valves, surgical or percutaneous, interventions. It was rarely described in mechanical mitral valve replacements. Aim: to describe a rare case of late LVOT obstruction after a mitral valve replacement by a low-profile mechanical prosthesis. Case Presentation: A 48-year woman, with a history of rheumatic mitral valve disease and mechanical mitral replacement by a hemi-disc valve 18 years ago, presented for a recent dyspnea. Echocardiography showed a narrowing of the LVOT, with anterior position of the mitral prosthesis, aorto-mitral annular angulation, septal thickening and remnant native sub-valvular tissue attached to the septum in the LVOT region. This resulted in LVOT obstruction with a peak gradient of 75 mmHg. The heart team opted for a redo surgery, but the surgical decision was refused by the patient. Discussion: This is a rare case of late LVOT obstruction after mitral valve replacement by mechanical low-profile prosthesis. Preserved native mitral valve tissue, which is the main described cause of LVOT obstruction after mechanical mitral valve replacements was not the unique cause of obstruction in this patient who had also a septal thickening and anterior prosthetic position. Aorto-mitral annular angulation that was identified as a risk factor of LVOT obstruction after trans-catheter mitral valve replacements, should be, probably, also took into account and assessed pre-operatively in patients undergoing surgical mitral replacements. Conclusion: LVOT obstruction can occur after mechanical mitral replacements event with low profile prosthesis. In patients with identified risk factors of LVOT obstruction, preservation mitral anterior leaflet should be avoided, and preservation of other native mitral tissue should be discussed.

Prediction of abdominal complication after gastroenterological surgery for gastric and colorectal cancer / 中华消化外科杂志

The postoperative complications in patients with gastric or colorectal cancer has been common but seriously affecting patients' recovery and even their life safety.According to the database of China Gastrointestinal Cancer Surgery Union,abdominal infectious complications are the main causes of secondary surgery and postoperative death,which deserve clinical attention.However,the incidence rate of postoperative abdominal infection varies widely from center to center.Due to the lack of nationwide data,it is unable to determine the incidence of abdominal infectious complications reasonably and formulate the corresponding strategies of evidence-based diagnosis and treatment.Therefore,this multi-center prospective cohort study,i.e.prediction of abdominal complication after gastroenterological surgery (PACAGE),aims to investigate the incidence,classification and outcomes of postoperative abdominal infection in patients with gastric or colorectal cancer,to implement the standardization of the complication registration,and to provide necessary data for improving surgical safety,preventing abdominal infection and decreasing the rate of postoperative complications in the future.

Prevention and treatment of complications of CT-guided percutaneous radiofrequency ablation for lung cancer / 中华放射学杂志

Objective To investigate the complications caused by CT-guided percutaneous radiofrequency ablations (RFA) for lung cancer and analyze the prevention approach. Methods A total of 125 lung cancer patients (142 RFA treatments) in our hospital were enrolled in this study between July 2015 and June 2017. This retrospective study analyzed the reasons and the strategies for preventing the complications. Results One hundred and twenty?five patients underwent RFA treatment for lung lesions. All the operations were successfully completed. During the treatment, 18 patients showed hemorrhage (3 of CTCAE grade 3 hemorrhage); 16 patients showed pneumothorax, among which, 15 patients have chronic obstructive pulmonary disease; 28 patients showed chest pain (23 cases were located under the pleura); 3 patients showed pneumonia;1 patient showed pulmonary abscess, which located in the subpleural space with a maximum diameter of ＞3 cm; 1 patient showed pulmonary embolism, and 1 patient with scald. Complications were attenuated after symptomatic treatment. Conclusion The main reasons of complications of RFA in treating lung cancer were direct injuries caused by punctures, tumors with abundant blood supplement, tumors adjacent to pleura, low scores of lung function, coagulation disorders, and diabetes. The key points for avoiding and reducing complications are preoperative evaluation of patients' basic situations, exclusion of intraoperative avoidable technical risk factors.

A randomized trial study on the effect of amniotic membrane graft on wound healing process after anal fistulotomy / Ensaio clínico randomizado sobre o efeito do enxerto de membrana amniótica sobre o processo de cicatrização após fistulotomia anal

Abstract Objective Human amniotic membrane (HAM) used as a wound coverage for more than a century. The aim of this study is to evaluate the efficacy of amniotic membrane on wound healing and reduce post-operative complication. Study design Randomized clinical trial study. Place and duration of study Surgery Department, Shahid Faghihi Hospital, Shiraz, in the period of between Sep. 2014 and Nov. 2015. Methodology 73 patients with anal fistula were divided into two groups. The patients suffered from simple perianal fistula (low type) without any past medical history. Fistulotomy were performed for all of them and in interventional group HAM were applied as biologic dressing. Their wound healing improvement was evaluated post-operative in two groups. Results From 73 patients participated in the study, 36 patients were in control group and 37 patients were in intervention group. According to the analysis of images taken from the wound, the rate of wound healing was 67.39% in intervention group and 54.51% in control group (p < 0.001). Discharge, pain, itching and stool incontinency was lower in intervention group. Analysis of pathology samples taken from the wound showed no differences between two groups. Conclusion HAM application could lead to improvement of wound healing and reduced post-operative complications. In conclusion, HAM may act as a biologic dressing in the patients with anal fistula.

Resumo Objetivo Membrana amniótica humana (MAH) tem sido usada para cobrir feridas por mais de um século. O objetivo deste estudo é avaliar a eficácia da membrana amniótica na cicatrização de feridas e reduzir complicações pós-operatórias. Desenho do estudo Ensaio clínico randomizado. Local e duração do estudo Departamento de Cirurgia, Shahid Faghihi Hospital, Shiraz, Irã, entre setembro de 2014 a novembro de 2015. Método 73 pacientes com fístula anal foram divididos em dois grupos. Os pacientes sofriam de fístula perianal simples (tipo baixo) sem histórico médico prévio. A fistulotomia foi realizada em todos eles e no grupo intervenção, MAH foi aplicada como curativo biológico. A melhora da cicatrização foi avaliada no período pós-operatório em dois grupos. Resultados De 73 pacientes que participaram do estudo, 36 pacientes eram do grupo controle e 37 pacientes do grupo intervenção. De acordo com a análise das imagens da ferida, a taxa de cicatrização foi 67,39% no grupo intervenção e 54,51% no grupo controle (p < 0,001). Secreção, dor, prurido e incontinência fecal foi menor no grupo intervenção. A análise das amostras patológicas retiradas da ferida não mostrou diferenças entre os dois grupos. Conclusão A aplicação de MAH pode levar à melhoria da cicatrização de feridas e reduzir as complicações pós-operatórias. Em conclusão, a MAH pode atuar como um curativo biológico nos pacientes com fístula anal.

Cardiac Herniation Following Pneumonectomy.

Abstracts: Cardiac herniation is rare. If it is untreated, lead to fatal complications of pneumonectomy. Symptoms are site related. It has sudden onset of hypotension, arrhythmia and cardiac arrest. Clinical suspicion with plain X- ray chest and ECG changes must lead to early diagnosis and require prompt surgical treatment. We present here one such case of cardiac herniation which was developed immediately after shifting the patient to recovery room, diagnosed, treated and saved the patient.

Comparison of facial nerve injury and recovery rate after anterograde and retrograde nerve dissection of benign parotid tumor / 中国肿瘤临床

Objective:Facial nerves can be dissected using anterograde and retrograde approaches. The optimal technique for the facial nerve dissection of a patient with benign parotid tumor has not yet been determined. This study focused on facial nerve dysfunc-tion and recovery rate after anterograde and retrograde facial-nerve dissections. Methods:The data of 110 patients with benign carotid adenoma from the Head and Neck Department of this hospital who were hospitalized between January 2011 and January 2013 were col-lected. These patients were divided into groups A (n=52) and B (n=58). Anterograde and retrograde dissections of the facial nerve were performed on group A and group B patients, respectively. Based on the preferential order of dissection, group B was divided into groups B1, B2, and B3 representing the zygomatic, buccal, and marginal mandibular branches, respectively. The patients were postoperatively observed to check for potential symptoms, such as facial paralysis along with its severity and recovery. The House-Brackmann grading system was used to assess all patients. Results:The operation could be successful, with better nerve exposure, using these approaches. Statistical differences were observed in the nerve injury and recovery rates between the groups, with group A better than group B, and group B2 better than the other two groups (P<0.05). Conclusion:Anterograde facial nerve dissection should be routinely used in be-nign parotid tumor, and the buccal branch of facial nerve dissection should be preferentially considered when no other option apart from retrograde dissection is available.

<b>A Case of Photophobia Post Cataract Surgery Successfully Treated </b><b>with the Kampo Formulation Ryokeikansoto </b> / 日本東洋医学雑誌

The number of senile eye cataract cases increases year by year. Recent developments in new operation techniques have brought more safety and ease i.e. ultrasonic phacoemulsication and lens replacement. However, some complications of these techniques result in troublesome outcomes. In this paper the authors report a female patient aged 74 years old who suffered from severe photophobia after cataract surgery, which was successfully treated with the Kampo formulation, ryokeikansoto. Such troublesome cases tend to be neglected to in medical journal publications when the background of the complaint is unknown.

Three-dimensional imaging of living transplanted kidney vasculature by 3D color Doppler ultrasonography.

Background: It is of clinical importance to display the vasculature of transplanted kidney in three-dimensional (3D) and in non-invasive way. 3D color Doppler ultrasonographic imaging (3D-CDUI) is a non-invasive technique to display the 3D vasculature of living organs. Objective: Probe into characteristics of 3D vasculature of living transplanted kidney by 3D-CDUI, and evaluate the clinical value of 3D-CDUI on monitoring complications after operation of renal transplant. Methods: Nine patients who received allogeneic transplantation of kidney were monitored with 3D-CDUI. The instruments used included ACUSON Sequoia 512 and TomTec computer station of 3D-CDUI. Using magnetic positioning free-hand scanning, the 3D reconstruction and display of renal tissue structure and blood flow were performed off-line. Results: All patients underwent 3D-CDUI examinations without any side effect or complication. When acute rejection occurred, the 3D distribution change of renal blood flow signal could be observed clearly. During treatment of acute necrosis of renal tubules, changes of renal blood flow signal in 3D color Doppler images could be detected earlier compared with 2D color Doppler images. The position of embolized vassels could be diagnosed accurately by 3D-CDUI. Conclusion: The 3D-CDUI was helpful to improve diagnosis level of ultrasonography by monitoring complications after renal transplantation.

Neurological Complications in Early Post-operation of Renal Transplant Recipients / 中国康复理论与实践

@#ObjectiveTo investigate the incidence, types and risk factors of neurological complications in the early post-operation of renal transplantation. MethodsThe clinical course of 3169 cases of renal transplantation were reviewed, the clinical data of 102 patients with neurological complications were analyzed retrospectively.ResultsThe total incidence of neurological complications was 3.2%, which including: encephalopathy 35 (1.1%), seizure 24 (0.76%), acute stroke 15 (0.47% ), peripheral nerve disease 15 (0.47%), headache 12 (0.38%), central nervous system infection 1 (0.03%). ConclusionThere were varied of neurological complications of renal transplantation in early post-operation, in which encephalopathy and seizure were more common. Some of the complications may be related to immunosuppressive agents.

Effects of Intraoperative Hypothermia on the Incidence of Post-operative Infection and Responses of Peripheral White Blood Cells / 대한마취과학회지

BACKGROUND: Hypothermia occurs commonly during surgery. An increased incidence of hypothermia- induced morbidity of surgical patients has been reported. Immunosuppression has also been demonstrated after major surgery. Therefore, we investigated the rate of infection and the changes of white blood cells depending on body temperature during a gastrectomy. METHODS: Sixty patients were randomly divided into be warmed intraoperatively with a circulating warm water mattress (group 1) or warm intravenous fluid/humidifier filter/circulating warm water mattress (group 2). Core temperature was recorded every 15 min during surgery and every 30 min in the recovery room. Blood samples for measurement of white blood cells were obtained preoperatively, immediately, post-op day 1 and day 2 after surgery. RESULTS: Group 1 began to have a decrease in temperature at 30 min after surgery and a significantly lower temperature than group 2 during the surgery and 60 min in the recovery room (P<0.05). Compared with preoperative values, surgery caused an increase in neutrophils, and a decrease in lymphocytes in both groups (P<0.05). Compared with group 2, more concentrations of neutrophils and less concentration of lymphocytes and monocytes were found in group 1 on the post-operative 2nd day (P<0.05). Fever above 37.3degrees C was found in 17 of 30 patients in group 1, but in only 14 of 30 patients in group 2. Pneumonia (one patient), urinary tract infection (one) and surgical wound infection (two) were only found in group 1, but the incidence of infection was not statistically significant between the groups. CONCLUSIONS: Intraoperative hypothermia was associated with a delayed recovery of changes in white blood cells.