- [Anesthesia, ventilation and pain treatment in thoracic trauma]. [Review]
- UUnfallchirurg 2018; 121(8):634-641
- The management of anesthesia plays a central role in the treatment of thoracic trauma, both in the initial phase when safeguarding the difficult airway and in the intensive care unit. A rapid transfe…
The management of anesthesia plays a central role in the treatment of thoracic trauma, both in the initial phase when safeguarding the difficult airway and in the intensive care unit. A rapid transfer to a trauma center should be considered in order to recognize and treat organ dysfunction in time. Development of atelectasis, pneumonia and acute lung failure are common pulmonary complications. Non-invasive ventilation combined with physiotherapy and respiratory training can help to minimize these pulmonary complications. If single lung ventilation is necessary as part of the operative patient care, a double-lumen tube, a bronchial blocker and the Univent®-Tubus (Fuji Systems Corporation, Tokyo, Japan) can be used. Special attention should be paid to the hypoxic pulmonary vasoconstriction that occurs in this maneuver. Pain therapy is ideally carried out patient-adapted with epidural anesthesia. In addition, intraoperatively inserted catheters in the sense of a continuous intercostal block or serratus plane block are good alternatives. The aim of these therapies should be early mobilization and transfer of the patient to rehabilitation.
- [STANDARD TRANSCUTANEOUS AND ULTRA-MINI TRANSCUTANEOUS NEPHROLITHOTRIPSY IN TREATMENT OF NEPHROLITHIASIS]. [Journal Article]
- KKKlin Khir 2017; (3):27-9
- Comparative analysis of two variants of transcutaneous nephrolithotripsy (TCNLT) in 45 patients, suffering nephrolithiasis, was performed. In 17 patients (the first group) the ultra-mini (UM) TCNLT, …
Comparative analysis of two variants of transcutaneous nephrolithotripsy (TCNLT) in 45 patients, suffering nephrolithiasis, was performed. In 17 patients (the first group) the ultra-mini (UM) TCNLT, using tubus 11Сh, was done, and in 28 patients (the second group) – TCNLT, using a standard tubus 24Сh. The operation duration in the first group have had constituted (86.2 ± 16.3) min at average, and in the second group – (51 ± 13.6) min. The method of UМ TCNLT is a secure, miniinvasive, owing low rate of morbidity, comparing with a standard procedure, but with equal efficacy, concerning the «stone free» status (accordingly, 95.3 and 96.5%) in patients when calculi’s diameter up to 2 sm. Тubus 11Ch guarantees lesser risk of hemorrhagic complications occurrence, permits to conduct UM TCNLT without nephrostomic draining of the renal calyx and pelvis system more confidently.
- [Long-term follow-up after tympanostomy tube insertion in children with serous otitis media]. [Journal Article]
- OHOrv Hetil 2015 Nov 15; 156(46):1859-64
- CONCLUSIONS: Application of tympanostomy tube is effective in the treatment of serous otitis media resulting from ventilation disorder. The authors draw attention to the importance of tympanometry examination to prevent the adhesive processes and cholesteatoma in chronic ventilation disorder of the middle ear.
- [Modified rapid sequence induction for Caesarian sections : case series on the use of rocuronium and sugammadex]. [Journal Article]
- AAnaesthesist 2012; 61(8):691-5
- CONCLUSIONS: The combination of rocuronium and sugammadex for RSI combines rapid onset and rapid reversal of neuromuscular blockades with avoidance of serious side effects and very comfortable conditions for intubation in all cases. Minor side effects such as hoarseness, throat discomfort (in up to 30%) and myalgia (10%) for up to 48 h were documented.
- Ectopic Cushing's syndrome caused by a well differentiated ACTH-secreting neuroendocrine carcinoma of the ileum. [Case Reports]
- ECExp Clin Endocrinol Diabetes 2010; 118(8):524-9
- Cushing's syndrome can be caused by adrenocorticotropic hormone-secreting solid tumors. We report a rare case of an ileal endocrine carcinoma that produced ACTH and induced hypercortisolism. A now 47…
Cushing's syndrome can be caused by adrenocorticotropic hormone-secreting solid tumors. We report a rare case of an ileal endocrine carcinoma that produced ACTH and induced hypercortisolism. A now 47-year-old man presented at age 41 with weight gain, tremor, perspiration, and general fatigue. Laboratory testing showed hypercortisolism and diabetes mellitus. Further examinations revealed ectopic Cushing's syndrome. The search for the primary tumor was difficult. The patient underwent subtotal thyroidectomy and surgical removal of a pituitary lesion. After resection of an ACTH-producing metastasis of the mesentery, temporary remission of Cushing's syndrome ensued. At the age 45 the primary tumor was detected in the ileum by Ga-68 DOTATOC-PET scan and explorative laparotomy. After surgical removal of this well differentiated neuroendocrine carcinoma the patient significantly improved clinically. He experienced better blood pressure and remission of his diabetes mellitus in addition to increased muscular strength. Endocrine laboratory testing at follow-up examinations confirmed remission of hypercortisolism and diabetes mellitus. A Ga-68 DOTATOC PET scan and a 1 mg dexamethasone suppression test 5 months after surgery showed normal results. Ectopic ACTH secretion within the small bowel is very rare. This case underscores the difficulty in locating the source of ectopic ACTH secretion and suggests using small bowel barium study, tubus endoscopy or video endoscopy for preoperative localization if the small bowel is suspected as tumor source.
- [A variant of transvesical extraurethral adenomectomy]. [Journal Article]
- UUrologiia 2007 Jul-Aug; (4):37-9, 41
- To facilitate extraurethral adenomectomy, we used a semicylindric scalpel and metallic tube (tubus) to make a semioval cut parallel to proximal prostatic portion of the urethra along the posterior se…
To facilitate extraurethral adenomectomy, we used a semicylindric scalpel and metallic tube (tubus) to make a semioval cut parallel to proximal prostatic portion of the urethra along the posterior semicircle of the bladder neck in 260 patients with prostatic adenoma (PA). The urethra was isolated from the adenomatous tissues. The vesicular cut was prolonged left and right to the level of ureteral ostia. This manipulation was followed with bimanual index finger enucleation of adenomatous tissue. The defect of the vesicourethral segment was sutured with catgut or monocril. Extra-urethral adenomectomy with semicylindric scalpel injured prostatic urethra in lesser extent than endourethral adenomectomy, it reduced the risk of hemorrhage, entailed neither stricture of the posterior urethra nor incontinence of urine in the postoperative period.
- [Comparison between the laryngeal tubus S and endotracheal intubation. Simulation of securing the airway in an emergency situation]. [Journal Article]
- AAnaesthesist 2006; 55(2):154-9
- CONCLUSIONS: The LTS represents a fast and reliable method to secure the airway and to achieve ventilation in the mannequin model described. The success rate, the time until successful ventilation and the rating by the participants indicates that the LTS is an important alternative to ETI. The LTS offers special benefits for the less experienced users.
- [Cytoreductive procedures in advanced primary ovarian carcinoma]. [Case Reports]
- ACActa Chir Iugosl 2001; 48(1):71-5
- Female patient, 68, hospitalized due to vaginal bleeding, anaemia and defecation disorder. We have done examinations as follows: clinical and laboratory exams, which confirmed severe anaemia. Explora…
Female patient, 68, hospitalized due to vaginal bleeding, anaemia and defecation disorder. We have done examinations as follows: clinical and laboratory exams, which confirmed severe anaemia. Explorative curretage of uterus--PH findings: malignant tissue. Rectoscopy: extraluminal compression at lo cm from the anal verge. Irigography: spasticity and extraluminal compression to proximal third of rectum and distal sigmoid colon. Ultrasound of abdomen: solid lobular formation 10 x 7 cm in diameter, on the left side of the urinary bladder, surrounded by thin layer of ascites. Ultrasound of liver: without signs of malignant disease. CT-scan of pelvis and abdomen: metastatic lymph nodes, up to 40 mm in diameter, alongside abdominal aorta; solid-lobular tumor, 10 x 7 cm, on the left side of urinary bladder, which fills the central portion of pelvic cavum. Secundary malignant deposits on the pelvic parietal peritoneum with minimal quantity of ascites (peritoneal carcinomatosis). Intraoperative findings confirmed malignant deposits on the right colon serosa, so we performed right hemicolectomy with ileo-colo anastomosis, omentectomy, hysterectomy, bilateral adnexectomy, low anterior resection of the rectum, peritonectomy of pelvis and reconstruction of digestive tubus by colo-rectal anastomosis with circular stapler ILS 33. Duration of operation was 6:45 hours, blood loss was 1100 ml. Intraoperatively was intraperitonealy applicated Adriamycin. One month after the operation, systemic chemotherapy consisting of Endoxan and Karboblastin was administered, for the duration of 6 months, once monthly. Twelve months after the operation NMR showed normal findings, patient was without evidents of recurrent disease.
- [Percutaneous intrarenal ultrasonography]. [Journal Article]
- UUrologiia 2001 Jan-Feb; (1):40-6
- In vivo and in vitro experiments were made to study percutaneous intrarenal ultrasonography (PIU). The transurethral ultrasonic probe (5.5 MHz, 1850 "Bruel&Kjer, Denmark) was inserted through the nep…
In vivo and in vitro experiments were made to study percutaneous intrarenal ultrasonography (PIU). The transurethral ultrasonic probe (5.5 MHz, 1850 "Bruel&Kjer, Denmark) was inserted through the nephrostomic fistula in the dilated pelvis with the tubus of the nephroscope K. Storz 27093B. Scanning of the cavitary renal system and ureteropelvic zone was conducted by moving the probe in the longitudinal and transverse directions. The experiment on 21 removed kidneys investigated potentialities of PIU in hydronephrotic transformation caused by ureteropelvic stricture (4 kidneys), urolithiasis (7 kidneys), carcinoma of renal parenchyma (5 kidneys), pelvic cancer (1 kidney), combined renal cell and epithelial renal carcinoma (1 kidney); in pyonephrosis (1 kidney) and contracted kidney (2 kidneys). 43 patients (19 males and 24 females aged 7 to 63 years) have undergone PIU in the course of percutaneous nephrolithotripsy (n = 23), percutaneous endopyelotomy (n = 15) and percutaneous endoresection of solitary renal cyst (n = 5). PIU accurately localizes residual and x-ray-negative concrement fragments raising the effectiveness of percutaneous nephrolithotripsy, precisely differentiates internal renal structures, visualizes pelvic wall, vessels and tissues of the renal sinus, provides additional information about ureteropelvic zone and its changes. PIU can find wide application in intraoperative diagnosis of different renal and upper urinary tract diseases.
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- [Diagnosis, procedures and conservative therapy of a bronchial rupture after intubation with double-lumen tube]. [Case Reports]
- AIAnasthesiol Intensivmed Notfallmed Schmerzther 1999; 34(1):66-70
- Bronchial rupture is a rare but severe complication of intubation with a double-lumen tube. Cardinal symptoms are mediastinal and subcutaneous emphysema as well as pneumothorax. Larger injuries resul…
Bronchial rupture is a rare but severe complication of intubation with a double-lumen tube. Cardinal symptoms are mediastinal and subcutaneous emphysema as well as pneumothorax. Larger injuries result in an air leak and the endtidal carbon dioxide decreases. The gas exchange may worsen drastically when mucosal prolapse or bronchial haemorrhagia lead to bronchial occlusion. Mediastinitis or sepsis can be the sequel of the opened mediastinum. If bronchial injury is suspected probably fibreoptic bronchoscopy is indicated. We report on a case of bronchial rupture due to overinflation of the endobronchial cuff or movement of the inflated cuff when repositioning the patient. The conservative therapy was successful in spite of the fact that surgical intervention is recommended in the literature following bronchial rupture. To avoid tracheobronchial injuries an adequate tubus size must be selected. The more flexible polyvinylchloride (PVC) tubes without a carinal hook should be preferred to the Carlens tube. An atraumatic intubation is promoted by leaving the stylet inside after the tip of the tube has passed the vocal cords. To identify the minimum occlusive pressure of the endobronchial cuff for lung isolation different methods are described and should be used. The cuff has to be deflated when the patient is repositioned and when one-lung-ventilation is not required. Tumours of the tracheobronchial tree and weakness of the bronchial wall caused by steroid hormone therapy or COPD may increase the risk of tracheobronchial laceration.