Biomedical subjects

A Metzger

Publications and source records attributed to A Metzger.

41 records · Page 3Linked to original sources

PubMedDate not supplied

Laparoscopic management of small bowel obstruction: indications and outcome.

Our aim was to evaluate the feasibility of a laparoscopic, minimal access approach for the management of patients with small bowel obstruction. Forty patients underwent laparoscopic treatment of radiologically documented or suspected small bowel obstruction based on history and/or motility study. None had chronic abdominal or pelvic pain. The operation was completed laparoscopically in 14 patients (35%) and with laparoscopic-assisted procedures in 12 (30%); 14 (35%) required conversion to open celiotomy because of dense adhesions (precluding complete inspection or adhesiolysis), small bowel necrosis in the setting of small bowel obstruction, or neoplasia. Three iatrogenic enterotomies occurred while "running" the bowel. There were three (7%) postoperative procedure-related complications (wound infection, intra-abdominal abscess, ileus). The combined group of patients treated laparoscopically or with laparoscopic-assisted procedures had a shorter hospital stay than those converted to open celiotomy (4 +/- 0.6 vs. 7 +/- 0.7 days; P <0.003). At median follow-up of 12 months, 21 of 26 patients managed laparoscopically or with laparoscopic-assisted procedures remain asymptomatic; all 21 patients with an operatively confirmed site of mechanical obstruction managed by a minimal access approach remain asymptomatic. Laparoscopic treatment of small bowel obstruction is effective, leads to a shorter hospital stay, and has good long-term results. A minimal access approach to treatment of small bowel obstruction should be considered in selected patients.

Abdomen↗

PubMedDate not supplied

Anti-Clq antibodies in patients with chronic hepatitis C infection.

OBJECTIVE: Extrahepatic autoimmune features of HCV infection include autoantibody production and the development of mixed cryoglobulinemia. Anti-Clq antibody, detected with high frequency in systemic lupus erythematosus and hypocomplementemic urticarial vasculitis, may have a direct pathogenic role in complement mediated autoimmune diseases. In this study, we investigate the prevalence of anti-Clq antibody in a population of patients with chronic HCV infection. METHODS: Serum was obtained from a group of 50 patients with chronic HCV infection and control groups comprised of patients with SLE, rheumatoid arthritis (RA), scleroderma (PSS), Sjögren's syndrome (SS), mixed connective tissue disease (MCTD), and healthy individuals. RESULTS: Anti-Clq antibody was detected in 38% of HCV patients compared with 2% of healthy controls (p < 0.0001). Levels were also significantly elevated in patients with SLE (61%), RA (20%), PSS (15%), SS (15%) and MCTD (15%). CONCLUSION: In addition to numerous other autoantibodies, patients with chronic HCV infection exhibit increased production of anti-Clq IgG antibodies. This observation may have implications for the pathogenesis of the mixed cryoglobulinemic vasculitis syndrome.

Arthritis, Rheumatoid↗

PubMedDate not supplied

Monopolar current, with particular attention to hook dissection in laparoscopic cholecystectomy.

Monopolar current has been part of surgical practice for decades. The introduction of laparoscopic surgery has led to new developments in electrosurgery, in instrumentation and in operative techniques. The hook electrode is a device specially created for laparoscopic surgery. Some essentials of modern electrosurgery and the technique of the hook electrode are reviewed, with special emphasis on its use during laparoscopic cholecystectomy.

Cholecystectomy, Laparoscopic↗

PubMedDate not supplied

Laparoscopic liver resection in the Large White pig--a comparison between waterjet dissector and ultrasound dissector.

Resection of 16 liver lobes was successfully undertaken laparoscopically in anaesthetised Large White pigs. These animals proved to be suitable for the instruments used in human laparoscopic procedures. It was planned to undertake a comparison between the waterjet and ultrasound dissectors, but this proved impossible because of the development of a thick intraabdominal mist during dissection with the waterjet dissector. The ultrasound dissector was effective in dissecting the intraparenchymal hepatic structures, especially the portal vein and the hepatic vein. These blood vessels were safely secured with endoclips, while bleeding points on the resection surface were coagulated with an argon beam coagulator. The liver specimens removed were approximately 75 g in weight. All ultrasound-dissected animals survived for 10 days. Post-mortem evaluation showed two cases of wound infection, one case of subphrenic abscess and two cases of biloma. Our results emphasise the potential of laparoscopic resection techniques for formal or at least peripheral liver resections in humans.

Animals↗

PubMedDate not supplied

Temporary exclusion of the perforated esophagus using a linear vascular stapler: a new surgical treatment.

BACKGROUND/AIMS: A new technique using a linear staple suture for temporary exclusion of the perforated esophagus is presented. MATERIALS AND METHODS: The procedure is combined with diversion of esophageal fluid by nasogastric tube and drainage of the periesophageal compartments by silicon drains. A gastrostomy is used to drain the stomach for 48 hours, and later for enteral nutrition. Since the suture line reopens spontaneously after approximately 10 days there is no need of reoperation. RESULTS: This method allows diversion of esophageal fluids and therefore enhances effective healing of esophageal perforations after primary repair. Complete spontaneous recanalization of the esophagus occurs approximately two weeks after operation. CONCLUSIONS: The combination of primary repair of an esophageal perforation with esophageal exclusion by using a linear stapler and diversion of esophageal fluid contents by naso-esophageal tube and gastrostomy is a simple effective procedure. Further experience and studies may be needed to verify the usefulness and place of this technique in armamentarium of the visceral surgeon.

Aged↗