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Intraoperative awareness

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https://www.readbyqxmd.com/read/27926358/recent-advances-in-pancreatic-cancer-surgery-of-relevance-to-the-practicing-pathologist
#1
REVIEW
Lennart B van Rijssen, Steffi J E Rombouts, Marieke S Walma, Jantien A Vogel, Johanna A Tol, Isaac Q Molenaar, Casper H J van Eijck, Joanne Verheij, Marc J van de Vijver, Olivier R C Busch, Marc G H Besselink
Recent advances in pancreatic surgery have the potential to improve outcomes for patients with pancreatic cancer. We address 3 new, trending topics in pancreatic surgery that are of relevance to the pathologist. First, increasing awareness of the prognostic impact of intraoperatively detected extraregional and regional lymph node metastases and the international consensus definition on lymph node sampling and reporting. Second, neoadjuvant chemotherapy, which is capable of changing 10% to 20% of initially unresectable, to resectable disease...
December 2016: Surgical Pathology Clinics
https://www.readbyqxmd.com/read/27920491/interactive-navigation-guided-ophthalmic-plastic-surgery-navigation-enabling-of-telescopes-and-their-use-in-endoscopic-lacrimal-surgeries
#2
Mohammad Javed Ali, Swati Singh, Milind N Naik, Swathi Kaliki, Tarjani Vivek Dave
PURPOSE: The aims of this study were to report the preliminary experience of using telescopes, which were enabled for navigation guidance, and their utility in complex endoscopic lacrimal surgeries. METHODS: Navigation enabling of the telescope was achieved by using the AxiEM™ malleable neuronavigation shunt stylet. Image-guided dacryolocalization was performed in five patients using the intraoperative image-guided StealthStation™ system in the electromagnetic mode...
2016: Clinical Ophthalmology
https://www.readbyqxmd.com/read/27917264/systemic-to-pulmonary-artery-pressure-ratio-as-a-predictor-of-patient-outcome-following-liver-transplantation
#3
Annette Rebel, Dung Nguyen, Brooke Bauer, Paul A Sloan, Amy DiLorenzo, Zaki-Udin Hassan
AIM: To assess the value of the mean systemic-to-pulmonary artery pressure (MAP/mPAP) ratio for predicting outcomes following orthotopic liver transplant (OLT). METHODS: A retrospective data analysis was performed and data (mean arterial blood pressure, mean pulmonary artery pressure and Cardiac Index) were collected at several points during OLT. Outcomes evaluated were duration of postoperative endotracheal intubation [ET; minutes after intensive care unit (ICU) arrival], length of ICU stay, total hospitalization and frequency of immediate postoperative complications...
November 18, 2016: World Journal of Hepatology
https://www.readbyqxmd.com/read/27900811/exuberant-squamous-metaplasia-with-calcification-following-intraoperative-radiotherapy-for-breast-carcinoma-report-of-an-unusual-case-and-retrospective-review-of-cases-from-a-single-institution
#4
Paula S Ginter, John Ng, Rebecca Zhuo, Alexander J Swistel, Timothy M D'Alfonso
Intraoperative radiotherapy (IORT) is a novel and increasingly utilized radiation technique in the treatment of breast carcinoma. There are few reports on the histologic changes seen in breast tissue from patients who have undergone IORT. We sought to evaluate the histologic changes observed in specimens received following IORT, as well as report an unusual case which prompted our study. A retrospective review of patients who received IORT and subsequently had breast tissue histologically evaluated at our institution was performed...
November 30, 2016: Breast Journal
https://www.readbyqxmd.com/read/27871582/glucagon-induced-hypertensive-emergency-a-case-report
#5
Aron Legler, Richard K Kim, Nikhil Chawla
Glucagon is well acknowledged as a sphincter of Oddi relaxant for both diagnostic and therapeutic uses in choledocholithiasis, and an empiric treatment for β-blocker overdose. Although it has been implicated in inducing cardiovascular crises in patients with asymptomatic pheochromocytoma, adverse effects in other patient populations have not been characterized. This case report describes a patient with hypertension controlled on β blockers who, after glucagon administration during an intraoperative cholangiography, experienced hypertensive emergency despite adequate pain control...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27871516/pediatric-patients-on-ketogenic-diet-undergoing-general-anesthesia-a-medical-record-review
#6
Elif Soysal, Heike Gries, Carter Wray
STUDY OBJECTIVE: To identify guidelines for anesthesia management and determine whether general anesthesia is safe for pediatric patients on ketogenic diet (KD). DESIGN: Retrospective medical record review. SETTING: Postoperative recovery area. PATIENTS: All pediatric patients who underwent general anesthesia while on KD between 2009 and 2014 were reviewed. We identified 24 patients who underwent a total of 33 procedures...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27871494/current-surgical-management-of-carotid-body-tumors
#7
Victor J Davila, James M Chang, William M Stone, Richard J Fowl, Thomas C Bower, Michael L Hinni, Samuel R Money
BACKGROUND: Carotid body tumors (CBTs) are rare. Management guidelines may include genetic testing for succinate dehydrogenase (SDH) mutations. We performed an institutional review of the surgical management of CBT. METHODS: A retrospective analysis (1994-2015) of CBT excisions at our institution was performed. Data obtained included demographics, genetic testing (if performed), intraoperative details, postoperative morbidity, and long-term outcomes. Data from the first CBT excision were included in patients with bilateral tumors...
December 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/27858533/revisiting-the-differences-between-irreducible-and-reducible-atlantoaxial-dislocation-in-the-era-of-direct-posterior-approach-and-c1-2-joint-manipulation
#8
Arsikere N Deepak, Pravin Salunke, Sushanta K Sahoo, Prashant K Prasad, Niranjan K Khandelwal
OBJECTIVE The current management of atlantoaxial dislocation (AAD) focuses on the C1-2 joints, commonly approached through a posterior route. The distinction between reducible AAD (RAAD) and irreducible AAD (IrAAD) seems to be less important in modern times. The roles of preoperative traction and dynamic radiographs are questionable. This study evaluated whether differentiating between the 2 groups is important in today's era. METHODS Ninety-six consecutive patients with congenital AAD (33 RAAD and 63 IrAAD), who underwent surgery through a posterior approach alone, were studied...
November 18, 2016: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/27843670/kirschner-wire-breakage-during-removal-requiring-retrieval
#9
Kai Yuen Wong, Rosalind Mole, Patrick Gillespie
Kirschner wires (K-wires) are widely used for fixation of fractures and dislocations in the hand as they are readily available, reliable, and cost-effective. Complication rates of up to 18% have been reported. However, K-wire breakage during removal is rare. We present one such case illustrating a simple technique for retrieval. A 35-year-old male presented with a distal phalanx fracture of his right middle finger. This open fracture was treated with K-wire fixation. Postoperatively, he developed a pin site infection with associated finger swelling...
2016: Case Reports in Surgery
https://www.readbyqxmd.com/read/27821134/asphyxia-due-to-laryngeal-spasm-as-a-severe-complication-of-awake-deep-brain-stimulation-for-parkinson-s-disease-a-case-report
#10
Kajetan L von Eckardstein, Friederike Sixel-Döring, Stephan Kazmaier, Claudia Trenkwalder, Jason M Hoover, Veit Rohde
BACKGROUND: In accordance with German neurosurgical and neurological consensus recommendations, lead placements for deep brain stimulation (DBS) in patients with Parkinson's disease (PD) are usually performed with the patient awake and in "medication off" state. This allows for optimal lead position adjustment according to the clinical response to intraoperative test stimulation. However, exacerbation of Parkinsonian symptoms after withdrawal of dopaminergic medication may endanger the patient by inducing severe "off" state motor phenomena...
November 8, 2016: BMC Neurology
https://www.readbyqxmd.com/read/27811496/a-case-report-of-onyx-pulmonary-arterial-embolism-contributing-to-hypoxemia-during-awake-craniotomy-for-arteriovenous-malformation-resection
#11
Brian T Tolly, Jenna L Kosky, Antoun Koht, Laura B Hemmer
A healthy 26-year-old man with cerebral arteriovenous malformation underwent staged endovascular embolization with Onyx followed by awake craniotomy for resection. The perioperative course was complicated by tachycardia and severe intraoperative hypoxemia requiring significant oxygen supplementation. Postoperative chest computed tomography (CT) revealed hyperattenuating Onyx embolization material within the pulmonary vasculature, and an electrocardiogram indicated possible right heart strain, supporting clinically significant embolism...
November 2, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27806841/diagnostic-pitfalls-of-infarcted-warthin-tumor-in-frozen-section-evaluation
#12
Yaohong Tan, Oleksandr N Kryvenko, Darcy A Kerr, Jennifer R Chapman, Christina Kovacs, David J Arnold, Andrew E Rosenberg, Carmen R Gomez-Fernandez
Warthin tumor (WT) is the second most common benign salivary gland neoplasm and has characteristic cytologic and histologic findings. Fine-needle aspiration is a common and useful preoperative diagnostic technique, which sometimes leads to ischemic injury resulting in the infarction of these lesions. Infarcted WT may demonstrate variable gross and histologic alterations that may render the diagnosis challenging, particularly during intraoperative frozen section evaluation. In this study, we collected 11 resection specimens from 9 patients with infarcted WT...
December 2016: Annals of Diagnostic Pathology
https://www.readbyqxmd.com/read/27797096/a-comparison-of-bis-recordings-during-propofol-based-total-intravenous-anaesthesia-and-sevoflurane-based-inhalational-anaesthesia-in-obese-patients
#13
Tomasz Gaszyński, Andrzej Wieczorek
BACKGROUND: Intraoperative awareness is a rarely occurring phenomenon. Obesity is considered as one of the factors increasing the probability of intraoperative awareness due to problems with the dosing of anaesthetics. In a randomized prospective study we compared bispectral index (BIS) recordings during propofol-based total intravenous anaesthesia (TIVA) and sevoflurane-based inhalation anaesthesia in morbidly obese patients as a sign of possible intraoperative awareness. METHODS: 120 morbidly obese patients were randomly allocated into two subgroups: TIVA or SEVO...
2016: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/27794573/diagnosis-and-clinical-management-of-ruptured-ileocecal-pouches-for-continent-cutaneous-urinary-diversion
#14
Charis Kalogirou, Arkadius Kocot, Philipp Mulfinger, Elena Hartmann, Markus Krebs, Daniel Vergho, Hubertus Riedmiller
BACKGROUND AND OBJECTIVES: The study aimed to report on pouch ruptures in 5 patients with ileocecal reservoirs for continent cutaneous urinary diversion. PATIENTS AND METHODS: Five male patients aged 48-89 were referred to our department between 2000 and 2016 with a ruptured ileocecal pouch 16-175 months postoperatively. RESULTS: With an incidence of 0.95% in our series (5 ruptures in 529 pouch patients out of a pool of 1,182 radical cystectomies) a rupture of the ileocecal pouch is a rare but severe complication...
October 29, 2016: Urologia Internationalis
https://www.readbyqxmd.com/read/27792117/use-of-central-motor-conduction-time-and-spinal-cord-evoked-potentials-in-the-electrophysiological-assessment-of-compressive-cervical-myelopathy
#15
Kazuhiro Fujimoto, Tsukasa Kanchiku, Yasuaki Imajo, Hidenori Suzuki, Masahiro Funaba, Norihiro Nishida, Toshihiko Taguchi
STUDY DESIGN: Retrospective study. OBJECTIVE: This study investigated the pathophysiology of compressive cervical myelopathy (CCM) with prolonged central motor conduction time (CMCT) in the upper limbs (UL) rather than lower limbs (LL) and prolonged CMCT at the thoracic level (TL). SUMMARY OF BACKGROUND DATA: Earlier reports indicated the usefulness of CMCT to assess preoperative CCM severity. However little information exists on patients with prolonged CMCT-UL rather than CMCT-LL and prolonged CMCT-TL...
October 25, 2016: Spine
https://www.readbyqxmd.com/read/27792079/obesity-hypoventilation-syndrome-sleep-apnea-overlap-syndrome-perioperative-management-to-prevent-complications
#16
Raviraj Raveendran, Jean Wong, Mandeep Singh, David T Wong, Frances Chung
PURPOSE OF REVIEW: The prevalence of sleep disordered breathing (SDB) is increasing proportional to the prevalence of obesity. Although anesthesiologists are familiar with obstructive sleep apnea (OSA) - the most common SDB, anesthesiologists may not be aware of other SDB such as obesity hypoventilation syndrome (OHS) and overlap syndrome (combination of OSA and chronic obstructive pulmonary disease). The present review provides an update of information regarding the perioperative management of OHS and overlap syndrome...
October 26, 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27789094/periprosthetic-joint-infections-caused-by-enterococci-have-poor-outcomes
#17
Michael M Kheir, Timothy L Tan, Carlos Higuera, Jaiben George, Craig J Della Valle, Mary Shen, Javad Parvizi
BACKGROUND: The definitive treatment and outcome of periprosthetic joint infection (PJI) caused by Enterococcus species is unknown. We performed a multi-institutional study to analyze the characteristics and treatment outcomes of patients with enterococcal PJI and to define an effective treatment protocol. METHODS: We retrospectively reviewed all PJIs at 3 institutions between 1999 and 2014 using an electronic query followed by manual chart review. We included patients who met the Musculoskeletal Infection Society's criteria for PJI and had at least 1 positive intraoperative culture for any Enterococcus species...
September 28, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27768218/varus-will-have-varus-a-radiological-study-to-assess-and-predict-varus-stem-placement-in-uncemented-femoral-stems
#18
Colin G Murphy, Michel P Bonnin, Antoine H Desbiolles, Yannick Carrillon, Tarik Aїt Si Selmi
BACKGROUND: Varus inclination of the uncemented stem is not necessarily a technical error. The proximal femoral anatomy of hips with a coxa vara deformity frequently predisposes varus inclination. METHODS: We reviewed a series of 200 patients undergoing primary uncemented THA with the Corail® hip system. Preoperative data were based on patient demographics, diagnosis, and radiographic information (preoperative templating-CT measurements), and compared postoperative alignment for each stem and type of stem used...
October 15, 2016: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
https://www.readbyqxmd.com/read/27767680/postoperative-urinary-retention-in-patients-undergoing-elective-spinal-surgery
#19
David Altschul, Andrew Kobets, Jonathan Nakhla, Ajit Jada, Rani Nasser, Merritt D Kinon, Reza Yassari, John Houten
OBJECTIVE Postoperative urinary retention (POUR) is a common problem leading to morbidity and an increased hospital stay. There are limited data regarding its baseline incidence in patients undergoing spinal surgery and the risk factors with which it may be associated. The purpose of this study was to evaluate the incidence of POUR in elective spine surgery patients and determine the factors associated with its occurrence. METHODS The authors retrospectively reviewed the records of patients who had undergone elective spine surgery and had been prospectively monitored for POUR during an 18-month period...
October 21, 2016: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/27765006/rigler-sign-in-a-child-with-posttransplant-lymphoproliferative-disease-a-sign-that-should-not-be-missed
#20
Nader Shakibazad, Karmella Kamali, Naser Honar, Mohammadreza Bordbar, Erfaneh Mohazabieh
Rigler sign is a double wall sign suggesting pneumoperitoneum and intestinal perforation, and it needs emergency surgical treatment. Early diagnosis of intestinal perforation by clinical symptoms, presence of Rigler sign in abdominal radiography, and then early surgical treatment can reduce mortality. Here, we report a patient with Crigler-Najjar syndrome who underwent liver transplant and then developed posttransplant lymphoproliferative disease and received chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone plus rituximab...
October 20, 2016: Experimental and Clinical Transplantation
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