Panminerva medica
-
The results obtained from 355 patients of both sexes subjected to general and orthopaedic surgery with super-selective subarachnoid anesthesia (SSA) by means of small (26-27 gauge) needles with a modified Whitacre needle with ogival point are described. The use of thin spinal needles with "pencil-point" type ends together with microdoses of local anesthetics has meant a reduction in the complications typical of this technique such as hypotension, post-dural puncture, headache (PDPH) and urinary retention. Super-selective subarachnoid anesthesia realised through an infusion of 0.8-1 ml of hyperbaric bupivacaine is a safe effective technique with a low percentage of side-effects.
-
Case Reports
Catheter-induced pulmonary artery perforation during cardiac surgery: intraoperative surgical management.
A case of pulmonary artery rupture due to Swan-Ganz catheterization is reported. A 73-year old women undergoing coronary artery bypass grafting developed massive endotracheal bleeding during weaning from the cardiopulmonary bypass and inflation of the balloon of the Swan-Ganz catheter. As bleeding could not be controlled by endobronchial Fogerty catheter blockade, resection of the lateral segment of the middle lobe was necessary before bypass could be terminated. The postoperative course was complicated by an abscess formation in the right middle lobe of the lung which required operative revision.
-
To assess retrospectively the effectiveness and the safety of the conservative medical management of asymptomatic cocaine body-packers. ⋯ Conservative management during spontaneous evacuation of the containers is the first choice approach to the body-packet ingestion. Close clinical observation allows an early detection of the patients with complications requiring emergency surgical treatment.
-
Case Reports
Graft replacement of the dissecting aneurysm originating in the suprarenal abdominal aorta. A case report.
Spontaneous dissection originating in the suprarenal aorta is very rare. We successfully treated a patient with this type of aneurysm by a safe and reliable operative method. ⋯ And for reconstruction of visceral arteries, a graft with multiple branches was used. In spite of renal dysfunction before surgery and aortic clamping time extending for 40 minutes, the patient recovered almost uneventfully, and postoperative angiography confirmed good patency of the graft.
-
Replacement of the ascending aorta for aneurysm or dissection remains a complex challenge for cardiac surgeons. Between January 1984 and December 1993, 30 patients have had simultaneous resection of the ascending aorta and aortic valve replacement. Sixteen of them had composite graft replacement of the ascending aorta and the aortic valve with a modified Bentall's technique (Group I). ⋯ Four patients in Group I and two in Group II had postoperatively low cardiac output, two of them necessitating intraaortic balloon pump insertion. 43% of the patients had no perioperative complications. At the end of follow-up (n = 25), average 6 months (range 1-52 months), twenty-two survivors (22/25 or 88.0%) were in NYHA functional class 1. Simultaneous ascending aortic aneurysm repair and aortic valve replacement can be accomplished with an acceptable mortality and little morbidity.