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https://www.readbyqxmd.com/read/29147587/dexmedetomidine-as-part-of-a-multimodal-analgesic-treatment-regimen-for-opioid-induced-hyperalgesia-in-a-patient-with-significant-opioid-tolerance
#1
Richard K Patch Iii, Jason S Eldrige, Susan M Moeschler, Matthew J Pingree
Acute postoperative pain in patients with opioid tolerance creates a significant management challenge for anesthesiologists and pain medicine physicians. A multimodal approach is key; however other factors can complicate management such as opioid induced hyperalgesia. We present the case of a patient on large amounts of intrathecal opioids for chronic pain syndrome with opioid induced hyperalgesia after an exploratory laparotomy. Dexmedetomidine was utilized successfully as part of a controlled multimodal analgesic plan and should be a consideration for opioid tolerant patients experiencing opioid induced hyperalgesia...
2017: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/29145325/perforated-appendicitis-after-colonoscopy-cause-or-coincidence-a-rare-case-report-and-literature-review
#2
Xiao-Cong Zhou, Chun-Wei Huang, Yan-Yan Dai, Zhi-Yang Huang, Zheng Lou
RATIONALE: Colonoscopy is a relatively safe and common procedure with low risks of complications, and acute appendicitis with perforation is an extremely rare complication of colonoscopy. The current study presents an unusual case of acute gangrenous appendicitis with perforation following a screening colonoscopy. PATIENT CONCERNS: A 73-year-old man presented to our emergency department with lower right abdominal pain 3 days after a routine screening colonoscopy...
November 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29137063/gallstone-ileus-displaying-the-typical-rigler-triad-and-an-occult-second-ectopic-stone-a-case-report
#3
Li Wang, Ping Dong, Yi Zhang, Bole Tian
RATIONALE: Gallstone ileus is a rare complication of cholecystolithiasis. It has a female predominance and can result in high mortality rates. PATIENT CONCERNS: A 71-year-old woman complaining of recurrent vomiting and vague epigastralgia for > 2 weeks presented to our department. DIAGNOSIS: Based on her physical examination, laboratory test results and radiographic findings (the typical Rigler's triad), she was diagnosed with gallstone ileus caused by multiple ectopic stones...
November 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29134308/appendicitis-rural-patient-status-is-associated-with-increased-duration-of-prehospital-symptoms-and-worse-outcomes-in-high-and-low-middle-income-countries
#4
Matthew C Hernandez, Eric Finnesgaard, Johnathon M Aho, Victor Y Kong, John L Bruce, Stephanie F Polites, Grant L Laing, Damian L Clarke, Martin D Zielinski
INTRODUCTION: Appendicitis is a significant economic and healthcare burden in low-, middle-, and high-income countries. We aimed to determine whether urban and rural patient status would affect outcomes in appendicitis in a combined population regardless of country of economic status. We hypothesize that patients from rural areas and both high- and low-middle-income countries would have disproportionate outcomes and duration of symptoms compared to their urban counterparts. METHODS: Adults (≥18 years) with appendicitis during 2010-2016 in South Africa and USA were reviewed using multi-institutional data...
November 13, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/29130005/a-case-of-haematometra-secondary-to-cervical-stenosis-after-vesicle-vaginal-fistula-surgical-repair
#5
Athanase Lilungulu, Willy Mwibea, Mzee Nassoro, Balthazar Gumodoka
Background. Haematometra is a rare postobstetrics fistula surgical repair outcome complication; however the condition can be misinterpreted especially in limited resource areas that lack routine ultrasound guidance and with a slowly progressed increase in size of abdomen accompanied with a history of amenorrhoea together with a history of having unprotective sexual intercourse which may increase the possibility of being controversial to full-term gravid uterus. The causes of haematometra might be either due to congenital abnormality of the vaginal canal or acquired iatrogenically...
2017: Case Reports in Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29129378/transvaginal-natural-orifice-transluminal-endoscopic-surgery-a%C3%A2-new-approach-to-myomectomy
#6
Jan Baekelandt
OBJECTIVE: To demonstrate a new approach for performing a myomectomy via transvaginal natural-orifice transluminal endoscopic surgery (vNOTES) as an alternative to laparoscopic myomectomy. DESIGN: Stepwise explanation of the technique with the use of original video footage. SETTING: Hospital. PATIENT(S): Eight patients were treated transvaginally for intramural, subserosal, and pedunculated myomas. INTERVENTION(S): In case of a posterior myoma, a 2...
November 9, 2017: Fertility and Sterility
https://www.readbyqxmd.com/read/29127649/-results-after-surgical-management-of-ileal-perforation-due-to-typhoid-fever-about-29-cases-in-ouahigouya-burkina-faso
#7
J L Kambire, S Ouedraogo, S Ouedraogo, E Ouangre, S S Traore
The aim of this study was to determine the results of management of typhoid perforations. This was a descriptive cross-sectional study carried out from January 1, 2016 to December 31, 2016 in the General Surgery Department of the Regional Teaching Hospital Center of Ouahigouya (Burkina Faso). It involved 29 operated patients, in whom the diagnosis of typhoid perforation was confirmed at laparotomy: age, sex, admission time, clinical, therapeutic and prognostic aspects were analyzed. Typhoid perforations accounted for 20% of acute generalized peritonitis and 38...
November 10, 2017: Bulletin de la Société de Pathologie Exotique
https://www.readbyqxmd.com/read/29127603/attempting-a-laparoscopic-approach-in-patients-undergoing-left-sided-colorectal-surgery-who-have-had-a-previous-laparotomy-is-it-feasible
#8
Murad A Jabir, Justin T Brady, Yuxiang Wen, Eslam M G Dosokey, Dongjin Choi, Sharon L Stein, Conor P Delaney, Scott R Steele
BACKGROUND: The feasibility of a laparoscopic approach in patients who have had a prior laparotomy (PL) remains controversial. We hypothesized that laparoscopic colorectal resection was safe and feasible in patients with previous open abdominal surgery. METHODS: A retrospective review (2007-2015) of all patients undergoing laparoscopic resection for sigmoid and rectal adenocarcinoma with or without prior midline laparotomy (NPL) was performed. Primary endpoints included conversion and perioperative morbidity...
November 10, 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/29126743/benign-and-malignant-pathology-of-the-uterus
#9
REVIEW
V Tanos, K E Berry
The diagnosis of a uterine myoma size and location can be very precise when a 3D sonograph and knowledge are available. The majority of fibroids are asymptomatic, and expectant management is recommended. In young patients, fibroids cause infertility and in middle-aged women, abnormal uterine bleedings. Laparoscopic myomectomy is the preferred way of surgery for IM and SS fibroids, versus hysteroscopy for SM fibroids. In both cases, the size, number of fibroids and the surgeon's experience determine the limitations of the MIGS...
October 16, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/29124860/safety-of-single-incision-laparoscopic-cholecystectomy-for-acute-cholecystitis
#10
Geon Young Byun, Sung Ryul Lee, Bum Hwan Koo
BACKGROUND: Single-incision laparoscopic cholecystectomy (SILC) is a common procedure performed worldwide. In this study, we evaluated the safety and efficacy of SILC for acute cholecystitis. METHODS: Patients who underwent SILC between September 2012 and December 2016 were retrospectively enrolled and divided into acute and chronic groups. Demographic, operative and outcome data were obtained by reviewing medical records, physical examination and telephone follow-up...
November 9, 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/29123864/right-sided-bochdalek-hernia-in-an-elderly-patient-a-case-review-of-adult-bochdalek-hernias-from-1982-to-2015-in-japan
#11
Yasuhiro Ohtsuka, Tiberiu H Suzuki
Case: An 89-year-old woman was admitted to our hospital because of dyspnea following abdominal pain and vomiting. According to chest computed tomography findings, a diagnosis of acute respiratory failure due to right-sided Bochdalek hernia was made. Outcome: Emergency laparotomy revealed that a bowel loop from the terminal ileum to the transverse colon had herniated into the right thoracic cavity through the foramen of Bochdalek. The herniated organs were reduced to the abdominal cavity and the foramen was repaired by direct suturing...
April 2017: Acute Medicine & Surgery
https://www.readbyqxmd.com/read/29121995/round-cell-sarcoma-of-the-colon-with-cic-rearrangement
#12
H Maghrebi, R Batti, A Zehani, N Chrait, H Rais, A Makni, A Haddad, M Ayadi, A Daghfous, M Jrad, N Kchir, Z Bensafta, A Mezlini
BACKGROUND: The CIC-rearranged sarcoma is a very rare highly aggressive malignant soft tissue group of tumors. It has recently been described as highly aggressive soft tissue tumors of children and young adults sharing similar morphological features with the Ewing sarcoma. The digestive localization is exceptional. CASE PRESENTATION: A 14-year-old male presented with a history of abdominal pain for 1 year, which increased in intensity over the last 2 months. Imaging findings showed a large heterogeneous mesenteric mass on the left flank of the abdomen...
November 9, 2017: BMC Research Notes
https://www.readbyqxmd.com/read/29121417/transabdominal-cerclage-tac-for-patients-with-ultra-short-uterine-cervix-after-uterine-cervix-surgery-and-its-impact-on-pregnancy
#13
Shinichi Ishioka, Miseon Kim, Yuko Mizugaki, Saori Kon, Kyoko Isoyama, Masahito Mizuuchi, Miyuki Morishita, Tsuyoshi Baba, Takao Sekiya, Tsuyoshi Saito
AIM: Patients with an ultra-short uterine cervix as a result of large conization, repeated conization or radical trachelectomy (RT), are at high risk of preterm premature rupture of the membrane, which leads to preterm birth. We have commenced performing transabdominal cerclage (TAC) of the uterine cervix for these patients. In this study, we examined the safety of TAC and its impact on pregnancy. METHODS: We have performed TAC in 11 patients before pregnancy: in six after large cervical operations, such as repeated conization; and in five for difficulties with cervical cerclage after RT...
November 9, 2017: Journal of Obstetrics and Gynaecology Research
https://www.readbyqxmd.com/read/29120568/common-bile-duct-stricture-after-laparoscopic-cholecystectomy-case-report
#14
Ivan Zoričić, Ivo Soldo, Ivan Simović, Marko Sever, Branko Bakula, Martin Grbavac, Marinko Marušić, Anamaria Soldo
Despite progress in laparoscopic surgery and increasing surgical experience, the incidence of bile duct injury during laparoscopic cholecystectomy fails to fall below 0.3%-0.6% and it is still higher than those recorded in the era of open cholecystectomy. Bile duct injuries belong to the most serious complications of abdominal surgery in general and often end up with liver transplantation as the only hope for cure. We present a case of a 78-year-old jaundiced male patient who sustained common hepatic duct injury during laparoscopic cholecystectomy eight months earlier...
March 2017: Acta Clinica Croatica
https://www.readbyqxmd.com/read/29120518/small-bowel-obstruction-after-transoral-robotic-surgery
#15
Joseph McClellan, Virginie Achim, Daniel Clayburgh
BACKGROUND: Head and neck surgery is not often considered a risk factor for intestinal ileus and small bowel obstruction. However, many of these patients may have had prior abdominal surgery, a known risk factor for small bowel obstruction, and may be at risk for bowel obstruction after a surgical procedure of the head and neck. METHODS: We present a case describing a patient who, after undergoing transoral robotic surgery, experienced delayed postoperative ileus and eventual small bowel obstruction requiring exploratory laparotomy and bowel resection...
November 9, 2017: Head & Neck
https://www.readbyqxmd.com/read/29117026/the-american-association-for-the-surgery-of-trauma-severity-grade-is-valid-and-generalizable-in-adhesive-small-bowel-obstruction
#16
Martin D Zielinski, Nadeem N Haddad, Asad Choudhry, Matthew C Hernandez, Daniel C Cullinane, David Turay, Ji-Ming Yune, Salina Wydo, Kenji Inaba, D Dante Yeh, Therese M Duane, Andrea Pakula, Ruby Skinner, Jill Watras, Carlos J Rodriguez, Kenneth A Widom, John Cull, Julie Dunn, Eric A Toschlog, Valerie G Sams, John C Graybill
INTRODUCTION: The American Association for the Surgery of Trauma (AAST) anatomic severity grading system for adhesive small bowel obstruction (ASBO) was validated at a single institution. We aimed to externally validate the AAST ASBO grading system using the Eastern Association for the Surgery of Trauma (EAST) multi-institutional SBO prospective observational study. METHODS: Adults (age≥18) with (ASBO) were included. Baseline demographics, physiologic parameters (heart rate, blood pressure, respiratory rate), labs (lactate, hemoglobin, creatinine, leukocytosis), imaging findings, operative details, length of stay, and Clavien-Dindo complications were collected...
November 7, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29108083/-pedicled-omentum-flaps-in-the-management-of-deep-sternal-wound-infections
#17
Nick Spindler, Christian Etz, Martin Misfeld, Christoph Josten, Michael Borger, Friedrich Wilhelm Mohr, Stefan Langer
Aim Coverage of a deep sternal wound infection with a greater omentum flap. Due to a persistent infection caused by an infected aortic prosthesis, the primarily performed reconstruction with a latissimus dorsi flap had to be revised, and an alternative solution had to be found. Indication A deep sternal wound infection is a rare but devastating complication following median sternotomy. If the commonly used muscle flap is not sufficient and artificial material is still present in the wound, for instant drivelines or a vascular prosthesis, the greater omentum flap is a useful option due to its immunologic capacity...
November 6, 2017: Zentralblatt Für Chirurgie
https://www.readbyqxmd.com/read/29107715/differed-surgery-in-patient-with-colorectal-endometriosis-and-pregnancy-intention-is-it-reasonable
#18
S Touleimat, E Huet, S Sanguin, H Roman
The management of patients presenting deep infiltrating endometriosis involving the rectum (DIER) and pregnancy intention is controversial. Assisted Reproduction Techniques (ART) are often proposed first, but this may lead to complications and further difficulties managing DIER. A 29-years-old woman was diagnosed with pre-occlusive DIER. However, she was offered in vitro fertilization (IVF) and underwent six unsuccessful cycles with serious complications: an ectopic pregnancy and a hemoperitoneum following arterial injury during oocyte retrieval, requiring two laparotomies in emergency...
October 28, 2017: Journal of gynecology obstetrics and human reproduction
https://www.readbyqxmd.com/read/29107397/traumatic-injury-to-the-portal-vein-with-shock-bowel
#19
Nicholas C Cleveland, Don N Nguyen, Cassie D Tran, Rishi K Maheshwary, Matthew S Hartman
A portal vein aneurysm is the dilatation of the portal vein due to a defect in the vein wall. This rare disease manifestation is difficult to predict and has the potential for severe complications. We describe the case of a 68-year-old man involved in a motor vehicle collision who presented with abdominal hemorrhage found on ultrasound, hypotension, and vague abdominal pain. The patient underwent an exploratory laparotomy to control bleeding. Surgery and a subsequent abdominal computed tomography revealed the presence of a portal vein pseudoaneurysm and shock bowel...
October 3, 2017: Current Problems in Diagnostic Radiology
https://www.readbyqxmd.com/read/29103256/-a-case-of-intravesical-foreign-body-by-erosion-of-surgical-mesh-used-for-an-inguinal-hernia-repair
#20
Kota Iida, Fumiaki Hoshiyama, Masahiro Tanaka, Kiyohide Fujimoto
We report our experience with a case in which eroded mesh used for inguinal hernia repair migrated into the bladder. An 84-year-old man underwent surgery for colorectal cancer at the age of 40, and radical surgery for a right inguinal hernia at the age of 83. At his initial visit, he reported macroscopic hematuria. Cystoscopy revealed a yellowish-brown foreign body on the right bladder wall, and computed tomography showed the presence of emphysema in association with the foreign body. Based on a presumptive diagnosis of vesical calculi, transurethral lithotripsy was performed...
October 2017: Hinyokika Kiyo. Acta Urologica Japonica
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