• Title/Summary/Keyword: Lithotomy position

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Study of Patient's Position to Reduce Late Complications in High Dose Rate Intracavitary Radiation of the Uterine Cervix Cancer (자궁경부암의 고선량율 강내 방사선치료 시 부작용을 줄이기 위한 적정 치료 자세의 연구)

  • Yun, Hyong-Geun;Shin, Kyo-Chul
    • Radiation Oncology Journal
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    • v.16 no.4
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    • pp.477-483
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    • 1998
  • Purpose : Radiation proctitis and radiation cystitis are frequent and problematic late complications in patients treated with radiation for the uterine cervix cancer. Authors tried to find out the better patient's position in high dose rate intracavitary radiation to reduce the radiation dose of bladder and rectum. Materials and Methods : In 13 patients, Foley Catheters were inserted to patient's bladder and rectum and were ballooned with radioopaque dye. After insertion of a tandem and two ovoids, semi-orthogonal anteroposterior and lateral films were taken in both lithotomy and supine position. The rectal point and bladder point were defined according to the criteria recommended in the ICRU Report 38 with modification. Using these films, all patients' bladder and rectal dose were calculated in both positions (the radiation dose of A point was set to 400 cGy). And also, the distance of bladder and rectum from uterine cervical os was calculated in both positions. Results : The average radiation dose of rectum was 240.7 cGy in lithotomy position and 278.3 cGy in supine position, and the average radiation dose of bladder was 303.5 cGy in lithotomy position and 255.8 cGy in supine position. After the paired t-test, the radiation dose of rectum in lithotomy position was marginally significantly lower than that in supine position, while the radiation dose of bladder in lithotomy position was significantly higher than that in supine position. On the other hand, the average distance between rectum and cervical os was 35.2 mm in lithotomy position and 32.3 mm in supine position. and the average distance between bladder and cervical os was 30.4 mm in lithotomy position and 34.0 mm in supine position. After the paired t-test. the distance between rectum and cervical os in lithotomy position was significantly longer than that in supine position, while the distance between bladder and cervical os in lithotomy position was significantly shorter than that in supine position. Conclusion : The radiation dose of bladder can be reduced in supine position and the radiation dose of rectum can be reduced in lithotomy position, so we can choose appropriate position in each patient.

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Acute limb ischemia following perineal reconstruction in lithotomy position: take-home message for plastic surgeons

  • Sapino, Gianluca;Deglise, Sebastien;Raffoul, Wassim;di Summa, Pietro G.
    • Archives of Plastic Surgery
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    • v.48 no.5
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    • pp.543-546
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    • 2021
  • Despite the extensive use of lithotomy position in several plastic surgery procedures, most reports regarding the related incidence of complications are presented in the urologic, gynecologic, and anesthesiologic fields. We present the case of a 54-year-old male patient. polytrauma patient who underwent internal iliac artery embolization leading to extensive gluteal necrosis requiring: debridement, abdominoperineal resection and composite anterolateral thigh flap reconstruction with prolonged lithotomy position. The patient presented lower limb ischemia briefly after surgical theater. A computed tomography scan revealed the obstruction of the left superficial femoral artery requiring emergency revascularization. Arterial thrombosis is a potentially devastating complication and plastic surgeons should be aware of the possible dangers when performing surgeries in prolonged lithotomy position. Preoperative detection of patients at high risks for developing complications should be performed in order to implement preventive measures and avoid potentially life-threatening sequelae.

Two Unusual Cases of Sciatic Neuropathy (궁둥신경병증 2예)

  • Lee, Sang-Soo;Lee, Sung-Hyun;Lee, Yeon-Soo;Song, Myung-Ja
    • Annals of Clinical Neurophysiology
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    • v.7 no.1
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    • pp.55-57
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    • 2005
  • Two different unusual cases of acute sciatic neuropathy are described. They appeared to have been caused by complications from a procedure performed on a patient in the lithotomy position, and an uncertain etiology associated with either a previous femur fracture or a recent blunt trauma to the buttock. Comprehensive histories of weakness, with radiographic or electrophysiological studies, or even exploratory surgery are important in order to understand the etiologies of the sciatic neuropathies.

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Video-Assisted Thoracic Surgery Thymectomy: Subxiphoid Approach

  • Cho, Sukki
    • Journal of Chest Surgery
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    • v.54 no.4
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    • pp.314-318
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    • 2021
  • In this paper, I present the technique of subxiphoid single-port video-assisted thoracic surgery (VATS) thymectomy for thoracic surgeons to perform this procedure safely. This procedure is indicated for all anterior mediastinal masses and may be extended to lung cancer. The patient is placed in the lithotomy position, and the operator should be on the midline. Below the xiphoid process, a skin incision is made 4-5 cm horizontally at a single thumb's width down. Under two-lung ventilation, CO2 is insufflated, maintaining 10 mm Hg. The fat tissue and thymic tissue are all resected from the sternum and pericardium between both phrenic nerves using an articulated grasper and an energy device. After retrieval of the mass with a wrap bag, a Jackson-Pratt drain is inserted instead of a chest tube. One of the advantages of this procedure is less postoperative pain than intercostal VATS. The subxiphoid approach can be used for bilateral pneumothorax, bilateral pulmonary metastasectomy, and simple lobectomy for both upper lobes and the right middle lobe.

Subarachnoid Morphine for Perianal Postoperative Pain Control (미양(微量) Morphine 지주막하(蜘蛛膜下) 주입(注入)에 의(依)한 항문각위술후(肛門脚圍術後) 제통효과(除痛效果)에 대(對)한 임상연구(臨床硏究))

  • Rhim, Hwa-Taeg;Lee, Yeong-Sik;Oh, Hung-Kun
    • The Korean Journal of Pain
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    • v.1 no.1
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    • pp.98-102
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    • 1988
  • In order to control the pain after hemorrhoidectomy and anal fistulectomy, 6 mg of 0.5% hyperbaric tetracaine without(control, group I) or wilt 0.3 mg(group II) or 0.5 mg (group III) of 0.1% morphine was injected with a 22 gauge spinal needle into the subarachnoid space through L 3-4 interspace of patients in lateral position. About 30 minutes in Fowler' sposition after injection, operation was performed in lithotomy position. All the patients who ha4 morphine showed remarkable relief of postoperative pain for an average of 27 hours. However, the dosage(0.3 or 0.5 mg) of morphine administered did not affect the duration of pain relief. Blood pressure, pulse rate and pupil size were unchanged in all patients. Dysuria after block developed for on average of 5,6, 13.2 and 14.6 hours in group I, II and III respectively. Most of these cases required urethral catheterization. Minor complications such as nausea, vomiting, itching, fever, burning sensation and paresthesia were observed 16.7, 20 and 20% of cases in group I, II and III respectively; however, no treatment was required.

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Development of Detachable IORT Table for Colorectal Cancer (장착-탈거 및 경사각 조절이 가능한 대장직장암의 수술 중 방사선 치료대의 개발)

  • Kim, Myung-Se;Lee, Joon-Ha
    • Radiation Oncology Journal
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    • v.12 no.1
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    • pp.117-121
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    • 1994
  • In spite of remarkable improvement of surgical skills and anesthesia, local failure still occurred in 36-45$ \% $ of locally advanced colorectal cancer after curative resection with or without pre-or post-operative irradiation. Intraoperative radiation therapy(IORT) is the ideal modality which resectable lesions are removed surgically 3nd the remaining cancer nests are sterilized by irradiation during a surgical procedure. Therefore, the excellent local control without the damage of the adjacent normal tissues can be achieved. In IORT, judicious set up of the treatment cone on the treatment surface of the patient is required for accurate and homogenous dose distribution within treatment field, especially on the slopping surface of sacrum and pelvic sidewall which are the common sites of the local recurrence in rectal cancer. For this purpose, adequate co-ordination of gantry rotation and table tilting are essential. Adjusting gantry rotation is not difficult but tilting of the table is impossible inconventional treatment couch. Department of Therapeutic Radiology in Yeungnam University Medical Center developed the IORT table for colorectal cancer which is easy to set up and detach on the Linac treatment couch within 5 minutes. The range of tilting with head-up and head-down is about 30 degree which is efficient and easy-to-use, not only for IORT but also for colorectal surgery. So far, authors performed IORT with newly developed treatment table in 2 patients with rectal cancer and we found that this newly developed table could contribute in improving the dose distribution of IORT and surgical procedure for colorectal cancer.

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The Effects of Muscle Energy Technique (MET) for Peroneal Nerve Palsy after Normal Delivery: A Case Report (자연분만 후 발생한 비골신경마비 환자에 대한 Muscle Energy Technique(MET)의 병행치료 효과 증례보고)

  • Jo, Na-Young;Roh, Jeong-Du
    • The Journal of Korean Obstetrics and Gynecology
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    • v.29 no.4
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    • pp.46-56
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    • 2016
  • Objectives: The purpose of this study is to evaluate the clinical effects of Muscle Energy Technique (MET) for peroneal nerve palsy after normal delivery. Methods: Two patients with peroneal nerve palsy were treated with acupuncture, moxibustion, cupping and MET. MET was performed in piriform, gluteus medius, anterior tibial and adductor muscles. To evaluate the effect of MET, we analyzed Ankle dorsiflexion range of motion (ROM), Manual Muscle Test (MMT), Numerical Rating Scale (NRS) and Ankle Hindfoot Scale (AHS). Results: In Case 1, ROM score was changed from −5 to 20, and MMT score was changed from 0 to 4. NRS score was changed from 5 to 1, and her AHS score was changed from 54 to 94 after treatment. In Case 2, ROM score was changed from 0 to 20, and her MMT score was changed from 1 to 5. NRS score was changed from 4 to 1, and her AHS score was changed from 64 to 97 after treatment. Conclusions: MET may be a useful treatment for patients who, shortly after childbirth or while breastfeeding, strongly refuse to treat the irritation.