ABSTRACT
OBJECTIVE: To increase awareness of adverse events associated with the use of implantable insulin pumps. RESEARCH DESIGN AND METHODS: A descriptive case report of a pump implant infection. RESULTS: This is a case report of one implanted insulin pump-pocket infection among a series of 15 patients. After exposure to a child with a respiratory infection on PID 30, V.L.C. (the patient) developed a fulminant pump-pocket infection. H. influenza was recovered from it. Despite aggressive antibiotic therapy, the infection could not be controlled. Insulin delivery ceased, and the pump was explanted. The pump-pocket infection rapidly resolved with pump removal, permitting later reimplantation. CONCLUSIONS: We have adopted the American Heart Association indications and antimicrobial prophylaxis regimens recommended for prevention of endocarditis in patients with prosthetic values for patients with implanted insulin pumps.
Subject(s)
Diabetes Mellitus, Type 1/drug therapy , Haemophilus Infections/transmission , Haemophilus influenzae , Insulin Infusion Systems/adverse effects , Adult , Ampicillin/therapeutic use , Drug Therapy, Combination/therapeutic use , Female , Haemophilus Infections/drug therapy , Humans , Rifampin/therapeutic use , Sulbactam/therapeutic useABSTRACT
Laparoscopic surgery impacted the surgical world in the United States in 1990. This report reviews the initial experience of 34 surgeons in 8 teaching hospitals of the Northeastern Ohio Universities College of Medicine. There were 538 cases reported from May 1, 1990 to January 31, 1991. There was no mortality and the morbidity rate was 4.8%, including three bile duct injuries. The conversion rate to an open procedure was 6.1%. The criteria for credentialing, training, and resident and faculty education are included. The data reported by the Surgery Department of Northeastern Ohio Universities College of Medicine are very similar to reported series from the current literature.
Subject(s)
Education, Medical, Continuing , General Surgery/education , Laparoscopy , Adult , Humans , Internship and Residency , Laparoscopy/adverse effects , Middle AgedSubject(s)
Carotid Arteries/surgery , Cerebrovascular Disorders/prevention & control , Endarterectomy , Thrombosis/surgery , Aged , Auscultation , Carotid Arteries/diagnostic imaging , Cerebrovascular Disorders/etiology , Female , Humans , Ischemic Attack, Transient/etiology , Male , Middle Aged , Radiography , Thrombosis/complications , Thrombosis/diagnosisABSTRACT
A Hartmann procedure was performed on 25 patients with complications of acute diverticulitis. Of the 20 patients in whom both stages were completed, 14 had a smooth course. Total hospitalization for both stages averaged 23 days. Mortality was 8%. The initial resection usually is not difficult. Subsequent reanastomosis is facilitated by an interval of at least three months between stages. The advantages of the Hartmann procedure are as follows: (1) The diseased bowel is removed at the first stage. (2) The risk of primary anastomosis is avoided. (3) Hospitalization and overall time of treatment are reduced. (4) Mortality is relatively low. The Hartmann procedure should be considered for a broader selection of patients with complications of acute diverticulitis.
Subject(s)
Colon, Sigmoid/surgery , Diverticulitis, Colonic/surgery , Intestinal Perforation/surgery , Abscess/complications , Aged , Colostomy , Diverticulitis, Colonic/complications , Female , Fistula/complications , Humans , Intestinal Fistula/complications , Intestinal Obstruction/complications , Intestine, Small/surgery , Male , Middle Aged , Peritonitis/complications , Postoperative Complications , Skin Diseases/complications , Urinary Bladder Fistula/complicationsABSTRACT
Forty-nine patients underwent sixty-four procedures for the treatment of the thoracic outlet compression syndrome. Detailed history and careful physical examination are of paramount importance in diagnosing this disease. Our findings strongly suggest that a positive arteriogram is confirmatory evidence of the thoracic outlet compression syndrome. Two problems are identified as the source of unsatisfactory results in this series: poor selection of patients and the regeneration of rib and dense scar tissue with recurrence of compression symptoms. We favor the transaxillary approach to resection of the first rib because it provides satisfactory exposure for removal of the entire rib and utilizes a more cosmetically pleasing incision. Division of muscles, traction on nerves, and entrance into a body cavity are not required, operating time and hospital stay are shortened, and blood loss is minimized. Favorable long-term results were seen in 86 per cent of the patients treated.
