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Biomedical subjects

E Mavor

Publications and source records attributed to E Mavor.

10 recordsLinked to original sources
PubMed1999

Laparoscopic management of benign solid and cystic lesions of the liver.

OBJECTIVE: The authors present their experience in the laparoscopic management of benign liver disease. The aim of the study is to analyze technical feasibility and evaluate immediate and long-term outcome. SUMMARY BACKGROUND DATA: Indications for the laparoscopic management of varied abdominal conditions have evolved. Although the minimally invasive treatment of liver cysts has been reported, the laparoscopic approach to other liver lesions remains undefined. METHODS: Between September 1990 and October 1997, 43 patients underwent laparoscopic liver surgery. There were two groups of benign lesions: cysts (n = 31) and solid tumors (n = 12). Indications were solitary giant liver cysts (n = 16), polycystic liver disease (n = 9), hydatid cyst (n = 6), focal nodular hyperplasia (n = 3), and adenoma (n = 9). Only solid tumors, hydatid cysts, and patients with polycystic disease and large dominant cysts located in anterior liver segments were included. All giant solitary liver cysts were considered for laparoscopy. Patients with cholangitis, cirrhosis, and significant cardiac disease were excluded. Data were collected prospectively. RESULTS: The procedures were completed laparoscopically in 40 patients. Median size was 4 cm for solid nodules and 14 cm for solitary liver cysts. Conversion occurred in three patients (7%), for bleeding (n = 2) and impingement of a solid tumor on the inferior vena cava (n = 1). The median operative time was 179 minutes. All solitary liver cysts were fenestrated in less than 1 hour. There were no deaths. Complications occurred in 6 cases (14.1%). Two hemorrhagic and two infectious complications were noted after management of hydatid cysts. There were no complications after resection of solid tumors. Three patients received transfusions (7%). The median length of stay was 4.7 days. Median follow-up was 30 months. There was no recurrence of solitary liver or hydatid cysts. One patient with polycystic disease had symptomatic recurrent cysts at 6 months requiring laparotomy. CONCLUSION: Laparoscopic liver surgery can be accomplished safely in selected patients with small benign solid tumors located in the anterior liver segments and giant solitary cysts. The laparoscopic management of polycystic liver disease should be reserved for patients with a limited number of large, anteriorly located cysts. Hydatid disease is best treated through an open approach.

Adult↗
PubMed1995

[Surgical treatment of nonpalpable mammographic abnormalities using guidewire localization].

Mammography remains the recommended method of detecting nonpalpable breast lesions. With increasing use of mammography as a screening and diagnostic modality for breast disease, more needle-localized biopsies are being performed. Preoperative localization of lesions detected by mammography enables the surgeon to resect affected breast tissue more accurately. The surgical biopsy should be a 1-step procedure with wide local excision. If it reveals malignancy, further surgical treatment should be planned, based on the clinical and pathological data. In our prospective study biopsies with localization were performed in 68 women; in 21 (30.9%) malignancy was found: solitary duct cell carcinoma in situ in 10 (multifocal in 4), duct cell carcinoma in situ with microinvasion in 3, and invasive carcinoma in 8. Lobular cancer was not found. Treatment consisted of mastectomy in 10 and breast conservation surgery in 11. Further studies are needed to clarify issues involved in surgical management of carcinoma-in-situ.

Biopsy, Needle↗
PubMed1992

Delayed operation for acute pancreatitis.

A retrospective study of 72 patients with acute biliary pancreatitis admitted to our department between 1982 and 1988 was carried out to evaluate our policy of delaying surgery in such cases. Of the 57 patients who underwent surgery, 17 were operated upon within 1 to 14 days of admission ("early operation"), and 40 patients were managed conservatively and readmitted for elective surgery about 6 weeks after resolution of the acute attack. Higher mortality and morbidity rates were observed in the "early operation" group (18% and 18% compared to 0% and 10%, respectively, P < 0.05). However, all deaths occurred in septic patients over the age of 70 who were operated on due to failure of maximal intensive medical therapy. Advanced age and early operation were found to be significant predictors of hospital mortality (P < 0.01). The two groups had similar mean hospital stay; 12 patients (30%) suffered an attack while waiting for elective surgery, however in only 3 (8%) the second attack occurred within 4 weeks of discharge from hospital. We conclude that a "delayed" operation for biliary pancreatitis is an acceptable option, and that recurrent attacks of acute pancreatitis in the time interval before the operation are avoidable if the operation is performed within 6 weeks of the initial acute attack.

Acute Disease↗
PubMed1992

Acute symptomatic hernia.

Acute symptomatic hernia is a clinical entity characterized by the coexistence of acute incarceration of an abdominal wall hernia together with an acute abdominal disease. Thirteen such cases are described. Increased awareness of this entity, both pre- and intraoperatively, is probably the basis for the improved rate of correct diagnosis (60%) and the decreased mortality (7%).

Adolescent↗
PubMed1990

Cecal volvulus.

A review of 561 cases of cecal volvulus that were published between 1959 and 1989 along with 7 new cases, was performed to characterize the clinical and laboratory profile and to evaluate the various surgical options in treating this life-threatening condition. The age and sex distribution of these patients have changed over the years and shifted toward older patients (mean, 53 years) and female predominance (female:male ratio, 1.4:1). The clinical presentation was usually of distal closed-loop small bowel obstruction. Forty-six percent of the plain abdominal radiographs were suspected for cecal volvulus, but only 17 percent were diagnostic. Barium enema had a high rate of accuracy (88 percent) and was associated with minimal complications. True volvulus was 6 times more common than bascule, and gangrenous cecum was found in 20 percent of cases. Detorsion alone and cecopexy had almost similar complications, mortality, and recurrence rates (15, 10, and 13 percent, respectively), whereas, resection, which was performed primarily for gangrenous cecum, had higher rates. However, the highest rates of complications (52 percent), mortality (22 percent), and recurrence (14 percent) were noticed after cecostomy. These data suggest that resection should be reserved for patients with necrotic cecum and that detorsion is sufficient for patients with viable cecum. Cecostomy should be abandoned.

Adolescent↗
PubMed1989

[Retroperitoneal desmoid tumor and familial polyposis coli].

A 43-year-old woman with familial polyposis coli (FPC) and adenocarcinoma of the rectosigmoid was treated by total colectomy, mucosal proctectomy and construction of an ileal pouch with ileoanal anastomosis. A year after operation she developed a huge retroperitoneal desmoid tumor which on exploratory laparotomy was found to be nonresectable. A 21-month course of indomethacin followed by tamoxifen failed to induce regression of the tumor. Desmoid tumors appear in 3.5-29.0% of patients with FPC, mostly after colectomy. This possibility must be considered in the differential diagnosis of recurrent carcinoma of the colon. The preferred treatment of abdominal and retroperitoneal desmoid tumors is conservative, and includes the use of non-steroidal antiinflammatory drugs, ascorbic acid and tamoxifen.

Adenomatous Polyposis Coli↗
PubMed1986

Brachial artery injury after cardiac catheterization.

During a 3-year period, 12,158 cardiac catheterizations were performed via the brachial artery. During this same period, 106 patients were operated on for complications of brachial artery injury and/or thrombosis, an incidence of 0.9%. The indication for the cardiac catheterization was coronary artery disease in almost 92% of the patients. Early (less than 4 days) brachial artery repair was done in 90% of the patients. The operative findings were thrombosis (91%), intimal injury (54%), stenosis (13%), laceration and/or perforation (11%), and atherosclerotic plaque (6%). Because of vessel injury, localized resection was done in two thirds of the patients. Vascular continuity was obtained with axial reanastomosis in 45 patients and interposition vein graft in 26 patients. Primary lateral repair was performed in 23 patients (22%). Ninety-five percent (101 patients) had initial excellent results. Of the five patients who required reoperation, flow was restored in four patients. Thus, 99% of patients had restoration of a patent brachial artery. Contributing factors for brachial artery complications are "redo" catheterization, prolonged catheterization time, catheter change, brachial artery atherosclerosis, improper arteriotomy closure, experience of cardiologist, female patient, and failure to use heparin. Because of the unpredictability of ischemic symptoms occurring after brachial artery thrombosis, the need for bypass graft surgery when delayed, and the good results with early surgical intervention, early exploration of brachial artery complications after cardiac catheterization and appropriate repair are recommended.

Adult↗
PubMed1985

Nutritional effects of postgastrectomy reconstructions.

To compare the nutritional effects of two modes of reconstruction after total gastrectomy, a Hunt-Lawrence pouch was constructed in five mongrel dogs, whereas five other dogs had a simple Roux-Y esophagojejunostomy performed. Total body weight, daily food intake, serum albumin values, and intestinal absorption of carbohydrates, fats, and amino acids were evaluated in both groups over a period of 3 months. All values decreased postoperatively when compared with the preoperative values; however, there was no significant difference between the two groups. This study suggests that there is no nutritional benefit from a Hunt-Lawrence pouch over a simple Roux-Y esophagojejunostomy after total gastrectomy.

Animals↗