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  • 1
    ISSN: 1436-2813
    Keywords: adult groin hernia ; transversalis fascia ; Marcy repair ; iliopubic tract repair ; Moschcowitz repair
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A new method of hernioplasty for adult groin hernias centering on repair of the transversalis fascia was assessed by a questionnaire conducted every five years on adult patients who had received the above operation. The efficacy of this method was evaluated in terms of the postoperative quality of life and prevention of recurrence of groin hernias. Over the last 9 years, 834 adult patients with 921 groin hernias, including bilateral lesions, have undergone the above procedure and overall, favorable results were obtained, with only one case of recurrence (0.1 per cent) being reported. Contralateral herniation, which has been often reported following Bassini's or Hatakoshi's method, was found in only one of our patients although the number of patients who complained of pain in the operated region was comparatively high, being 51 cases or 11.4 per cent.
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  • 2
    ISSN: 1436-2813
    Keywords: bile duct cancer ; superficial spreading ; early carcinoma ; lymphatic micrometastasis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report herein the case of a 69-year-old woman with extrahepatic bile duct cancer which had developed superficially along the ductal mucosa without penetrating the fibromuscularis. She underwent a pancreatoduodenectomy; however, micrometastases were found histologically in the regional lymph nodes and she died with involved para-aortic lymph nodes and bone metastases 14 months after the operation.
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  • 3
    ISSN: 1438-8359
    Keywords: Glyceryl trinitrate ; Sodium nitroprusside ; Aerosol ; Inhalation ; Pulmonary hypertension
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose To test the hypothesis that inhalation of aerosol of glyceryl trinitrate or sodium nitroprusside might produce selective pulmonary vasodilation, causing an improvement of oxygenation with minimal systemic hypotension as inhaled nitric oxide gas, we investigated the effect of inhaled nitroglycerine and sodium nitroprusside aerosol on hemodynamics and oxygenation in dogs with pulmonary hypertension. Methods Pulmonary hypertension was induced by a continuous infusion of 1.0 to 4.0μg·kg−1·min−1 U-46619 in anesthetized and mechanically ventilated dogs. Aerosol preparations consisted of normal saline, 250, 500, 1000, and 2000 ppm solutions of either glyceryl trinitrate or sodium nitroprusside were administered sequentially via the breathing circuit. Results Inhaled nitroglycerine and sodium nitroprusside aerosol caused neither selective pulmonary vasodilation nor improved oxygenation in this pulmonary hypertension model, unlike inhaled nitric oxide gas. Conclusion These findings suggest that inhaled nitroglycerine and sodium nitroprusside aerosol is not effective in improving hemodynamic derangement or oxygenation in pulmonary hypertension. However, the effect of the substances in higher dose ranges remains to be defined.
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  • 4
    ISSN: 1438-8359
    Keywords: Key words SMA aneurysm ; Tetanus ; Transcatheter embolization
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 5
    ISSN: 1438-8359
    Keywords: Epidural ; Test dose ; Clonidine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Clonidine premedication has been increasingly used in clinical anesthesia. Though clonidine was found to alter pressor responses to various sympathomimetics, its effect on epidural test dose efficacy to detect intravascular injection has never been evaluated. Eighty healthy patients were randomly assigned to one of four groups, each of which was anesthetized with 1% end-tidal isoflurane and 67% nitrous oxide in oxygen after endotracheal intubation. The control-epinephrine group (n=20) given no clonidine premedication received 3 ml of 1.5% lidocain with 15 μg epinephrine (1:200000) intravenously to simulate an intravenously administered epidural test dose. The control-saline group (n=20) given no clonidine premedication received 3 ml of normal saline intravenously. The clonidine-epinephrine and clonidine-saline groups (n=20 each) were identical to the control groups, but were premedicated with oral clonidine, approximately 5 μg·kg−1, 90 min before induction of general anesthesia. Heart rate (HR) and systolic blood pressure (SBP) were measured by a blinded observer at 20-s intervals for 4 min after intravenous injections of the test dose or saline. Following intravenous test dose injection, there were no significant diferences between the control-epinephrine and the clonidine-epinephrine groups in mean maximum increments of both HR (28±3vs 30±3 bpm, [mean±standard error], respectively) and SBP (46±6vs 45±4 mmHg, respectively). Six patients in the control-epinephrine and 4 in the clonidine-epinephrine group developed negative HR responses (HR increment <20 bpm). Since HR and SBP were essentially unchanged in the two groups receiving saline, sensitivities (negative predictive values) based on the HR criterion (positive if ≥20 bpm increase in HR) were 80% and 70% (83% and 77%) with and without clonidine premedication, respectively (P>0.05 between groups). However, when a modified HR criterion (positive if ≥10 bpm increase in HR) was used, sensitivities, specificities, and positive and negative predictive values were all 100% with or without clonidine. On the other hand, all of 20 patients in the control-epinephrine and the clonidine-epinephrine groups exhibited positive SBP responses (SBP increment ≥15 mmHg). Therefore, based on the SBP criterion, sensitivities, specificities, and positive and negative predictive values were all found to be 100% regardless of the presence of clonidine. We conclude that oral clonidine 5μg·kg−1 premedication alters neither (a) hemodynamic responses to the intravenously administered epidural test dose containing 15 μg epinephrine, nor (b) the efficacy for detecting intravascular injection based on either criterion in adult patients under stable isoflurane anesthesia.
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  • 6
    ISSN: 1438-8359
    Keywords: Key words: Early oral intake ; Spinal anesthesia ; Bowel function
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose. We investigated the tolerability of early oral feeding (EOF) and its effects on the recovery of bowel function after spinal anesthesia. Methods. Thirty-one healthy adult patients undergoing knee arthroscopy or arthroscopic surgeries were randomly assigned to either the EOF group (n = 16) or the nil per os (NPO, n = 15) group. Spinal anesthesia was performed using hyperbaric tetracaine solution in all patients. Patients in the EOF group were allowed free access to solid and liquid food immediately after surgery before analgesia from spinal tetracaine resolved. Oral intake was prohibited for 24 h after completion of surgery in the NPO group. Results. Two patients in each group were mildly nauseated without the need for treatment. While degree of appetite determined by a visual analog scale before the first meal and time to the first gas emission showed no significant differences between groups, the median time to the first defecation in the EOF group (20.6 h) was significantly shorter than that of the NPO group (33.5 h, P = 0.005). No other complications associated with anesthesia, surgery, or EOF were noted. Conclusion. Our results suggest that the restriction of EOF after surgery not involving the gastrointestinal tract under spinal anesthesia may not be rational, and that EOF may facilitate recovery of bowel function.
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  • 7
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    Journal of anesthesia 13 (1999), S. 217-229 
    ISSN: 1438-8359
    Keywords: Key words: Obesity ; Pregnancy ; Pathophysiology ; Anesthetic management
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 8
    ISSN: 1432-1459
    Keywords: Olivopontocerebellar atrophy ; Late cerebellar cortical atrophy ; Positron emission tomography ; Cerebellar metabolism ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Fourteen patients with spinocerebellar degeneration (SCD) were subjected to MRI and PET studies. The quantitative MRI data revealed significant cerebellar and pontine atrophy in the patients with olivopontocerebellar atrophy (OPCA), and cerebellar atrophy in the patients with late cerebellar cortical atrophy (LCCA). We failed to demonstrate significant differences in the pons between LCCA patients and normal controls. PET measurements revealed decreases in cerebral oxygen metabolic rate (CMRO2) in the cerebellar hemisphere and vermis in both groups of patients. The markedly decreased cerebral blood flow (CBF) and CMRO2 in the pons were found only in the patients with OPCA. PET data corrected for the tissue shrinkage on the basis of MRI morphometry indicated a net reduction in cerebellar CMRO2 and CBE The present study has demonstrated that a combination of functional and anatomical data offers further evidence in favour of the current acceptable classification of SCD based on clinicopathological grounds. Our data further suggest that the amount of atrophy in the cerebellum could not fully account for the decreased metabolic rates observed in PET studies.
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  • 9
    ISSN: 1432-0851
    Keywords: Polysaccharide SPR-901 ; Antitumor effect ; Oral administration ; T cell effector
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The growth of MethA tumor was significantly inhibited by oral administration of the α-glucan SPR-901 in BALB/c (+/+) mice but not in nude mice. Mice treated orally with SPR-901 exhibited an augmentation of antigen-specific resistance against rechallenge with the tumor cells. The tumor-neutralizing activity of regional lymph node cells from MethA-bearing mice against the tumor was augmented by oral administration of SPR-901. The tumor-neutralizing activity of lymph node cells from SPR-901-treated mice mainly appeared in Lyt2+cells. Furthermore, lymphokine-activated killer activity of these cells was enhanced by administration of SPR-901. The antitumor effect of SPR-901 was abrogated in mice depleted of either L3T4+ or Lyt2+ cells, and in cyclosporin-A-treated mice. These results suggest that Lyt2+ cells are important effector cells in MethA-bearing mice orally adminstered SPR-901 and that functional exertion of both Lyt2+ and L3T4+T cells is necessary for the antitumor effect of orally administered SPR-901 in vivo.
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  • 10
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Methods: To determine effects of i.v. metoclopramide, atropine and their combination on the airway pressures at which gastric insufflation occurs in children, 45 healthy infants and children (ASA I) received an inhalational induction of anaesthesia with sevoflurane, N2O and O2. A blinded observer used a stethoscope to auscultate over the upper abdomen for any air entry. First, proximal airway pressure was slowly increased by closing the pop-off valve of the anaesthesia machine until gas was heard entering the stomach (pop-off point, control measurement). If the peak inspiratory pressure reached 40 cm H2O, the patient was to be excluded from the study. Then, all subjects randomly received i.v. atropine 0.01 mg·kg–1, metoclopramide 0.2 mg·kg–1, or atropine 0.01 mg·kg–1 plus metoclopramide 0.2 mg·kg–1 (n=15 each), and determination of the pop-off point was repeated 5 min later. The stomach was evacuated before each measurement. Results: Atropine significantly decreased the pop-off point [from 21 ± 3 to 19 ± 2 cm H2O (mean ± SD), P < 0.05], while metoclopramide significantly increased the pop-off point (from 20 ± 3 to 26 ± 6 cm H2O, P < 0.05). The combination of metoclopramide and atropine did not alter the pop-off point (from 20 ± 2 to 19 ± 5 cm H2O). Conclusions: Since metoclopramide exerts only mild effect on the pop-off point, cricoid pressure still remains the standard anaesthetic practice to prevent gastric insufflation in children. Prophylactic i.v. metoclopramide may be restricted to, and its clinical usefulness should be determined in, symptomatic patients with gastro-oesophageal reflux.
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