			Home About us Contact

One Failure (one + failure)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Ultrasound-guided training in the performance of brachial plexus block by the posterior approach: an observational study

ANAESTHESIA, Issue 10 2007
G. J. Van Geffen
Summary The application of ultrasonography in guiding and controlling the path of the stimulating needle to the brachial plexus via the posterior approach (Pippa technique) was studied. In 21 ASA physical status 1 and 2 patients, scheduled for surgery of the shoulder or upper arm, needle insertion was monitored by ultrasonography and the interaction between needle, surrounding structures and brachial plexus was followed. During injection, the spread of local anaesthetic was visualised and a prediction of block success was made. One failure was predicted. Complete block was achieved in 20 (95%) patients. One potential complication, puncture of the carotid artery, was prevented using ultrasound. Ultrasound is a useful tool in the training and performance of a neurostimulation-guided brachial plexus block by the posterior approach. Ultrasonographic guidance may prevent serious complications associated with this approach to the brachial plexus. [source]

Evaluation of an insulated Tuohy needle system for the placement of interscalene brachial plexus catheters

ANAESTHESIA, Issue 6 2003
N. M. Denny
Summary Major shoulder surgery can be extremely painful. Interscalene brachial plexus catheters provide excellent postoperative analgesia but are technically difficult to place. A new insulated Tuohy needle system for plexus catheterisation is now available. This prospective study examined its ease of use and the postoperative analgesia produced by patient-controlled interscalene analgesia with ropivacaine 0.2%. Nineteen patients undergoing major shoulder surgery were studied. Interscalene brachial plexus blocks were performed using a modified Winnie technique with the insulated Tuohy needle and a nerve stimulator. After injection of ropivacaine 0.75% 30,40 ml into the plexus, a catheter was inserted. Block and catheter insertion times were recorded. All 19 patients had successful blocks and had catheters successfully threaded. Catheter infusions provided successful analgesia (visual analogue pain score <,5/10) in 18 patients, with one failure, giving a 95% success rate. Mean [range] catheter insertion time was 3.6 [1,10] min. Decreased block and catheter insertion times were associated with experience with the equipment when comparing the mean (SD) times for the first seven catheters and the last seven catheters inserted (12.1 (4.2) min vs. 7.9 (2.4) min), p < 0.05). It is concluded that the insulated Tuohy needle system for interscalene catheterisation proved easy to use in the hands of someone who had not used it before, and can be recommended. [source]

Outcomes of the overlay graft technique in tympanoplasty

ANZ JOURNAL OF SURGERY, Issue 9 2010
Jennifer E. Ryan
Abstract Background:, This audit was undertaken to review the outcomes achieved with the overlay graft technique of tympanic membrane repair in tympanoplasty surgery. Methods:, The charts of all patients who underwent tympanoplasty, in whom an overlay graft technique of temporalis fascia tympanic membrane repair was used, between 1994 and 2007 were reviewed. Information with respect to patient demographics, presence of cholesteatoma or active infection and perforation size was documented. Details of the surgical procedure and clinical outcomes and pre- and post-operative hearing thresholds were recorded in a computer database. Results:, A total of 147 overlay graft procedures were performed in 130 patients. Graft failure with reperforation occurred following five procedures, for an overall success rate of 96.6%. Eighty Type 1 tympanoplasty procedures were performed in which one failure occurred for a 98.75% success rate. Overlay grafting was combined with intact canal wall mastoidectomy (ICW) in 38 cases and with modified radical mastoidectomy (MRM) in 17 cases for a success rate of 93.8 and 95%, respectively. Delayed graft healing as a result of infection, problems such as epithelial pearl, blunting and myringitis occurred in 39 cases (26.5%). Thirty-one cases underwent procedures for ossicular chain reconstruction, 21 of which were 2nd stage procedures. Hearing outcomes were significantly better with Type 1 tympanoplasty compared with ICW or MRM procedures. Conclusion:, This review demonstrates the overlay graft technique of tympanoplasty to be highly successful for tympanic membrane repair, particularly for the more difficult cases such as revision surgery, subtotal perforations and mesotympanic cholesteatoma. [source]

Open mini-access ureterolithotomy: the treatment of choice for the refractory ureteric stone?

BJU INTERNATIONAL, Issue 6 2003
D.M. Sharma
OBJECTIVE To report the experience in one centre of the efficacy and safety of open mini-access ureterolithotomy (MAU) and to discuss relevant current indications. PATIENTS AND METHODS MAU was undertaken in 112 patients (mean age 38 years, range 26,57) between 1991 and 2001; the details and outcomes are reviewed. The mean (range) stone size was 12 (8,22) mm, with 30 stones in the upper, 69 in the mid- and 13 in the lower ureter. In 15 cases the stones were impacted and there were signs of infection in the proximal ureter. RESULTS MAU was successful in 111 patients; the one failure was caused by proximal stone migration early in the series. The mean (range) operative duration was 28 (10,44) min and the hospital stay 42 (24,72) h; 33 patients were in hospital for 24 h, 72 for 48 h and seven for 72 h. The blood loss was minimal, at 50 (30,150) mL. The drain was removed after 5 (5,7) days. Patients reported using opioid or nonsteroidal anti-inflammatory analgesia for a mean of 4 (1,7) days after surgery. The mean time to resumption of work was 16 (8,35) days. CONCLUSIONS MAU is a safe and reliable minimally invasive procedure; its role is mainly confined to salvage for failed first-line stone treatments but in selected cases, where a poor outcome can be predicted from other methods, it is an excellent first-line treatment. [source]