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Biomedical subjects

C R Voyles

Publications and source records attributed to C R Voyles.

32 records · Page 2Linked to original sources
PubMed1981

Emergency abdominal wall reconstruction with polypropylene mesh: short-term benefits versus long-term complications.

The acute replacement of full-thickness abdominal wall has been facilitated by polypropylene mesh (Marlex) (PPM), allowing debridement of nonviable tissue and restoration of abdominal wall integrity without tension. However, no substantial long-term follow-up has been reported on the definitive wound coverage after the use of PPM in open wounds. Since 1976, we have placed PPM in 31 patients; 25 for infectious complication, three for massive bowel distension preventing abdominal closure, and three for shotgun wounds with extensive tissue loss. In 29 of 31 patients, the mesh was placed in heavily contaminated wounds; extensive fasciitis was present in 23 patients and 21 had intra-abdominal abscesses. Following mesh placement, 23 reoperations were required for continuing complications. No patients eviscerated, despite these multiple procedures. Polypropylene mesh was highly effective in restoring abdominal wall continuity. Despite advantages when PPM was used, significant long-term problems developed. Seven patients died from their primary illness in the postoperative period. Nine wounds were closed by granulation and subsequent split-thickness skin grafts. All nine developed mesh extrusion and/or enteric fistulae. Nine wounds healed by secondary intention, six developed enteric fistulae or continuing mesh extrusion. Full-thickness flap coverage after granulation provided the best means of wound closure. Polypropylene mesh had significant early advantages for providing abdominal wall integrity even in the presence of severe infection. However, long-term problems were common when wounds were closed to skin grafts or secondary intention. If the mesh cannot be completely removed, strong consideration should be given to myocutaneous flaps for coverage after the primary illness has resolved.

Abdominal Injuries↗
PubMed1981

Manometric evaluation of esophageal disease.

Esophageal manometry has been helpful in delineating several aspects of the pathophysiology of esophageal disease. Its immediate contribution to patient care, however, is not clear. We reviewed our experience with 59 consecutive patients who had been referred to our laboratory specifically for this study. Manometry provided new information resulting in better patient management in only eight patients (14%). Manometric abnormalities are uncommon when radiographs and endoscopy are normal; thus, manometry should rarely be used alone to evaluate subjective complaints. It is useful preoperatively in patients with reflux esophagitis if a motility disorder is suspected and in patients with cricopharyngeal abnormality. After hiatal hernia repair performed with an adequate preoperative radiologic and endoscopic evaluation for reflux esophagitis, esophageal manometry contributes little additional information to the evaluation of postoperative dysphagia.

Esophageal Achalasia↗
PubMed1980

Diversion of duodenal contents: its effect on the production of experimental gastric cancer.

Diversion of duodenal contents after gastroenterostomy and vagotomy did not protect 240 laboratory rats from increased risk of gastric carcinoma. They were divided into three groups of 80: group 1 received 0.9 mg of 3-methylcholanthrene injected submucosally into the gastric antrum; groups 2 and 3 had bilateral truncal vagotomy and gastroenterostomy, with carcinogen injected into the gastric submucosa near the anastomosis; group 3 also had total duodenoenteric diversion. Blind histopathologic examination of surviving rats during necropsy eight months later disclosed that cancer had developed in six of 60 (10%) group 1 rats, in 23 of 71 (33%) group 2 rats, and in seven of 27 (22%) group 3 rats. Compared with group 1, groups 2 and 3 had an increased incidence of gastric cancer but did not differ from one another in this regard.

Adenocarcinoma↗
PubMed1978

Missile tract infections after transcolonic gunshot wounds.

Severe invasive infections around missiles or missile tracts may occur after transcolonic gunshot wounds. Observations in seven patients disclosed that infections of bone, soft tissue, retroperitoneum, and vascular structures resulted from the contamination of these tissues by missiles that had passed through the lumen of the colon. The infections were frequently obscure and difficult to diagnose unless the missile was considered to be a potential source of contamination. Two of seven patients died as a direct result of infection. Aggressive debridement of missile tracts, removal of accessible missiles, and adjunctive antibiotic therapy were useful.

Adult↗
PubMed1978

Effect of limiting post-shock pulmonary edema on mortality from bacterial pneumonia.

Dogs were subjected to hemorrhagic shock and then resuscitated according to physiological parameters. Randomly selected dogs received a sublethal dose of intratracheal microorganisms. In comparing the results with those previously reported from our laboratory, in which animals received an 85% greater resuscitation of Ringer's lactate, it appears that pulmonary edema in the post-shock contaminated state can be limited. Furthermore, through minimization of pulmonary edema, pulmonary defenses appear to be improved and mortality from infection reduced.

Animals↗
PubMed1977

Wound management after trauma to the colon.

The records of 62 patients with injury of the colon were reviewed to ascertain the contribution of technics in wound care to morbidity. Primarily closed wounds had a very high frequency of infection (56%). Wounds treated by delayed primary closure or secondary intention developed infection in 19% of patients. Infection in an open wound was associated with intraperitoneal abscess in 73% of cases.

Adolescent↗
PubMedDate not supplied

Litigious consequences of open and laparoscopic biliary surgical mishaps.

Three hundred six injuries or complications coincident to 296 laparoscopic cholecystectomies were analyzed for the nature and extent of injuries and litigious outcomes that followed. The data were drawn from 31 member companies of the Physician Insurers Association of America, a trade association that initiated the study. The outcomes were compared to 261 contemporaneous open cholecystectomy claims. Biliary tract injuries were the most common, accounting for almost two thirds of all injuries. The spectrum of cases, originally selected for indemnity potential, reflected relative incidences in the medical literature. Laparoscopic injuries were significantly more severe, more likely to result in indemnity, and more apt to involve higher mean +/- standard deviation dollar values (160 dollars +/- 154 x 10(3)) to surviving claimants than injuries resulting from open procedures (106 dollars +/- 122 x 10(3), P = 0.01). Injury recognition at the time of the original procedure had no discernible mitigating effect because 80% of recognized injuries required an additional operative procedure. Risk-aversive behavior should include paying particular attention to placement of the first port, more liberal use of the Hasson technique, placement of all other ports under direct vision, elimination of intraoperative anatomic uncertainty, programmed inspection of the abdomen before withdrawing the laparoscope, and acquiring sufficient knowledge of electrosurgical principles to ensure the safe use of this potentially dangerous modality.

Adolescent↗
PubMedDate not supplied

Criteria and benchmarks for laparoscopic cholecystectomy in a free-standing ambulatory center.

BACKGROUND AND OBJECTIVES: Keys to economic survival in an era of decreasing reimbursement include controlling costs and avoiding complications. In an effort to reduce costs, laparoscopic cholecystectomy has been performed with same-day discharge from a hospital setting. The free-standing ambulatory surgery center offers even greater cost savings if safety can be assured. Facility charges, surgical technique and instrument selection influence the costs of the procedure. METHODS: A database was accumulated prospectively on the first 100 laparoscopic cholecystectomies performed in a free-standing ambulatory surgery center to assess costs, logistical constraints, and safety. RESULTS: Laparoscopic cholecystectomies were accomplished in 99 of 100 patients. One patient was suspected of having cancer during laparoscopy and was transferred to a nearby hospital for open cholecystectomy. There were no other postoperative hospitalizations for complications. The fixed facility charge for the procedure was $2,990, and the total costs for all routinely disposable items (gowns, gloves, instruments, and adhesive bandages was $98. The mean OR time was 29 minutes (standard deviation 13.7). CONCLUSIONS: The free-standing ambulatory surgery center is an appropriate facility for an experienced operating team to perform laparoscopic cholecystectomy in selected patients. The surgeon's selection of appropriate energy sources and instruments is essential to complete the operation in a most cost-effective manner.

Adult↗
PubMedDate not supplied

Capacitive coupled stray currents during laparoscopic and endoscopic electrosurgical procedures.

Capacitively coupled currents may not be appreciated during laparoscopic and endoscopic radiofrequency electrosurgery. Two specific problems are documented and quantified: coupling of current into metal trocar cannulas during laparoscopic surgery and coupling of current into a guide wire during endoscopic surgery. The examples can yield power levels in excess of 25 watts (laparoscopic) and 15 watts (endoscopic) on nearby metal conductors, which can in turn be dissipated into patient organs such as the bowel or the common bile duct. This capacitive coupling can be, in part, responsible for serious patient complications. Methods to minimize capacitive coupling, e.g., active electrode shielding, dispersive metal cannulas, sheathed guide wires, and bipolar active electrodes, are discussed for each example.

Electric Conductivity↗
PubMedDate not supplied

The "floppy diaphragm" sign with laparoscopic-associated pneumothorax.

Pneumothoraces in association with laparoscopy are uncommon and potentially disastrous complications that may also occur without adverse sequelae. The "floppy diaphragm sign" is a readily discernible and useful sign of a laparoscopic-induced pneumothorax. Tube thoracostomy is generally not indicated in stable patients as the pneumothorax typically resolves quickly upon desufflation of the pneumoperitoneum.

Aged↗