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 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The incidence of parturition difficulties from 239 sheep and 21 does from the last seven lambing periods was recorded at a clinic for obstetrics. Without exception the does were housed under extensive conditions by hobby-breeders. The sheep also originated predominantly from hobby-breeders and in a smaller amount from professional breeders, both practising extensive housing. The incidence of manual deliveries (m.d.) in both species was lower (39.3% in sheep; 42.8% in does) than that of caesarean sections (c.s; 57.3% in sheep; 47.7% in does). In a small amount the obstetrics were solved via fetotomy. The practical proceedings concerning the different methods of therapies including analgesia, surgical approaches and postoperative treatments are described. In sheep ringwomb was the dominating reason for dystocia for m.d. (43.5%) as well as for c.s. (73.7%), followed by obstetrics due to fetal abnormal presentation and/or position or posture (25.2% m.d.; 1.1% c.s.), secondary oversized fetuses due to postmortal emphysema and edema (19.1% m.d.; 10.7% c.s.), followed by primary relative or absolute oversized fetuses (1.0% m.d.; 4.8% c.s.) and simultaneously presentation of multiple fetuses (4.2% m.d.). Other causes of dystocia remained scarce (i.e. uterine torsion, hydrallantois, abdominal or perineal hernia). There rested an amount of sheep (7.1%) with preterm s.c. because of continuous pressure and pain symptoms followed by infections or injuries of the prolapsed vagina and/or rectum, pregnancy toxemia and other reasons. The main indication for fetotomy in sheep were fetuses with postmortal edema and emphysema (80.0%), deformity of the kids (20.0%) respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Birth difficulties in sheep and goats--evaluation of patient outcome from seven lambing periods in an obstetrical clinic]. 772 May 47

Laparoscopic cholecystectomy is a relatively new surgical procedure which is enjoying ever-increasing popularity and presenting new anesthetic challenges. The advantages of shorter hospital stay and more rapid return to normal activities are combined with less pain associated with the small limited incisions and less postoperative ileus compared with the traditional open cholecystectomy. The efficacy of laparoscopic appendectomy and hemicolectomy has been recently evaluated. However, there have been no prospective randomized studies to date comparing laparoscopic with traditional laparotomy techniques. The physiological effects of prolonged pneumoperitoneum and the longer duration of surgery with the laparoscopic techniques are of concern. The application of laparoscopic inguinal hernia repair may be limited because, unlike traditional surgical hepair, general anesthesia is required and concerns have been expressed about the duration of surgery and the possibility of hernia recurrence. Notwithstanding case reports and series describing successful diaphragmatic and hiatus hernia repair using a laparoscopic surgical technique, the frequently encountered complications of cervical surgical emphysema, pneumothorax, and pneumomediastinum, attributed to passage of insufflating gas through weak points or defects in the diaphragm, must be of major concern. Anesthesiologists must maintain a high index of suspicion for these potential complication and must undertake appropriate monitoring. If there is clinical evidence of a tension pneumothorax, immediate chest tube decompression is indicated. Intraoperative complications of laparoscopic surgery are mostly due to traumatic injuries sustained during blind trocar insertion and physiological changes associated with patient positioning and pneumoperitoneum creation. The choice of anesthetic technique for upper abdominal laparoscopic procedures is most frequently limited to general anesthesia. Controlled ventilation avoids hypercarbia, and an anesthetic technique incorporating antiemetics and nonsteroidal anti-inflammatory agents has reduced postoperative nausea and vomiting following laparoscopic cholecystectomy. The use of nitrous oxide during laparoscopic procedures remains controversial. Laparoscopic cholecystectomy is a major advance in the management of patients with symptomatic gall-bladder disease. However, in the present era of cost containment, older and sicker patients may present for this procedure on the day of surgery without adequate preoperative evaluation. Anesthesiologists should thus be prepared to recommend deflation of the pneumoperitoneum and possibly conversion to an open procedure if hemodynamic, oxygenation, or ventilation difficulties arise during the procedure.
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PMID:Laparoscopic surgery--anesthetic implications. 783 96

We present our experience of 26 cases of cystic adenomatoid malformations of the lung (CAM), treated in the Department of Pediatric Surgery in our hospital between 1967-1991. There were two clinical pictures: one neonatal severe respiratory distress and successive repeated pulmonary infection appearing after the patient's first year of life and requiring both urgent diagnosis and treatment. Embryological development determines the pathologic classification of this entity in 3 types. Basic examinations by image are analyzed, bearing in mind their diagnostic value and the patterns they show. After analysing all the conditioning factors, no explanation has been found to the different course that this affectation (< 1 month and > 1 year of age respectively). Normally, neonatal mortality is closely related to other malformations, particularly to cardiovascular ones. Differential diagnosis is very important in the neonatal period, especially with regard to diaphragmatic hernia, lobar emphysema and pulmonary cysts. All these cases have been verified and classified by means of a pathologic study, which has shown the need for surgical operation. In the follow up of the patients no alteration has been noticed in the pulmonary function.
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PMID:[Adenomatous cystic pulmonary malformations: presentation of 26 cases]. 808 98

This research proposes a new treatment for pulmonary hypertension secondary to perivascular emphysema, the so-called air-block syndrome. Vibrations applied on the thorax can fraction air bubbles around the vessels into smaller ones, facilitating their redistribution and reabsorption, thus reducing the extrinsic compression on pulmonary vasculature. In cats, pulmonary lesions were obtained by continuous insufflation of air at 40 cm H2O for 2 minutes in a lower lobe of the lung. Vibrations applied on the thorax were produced with the same apparatus as used by physiotherapists to eliminate pulmonary secretions. Thirty-three cats were divided into three groups: lesions without treatment, lesions treated by vibrations, and controls. A catheter was inserted in the pulmonary artery for pulmonary artery pressure (PAP) measurements. One carotid was cannulated for arterial pressure and blood gases monitoring. Morphometric analysis of the lung had also to be carried out in all cases. Results showed a very significant decrease on pulmonary hypertension in the treated group after only 20 minutes of treatment by vibrations (P < .004). Results also confirmed the very strong relationship between PAP variations and perivascular emphysema found on postmortem examination (r2 = .64, P < .01). Extrinsic compression decreased from 29% in the untreated group to 21% in the treated one (n = 10 pairs, P < .08). These data suggest that vibrations may be a new simple treatment for pulmonary hypertension, when perivascular emphysema is involved, and could be useful in congenital diaphragmatic hernia as well in other neonatal pathologies.
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PMID:A new method of treatment for pulmonary hypertension in congenital diaphragmatic hernia: experimental study in cats. 830 66

Advances in laparoscopic technique have provided the opportunity to perform preperitoneal herniorrhaphy and potentially avoid the morbidity associated with open techniques. From January 1991 to May 1992, two primary surgeons repaired 63 inguinal hernias (42 indirect, 20 direct, 1 femoral) on 48 patients using a standardized laparoscopic technique. The hernia defect was visualized laparoscopically, and the peritoneum anterior to the defect was incised. The hernia sac was dissected from the inguinal canal. The hernia defect was then loosely packed with rolled 1 x 6-inch polypropylene mesh (average number of rolls used was 3.4). A sheet of polypropylene mesh (average 5 x 8 cm) was then placed over the mesh rolls and the hernia defect and anchored with an endostapler. The peritoneum was closed over the mesh sheet with standard laparoscopic clips. There were 44 males and 4 females in the study group. The mean age was 55 years (range, 17-89 years). The mean follow-up was 5.8 months (range, 1-12 months). Thirty-three patients underwent unilateral hernia repair, and 15 patients underwent bilateral hernia repair. Clinically unsuspected contralateral hernias were identified at the time of laparoscopy in seven patients. The mean duration of surgery was 118 minutes (range, 80-165 minutes) for bilateral hernia repair, and 70 minutes (range, 45-100 minutes) for unilateral hernia repair. All patients with laparoscopic hernia repairs were treated on a same-day or less-than-24-hour in-hospital stay. Complications were designated as minor, moderate, or severe. There were 14 minor complications, which included subcutaneous hematomas at the trocar site, scrotal ecchymosis, groin swelling emphysema, and testicular asymmetry.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Laparoscopic hernia repair: a preliminary report. 847 47

This is the first report, to our knowledge, of a case of massive subcutaneous emphysema during totally preperitoneal laparoscopic hernia repair causing a "respiratory acidosis" with a systemic pH 7.20 and a pCO2 of 64 and PO2 of 84. The acidosis was corrected by increased mechanical ventilation. It appears that because of its lack of defined borders, the preperitoneal space is particularly vulnerable to the formation of massive subcutaneous emphysema. Thus, there is a large potential surface area for CO2 absorption. The complication may be prevented by increased attention to the length of fascial incisions, inflation of balloon expanding devices, and securing gripping devices in the port sites.
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PMID:Iatrogenic "respiratory acidosis" during laparoscopic preperitoneal hernia repair. 880 20

Gastro-oesophageal reflux disease (GORD) is a chronic disorder requiring lifelong medical therapy or surgery. In the present study we evaluated the postoperative course and effect of laparoscopic fundoplication on GORD in 27 patients with a median age of 44 (range 27-73) years. Fifteen were operated on with a Watson procedure, and 12 patients had a Nissen procedure. Median stay and convalescence after surgery was one and 10 days respectively. Three patients had to be converted into open surgery (bleeding: two, unclear anatomy: one). No major complications were seen, but four patients had postoperative complications (stenosis requiring dilatation: one, subcutaneous emphysema: one, wound sepsis: one, hernia: one. The two latter complications were seen in converted patients). Two patients had prolonged dysphagia, and two patients needed slight dietetic advice for gasbloat syndrome. In 25 of 27 patients good control of GORD was accomplished as judged by symptomatology, endoscopy and 24-hour pH measurements. It is concluded that laparoscopic fundoplication offers good control of GORD with few complications, and short hospital stay and convalescence.
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PMID:[Laparoscopic fundoplication in gastroesophageal reflux]. 904 46

To test the hypothesis that perfluorochemical (PFC) instillation may reduce the pulmonary trauma commonly associated with conventional gas ventilation, we studied 12 lambs with normal lungs and 10 with pulmonary hypoplasia secondary to congenital diaphragmatic hernia (CDH). We used mechanical ventilation for up to 3.5 h, with and without tracheal instillation of LiquiVent PFC liquid. At the end of experimentation lungs were fixed for morphometrical analysis of their components and pulmonary trauma was evaluated by measurement of the perivascular compression index (PCI = % perivascular emphysema/% vessels). In normal lungs good gas exchange and respiratory mechanics were obtained with all modes of ventilation, with no statistical difference in the index of pulmonary trauma with or without instillation of LiquiVent (P >0.05). In the hypoplastic lungs, tracheal instillation of PFC liquid after 30 min of conventional gas ventilation significantly improved PaCO2 (from 107+/-8 to 55+/-6 mmHg, P <0.05), pH (from 7.00+/-0.03 to 7.29+/-0.04, P <0.05), compliance (from 0.08+/-0.01 to 0.25+/-0.03 ml/cmH2O . kg, P <0.05), and ventilatory index (from 1,445+/-148 to 794+/-139, P <0.05). Survival was 6/6 animals with PFC ventilation compared to 1/4 with conventional gas ventilation with no more pulmonary trauma (mean PCI 12.6+/-1.8 vs. 11.4+/-4.0%, P >0.05) for a longer mean ventilatory period in the PFC group. We conclude that the PFC liquid technique of ventilation can improve respiratory physiology when conventional gas ventilation alone is proving inefficient. There was no significant difference in pulmonary trauma at morphometrics between gas and partial liquid ventilation.
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PMID:Morphometrics of normal and hypoplastic lungs in preterm lambs with gas and partial liquid ventilation 906 11

Lung hernia is an uncommon entity usually resulting from trauma or inadequate healing from recent or remote thoracic surgery. A small percentage may be congenital. Four cases are reported, each demonstrating lung herniation resulting from either accidental or postsurgical trauma. Most of the previous cases have been reviewed in various surgical and radiological journals with only rare mention in the emergency medicine literature. Because emergency physicians may be the most immediate contact for patients who develop a lung herniation, they should be cognizant of this entity as a possible delayed complication to chest wall injury. Awareness of the clinical and radiological appearance of lung hernia will help to avoid its confusion with other conditions such as subcutaneous emphysema, chest tumor, pneumothorax, or a focus of infection.
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PMID:Lung hernia. 914 81

To test the hypothesis that perfluorochemical (PFC) instillation may reduce the pulmonary trauma commonly associated with conventional gas ventilation, we studied 12 lambs with normal lungs and 10 with pulmonary hypoplasia secondary to congenital diaphragmatic hernia (CDH). We used mechanical ventilation for up to 3.5 h, with and without tracheal instillation of LiquiVent PFC liquid. At the end of experimentation lungs were fixed for morphometrical analysis of their components and pulmonary trauma was evaluated by measurement of the perivascular compression index (PCI = % perivascular emphysema/% vessels). In normal lungs good gas exchange and respiratory mechanics were obtained with all modes of ventilation, with no statistical difference in the index of pulmonary trauma with or without instillation of LiquiVent (P >0.05). In the hypoplastic lungs, tracheal instillation of PFC liquid after 30 min of conventional gas ventilation significantly improved PaCO2 (from 107+/-8 to 55+/-6 mmHg, P <0.05), pH (from 7.00+/-0.03 to 7.29+/-0. 04, P <0.05), compliance (from 0.08+/-0.01 to 0.25+/-0.03 ml/cmH2O . kg, P <0.05), and ventilatory index (from 1,445+/-148 to 794+/-139, P <0.05). Survival was 6/6 animals with PFC ventilation compared to 1/4 with conventional gas ventilation with no more pulmonary trauma (mean PCI 12.6+/-1.8 vs. 11.4+/-4.0%, P >0.05) for a longer mean ventilatory period in the PFC group. We conclude that the PFC liquid technique of ventilation can improve respiratory physiology when conventional gas ventilation alone is proving inefficient. There was no significant difference in pulmonary trauma at morphometrics between gas and partial liquid ventilation.
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PMID:Morphometrics of normal and hypoplastic lungs in preterm lambs with gas and partial liquid ventilation. 915 36


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