Surgery today
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Case Reports
Intrapleural rupture of a pulmonary arteriovenous fistula occurring just beneath the pleura: report of a case.
We report herein a rare case of a 21-year-old man with Rendu-Osler-Weber disease, otherwise known as hemorrhagic teleangiectasia, in whom a spontaneous hemothorax occurred following the rupture of one of multiple pulmonary arteriovenous fistulae (PAVF). An emergency life-saving operation was performed which revealed the ruptured fistula lying just beneath the visceral pleura. This case demonstrates that patients in whom a pulmonary angiogram shows an arteriovenous fistula lying just beneath the visceral pleura should undergo prophylactic surgery to avoid a life-threatening emergency, whenever possible.
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Case Reports
A case of bilateral obturator hernias: image diagnosis and description of a retropubic operative approach.
A case of bilateral obturator hernias which was diagnosed by ultrasonography (US) and computed tomography (CT), and repaired by a retropubic extraperitoneal operative approach under spinal anesthesia is reported herein. A 91-year-old woman presented with lower abdominal and left groin pain consistent with a Howship-Romberg sign. US demonstrated an image of the bowel projecting from the small pelvic space to the left thigh with a to-and-fro movement of the bowel contents. ⋯ No necrosis was observed in the incarcerated bowel and resection was not necessary. A simple hernial sac was found in the right obturator canal. The operation using the retropubic extraperitoneal approach was successful and we believe it to be the most effective procedure for obturator hernias which have been diagnosed early.
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Abdominal wall lifting is a method to produce operative space between the anterior abdominal wall and the intra-abdominal organs during laparoscopic surgery. We devised a hanger lifting procedure for the anterior abdominal wall to avoid complications as well as reduce the costs related to the pneumoperitoneum. ⋯ Though at the beginning we performed laparoscopic cholecystectomy by the pneumoperitoneum, we discarded the insufflator for this operation since starting the new procedure. There was no incidence of conversion to pneumoperitoneum and a fairly good operative view was achieved enabling a smooth laparoscopic cholecystectomy.
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Palmar hyperhidrosis is a troublesome and embarrassing disorder that causes professional, psychological, and social handicaps. Its etiology is unknown, although surgical treatment by thoracic sympathectomy is presently believed to be the best method of cure. Up to now, numerous methods of sympathectomy, including open thoracotomy, as well as posterior and supraclavicular approaches have been described. ⋯ Compensatory hyperhidrosis was the major complication. There was no mortality. We therefore consider thoracoscopic sympathectomy to be a simple, safe, and effective method for treating palmar hyperhidrosis.
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The aim of this study was to clarify the role of oxygen-derived free radicals and the effect of free radical scavengers on skeletal muscle ischemia/reperfusion injury. Male Wistar rats were divided into a complete ischemia group (C-group) and an incomplete ischemia group (IC-group) and each animal was subjected to 2 h of ischemia and 1 h of reperfusion. In an attempt to decrease reperfusion injury, the rats were given free radical scavengers either as allopurinol 50 mg/kg for 2 days or as superoxide dismutase 60,000 units/kg plus catalase 500,000 units/kg. ⋯ In the C-group, these values were significantly higher than in the IC-group. The administration of free radical scavengers suppressed the increase in malondialdehyde in the gastrocnemius muscle after reperfusion in both groups. The increase in water content and CPK-MM after reperfusion was also suppressed by free radical scavengers in the IC-group, but not in the C-group.(ABSTRACT TRUNCATED AT 250 WORDS)