RESUMEN
In the years 1991-2000, 6873 patients were operated at the Department of General, Oncological and Thoracic Surgery in Central Medical Hospital in Warsaw, due to cholecystolithiasis. Extrahepatic bile ducts were damaged in 9 patients. These lesions included: pointed damage with electrocoagulation, bile duct incision or sectioning and the resection of the main stem of bile duct. In 7 patients, the lesions were diagnoses intraoperatively and the conversion was performed. Two patients required laparotomy at later stage. As complications developed, some patients required relaparotomy. Two patients died due to multiorgan failure. The injury of extrahepatic bile ducts remains a dangerous, potentially life-threatening complication of cholecystectomy, irrespective of the operative technique applied.
Asunto(s)
Conductos Biliares Extrahepáticos/lesiones , Colecistectomía Laparoscópica/efectos adversos , Humanos , Complicaciones PosoperatoriasRESUMEN
A 45-year-old male, with symptoms of many years standing of gastro-oesophageal reflux disease, was subjected, under general anaesthesia, to laparoscopic fundoplication. Tracheal intubation yielded no problems but great difficulties were encountered during tube insertion into the oesophagus. After surgery, aphonia developed. Laryngological examination demonstrated paralysis of the left vocal cord. Voice strength returned to the pre-operative status after 3 months, and laryngological examination confirmed normal mobility of both cords. The possible cause of the complication was damage to the left recurrent laryngeal nerve which occurred during insertion of the tube into the oesophagus. Gastro-oesophageal reflux disease causing 'acid laryngitis' can create conditions favouring this type of complication.
Asunto(s)
Hernia Hiatal/complicaciones , Laparoscopía/efectos adversos , Parálisis de los Pliegues Vocales/etiología , Esófago , Fundoplicación/efectos adversos , Fundoplicación/métodos , Reflujo Gastroesofágico/cirugía , Humanos , Complicaciones Intraoperatorias , Intubación/efectos adversos , Intubación Intratraqueal , Masculino , Persona de Mediana Edad , Traumatismos del Nervio Laríngeo RecurrenteRESUMEN
The experiment was carried out on 27 sheep with traumatic-haemorrhagic shock caused by a gunshot wound produced using high-velocity missiles from the HM16 rifle. Sixty minutes after injury treatment with blood-replacing fluids was started. In Group I Ringer's solution with sodium lactate pH 8.2 was infused, Group II received Ringer's solution with sodium lactate pH 6.5, and Group III was given Ringer's solution alone. Volume of the infused fluid exceeded threefold the volume of lost blood. During and after fluid replacement blood samples were drawn for biochemical investigations and haemodynamic disturbances were carefully observed. In conclusion, we can say that Ringer's solution filled the vascular bed and improved tissue perfusion, but it failed to correct metabolic and acid-base equilibrium disturbances to such a degree and for as long a long time as did Ringer's solution with lactate.