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Biomedical subjects

H Reich

Publications and source records attributed to H Reich.

At least 73 records · Page 4Linked to original sources
PubMed1992

Laparoscopic lymphadenectomy.

Although first performed by gynecologists in the United States and Europe, laparoscopic pelvic lymphadenectomy has recently become a popular procedure among many urologists. Gynecologists in the United States, however, have been slow to adopt this procedure. Indications for this procedure include malignancies where accurate histologic staging is required to determine the appropriate management and where subsequent therapy does not necessarily include an open laparotomy.

Female↗
PubMed1992

Laparoscopic bowel injury.

Laparoscopy is not a new procedure, but instead represents a minimally invasive method of access to the peritoneal cavity, accomplishing the same procedures under laparoscopic guidance as performed through a large abdominal incision. The adoption of any new surgical procedure or technology is associated with new as well as previously recognized complications. Intestinal injuries associated with laparoscopic surgery can occur as a result of insufflation needle or trocar insertion, or they can occur during the operative dissection. Insufflation needle injuries are usually self-limiting and require no specific treatment. Injuries associated with trocar insertion or operative dissection should be identified and managed appropriately. As surgeons increase their experience with laparoscopic surgery, they should be able to manage many such injuries without needing to convert to open laparotomy. Direct suture repair under laparoscopic guidance and the use of innovative endoscopic stapling devices have been successfully used to manage such injuries.

Female↗
PubMed1992

Laparoscopic hysterectomy.

Approximately 600,000 hysterectomies are performed each year in the United States, more than 75% of which are removed via an open laparotomy. Most hysterectomies that currently require an abdominal approach may be performed with laparoscopic dissection of part or all of the abdominal portion, followed by vaginal removal of the specimen. Indications for laparoscopic-guided hysterectomy include endometriosis, extensive fibroid disease, adnexal masses, adhesions from prior surgery, or inflammatory disease. Laparoscopic hysterectomy may also be considered for stage I endometrial, ovarian, and cervical cancer.

Female↗
PubMed1992

Laparoscopic management of ovarian dermoid cysts.

Benign cystic teratoma (dermoid cyst) was managed laparoscopically in 25 cases (16 cyst excisions and 9 oophorectomies). Surgical procedures to avoid spill during ovarian cystectomy and oophorectomy were developed (14 cases). This series demonstrates a gradual evolution in surgical technique. Surgical outcome was good in all cases, complications were rare, and the procedure required a hospital stay less than 24 hours.

Adolescent↗
PubMed1992

Laparoscopic adnexectomy in postmenopausal women.

Postmenopausal palpable ovaries and pelvic masses require histologic examination to preclude missing ovarian carcinomas. However, the majority of such lesions are benign. Of 44 such patients, 42 (95.4%) underwent successful management with laparoscopic adnexectomy. The average operating time was 115.8 minutes, and 40 patients were discharged the day of surgery. Thirty-eight patients had a blood loss of less than or equal to 50 mL. The laparoscopic procedures were well tolerated and allowed the patients to return rapidly to normal activity.

Adnexal Diseases↗
PubMed1991

A comparison of cardiopulmonary resuscitation with cardiopulmonary bypass after prolonged cardiac arrest in dogs. Reperfusion pressures and neurologic recovery.

Resuscitability and outcome after prolonged cardiac arrest were compared in dogs with standard external cardiopulmonary resuscitation (CPR) vs. closed-chest emergency cardiopulmonary bypass (CPB). Ventricular fibrillation (VF) was with no blood flow from VF 0 min to VF 10 min. Subsequent CPR basic life support (BLS) was from 10 min to VF 15 min. Then, group I (n = 13) received CPR advanced life support (ALS) from VF 15 min until restoration of spontaneous circulation to occur not later than VF 40 min. Group II (n = 14) received CPR-ALS from VF 15 min to VF 20 min without defibrillation, and then total CPB to defibrillation attempts started at VF 20 min, followed by assisted CPB to 2 h. Total ischemia time (no-flow time plus CPR time of MAP less than 50 mmHg) was unexpectedly shorter in group I (14.3 +/- 2.5 min) than in group II (18.6 +/- 2.3 min) (P less than 0.01). During CPR-BLS, coronary perfusion pressures were 25 +/- 9 mmHg in group I and 18 +/- 8 mmHg in group II (NS). Epinephrine during CPR-ALS, before countershock, raised coronary perfusion pressure to 40 +/- 10 mmHg in group I and 27 +/- 10 mmHg in group II (NS). In group II, coronary perfusion pressure increased during total CPB to 58 +/- 16 mmHg (P less than 0.01 vs. group I). Spontaneous normotension was restored in 11/13 dogs of group I and all 14 dogs of group II (NS). Ten dogs in each group followed protocol and survived to 96 h. Five of ten in group I and six of ten in group II were neurologically normal (NS). We conclude that: (1) Reperfusion with CPB yields higher coronary perfusion pressures than reperfusion with CPR-ALS; and (2) even after no blood flow for 10 min, optimized CPR can result in cardiovascular resuscitability and neurologic recovery, similar to those achieved by CPB.

Animals↗
PubMed1991

External cardiopulmonary resuscitation preserves brain viability after prolonged cardiac arrest in dogs.

Standard external cardiopulmonary resuscitation (CPR) steps A-B-C produce a low blood flow that may or may not preserve brain viability during prolonged cardiac arrest. A dog model was used with ventricular fibrillation (VF) of 20 minutes, reperfusion with brief cardiopulmonary bypass, controlled ventilation to 20 hours, and intensive care to 96 hours. A retrospective comparison was made of the results of one series, now called "group I" (n = 10)--which received CPR basic life support interposed from VF 10 to 15 minutes, and CPR advanced life support with epinephrine (without defibrillation) from VF 15 to 20 minutes--to the results of another series, now "control group II" (n = 10)--which received VF no flow (no CPR) for 20 minutes. All 20 dogs within protocol were resuscitated. All 10 of group I and 7 of 10 of group II survived to 96 hours. Pupillary light reflex returned after the start of cardiopulmonary bypass at 7.7 +/- 3.7 minutes in CPR group I, versus 16.3 +/- 7.4 minutes in control group II (P = .032). At 96 hours postarrest, final overall performance categories (1, normal; 5, brain death) were better in group I. Six of 10 dogs achieved normality (overall performance category 1) in group I, as compared with none of 10 in group II (P = .004). Final neurologic deficit score (0%, best; 100% worst) was lower (better) in group I (15% +/- 20%) than in group II (51% +/- 6%; P less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

Transperitoneal endosurgical lymphadenectomy in patients with localized prostate cancer.

The main appeal of radiotherapy for carcinoma of the prostate lies in the low morbidity and good subsequent quality of life. The handicap of this approach is the absence of adequate staging through pelvic lymphadenectomy. A new operation with minimal morbidity for the patient is presented and described in detail: endosurgical (laparoscopic) pelvic lymphadenectomy. This operation can be performed on an outpatient basis and is extremely well tolerated by the patient. The results of the first 12 consecutive cases indicate that, with experience, the procedure can be performed within a reasonable time limit (90 to 205 minutes) and that the number of lymph nodes removed (right and left obturator fossae mean 7.6 and 7.1, respectively) is adequate. Endosurgical lymphadenectomy adds only minimal morbidity to the radiotherapeutic treatment of prostatic cancer but permits more accurate staging and, therefore, counseling of the patients.

Aged↗
PubMed1991

Laparoscopic repair of full-thickness bowel injury.

Laparoscopic resection of full-thickness lesions of the anterior rectum followed by repair using a two-layer suture technique is described. Anterior rectal laceration occurred in two bowel-prepped women during excision of deep fibrotic endometriosis. Neither patient required subsequent surgery nor suffered any postoperative sequela. While not all rectal injuries are suitable for laparoscopic suture repair, in selected cases, bowel injury can be effectively managed laparoscopically without resorting to major abdominal surgery.

Adult↗
PubMed1991

Encephalopathy with intracerebral calcification, white matter lesions, growth hormone deficiency, microcephaly, and retinal degeneration: two sibs confirming a probably distinct entity.

Two sibs with an encephalopathy, including intracerebral calcification and white matter lesions, dwarfism owing to growth hormone deficiency, and retinal degeneration are reported. The onset of the disease in both patients occurred with retardation of motor development during the first year of life. Later, dwarfism, mental retardation, spasticity, ataxia, and retinal degeneration became apparent. These cases probably represent some form of connatal leucodystrophy. The differential diagnosis is discussed.

Brain Diseases↗
PubMed1991

CO2 laser used through the operating channel of laser laparoscopes: in vitro study of power and power density losses.

The purpose of this study was to measure the effects of several variables on energy transmission and power density through the CO2 laser laparoscope. The factors studied included the laser beam diameter, coupler optics, laparoscope lumen size, and absorption of the laser wavelength by the insufflation gas. The addition of CO2 insufflating gas to the operating channel at higher power settings not only reduced the energy transmitted to tissue by 35-58% with a 7.2-mm laparoscopic operating channel and by as much as 61% with a 5-mm operating channel, but also increased the spot size. This "blooming" of the laser beam definitely reduced power density at tissue and eliminated the pinpoint spot size needed for microdissection. Even under optimal conditions regarding lumen size and beam diameter, our data indicate a point of diminishing returns for power density above 40 W for the systems tested. Power densities obtainable at laparotomy were not possible. Clinically, this effect resulted in optimal cutting (vaporization) at low power settings and coagulation accompanying cutting at higher settings.

Carbon Dioxide↗
PubMed1991

Laparoscopic excision of benign liver lesions.

Increasing sophistication in laparoscopic instrumentation and techniques has led to an ever-expanding list of surgical indications that are no longer exclusive to gynecology. This report describes our experience with three women who had benign lesions of the liver edge found incidentally during laparoscopic surgery for gynecologic symptoms. The first women was managed traditionally with subsequent exploratory laparotomy; she developed ileus postoperatively and required a 5-day hospital stay. The other two were managed laparoscopically without incident. Each was hospitalized less than 24 hours. All three liver lesions proved benign on histologic examination. Although not all liver lesions can or should be excised laparoscopically, selected superficial neoplasms can be managed expediently by a laparoscopic approach.

Adult↗
PubMed1991

Laparoscopic treatment of cul-de-sac obliteration secondary to retrocervical deep fibrotic endometriosis.

One hundred women with cul-de-sac obliteration secondary to retrocervical deep fibrotic endometriosis (48 partial, 52 complete) were treated laparoscopically for infertility (46 cases), pain (46), hypermenorrhea (7) and a mass (1). The surgical techniques included aqua-dissection, electrosurgery, CO2 laser, scissors, probes to identify the upper posterior vagina and rectum, and multiple rectovaginal examinations. In all the procedures the anterior rectum was freed to the loose areolar tissue of the rectovaginal septum prior to excising deep fibrotic endometriosis. The viable intrauterine pregnancy rate among patients with infertility was 70% (32/46). Of patients presenting with pain, 89% (41/46) reported significant relief. The average operating time was 178 minutes. Laparoscopic cul-de-sac dissection, though time intensive, offers increased fertility potential and significant symptom relief.

Adult↗
PubMed1990

Short self-retaining trocar sleeves for laparoscopic surgery.

Problems with currently available trocar sleeves are listed. A second-puncture, lower-quadrant sleeve of a special design that eliminates these problems is described: short, self-retaining because of a screw grid on its external surface, and without a trap. Suggestions for modification of the umbilical sleeve trocar are advanced.

Female↗
PubMed1990

Factors influencing variable outcomes after ventricular fibrillation cardiac arrest of 15 minutes in dogs.

Animal experiments with cardiac arrest and cardiopulmonary resuscitation (CPR) despite controlled insult and postinsult life support, have yielded variable individual outcomes. This report concerns 10 dog experiments with a standardized model of VF cardiac arrest with no flow for 10 min followed by CPR basic life support (BLS) from VF 10 to 15 min and then CPR advanced life support (ALS) with epinephrine at 15 min. Defibrillating countershocks began at 17 min, for restoration of spontaneous circulation. After controlled ventilation to 20 h and intensive care to 96 h, outcome was evaluated using the overall performance category (OPC) 1 (normal) (n5) vs. OPC 2-4 (impaired) (n5) (P less than 0.001). We searched for correlations between normal vs. impaired outcome in various prearrest, arrest and postarrest factors that are suspected to influence postarrest neurologic deficit. Prearrest variables were similar in the normal and impaired groups. Resuscitation variables were similar in both. Coronary perfusion pressure during CPR-ALS was higher in the normal outcome group (P = 0.03). Among postarrest variables, postarrest reperfusion pressure pattern (initial hypertensive bout), blood glucose, cardiac output, Hct, pHa, PaO2 and PaCO2 were the same. Our data support the importance of maximizing coronary perfusion pressure not only for restoration of heart beat but also as a possible predictor of improved cerebral outcome.

Animals↗