These studies were performed to establish more effective surgical method for correcting congenital atresia coli in calves. Distal colon fistulation, proximal colon fistulation and colon anastomosis which could be applied for surgical repair of intestinal obstruction were carried out in goatlings experimentally and in calves with atresia coli clinically. After treatment of the animals clinical signs, blood component values, body weight gain, survival and necropsy findings were observed. In goatlings, clinical signs after colon fistulation were diarrhea, anorexia and vitality loss, and those of proximal colon fistulation group were severer than those of distal colon fistulation group. Surviviability after operation was 9~16 weeks in distal colon fistulation group, 2~8 weeks in proximal colon fistulation group, and 2-3 days in colocolic anastomosis group, respectively. There were no alterations in blood component values among experimental groups. Weight gain rates were 54.6% in distal colon fistulation group and 42.9% in proximal colon fistulation group compared with those of control. Necropsy findings observed in experimental groups were distension of intestine and excessive fluid in abomasum and intestine. Two calves with atresia coli died 1 day and 6 days after operation but one with colon fistulation survived more than two months. Preoperative clinical signs in calves with atresia coli were abdominal distension, progressive anorexia, no defecation and postoperative clinical signs wert diarrhea and periodic abdominal distension. After operation there were no alterations in blood component values between the calf with atresia coli and control calf. Weight gain rate of calf with atresia coli was similar to that of control but revealed the tendency to decrease from the 2nd month after operation. Necropsy findings observed in two calves with atresia coli were intestinal distension. intraluminal excessive fluid, blind atretic sac and absence of intrarectal content. It was concluded that proximal or distal colon fistulation could be available for surgical correction of congenital atresla coli and prognosis of distal colon fistulation was better than of proximal colon fistulation, but that extensive colocolic anastomosis could not be compatible with life in ruminants.
Kim, Young-Jin;Cho, Hyun-Min;Yoon, Chee-Soon;Lee, Chan-Kyu;Lee, Tae-Yeon;Seok, June-Pill
Journal of Chest Surgery
/
v.44
no.2
/
pp.178-182
/
2011
Background: We analyzed the results of surgical reduction and fixation of ribs under thoracic epidural anesthesia and analgesia (TEA) in patients who had no more than 3 consecutive rib fractures with severe displacement to examine the clinical usefulness of this method. Materials and Methods: From May 2008 to March 2010, 35 patients underwent surgical reduction and fixation of ribs under TEA. We reviewed the indications for this technique, number of fixed ribs, combined surgical procedures for thoracic trauma, intraoperative cardiopulmonary events, postoperative complications, reestablishment of enteral nutrition, and ambulation. Results: The indications of TEA were malunion or nonunion of fractured ribs in 29 (82.9%; first operation) and incompletely ribs under previous general anesthesia in 6 (17.1%; second operation). The average number of fixed ribs per patient was 1.7 (range: 1~3). As a combined operation for thoracic trauma, 17 patients (48.6%) underwent removal of intrathoracic hematomas, and we performed repair of lung parenchyma (2), wedge resection of lung (1) for accompanying lung injury and pericardiostomy (1) for delayed hemopericardium. No patient had any intraoperative cardiopulmonary event nor did any need to switch to general anesthesia. We experienced 3 postoperative complications (8.6%): 2 extrapleural hematomas that spontaneously resolved without treatment and 1 wound infection treated with secondary closure of the wound. All patients reestablished oral feeding immediately after awakening and resumed walking ambulation the day after operation. Conclusion: Thoracic epidural anesthesia and analgesia (TEA) may positively affect cardiopulmonary function in the perioperative period. Moreover, this technique leads to an earlier return of gastrointestinal function and early ambulation without severe postoperative complications, resulting in a shortened hospital stay and lowered costs.
The purpose of this study was to use as a basic data to develop suitable nursing intervention program and decide an appropriate intervention time after assessing shoulder range of motion in postmastectomy from 2 weeks to 3 month. 147 patients are chosen as study subject among patients who were in recovery of 2weeks, 1month, 2months and 3 months after surgical operation which is modified radical mastectomy. Data were collected at oncology medicine local and general surgery local in Seoul National University Hospital from May, 2003 to October, 2003. The range of motion of the shoulder(flexion, extension, abduction, internal rotation, external rotation) were examined. Analysis of data that shoulder range of motion average and standard deviation, percentage of the unaffected side and affected side compare with normal shoulder range of motion. Paired t-test was adopted to analyze the difference between affected side and unaffected side. Conclusion from this study is as following, 1. The most serious problem was external rotation (0.56%) and internal rotation is the next (19.9%) in 5 kinds of shoulder range of motion in 2 weeks after surgical operation 2. There was no difference in internal rotation after post operation 3 months but there were differences and shown to recover more than 90% in flexion and abduction. Also shoulder function incresed in flextion less than 80% and more than 80% in external rotation. As this study finding was shown that shoulder range of motion did not get back perfectly except of internal rotation and extension in point of 3 months after breast cancer surgical operation. External rotation was specially shown the lowest result so it is needed to exercise for improving their physical functioning recovery in postmastectomy patients. And it is suggested to study for helping to postmastectomy patients' physical and psycosocial functions with the early rehabilitation program which is based on these results.
A 31 year-old male patient underwent surgical treatment of the pseudoaneurysm of the ascending aorta complicating after the Bentall operation, He had undergone the replacement of the ascending aorta using the composite valved graft with direct coronary reimplantation under the diagnosis of the annuloaortic ectasia of ascending aorta associated with Marfan syndrome. Eleven months after the operation, he started to feel dyspnea and anterior chest pain, and was diagnosed as pseudoaneurysm around the ascending aortic graft. The second operation consisted of the dacron patch closure of the defect of the aortic graft which was the hole for previous coronary reimplantation, and the anastomosis between the coronary orifice and the aortic graft with the intermediate graft of a 10mm woven dacron tube, and suture closure of the fistula opening from the aneurysm. His postoperative course was uneventful and discharged without complication. He is doing well 10 months postoperatively.
This 27 year-old male patient had severe mandibular prognathism (right and left mesio-occlusion were 0.4㎝ and 1.2㎝ , respectively). He had good oral health relatively exception of missing teeth. We examined all of his oral and skeletal status with full mouth x-ray taking, study model, and cephalogram. His general condition was good but above examination indicated the surgical operation for the mandibular prognathism. His laboratory tests were within normal limits. We determined surgical operation which was done by extraoral approach bilaterally. Incisions were made bilaterally 1.5㎝ beneath the inferior border of the mandible in the selected area and then the inferior border of the ascending rami was exposed. Retracting the periosteum to the lingual and buccal a slight amount, the cut in the bone was performed by use of bone drill. Avoiding T.M.J. troubles, the proximal segmant was not fixed to anterior segment, being in overlapping state buccally, in order to expect a natural healing by the environmental muscles and ligaments. We had immobilization with intermaxillary fixation by using the multiple Stout's method. He was discharged 17 days after operation. His general condition and operation results were good and satisfactory.
This report documents the clinical k pathologic features of 33 patients treated for thymoma for 11 years & 6 months between September 1977 and February 1989. At the Thoracic & Cardiovascular Surgery, Yonsei University, College of Medicine of the group, 31 patients treated with surgery were examined for the result of operation & prognosis. Mean age was 50 years. Thirteen were female and twenty were male. Dyspnea on exertion and chest discomfort were common in the patients without myasthenia gravis. Fourteen patients[42.6%] had myasthenia gravis and one patient had autoimmune thyroid disease. Four patients[12.1%] presented without symptoms attributable to their thymoma. Histologic review disclosed 12[36.4%] epithelial thymoma, 10[30.3%] mixed lymphoepithelial, 9[27.3%] lymphocytic, 1[3.0%] spindle cell and 1[3.0%] unknown cell thymoma. They were classified according to Masaoka`s clinical staging criteria; by these criteria, 8 patients were stage I, 5 patients were stage II, 15 patients were stage III and 3 patients were stage IV. Total excision of mass was possible in 20 patients. Partial excision of mass in 4 patients and biopsy in 7 patients were carried out during the operation. There was only one operation mortality. Follow-up was possible in 26 patients and follow-up ranged from 4 months to 10.5 years[mean 28.9 months]. One-year survival rates were 77.8% and eight patients expired during follow-up period. Eleven[78.6%] patients with myasthenia gravis were improved after the operation. This observation suggests that the most significant factor determining the survival is whether or not total surgical excision had been performed.
In cleft palate surgery, the environment is especially critical when suturing. Encum-bered, obstructive space in the environment can hinder a suture while using the Dingman mouth gag. We introduced a novel but simple draping technique. A simple hand towel is placed over the gag. A hole is cut out in the middle according to each patient's mouth. After making the hole, the hand towel is soaked in water and gently squeezed. Then the towel is properly placed over the Dingman mouth gag. Dripping water on the hand towel during the suture helps keep it in place. Using this draping technique, we cut 14 minutes of operation time compared to the average operation time of the past 2 years. There were several disadvantages in previous draping method. First, long suture material may easily get caught. Second, the operation field can easily be contaminated. Third, focusing on the operation becomes difficult due to the obstruction. This draping technique can compensate for the disadvantages of the previous Dingman mouth gag.
Purpose: This study was done to identify nursing interventions clinically applicable to relieve displeasure and anxiety of patients having an operation in which loud noise was unavoidable. Methods: Participants were 34 patients scheduled to have a total knee replacement. They were assigned to either the control (17 patients) or experimental (17 patients) group. Data were collected from September to November 2010. The instruments used for the survey included noise-control earplugs, a noise level meter (TES-1358) and a structured scale measuring degree of noise perception, displeasure and anxiety. Data were analyzed using frequency, percentage, standard deviation, $x^2$-test, and t-test with the SPSS WIN 18.0 program. Results: Hypothesis 1: 'The displeasure levels of the experimental group of patients wearing earplugs will be lower than the control group patients without earplugs' was accepted (t=-20.769, p<.001). Hypothesis 2: 'The anxiety levels of the experimental group of patients wearing earplugs will be lower than the control group patients without earplugs' was accepted (t=-6.298, p<.001). Conclusion: Based on these findings, the wearing of earplugs for patients having a surgical operation with loud noises is recommended as an effective nursing intervention to relieve patient displeasure and anxiety during their surgical operations.
Purpose: Many researches about various surgical method for blepharoptosis have already been introduced. But researches for complications after blepharoptosis correction is relatively insufficient. So, this study was performed to recognize common complications that arised depending on the severity of blepharoptosis, levator function and surgical method. Methods: 250 patients who have underwent surgical treatment for blepharoptosis from 1987 to 2006 were employed in this study. Patients were categorized by severity of blepharoptosis, levator function and surgical method that has been used. Complications after blepharoptosis correction were analyzed. Result: Total of 64 patients had occurred complications, the specifics are as following; undercorrection 22, asymmetry 13, overcorrection 12, lagophthalmos 4, abnormal eyelid contour 4, exposure keratitis 3, ectropion 2, inclusion cyst 2, infection 1 and conjunctival prolapse 1. Among above patients, 3 patients had two kinds of complications. 21 patients was underwent secondary surgery due to complication. Conclusion: Evaluating the outcomes of the secondary surgery, the early correction was better than the late correction. The most of the complications were recovered through conservative and surgical treatments. The most of the complications (47 patients) were undercorrection, asymmetry, overcorrection and took 73.4% of the total complications. The more severe the blepharoptosis and the more poor the levator function, the rate of complications were higher. According to the operation methods, most complications were occurred in levator operation, frontalis transfer and OOM flap.
Total hip arthroplasty(THA) considerably depends on high-experienced doctors because of high difficulty of the operation. Selection of acetabular cup's and femoral implant's position is closely related with success or failure of THA. Nevertheless the selection has usually depended on doctor's eye measurement, which makes the position accuracy of artificial joint lower after THA, often resulting in revision of THA. The present study determined a method to select accurately the position of acetabular cup and femoral implant through surgical simulation with 3D characteristic geometrical information of patient's pelvis and femur. We examined the change of femoral anteversion angle and neck-shaft angle accompanied by the change of acetabular cup's position and the insertion position of femoral implant. As result of analyzing geometrical information through different surgical simulations, we found that it was possible to select the accurate position of acetabular cup and femoral implant. It is expected to help doctors get experienced in THA operation through repetitive surgical simulations using the method suggested in the study.
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