Severe case of postpartum-acquired haemophilia A after laparoscopic cholecystectomy.

Acquired factor VIII inhibitor, also known as acquired haemophilia A, has been associated with the postpartum state in young females. Treatment of acquired haemophilia A is focused on two goals: control of bleeding and eliminating the factor VIII inhibitor. Management requires successful intervention to accomplish both goals.

Helicobacter pylori is not the predominant etiology for peptic ulcers requiring operation.

As the number of patients requiring operation for peptic ulcer disease (PUD) declines, presumed contemporary ulcer etiology has largely been derived from medically treated patients not subjected to surgery. The purpose of this study was to examine the specific causes of PUD in patients requiring surgery. Our Acute Care Surgical Service registry was reviewed for patients operated on for complications of PUD from 2004 to 2009.

Rapid ventricular pacing due to electrocautery: a case report and review.

It is well known that the use of electrocautery during surgery can interfere with the functioning of pacemakers. The most common problem is that the electrocautery is interpreted by the pacemaker as cardiac electrical activity, which inhibits the pacemaker from firing, leading to bradycardia. The use of electrocautery in a site remote from the pacemaker generator normally does not cause interference.

Complications arising after implantation of DDD pacemakers: the MOST experience.

The purpose of this study was to characterize the incidence, time course, frequency, and spectrum of acute and chronic complications arising from dual-chamber pacemaker implantation. This information may serve as a benchmark when comparing complication rates for dual-chamber pacemaker implantation with those for biventricular pacemaker implantation.

Late complications in patients with pectoral defibrillator implants with transvenous defibrillator lead systems: high incidence of insulation breakdown.

As the majority of ICDs with transvenous leads are now implanted in the pectoral region, complications associated with the technique are being identified. To determine the incidence of lead complications in patients with transvenous defibrillator leads and ICDs implanted in the pectoral region, 132 unselected consecutive patients with transvenous defibrillator leads had ICDs implanted in the pectoral region. Three lead systems were used: (1) lead system 1 (45 patients) consisted of a transvenous pacing sensing lead and a superior vena cava coil with a submuscular patch used for defibrillation; (2) lead system 2 (36 patients) utilized a CPI Endotak lead system; and (3) lead system 3 (51 patients) utilized a Medtronic Transvene lead system.

The value of Hughes-Cardiff classification in the management of perianal Crohn's disease.

Purpose: The aim of this study was to assess the value of Hughes' pathogenic classification in the prognosis and management of perianal Crohn's disease (CD).

Patients And Methods: This classification differentiates between purely inflammatory lesions and their mechanical or septic complications, and defines the presence of ulceration (U), fistula (F) and stricture (S), which are assigned a score of 0, 1 or 2 according to the severity and associated conditions, proximal intestinal involvement and disease activity (A, P and D). Of a series of 96 patients with CD, 12 underwent 16 procedures involving anesthesia to treat symptomatic anal lesions.

Use of single lead VDD pacing in children.

The development of transvenous ventricular pacing leads with proximal electrodes capable of atrial sensing and the recent availability of smaller generators has created the opportunity to treat children with complete AV block and normal sinus node function with a transvenous single lead VDD pacing system. Studies in adults have demonstrated this system to be efficacious with low complication rates. Transvenous single lead VDD pacemakers were implanted in ten children, aged 5-15 years, between December 1993 and April 1996, in our institution.

Predictors of long-term survival in patients with malignant ventricular arrhythmias.

The study consisted of 369 patients (age 62 +/- 13 years) who presented to our institution from April 1984 to April 1994 for malignant ventricular arrhythmias presenting as sustained ventricular tachycardia (VT) in 57% of patients, ventricular fibrillation in 25% of patients, and syncope due to VT in 17% of patients. Coronary artery disease was present in 74% of patients, cardiomyopathy in 19% of patients, and no evident heart disease in 7% of patients. Two hundred twenty-one patients were given drug, therapy, 47 patients underwent arrhythmia surgery, and 75 patients had an implantable cardioverter-defibrillator (ICD).

Evaluation of serum carcinoembryonic antigen monitoring in the follow-up of colorectal cancer patients with metastatic lymph nodes and a normal preoperative serum level.

The value of serial serum carcinoembryonic antigen (CEA) assay in the follow-up of colorectal cancer patients with metastatic lymph nodes and normal (< or = 5 ng/ml) preoperative CEA levels, was examined in this study. Thirty-eight patients were studied and compared with 22 patients with elevated CEA levels. The overall sensitivity of CEA for the diagnosis of recurrence was 36%.

Medical factors in the morbidity and mortality associated with emergency colorectal cancer surgery.

Objective: To review the results of the analysis and quantification of the influence of medical factors on the morbidity and mortality associated with emergency surgery for colorectal cancer.

Patients And Methods: We analyze retrospectively the data for 51 patients who underwent emergency surgery: 34 (67%) to treat acute obstruction and 17 (33%) for perforation. The median follow-up period was 18.

Permanent pacemaker lead implantation via the transhepatic route.

A 4-year-old male with transposition of the great arteries, status post-Senning repair, required placement of an atrial pacemaker for sinus node dysfunction and atrial flutter. Multiple systemic venous occlusions precluded conventional transvenous lead implantation. A transhepatic approach resulted in successful placement of an endocardial atrial pacing lead.

[A comparative study on the prognostic value of the nuclear expression of protein p53 vis-à-vis histopathology in colorectal cancer].

Objective: To determine the predictive value of p53 nuclear overexpression in comparison with established prognostic pathological features in colorectal adenocarcinoma.

Patients And Methods: 61 patients operated on for cure between January 1989 an December 1991 were included. Expression of p53 protein was examined by immunohistochemistry in paraffin-embedded sections.

Prediction of recurrence in B-C stages of colorectal cancer by p53 nuclear overexpression in comparison with standard pathological features.

This study investigated the predictive value of p53 nuclear overexpression on recurrence of colorectal adenocarcinomas compared with established prognostic pathological features. Sixty-one paraffin-embedded sections from primary tumours were examined by immunohistochemistry. Specific nuclear staining was detected in 27 (44.

Incidence of malposition of polyvinylchloride and red rubber left-sided double-lumen tubes and clinical sequelae.

Currently, fiberoptic bronchoscopy (FB) is recommended for correct positioning of double-lumen endobronchial tubes (DLTs) because of the high incidence of malpositions not appreciated by clinical signs. The aims of this study were to assess whether clinical signs allow accurate confirmation of adequate positioning with left red rubber (RR) or polyvinyl-chloride (PVC) double-lumen tubes and to compare the incidence of malpositions between the two tubes. Another goal was to assess whether these malpositions, not appreciated by clinical assessment, adversely affected outcome.

Subpectoral implantation of ICD generators: long-term follow-up.

A nonthoracotomy surgical approach using an endocardial electrode and combined implantation of a subcutaneous patch and the implantable cardioverter defibrillator (ICD) generator in a subpectoral pocket has been described. We report the long-term follow-up results in patients undergoing implantation using this approach. The patient population consisted of 28 patients (22 men and 6 women) with a mean age of 59 +/- 12 years.

[Profile of health services utilization during the XVII Central American and Caribbean Sport Games: Delegation of Puerto Rico, Ponce 1993].

During the XVII Central American and Caribbean Sports Games held in Ponce in 1993 the health services offered to the Puerto Rico Delegation included medical, dental and psychological assistance, physical therapy and services on the playing field. Information about the use of these services was obtained from the encounter sheets. The Puerto Rican delegation of 750 members had 1,800 encounters with the health team; 612 (34.

Patterns of injuries in athletes evaluated in an interdisciplinary clinic.

The pattern of sports injuries appears to be population-specific. The purpose of the present study is to describe 1750 injuries evaluated between April 1988 and April 1994 in our Olympic Training Center Interdisciplinary Sports Injury Clinic. Our patient population included elite and recreational athletes of both sexes between the ages of 7 and 71 years.

[Morbidity during the XVI Central American and Caribbean Games: Puerto Rican delegation, Mexico 1990].

The health services offered to the Puerto Rican Delegation during the XVI Central American and Caribbean Sports Games in México in 1990 included: medical, dental and psychological assistance, physical therapy and services on the playing field. From the consultation sheets completed during the Games we obtained information about the use of these services. The 336 members of the Puerto Rico Delegation in the village at México City had 1,838 encounters with the health team.

Total pectoral implantation: a new technique for implantation of transvenous defibrillator lead systems and implantable cardioverter defibrillator.

We describe a new approach to total pectoral implantation of cardioverter defibrillators with an endocardial defibrillation lead system. Endocardial lead configuration used was an FDA approved right atrial-superior vena cava defibrillation spring electrode, right ventricular bipolar sensing electrode, and a pectoral patch. Endocardial leads were implanted via a cephalic or an axillary venesection.

Chest wall resection for locally recurrent breast cancer: indications, technique, and results.

A series of 100 patients with locally advanced carcinoma of the breast was analyzed for chest wall recurrence alone after primary treatment. Five patients were found to have had chest wall recurrence alone and were treated with en bloc chest wall resection. This group of patients was analyzed for the pathophysiology of recurrence including characteristics of the primary tumor, location of the chest wall recurrence, and overall local salvage and survival after chest wall recurrence.

Value of follow-up in the management of recurrent colorectal cancer.

The purpose of this article was to study the effectiveness of a prospective follow-up programme in patients after curative surgery for colorectal cancer. Of the initial 151 selected patients, 61 (40%) developed a recurrence in whom only six cases (10%) of potentially curable recurrent lesions were detected. The first clues to recurrence in the 61 patients were history or physical examination in 49%, a rising CEA in 29% and a positive imaging finding in 10%, being difficult to decide which test first signalled a recurrent cancer in an additional 11%.