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Biomedical subjects

G Berci

Publications and source records attributed to G Berci.

At least 163 records · Page 9Linked to original sources
PubMedDate not supplied

Bile leakage after biliary tract surgery. A laparoscopic perspective.

The incidence of bile leaks has increased with laparoscopic cholecystectomy as compared with open cholecystectomy. Minor bile leaks are not infrequent but are clinically insignificant; of the major bile leaks the most common sequela is the biloma, the most serious, bile peritonitis. Early symptoms may be very subtle; all untoward symptoms should be investigated with a HIDA scan to rule out bile leakage. Positive HIDA scans should be followed with endoscopic retrograde cholangiography (ERC) or percutaneous transhepatic cholangiography (PTC). Management of the leakage depends on identification of its source. Prompt identification of ductal injuries permits earlier effective treatment and consequently less morbidity and/or mortality.

Ascites↗
PubMedDate not supplied

Elective and emergent laparoscopy.

Although laparoscopy has been received enthusiastically by gastroenterologists, mainly in Europe, over the past four decades, its usefulness in surgery has been ill-defined or neglected. Gynecologists recognized the value and included laparoscopy as one of the most important diagnostic and therapeutic tools for pelvic pathology. After the introduction of laparoscopic cholecystectomy, several thousand surgeons were trained in laparoscopic techniques. Laparoscopy allows direct visualization of abdominal organs and the parietal peritoneum. It permits a safe target biopsy under precise visual control. The practical value of laparoscopy is the observation of lesions that would not be discovered by other investigations and the ability to assess the dissemination of malignant disease and its operability. Hence many unnecessary explorations are avoided. Diagnostic laparoscopy has a high overall diagnostic yield, has an excellent safety record in the hands of a well trained operator, and is cost-effective. Minilaparoscopy in the emergent (blunt abdominal) trauma case gives the surgeon a much larger latitude for decision making than does diagnostic peritoneal lavage. Emergency minilaparoscopy has been performed in 150 trauma patients and has accurately predicted the need for laparotomy in all but one patient (0.7%). No major complications have occurred as a result of minilaparoscopy in this setting. A large number of emergency laparotomies in the multiorgan-injured or high-risk case can be avoided. Minilaparoscopy may be useful also in the elderly patient with an equivocal abdominal examination but suspicion of visceral injury.

Contraindications↗
PubMedDate not supplied

Endoscopic skull base surgery II: a new animal model for surgery of the posterior fossa.

The field of skull base surgery has been influenced by a general philosophy that currently exists in modern surgical practice favoring less invasive means of managing surgical disease. Adapting techniques developed by general surgeons and other surgical subspecialists, skull base surgeons are now experimenting with endoscopy to resect tumors, manage vascular lesions, and manipulate critical intracranial structures. Lesions formerly requiring significant soft tissue dissection and craniotomy for exposure are now potentially amenable to treatment via a keyhole approach. As in other surgical specialties, however, a reliable animal model is necessary for experimentation with and development of new endoscopic techniques in the skull base. The swine provides just such a model, primarily due to craniofacial and skull base relationships that are analogous to humans. We have focused on the posterior skull base of the swine in this experiment: Via a retrosigmoid craniotomy we opened the dura of the posterior fossa and used endoscopes to visualize and manipulate the critical structures in this area. The cerebellum and midbrain were appreciated, as were cranial nerves V, VII, VIII, IX, X, and XI. Blood vessels on the surface of the midbrain were also identified. This experience further supports the use of the swine as an appropriate animal model for endoscopic skull base surgery.

Animals↗
PubMedDate not supplied

Endoscopic skull base surgery I: a new animal model for pituitary surgery.

Endoscopy has emerged as a new means to perform minimally invasive surgery of the skull base. Specifically, endoscopic techniques and instruments can be used to safely and effectively approach and resect tumors of the pituitary gland in humans. No animal model currently exists to serve as a template upon which to refine and develop endoscopic surgical technique in this region of the anatomy. We operated on two purpose-bred Hampshire-Yorkshire-Duroc hybrid swine to demonstrate the application of endoscopy to pituitary surgery. Based upon similar anatomical relationships in humans and swine between the oropharynx, nasopharynx, and skull base, we used a transoral, transpalatal approach to access the vomer of the swine. Under endoscopic exposure, we resected the vomer, entered the sphenoid sinus, and then resected the sphenoid septum, sella turcica, and adenohypophysis. Clear visualization of the pituitary, hypophyseal stalk, cavernous sinuses, and carotid prominences was achieved and documented with digital photography. Benefits and limitations of the technique were noted. These results have pertinent implications both for the study of the surgical anatomy of the swine craniofacial skeleton, and for future development of endoscopic surgical manipulation of the skull base.

Animals↗
PubMedDate not supplied

Coccidioidomycosis of the larynx in infants and adults.

Coccidioidomycosis is a fungal disease endemic to the southwestern United States. The primary form of the disease is relatively benign and many patients, after exposure by inhalation of the sapyrophytic form of the organism, convert from negative to positive skin testing without significant clinical symptoms. The less common disseminated form represents a serious life-threatening disease and can present with granulomatous changes in the larynx. The authors' experience with disseminated coccidioidomycosis presenting in the larynx of adults and infants successfully treated with amphotericin B are presented and discussed.

Amphotericin B↗
PubMedDate not supplied

New insights into the causes of postoperative aspiration following conservation surgery of the larynx.

This study was conducted specifically to determine and document the various possible causes of postoperative aspiration. Such information may assist in better selection of candidates as well as provide insights that facilitate improvement of operative techniques for conservation surgery for cancer of the larynx. The major significant information derived from this study is the recognition and delineation of the part played by paralysis of the superior and recurrent laryngeal nerves as causes for aspiration following conservation laryngeal surgery.

Aged↗
PubMedDate not supplied

Chevalier Jackson Lecture. Analysis of new optical systems in bronchoesophagology.

A new image transmitting system (Hopkins rod lens) made it possible to redesign the entire armamentarium of rigid broncho- and esophago- laryngology. The introduction of an optical biopsy forceps made tissue sampling more accurate. The increased light transmission produces a brighter image and easier perception. The larger viewing angle facilitates orientation. The new miniature pediatric bronchoscope, with a telescope, changed the pinpoint vision to a panoramic view. The optical foreign body forceps is of great help in fast and precise manipulations. The indirect laryngoscope proved to be a great investigative tool with the capability to obtain, with ease, a movie filmstrip for detailed analysis in the outpatient clinic. The introduction of the flexible fiber bronchoscope brought new dimensions in tissue sampling of peripheral lesions, treatment of pulmonary complications in the intensive care units, and became an important aid in intubating patients with difficult anatomy. The possibility to obtain moive films and to study our visual findings, at leisure, is an important diagnostic and teaching aid.

Adult↗
PubMedDate not supplied

Evaluation of computerized tomography, cinelaryngoscopy, and laryngography in determining the extent of laryngeal disease.

A prospective study of over 100 cases comparing computerized tomography (CT) and correlating these studies with photographic motion picture studies of the larynx, conventional tomography and contrast laryngography has been performed. The authors give illustrative examples of cases in which the CT scan has been documented as providing equal and often times greater information concerning not only tumors, but also cystic lesions and traumatic lesions. With the newer technology, the reduced radiation (which is less than one half that of conventional tomography), and the decreased expense (now comparable to that of laryngography alone), eliminates the need for conventional laryngography and tomography examinations. The incorporation of motion picture documentation of the lesions allowing future comparative studies between the original lesion and the CT are recommended for a more accurate retrospective classification and assessment of therapeutic results.

Adult↗
PubMedDate not supplied

Optical stylet: an aid to intubation and teaching.

An optical stylet was developed which can be inserted into an endotracheal tube, and the passage through the vocal cords and position of the cuff in the trachea could be controlled visually. It is of great help in difficult intubations in adults and children. It became an invaluable tool in teaching endotracheal intubation by coupling a teaching attachment (beam splitter) to theoptical system. The operator and the second observer (student) can see the actual manipulations simultaneously.

Education, Medical↗