Post thoracotomy spinal cord compression in a child. A word of caution

AbstractINTRODUCTIONOxidised regenerated cellulose is a commonly used haemostatic agent in surgery which, in rare cases, has been held responsible for severe complications.PRESENTATION OF CASEA 6-year-old girl developed flaccid paraplegia following the excision of a large thoracic ganglioneuroblastoma. Magnetic resonance imaging revealed spinal cord compression at the T10–11 level and the patient underwent emergency decompression via the previous thoracotomy. At operation the causative factor was found to be a mass consisted of cellulose used at the original procedure to control local bleeding in the vicinity of the intervertebral foramen.DISCUSSIONThe accessibility of the spinal canal from the thoracic cavity through the opening of the intervertebral foramen may allow migration of material and in this case oxidized regenerated cellulose, commonly used during cardiothoracic procedures, can cause rare but severe complications such as compression of the spinal cord.CONCLUSIONThe value of hemostatic gauze is well established in cardiothoracic surgery. However, surgeon should be cautious with the application of material in the proximity of the intervertebral foramen, especially if this is to leave behind after the completion of the procedure

Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients

INTRODUCTION: Central venous cannulation is crucial in the management of the critical care patient. This study was designed to evaluate whether real-time ultrasound-guided cannulation of the internal jugular vein is superior to the standard landmark method. METHODS: In this randomised study, 450 critical care patients who underwent real-time ultrasound-guided cannulation of the internal jugular vein were prospectively compared with 450 critical care patients in whom the landmark technique was used. Randomisation was performed by means of a computer-generated random-numbers table, and patients were stratified with regard to age, gender, and body mass index. RESULTS: There were no significant differences in gender, age, body mass index, or side of cannulation (left or right) or in the presence of risk factors for difficult venous cannulation such as prior catheterisation, limited sites for access attempts, previous difficulties during catheterisation, previous mechanical complication, known vascular abnormality, untreated coagulopathy, skeletal deformity, and cannulation during cardiac arrest between the two groups of patients. Furthermore, the physicians who performed the procedures had comparable experience in the placement of central venous catheters (p = non-significant). Cannulation of the internal jugular vein was achieved in all patients by using ultrasound and in 425 of the patients (94.4%) by using the landmark technique (p < 0.001). Average access time (skin to vein) and number of attempts were significantly reduced in the ultrasound group of patients compared with the landmark group (p < 0.001). In the landmark group, puncture of the carotid artery occurred in 10.6% of patients, haematoma in 8.4%, haemothorax in 1.7%, pneumothorax in 2.4%, and central venous catheter-associated blood stream infection in 16%, which were all significantly increased compared with the ultrasound group (p < 0.001). CONCLUSION: The present data suggest that ultrasound-guided catheterisation of the internal jugular vein in critical care patients is superior to the landmark technique and therefore should be the method of choice in these patients

Sclerosing mesenteritis affecting the small and the large intestine in a male patient with non-Hodgkin lymphoma: a case presentation and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>Sclerosing mesenteritis is a rare disease resembling a mesenteric tumour. We present here a case of sclerosing mesenteritis that affected both the large and the small intestine of the patient. Therapeutic and diagnostic issues are discussed.</p> <p>Case presentation</p> <p>A 62-year-old man with a history of non-Hodgkin lymphoma presented with fatigue, a palpable tender abdominal mass and clinical signs of progressing intestinal obstruction. The preoperative evaluation failed to prove recurrence of the lymphoma or any other definite diagnosis. A laparotomy was performed through a midline incision. The mesentery resembled a tumour-like thickened and fibrotic mass. Abundant, rigid intestinal loop adhesions were observed. Diffuse fibrotic infiltration of the ileum and of the sigmoid colon, which obviously affected the intestinal vascular supply, were identified. A right colectomy and partial sigmoidectomy were performed. Pathological evaluation revealed extensive myofibroblastic reaction of the mesentery with accompanying loci of fat necrosis and areas of inflammation. A diffuse fibrotic infiltration that focally showed a ground-glass appearance was observed. The post-operative course was complicated by respiratory insufficiency and infections and the patient died 2 months after the operation.</p> <p>Conclusion</p> <p>Sclerosing mesenteritis that affects both the small and the large intestine is extremely rare. The disease is characterized by myofibroblastic reaction, fat necrosis and diffuse fibrosis of the mesentery. Pathological confirmation may be required for definite diagnosis. If the disease is characterized by severe and diffuse fibrosis, then the application of surgical therapy may be problematic.</p

Force transfer between existing concrete columns with reinforced concrete jackets subjected to axial loading

The study presents the results of an experimental program concerning the force transfer between reinforced concrete (RC) jackets and existing columns. It includes 16 columns (core) of low concrete strength (fc= 24,37 MPa) with square section (150 mm side, 500 mm height, and scale 1:2). Fourteen columns have full jacketing at all four faces with 80 mm thickness and contain longitudinal bars and closed stirrups spaced at 25 mm, 50 mm or 100 mm. Twelve specimens contain dowels between the interface of old and new concrete. Ten columns have initial (construction) damages. All columns are subjected to repeated (pseudo-seismic) axial compression with increasing deformation cycles up to failure. The effects of the initial damages, of the reinforcement of the interface (dowels) and of the confinement generated by the stirrups are investigated through their axial forcedeformation (slip) diagrams.The study presents the results of an experimental program concerning the force transfer between reinforced concrete (RC) jackets and existing columns. It includes 16 columns (core) of low concrete strength (fc= 24,37 MPa) with square section (150 mm side, 500 mm height, and scale 1:2). Fourteen columns have full jacketing at all four faces with 80 mm thickness and contain longitudinal bars and closed stirrups spaced at 25 mm, 50 mm or 100 mm. Twelve specimens contain dowels between the interface of old and new concrete. Ten columns have initial (construction) damages. All columns are subjected to repeated (pseudo-seismic) axial compression with increasing deformation cycles up to failure. The effects of the initial damages, of the reinforcement of the interface (dowels) and of the confinement generated by the stirrups are investigated through their axial forcedeformation (slip) diagrams

Upgraded experimental database of uniformly FRP confined concrete columns for assessment of existing recommendations

Current studies concerning statistical elaboration and review of existing experimental results in databases, usually include only the characteristic maximum bearing stress and corresponding strain values as well as the failure values. In cases of uniform confinement failure values may be defined at 20% or 15% drop of maximum load or when the FRP jacket is fractured. Several recommendations include additional failure criteria related to lateral strain level or axial strain level in order to ensure the integrity of the columns or avoidance of shear failures among else. An experimental database based on the whole stress-strain response curves is presented, providing significant data necessary for the extensive assessment of the existing design models. The experimental database contains information on: a) the failure stress and strain values, b) on the stress and strain values at the level of 0.4% lateral strain as well as c) on the stress at the level of 1% axial strain. FRP confinement strength models recommended by existing guidelines are compared against experimental values