carotid endarterectomy with Dacron patch angioplasty

PREOPERATIVE DIAGNOSIS: 

Right carotid stenosis.

POSTOPERATIVE DIAGNOSIS: 

Right carotid stenosis.

OPERATION:

Right carotid endarterectomy with Dacron patch angioplasty.

SURGEON:  

ASSISTANTS:  

ANESTHESIA:  General block.

COMPLICATIONS:  None.

DRAINS:  None.

SPECIMENS REMOVED:  Carotid plaque.

ESTIMATED BLOOD LOSS:  Minimal.

DESCRIPTION OF PROCEDURE/FINDINGS: 

After the induction of region anesthesia, the right neck was prepped and draped in the normal sterile fashion.

An incision was made anterior to the medial border of the sternocleidomastoid.  The skin and subcutaneous tissue was entered.  The medial border of the sternocleidomastoid was dissected out and this muscle was retracted laterally.  The internal jugular vein was identified and the medial border of this vein was dissected out.  The tributaries to this vein were taken between snaps and ligated with 2-0 and 3-0 silk ties.

The common carotid artery was identified and dissected out and controlled with vessel loops.  Dissection was carried out distally until the internal and external carotid arteries, as well as, the superior thyroid artery.  The hypoglossal ad vagus nerves were seen and preserved throughout the procedure.  The patient was systemically heparinized with 5,000 units of intravenous heparin.  Clamps were placed on the internal, external, and common carotid arteries.  The patient remained neurologically intact.

An arteriotomy was made in the common carotid artery extending into the internal carotid artery.  Endarterectomy was performed with adequate proximal and distal end points.  A Dacron patch was used to close the arteriotomy.  Prior to the closure of the arteriotomy, antegrade and retrograde flushing maneuvers were performed.  Patch closure was completed.

Clamps were removed.  There was a palpable pulse in the internal carotid artery and adequate Doppler signal.  The wound was irrigated with antibiotic solution and closed in layers.  The patient remained neurologically intact throughout the procedure.

Postmenopausal bleeding and endometrial polyp Dilatation and curettage, diagnostic hysteroscopy.

PREOPERATIVE DIAGNOSES: 

Postmenopausal bleeding and endometrial polyp.

POSTOPERATIVE DIAGNOSES:

Postmenopausal bleeding and endometrial polyp.

OPERATION: 

Dilatation and curettage, diagnostic hysteroscopy.

ANESTHESIA:

General given by Jean.

SURGEON:

ASSISTANTS:

None.

ESTIMATED BLOOD LOSS:

SPECIMENS REMOVED:

DESCRIPTION OF PROCEDURE/FINDINGS:

Under satisfactory general anesthesia, the patient was placed in the dorsal lithotomy position.  The perineum and the vagina were painted with Betadine before applying sterile drapes.  The pelvic examination disclosed a closed cervix.  The uterus was normal size, anteverted.  Adnexa was negative.  A heavy-weighted speculum was inserted into the vagina followed by the anterior retractor.  The anterior lip of the cervix was grasped with a tenaculum forceps.  After satisfactory dilatation, a rigid hysteroscope was introduced into the endocervical canal and brought through the endometrium which was described as being normal and pale without any evidence of polyp or point of bleeding.  No friable mass was also noted.  The ostium on the left side was identified as well as the ostium on the right side and appeared to be normal and patent.  Upon withdrawing slowly from the uterine cavity, anterior, posterior and lateral all were identified, they appeared to be normal.  The endocervical canal was identified as well and (_____) but no evidence of polyps was seen inside.  Then the scope was removed.  Then the endocervical canal was curetted, which has been given and scanty amount of tissue was obtained.  The endometrial cavity was also curetted and moderate amount of tissue was obtained.  The procedure was well tolerated, 4 L of fluid was used during the hysteroscope.

Suction curettage for Missed abortion

PREOPERATIVE DIAGNOSIS: 

^Missed abortion.

POSTOPERATIVE DIAGNOSIS: 

^Missed abortion.

OPERATION: 

^Suction curettage.

SURGEON: 

ASSISTANTS:  ^

ANESTHESIA:

General.

ESTIMATED BLOOD LOSS:  ^

SPECIMENS REMOVED:  ^

DESCRIPTION OF PROCEDURE/FINDINGS: 

^The patient was taken to the operating room, where general anesthesia was induced.  After an adequate level of anesthesia was obtained, she was then prepped and draped in the usual sterile manner. A weighted speculum was emptied placed in the vagina. Single-toothed tenaculum was used to grasp the anterior lip of the cervix, it could be seen. There was some tissue in the os. A #8 curved curette was inserted into the endometrial cavity and the contents were aspirated.  The sharp curettage was carried out to ensure the cleanliness of the cavity and then again suction was reapplied. The bleeding was minimal post procedure. The patient tolerated the procedure well and was sent to the Recovery Room in satisfactory condition.