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Biomedical subjects

A J Kirsch

Publications and source records attributed to A J Kirsch.

44 records · Page 3Linked to original sources
PubMed1994

Preliminary results of laser tissue welding in extravesical reimplantation of the ureters.

One exciting potential use of laparoscopic technology is the extravesical reimplantation of the ureters. We have assessed the efficacy of laser-activated fibrinogen solder to close vesical muscle flaps over submucosal ureters (Lich-Gregoir technique) in a canine model. Four dogs were subjected to unilateral flap closures via a protein solder (indocyanine green and fibrinogen) applied to the bladder serosa and exposed to 808 nm. continuous wave diode laser energy. Contralateral reimplantation was performed using 4-zero vicryl muscle flap closures (controls). At 7, 14 and 28 days postoperatively, intravenous pyelograms confirmed bilateral ureteral patency. At intravesical pressures above 100 cm. H2O, there was no evidence of wound disruption in either group. Nondisrupted wound closures were sectioned and strained until ultimate breakage to determine tensile strength. At each study interval the laser-welded closures withstood greater stress than the controls. Although these data represent single tissue samples and are not amenable to statistical analysis, laser-welded closures appeared to be stronger at each study interval. In conclusion, laser-welded vesical wound closures appear at least as strong as suture closures in the canine model.

Animals↗
PubMed1994

Symptomatic cholelithiasis following continent urinary diversion using ileocolonic bowel segments.

Cholelithiasis is uncommon prior to adulthood. Several risk factors have been identified as causing cholelithiasis but continent urinary diversion has not been considered a factor. To our knowledge there has been no other report of cholelithiasis developing after urinary tract reconstruction. Between 1979 and 1992, 116 patients younger than 23 years underwent urinary tract reconstruction at our clinic. Symptomatic cholelithiasis developed in 4 patients (3.4%) following continent urinary diversion with an Indiana pouch.

Adolescent↗
PubMed1994

Incidence of external spermatic veins in patients undergoing inguinal varicocelectomy.

OBJECTIVES: To determine the incidence of external spermatic veins at inguinal varicocelectomy. METHODS: A prospective study was performed by making intraoperative observations on 78 varicocelectomies (47 patients) performed by a single surgeon. All patients were referred for evaluation of male infertility and had a palpable varicocele present when examined while performing a Valsalva maneuver in the upright position. Varicocelectomies were performed via the inguinal approach using x 2.5 loupe magnification. Presence of external spermatic veins was defined as visualization (with x 2.5 loupe magnification) of veins on the floor of the inguinal canal traveling posterolateral to the spermatic cord that then subsequently exited the spermatic cord before passing through the internal inguinal ring. Age, anesthetic technique, and need for incision of the external inguinal ring were also recorded for each patient. RESULTS: One third of patients had undergone left-sided varicocelectomies, while two thirds had undergone bilateral procedures. External spermatic veins were identified in 15% of left-sided varicoceles and 19% of right-sided ones. Of 31 patients undergoing bilateral varicocelectomies, 19% had at least 1 external spermatic vein. Of these patients, only 2 (7%) had a unilateral right external spermatic vein, none had a unilateral left external spermatic vein, and 4 (13%) had bilateral external spermatic veins. Overall, of all patients studied, 16% had at least 1 external spermatic vein. Follow-up at 1 year showed no evidence of clinical recurrence in any patient. CONCLUSIONS: These results emphasize the importance of distal gonadal venous anatomy in the surgeon's choice of the proper approach to varicocele repair, since external spermatic veins are only accessible via an inguinal approach.

Collateral Circulation↗
PubMed1994

Oliguria during laparoscopic surgery.

Oliguria is infrequently viewed as a complication of laparoscopic surgery. The rate of urine output in six healthy patients undergoing laparoscopic surgery was measured during the period of CO2 pneumoperitoneum and for several hours after desufflation. The average hourly urine output during insufflation was 0.30 +/- 0.14 mL/kg despite an average hourly intravenous infusion rate of lactated Ringer's solution of 13.0 +/- 4.0 mL/kg. After release of pneumoperitoneum, urine output increased 467% to 1.7 +/- 1.1 mL/kg per hour. Patients remained hemodynamically unchanged perioperatively. Preoperative and postoperative blood urea nitrogen and creatinine concentrations did not significantly differ. We discuss the potential etiologic factors in the development of oliguria in the setting of the increased intra-abdominal pressure of pneumoperitoneum and the implications of this acute but reversible renal dysfunction.

Abdomen↗
PubMed1993

Operative management of adrenal metastases from lung carcinoma.

Most surgeons consider patients with solitary adrenal metastasis from a primary lung carcinoma incurable and avoid excision of both the adrenal and primary lung tumors. However, several cases of successful surgical management of these patients recently have been reported. We reviewed 12 surgically treated patients with isolated adrenal and lung disease and identified 2 survivors of greater than fifteen years (17%) and 4 additional patients who are still alive following combined resection (34%). This survival rate, albeit in a selected population, represents an improvement over the natural history of nine months' survival. We suggest that if after six to twelve months of following patients with lung cancer and isolated adrenal metastasis no other evidence of spread of disease is evident, the tumor biology may be favorable and resection of both adrenal and lung lesions is reasonable.

Adenocarcinoma↗
PubMed1991

The adaptive ability of transplanted rat small intestine.

This study was performed to determine the extent to which intestinal transplants undergo functional and morphologic compensation. Animals were studied after 25 days to document how rapidly the changes occurred and after 150 days to establish whether the effects were maintained long term. Lewis isografts and Lewis Brown Norway F1 allograft recipient rats had comparable degrees of morphologic (increased bowel diameter, crypt depth, and villus height) and functional (absorption of 3H-glucose, 14C-maltose, and cyclosporine) compensation. These changes were already present by day 25 and persisted until at least day 150. The results were independent of the loss of extrinsic innervation or the intramuscular administration of cyclosporine (5 mg/kg/day). These observations support the usefulness of segmental intestinal transplantation in the treatment of surgically induced short bowel syndrome.

Animals↗