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Biomedical subjects

Daniel B Jones

Publications and source records attributed to Daniel B Jones.

28 records · Page 2Linked to original sources
PubMed2003

Laparoscopic totally extraperitoneal versus Lichtenstein herniorrhaphy: cost comparison at teaching hospitals.

Laparoscopic hernia repair is safe and effective and may result in less postoperative pain and faster recuperation compared with traditional open hernia repairs. Controversy exists as to the increased cost associated with laparoscopic repairs. The purpose of this study was to quantify and compare the cost of the totally extraperitoneal (TEP) laparoscopic repair and the tension-free Lichtenstein repair at teaching hospitals. The records of consecutive TEP (n = 28) and Lichtenstein (n = 28) repairs performed at Parkland Memorial Hospital and Zale-Lipshy University Hospital were reviewed. A detailed cost analysis was performed. Total patient charge (5,509 US dollars vs. 3,999 US dollars) and total cost (2,861 US dollars vs. 2,009 US dollars) were higher for TEP versus Lichtenstein repairs, respectively (P < 0.05). Operative time and complications were similar for both groups. Return to full activity (15 vs. 34 days) was faster for TEP versus Lichtenstein repairs, respectively (P < 0.05). Of 9 patients in the TEP group who had previously undergone an open hernia repair, 8 (89%) preferred the laparoscopic approach. The laparoscopic TEP repair costs 852 US dollars more than the Lichtenstein repair. The TEP repair results in faster recuperation. Patient preference and faster recuperation may offset the increased cost associated with laparoscopic hernia repair.

Adult↗
PubMed2003

Routine upper gastrointestinal Gastrografin swallow after laparoscopic Roux-en-Y gastric bypass.

BACKGROUND: Upper gastrointestinal (UGI) swallow radiographs following laparoscopic Roux-en-Y gastric bypass (LRYGBP) may detect an obstruction or an anastomotic leak. The aim of our study was to determine the efficacy of routine imaging following LRYGBP. METHODS: Radiograph reports were reviewed for 201 consecutive LRYGBP operations between April 1999 and June 2001. UGI swallow used Gastrografin, static films, fluoroscopic video, and a delayed image at 10 minutes. Mean values with one standard deviation were tested for significance (P < 0.05) using the Mann-Whitney U test statistic. RESULTS: Of 198 available reports, UGI detected jejunal efferent (Roux) limb narrowing (n = 17), partial obstruction (n = 12), anastomotic leak (n = 3), complete bowel obstruction (n = 3), diverticulum (n = 1), hiatal hernia (n = 1), and proximal Roux limb narrowing (n = 1). A normal study was reported in 160 cases (81%). Partial obstruction resolved without intervention. Complete obstruction required re-operation. Compared to 6 patients who developed delayed leaks, early identification of a leak by routine UGI swallow resulted in a shorter hospital stay (mean 7.7 +/- 1.5 days vs 40.2 +/- 12.3 days, P < 0.03). CONCLUSIONS: Early intervention after UGI swallow may lessen morbidity. Routine UGI swallow following LRYGBP does not obviate the importance of close clinical follow-up.

Adult↗
PubMed2002

Comparison of acustimulation and ondansetron for the treatment of established postoperative nausea and vomiting.

BACKGROUND: This study was designed to evaluate transcutaneous electrical acupoint stimulation (acustimulation) using the ReliefBand compared with ondansetron for the treatment of established postoperative nausea and vomiting (PONV) after outpatient laparoscopic surgery. METHODS: After the authors obtained institutional review board approval and written informed consent, 268 outpatients were enrolled in this randomized, double-blind, placebo- and sham-controlled study. All patients received antiemetic prophylaxis with metoclopramide, 10 mg intravenously, or droperidol, 0.625 mg intravenously, after induction of anesthesia. A total of 90 patients developed PONV in the recovery units and were randomized to one of three treatment groups: (1) the ondansetron group received 4 mg intravenous ondansetron and a sham ReliefBand; (2) the acustimulation group received 2 ml intravenous saline and a ReliefBand; and (3) the combination group received 4 mg intravenous ondansetron and a ReliefBand. A rescue antiemetic (10 mg intravenous metoclopramide) was administered only if the PONV symptoms persisted for 15 min or longer after initiating the treatment. A blinded observer recorded the recovery times, emetic symptoms, rescue antiemetics, maximum nausea scores, complete response to study treatment, and time to achieve discharge criteria. Postdischarge side effects, as well as patient satisfaction and quality of recovery scores, were assessed at 24 and 72 h after surgery. RESULTS: The combination group had a significantly higher complete response rate than the acustimulation group (73% vs.40%, P <0.01). In addition, fewer patients (8 vs. 18) in the combination (vs. acustimulation) group experienced subsequent emetic events (P < 0.03). However, there were no significant differences between the three groups with respect to patient satisfaction and quality of recovery scores. CONCLUSIONS: Acustimulation with the ReliefBand can be used as an alternative to ondansetron for the treatment of established PONV. However, the use of ondansetron (4 mg intravenously) in combination with the ReliefBand device improved the complete response rate to the acustimulation therapy.

Adult↗
PubMed2002

Simulation of bleeding during laparoscopic herniorrhaphy.

Simulation of intragastric bleeding due to an accidental cut by the surgeon is an important component of a virtual laparoscopic herniorrhaphy trainer. We present a method for simulating bleeding during laparoscopic hemiorrhaphy here. The various approaches used in previous research work are reviewed and our present approach is justified. Physically based fluid models used in computer graphics are used to simulate bleeding.

Algorithms↗
PubMed2002

Adaptive hybrid interpolation techniques for direct Haptic rendering of isosurfaces.

Direct Haptic rendering of voxels from an anatomical dataset provides patient specific haptic feedback vital for diagnosis and surgical planning. Our algorithm uses zero sets of scalar trivariate function for polynomial interpolation with sixty-four neighborhood points to generate isosurfaces on the fly for haptic rendering. This approach gives continuity in surfaces as well as better capture of isosurface features of the medical dataset. The detailed algorithm is presented along with the description of results from haptically rendering medical datasets.

Algorithms↗
PubMedDate not supplied

Intussusception after Roux-en-Y gastric bypass for morbid obesity: case report and literature review of rare complication.

Obstruction of the small intestine is a recognized complication after Roux-en-Y gastric bypass surgery for morbid obesity. Reported causes after bariatric surgery include volvulus, adhesion, internal hernia, hemorrhagic bezoar, incarcerated ventral hernia, and intussusception. Intussusception after Roux-en-Y gastric bypass for morbid obesity is rare. The etiology remains largely obscure. A delay in the diagnosis and management may result in catastrophic outcomes. Management should include the early involvement of a bariatric surgeon. We describe the clinical and radiologic presentation of a case of jejunojejunal intussusception 4 years after open Roux-en-Y gastric bypass.

Adult↗
PubMedDate not supplied

Use of fibrin sealant in laparoscopic gastric bypass for the morbidly obese.

Roux-en-Y gastric bypass is the most commonly performed bariatric operation in the USA. Anastomotic leak is one of the devastating complications in this operation. By using fibrin sealant around the anastomosis, surgeons can achieve better hemostasis around the suture-line and prevent or decrease the incidence of anastomotic leaks. This paper discusses the biological and clinical evidence for use of fibrin sealant in laparoscopic gastric bypass.

Anastomosis, Roux-en-Y↗