摘要:

SummaryFlexible esophagogastroscopy (EG) and external beam radiotherapy (EBR) have become important means of diagnosing and treating both squamous and adenocarcinoma of the esophagus and gastroesophageal (GE) junction. Recently, new technology, termed high-dose-rate brachytherapy (HDRB), utilizing the placement of radioisotopes in the esophagus by endoscopic techniques has been introduced. This report describes the endoscopic application of the brachytherapy afterloading catheters and the additional role of EG in the posttreatment assessment of these patients. Twenty-four patients (21 esophageal, 3 GE junction) were treated using HDRB delivered by after-loading catheter techniques utilizing flexible EG. Radiation dosages ranged from 5 Gy (500 rads) to 8 Gy (800 rads) delivered to the tumor bed over an average of three applications. All patients were followed to assess swallowing ability, endoscopic evidence of tumor reduction, and complications resulting from intraluminal radiation therapy. Fifteen patients had reduction in intraluminal tumor based on endoscopic evaluation. Seven had partial or complete relief of dysphagia. Nine patients required gastrostomy tube placement for alimentation before or after therapy. Four patients had complications of perforation (1), fistula (1), or bleeding (2) after HDRB. Overall survival ranged from 2 to 27 months (mean = 8.9 months) after the first HDRB treatment. EG proved to be an efficient and safe technique for the introduction of intraluminal esophageal radiation therapy.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SummaryIn order to safely and reliably perform laparoscopic cholecystectomy in severe inflammatory cases (e.g., acute or chronic cholecystitis), we have designed a method of suturing the liver bed to the diaphragm, lifting it cephalad so as to maintain a good operative field. Initially, we dissect the gallbladder fundus, fully dissecting the neck of the gallbladder from the liver and finally dissecting the cystic duct (laparoscopic retrograde cholecystectomy facilitated by lifting the liver bed up to the diaphragm; Lap-RC). This method is different from laparoscopic standard cholecystectomy (Lap-SC), in which dissection of the cystic duct is done first. One hundred and twenty-nine consecutive laparoscopic cholecystectomies for various gallbladder diseases were carried out at Nerima General Hospital between August 1991 and June 1994. Fifteen cases of Lap-RC and six cases of Lap-SC in a severe inflammatory group were comparatively evaluated. Thirteen cases of Lap-RC and 92 cases of Lap-SC in a noninflammatory group were also comparatively evaluated. The rates of con-version to laparotomy were 0% in Lap-RC cases (0/15) and 33% in Lap-SC cases (3/9) in the severe inflammatory group. The incidences of major postoperative complications were 0% in Lap-RC cases (0/15) and 17% in Lap-SC cases (1/6) in the severe inflammatory group. In conclusion, Lap-RC showed satisfactory results in terms of both safety and reliability in patients with severe inflammatory disease.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SummaryWe studied deviations from normal physiology in piglets (n = 10; average weight 5.75 kg) during carbon dioxide (CO2) pneumoperitoneum. Cardiopulmonary data were gathered during varying intraabdominal pressures (IAP = 8, 12, 15, 20 mm Hg), each sustained for 10 mins. Each animal was its own preinsufflation and exsufflation control. A rapid, significant rise in arterial CO2pressure from preinsufflation (46.5 ± 6.7 mm Hg) to insufflation at 20 mm Hg (72.9 ± 15 mm Hg; p < 0.05) initiated further cardiac adjustments. Responses included a sustained increase in cardiac index (presufflation = 3.1 ± 1.4; 20 mm Hg IAP = 3.6 ± 1.2), increased heart rate (preinsufflation = 121 ± 21; 20 mm Hg IAP = 150 ± 28; p < 0.05), and left ventricular stroke work (20 mm IAP = 22.7 ± 8.9; exsufflation 20 min = 15.3 ± 9.4 g.m/m2; p < 0.05). There was a significant arterial-end CO2tidal difference throughout insufflation, as great as 15 mm Hg (p < 0.05), suggesting increasing ventilation dead space. Core temperature decreased significantly from preinsufflation (35.3 ± 1.3°C) to 20 mm Hg IAP (33.6 ± 1.5°C, p < 0.05). We suggest the following guidelines based on the above data: (a) preoperative examination screening for cardiopulmonary abnormalities; (b) fluid replacement to normal hydration only; (c) cuffed endotracheal tubes for effective ventilation; (d) careful adjustment of minute ventilation to achieve normocapnia; (e) CO2warming; (f) maximal insufflation pressure of 12 mm Hg; (g) postoperative care emphasizing respiratory and thermoregulation status.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SummaryThe present study reports on the usefulness of laparoscopic micro-wave coagulonecrotic therapy as a new option in the treatment of hepatocellular carcinoma. Five patients with liver tumors associated with cirrhosis were treated from July 1993 to March 1994 with a microwave electrode (output 100 W, 3 to 4 cm long) devised for laparoscopic use. The tumors, all with diameters less than 3 cm and superficially located, were coagulated for a total radiation period of 20 to 30 min under laparoscopic, intraoperative ultrasonographic control. Postoperative complications were negligible, and laboratory values (glutamate-pyruvate transaminase, bilirubin, prothrombin time, platelet count) returned to preoperative levels within 7 days. Complete necrosis, including the surrounding liver tissue, was confirmed by a follow-up dynamic computed tomography scan during the follow-up period of 6 to 17 months (mean, 13 months). Laparoscopic microwave coagulonecrotic therapy can exert an effect on tumor equivalent to that obtained from a wedge resection but is noninvasive and may represent a new option for unresectable liver cancers.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SummaryTotally preperitoneal laparoscopic hernioplasty has become more popular recently and will possibly replace the transabdominal preperitoneal procedure. This procedure, however, is more demanding for the surgeon, especially in large indirect hernias. We describe an alternative technique derived from Darzi's anterior endoscopic approach. To date, it has been used in 15 patients, all with good success. The technique results in a shorter operative time and is easier for the surgeon.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SummaryIn 16 patients with acute biliary pancreatitis, we performed endoscopic retrograde cholangiopancreatography (ERCP) 10 to 14 days after onset of the attack. All patients had mild pancreatitis. In 10 patients with normal-appearing common bile duct (CBD) on ultrasonography, ERCP was normal also. In two patients with dilated CBD on ultrasonography, stones were found in the CBD on ERCP, sphincterotomy was performed, and the stones were extracted endoscopically. We think there is no need for preoperative ERCP in patients with mild attacks of biliary pancreatitis if the CBD appears undilated on ultrasonography.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SummaryTo characterize the learning curve for laparoscopic cholecystectomy, we compared the first 47 cases (group A), which were performed by two senior attending surgeons who assisted each other when the procedure was introduced into clinical practice (1990–1991), with the first 46 cases (group R) performed by two surgical chief residents who were assisted by members of the teaching faculty in 1992–1993. The patient groups were comparable in terms of age, sex, and anesthetic class, but pathologically proven acute cholecystitis was more common in group R (33% vs. 9%; p < 0.005). To analyze operative procedures and outcomes, we compared operative time, frequency of successful operative cholangiography (attempted in all cases), frequency of conversion to open cholecystectomy, major complication rate, and days of postoperative stay for all patients and for those without complications. Of these parameters, only operative time for nonacute cases differed significantly between the groups (144 min for group A vs. 114 min for group R; p < 0.05). Complications in group A included one ductal injury and one case of postoperative pancreatitis; group R had one ductal injury and two cases of postoperative bleeding. We conclude that (a) the learning curve has similar structure for senior surgeons and resident trainees; and (b) the resident learning curve is not hazardous when teaching assistants are trained in the procedure, which has implications for safe instruction and proctoring of residents and staff.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SummaryThe most efficacious energy source for laparoscopic surgery is constantly being debated. Monopolar electrocautery has gained wide popularity over laser energy because of its lower cost and ease of use. Bipolar current has been extensively used by gynecologists for peritoneoscopic surgery after reports of injuries from monopolar current. The purpose of this study was to compare bipolar scissors (Evershears, Everest Medical) and monopolar scissors (Endoshears, United States Surgical Corporation). Eighty patients were prospectively randomized as to the type of scissors to be used for dissection of the gallbladder from the liver bed during laparoscopic cholecystectomy. The scissors were evaluated subjectively with regard to cutting, coagulation, char, and smoke. The two groups were similar in age, sex, weight, blood loss, and hospital stay. Cutting ability and charring were equal. Coagulation was superior in the monopolar group. Smoke was much less with bipolar energy. Over-all satisfaction was similar. We concluded that bipolar scissors are a good, safe device for dissection of the gallbladder from the liver bed during laparoscopic cholecystectomy and compare favorably with monopolar scissors.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SummaryA method of performing a laparoscopic splenectomy with the aide of intraabdominal manipulation is described. We believe that this is a versatile technique that compares quite favorably with a pure cannula approach. It is likely that this approach is safer because vascular control can readily be assured by the intraabdominal operator. It is also less costly because it is more rapid than a procedure done solely by cannula techniques. Moreover, it is reproducible by an experienced general surgeon. The results appear equal in terms of access morbidity and hospitalization time to those seen with a purely laparoscopic approach. Experience with 21 splenectomies is described and compared with 20 others performed by the traditional open approach.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SummaryThe first 60 successfully completed laparoscopic colectomies in our series are reported. Patients used moderate amounts of narcotic postoperatively, tolerated oral intake early postoperatively (mean, 1.5 days), and returned to work 2.5 weeks postoperatively. Mean blood loss was 127 cc. Morbidity (11.6%) and mortality (1.6%) were acceptable. Length of stay, complications, and operating time all decreased with experience suggesting a steep learning curve.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID