Int Surg
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Postoperative iliac and popliteal arteriovenous fistulas are extremely rare. This article describes the percutaneous endovascular treatment of iatrogenically induced arteriovenous fistula in two patients with simultaneous use of intravascular ultrasound. In a 61-year-old woman, a fistula between popliteal artery and vein, inadvertently created during implantation of a prosthetic knee joint, was treated with a novel polytetrafluorethylene (PTFE) stent graft. ⋯ Congestive heart failure induced by the arteriovenous communication was reduced rapidly. Our results indicate that percutaneous treatment in conjunction with intravascular ultrasound is a useful therapeutic option for vascular lesions. It is less invasive than open vascular reconstruction and has a comparably high success rate.
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Randomized Controlled Trial Clinical Trial
Randomized prospective study of local transdermic anesthetic in fine needle aspiration biopsy for breast lumps.
To evaluate the use of local transdermic anesthetics in fine needle aspiration biopsy (FNAB) in breast lesions. ⋯ Both the quantification and the type of pain referred to were similar in all three groups. However, there was a tendency of the patient to refer to less pain when the active substance or the placebo were used, when results were compared to the control group.
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A retrospective study of 46 patients who received bupivacaine local injections after hemorrhoidectomy were compared to a matching group of 46 patients of similar age and sex distribution who underwent the same operation. Pain medications requirement on the same day of operation and on subsequent days were measured and found to be the same in both groups. ⋯ However, the group receiving bupivacaine had a shorter hospital stay. In this respect, local injection of bupivacaine after hemorrhoidectomy may have a role in making patients more comfortable and shortening hospital stay.
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Laparoscopic surgery is estimated to produce a minor surgical injury in comparison with open and laparoscopic cholecystectomies. Studies in the past compare almost data of the first hours until day two. However, the surgical injury and the wound healing metabolism has to be detected. ⋯ Cytokine response after cholecystectomy demonstrates the lesser degree of surgical injury in the laparoscopic group, however, TNF-alpha demonstrates on day 4 a similar increase in both groups. This is a new result of studies working in this field. In conclusion, the benefit of laparoscopic surgery results only in the minimal access to the abdominal cavity, the wound healing metabolism is at last the same in both groups.
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Blunt transhiatal esophagectomy is largely performed in selected cases of esophageal cancer according to the experience of Mark Orringer. We have recently performed eleven consecutive videolaparoscopy assisted transhiatal esophagectomies in order to help esophageal dissection and to avoid injuries to mediastinal structures. In our experience the routine use of laparoscopic assistance during transhiatal esophageal dissection improves the safety of this technique and lowers postoperative complications. The results of neoadjuvant treatments (radio-chemotherapy) recently reported emphasize the role of transhiatal esophagectomy for cancer.