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Biomedical subjects

G Berci

Publications and source records attributed to G Berci.

At least 73 records · Page 4Linked to original sources
PubMed1991

Laparoscopic trancystic choledocholithotomy as an adjunct to laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is rapidly becoming the standard operation for symptomatic cholelithiasis. Initially, common duct stones presented a barrier to this treatment modality and are said to be unsuspected in 5-9 per cent of patients. A technique is described that removes common bile duct stones through the cystic duct with a flexible nephroureteroscope, thereby extending the range of laparoscopic cholecystectomy.

Adult↗
PubMed1990

The effect of ursodiol on the efficacy and safety of extracorporeal shock-wave lithotripsy of gallstones. The Dornier National Biliary Lithotripsy Study.

BACKGROUND: In the treatment of gallstones with extracorporeal shock-wave lithotripsy, the bile acid ursodiol is administered to dissolve the gallstone fragments. We designed our study to determine the value of administering this agent. METHODS: At 10 centers, 600 symptomatic patients with three or fewer radiolucent gallstones 5 to 30 mm in diameter, as visualized by oral cholecystography, were randomly assigned to receive ursodiol or placebo for six months, starting one week before lithotripsy. RESULTS: The stones were fragmented in 97 percent of all patients, and the fragments were less than or equal to 5 mm in diameter in 46.8 percent. On the basis of an intention-to-treat analysis of all 600 patients, 21 percent receiving ursodiol and 9 percent receiving placebo (P less than 0.0001) had gallbladders that were free of stones after six months. Among those with completely radiolucent solitary stones less than 20 mm in diameter, 35 percent of the patients receiving ursodiol and 18 percent of those receiving placebo (P less than 0.001) were free of stones after six months. Biliary pain, usually mild, occurred in 73 percent of all patients but in only 13 percent of those who were free of stones after three and six months (P less than 0.01). There were few adverse events. Only diarrhea occurred with a significantly different frequency in the two groups: 32.6 percent were affected in the ursodiol group, as compared with 24.7 percent in the placebo group (P less than 0.04). Severe biliary pain occurred in 1.5 percent of all patients, acute cholecystitis in 1.0 percent, and acute pancreatitis in 1.5 percent; endoscopic sphincterotomy was performed in 0.5 percent, and cholecystectomy in 2.5 percent. CONCLUSIONS: Extracorporeal shock-wave lithotripsy with ursodiol was more effective than lithotripsy alone for the treatment of symptomatic gallstones, and equally safe. Treatment was more effective for solitary than multiple stones, radiolucent than slightly calcified stones, and smaller than larger stones.

Blood Pressure↗
PubMed1990

Percutaneous endoscopic laser lithotripsy of retained stones in the left hepatic duct. The role of the surgeon.

A 35-year-old woman with a retained stone in a branch of the left hepatic duct was referred to us. The stone was discovered on the postoperative T-tube cholangiogram. A flexible ureteroscope was introduced into the duct, under fluoroscopic and direct endoscopic vision and the pulse dye laser was used successfully to disintegrate the calculus. The postoperative course was uneventful. We suggest that in certain selected cases, the pulsed dye laser might be useful in disintegrating stones sited in difficult positions.

Adult↗
PubMed1990

Extracorporeal shockwave lithotripsy of gallstones and the importance of operative cholangiography during laparoscopic cholecystectomy.

Our institute participated in a national study. We had 68 patients (two-thirds had solitary and one-third multiple gallstone calculi). Our extracorporeal lithotripsy results at 9-18 months' follow-up showed 25% to be free of stone (fragment). Forty-four percent required a second session. This technique has limitations and needs further improvement in the aiming devices available and the size of fragments in order to be useful to a larger group of patients. Laparoscopic cholecystectomy is a new modality for endoscopic removal of the stone-filled gallbladder. It can be performed safely in a well-selected group of elective cases. It represents a final cure because the diseased stone-containing gallbladder is removed. Patients have distinct advantages: less postoperative pain, a short hospital stay, and early return to work. Intraoperative cholangiography is of help to define the anatomy. Surgeons need to be competent in laparoscopy before using this technique to perform endoscopic cholecystectomy. It will play a dominant role in the future treatment of symptomatic cholelithiasis.

Cholangiography↗
PubMed1990

The importance of intraoperative cholangiography during laparoscopic cholecystectomy.

Laparoscopic cholecystectomy (LC) using electrocoagulation was successfully performed in 56 out of 58 selected patients. Cholangiography was performed in 53 patients. Six patients had common duct stones; five were unsuspected preoperatively. After the gallbladder was removed, three patients underwent open common duct exploration. In another five cases, anatomical anomalies were discovered. Cholangiography performed via the cystic duct before any structures are divided can prevent the most serious complication--common duct injury. Cholangiography should be attempted on all patients undergoing LC.

Adolescent↗
PubMed1989

Lithotripsy for bile duct stones.

Fragmentation of bile duct stones by mechanical, electrohydraulic, and laser intraluminal lithotripsy has greatly facilitated the ability to remove stones that are otherwise difficult to remove by standard manipulative techniques. Even these approaches fail when stones lack access or are impacted within the biliary tree. Extracorporeal shock-wave lithotripsy (ESWL) was evaluated in the United States in a multicenter trial with 56 patients. Stone fragmentation occurred in 91 percent of patients and duct clearance in 79 percent. Adjunctive procedures were used in 54 percent. Two ESWL treatments were required for fragmentation in 28 percent. Complications were mild and relatively infrequent. Hemobilia (8 percent), gross hematuria (6 percent), and biliary sepsis (4 percent) occurred less frequently than expected. There were no deaths during the 1 to 31 days of hospitalization (mean 9 days). We conclude that ESWL is a safe and effective adjunct to the treatment of difficult-to-remove bile duct stones under the conditions observed in this trial.

Bile Duct Diseases↗
PubMed1989

Intraoperative and postoperative biliary endoscopy (choledochoscopy).

Surgical exploration of the common bile duct is performed blindly, and perhaps this is one of the reasons the incidence of retained stones is higher than it should be. The introduction of the choledochoscope was promising, but a recent survey found that although a majority of hospitals where biliary surgery is performed have the instrument in the operating room, only a small percentage of surgeons use it routinely. This means that the general surgeon is not an endoscopist and choledocholithotomy cases are only 10 to 20 per cent of the existing biliary material. The introduction of the video choledochoscope shortened the learning curve for the surgeon significantly. The enlarged image can be seen conveniently from a distance with both eyes. Intraoperative stone retrieval requires four hands, and with video endoscopy, movements are coordinated, as the entire operating team can see the process. Therefore, the procedure is more precise and faster. The few missed stones can be removed with ease in the postoperative period through the T-tube tract. The procedure is safe and accurate and can be performed on an outpatient basis.

Common Bile Duct↗
PubMed1989

Intraoperative and postoperative biliary endoscopy (choledochoscopy).

The majority of choledocholithiasis patients still require surgery. If the stones are removed, the patient is cured. With modern cholangiography, the anatomy and the location of the calculi can be immediately identified at the beginning of the operation. In 6% of cases, anomalies of surgical importance are detected. The general surgeon is not an endoscopist and therefore, choledochoscopy is used infrequently. The introduction of video techniques changed this pattern because the learning curve is shorter and the procedure is easier and faster to perform with a higher success rate. A permanent (objective) record of the findings and the visualization of the sphincter location and function is an added bonus. If a stone is missed and the T-tube is inserted in the proper fashion, the same video choledochoscope which is employed in the intraoperative phase can be used in the postoperative period. In our experience (108 cases) we had a success rate of 98%. It can be performed on an outpatient basis. The surgeon should be acquainted with intraoperative and postoperative biliary endoscopy to improve the final outcome of this common and important surgical procedure.

Endoscopes↗
PubMed1989

Extracorporeal shock-wave lithotripsy of bile duct calculi. An interim report of the Dornier U.S. Bile Duct Lithotripsy Prospective Study.

A multi-institutional study to evaluate the efficacy, clinical application, and safety of extracorporeal shock-wave lithotripsy (ESWL) with the Dornier HM-3 or HM-4 lithotripter for bile duct calculi (BDC) was initiated in September, 1987. Symptomatic patients who entered into this prospective trial had BDC in the common bile duct and/or the intrahepatic, cystic or lobar ducts of the liver that were inaccessible or untreatable by papillotomy or percutaneous stone extraction. The study excluded gallbladder stones. Nasobiliary (54.4%) or transhepatic catheters (10.5%) and T-tube or cholecystostomy tubes (17.5%) or combinations (14.0%) permitted access for radiographic contrast to allow fluoroscopic monitoring of stone position and fragmentation. Exclusion criteria included pregnancy, failure to localize the stone, disturbances of coagulation, pacemakers, or vascular aneurysms or large bones that lie in the focal axis of the shock waves. Eleven institutions treated 42 patients (23 male, 19 female) with BDC; age range was 25 to 95 years (mean +/- SD, 73.5 +/- 13.8) and ASA risk category was 1 to 4 (mean, 2.3 +/- 0.8). Fourteen patients (33.3%) had a single BDC; 28 had 2 to 8 stones (mean, 2.7 +/- 1.8) ranging in size from 6 mm to 30 mm (mean, 18.5 +/- 6.4). The majority (66.7%) of patients were postcholecystectomy. The 42 patients received 57 ESWL treatments consisting of 600 to 2400 shocks per treatment (mean, 1924 +/- 289) at 12 to 22 kV (mean, 18.5 +/- 1.9) administered over 20 to 125 minutes (mean, 52.9 +/- 20.8). General anesthesia was used in 32% of the treatments; the majority were treated with epidural or regional block (42.1%), local infiltration (28.1%), or intravenous sedation (38.6%). Fifteen patients (35.7%) required two ESWL treatments. Stone fragmentation occurred in 94.6% of evaluable patients and in 90.4% of ESWL treatments, respectively; however, BDC fragments remained in 59.5% of patients 24 hours after treatment (diameter less than or to 3 mm, 12%; 4 to 9 mm, 16%; greater than or equal to 10 mm, 68%). Some patients (50%) required adjunctive procedures to achieve stone removal that included endoscopic extraction (n = 10; 47.6%), biliary lavage (n = 8; 38.1%), endoscopic bile duct prosthesis (n = 1; 4.8%), and operation (n = 2; 9.5%). ESWL treatment complications during hospitalization were observed in 15 patients (35.7%) and were present in four (9.5%) at discharge. Complications included macrohematuria (5%), biliary pain (15%), biliary sepsis (5%), hemobilia (10%), ileus (2.5%), and adverse pulmonary changes (7.5%). One patient developed pancreatitis before ESWL at ERCP that resolved prior to discharge.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1989

Bedside videolaryngoscopic assessment of intubation trauma.

Telescopic laryngoscopic examination was performed at the bedside after extubation in 29 consecutive surgical intensive care unit patients who required endotracheal intubation for more than 16 hours. The examinations were documented with a portable video recording system. The majority of patients exhibited evidence of acute endolaryngeal trauma. Vocal fold ulceration and vocal fold motion abnormalities were the most common lesions. Patients with abnormal larynges were followed up after discharge from the intensive care unit. Most of the identified injuries resolved without intervention. However, silent aspiration was identified frequently in patients with vocal fold paresis and was thought to be a significant factor in postoperative pulmonary complications. Early identification of significant laryngeal trauma and/or vocal fold paresis in critically ill patients is important for both postoperative pulmonary care and voice rehabilitation. This pilot study demonstrated that documentation of the laryngeal examination is feasible in critically ill patients in an intensive care unit setting.

Aged↗
PubMed1989

Intra-operative and postoperative biliary endoscopy (choledochoscopy). The role of the surgeons.

Intra-operative and postoperative choledochoscopy is an important adjunct to biliary surgery. In the last two decades, the necessity of this examination became obvious but two surveys clearly indicated that despite the availability of instruments surgeons do not use it routinely. One of the reasons is the long learning curve and the limited experience. The introduction of the video choledochoscope opened a new chapter because the surgeon could learn it faster and the technique is easier to use. Choledochoscopy is a "two man" job, requiring four hands. Using video choledochoscopy, the assistant and the operator can observe the situation together, therefore coordination of movement is easier. The actual endoscopic procedure is faster and the location of the stone, its removal, and the sphincter function are recorded on tape. This is a great step forward in analyzing sphincter function. It became the method of choice in teaching. It is assumed that, with the introduction of video choledochoscopy, the incidence of missed stones will be decreased significantly.

Animals↗
PubMed1988

Electronic imaging in endoscopy.

Endoscopy evolved from a hollow tube view of visually restricted areas into an expansive, distal representation of the anatomy. Rod lens telescopes, improved coherent imaging bundles, superior light sources, and other optical advances enhanced endoscopic observations. Yet complicated endoscopic procedures remained visible to the endoscopist alone, relegating assistance and consultation to verbal description of sophisticated visual observation. Instrumentational advances alone did not promote three crucial elements: participation, cooperation and documentation. The importance of these elements has increased with the need for coordinated assistance in complex operative endoscopic manipulations, as well as in a visual record for improved documentation and consultation. New imaging technologies are supplanting the unwieldy, often daunting equipment once required for photodocumentation. The charged couple device (CCD) 2/3 and 1/2 in. "chip" video camera miniaturization provides nearly weightless TV coobservation. Distal chip placement has created the "video endoscope". Combined with the 8 mm tape format, the chip has created a lightweight, single unit camera, monitor, and recorder. A recent advantage, magnetic disc recording, permits still video storage of up to 25 images. An electronic printer produces a hard color copy (4 x 5), which is inserted in the chart before the patient leaves the endoscopy room. The cost of the equipment can be shared in multidisciplinary institutions.

Costs and Cost Analysis↗
PubMed1988

The impact of electronic imaging in intraoperative biliary endoscopy (choledochoscopy).

In the last decade, choledochoscopy has become an essential tool for biliary surgery. It is widely accepted, but it is not employed by every surgeon who performs choledocholithotomies. The reason is the limited experience of surgeons performing 30-40 cholecystectomies per year. A survey of 150 hospitals clearly showed that common bile duct exploration is performed in 10%-15% of these cases. General surgeons are not endoscopists. A new video choledochoscope that displays the image in a large format via the TV monitor was developed, which can be viewed with both eyes and an assistant's help; this expedites and coordinates the procedure. The entire process is videotaped and can be used for further analysis and during consultation. It has become the method of choice for teaching. Most importantly, the learning curve of general surgeons has become significantly shorter. The procedure is taught and the surgeon can learn it easily. Its use will contribute to a decrease in the incidence of retained stones and will improve patient care.

Animals↗
PubMed1988

Mini-laparoscopy in blunt abdominal trauma.

Blunt abdominal trauma in multiorgan injured or comatose patients always presents a problem. The aim is to assess, in the shortest period of time, which organ injury requires priority and whether intra-abdominal bleeding or perforation exists. Abdominal lavage proved to be too sensitive. Not every positive case needs exploration. Approximately 15%-20% of the cases explored because of positive lavage did not show a significant bleeding site that would require surgical treatment. The authors developed a mini-laparoscope that can be used at the bedside, in the emergency room, or in the intensive care unit. The procedure can be performed with intravenous sedation and local anesthesia. In 150 cases, no hemoperitoneum was found in 53% of these cases. Except for 1, none of these patients needed further exploration. In 21%, severe hemoperitoneum was discovered; these patients were transferred to the operating room, and this was confirmed by surgery. In 26%, a small amount of blood was found in the gutters. These patients were observed in the intensive care unit and an unnecessary exploration was avoided. Laparoscopy gives a wider range of decision making by observing the abdominal cavity. It can be completed in 10-20 min at the bedside. No serious complications were encountered. This procedure should be taught and practiced in trauma centers.

Abdominal Injuries↗
PubMed1988

Diagnosis of significant abdominal trauma after road traffic accidents: preliminary results of a multicentre clinical trial comparing minilaparoscopy with peritoneal lavage.

A prospective multicentre study comparing the value of the recently introduced minilaparoscopy with peritoneal lavage in patients with abdominal trauma is in progress. To date 55 patients with blunt abdominal trauma have been entered into the study. Following initial resuscitation, 26 were randomised to peritoneal lavage and 29 to minilaparoscopy performed under intravenous sedation and local anaesthesia. The two groups were comparable with respect to age, sex, incidence of multiple injuries and mortality (2 patients in the lavage group and 1 in the minilaparoscopy group). A negative test was obtained in 15 patients subjected to lavage and 12 patients who underwent minilaparoscopy. A further four patients in the minilaparoscopy group were found to have a minimal static haemoperitoneum. All these patients were treated conservatively and none required surgical intervention on the abdomen. Thus neither investigation carried a false negative rate. A positive test was obtained in 11 patients in the lavage group and significant findings were observed in 13 patients assessed by minilaparoscopy. All these patients were subjected to emergency laparotomy. Absence of significant bleeding or trauma was observed at laparotomy in 3/11 (27%) and 1/13 (8%) in the lavage and minilaparoscopy groups respectively. Although both procedures were highly sensitive for the detection of significant intra-abdominal injury (100%), the specificity was 83% for peritoneal lavage and 94% for minilaparoscopy. The predictive value of a positive minilaparoscopic examination was 92% as opposed to a positive predictive value of 72% for peritoneal lavage.

Abdominal Injuries↗
PubMed1987

Diagnostic and therapeutic laparoscopy. An entity often overlooked by the surgeon.

For unknown reasons, only a few surgeons have become interested in diagnostic and therapeutic laparoscopy. Electronic imaging, the recent adjunct to endoscopy, has enhanced its value. In problematic cases, it is not only important to establish the diagnosis but also to be able to demonstrate the interesting findings during weekly conferences or to reevaluate or recapitulate the findings in the follow-up period. Ascites, pyrexia, abdominal pain with weight loss of unknown origin, a palpable mass, suspected primary or secondary liver tumors, staging, second look, and questionable operability of known primaries are examples of the indications for laparoscopy. If intra-abdominal malignancy is suspected, a computed tomographic (CT) scan or ultrasonic examination is the common current procedure. If liver or parietal peritoneal involvement is present, these costly examinations will not display lesions smaller than 1 cm, whereas they can often be seen during laparoscopy. Repeated CT or ultrasound examinations with guided needle biopsies have a high incidence of noninformative (cytological) specimen retrieval. Laparoscopy, providing a precise, well-aimed biopsy, can be performed under local anesthesia following premedication. It represents an important advantage for high-risk patients because it can be performed with a negligible incidence of complications.

Anesthesia, Local↗