Southern medical journal
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We describe the case of a woman who had cannulation of the internal jugular vein for the placement of a hemodialysis catheter. The procedure was unsuccessful and resulted in a retropharyngeal hematoma, which in turn caused severe compression on a carotid artery that was already severely narrowed by atherosclerosis. ⋯ During the course of hospitalization, ultrasonography, computed tomography, and angiographic studies were done. Cannulation of neck vessels in patients with bleeding diatheses must be done with caution, especially in the presence of severe stenotic disease of the carotid arteries.
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Southern medical journal · Oct 1995
Case ReportsCardiopulmonary complications during laparoscopy: two case reports.
Laparoscopic surgery is growing in popularity. As a result, laparoscopic procedures are being done on a broader and older patient population. These patients may have underlying cardiopulmonary disease that predisposes them to complications not seen in younger patients. ⋯ We present two cases involving elderly patients to illustrate cardiopulmonary complications that can occur during establishment or maintenance of the increased intra-abdominal pressures required for laparoscopic surgery. The first case describes a patient who developed bradycardia and asystole during insufflation for a laparoscopic hernia repair. The second case involves severe hypercarbia and a pneumothorax due to massive subcutaneous emphysema that developed during a laparoscopic colon resection.
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Southern medical journal · Oct 1995
Comparative StudyProspective survey of continuous versus single-injection spinal anesthesia in obstetrics.
Prior to the removal of spinal microcatheters from the market in 1992, these catheters were used extensively in the Obstetric Anesthesia Service at the Medical Center of Louisiana. We report on a prospective survey of the clinical application of single-injection versus continuous-catheter spinal anesthesia. Two hundred sixteen patients had single-injection anesthesia, and 218 had continuous-catheter anesthesia. ⋯ Patients with diabetes were at higher risk for PDPH, and blacks were at lower risk (relative risks 4.35 and 0.31, respectively). Additionally, PDPH was associated with lower intraoperative urine output. No increased risk of complications was found after continuous spinal anesthesia with microcatheters.
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Southern medical journal · Oct 1995
Comparative StudyPercutaneous dilatational tracheostomy: an alternative approach to surgical tracheostomy.
Percutaneous dilatational tracheostomy (PDT) offers a nonoperative alternative to patients needing an elective tracheostomy. The technique associated with PDT is essentially a progressive dilatation using blunt-tipped dilators for the placement of a tracheostomy tube. We retrospectively compared patient charges and operating time for 18 PDTs and 18 surgical tracheostomies. Our analysis suggests that percutaneous dilatational tracheostomy is a cost-effective alternative to the open procedure for elective tracheostomy.
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Southern medical journal · Sep 1995
Case ReportsTreatment of idiopathic pulmonary hemosiderosis with inhaled flunisolide.
Idiopathic pulmonary hemosiderosis (IPH), a rare clinical entity, is characterized by bleeding into the alveoli and progressive pulmonary fibrosis. It is usually treated with systemic corticosteroids during acute bleeding episodes and with prolonged courses of oral corticosteroids and/or other immunosuppressant drugs for maintenance therapy. Because prolonged treatment with these agents is frequently associated with significant side effects, favorable response to inhaled corticosteroids would be ideal in this condition. We report the case of a patient with IPH successfully treated with inhaled flunisolide.