ABSTRACT
Hydatid cysts of the liver have been treated surgically for many years by several surgical techniques including evacuation, marsupialization, and filling the cyst with saline after evacuation of the endocyst. We have previously reported laparoscopic treatment of hydatid cysts using the same hydatid asepsis and surgical techniques as in open surgery, with comparable results. Spillage of hydatid fluid during open surgery has been shown to result in serious anaphylactic reaction. The present report describes the first case report of such a reaction during laparoscopic treatment of hydatid cyst of the liver.
Subject(s)
Anaphylaxis/etiology , Echinococcosis, Hepatic/surgery , Intraoperative Complications , Laparoscopy/adverse effects , Adolescent , Female , Humans , Liver/injuriesABSTRACT
BACKGROUND AND OBJECTIVES: During laparoscopy, the increase of the carbon dioxide tension may increase the synthesis of hydrochloric acid in the parietal cells of the stomach; the source of the secreted hydrogen ions is carbonic acid derived from the hydration of carbon dioxide. The present report tests this hypothesis by correlating the changes of end-tidal PCO2 (ETCO2) with the pH of the gastric juice in patients undergoing laparoscopic cholecystectomy. METHODS: 40 adult patients were investigated: 20 controls, and 20 patients receiving 100 mg nizatidine intravenously, prior to surgery. In both groups, the ETCO2 was measured by capnography and the pH of the gastric juice was monitored before carbon dioxide insufflation and at the end of laparoscopy prior to carbon dioxide deflation. RESULTS: In the control group, the ETCO2 increased following carbon dioxide insufflation from a mean basal value of 30.2 (standard deviation [SD] 4.6) mm Hg to 41.1 (SD 9.5) mm Hg, while the mean pH of the gastric juice decreased significantly from 1.9 (SD 0.4) to 1.27 (SD 0.43). There was a significant negative correlation between the ETCO2 and pH of the gastric juice (r = -0.4). In the Nizatidine group, the ETCO2 also increased following carbon dioxide insufflation from a mean basal value of 30.9 (SD 3.0) mm Hg to 39.4 (SD 5.3) mm Hg. However, in contrast with the control group, the mean pH of the gastric juice did not decrease, but paradoxically increased from 1.68 (SD 0.36) to 3.6 (SD 1.02). CONCLUSIONS: During laparoscopy, the pH of the gastric juice is significantly decreased. This decrease is inversely related to the increase of ETCO2. The preoperative administration of the selective H2-blocker nizatidine can prevent the increase in gastric acidity and can result in a paradoxical increase of pH of the gastric juice.
Subject(s)
Carbon Dioxide/metabolism , Cholecystectomy, Laparoscopic/adverse effects , Gastric Juice/drug effects , Histamine H2 Antagonists/pharmacology , Nizatidine/pharmacology , Pneumoperitoneum, Artificial/adverse effects , Capnography , Carbon Dioxide/administration & dosage , Cholecystectomy, Laparoscopic/methods , Cholecystitis/surgery , Female , Gastric Acidity Determination , Gastric Juice/metabolism , Humans , Hydrogen-Ion Concentration/drug effects , Male , Middle Aged , Preoperative Care , Prospective Studies , Reference ValuesABSTRACT
Between January 1975 and December 1989, 1860 patients were admitted to the American University of Beirut Medical Centre with abdominal injuries. Their mean age was 23 years. Of these patients 107 had vascular injuries (an incidence of 6%). Bullets were the most common injurious agents (72%), followed by shrapnel (22%). There were 28 arterial and 113 venous injuries. All patients presented to the emergency unit within 5 h of injury (mean 45 min) and were surgically explored. The overall mortality rate was 36.5%. Patients who were haemodynamically stable had a better outcome than those who presented in shock (P < 0.005). The major cause of death was haemorrhage from uncontrolled bleeding. Two subgroups with a higher mortality were identified: patients with inferior vena caval injury associated with a liver injury had a mortality rate of 78.5%, and those with vascular injury associated with pelvic fracture had a mortality rate of 57% (P < 0.05). Abdominal vascular injuries have a high mortality rate, especially if the inferior vena cava is involved or associated pelvic fractures are present. Prompt resuscitation and control of bleeding are the key to an improved salvage rate.
Subject(s)
Abdominal Injuries/surgery , Aorta, Abdominal/injuries , Iliac Artery/injuries , Iliac Vein/injuries , Vena Cava, Inferior/injuries , Wounds, Penetrating/surgery , Abdominal Injuries/mortality , Adolescent , Adult , Aorta, Abdominal/surgery , Cause of Death , Child , Child, Preschool , Female , Humans , Iliac Artery/surgery , Iliac Vein/surgery , Lebanon , Male , Middle Aged , Prognosis , Surgical Wound Infection/mortality , Survival Rate , Vena Cava, Inferior/surgery , Wounds, Gunshot/mortality , Wounds, Gunshot/surgery , Wounds, Penetrating/mortalityABSTRACT
Bronchial transection of a main bronchus is usually recognized and repaired immediately after injury. Delayed repair is uncommon, especially in pediatric patients. We report a case of delayed repair of a transected right mainstem bronchus in a 5-year-old girl, 3 years after the initial injury. The transected lung re-expanded immediately and showed continued growth 3 years later.
Subject(s)
Bronchi/surgery , Wounds, Nonpenetrating/surgery , Bronchi/injuries , Bronchography , Bronchoscopy , Child, Preschool , Female , Humans , Lung/diagnostic imaging , Time Factors , Wounds, Nonpenetrating/physiopathologyABSTRACT
We report for the first time treatment of hydatid cyst of the liver laparoscopically. The patient is a 27-year-old man who presented to our hospital with a 6-week history of recurrent right-upper-quadrant pain with abdominal ultrasound findings compatible with hydatid cyst of the liver. The cyst was approached laparoscopically using the same hydatid asepsis as in open surgery. The cyst was evacuated laparoscopically and marsupialized, and its remaining cavity was packed with omentum. The patient did well postoperatively and was discharged home on the third postoperative day. He had minimal biliary leak that ceased spontaneously on the fifth postoperative day.
Subject(s)
Echinococcosis, Hepatic/surgery , Laparoscopy , Adult , Anti-Infective Agents, Local/administration & dosage , Anti-Infective Agents, Local/therapeutic use , Anticestodal Agents/administration & dosage , Anticestodal Agents/therapeutic use , Cetrimonium , Cetrimonium Compounds/administration & dosage , Cetrimonium Compounds/therapeutic use , Humans , Laparoscopes , Laparoscopy/methods , Male , SuctionABSTRACT
Over a 16-year period from January 1975 to December 1990, 823 patients with 840 vascular injuries were treated at the American University of Beirut Medical Center. Of these, 661 injuries involved peripheral vessels; 26 of which had 31 arteriovenous fistulae (AVF). Most of the AVF (80%) were diagnosed within 1 year from the injury. The most common presenting symptom was a thrill (74%) followed by a pulsating mass (32%). The most commonly affected vessels were the femoral and popliteal arteries. Angiograms were used preoperatively to delineate the extent and location of the fistulae. All patients except three, underwent surgical repair with excellent results with no limb loss. None of the patients developed late complications such as claudication or a vascular deficit in the involved limb. Arteriovenous fistula is a rare but challenging condition following vascular trauma. Its recognition and treatment give excellent results.
Subject(s)
Arteriovenous Fistula/etiology , Carotid Artery Injuries , Femoral Artery/injuries , Femoral Vein/injuries , Popliteal Artery/injuries , Popliteal Vein/injuries , Warfare , Adult , Arteriovenous Fistula/epidemiology , Arteriovenous Fistula/surgery , Female , Humans , Incidence , Lebanon/epidemiology , MaleABSTRACT
In order to study the behaviour of rectal cancer in our country, we have reviewed our experience at AUBMC over a 10-year period. We had 82 patients with rectal cancer, 36 males and 46 females, out of which 69 patients underwent surgical resection. Epidemiologically we have a significantly higher incidence of rectal cancer among females in contrast to western countries. Our operative results with respect to morbidity, mortality, recurrence and survival are discussed and compared to the literature.
