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Khirurgiia (Sofiia). 2001;57(3-4):38-40.
[Endoscopic treatment of complete obliteration of posterior urethra]
[Article in Bulgarian]
Neikov K, Panchev P, Kirilov S.
The authors shared their experience in regard of treatment of complete urethral obliteration. In a 14-year they diagnosed and treated 37 patients (aged 22-74 years) with obstruction of the lower urinary tract as a result of complete urethral obliteration. The etiology include 14 patients after perineal urethral trauma, in 10 patients the main cause was urethral inflammation of posterior urethra, in 8--as a consequence of transurethral surgery and in 5--after suprapubic prostatectomy. Main diagnostic methods they used were retrograde urethrography and urethroscopy with 0 degree fiberoptic. In all patients an endoscopic incision of fibrotic tissue was carried out thus the entering the bladder cavity was successful. In some patients operative technique with a Benique through cystostomy cannel and bladder neck just opposite to the urethrotome knife was used. In three patients (8.2%) the procedure failed due to the massive urethral hemorrhage. They report recurrent urethral strictures in 24 patients (64.8%), treated with visual urethrotomy. The continence was compromised in 6 patients (16.2%).
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12024672&dopt=Abstract hemorrhage
J Card Surg. 2002 Jan-Feb;17(1):4-13.
How to do safe sternal reentry and the risk factors of redo cardiac surgery: a 21-year review with zero major cardiac injury.
O'Brien MF, Harrocks S, Clarke A, Garlick B, Barnett AG.
Department of Cardiac Surgery, The Prince Charles Hospital, Chermside, Brisbane, Australia. Mark_OBrieealth.qld.gov.au
OBJECTIVES: Resternotomy is a common part of cardiac surgical practice. Associated with resternotomy are the risks of cardiac injury and catastrophic hemorrhage and the subsequent elevated morbidity and mortality in the operating room or during the postoperative period. The technique of direct vision resternotomy is safe and has fewer, if any, serious cardiac injuries. The technique, the reduced need for groin cannulation and the overall low operative mortality and morbidity are the focus of this restrospective analysis. METHODS: The records of 495 patients undergoing 546 resternotomies over a 21-year period to January 2000 were reviewed. All consecutive reoperations by the one surgeon comprised patients over the age of 20 at first resternotomy: M:F 343:203, mean age 57 years (range 20 to 85, median age 60). The mean NYHA grade was 2.3 [with 67 patients (I), 273 (II), 159 (III), 43 (IV), and 4 (V classification)] with elective reoperation in 94.6%. Cardiac injury was graded into five groups and the incidence and reasons for groin cannulation estimated. The morbidity and mortality as a result of the reoperation and resternotomy were assessed. RESULTS: The hospital/30 day mortality was 2.9% (95% CI: 1.6%-4.4%) (16 deaths) over the 21 years. First (481), second (53), and third (12) resternotomies produced 307 uncomplicated technical reopenings, 203 slower but uncomplicated procedures, 9 minor superficial cardiac lacerations, and no moderate or severe cardiac injuries. Direct vision resternotomy is crystalized into the principle that only adhesions that are visualized from below are divided and only sternal bone that is freed of adhesions is sewn. Groin exposure was never performed prophylactically for resternotomy. Fourteen patients (2.6%) had such cannulation for aortic dissection/aneurysm (9 patients), excessive sternal adherence of cardiac structures (3 patients), presurgery cardiac arrest (1 patient), and high aortic cannulation desired and not possible (1 patient). The average postop blood loss was 594 mL (95% CI:558-631) in the first 12 hours. The need to return to the operating room for control of excessive bleeding was 2% (11 patients). Blood transfusion was given in 65% of the resternotomy procedures over the 21 years (mean 854 mL: 95% CI 765-945 mL) and 41% over the last 5 years. CONCLUSIONS: The technique of direct vision resternotomy has been associated with zero moderate or major cardiac injury/catastrophic hemorrhage at reoperation. Few patients have required groin cannulation. In the postoperative period, there was acceptable blood loss, transfusion rates, reduced morbidity, and moderate low mortality for this potentially high risk group.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12027125&dopt=Abstract hemorrhage
Surg Today. 2002;32(4):305-9.
Postoperative complications after local resection of the stomach.
Ueda E, Kitayama J, Seto Y, Motoi T, Nagawa H.
Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan.
PURPOSE: Local resection of the stomach for early gastric cancer is being performed more frequently, despite which no report focusing on the postoperative complications has been published. The purpose of this study was to investigate the incidence and factors affecting postoperative complications after local resection of the stomach. METHODS: Local resection of the stomach was performed in 37 patients with gastric cancers, submucosal tumors (SMT), or bleeding gastric ulcers, 24 of whom underwent gastroscopy at least once after their operation. We retrospectively examined the complications and background relating to the operations performed in those 24 patients. RESULTS: Postoperative hemorrhage occurred in 2 patients, an open ulcer developed on the suture line in 2 and leakage developed in 1. The hemorrhage and open ulcer were observed only when wide resection with regional lymph node dissection was performed for early gastric cancers in the middle third of the stomach. CONCLUSION: These findings show that the possibility of postoperative hemorrhage and open ulcers on the suture line should be borne in mind, especially when wide local resection with lymph node dissection is performed for cancers in the middle part of the stomach.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12027194&dopt=Abstract hemorrhage
Surg Today. 2002;32(4):378-82.
Massive hemorrhage in a patient with intestinal Behcet's disease: report of a case.
Fujita H, Kiriyama M, Kawamura T, Ii T, Takegawa S, Dohba S, Kojima Y, Adachi H, Morimoto H, Kobayashi A, Watanabe K.
Department of Surgery, National Kanazawa Hospital, Ishikawa, Japan.
Major gastrointestinal bleeding is a rare manifestation of intestinal Behcet's disease. We report herein the case of a 64-year-old man with intestinal Beh,et's disease complicated by myelodysplastic syndrome who suffered massive hemorrhage. Colonoscopy demonstrated ulceration of the entire colon from the cecum to the rectum, characterized by punched-out ulcers. Angiography demonstrated apparent extravasation of contrast material in the terminal ileum, and embolization was not successful. Continued and massive bleeding necessitated surgical resection of the involved segment of ileum; however, massive bleeding recurred. Re-endoscopy showed oozing hemorrhage from the multiple colon ulcerations. Intra-arterial prednisolone injection therapy was given, following which the melena gradually subsided and completely stopped within a few days.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12027208&dopt=Abstract hemorrhage
Epilepsia. 2002 May;43(5):457-68.
Embryonic arrhythmia by inhibition of HERG channels: a common hypoxia-related teratogenic mechanism for antiepileptic drugs?
Azarbayjani F, Danielsson BR.
Department of Pharmaceutical Biosciences, Division of Toxicology, Uppsala University, Uppsala, Sweden.
PURPOSE: There is evidence that drug-induced embryonic arrhythmia initiates phenytoin (PHT) teratogenicity. The arrhythmia, which links to the potential of PHT to inhibit a specific potassium channel (Ikr), may result in episodes of embryonic ischemia and generation of reactive oxygen species (ROS) at reperfusion. This study sought to determine whether the proposed mechanism might be relevant for the teratogenic antiepileptic drug trimethadione (TMO). METHODS: Effects on embryonic heart rhythm during various stages of organogenesis were examined in CD-1 mice after maternal administration (125-1,000 mg/kg) of dimethadione (DMO), the pharmacologically active metabolite of TMO. Palatal development was examined after administration of a teratogenic dose of DMO and after simultaneous treatment with DMO and a ROS-capturing agent (alpha-phenyl-N-tert-butyl-nitrone; PBN). The Ikr blocking potentials of TMO and DMO were investigated in HERG-transfected cells by using voltage patch-clamping tests. RESULTS: DMO caused stage-specific (gestation days 9-13 only) and dose-dependent embryonic bradycardia and arrhythmia at clinically relevant maternal plasma concentrations (3-11 mM). Hemorrhage in the nasopharyngeal part of the embryonic palate (within 24 h) preceded cleft palate in fetuses at term. Simultaneous treatment with PBN significantly reduced the incidence of DMO-induced cleft palate, from 40 to 13%. Voltage patch-clamping studies showed that particularly DMO (70% inhibition), but also TMO, had Ikr blocking potential at clinically relevant concentrations. CONCLUSIONS: TMO teratogenicity, in the same way as previously shown for PHT, was associated with Ikr-mediated episodes of embryonic cardiac arrhythmia and hypoxia/reoxygenation damage.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12027905&dopt=Abstract hemorrhage
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