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Emergency Operation (emergency + operation)

Distribution by Scientific Domains

Medical Sciences	94%

Selected Abstracts

CLINICAL USEFULNESS OF COLONOSCOPIC INSERTION OF A DECOMPRESSION TUBE FOR OBSTRUCTIVE COLORECTAL CANCER

DIGESTIVE ENDOSCOPY, Issue 2004
Kiyonori Kobayashi
ABSTRACT We evaluated the clinical usefulness of colonoscopic insertion of a decompression tube (decompression method) for the treatment of ileus associated with left-sided colorectal cancer. Decompression method was done in 48 patients with colorectal cancer (38 primary cancer, 10 metastatic cancer). A decompression tube was successfully inserted in all but 10 patients who had primary cancer with severe strictures. The overall insertion rate was 79%. Decompression method improved obstructive symptoms and decreased intestinal gas as evaluated on plain X-ray films of the abdomen. Emergency operation was unnecessary in 96% of the patients with primary cancers, in whom the decompression tube was successfully inserted. We conclude that decompression method can improve abdominal symptoms caused by obstructive colorectal cancer and reduce the need for emergency operation. [source]

Lungenembolie durch Aspergillose (sog. Pilzembolie) Pulmonary embolism by aspergillosis (so called fungal embolism)

MYCOSES, Issue 2008
G. Schwesinger
cardiac tumour; aspergillosis; pulmonary embolism Zusammenfassung Ein 71jähriger Mann entwickelte bei einem Zustand nach Schrittmacherimplantation bei Arrhythmie und Mehrfachrevisionen wegen Schrittmachertascheninfektionen einen Tumor im rechten Ventrikel. Notfallmäßiger Trikuspidalklappenersatz durch ein Carpentier Edwards Xenograft. Die Schrittmachersonden und das Endokard waren durch Aspergillus in Gestalt eines Aspergilloms infiziert. Durch dieses Material kam es zu einer Lungenembolie, was relativ selten ist. Summary A 71-year-old man developed a cardiac tumour in the right ventricle and a pulmonary embolism caused by aspergillosis after implantation of a pacemaker because of arrhythmia. Repeated revisions during pocket infections. Emergency operation and tricuspid valve replacement with a Carpentier Edwards xenograft. The pacing electrodes and the endocardium were infected by Aspergillus in form of an aspergilloma. This case is an example of the rare condition of a pulmonary embolism with pure fungal material. [source]

CLINICAL USEFULNESS OF COLONOSCOPIC INSERTION OF A DECOMPRESSION TUBE FOR OBSTRUCTIVE COLORECTAL CANCER

Emergency preparedness consultants at the local government level: the Israeli experience

DISASTERS, Issue 4 2010
Moshe Maor
This study evaluates the effectiveness of the Municipal Emergency Consultation project in eight Israeli local authorities. The initiative centres on the appointment of independent emergency preparedness consultants entrusted with tailoring an emergency preparedness package to suit the specific needs of each locality. Regarding emergency preparedness improvements, in all of the municipalities examined, a concept of municipal emergency operation was consolidated and the derived emergency plan tested. Emergency work processes were structured and service-level agreements reached between municipality departments. Where necessary, a-linear patterns of municipal functioning in an emergency were established. Concerning a ,spillover' of emergency preparedness improvements into routine operations, and a ,spillover' of routine management improvements into local emergency preparedness, two municipalities near Gaza, which typically function in an emergency routine, saw a significant ,spillover' of emergency preparedness into routine functioning. In other localities, local managers chose to improve a number of municipal structures and procedures in times of routine functioning, which are also related to the functioning of the municipality during an emergency. [source]

Malignant pheochromocytoma with progressive paraparesis in von Hippel,Lindau disease

EUROPEAN JOURNAL OF NEUROLOGY, Issue 4 2000
R. Mössner
Pheochromocytomas are a feature of the von Hippel,Lindau disease spectrum, a multisystem disorder of autosomal dominant inheritance. Pheochromocytomas are, however, observed during life with a lower frequency than other features of this disease, such as retinal angiomas, haemangioblastomas of the CNS, and renal carcinomas. We present the highly unusual case of a patient who required an emergency operation for an intradural extramedullary thoracic tumour which was clinically suggestive initially of neurinoma. We present evidence from NMR, histological and isotope scan investigations of this being a pheochromocytoma metastasis and of an additional right-sided paraganglioma at the same height. A detailed history revealed that this patient had suffered from four other pheochromocytomas and two other paragangliomas, in addition to retinal angiomatosis of von Hippel,Lindau disease. This case is extraordinary due to (i) the unusual site of the metastasis, (ii) the neurological requirement for an emergency operation of pheochromocytoma, (iii) metastasis of pheochromocytoma in von Hippel,Lindau disease (only eight previous cases), and (iv) the number of recurrent pheochromocytomas. It clearly demonstrates the necessity for frequent and life-long follow-up in von Hippel,Lindau disease. [source]

Massive hematuria after cystoscopy in a patient with an internal iliac artery aneurysm

INTERNATIONAL JOURNAL OF UROLOGY, Issue 7 2002
Ichiya Honma
Abstract An unusual case is reported here of a patient with internal iliac artery aneurysm who developed massive hematuria after cystoscopic examination. A 75-year-old man presented with asymptomatic gross hematuria. Cystoscopic examination revealed that the bladder neck was congested and that the right-side wall was being pressed on by an extrinsic mass. Computed tomography showed a right internal iliac artery aneurysm and tortuous perivesical vessels. Three days after the cystoscopic examination the patient suffered massive hematuria. Hemorrhage due to an arteriovesical or arterio-ureteral fistula secondary to rupture of the internal iliac artery aneurysm was suspected, and an emergency operation was performed. At operation the aneurysm had not ruptured but overswelling perivesical vessels were found to have developed, and these fed a high blood flow to the bladder neck. In the present case cystoscopic examination injured the mucosa and led to massive hemorrhage from the bladder neck. [source]

Autohemicastration in a man without schizophrenia

INTERNATIONAL JOURNAL OF UROLOGY, Issue 5 2001
Akiko Murota-Kawano
Abstract A 52-year-old unmarried bag craftsman was admitted to East Tokyo Metropolitan Hospital because of a large scrotal hematoma. He had accidentally hit his right testis against the edge of a desk early the previous morning. He had resected his right testis with scissors to release from severe pain 30 min after the accident. He had sutured the scrotal incision with two stitches of string by himself. At the emergency operation 36 h after the self-mutilation, we removed a hematoma weighing 283 g and ligated the cut end of the right spermatic cord after adequate debridement. He was diagnosed by a psychiatrist as having slightly low intelligence without psychotic disorder or drug abuse. [source]

Left Ventricular Rhabdomyoma With Severe Left Ventricular Outflow Tract Obstruction

JOURNAL OF CARDIAC SURGERY, Issue 5 2007
Ali Sarigul M.D.
Rhabdomyomas are the most common tumors in this group of patients. We herein report a 40-day-old male patient with left ventricular rhabdomyoma. The tumor caused syncope attack and supraventricular tachycardia. An emergency operation was planned and the life-threatening lesion was excised via left ventriculotomy. The patient was extubated on postoperative sixth hour and discharged from hospital on the sixth day of the postoperative period without any problem. This successful operation encourages us not to hesitate to perform an operation in newborns with cardiac neoplasms causing hemodynamic instability. [source]

Delayed Presentation of Injury to the Sinus of Valsalva with Aortic Regurgitation Resulting from Penetrating Cardiac Wounds

JOURNAL OF CARDIAC SURGERY, Issue 3 2003
Narutoshi Hibino M.D.
An emergency operation was performed successfully to repair the penetrating cardiac injury of the right ventricular outflow tract without using cardiopulmonary bypass. Two years after the operation, he was complained of dyspnea and a continuous murmur was detected. Echocardiography and cardiac catheterization revealed aorto-right ventricular fistula in the sinus of valsalva with aortic regurgitation. In operation, the healed laceration of the right coronary cusp and the fistula between aorta and right ventricle were identified. The fistula was closed using a Dacron patch and the aortic valve was replaced with a mechanical valve. Long-term follow-up of penetrating thoracic injuries is important for detecting underlying intracardiac lesions. (J Card Surg 2003;18:236-239) [source]

Abdominal hernias in pregnancy

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 2 2009
Goran Augustin
Abstract A hernia is an area of weakness or complete disruption of the fibromuscular tissues of the body wall. In addition to the body wall, hernias can occur in the diaphragm, pelvic wall, perineum, pelvic floor, and internal abdominal viscera (hernias through omental or mesenteric defects, ligaments and folds). Surgical repair of different types of hernia is the most common general surgical procedure with more than 20 million hernioplasties performed each year. Abdominal wall hernias are not common during pregnancy. Hernias can be symptomless or have minimal symptoms, including slight discomfort or pain. Such hernias are not life-threatening and should be controlled on regular basis. After spontaneous delivery and uterine involution, they should be repaired on an elective basis. It is of utmost importance for a clinician to diagnose emergent situations, which include incarceration, strangulation and perforation caused by hernia because consultation with a surgeon and emergency operation are mandatory. There is still no consensus for irreducible hernia during pregnancy, but complications during pregnancy outweigh elective operation. Therefore, hernioplasty is recommended during pregnancy, especially in early gestation. [source]

A case of pulmonary type of ovarian small cell carcinoma

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 2 2007
Nao Suzuki
Abstract Small cell carcinoma is a rare form of ovarian cancer with a poor prognosis. It is divided into two types, the hypercalcemic and the pulmonary type, of which the latter is extremely rare. A 49-year-old woman presented with an acute abdomen and was suspected to have torsion of a left ovarian tumor, which was followed up with an emergency operation. Postoperative pathological examination gave a diagnosis of the pulmonary type of ovarian small cell carcinoma. Six courses of paclitaxel and carboplatin therapy were given as adjuvant chemotherapy. The patient has survived for 36 months without recurrence. Here we present an extremely rare patient with the pulmonary type of ovarian small cell carcinoma. [source]

Life threatening unilateral pulmonary overinflation might be more successfully treated by contralateral selective intubation than by emergency pneumonectomy

PEDIATRIC ANESTHESIA, Issue 5 2003
Josef Holzki MD
Summary During a period of 3 years, three infants were admitted to our hospital for unilateral emergency pneumonectomy due to life threatening overinflation of one lung, preventing adequate ventilation of the unaffected contralateral side. All three patients were able to be stabilized by unilateral selective bronchial intubation of the unaffected lung after bronchoscopy, ruling out a flap valve mechanism. No emergency pneumonectomies were required. In one patient, lung function of the overinflated side (three lobes) recovered fully and, in the two remaining patients, one lobe of the overinflated side recovered. The overinflated lobes were removed later by elective surgery, thus not exposing the children to a potentially dangerous emergency operation. These results are in contrast with reports in the literature. Emergency pneumonectomy in neonates and infants due to overinflation of one lung may be avoided by selective unilateral intubation of the main stem bronchus of the compressed lung. [source]

Evolution of pancreas transplant surgery

ANZ JOURNAL OF SURGERY, Issue 6 2010
Vincent W. T. Lam
Abstract Background:, Type 1 diabetes mellitus is a chronic condition often leading to disabling complications including retinopathy, neuropathy and cardiovascular disease which can be modified by intensive treatment with insulin. Such treatment, however, is associated with a restrictive lifestyle and risk of hypoglycaemic morbidity and mortality. Methods:, This review examines the role of pancreas transplantation in patients with Type 1 diabetes mellitus. Results:, Pancreas transplantation is currently the only proven option to achieve long-term insulin independence, resulting in an improvement or stabilization of those diabetic related complications. The hazards of pancreas transplantation as a major operation are well known. Balancing the risks of a surgical procedure, with the benefits of restoring normoglycaemia remains an important task for the pancreas transplant surgeon. Pancreas transplantation is not an emergency operation to treat poorly managed and non-compliant patients with debilitating complications. It is a highly specialized procedure which has evolved both in terms of the surgical technique, patient selection and assessment. Conclusion:, Pancreas transplantation has emerged as the single most effective way to achieve normal glucose homeostasis in patients with Type 1 diabetes mellitus. [source]

Comparative study of left colonic Peritonitis Severity Score and Mannheim Peritonitis Index

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 5 2006
S. Biondo
Background: Prognostic evaluation of patients with left colonic perforation is useful in predicting mortality. The aims of this prospective study were to determine the prognostic value of the left colonic Peritonitis Severity Score (PSS) and to compare it with the Mannheim Peritonitis Index (MPI). Methods: One-hundred and fifty-six patients underwent emergency operation for distal colonic peritonitis. The PSS and MPI were calculated for each patient. The Spearman rank correlation coefficient was used to measure the association between the two scores. The predictive power of the two scoring systems and their differences were studied using the area under the receiver-operator characteristic (ROC) curve. Results: Forty-one patients died (26·3 per cent). The relationship between scores and mortality was statistically significant for each scoring system (P < 0·001). The Spearman rank correlation coefficient for the correlation between the MPI and PSS was 0·55 (P < 0·001). There was no difference between areas under the ROC curves for the two systems. Conclusion: The PSS and MPI are both well validated scoring systems for left colonic peritonitis. Their routine use might allow stratification of patients according to mortality risk. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Development of a dedicated risk-adjustment scoring system for colorectal surgery (colorectal POSSUM),,

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 9 2004
P. P. Tekkis
Background: The aim of the study was to develop a dedicated colorectal Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (CR-POSSUM) equation for predicting operative mortality, and to compare its performance with the Portsmouth (P)-POSSUM model. Methods: Data were collected prospectively from 6883 patients undergoing colorectal surgery in 15 UK hospitals between 1993 and 2001. After excluding missing data and 93 patients who did not satisfy the inclusion criteria, 4632 patients (68·2 per cent) underwent elective surgery and 2107 had an emergency operation (31·0 per cent); 2437 operations (35·9 per cent) for malignant and 4267 (62·8 per cent) for non-malignant diseases were scored. Stepwise logistic regression analysis was used to develop an age-adjusted POSSUM model and a dedicated CR-POSSUM model. A 60 : 40 per cent split-sample validation technique was adopted for model development and testing. Observed and expected mortality rates were compared. Results: The operative mortality rate for the series was 5·7 per cent (387 of 6790 patients) (elective operations 2·8 per cent; emergency surgery 12·0 per cent). The CR-POSSUM, age-adjusted POSSUM and P-POSSUM models had similar areas under the receiver,operator characteristic curves. Model calibration was similar for CR-POSSUM and age-adjusted POSSUM models, and superior to that for the P-POSSUM model. The CR-POSSUM model offered the best overall accuracy, with an observed : expected ratio of 1·000, 0·998 and 0·911 respectively (test population). Conclusion: The CR-POSSUM model provided an accurate predictor of operative mortality. External validation is required in hospitals different from those in which the model was developed. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Role of resection and primary anastomosis of the left colon in the presence of peritonitis,

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 11 2000
Dr S. Biondo
Background Classically a primary colonic anastomosis is not performed in the presence of left colonic peritonitis. Recently there has been a trend towards resection and anastomosis in selected patients, but no prospective study concerning the safety of this approach has been published. The objective of this study was to define the role of intraoperative colonic lavage with resection and primary anastomosis (RPA) in left colonic peritonitis, and to evaluate the differences in outcome in patients with diffuse or localized peritonitis. Methods Between January 1994 and December 1998, 127 patients underwent emergency operation for a distal large bowel perforation. RPA was the operation of choice and was performed in 61 patients, 38 with localized and 23 with diffuse peritonitis. Septic shock, faecal peritonitis, immunocompromised status and American society of Anesthesiologists grade IV were contraindications to the one-stage procedure. Alternative operations used in high-risk patients were Hartmann's procedure in 55 patients, subtotal colectomy in eight and colostomy in three. Results There were two deaths (3 per cent) among 61 patients treated by RPA and one (2 per cent) case of clinical anastomotic dehiscence. Overall morbidity was 39 per cent and the overall mean(s.d.) hospital stay was 18(15) days. No statistical differences were observed between patients with localized and diffuse peritonitis treated by RPA. Conclusion RPA may be the operation of choice in selected patients with left colonic diffuse peritonitis. © 2000 British Journal of Surgery Society Ltd [source]

Tumour location is a prognostic factor for survival in colonic cancer patients

COLORECTAL DISEASE, Issue 1 2008
O. H. Sjo
Abstract Objective, To evaluate survival and prognostic factors in a consecutive series of colon cancer patients from a defined city population in Norway. Method, All patients with adenocarcinoma of the colon diagnosed between 1993 and 2000 were registered prospectively. Five-year actuarial survival and 5-year relative survival rates were calculated. Cox regression analyses were used to study the effect of prognostic factors on survival. Results, In the study period 627 patients were admitted. Overall 5-year relative survival was 50% in females and 52% in males. Five-year relative survival in 410 (65%) patients operated with curative intent, was 74% for females and 79% for males. Tumour location in the transverse colon, splenic flexure and descending colon (OR = 1.8), emergency operation (OR = 1.7), TNM stage (OR = 1.8,2.9), blood transfusion of more than two units (OR = 1.8) and age (OR = 4.0,7.1) were independent negative prognostic factors. Conclusion, Colon cancer located in the transverse and descending colon is associated with poor prognosis. Comparison of results from different centres is difficult due to selection and classification differences, and different methods used for calculation of survival. [source]

Small bowel malignancies: A review of 29 patients at a single centre

COLORECTAL DISEASE, Issue 3 2004
M. H. Kam
Abstract Objective We analysed the incidence, clinical presentation and outcome of small bowel malignancies treated in the department. Patients and methods From July 1993 to December 2001, 29 patients with small bowel malignancies were operated upon. The median age was 60 years (30,87 years), and there were 11 males and 18 females. The more frequently used diagnostic investigations included barium contrast studies, and CT scanning. Results The most frequent complaint was abdominal pain, though other symptoms like abdominal mass, weight loss and change in bowel habit may also be present. Intestinal obstruction necessitated emergency operation in some cases. One case was treated as Crohn's stricture and two others, as irritable bowel syndrome for nearly 6 months before referral was made for surgery. Fifteen cases were secondaries to the small bowel, and forteen were primary small bowel malignancies. The secondaries were metastases from colorectal cancers (8), gynaecological cancers (5), breast (1) and transitional cell carcinomas (1). Of the 14 primary small bowel malignancies, there were 8 lymphomas, 4 adenocarcinaomas and 2 neuroendocrine tumours. Eleven of these patients were alive at mean follow-up of 25 months (1,97 months) and 2 were lost to follow-up. Only one of the secondary small bowel malignancies was alive at the time of review. Conclusion Small bowel malignancy is a rate entity with pre-operative diagnosis remaining difficult. Early surgical intervention with a high index of suspicion is required to improve survivial. [source]