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Bariatric surgery
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Lindel C.K. Dewberry, Thomas H. Inge
A locking, toothed grasper is next inserted below the xiphoid, applied to tissue just superior to the right crus of the diaphragm, and used to retract the left lobe of the liver anteriorly to expose the gastroesophageal junction. The lesser curve gastric pouch will be created beginning with the dissection at the angle of His. A sufficient plane is then created between the stomach and diaphragm at the angle of His, extending to the left crus, utilizing dissection both bluntly and with the Harmonic scalpel (Ethicon Inc., Cincinnati, OH, USA).
Obese Patient (BMI 32) with Reflux Disease and Diabetes Mellitus
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
It is possible to separate the operation into three distinct phases. The first is the creation of a non-distensible lesser curve–based gastric pouch using an endoscopic stapler. This is achieved through dissection at the angle of His, followed by the lesser curve using an energy device, such as the Harmonic Ace. The first staple firing is then performed horizontally no more than 5 cm distal to the gastroesophageal junction. A 36-Fr bougie is then inserted to calibrate the size of the pouch following which further staple firings are performed in a vertical direction toward the angle of His until pouch creation is complete.
Ski-Jumping, Alpine-, Cross-Country-, and Nordic-Combination Skiing
Published in Christopher L. Vaughan, Biomechanics of Sport, 2020
Iizuka et al.44 compared skilled and unskilled skiers when passing over a bump by analyzing their postural behavior by using a 16-mm high-speed camera and a specially designed transducer on the ski, which was previously described in this chapter. They pointed out that the most significant difference in the “over-bump” motion between the skilled and unskilled skier was observed in their body rotation before the summit. Their results showed that when the skilled skier ascended the bump, the ski/body angle gradually decreased and his body was rotated forward. However, the unskilled skier first increased the ski/body angle, and his body was rotated backward when he hit the bump. Miyashita et al.70 did further experimentation on this point by using EMG, and pointed out that the highly trained skier takes up a “ready” posture toward the bump as compared with the beginner.
A case-control comparative study between Toupet-Sleeve and conventional sleeve gastrectomy in patients with preoperative gastroesophageal reflux
Published in Acta Chirurgica Belgica, 2023
Philippe Hauters, Etienne van Vyve, Iulia Stefanescu, Charles-Edouard Gielen, Sylvie Nachtergaele, Manon Mahaudens
All the patients had a 5-port laparoscopic procedure with the surgeon standing between the legs of the patient positioned in an anti-Trendelenburg position. Before starting the sleeve procedure, hiatal hernias were repaired or not at the discretion of the surgeon. The greater omentum was divided from the greater curvature of the stomach using a Ligasure® or Harmonic® device, beginning approximately midway along the greater curvature and first heading toward the angle of His, and then heading distally to a point located 5–6 cm proximal to the pylorus. Special care was taken to fully mobilize the gastric fundus with meticulous dissection of the posterior gastric wall from the left diaphragmatic crus. A 40-Fr calibration bougie was placed down the stomach. Stomach resection is begun 5–6 cm proximal to the pylorus and is continued upwards with a linear stapler, cephalad to the angle of His while not getting too close to the esophagus. Sizes of the cartridges were selected based on stomach thickness and the patient’s BMI. Staple lines were not oversewn. The resected portion of the stomach was extracted from the left subcostal trocar site.
Turbulent Flow in a Cavernous Sinus Lesion: Does It Suggest Something?
Published in Neuro-Ophthalmology, 2021
Vaibhav Kumar Jain, Vivek Singh, Akshata Charlotte, Vikas Kanaujia, Kumudini Sharma
A 14-year-old boy was referred for neuro-ophthalmological evaluation due to a one month history of double vision. He reported having a boil at the angle of his mouth with cellulitis on the left side of the face two weeks before the onset of the diplopia, which had resolved on systemic antibiotics. On examination at his initial presentation elsewhere, he had visual acuity of 20/20 in each eye. A −3 restriction of abduction of the right eye was noted on ocular motility examination.2 The rest of the ophthalmological examination including the pupillary reactions and fundi was within normal limits. His systemic evaluation did not reveal any abnormalities. A clinical diagnosis of an isolated VIth nerve palsy was made and a post-infectious cause, intracavernous sinus lesion, or clival chordoma were suspected. Magnetic resonance imaging (MRI) with contrast demonstrated a sellar mass with contrast enhancement and extension into the right cavernous sinus with the internal carotid artery being pushed peripherally, suggestive of a cavernous sinus haemangioma.
Managing respiratory complications in infants and newborns with congenital diaphragmatic hernia
Published in Expert Opinion on Orphan Drugs, 2020
Sandeep Shetty, Fahad M. S. Arattu Thodika, Anne Greenough
Gastroesophageal reflux disease (GORD) is the most common gastrointestinal sequelae [145], occurring in more than 50% of infants with CDH [144]. The incidence of gastroesophageal reflux in CDH survivors, however, is variable between institutions, likely due to differences in the diagnostic method used, for example pH monitoring, upper gastrointestinal contrast study or clinical history. The incidence of gastroesophageal reflux also correlates with defect size and need for patch repair [145,146]. The pathophysiology of gastroesophageal reflux may include abnormal hiatal anatomy at the gastroesophageal junction and lack of an angle of His in some patients [147]. A trend toward more infants who underwent FETO having GORD has been reported (71% versus 44%; p = 0.070) [148].