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Biomedical subjects

A G Shulman

Publications and source records attributed to A G Shulman.

50 records · Page 3Linked to original sources
PubMed1985

Television choledochoscopy.

Present techniques of intraoperative cholangiography and choledochoscopy have not completely solved the problem of the common bile duct stone that is missed. Televised choledochoscopy provides an improved imaging technique which should facilitate stone retrieval. A similar television endoscopic technique has already become standard among orthopedic surgeons performing diagnostic and therapeutic arthroscopy. This equipment can be shared by surgeons specializing in orthopedic or general surgery.

Endoscopy↗
PubMed1974

High bulk diet for diverticular disease of the colon.

In the past century diverticular disease of the colon has changed from being almost unknown to becoming the most common disease of the colon. Studies in Britain indicated that the pathological basis of the disease is a thickening of the colonic musculature, with diverticulosis and diverticulitis developing because of increased intracolonic pressures generated by the thickened colon wall. This pressure can be sharply reduced by increased colonic bulk. Geographical and anthropological data reveal that diverticular disease results from Western civilization's food habits, specifically the reduced fiber content in food. There is evidence that increasing the dietary intake of fiber by the addition of bran can prevent formation of diverticula and relieve the symptoms of established disease. Large scale studies are recommended both as treatment and to further test the validity of this concept.

Animals↗
PubMedDate not supplied

The femoral canal: the key to femoral herniorrhaphy.

It is conceded by many Authors that femoral hernias not uncommonly result from a previous inguinal herniorrhaphy. Why? A clear visualization of the femoral canal is hampered by the confusing structure of two of its components, the iliopubic tract and the lacunar ligament. Both entities have horizontal as well as vertical extensions. Therefore, a clear understanding of the femoral canal anatomy requires an appreciation of its three dimensional character. The various approaches to femoral hernia are documented. Obliteration of the entire canal by means of a "plug" prosthesis which occludes both the entrance and exit of the canal offers a simple and very effective means of correction. The results of the surgery are documented.

Abdominal Muscles↗
PubMedDate not supplied

The iliopubic tract. The key to inguinal herniorrhaphy?

The iliopubic tract exists. It is not illusory. It is the small inferior tongue of the transversus abdominis aponeurosis; separated from its parent by the spermatic cord at the internal ring. The tract may be reinforced by a variable number of fibers from the transversalis fascia, however the entire structure is of significant strength in less than 25% of cases. Since the iliopubic tract inserts into the pubic ramus, a significant gap is created between it and the main transversus aponeurosis which inserts some distance above into the rectus sheath. Despite the use of a relaxing incision and irrespective of whether one sutures the transversus aponeurosis to Cooper's ligament, Poupart's ligament, or the iliopubic tract, unacceptable tension occurs. This results from attempting to approximate tissues not normally in apposition. A tension free repair is suggested which should significantly reduce the bête noir of the hernia surgeon-recurrence.

Groin↗
PubMedDate not supplied

Ambulatory outpatient hernia surgery. Including a new concept, introducing tension-free repair.

In 1985, Medicare started an experimental study in California mandating "Same-day" herniorrhaphy for all patients unless serious medical contraindication existed. Blue Shield and Blue Cross are rapidly following suit. It is little wonder therefore that ambulatory outpatient surgi-centers are now including hernia repair in their armamentarium. Change in environmental milieu must not compromise the quality of the surgery and care of the patient. This paper reviews the author's experience with outpatient hernia surgery and introduces a new surgical concept, tension-free repair. Since the first true herniorrhaphy was performed by Bassini over 100 years ago, all modifications and surgical techniques have shared a common disadvantage-suture line tension. This is the prime etiologic factor behind hernia recurrence. By using modern mesh prosthetics, it is now possible to repair all hernias without distortion of normal anatomy and with no suture line tension. The technique is simple, rapid, less painful, and effective; allowing prompt resumption of unrestricted physical activity.

Ambulatory Surgical Procedures↗
PubMedDate not supplied

A survey of non-expert surgeons using the open tension-free mesh patch repair for primary inguinal hernias.

UNLABELLED: The aim of this study was to learn if general surgeons with no special interest in hernia repairs, using the open tension free repair, could achieve a degree of success comparable to that of the experts. MATERIALS AND METHODS: A survey was undertaken of 72 surgeons who were known to be performing an open tension-free onlay mesh patch repair for primary inguinal hernias with no attempt to suture together the edges of the hernia defect. While several European surgeons were included, most were from the United States. RESULTS: There was a minimal amount of wound infection, an absence of mesh rejection when Marlex mesh was used, and a recurrence rate under 0.5% in 16,068 operations. CONCLUSIONS: The experience of the non-experts demonstrated that excellent results were attained by surgeons who had no special interest in hernia surgery and testifies to the simplicity and reliability of the method.

Data Collection↗
PubMedDate not supplied

An analytic comparison of laparoscopic hernia repair with open "tension-free" hernioplasty.

Two of the most important etiological factors in the development of primary and recurrent inguinal hernias are collagen deficiency and tension on the suture line respectively. These factors can be eliminated by the use of open "tension-free" hernioplasty, advocated by the Lichtenstein Hernia Institute since 1984. In this procedure, the entire floor of the inguinal canal is reinforced by an 8 cm x 16 cm sheet of Marlex mesh that is sutured in place to protect the floor from all future adverse mechanical and metabolic effects without the risk of displacement or folding. A new ring and shutter mechanism is also created by the procedure, which is performed under local anesthesia and requires only a few hours of in-hospital postoperative observation. Pain control following the operation involves only 2-20 tablets of 5 mg hydrocodone bitartrate, for 2-4 days. The recurrence rate of early procedures was a mere 0.1%, and has been zero for 2,500 patients treated in the past five years. In addition, there has only been one complication (a testicular atrophy) in 4,000 operations over ten years. The postoperative pain and recovery period of the "tension free" procedure compare favorably with those of laparoscopic repair, while the complication and recurrence rate and costs are significantly lower. The Lichtenstein "tension-free" method has been performed on tens of thousands of patients worldwide and these results have been duplicated and published by authors from the United States, England, Belgium, Spain, Italy and Austria.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

A critical evaluation of the Lichtenstein tension-free hernioplasty.

All standard methods of hernia repair involve suturing together tissues which are not normally in apposition. This violates the basic surgical principle that tissue must never be approximated under tension and accounts for an unacceptable number of failures. Total reinforcement of the inguinal floor with a sheet of suitable biomaterial and employment of a "tension-free" technique is a more effective approach. Since June of 1984, 3,250 primary inguinal hernias have been repaired at the Lichtenstein Hernia Institute by the open "tension-free" technique using Marlex mesh. The patients were followed from one to 8 years by physician examination. The follow-up rate was 87%. There were four recurrences. The causes of recurrence and how to avoid them are discussed.

Adult↗
PubMedDate not supplied

Ligation of hernial sac. A needless step in adult hernioplasty.

High ligation of indirect hernia sacs in adults is still commonly practiced. Animal and clinical studies have shown that this is unnecessary. To previous studies we add our own experience of over 6,321 adult hernia repairs in which the sacs were rarely excised and never ligated. The questionable logic leading to high ligation is outlined. Experience reveals that non-ligation of indirect sacs is harmless and may decrease post-operative pain.

Adult↗