Clinical Evidence Of Obstruction Research Articles

Comparison of one-layer Utrecht pattern with two-layer (simple continuous/Cushing) pattern for jejunojejunostomy in healthy horses in vivo.

To compare end-to-end jejunal anastomoses with a one-layer (Utrecht) and two-layer (simple continuous/Cushing) patterns. Experimental study. Eight healthy adult horses. Jejunal end-to-end anastomoses were performed in randomly assigned one-layer or two-layer patterns. Horses were recovered from surgery and monitored for complications. At 14 days, the opposite pattern was performed (cross-over design) prior to euthanasia. Duration of closures was compared between patterns. Serosal width was measured before harvesting anastomotic sites from the first procedure. Luminal diameter was measured, and sections were collected for histological evaluation of heating after routine and immunohistochemical staining. One-layer closure was faster (716 ± 86 s) than two-layer closures (1136 ± 111 s). Postoperative complications were minimal. No difference was detected in lumen size between groups. The lumen was reduced by 18% after one-layer and 15% after two-layer closures (p=.34). Serosal adhesions to the mesentery without clinical evidence of obstruction were observed in two horses with two-layer closure. Histopathological scores for inflammation, infection, and healing did not differ between groups. Jejunal anastomosis with one-layer Utrecht technique was about 7min faster and led to similar luminal reduction and histological healing scores as two-layer jejunojejunostomies. The outcomes of one-layer Utrecht jejunojejunostomies in healthy horses justify clinical evaluation of this technique.

The effects of anesthesia and opioids on the upper airway: A systematic review.

Drug-induced sleep endoscopy (DISE) is used to determine surgical therapy for obstructive sleep apnea (OSA); however, the effects of anesthesia on the upper airway are poorly understood. Our aim was to systematically review existing literature on the effects of anesthetic agents on the upper airway. PubMed, CINAHL, EBM reviews and Scopus (all indexed years). Inclusion criteria included English language articles containing original human data. Two investigators independently reviewed all articles for outcomes related to upper airway morphology, dynamics, neuromuscular response, and respiratory control. The initial search yielded 180 abstracts; 56 articles were ultimately included (total population = 8,540). The anesthetic agents studied were: topical lidocaine, propofol, dexmedetomidine, midazolam, pentobarbital, sevoflurane, desflurane, ketamine, and opioids. Outcome measures were diverse and included imaging studies, genioglossus electromyography, endoscopic airway assessment, polysomnography, upper airway closing pressure, and clinical evidence of obstruction. All agents caused some degrees of airway collapse. Dexmedetomidine did not have dose-dependent effects when evaluated using cine magnetic resonance imaging, unlike sevoflurane, isoflurane, and propofol, and caused less dynamic collapse than propofol. Studies assessing the effect of anesthesia on the upper airway in patients with and without OSA are limited, and few compare effects between agents. Medications with minimal effect on respiratory control (e.g., dexmedetomidine) may work best for DISE.

Comparison between one stage operation for obstructed left colon cancer and Hartmann's procedure

Background: Although acute obstruction of the right colon is usually dealt with by primary anastomosis following resection, many surgeons are reluctant to offer one stage resection and anastomosis to patients with obstructive lesions of the left colon. Aim: The aim of the study is to compare the result of one stage resection and anastomosis for patients with acute complete obstruction due to left colon cancer versus Hartman's procedure. Patients and methods: Eighty four patients with acute left colonic obstruction presented to Sohag University Hospital between march 2008 and February 2012. The diagnosis was based on clinical evidence of obstruction and radiological features of left colonic obstruction on plain x-ray abdomen. No pre-operative histopathological confirmation of the diagnosis was done for all patients. Thirty eight patients were managed by one stage left colectomy without intra­ operative lavage (only manual evacuation of colon and mobbing of the two ends of anastomosis). Hartmann's procedure was performed in thirty four patients. Twelve patients were excluded from the study according to the following criteria: 1- patients with inoperaple tumors (liver metastasis, peritoneal seedling, haemorrhagic ascitis or unresectable). 2-medically unfit or haemodynamiclly unstable patients. 3- colonic perforation or peritonitis. Results: As regards the post operative complications related to left sided colonic surgery (wound sepsis, intra-peritoneal sepsis, anastomotic leakage), there were no significant difference between the two techniques

Is an Elective Diverting Colostomy Warranted in Patients With an Endoscopically Obstructing Rectal Cancer Before Neoadjuvant Chemotherapy?

Many surgeons prefer immediate diversion in patients with endoscopically obstructed rectal cancer before starting neoadjuvant chemotherapy. The aim of this study was to compare immediate neoadjuvant chemoradiotherapy with diversion for endoscopically obstructed rectal cancer. This study is a retrospective review of patients with rectal adenocarcinoma treated from January 2000 to December 2009. Demographic, tumor, treatment, and outcome data were obtained. Data were analyzed by the use of the Fisher exact probability test and the Student t test. This study was conducted at a tertiary care hospital/referral center. Included were patients with a rectal adenocarcinoma unable to be traversed endoscopically but without clinical evidence of obstruction before the initiation of neoadjuvant chemoradiotherapy. Patients with recurrent tumors or those who did not complete neoadjuvant chemoradiotherapy because of compliance were excluded. The primary outcomes measured were the interval from diagnosis to neoadjuvant chemoradiotherapy initiation and resection and the incidence of complete obstruction. Eighty-five patients with endoscopically obstructed rectal cancer were identified; 16 underwent immediate diversion before neoadjuvant chemoradiotherapy (diverted group) and 69 were treated with immediate neoadjuvant chemoradiotherapy. Five patients undergoing immediate neoadjuvant chemoradiotherapy presented with bloating and distension; 2 were treated with dietary modification, and 3 (4.3%) progressed to complete obstruction following completion of neoadjuvant chemoradiotherapy and required diversion. Both groups were similar in age, tumor height, and surgical margin status. Patients undergoing diversion required a significantly greater number of permanent stomas and were associated with a higher rate of radical pelvic surgery. There was a significant delay in the initiation of neoadjuvant chemoradiotherapy (p < 0.05) and proctectomy (p < 0.001) from the time of diagnosis in the diverted group compared with the immediate neoadjuvant chemoradiotherapy group. The tumors of patients undergoing diversions were more likely to be unresectable following neoadjuvant chemoradiotherapy. This study was limited by its retrospective design and possible selection bias. Immediate diversion is unnecessary in endoscopically obstructed rectal cancer without clinical signs of obstruction. There appears to be a relationship between immediate diversion and delay in initiation of neoadjuvant chemoradiotherapy and proctectomy. We conclude that immediate neoadjuvant chemoradiotherapy in patients with endoscopically obstructed rectal cancer is safe and feasible.

Can endoscopic injection (ei) of dextranomer/hyaluronic acid (dxha) be performed at time of pyeloplasty in treating vesicoureteral reflux (vur) with coexisting uretropelvic junction obstruction (upjo)?

Purpose There is paucity of data regarding the order and optimal management of VUR with coexisting UPJO. We explored the feasibility of simultaneous correction of both pathologies in one operative session taking advantage of the minimally invasive nature, the reasonable success rate and the extremely low incidence of ureteral obstruction associated with treatment of VUR by EI. Material and Methods From October 2002-January 2009, 14 children (15 renal units,9 boys and 5 girls, age range 10-48, median 26 months) were diagnosed with dilating VUR and coexisting UPJO as suspected by discrepancy between ureteral and pelvic dilatation associated with poor flow of the dye to the latter and persistent hold up that was further confirmed on nuclear renogram with a catheter in-situ. EI with DxHA and a dismembered pyeloplasty drained exclusively by a nephrostomy were performed at the same operative session. A nephrostogram was performed 7-10 days postoperatively in the first 3 patients. In the following, the nephrostomy was clamped on day 10 and if the child showed no clinical evidence of obstruction or leakage it was removed. Sonographic follow-up was performed at 4,8,12 months and yearly thereafter and a VCUG was done at 4 months. Results Follow-up range was 8-72 months (Median 36). None developed clinical evidence of obstruction or leakage after nephrostomy clamping. UPJO was successfully corrected in all patients as evidenced by appreciable reduction in their hydronephrosis. VUR resolved initially in 9 units (60%). Repeat injections in 2 and a formal open reimplant in 4 were needed to reach a definitive cure. Conclusions In dilating VUR with coexisting UPJO, a reasonable proportion of affected children can be cured in a single operative session by a dismembered pyeloplasty and EI with DxHA. The latter does not seem to increase the perioperative morbidity or negatively affect the late results of pyeloplasty. The proposed risk of devascularizing the ureter if operated upon simultaneously at both poles is virtually eliminated.

Polyurethane Internal Ureteral Stents in Treatment of Stone Patients: Morbidity Related to Indwelling Times

The morbidity and complications associated with use of internal polyurethane ureteral stents in a series of 290 stone patients treated endourologically or with extracorporeal shock wave lithotripsy were retrospectively reviewed. Of the 299 stents retrieved 141 were also tested for patency to relate the rate of luminal blockage with stent caliber, indwelling time and clinical evidence of obstruction in the stented tract. Stent indwelling times ranged from a few days to 18 months: 11.3% were indwelling longer than 6 months and 1.9% were lost to followup. Incrustation occurred in 9.2% of the stents retrieved before 6 weeks, 47.5% indwelling 6 to 12 weeks and 76.3% thereafter. In 19 cases over-all (6.4%) an auxiliary procedure was required to decrease incrusted stone burden and enable stent retrieval. Other complications included stent migration (3.7%), infection (6.7%) and breakage (0.3%). Despite a 30% rate of luminal blockage in stents retrieved after indwelling times up to 3 months, the incidence of clinical obstruction in stented tracts up to 3 months was 4%, confirming other reports that significant urine flow occurs around rather than through hollow, vented stents. Our findings underline the importance of restricting the use of stents to stone patients who will be reliable at followup. Morbidity was minimal if stent indwelling times did not exceed 6 weeks.

Mode of inheritance of hypertrophic cardiomyopathy in Iceland. Echocardiographic study.

We used an abnormally thick interventricular septum (greater than or equal to 1.3 cm) as an echocardiographic marker to find the inheritance pattern of hypertrophic cardiomyopathy among relatives of eight patients who had that disease at necropsy. Forty normal subjects served as a control group. Fifty-eight family members were examined and 18 (41%) of the 44 first degree relatives had hypertrophic cardiomyopathy. The overall inheritance pattern was consistent with an autosomal dominant genetic disorder and in one family a recessive trait could be excluded. The diagnosis of hypertrophic cardiomyopathy can be difficult clinically as only 13% of our patients had serious symptoms and only 30% had abnormal auscultatory findings. The electrocardiogram is a useful screening test among relatives as it was abnormal in 20 (87%) of those who had an abnormally thick septum. Symmetric septal hypertrophy was found in 30% of patients with cardiomyopathy in this study and only 17% had clinical evidence of obstruction.

Patient presentation: Panel discussion: Endometriosis of the ileum: Four cases with obstruction

0 B s T R u c T I o N of the ileum by endometriosis occurs only as frequently as 0.7 to 0.8 per cent of all cases of endometriosis treated surgically, and it is, therefore, an unusual finding. l, 3l 7 The 4 cases detailed in this report occurred in 354 operative cases, representing all charts coded as endometriosis, over a twenty year period (1950 to 1970) in a 450 bed, general, city-county hospital. This is an incidence of 1.1 per cent. Excellent historical reviews of this disease have been published during the past decade, so no attempt will be made to review this information here.*> 4, G In a typical case, a woman of low parity, about 35 to 40 years old, develops intestinal-type abdominal cramping, associated with nausea, vomiting, and abdominal distention, at the time of her menses. Occasionally, symptoms of total small bowel obstruction appear with the onset of a menstrual cycle. According to most reports, significant lesions of the ileum have been accompanied by moderate to severe pelvic lesions. In some of the cases, no clinical evidence of obstruction had been noted prior to operation. In most severe cases, treatment has included bilateral oophorectomy. It is commonly accepted that most extragenital lesions subside after this treatment. It is likely, therefore, that a number of these ileal lesions are overIooked.s* s In Melody’s6 survey of 36 cases of ileal obstruction, 35 lesions were located in the terminal 10 cm. of ileum. The majority of all cases have been reported as occurring in the terminal ileum. Recently, however, Rio and associates’ reported a case in which the site of obstruction was the jejunem. The other 6 cases in their report did occur in the terminal ileum.

An experimental study of resection and replacement of the superior vena cava

A review of the literature on the treatment of obstruction of the superior vena cava and its replacement is presented. Experiments were performed on fourteen dogs using nylon and teflon prostheses for replacement. Edwards-Tapp nylon prostheses were implanted in seven dogs, two of which had undergone partial occlusion of the superior vena cava. Teflon tubes were used for replacement of the superior vena cava in the remaining seven animals, one of which had undergone partial ligation of the superior vena cava and transaction of the azygos vein. The teflon prostheses showed excellent results in seven dogs followed up to six months. Superior vena caval prostheses of nylon in the other seven dogs were less successful as shown by necropsy with narrowing in all the prostheses. Only one animal in this group, however, had complete occlusion by thrombus, and in the remaining six there was no clinical evidence of obstruction, and venous pressures remained normal postoperatively.

EFFECT OF "AVERTIN" ON THE CEREBROSPINAL FLUID PRESSURE

Since January, 1930, Avertin has been the general anesthetic of choice in the neurosurgical service of the Cleveland Clinic Hospital. This anesthetic has been employed in 130 neurosurgical operations with the most gratifying results and with no undesirable effects. The dosage has been as a routine the same, 100 mg. of Avertin per kilogram of body weight. As far as can be determined clinically, Avertin apparently does not cause as great an increase in intracranial tension as do other general anesthetics, although it has been shown by spinal puncture that there is some increase in pressure following its administration. Also it has been observed that when Avertin was used as an anesthetic in encephalography, the ventricles occasionally failed to empty, even though there was no clinical evidence of obstruction in the ventricular system. It is possible that this failure of the ventricles to empty is due to an intracranial vascular

On steam boilers and the causes of their explosion

The morbidity and complications associated with use of internal polyurethane ureteral stents in a series of 290 stone patients treated endourologically or with extracorporeal shock wave lithotripsy were retrospectively reviewed. Of the 299 stents retrieved 141 were also tested for patency to relate the rate of luminal blockage with stent caliber, indwelling time and clinical evidence of obstruction in the stented tract. Stent indwelling times ranged from a few days to 18 months: 11.3% were indwelling longer than 6 months and 1.9% were lost to followup. Incrustation occurred in 9.2% of the stents retrieved before 6 weeks, 47.5% indwelling 6 to 12 weeks and 76.3% thereafter. In 19 cases over-all (6.4%) an auxiliary procedure was required to decrease incrusted stone burden and enable stent retrieval. Other complications included stent migration (3.7%), infection (6.7%) and breakage (0.3%). Despite a 30% rate of luminal blockage in stents retrieved after indwelling times up to 3 months, the incidence of clinical obstruction in stented tracts up to 3 months was 4%, confirming other reports that significant urine flow occurs around rather than through hollow, vented stents. Our findings underline the importance of restricting the use of stents to stone patients who will be reliable at followup. Morbidity was minimal if stent indwelling times did not exceed 6 weeks.