Biomedical subjects
Publications and source records attributed to C Vara Thorbeck.
Un uncommon case of aneurysm located in an aberrant hepatic artery is described. It was the cause of massive hemoperitoneum. It was treated by ligation and excision without post-operative complications. In spite of the complex vascular malformation, there was no hepatic insufficiency. We have not been able to find a similar case in the literature.
Lymphangiomas are benign tumors of the lymphatic system. Their abdominal location is infrequent. We report two cases, one in the first jejunal loop and the other one in the mesentery. The latter was removed by laparoscopic surgery, technique that allows a wider resection.
The present article describes a procedure for bladder neck suspension. The peritoneum is detached using a technique that we previously described. A 1.5 cm suprapubic incision is performed. The fascia is incised and a sound is introduced to dissect the retropubic space. A balloon tipped catheter is introduced into the Retzius space and inflated with saline to release the peritoneum. A blunt trocar is inserted, the optics is introduced and a Stamey needle is used to pass a no. 1 nylon suture to fix the vagina to the rectus fascia. The maneuver is repeated on the other side. The sutures are then tied independently on each side under visual control, without tension and ensuring adequate elevation of the bladder neck. This technique requires only one port, allows direct visualization of the bladder neck and avoids all the risks of an intraperitoneal approach. In conclusion, we believe this technique has all the advantages of an open procedure, but using a minimally invasive approach, and may well become the treatment of choice in urinary stress incontinence.
The authors describe an experimental technique of endoscopic autotransplantation of the testis. Four trocars are utilized; one is placed at the level of the umbilicus, one in the right flank, another in the left flank, and one in the hypogastrium. Five or six cms of the epigastric vessels are dissected and sectioned. Then the spermatic vessels and released from the inguinal orifice up to their origin and sectioned. The testis is taken to the peritoneal cavity through the skin and the sustenaculum testis is sectioned. Both vascular pedicles are exteriorized through an incision at the level of the inguinal duct. Microvascular anastomosis is performed as in a routine procedure and the vessels are inserted into the abdomen again, the testis is taken to the scrotum and the inguinal duct is closed from inside.
The authors have experimented in the pig the possibility of endoscopic treatment of cryptorchidism. Sixteen orchidopexy procedures were performed utilizing 12 Large White pigs weighing 10 to 15 kg. The procedure is described herin, including some details of anesthetic induction. The animal is placed in the Trendelenburg position and three trocars are inserted, in a position which corresponds to that of the umbilicus in humans (through which a laparoscope is passed), in the hypogastrium and in the hypochondrium of the corresponding side. The spermatic vessels are dissected all the way up to their origin and the vas deferens up to a short distance from the bladder. Then an incision is made in the inguinal canal, from the epigastric vessels up to the conjoined tendon. Pressure is applied outside until the testis is introduced into the peritoneal cavity where it is released by sectioning the sustenaculum testis. The cord is then pulled and passed in front of the epigastric vessels and taken out through the deep orifice of the inguinal canal. Once it is free in the peritoneum and after the vessels and the vas have been dissected, it is brought to the bottom of the scrotum with the grasping forceps and the aid of the hand outside. Then it is fixed with a suture through the skin. Finally, the incision in the inguinal canal is sutured with atraumatic nylon 0 suture as in the McVay technique for inguinal hernia repair. The procedure has started to be employed in the clinical setting.
The first one-hundred cases of laparoscopic cholecystectomy performed in this department are reviewed. The patients are grouped according to the classification of McSherry: type I: 5%; type II: 50%; type III; 27%; and type IV: 18%. Our technique, which is similar to the one of Troidl, except for entry of the number 4 port, is described. The results are analyzed according the classification of Troidl and 83% of the cases had no complications. There were technical incidents which had no repercussion for the patient in 7% of the cases. In 3% of the patients there were minor complications. There was no mortality.
The authors describe an experimental model for performing the Bricker procedure endoscopically. After placing the operating table in the Trendelenburg position, the trocars are inserted through the incisions at the level of the umbilicus, the right and left flanks and the hypogastrium. Both ureters are dissected free from the inferior pole of the kidney up to a short distance from the bladder, clamped and cut. The right flank incision is extended a few cms longitudinally and the right ureter and ileal loop are brought out through the incision. Once exteriorized, a segment of the ileum is separated and intestinal continuity reestablished. The right ureter is then attached to the distal end of the ileal segment. The other end of the loop is brought to the left flank and exteriorized together with the left ureter, as described above. Once the ureter has been attached, they are passed inside. The incisions are sutured and a stoma is created in the right flank. The authors recommend the application of this simple technique in the clinical setting.
Herein we report our experience in the treatment of varicocele by endoscopic surgery. After a 5 mm. transverse incision has been made immediately below the umbilicus, air is insufflated and a trocar is introduced through the incision. We then introduce the optics through the trocar and a similar incision is made 4 or 5 cm. above the internal orifice of the left inguinal duct. A grasping forceps is inserted through the second incision to coagulate the dilated testicular veins. These veins are easily identifiable, making dissection unnecessary. In our series comprised of 16 patients, good results were achieved in 68.7% and no important complications were observed.
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We describe our experience in using a new endoscopic technique for suspending the bladder neck and urethra in 16 patients with stress incontinence. The procedure was started by dissecting the retropubic space, first with a sound and then with a Foley catheter before passing an absorbable suture from the abdominal fascia to the bladder neck using an elbowed needle introduced into the bladder through the neck and exteriorized through the urethra. The dissection of the retropubic space helped to form postoperative adherences which fixed the bladder neck and the urethra firmly to the pubic symphysis. The technique is simple, it does not require vaginal surgery, and the incidence of complications is minimal.
Following the induction of experimental diabetes in two groups of rats using an isograft model, a comparative study was made of two types of pancreas transplants in which several procedures were employed. The vascular anastomosis in one group were to the renal artery and vein, and in the other, to the iliac vessels. The pancreatic ducts in one subgroup were ligated, in another, they were diverted to the urinary system; in a third sub-group, they were diverted to the intestine. The results obtained for the sub-group with the transplant anastomosed to the renal vessels were the best. It is suggested that this was due to two factors: the simplicity of the technique and the short operating times. In this present work the two best methods of dealing with the exocrine secretion were diversion to the ureter and ligation of the common bile duct. The worst results were in the group with duodeno-cystostomy.
A case of Morgagni's hiatal hernia is presented. Because of clinical symptoms (dizziness and chest pain) the patient was referred to the Cardiology Department and the diagnosis was a casual finding. The hernia sac contained transverse colon, great omentum and round ligament. We comment on the mechanism, etiologic factors, diagnosis, and surgical treatment. The present case was treated by an abdominal approach.
The present study in 10 breast cancer patients supports the concept that newly synthetized, nascent histamine is involved in tumour growth. Histidine decarboxylase (HDC) activity is increased in mammary tumour tissue compared to healthy mammary gland-, skin- and muscle tissue in all but one patient studied. The newly formed histamine is probably not stored in the tumour tissue. Significantly decreased histamine concentrations were measured in parallel samples in the tumour tissue. Moreover, the preliminary results from urinary analysis of histamine and N tau-methylhistamine in 3 of the 10 patients studied showed a significant decline after tumour extirpation compared to preoperative values.
Diverticuli of the small intestine are a rare, usually asymptomatic affectation. These diverticuli are acquired by pulsion and are the consequence of previous intestinal dyskinesia. Acute complications of jejunoileal diverticulosis are: diverticulitis, perforation, as in one of our cases, hemorrhage and obstruction; chronic complications are: megaloblastic anemia, malabsorption syndrome and steatorrhea. The preoperative diagnosis at the present poses great difficulties and surgical treatment is only indicated for complications.
An attempt was made to modify postoperative ileus in rats by using different drugs (propranolol, phentolamine, neostigmine and mepivacaine). The election of these drugs was based on their effect on the extrinsic innervation of the digestive tract. No statistically appreciable acceleration of the intestinal transit was found in any case, but we observed on radiography that the injection of mepivacaine accelerated gastric emptying.
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