Biomedical subjects
Publications and source records attributed to C G Eden.
The scope of reconstructive laparoscopy is currently limited by the difficult and time-consuming nature of laparoscopic suturing. Alternative methods to suturing, such as the use of biocompatible glues and laser tissue welding, have the potential to produce anastomoses which are immediately water-tight, achieved with less tissue trauma and reduce operating times.
Operative retroperitoneoscopy provides a less traumatic alternative to transperitoneal laparoscopy for the minimal access surgery of retroperitoneal structures. Although open and closed techniques have been described for achieving access, the former allows the creation of a larger initial retroperitoneal workspace with a greater margin of safety and in a shorter space of time.
Malignant mesothelioma is a rare, often aggressive tumor of the tunica vaginalis. We report 2 cases and review the literature concerning current management strategies. It appears that, although adjuvant chemotherapy and radiotherapy have little value, local and nodal recurrence may be successfully treated by local excision.
The pulmonary response to nephrectomy was studied in 16 patients undergoing laparoscopic (n = 8) or open (n = 8) nephrectomy using a standardized anesthetic technique. Although there was no significant difference between the two groups at 24 hours, postoperative pulmonary function measures (P = 0.02-0.03) and oxygenation (P = 0.03) were significantly better in the laparoscopic surgery group at 48 hours. The median opiate analgesic requirement (P = 0.02) and the number of nights spent in the hospital (P = 0.003) also were significantly lower in this group. The results of this study suggest that laparoscopic nephrectomy offers a real biological advantage in terms of postoperative preservation of lung function and that this might therefore be the safest technique for nephrectomy in patients with limited respiratory reserves.
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The ever increasing amount of laparoscopic instrumentation and the lack of any objective comparison make choosing the most appropriate equipment a difficult task for the urological neo-laparoscopist. All major manufacturers of laparoscopic equipment were invited to submit as much of their equipment as possible for inspection. A selection of ports, hand instruments, haemostatic devices and imaging systems was then tested in a laboratory and clinical setting. Costings are provided for evaluated ports, hand instruments and imaging systems. Vessels with a diameter greater than 7 mm, such as renal artery and vein, should be secured with a linear stapler-cutter. The optics of the Olympus OTV-S4, CLV-10 light source, Olympus light cable and A5254A telescope are superior to the other imaging systems tested. Laparoscopic equipment is diverse in specification, performance and cost. Due consideration must be given to these factors when purchasing equipment to avoid disappointment and wastage of resources, particularly with regard to disposable instruments and imaging systems.
A case is reported of duodenal perforation complicating laparoscopic cholecystectomy performed by laser dissection. The importance of investigating a patient with persistent shoulder-tip pain following this technique to exclude a subphrenic abscess is emphasised.
A 24 year old woman with Gardner's syndrome developed a massive chest wall desmoid tumour, which required radical excision and prosthetic reconstruction. In view of the local aggressiveness of this tumour and the fact that it does not metastasize a policy of radical surgery when possible is recommended.
For a study of penetration of enoxacin into lung, patients undergoing pneumonectomy were given 400 mg by mouth the night before and again approx 2 h before operation. A blood sample was taken as the lung was excised. Lung and serum enoxacin concentrations were assayed by high pressure liquid chromatography. Results from 15 patients showed that enoxacin was concentrated in the lung. Enoxacin lung concentrations were 3.2-13.1 mg/l, and ratios of lung to serum concentrations were 3-6 (mean, 4.2).