Upper surgery

Cellulitis and erysipelas are bacterial infections of the skin. Although separate entities, there is some clinical difficulty in distinguishing the two. 0 Cellulitis is a bacterial infection of the dermis and subcutaneous tissue, whereas erysipelas is a more superficial infection of the upper dermis and superficial lymphatics. Although both can occur on any part of the body, about 90% of infections involve the leg.8,9 Another 7.5% of cases involve the arm or face. Erysipelas is most common in the young and the elderly. Typically, both infections develop after a break in skin integrity, resulting from trauma, surgery, ulceration, burns, tinea infection, or other skin disorder. 

In addition, the buccal route may be useful for unconscious patients and in patients who have recently undergone surgery or have experienced upper GI tract disease which would affect oral drug absorption. 

Fig. 15. Relationship between the alfentanil plasma concentrations and the probability of needing naloxone to restore adequate spontaneous ventilation. The diagram at the upper part shows the alfentanil plasma concentrations of the patients who required naloxone (upward deflection) or did not require naloxone (downward deflection). The plasma concentration-effect curve for this clinical endpoint (lower part) was defined from the quantal data shown in the upper diagram using logistic regression. Bars indicate SE of C5o%. (From Ausems ME, Hug CC, Stanski DR, Burm AGE. Plasma concentrations of alfentanil required to supplement nitrous oxide anaesthesia for general surgery. Anaesthesiology 1986 65 362-73, reproduced by permission.)...

Fig. 8. Assessment of gut oxygenation status during surgery. Changes in CO2 gap in surgical patients randomized to Oxygent (RFC) or placebo (controls) (ANH = acute normovolemic hemodilution PP = post-protamine administration CC = chest closure p<0.05 between groups). The dashed line represents the upper limit of normal for CO2 gap (8 torr). Postoperative recovery of gut function was determined by shorter time to first bowel movement (2 vs. 5 days p<0.007) and earlier consumption of solid food (1.8 vs. 4.1 days p = 0.056). From Ref. [29], with permission.

Shibata, C., I. Sasaki, H. Naito, T. Ueno, and S. Matsuno. The herbal medicine Dai-Kenchu-Tou stimulates upper gut motility through cholinergic and 5-hydroxytryptarn ine 3 receptors in conscious dogs. Surgery 1999 126(5) 918-924. 

Unlabeled Uses Prevention of aspiration pneumonia, treatment of recurrent postoperative ulcer, upper GI bleeding, prevention of acid aspiration pneumonitis during surgery, prevention of stress-induced ulcers. 

It is indicated in the treatment of a variety of painful inflammatory conditions, including osteoarthritis, oncology, postopera-tively, trauma, sports injuries, ear, nose and throat disorders, dental surgery, bursitis/ tendinitis, thrombophlebitis, upper airways inflammation and gynaecological disorders. Nimesulide has shown to be well tolerated even by aspirin sensitive asthmatic patients. 

A 35-year-old woman, who had been fitted with Norplant 2 years before and had used oral contraceptives for some 20 years before that, developed epigastric and right upper quadrant abdominal pain (221). A liver mass was found and at surgery proved to consist of multiple adenomata part of the liver had to be resected. 

Lund J, Stjernstrom H, Jorfeldt L, Wiklund L. Effect of extradural analgesia on glucose metabolism and gluconeo-genesis. Studies in association with upper abdominal surgery. Br J Anaesth 1986 58(8) 851-7. 

Individuals who face extended bedrest or immobilization in order to recover from surgery may also benefit from creatine supplementation. One study, which looked at knee surgery patients in rehabilitation, found that subjects who received creatine intravenously during their recovery gained leg strength faster than those who did not. Further research published in the Archives of Physical Medicine and Rehabilitation in 2002 found that creatine supplementation improved upper body exercise capacity in patients with cervical spinal cord injuries. 

Some of the respiratory disturbances experienced by Parkinson s patients are similar in nature to that experienced by non-Parkinson s patients with sleep-related respiratory disturbances. Hence the same treatments may be used in both patient groups, depending on the stage of the Parkinson s. Continuous positive airway pressure (CPAP) can improve sleep in Parkinson s patients, but is not suitable during the advanced stages of Parkinson s. Alternatively, upper-airway surgery may provide some relief. Neither of these measures, however, alleviates the respiratory disturbance that may be due to the muscle rigidity associated directly with Parkinson s disease. 

Sher AE (2002) Upper airway surgery for obstructive sleep apnea. Sleep Med Rev 6 195-212... 

W6. Williams, ]. A., Effects of upper gastro-intestinal surgery on blood formation and bone metabolism. Br. J. Surg. 51, 125-135 (1964). 

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