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13 results

  • 3.13.5 - Traumatic Abdominal and Pelvic Injuries

  • from Section 3.13 - Severe Trauma and Multiple Injuries
  • Edited by Ned Gilbert-Kawai, The Royal Liverpool Hospital, Debashish Dutta, Princess Alexandra Hospital NHS Trust, Harlow, Carl Waldmann, Royal Berkshire Hospital, Reading
  • Book:
    Intensive Care Medicine
    Published online:
    27 July 2023
    Print publication:
    01 December 2021, pp 408-410

  • Summary

    Key Learning Points

    1. 1. Abdominal and pelvic trauma may be concealed.

    2. 2. Exsanguination into the abdominal or pelvic cavity should be managed in the resuscitation phase.

    3. 3. Obvious abdominal distension is an indication for laparotomy.

    4. 4. Post-operative ileus should be anticipated and managed appropriately.

    5. 5. Abdominal compartment syndrome is a serious complication of abdominal/pelvic trauma.

  • Use of a dissected intravenous giving set to assist large metal oesophageal foreign body removal in rigid oesophagoscopy

  • M Robinson, R Pankhania, A Pelser, P Bowles
  • Journal:
    The Journal of Laryngology & Otology / Volume 136 / Issue 4 / April 2022
    Published online by Cambridge University Press:
    16 September 2021, pp. 366-367
    Print publication:
    April 2022
  • Background

    Oesophageal foreign body removal may be challenging. If a foreign body is sufficiently high risk and cannot be retrieved via oesophagoscopy, laparotomy may be required as the foreign body migrates distally.

    Objective

    This paper presents the use of the plastic tubing from an intravenous giving set, combined with rigid oesophagoscopy grasping forceps, in order to improve purchase and obtain sufficient traction on a large, smooth, metallic distal oesophageal foreign body (knife).

    Results and conclusion

    This method offers an option for removal of oesophageal foreign bodies that may be rendered challenging with traditional metal grasping forceps given the lack of purchase and traction afforded by a ‘metal on metal’ grip, potentially avoiding the need for open surgery.

  • 22 - Bradyarrhythmias

  • from Section 4 - Cardiovascular emergencies
  • Edited by Kaushal Shah, Jarone Lee, Kamal Medlej, American University of Beirut, Scott D. Weingart
  • Book:
    Practical Emergency Resuscitation and Critical Care
    Published online:
    05 November 2013
    Print publication:
    24 October 2013, pp 153-157

  • Summary

    This chapter discusses the diagnosis, evaluation and management of solid organ abdominal trauma. It presents special circumstances which make diagnosis and management of solid organ abdominal trauma difficult in pediatric patients. The primary survey for solid organ abdominal trauma should be aimed at determining which patients need immediate laparotomy versus those that are stable for further diagnostic workup. Vital signs provide a key to hemodynamic stability. Unstable patients with blunt or penetrating trauma to the abdomen require immediate laparotomy. All patients after significant trauma, both blunt and penetrating, should receive screening AP chest radiography. Given small anteroposterior diameter and developing abdominal musculature, children are more vulnerable to blunt forces. The most likely reason for sudden deterioration in a trauma patient with solid organ injury is hemorrhagic shock; therefore more aggressive resuscitation has to be considered and the process to get patient to the OR for laparotomy is facilitated.

  • 54 - Pneumonia

  • from Section 9 - Infectious disease emergencies
  • Edited by Kaushal Shah, Jarone Lee, Kamal Medlej, American University of Beirut, Scott D. Weingart
  • Book:
    Practical Emergency Resuscitation and Critical Care
    Published online:
    05 November 2013
    Print publication:
    24 October 2013, pp 362-366

  • Summary

    This chapter discusses the diagnosis, evaluation and management of acute mesenteric ischemia. The diagnosis should be considered in those older than 50 years, presenting with nonspecific abdominal pain and risk factors for the disease. The physician must have a high index of suspicion as the history of the disease may be difficult to obtain. The chapter lists clinical presentations of the subtypes of mesenteric ischemia. Emergent laparotomy is indicated, especially if signs of peritonitis are present. Surgery is generally the standard of care for mesenteric arterial embolism and thrombosis. Surgery is done to determine the extent of damage, to find the underlying cause, to revascularize viable bowel, and to resect infarcted bowel. Second-look procedures are often performed 24-48 hours after the initial surgery in order to restore continuity and assess extension of ischemia to ensure that at-risk or ischemic bowel is not used for the final anastomosis.

  • Chapter 32 - Molecular and cellular integrity of cultured follicles

  • from Section 8 - In vitro follicle growth and maturation
  • Edited by Jacques Donnez, Université Catholique de Louvain, Belgium, S. Samuel Kim, University of Kansas
  • Book:
    Principles and Practice of Fertility Preservation
    Published online:
    04 February 2011
    Print publication:
    03 February 2011, pp 389-396

  • Summary

    Patients with early cervical cancer (FIGO stage IB1 or less) are conventionally considered treated with a surgical approach while those with more advanced disease are treated by radiotherapy with concurrent chemotherapy. Dargent's operation is the realization of a laparoscopic pelvic lymph-node dissection associated with a radical cervical amputation through a vaginal approach. Dargent's operation or radical trachelectomy enables preservation of fertility among women with early cervical cancer. The benefits of Dargent's operation are linked to the laparoscopic approach, which reduces the risk of adhesions on pelvis organs and the vaginal route that allows the preservation of uterine body and its optimal vascularization. Following the excellent results achieved by the Dargent's operation, several teams have proposed operating variants through laparotomy or laparoscopy. These modifications are subject to criticism because they are usually associated with the section of the uterine arteries and, thus, with a partial devascularization of the uterus.

  • 5 - Surgical principles

  • Edited by Nigel Acheson, David Luesley
  • Book:
    Gynaecological Oncology for the MRCOG and Beyond
    Published online:
    05 August 2014
    Print publication:
    01 January 2011, pp 67-82

  • Summary

    Surgery has various applications in the management of cancer. This chapter discusses the roles performed by surgery such as: diagnosis, staging, treatment, reconstruction, and palliation. It reviews the intraoperative complications of laparotomy. A number of studies have proposed chemotherapy before definitive surgery in patients with advanced ovarian carcinoma. A significant number of women with recurrent disease will develop bowel obstruction, and surgery is often the palliation method of choice. Stage IB disease can be treated by surgery or radiotherapy, and the surgical options are radical vaginal hysterectomy and laparoscopic or extraperitoneal lymph node dissection, and radical trachelectomy with laparoscopic or extraperitoneal lymph node dissection. The standard surgical management for endometrial cancer in the UK has been total abdominal hysterectomy and bilateral salpingo-oophorectomy. Biopsy of a vulval lesion is essential for diagnosis before definitive surgery. Conservative surgery should be considered for young patients with early cervical cancer.

  • Chapter 10 - Cytogenetic factors in recurrent early pregnancy loss

  • Edited by Roy G. Farquharson, University of Liverpool, Mary D. Stephenson, University of Chicago
  • Book:
    Early Pregnancy
    Published online:
    05 October 2010
    Print publication:
    09 September 2010, pp 85-90

  • Summary

    The incidence of congenital uterine anomalies in the general population is between 0. 4% and 3. 2%. This chapter describes the principles of ultrasound diagnosis of uterine anomalies and compares the results with other available diagnostic modalities. The gold standard in the diagnosis of congenital uterine anomalies used to be a simultaneous laparotomy/ laparoscopy and hysteroscopy to visualize the serosal surface of the uterus and the endometrial cavity. The real breakthrough in ultrasound assessment of congenital uterine anomalies was the development of three-dimensional transvaginal probes. This technique involves the acquisition and storage of a volume of ultrasound information. Magnetic resonance imaging (MRI) has been shown to be effective for the diagnosis of congenital uterine anomalies with sensitivity and specificity up to 100%. The advent of three-dimensional ultrasound has greatly enhanced the ability to diagnose congenital uterine anomalies in an outpatient setting.

  • 63 - Ectopic and Heterotopic Pregnancies Following in Vitro Fertilization

  • from PART III - ASSISTED REPRODUCTION
  • Edited by Botros R. M. B. Rizk, University of South Alabama, Juan A. Garcia-Velasco, Hassan N. Sallam, Antonis Makrigiannakis, University of Crete
  • Book:
    Infertility and Assisted Reproduction
    Published online:
    04 August 2010
    Print publication:
    15 September 2008, pp 619-628

  • Summary

    The incidence of ectopic pregnancies is increased in assisted reproductive technology (ART) due to a higher number of embryos transferred and a higher prevalence of tubal disease in patients undergoing in vitro fertilization (IVF). The incidence of heterotopic pregnancies increased with increasing number of embryos transferred. Ectopic pregnancy occurs usually within the fallopian tubes. Abdominal pain is the most common clinical manifestation. Other symptoms and signs include vaginal spotting, amenorrhea, and a pelvic mass. The recent advances in ultrasound technology and the higher expertise of sonographers have improved the early diagnosis of ectopic pregnancies. The beta sub-unit of human chorionic gonadotropin (hCG) has been used to differentiate a developing viable intrauterine pregnancy from an abnormal pregnancy. Vascular endothelial growth factor (VEGF) is elevated in ectopic pregnancies. Methotrexate and mifepristone are used in the treatment of ectopic pregnancy. Laparoscopy, laparotomy and salpingectomy are the surgical options for treating ectopic pregnancies.

  • 34 - Reproductive Surgery for Endometriosis-Associated Infertility

  • from PART II - INFERTILITY EVALUATION AND TREATMENT
  • Edited by Botros R. M. B. Rizk, University of South Alabama, Juan A. Garcia-Velasco, Hassan N. Sallam, Antonis Makrigiannakis, University of Crete
  • Book:
    Infertility and Assisted Reproduction
    Published online:
    04 August 2010
    Print publication:
    15 September 2008, pp 318-326

  • Summary

    The optimal management approach to the infertile patient with endometriosis requires an evaluation of the extent of disease and the reproductive goals of the patient. The surgical approaches to endometriosis treatment are accomplished by laparotomy or laparoscopy. Surgical treatment for endometriosis-associated infertility employs techniques that are designed to minimize trauma, maintain hemostasis, and reduce operating time while facilitating the removal of all disease. The probability of conception may potentially be affected by other factors in addition to the outcome of surgery. In these patients, further assistance with ovulation induction or assisted reproductive technologies (ART) after surgery may be beneficial. Ovarian endometriomas are typically treated utilizing various techniques such as cyst stripping or ablation, drainage, and wide excision. The development of an endometriosis scoring system that has good correlation with the severity of reproductive impairment would contribute significantly to future studies.

  • Pharmacodynamic interaction of nitrous oxide with sevoflurane, desflurane, isoflurane and enflurane in surgical patients: measurements by effects on EEG median power frequency

  • H. Röpcke, S. Wirz, T. Bouillon, J. Bruhn, A. Hoeft
  • Journal:
    European Journal of Anaesthesiology / Volume 18 / Issue 7 / July 2001
    Published online by Cambridge University Press:
    16 August 2006, pp. 440-449
    Print publication:
    July 2001

  • Background and objective This study investigates the interaction of sevoflurane and nitrous oxide on EEG median power frequency of 2.5 Hz during surgery.

    Methods Sevoflurane concentrations required for electroencephalographic median power frequency between 2 and 3 Hz were measured in 25 patients during gynaecological laparotomies. Nitrous oxide was randomly administered at 0, 20, 40, 60 and 75 vol%, subsequently two different concentrations in each patient. The data were analysed using isobolographic analysis together with previously published data on nitrous oxide-isoflurane, -enflurane, or -desflurane interaction.

    Results The interaction is described by the equation: C volatile anaesthetic/C0 volatile anaesthetic + C N2O/C0 N2O = 1 (C is the concentrations for a drug combination to achieve the desired effect; C0 is the concentration for single drug use). The parameters are C0 isoflurane = 1.11 vol% (95% CI 1.03–1.19), C0 enflurane = 1.64 (1.52–1.77), C0 desflurane = 5.31 (4.92–5.73), C0 sevoflurane = 2.12 (1.96–2.29), C0 N2O = 174 (153–202). These parameters decrease by 6% (2.5–10) for every 10 years of patients’ age > 40 years.

    Conclusions The interaction is compatible with additivity. The potency of nitrous oxide to substitute the volatile anaesthetics is less than anticipated from previously reported MAC values.

  • The Management of Mass Casualties of Serious Earthquakes in China

  • Yi Bin Zhang
  • Journal:
    Prehospital and Disaster Medicine / Volume 16 / Issue S1 / June 2001
    Published online by Cambridge University Press:
    28 June 2012, p. S90
    Print publication:
    June 2001
    • Article
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  • Clinical Analysis of 1,076 Cases of Abdominal Injury

  • Bai Tie
  • Journal:
    Prehospital and Disaster Medicine / Volume 16 / Issue S1 / June 2001
    Published online by Cambridge University Press:
    28 June 2012, p. S15
    Print publication:
    June 2001
    • Article
      • You have access
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