Articles: surgery.
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The development of microvascular surgical techniques during the last quarter century has advanced the ability of the hand surgeon to reconstruct the traumatically amputated thumb. The use of tissue from the foot has become the mainstay of therapy for this previously exceedingly difficult reconstructive problem. Although numerous minor variations of thumb reconstruction with use of the toes from the foot are available, three main techniques--the complete great toe transfer, wraparound flap, and second toe transfer--provide a predictable outcome. ⋯ This type of transfer does not permit interphalangeal joint motion and may not permit metacarpophalangeal joint motion. Therefore, the requirements of a normal carpometacarpal joint with excellent thenar musculature so that the postoperative thumb can be put through a functional arc of motion are essential. Transferring a portion of the distal phalanx in the wraparound flap permits the intercalary iliac crest graft to have viable bone on both the distal and proximal aspects, thereby reducing postoperative osteopenia of the iliac crest graft itself.(ABSTRACT TRUNCATED AT 400 WORDS)
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The case of a 33-year-old woman who presented with abdominal pain referable to the lower abdomen is discussed. She had had an uncomplicated intrauterine abortive procedure two weeks earlier. It was determined that a ruptured ectopic pregnancy was the etiology of her abdominal pain. The rare phenomenon of combined intrauterine and extrauterine pregnancy is discussed.
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Anesthesia progress · Jan 1992
Randomized Controlled Trial Comparative Study Clinical TrialComparison of nalbuphine and fentanyl as intravenous analgesics for medically compromised patients undergoing oral surgery.
This study compared the efficacy and side effects of equianalgesic doses of nalbuphine and fentanyl as intravenous (IV) analgesics for medically compromised patients undergoing oral surgery with local anesthesia. A total of 24 inpatients scheduled for oral surgery and with an ASA physical status of 3 or 4 were randomly assigned to two treatment groups and received IV analgesia with an injection of either 0.2 mg/kg nalbuphine or 2 micrograms/kg fentanyl. Three minutes later, local anesthesia was administered. ⋯ Analgesia and sedation appeared sufficient and comparable according to the surgeon, anesthesiologists, and patients in the two groups, and there were no significant differences in blood pressure or heart rate. Respiratory rate and SpO2 were lower in patients treated with fentanyl (P < 0.05), and eight patients of this group experienced episodes of oxygen desaturation (SpO2 < 90%) compared with only two patients who received nalbuphine (P < 0.05). Nalbuphine produced less respiratory depression and should be considered a suitable alternative to fentanyl for use in medically compromised patients undergoing oral surgery.
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Complete atrioventricular canal defect is a serious and complex cardiac anomaly that is frequently associated with other congenital cardiac defects. Its natural course is ultimately fatal; 80% of children born with this defect will die within 2 years. ⋯ The risk of corrective surgery for this defect in infancy has steadily decreased because of improvements in surgical techniques, anesthesia, and postoperative management. This report describes our current surgical technique for primary corrective repair of complete atrioventricular canal defect, with a review of recent results of this procedure in 34 patients.
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Anesthesia progress · Jan 1992
Comparative StudySupplemental oxygen after outpatient oral and maxillofacial surgery.
Arterial oxygen saturation (SpO2) was monitored postoperatively with pulse oximetry in 72 dental patients. Intravenous general anesthesia was employed in 57 patients. All of these patients received supplemental oxygen intraoperatively, and of these, 29 received supplemental oxygen postoperatively. ⋯ Patients with a smoking history had more episodes of desaturation than did nonsmokers in the group that received general anesthesia and breathed room air postoperatively. The total amount of methohexital administered had no significant effect on the number of patients with desaturation episodes. These observations emphasize the need for postoperative oxygen for patients who undergo general anesthesia for outpatient oral and maxillofacial surgery.