Acta Chir Belg
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Some children requiring chemotherapy, total parenteral nutrition, or repeated blood sampling for long periods have no more axillary, internal jugular, external jugular, saphenous, or femoral veins available for cannulation. In such patients, the central venous system can still be accessed via alternate routes e.g. the azygos vein, the gonadal vein or the inferior epigastric vein. ⋯ The knowledge of alternate routes to obtain central venous access for children requiring chemotherapy, total parenteral nutrition, or repeated blood sampling for long periods is critically important, and the azygos system, right gonadal vein or the inferior epigastric vein can be used when standard accessible veins are unavailable.
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Comparative Study
Comparison of transperitoneal and retroperitoneal approaches in abdominal aortic surgery.
The transperitoneal approach (TP) to the aorta is the most widely accepted surgical approach in aortic surgery as it is simple, fast and provides excellent exposure of the intra-abdominal cavity and vascular structures. In recent years, there has been an increasing interest in the retroperitoneal (RP) approach to the aorta since it has been described as having a better outcome, i.e., preserving pulmonary function and gastro-intestinal physiology, reducing the intra-operative blood loss, minimising patient discomfort or pain, decreasing the incidence of wound complications and shortening ICU and hospital stay. The aim of this study is to compare the transperitoneal and retroperitoneal approaches in aortic surgery for aorto-iliac occlusive disease (AIOD). ⋯ This report presents our experience with the use of TP and RP approaches in a patient population merely consisting of AIOD. The RP approach was associated with a significantly lower incidence of postoperative pulmonary complications, rapid recovery of gastro-intestinal functions, shorter ICU and hospital stay, less peri-operative blood loss and lower mean effort-pain scores. We conclude that the RP approach is a safe and feasible technique that exposes patients to less postoperative complications.
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Until the no-fault law in Belgium (15/05/2007) comes in action on 01/01/2009 it will be a system of fault to prove. Therefore the informed consent stays a mean or not liability progress. At this moment it stays a problem for the surgeon when he has not given any information about informed consent to the patient. ⋯ Thirdly the patient must have the possibility to read it. Fourth the patient has to give his oral and written informed consent to the surgeon before being operated on by that same surgeon or any member of his staff. There is always a risk for sanctions in several procedures like criminal law and civil law until the no-fault system comes into action on 01/01/2009.