Articles: surgery.
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The paper describes an original method of endoluminal electrical stimulation of the stomach developed by authors. The aim of the study was to compare two types of electrical stimulation: low frequency (LF) and high frequency (HF) in human patients. Twenty-three patients with postoperative gastroparesis (after abdominal surgery) were involved in the study and randomized into two groups. ⋯ Symptoms score decreased on the consecutive days of pacing from 8.3 to 3.8, 1.3, to 0.9 in the LF group and from 8.2 to 3.1, 1.0, to 0 in the HF group. We conclude that HF is more effective than LF in the treatment of postoperative gastroparetic human patients. No adverse effects of HF and LF were observed in this study.
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Spinal cord compression from catheter tip granulomatous masses following intrathecal drug administration may produce devastating permanent neurologic deficits. Some authors have advocated intrathecal catheter placement below the conus medullaris to avoid the possibility of spinal cord involvement. Multiple cases of catheter tip granulomas in the thoracolumbar region have been reported. ⋯ Histologic examination of the mass confirmed a sterile inflammatory mass. It has been suggested that intrathecal catheters be placed below the conus medullaris to avoid the possibility of spinal cord involvement. We present an unusual case documenting devastating permanent neurologic deficits from a catheter tip granuloma in the sacral region.
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Plast. Reconstr. Surg. · Oct 2003
The integral role of the plastic surgeon at a level I trauma center.
The role of plastic surgery in urban level I trauma centers in the United States has been largely undefined, despite the undeniable historical involvement of plastic surgery in reconstruction of posttraumatic defects. To explore and define this role, case data were prospectively collected during a 29-month period following initiation of a full-time plastic surgery position at an established urban level I trauma center. Referring and/or interacting surgical service, anatomical area of interest, and procedure data were tabulated. ⋯ Additional procedures commonly performed demonstrated considerable overlap with other fields of surgical specialization. This overlap in skills proved advantageous in distribution of facial trauma call and hand surgery coverage. Data presented in this study reinforce the idea that plastic surgery is a specialty defined by concept rather than anatomical area, and also demonstrate a significant role for plastic surgeons in a level I trauma center.
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Journal of neurosurgery · Sep 2003
Comparative StudyUse of 18F-choline and 11C-choline as contrast agents in positron emission tomography imaging-guided stereotactic biopsy sampling of gliomas.
Neuroimaging-guided stereotactic biopsy procedures are commonly used for diagnosis of gliomas. A number of the imaging modalities currently in use are not reliable enough in depicting these tumors. The authors developed 18F-choline and 11C-choline as tumor imaging agents for positron emission tomography (PET) scanning, and used them to visualize gliomas prior to stereotactic biopsy procedures. ⋯ The uptake of contrast agents was always low in low-grade gliomas, and the uptake in high-grade glioma was always high. The tumor/normal (T/N) ratio of 18F-choline was 10.5:12 in anaplastic astrocytoma and 13.2:21 in glioblastoma. The 18F-choline yielded slightly superior results compared with 11C-choline with regard to the T/N ratio. In one case of oligodendroglioma the tumor showed no uptake of 18F- and 11C-choline. With this exception, the PET scans of gliomas in which 18F- and 11C-choline contrast agents were added would guide the approach to the most malignant areas for stereotactic biopsy sampling.
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Estimation of stroke volume variation (e.g. systolic blood pressure and systolic area variability) and central extracellular compartment volume (e.g. initial volume of distribution of glucose, IVDG) may be useful in guiding fluid therapy in mechanically ventilated patients. The reliability of systolic blood pressure (SBP) variability has been well validated, but little is known about systolic area (SA) variability or IVDG. Our aim was to investigate SBP and SA variability and IVDG as predictors of preload responsive hypovolaemia in post-cardiac surgery patients. ⋯ Our results indicate that neither IVDG, nor SBP and SA variability are predictive of preload responsive hypotension in post-cardiac surgery patients. Spectral analysis of SBP and SA may be more sensitive at assessing preload responsiveness in this patient group than traditional maximum-minimum measures.