30,992 research outputs found
Bronchoscopy for Removal of Aspirated Tracheobronchial Foreign Bodies at Kenyatta National Hospital, in Kenya
Background: This study was aimed at defining the presentation, morbidity and mortality following inhalation and subsequent removal of tracheobronchial foreign body using a rigid bronchoscope.Methods: This was a retrospective, cross-sectional study undertaken in the Ear Nose and Throat-Head and Neck Surgery Unit of Kenyatta National Hospital. The study population consisted of patients with brochoscopically proven tracheobronchial foreign body. Case notes of 107 consecutive admissions with brochoscopically verified tracheobronchial foreign bodieswere analyzed for age, sex, time interval between inhalation and removal, duration of stay in hospital, complications and mortality.Results: The vast majority of patients were below 3 years of age and 63% of them presented within 3 days after onset of symptoms. The right bronchus was the most frequent destination of inhaled foreign bodies (50.5%) followed by the left bronchus (17.8%) and carina (14.2%) inthat order. The turnover of patients with inhaled foreign bodies was high with 86.9% being discharged within 6 days after surgery. The bronchoscopic procedure was uneventful in 76.6% of patients. Repeat bronchoscopy was performed in three patients with one undergoing eventual thoracotomy.Intraoperative cardiac arrest occurred in 5 cases (4.6%) with successful resuscitation in 2 and mortality in three (2.7%) % cases.Conclusion: Bronchoscopic removal of inhaled foreign bodies remains one of the riskiest otolaryngologic emergencies in Kenyatta National Hospital partly because of involvement of the life sustaining airway and partly because of lack of ideal equipment and adequate expertise. The need for hands on experience and close cooperation and familiarity between theanaesthesiologist and the bonchoscopist is emphasized
Perioperative and anesthetic deaths: toxicological and medico legal aspects
Background: Anesthesia has become safer during decades, though there is still a preventable mortality; the complexity of medical and surgical interventions, increasingly older and sicker patients, has created a host of new hazards in anesthesiology. In this paper, some of these perioperative (PO) fatal adverse events are investigated in terms of health responsibility. Selective literature research in several data bases, concerning perioperative and anesthetic deaths and medical responsibility, was performed. Main text: A generally accepted definition of the anesthesia and perioperatory-related death still remains one of the major concerns in forensic pathology, and the terms “operative deaths” and “anesthetic deaths” are usually applied inaccurately within the medico-legal literature. Such events involve comprehensively PO fatalities and allow for subtle separation of natural and unnatural death, at least from the prospective of forensic pathology. Iatrogenic deaths in this field can be separated into some major categories, as attributable to previous patient’s unfavorable conditions or depending from surgical procedure per se (such as PO cardiac and cerebrovascular events). In this review, the authors carried out syntheses of specific research areas regarding epidemiology, complications of general and spinal anesthetic, failure in airway management and patient’s circulatory homeostasis, and adverse drugs reactions; analysis considering the challenge of anesthetic-related mortality, epidemiology and classifications, by indicating causal chain of death, in respect of both contributing and associated anesthetic and surgery facts. Conclusions: Perioperative quality control programs and its relevance for medico-legal evaluation are emphasized as, although mortality rates have decreased worldwide over the last decades, however, preventable drug-related deaths still happen. Such fatal events have to be considered within the field of forensic pathology experts, with regard of malpractice claims, to implement a strategy for preventing potentially fatal complications
Sir Charles Ballance : A pioneer surgeon in Malta
Charles Ballance was arguably the most eminent surgeon stationed in Malta during the Great War. On the 16th February 1918 he removed a bullet from the heart of trooper Robert Martin who was shot in the chest in Salonika three months previously. Sadly the patient died of sepsis one month later, a fact that obscured the importance of this landmark operation, the third of its kind worldwide. This paper sets the background to this achievement and celebrates the impact that this surgical pioneer left on our shores.peer-reviewe
Prevalence of disorders recorded in Cavalier King Charles Spaniels attending primary-care veterinary practices in England
Concerns have been raised over breed-related health issues in purebred dogs, but reliable prevalence estimates for disorders within specific breeds are sparse. Electronically stored patient health records from primary-care practice are emerging as a useful source of epidemiological data in companion animals. This study used large volumes of health data from UK primary-care practices participating in the VetCompass animal health surveillance project to evaluate in detail the disorders diagnosed in a random selection of over 50% of dogs recorded as Cavalier King Charles Spaniels (CKCSs). Confirmation of breed using available microchip and Kennel Club (KC) registration data was attempted
Ten Years of Experience Training Non-Physician Anesthesia Providers in Haiti.
Surgery is increasingly recognized as an effective means of treating a proportion of the global burden of disease, especially in resource-limited countries. Often non-physicians, such as nurses, provide the majority of anesthesia; however, their training and formal supervision is often of low priority or even non-existent. To increase the number of safe anesthesia providers in Haiti, Médecins Sans Frontières has trained nurse anesthetists (NAs) for over 10 years. This article describes the challenges, outcomes, and future directions of this training program. From 1998 to 2008, 24 students graduated. Nineteen (79%) continue to work as NAs in Haiti and 5 (21%) have emigrated. In 2008, NAs were critical in providing anesthesia during a post-hurricane emergency where they performed 330 procedures. Mortality was 0.3% and not associated with lack of anesthesiologist supervision. The completion rate of this training program was high and the majority of graduates continue to work as nurse anesthetists in Haiti. Successful training requires a setting with a sufficient volume and diversity of operations, appropriate anesthesia equipment, a structured and comprehensive training program, and recognition of the training program by the national ministry of health and relevant professional bodies. Preliminary outcomes support findings elsewhere that NAs can be a safe and effective alternative where anesthesiologists are scarce. Training non-physician anesthetists is a feasible and important way to scale up surgical services resource limited settings
Bioresorbable Film for the Prevention of Adhesion to the Anterior Spine After Anterolateral Discectomy
Background context The development of scar tissue and adhesions postoperatively is a natural consequence of healing but can be associated with medical complications and render reoperation difficult. Many biocompatible products have been evaluated as barriers or deterrents to adhesions. Purpose To evaluate the efficacy of a bioresorbable polylactide film as a barrier to adhesion formation after anterolateral discectomy. Study design Experimental study. Methods Seven, skeletally mature female sheep underwent a retroperitoneal approach to the anterolateral lumbar spine. A discectomy was performed at two levels with an intervening unoperated disc site. One site was treated with a polylactide film barrier (Hydrosorb Shield; MacroPore Biosurgery, San Diego, CA) affixed with tacks manufactured from the same material. The second site was left untreated. Treatment and control sites were randomly assigned. Postmortem analysis included scar tenacity scoring on five spines and histological evaluation on two spines. Results The application of the Hydrosorb film barrier allowed a definite dissection plane during scar tenacity scoring and there was a significant difference in the development of adhesions to the disc between the control and treated sites. Histological evaluation revealed evidence of barrier formation to scar tissue and no significant adverse inflammatory reactions. Conclusions Hydrosorb Shield appears to be an effective postoperative barrier to scar tissue adhesion after anterolateral discectomy. The use of polylactide tacks was beneficial to affix the barrier film in place. Safety issues associated with delayed healing or adverse response to the film or tacks were not observed. Hydrosorb film may be useful as an antiadhesion barrier facilitating dissection during surgical revision in anterior approaches to the spine. Further studies are indicated to evaluate the performance of the bioresorbable material as an antiadhesion barrier in techniques of spinal fusion and disc replacement
Leadership, clinical freedom and costcontainment: lessons from recent history
Public Health provision, free at the point of contact, is espoused in many countries within the European Union. The method of funding, whether by direct taxation, or via insurance companies, is not so much a problem as the ever increasing cost of medical advances and are. Clearly structures need to be in place to manage this service, and the modern doctor is called upon to play an ever- increasing role. The British National Health Service has served as a template for our local health service, albeit with various divergences along the way. This article highlights the central role of the doctor, as leader and manager, in effecting constant change within the service.peer-reviewe
Acellularized Biomaterial From Embryonic Stem Cells
Compositions containing acellularized biomaterial derived from differentiating pluripotent cells, for example, embryonic stem cells are provided. The acellularized biomaterial can be used to promote wound healing, promote tissue regeneration, or inhibit scarring. Methods for using the acellularized biomaterial for treating degenerative diseases are also provided.Georgia Tech Research Corporatio
An unusual intracardiac foreign body following penetrating thoracic injury
Foreign bodies in the heart after thoracic trauma may result in fatal outcome. We report a pendant inside the pericardium after penetrating injury that did not cause major cardiac injury with a favorable outcome
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