RESUMO
Benign cystic teratoma (dermoid cyst) was managed laparoscopically in 25 cases (16 cyst excisions and 9 oophorectomies). Surgical procedures to avoid spill during ovarian cystectomy and oophorectomy were developed (14 cases). This series demonstrates a gradual evolution in surgical technique. Surgical outcome was good in all cases, complications were rare, and the procedure required a hospital stay less than 24 hours.
Assuntos
Cisto Dermoide/cirurgia , Neoplasias Ovarianas/cirurgia , Ovariectomia , Adolescente , Adulto , Feminino , Humanos , Complicações Intraoperatórias , Laparoscopia , Pessoa de Meia-Idade , Ovariectomia/métodosRESUMO
After prolonged cardiac arrest and reperfusion, global cerebral blood flow (gCBF) is decreased to about 50% normal for many hours. Measurement of gCBF does not reveal regional variation of flow or permit testing of hypotheses involving multifocal no-flow or low-flow areas. We employed the noninvasive stable Xenon-enhanced Computerized Tomography (Xe/CT) local CBF (LCBF) method for use in dogs before and after ventricular fibrillation (VF) cardiac arrest of 10 min. This was followed by external cardiopulmonary resuscitation (CPR) and control of cardiovascular pulmonary variables to 7 h postarrest. In a sham (no arrest) experiment, the three CT levels studied showed normal regional heterogeneity of LCBF values, all between 10 and 75 ml/100 cm3 per min for white matter and 20 and 130 ml/100 cm3 per min for gray matter. In four preliminary CPR experiments, the expected global hyperemia at 15 min after arrest, was followed by hypoperfusion with gCBF reduced to about 50% control and increased heterogeneity of LCBF. Trickle flow areas (LCBF less than 10 ml/100 cm3 per min) not present prearrest, were interspersed among regions of low, normal, or even high flow. Regions of 125-500 mm3 with trickle flow or higher flows, in different areas at different times, involving deep and superficial structures migrated and persisted to 6 h, with gCBF remaining low. These preliminary results suggest: no initial no-reflow foci (less than 10 ml/100 cm3 per min) larger than 125 mm3 persisting through the initial global hyperemic phase; delayed multifocal hypoperfusion more severe than suggested by gCBF measurements; and trickle flow areas caused by dynamic factors.
Assuntos
Isquemia Encefálica/diagnóstico por imagem , Circulação Cerebrovascular/fisiologia , Parada Cardíaca/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Animais , Isquemia Encefálica/etiologia , Reanimação Cardiopulmonar , Cães , XenônioRESUMO
Standard external cardiopulmonary resuscitation (CPR) steps A-B-C produce a low blood flow that may or may not preserve brain viability during prolonged cardiac arrest. A dog model was used with ventricular fibrillation (VF) of 20 minutes, reperfusion with brief cardiopulmonary bypass, controlled ventilation to 20 hours, and intensive care to 96 hours. A retrospective comparison was made of the results of one series, now called "group I" (n = 10)--which received CPR basic life support interposed from VF 10 to 15 minutes, and CPR advanced life support with epinephrine (without defibrillation) from VF 15 to 20 minutes--to the results of another series, now "control group II" (n = 10)--which received VF no flow (no CPR) for 20 minutes. All 20 dogs within protocol were resuscitated. All 10 of group I and 7 of 10 of group II survived to 96 hours. Pupillary light reflex returned after the start of cardiopulmonary bypass at 7.7 +/- 3.7 minutes in CPR group I, versus 16.3 +/- 7.4 minutes in control group II (P = .032). At 96 hours postarrest, final overall performance categories (1, normal; 5, brain death) were better in group I. Six of 10 dogs achieved normality (overall performance category 1) in group I, as compared with none of 10 in group II (P = .004). Final neurologic deficit score (0%, best; 100% worst) was lower (better) in group I (15% +/- 20%) than in group II (51% +/- 6%; P less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Encéfalo/irrigação sanguínea , Parada Cardíaca/fisiopatologia , Cuidados para Prolongar a Vida/métodos , Ressuscitação/métodos , Animais , Encéfalo/fisiologia , Isquemia Encefálica/prevenção & controle , Cães , Cardioversão Elétrica , Coração/fisiologia , Estudos Retrospectivos , Fatores de Tempo , Fibrilação Ventricular/fisiopatologiaRESUMO
Laparoscopic resection of full-thickness lesions of the anterior rectum followed by repair using a two-layer suture technique is described. Anterior rectal laceration occurred in two bowel-prepped women during excision of deep fibrotic endometriosis. Neither patient required subsequent surgery nor suffered any postoperative sequela. While not all rectal injuries are suitable for laparoscopic suture repair, in selected cases, bowel injury can be effectively managed laparoscopically without resorting to major abdominal surgery.
Assuntos
Endometriose/cirurgia , Laparoscopia/métodos , Neoplasias Retais/cirurgia , Adulto , Cicatriz , Feminino , Humanos , Neoplasias Pélvicas/cirurgia , Reto/cirurgia , Técnicas de SuturaRESUMO
Animal experiments with cardiac arrest and cardiopulmonary resuscitation (CPR) despite controlled insult and postinsult life support, have yielded variable individual outcomes. This report concerns 10 dog experiments with a standardized model of VF cardiac arrest with no flow for 10 min followed by CPR basic life support (BLS) from VF 10 to 15 min and then CPR advanced life support (ALS) with epinephrine at 15 min. Defibrillating countershocks began at 17 min, for restoration of spontaneous circulation. After controlled ventilation to 20 h and intensive care to 96 h, outcome was evaluated using the overall performance category (OPC) 1 (normal) (n5) vs. OPC 2-4 (impaired) (n5) (P less than 0.001). We searched for correlations between normal vs. impaired outcome in various prearrest, arrest and postarrest factors that are suspected to influence postarrest neurologic deficit. Prearrest variables were similar in the normal and impaired groups. Resuscitation variables were similar in both. Coronary perfusion pressure during CPR-ALS was higher in the normal outcome group (P = 0.03). Among postarrest variables, postarrest reperfusion pressure pattern (initial hypertensive bout), blood glucose, cardiac output, Hct, pHa, PaO2 and PaCO2 were the same. Our data support the importance of maximizing coronary perfusion pressure not only for restoration of heart beat but also as a possible predictor of improved cerebral outcome.