Hepatic to azygos connection by autologous pericardial roll for Fontan completion

Techniques for performing the Fontan completion procedure after Kawashima procedure have developed in recent years. This paper presents a case in which we performed an off-pump hepatic-to-azygos connection by autologous pericardial roll via thoracotomy as a modified Fontan completion. The operation wound was limited, and the short-term follow-up was satisfactory. Notably, it was found that the autologous pericardium might require a shorter period of anticoagulation treatment than what is needed for artificial prosthetic materials.

Free vascularized fibular graft in patient with skeletal defect after neurofibroma surgical excision of forearm

The free vascularized fibular graft has been successfully applied as a reconstruction option in patient with large secondary skeletal defects result from excision of pathologic tissue after neurofibroma surgical excision. It provides a strong cortical strut for reconstruction of defects, so that the free vascularized fibular graft is ideal for ulna reconstruction. A 22-year-old male with lump in his right forearm for 3 months previously which become bigger and more painful. There was also sings of ulnar nerve disfunction. From the CPC result, we diagnosed forearm neurofibroma. We performed wide excision and reconstruction using free vascularized fibular graft. On the last follow up, the active and passive ranges of motion (ROM) of 4th and 5th metacarpal was measured with the help of a goniometer. The ulnar neurological state was tested by manual testing and graded on the Medical research council (MRC) scale. Four weeks after surgery, the operation wound at the right forearm and right lower leg was good and no infection signs. The graft viability was good with compromised vascularity. The post-operative passive and active ROM of the 4th and 5th metacarpal able did full extend. The post-operative sensoris level of the ulnar area improved from pre-operative sensoris level.Post-operative follow-up, in the early period (up to 6 weeks) we monitor the graft viability. Our case reported good result in the operation wound, the graft viability, the passive and active ROM of the 4th and 5th metacarpal and the sensoris level of the ulnar area.

Modern strategy of abdominal delivery

In recent decades, increasing rate of cesarean section became one of the most prominent problems of obstetrics, that raises a problem of management of the labor in women with uterine scar, related with high risk of maternal and fetal complications. Complete reparation of the myometrium after cesarean section is an actual issue. Development and implementation of materials influencing the reparative processes in the myometrium is the problem of current interest of modern obstetrics. «Collost» is one of the new generation materials based on unreconstructed type I collagen, which contributes to fibroblast activation and migration, new collagen fibers formation, migration of immunocompetent cells and endothelial cells, providing the formation of vasculature of operation wound zone, excluding chaotic growth of scar tissue.

Paraspinal gossybipoma: A case report and review of the literature

ABSTRACTSpinal or paraspinal retained surgical sponges (gossybipoma or textiloma) are rare incidents and mostly asymptomatic in chronic cases, but can be confused with other masses such as a hematoma, an abscess or a tumor. In chronic cases, the presentation can be as late as decades after the initial surgery; however, some gossybipomas cause infection or abscess formation in the early stages. The authors report a 40-year-old woman with a history of operation for lumbar disk herniation before 8 months, and got admitted with a complaint of serous fluid leakage from the operation wound. In this report, the authors discuss the clinical presentation, the radiologic findings and the differential diagnosis of gossybipoma.

Infected Urine as a Risk Factor for Postprostatectomy Wound Infection

Objective:To study the relation of preoperative infected urine and postprostatectomy wound infection in patients with and without indwelling bladder catheters.Design:Patients undergoing prostatectomy were evaluated for the presence of infected urine prior to prostatectomy and postoperative wound infection. They were further divided into patients with indwelling urinary catheter and catheter-free patients. All had received antibiotic prophylaxis.Patients: One hundred fifty consecutive patients undergoing open prostatectomy-mean age was 67 years; 100 patients with an indwelling catheter for a mean period of 50 days; 50 catheter-free patients.Results:Wound infection was found in 19 of 81 (23.5%) and in 6 of 69 (8.7%) patients with infected and sterile urine, respectively p = .028). In patients with indwelling catheters prior to operation, wound infection was 22.4% when urine was infected and 8.3% when it was not. In patients without catheters, infected urine was associated with 40% of wound infections, as compared with 8.9% of wound infections in patients with sterile urine. Organisms obtained from infected wound and urine were identical in 84% of cases. These results were obtained despite antibiotic prophylaxis.Conclusions:Wound infection has been demonstrated to be a postprostatectomy complication directly related to the presence of urinary infection at surgery; thus, elective prostatectomy should be deferred until urine becomes sterile.

A comparison between tracer gas and tracer particle techniques in evaluating the efficiency of ventilation in operating theatres

Operating theatres are ventilated for a number of reasons, one of them being to keep numbers of airborne bacteria low at the operation wound. No matter how air is brought into the room, bacteria are removed by dilution rather than by air currents, because of turbulence caused by heat liberated by people and equipment and by movement in the room (Lidwell & Williams, 1960). With ventilation rates up to 20 air changes/hour, the dilution may differ at different sites in the room depending on the design of its ventilation system.

Pre-operative disinfectants for surgeons’ and nurses’ hands

Pre-operative washing of the hands and forearms is intended to remove dirt, desquamating epidermis, ‘transient’ contaminating organisms, and as many ‘resident’ bacteria as possible. In addition to the normally harmless bacteria commonly found on the skin certain pathogens can colonise minimally damaged skin1 and in some individuals Staph. aureus appears to colonise normal skin. Such organisms can readily reach the operation wound, since surgical gloves often become punctured and conventional gowns are poor barriers to bacteria from the forearm.