Surgical endoscopy
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Herein we report the cause of a 46-year-old woman who presented with recurrent right pneumothorax following hysterectomy with right salpingo-oophorectomy for pelvic endometriosis. Video-assisted thoracoscopy revealed endometrial implants in the posterior parietal pleura and the middle lobe. ⋯ A partial pleurectomy was carried out to remove the endometrial foci in the parietal pleura; the remaining pleural surface was mechanically abraded. The favorable outcome was confirmed at 2-year follow-up.
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Carbon dioxide is usually preferred as the insufflating agent for laparoscopic surgery because it is readily available, noncombustible, and chemically stable. It is still questionable, however, if CO2 pneumoperitoneum has any effect on free radicals and lipid peroxidation. The purpose of this study was to investigate the possible effects of CO2 pneumoperitoneum on free radicals and lipid peroxidation in the erythrocytes of rats. ⋯ These results indicate that CO2 pneumoperitoneum applied with 5-10 mmHg pressure increases the formation of free oxygen radicals by inhibiting SOD activity and that the accumulation of free radicals elevates the level of MDA, a metabolite of lipid peroxidation. The effect of CO2 pneumoperitoneum on free radicals and lipid peroxidation is pressure-dependent in rats. The mechanism underlying this pressure dependency is still under investigation.
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Clinical Trial
Bougienage and balloon dilation using a conventional tracheal tube for tracheobronchial stenosis before stent placement.
In order to achieve urgent restoration of the airways in tracheobronchial stenosis and to make stent placement simpler and safer, we developed a method that allows combined bougienage and balloon dilation via the use of a conventional tracheal tube. Fifteen patients with tracheobronchial stenosis underwent bougienage and balloon dilation using a tracheal tube with a cuff attached, inserted via a tracheostomy, before stent placement. The conventional tracheal tube was inserted via a tracheostomy, the cuff was expanded at the stenotic site, and the tube was fixed to the tracheostomy and left in place for a few days until sufficient dilation was achieved. ⋯ Thereafter, Dumon stents were inserted in 10 patients, dynamic stents in four patients, and an expandable metallic stent in one patient. The stents were introduced easily with no other dilation procedure after a mean of 5 days from the start of the procedure. For tracheobronchial stenosis, bougienage and balloon dilation using a tracheal tube with an integral cuff via a tracheostomy is a simple and safe method for achieving both urgent relief of airway stenosis and dilation before stent placement.
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Benzocaine is a commonly used topical anesthetic present in many over-the-counter preparations. The development of methemoglobinemia, associated with the use of benzocaine, is potentially fatal. ⋯ We report two cases of benzocaine-induced methemoglobinemia occurring 3 months apart at the same institution. A brief discussion regarding methemoglobin is presented.