Retrograde cerebral perfusion for intracardiac air embolism in Fontan procedure.

We report the case of a 5-year-old boy who suffered from an intracardiac air influx with suspected cerebral air embolism during the Fontan procedure. We immediately transformed the cardiopulmonary bypass circuit to perform a retrograde cerebral perfusion, which resulted in successful neuroprotection. He was extubated in the operating room without any neurological defects.

[Laparoscopic resection of malignant liver tumors: immediate and long-term results].

The study was concerned with laparoscopic liver resection for cancer (140) (1998-2009). Faulty intraoperative performance and postoperative complications were evaluated according to Clavien and Satava. 188 resections were performed in the course of 154 operations. Median operation duration and blood loss were 180 min and 300 ml, respectively. Most patients started taking water on the same day and eating the next day. There were 16 incidents including 6 (3.9%) cases involving change of surgical strategy. Surgical complications were reported in 22 (14.3%) cases including one death from multiple organ failure. Median postoperative intensive care duration and inpatient stay were zero and 3 days, respectively; median follow-up--24-105 months; 3-5 year survival--(68 +/- 6%) and (46 +/- 8%), respectively. 3-year survival in patients with colorectal metastasis to liver, metastasis of neuroendocrine tumors of the gastrointestinal tract and those of hepatocellular carcinoma was 71, 50 and 47%, respectively. Laparoscopic liver resection is a safe and effective method of tumor treatment. It is least invasive and followed by good end results.

[High-intensity focused ultrasound ablation, a new method for the minimally invasive treatment of hepatic tumours].

High-intensity focused ultrasound (HIFU) is a new totally noninvasive treatment of liver neoplasms allowing for selective ablation of the neoplastic tissue. It was first described in the 1920s but attracted more attention only in the 1990s when the possibility of high-quality three-dimensional monitoring substantially improved efficiency of diagnostic ultrasound scanning and magnetic resonance imaging. Numerous experimental and clinical studies demonstrated the safety of the method and its applicability to the treatment of oncological patients. This review highlightens the principles of HIFU, describes the equipment for HIFU and the current state of investigations with the use of this technique with special reference to hepatic tumours. Prospects for the further development of HIFU are outlined.

Placebo theory and its implications for research and clinical practice: a review of the recent literature.

Although placebo effect is a common phenomenon in medicine and research, its mechanisms are not well understood. With the advent of modern medicine, placebo became a symbol for an outdated, morally questionable practice implying deceit and paternalism. However, in recent years, there has been an increasing amount of rigorous research into the mechanisms of placebo response and placebo analgesia with most studies coming from the field of pain medicine. New theories on placebo mechanisms have shown that placebo represents the psychosocial aspect of every treatment and the study of placebo is essentially the study of psychosocial context that surrounds the patient. Therefore, its understanding is essential for researchers and all medical practitioners, particularly those dealing with patients suffering from pain, depression, and motor disorders. In this article, we review the theories on placebo mechanisms and discuss their implications for clinical practice and the design of clinical trials.

The effect of rolling resistance on stationary wheelchair wheelies.

OBJECTIVE: To test the hypotheses that increased rolling resistance (RR) reduces rear-wheel displacement and perceived difficulty during the takeoff and balance phases of stationary wheelchair wheelies. DESIGN: We carried out within-subject comparisons of 20 participants as they each performed, in random order, two 30-sec stationary wheelies in three RR settings (tile, 5-cm-thick foam, and 12.5-cm-high blocks in front of and behind the rear wheels). The main outcome measures were rear-wheel displacement (in centimeters for the takeoff phase and centimeters per second for the balance phase) from a spring-loaded potentiometer and Likert scales of perceived difficulty. RESULTS: For rear-wheel displacement, all six of the pairwise comparisons (three terrains x two phases (takeoff and balance)) showed a significant statistical difference (P < 0.002). In each of the six pairwise comparisons, displacement was less for the higher of the two RR conditions. For perceived difficulty, during the balance phase, participants perceived tile to be significantly more difficult than either foam (P = 0.0067) or blocks (P = 0.0002). The other pairwise comparisons were not statistically significant. CONCLUSION: In conditions of increased RR, rear-wheel displacement and perceived difficulty are reduced during stationary wheelchair wheelies. These findings have implications for teaching wheelchair users to perform wheelies, a foundation of many advanced wheelchair skills.

Breast reconstruction in Nova Scotia: Rate, trends and influencing factors.

BACKGROUND: During their lifetime, approximately 10% of Canadian women will develop breast cancer. An increased awareness of breast reconstruction in patients undergoing mastectomy appears to have increased the demand for breast reconstructive surgery. OBJECTIVES: To study the rate of breast reconstructive surgeries performed in the province of Nova Scotia to determine whether the breast reconstructive services now offered are adequate to meet the needs of the population of this area. METHODS: The number of breast reconstruction procedures and mastectomies completed in the province of Nova Scotia during the time period of 1992 to 2001 was reviewed. The data were obtained from Maritime Medical Care Incorporated, the provincial medical plan. Information available on patients coded as undergoing breast surgeries was reviewed (n=10,056). The data on the trends and demographics of the Nova Scotia population were obtained from Statistics Canada. The data on incidence, prevalence and trends of breast cancer were obtained from the Canadian Cancer Society and the National Cancer Institute of Canada. RESULTS AND CONCLUSIONS: There is strong evidence of an increasing trend in the number of reconstructive surgeries among the women who underwent mastectomy. The number of breast reconstruction procedures increased 15 fold during the study period. This is mainly attributed to the increased awareness of women undergoing mastectomy and improved education by surgeons, family physicians and breast cancer support groups. Health sector employees must evaluate these trends to determine if the breast reconstructive services currently offered in this region are adequate. Reconstructive surgery was negatively associated with increasing age. Place of residency (urban versus rural) seems to play a role in women's decisions to proceed with breast reconstruction.

CONTEXTE: Environ 10 % des femmes au Canada seront touchées par le cancer du sein au cours de leur vie. Une conscientisation accrue à l'égard de la plastie du sein chez les femmes qui subissent une mastectomie semble avoir augmenté la demande de reconstructions mammaires. OBJECTIF: Étudier le taux de reconstructions mammaires pratiquées en Nouvelle-Écosse pour savoir si les services de plastie actuellement offerts répondent aux besoins de la population concernée. MÉTHODE: Nous avons passé en revue le nombre de reconstructions mammaires et de mastectomies pratiquées en Nouvelle-Écosse entre 1992 et 2001. Les données ont été tirées du Maritime Medical Care Incorporated, le régime provincial de soins de santé. Nous avons ensuite examiné les renseignements concernant les patients associés aux codes de chirurgie du sein (n=10 056). Les données sur les tendances et l'évolution démographique en Nouvelle-Écosse ont été obtenues de Statistique Canada et celles sur l'incidence, la prévalence et les tendances du cancer du sein, de la Société canadienne du cancer et de l'Institut national du cancer du Canada. RÉSULTATS ET CONCLUSIONS: Les chiffres font nettement état d'une tendance à la hausse du nombre de reconstructions mammaires chez les femmes ayant subi une mastectomie. En effet, le nombre de plasties a augmenté de 15 fois durant la période à l'étude. Cela est en grande partie attribuable à la conscientisation accrue des femmes qui subissent une mastectomie et à une meilleure éducation par les chirurgiens, les omnipraticiens et les groupes de soutien aux femmes atteintes du cancer du sein. Les employés du secteur de la santé doivent évaluer les tendances observées pour savoir si les services de reconstruction mammaire actuellement offerts dans la région suffisent à la demande. Par ailleurs, la plastie est mal perçue à mesure qu'augmente l'âge des femmes. De plus, le milieu où vivent les femmes (urbain versus rural) semble jouer un rôle dans la décision de subir ou non une reconstruction mammaire.