Jejunal diverticulosis is a rare entity with variable clinical and anatomical presentations.Its reported incidence varies from 0.05% to 6%.Although there is no consensus on the management of asymptomatic jejunal diver...Jejunal diverticulosis is a rare entity with variable clinical and anatomical presentations.Its reported incidence varies from 0.05% to 6%.Although there is no consensus on the management of asymptomatic jejunal diverticular disease,some complications are potentially life threatening and require early surgical treatment.We report a case of an 88-year-old man investigated for acute abdominal pain with a high biological inflammatory syndrome.Inflammation of multiple giant jejunal diverticulum was discovered at abdominal computed tomography (CT).As a result of the clinical and biological signs of early peritonitis,an emergency surgical exploration was performed.The first jejunal loop showed clear signs of jejunal diverticulitis.Primary segmental jejunum resection with end-to-end anastomosis was performed.Histopathology report confirmed an ulcerative jejunal diverticulitis with imminent perforation and acute local peritonitis.The patient made an excellent rapid postoperative recovery.Jejunal diverticulum is rare but may cause serious complications.It should be considered a possible etiology of acute abdomen,especially in elderly patients with unusual symptomatology.Abdominal CT is the diagnostic tool of choice.The best treatment is emergency surgical management.展开更多
The three surgical patient safety events, wrong site surgery, retained surgical items (RSI) and surgical fires are rare occurrences and thus their effects on the complex modern operating room (OR) are difficult to stu...The three surgical patient safety events, wrong site surgery, retained surgical items (RSI) and surgical fires are rare occurrences and thus their effects on the complex modern operating room (OR) are difficult to study. The likelihood of occurrence and the magnitude of risk for each of these surgical safety events are undefined. Many providers may never have a personal experience with one of these events and training and education on these topics are sparse. These circumstances lead to faulty thinking that a provider won't ever have an event or if one does occur the provider will intuitively know what to do. Surgeons are not preoccupied with failure and tend to usually consider good outcomes, which leads them to ignore or diminish the importance of implementing and following simple safety practices. These circumstances contribute to the persistent low level occurrence of these three events and to the difficulty in generating sufficient interest to resource solutions. Individual facilities rarely have the time or talent to understand these events and develop lasting solutions. More often than not, even the most well meaning internal review results in a new line to a policy and some rigorous enforcement mandate. This approach routinely fails and is another reason why these problems are so persistent. Vigilance actions alone havebeen unsuccessful so hospitals now have to take a systematic approach to implementing safer processes and providing the resources for surgeons and other stake-holders to optimize the OR environment. This article discusses standardized processes of care for mitigation of injury or outright prevention of wrong site surgery, RSI and surgical fires in an action-oriented framework illustrating the strategic elements important in each event and focusing on the responsibilities for each of the three major OR agents-anesthesiologists, surgeons and nurses. A Surgical Patient Safety Checklist is discussed that incorporates the necessary elements to bring these team members together and influence the emergence of a safer OR.展开更多
Objective:The aim of our study was to find out the best operative therapeutic regimen by reviewing the comprehension of operation,the improvement of operative method and the selection of operative approach concerning ...Objective:The aim of our study was to find out the best operative therapeutic regimen by reviewing the comprehension of operation,the improvement of operative method and the selection of operative approach concerning pineal region meningioma combining obstructive hydrocephalus.Methods:We retrospected the clinic data,comprehension of operation and prognosis of 6 cases of pineal region meningioma.Results:Six tumors were all removed,after that the back wall of the third ventricle was cut open.The 6 tumors were defined as meningioma by pathological examination.After 4-48 months follow-up,the manifestation of hydrocephalus disappeared,other symptoms were relieved more or less without any complication with one patient dismissing.The regular MRI examination indicated that the lesions had not reoccur and the cerebral ventricles had been normal.Conclusion:We identify the nourish arteries of the tumor and anatomy relationship between the tumor and its peripheral blood vessels through modern imaging devices,to select reasonable operative method are the premier therapy of pineal region meningioma.The back wall of the third ventricle becomes thin and the suprapineal recess develops shallow and wide,so the third ventricle-quadrigeminal cistern fistulation can effectively eliminate the obstructive hydrocephalus due to the long-term compression on the aqueduct after removing the tumor.展开更多
Objective:To evaluate the effect of modified surgical techniques on hemostasis used in aortic root replacement with a composite graft(Bentall procedure).Methods:Data on 15 patients who underwent Bentall procedure duri...Objective:To evaluate the effect of modified surgical techniques on hemostasis used in aortic root replacement with a composite graft(Bentall procedure).Methods:Data on 15 patients who underwent Bentall procedure during 2005 to 2007 were analyzed.The first 5 patients(Group 1) received the standard procedure.Then next 10 patients(Group 2) received the modified procedure.Techniques including "tandem suture line","endo-button buttress","sandwich anastomosis" and "left ventricle filling" were added to the standard procedure.Perioperative bleeding and the volume of blood transfusion required were compared to estimate hemostasis in different groups.Results:Between groups 1 and 2,a significant difference was found in postoperative bleeding [(2193±383) ml vs(1012±258) ml,respectively;P<0.05] and in volume of blood transfusion required [(7242±1416) ml vs(2520±708) ml,respectively;P<0.05].Conclusion:The modified surgical techniques used in our study are effective in the improvement of the hemostasis in Bentall procedure.展开更多
文摘Jejunal diverticulosis is a rare entity with variable clinical and anatomical presentations.Its reported incidence varies from 0.05% to 6%.Although there is no consensus on the management of asymptomatic jejunal diverticular disease,some complications are potentially life threatening and require early surgical treatment.We report a case of an 88-year-old man investigated for acute abdominal pain with a high biological inflammatory syndrome.Inflammation of multiple giant jejunal diverticulum was discovered at abdominal computed tomography (CT).As a result of the clinical and biological signs of early peritonitis,an emergency surgical exploration was performed.The first jejunal loop showed clear signs of jejunal diverticulitis.Primary segmental jejunum resection with end-to-end anastomosis was performed.Histopathology report confirmed an ulcerative jejunal diverticulitis with imminent perforation and acute local peritonitis.The patient made an excellent rapid postoperative recovery.Jejunal diverticulum is rare but may cause serious complications.It should be considered a possible etiology of acute abdomen,especially in elderly patients with unusual symptomatology.Abdominal CT is the diagnostic tool of choice.The best treatment is emergency surgical management.
文摘The three surgical patient safety events, wrong site surgery, retained surgical items (RSI) and surgical fires are rare occurrences and thus their effects on the complex modern operating room (OR) are difficult to study. The likelihood of occurrence and the magnitude of risk for each of these surgical safety events are undefined. Many providers may never have a personal experience with one of these events and training and education on these topics are sparse. These circumstances lead to faulty thinking that a provider won't ever have an event or if one does occur the provider will intuitively know what to do. Surgeons are not preoccupied with failure and tend to usually consider good outcomes, which leads them to ignore or diminish the importance of implementing and following simple safety practices. These circumstances contribute to the persistent low level occurrence of these three events and to the difficulty in generating sufficient interest to resource solutions. Individual facilities rarely have the time or talent to understand these events and develop lasting solutions. More often than not, even the most well meaning internal review results in a new line to a policy and some rigorous enforcement mandate. This approach routinely fails and is another reason why these problems are so persistent. Vigilance actions alone havebeen unsuccessful so hospitals now have to take a systematic approach to implementing safer processes and providing the resources for surgeons and other stake-holders to optimize the OR environment. This article discusses standardized processes of care for mitigation of injury or outright prevention of wrong site surgery, RSI and surgical fires in an action-oriented framework illustrating the strategic elements important in each event and focusing on the responsibilities for each of the three major OR agents-anesthesiologists, surgeons and nurses. A Surgical Patient Safety Checklist is discussed that incorporates the necessary elements to bring these team members together and influence the emergence of a safer OR.
文摘Objective:The aim of our study was to find out the best operative therapeutic regimen by reviewing the comprehension of operation,the improvement of operative method and the selection of operative approach concerning pineal region meningioma combining obstructive hydrocephalus.Methods:We retrospected the clinic data,comprehension of operation and prognosis of 6 cases of pineal region meningioma.Results:Six tumors were all removed,after that the back wall of the third ventricle was cut open.The 6 tumors were defined as meningioma by pathological examination.After 4-48 months follow-up,the manifestation of hydrocephalus disappeared,other symptoms were relieved more or less without any complication with one patient dismissing.The regular MRI examination indicated that the lesions had not reoccur and the cerebral ventricles had been normal.Conclusion:We identify the nourish arteries of the tumor and anatomy relationship between the tumor and its peripheral blood vessels through modern imaging devices,to select reasonable operative method are the premier therapy of pineal region meningioma.The back wall of the third ventricle becomes thin and the suprapineal recess develops shallow and wide,so the third ventricle-quadrigeminal cistern fistulation can effectively eliminate the obstructive hydrocephalus due to the long-term compression on the aqueduct after removing the tumor.
文摘Objective:To evaluate the effect of modified surgical techniques on hemostasis used in aortic root replacement with a composite graft(Bentall procedure).Methods:Data on 15 patients who underwent Bentall procedure during 2005 to 2007 were analyzed.The first 5 patients(Group 1) received the standard procedure.Then next 10 patients(Group 2) received the modified procedure.Techniques including "tandem suture line","endo-button buttress","sandwich anastomosis" and "left ventricle filling" were added to the standard procedure.Perioperative bleeding and the volume of blood transfusion required were compared to estimate hemostasis in different groups.Results:Between groups 1 and 2,a significant difference was found in postoperative bleeding [(2193±383) ml vs(1012±258) ml,respectively;P<0.05] and in volume of blood transfusion required [(7242±1416) ml vs(2520±708) ml,respectively;P<0.05].Conclusion:The modified surgical techniques used in our study are effective in the improvement of the hemostasis in Bentall procedure.
