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Biomedical subjects

G C Gardner

Publications and source records attributed to G C Gardner.

12 recordsLinked to original sources
PubMed2001

An unusual case of gastric volvulus after laparoscopic paraesophageal hernia repair.

Laparoscopic surgery for paraesophageal hernia is well accepted. However, the complications of this relatively new procedure have not been thoroughly investigated. Only four cases of recurrent volvulus after paraesophageal hernia repair have been reported. A 52-year-old man presented with a large right-side paraesophageal hernia. He experienced a retroperitoneal midgastric volvulus despite correct orientation of the stomach distally and proximally. We report an unusual complication that seems congenital in origin. Diagnostic and corrective measures are suggested.

Hernia, Hiatal↗
PubMed2001

Laparoscopic surgery and the common bile duct.

Many biliary tract surgeons have now reached a level of sophistication with laparoscopic cholecystectomy that they are now able to deal with the common bile duct at the same time. Preoperative endoscopic cholangiography can be reserved for cases where choledocholithiasis has a high degree of probability. This has served to decrease the number of negative studies. The surgeon has five choices regarding stones confirmed by operative cholangiography during laparoscopic cholecystectomy: (1) do nothing, hoping the stones will pass spontaneously or that a postoperative sphincterotomy with stone extraction will be successful; (2) perform a transcystic laparoscopic common bile duct exploration (best for stones less than 1 cm and distal to the cystic duct); (3) perform a laparoscopic common bile duct exploration by choledochotomy (best for large stones in patients with common bile ducts greater than 1 cm. It is also the preferred approach with stones proximal to the insertion of the cystic duct.); (4) perform an intraoperative sphincterotomy with stone extraction, either retrograde or antegrade (this approach has some proponents but has not gained popularity among the majority of surgeons); and (5) place a double lumen catheter through the cystic duct with a proximal lumen in the common bile duct and the distal lumen in the duodenum. This can be used for serial postoperative cholangiography to confirm spontaneous stone passage or falsely positive operative cholangiograms. It is useful in situations when laparoscopic common bile duct exploration equipment or surgeon expertise is not available. If stones persist, a guidewire can be introduced through the distal lumen of the catheter for a guidewire-assisted sphincterotomy. Other CBD interventions that have been reported include laparoscopic biliary bypass and resection of choledochal cysts. Malignant lesions should not be approached by a laparoscopic method except in unusual circumstances.

Biliary Tract Surgical Procedures↗
PubMed2000

Laparoscopic repair of a Morgagni hernia.

Morgagni hernias are unusual diaphragmatic hernias which usually present in adulthood. They have traditionally been repaired through transabdominal or transthoracic approaches. The authors present a case of a laparoscopic repair of a Morgagni hernia in a 52-year-old female. A tension free repair of the defect was accomplished utilizing Goretex (W.L. Gore & Associates, Inc., North Elkton, MD) mesh. The patient had an uneventful recovery and is asymptomatic at 6 months follow-up. The etiology, diagnosis and traditional surgical approaches to this problem are discussed. A technique for laparoscopic repair of a Morgagni hernia is described. The literature on the laparoscopic repair of a Morgagni hernia is reviewed and different operative techniques are discussed.

Diaphragm↗
PubMed2000

Fibromyalgia following trauma: psychology or biology?

The concept that fibromyalgia may follow trauma is currently an area of intense debate within the medical field and is driven to a large extent by social and legal issues. This article questions whether the current literature supports the notion that trauma may cause fibromyalgia and explores the relative contribution of biology and psychology in the development of and sense of disability from fibromyalgia.

Diagnosis, Differential↗
PubMed1995

Quantitative magnetic resonance imaging predicts clinical outcome of core decompression for osteonecrosis of the femoral head.

OBJECTIVE: To determine whether the course of femoral head osteonecrosis after core decompression can be predicted from the extent of necrotic bone in the preoperative magnetic resonance imaging (MRI). METHODS: In 31 femoral head lesions (Ficat stage I or II), the percentage volume of necrotic bone was calculated by dividing the sum of the necrotic areas from all MRI slices by the sum of the femoral head areas. Osteonecrosis risk factors, pain scores, and the need for further surgery were assessed at a minimum of 12 mo post-core decompression. Clinical outcomes were considered good when post-core decompression pain scores improved and further surgery was not required. RESULTS: Fourteen of the 15 hips with good outcomes after a mean followup of 32 mo had less than 21% femoral head involvement. All 16 hips with poor outcomes after a mean followup of 17 mo had more than 21% of the femoral head affected. CONCLUSION: Quantitative MRI of femoral head necrosis was a useful predictor of clinical outcome following core decompression.

Adult↗
PubMed1990

Pyarthrosis in patients with rheumatoid arthritis: a report of 13 cases and a review of the literature from the past 40 years.

PURPOSE: The purpose of this study is to report 13 cases and review the literature for pyarthrosis occurring in the setting of rheumatoid arthritis (RA). Special emphasis is placed on evaluating both the changing, as well as the constant, features of this complication and on assessing diagnostic and therapeutic aspects that have a bearing upon outcome. PATIENTS AND METHODS: A retrospective review of records from our institution revealed 13 cases of pyarthrosis in patients with RA over the past 14 years. Information obtained included patient demographics, RA history, concomitant illnesses and medications, length of symptoms prior to the diagnosis of pyarthrosis, peri-articular manifestations, probable source of infection, joint(s) involved, relevant laboratory data, and information on treatment and outcome based on initial surgical therapy versus closed needle drainage. In addition, 213 cases from 45 citations were reviewed for similar information. RESULTS: Our series was notable for a high percentage of associated serious medical illnesses and peri-articular manifestations of the pyarthrosis (i.e., sinus tract formation, concomitant septic bursitis, or infected synovial cyst). The erythrocyte sedimentation rate was a useful monitor of adequate therapy and was often a signal of recurrent infection. In all patients, the skin was the major source of infection. The mortality from pyarthrosis has declined over the past 40 years but is still unacceptably high, especially in patients with polyarticular involvement. Preliminary observations suggest that an initial surgical approach to joint drainage may be preferable to closed needle drainage in order to improve joint outcome in patients with RA and pyarthrosis. CONCLUSION: Pyarthrosis occurring in patients with RA continues to produce unacceptable morbidity and mortality despite 40 years' experience. Earlier recognition (which may include peri-articular features) and perhaps an aggressive surgical approach to drainage may improve the prognosis.

Aged↗
PubMed1989

Acute monoarthritis associated with intracellular positively birefringent Maltese cross appearing spherules.

A 57-year-old black woman presented with acute monoarthritis of the left knee. Numerous intra and extracellular strongly positively birefringent lipid spherules with a Maltese cross appearance were seen in the synovial fluid from the affected joint when viewed under compensated polarized light microscopy. This represents the 7th reported case of atraumatic acute arthritis associated with large numbers of positively birefringent lipid spherules. We review previous case reports and discuss the present understanding of the pathogenesis and the significance of the association of large numbers of birefringent lipid spherules with acute arthritis.

Acute Disease↗