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Biomedical subjects

I Irgau

Publications and source records attributed to I Irgau.

10 recordsLinked to original sources
PubMed2000

Consumer-driven cholecystectomy: myth or reality?

OBJECTIVE: To discover if a consumer-driven process is fueling the high rate of cholecystectomies in the laparoscopic era. DESIGN: A 12-question survey. SETTING: A 1000-bed, university-affiliated hospital. PATIENTS: Patients admitted for elective cholecystectomies. MAIN OUTCOME MEASURES: Survey responses suggesting positive perceptions about laparoscopic cholecystectomy persuade patients to undergo gallbladder surgery. RESULTS: Patients' symptoms persisted for a mean of 20.7 months, range zero to 204. Mean time between diagnosis and surgery was ten months, range 0.1-312. Ninety-five and three-tenths percent knew their gallbladder would be removed; 1.7 percent thought it would be opened to extract stones. Ninety-one and four-tenths percent correctly identified the procedure as "laparoscopic cholecystectomy." Fifty and four-tenths percent believed they would fully recover within a week, 24.1 percent within two weeks, and 14.7 percent within two days. Eighty-three and two-tenths percent knew laparoscopic cholecystectomy required less cutting; 33.6 percent thought a laser was used. Forty-four and eight-tenths percent assumed laparoscopy was the safer method. Sixty-two and one-tenth percent were referred for surgery by family physicians; Seven percent approached surgeons themselves. When asked who first suggested the laparoscopic procedure, 43.1 percent indicated family doctor, 41.4 percent, surgeon, and three percent requested laparoscopy themselves. Twenty-four and one-tenth percent who delayed surgery despite more than 12 months of symptoms indicated escalating pain as their reason for seeking surgery now; 0.9 percent cited the newer procedure. CONCLUSIONS: We found no clear evidence that consumer awareness of laparoscopy has encouraged more cholecystectomies. Misconceptions exist about the procedure's execution and safety. Education about risks, especially bile duct injury, is needed. More frequent referral by family doctors probably plays a role in the higher incidence of cholecystectomies.

Cholecystectomy, Laparoscopic↗
PubMed1998

Mediastinal lipoblastoma involving the left innominate vein and the left phrenic nerve.

Lipoblastoma, a rare tumor of childhood, was first described by Vellois and associates in 1958. The extremities are the most common location for this tumor. Mediastinal lipoblastoma is exceedingly rare, with only four cases reported in the English-language literature. The authors report a case of mediastinal lipoblastoma in a 6-year-old girl, which, in contrast to previously reported cases, presented late in childhood and included sacrifice of the left innominate vein and phrenic nerve for successful resection.

Brachiocephalic Veins↗
PubMed1995

Elective intraoperative intracranial pressure monitoring during laparoscopic cholecystectomy.

The effects of artificial pneumoperitoneum on intracranial pressure have not been clearly defined. Initial animal studies indicate that elevated intra-abdominal pressure might have a deleterious effect on intracranial pressure. We report a case in which intracranial pressure was monitored intraoperatively during laparoscopic cholecystectomy. Intracranial pressure increased abruptly when the peritoneal cavity was insufflated, with the operating table in the Trendelenburg position, and decreased slightly with elevation of the head of the operating table. Initial opening intracranial pressure values were re-established on desufflation of the abdomen. Intracranial pressure monitoring should be considered when planning a laparoscopic procedure on patients with the potential for decreased intracranial compliance.

Adult↗
PubMed1995

Internal mammary artery injury, anterior mediastinal hematoma, and cardiac compromise after blunt chest trauma.

A rare case of blunt chest trauma resulting in internal mammary artery hemorrhage and cardiac tamponade is presented. Thoracotomy revealed anterior mediastinal hemorrhage but no pericardial hematoma. The significance of chest wall vessel hemorrhage as a cause of widened mediastinum is reiterated. The importance of accurate angiographic assessment and vigilant care of victims of blunt chest trauma who present with a widened mediastinum is emphasized.

Aortography↗
PubMed1995

Paired temporary loop ileostomies in the localization of small bowel hemorrhage of obscure origin.

Hemorrhage from the gastrointestinal tract can be a challenging clinical problem when it persists and the source remains obscure. Intraoperative enteroscopy has been shown to be of value when standard diagnostic tests fail to localize the source of bleeding. We describe a case of small bowel hemorrhage that required multiple trips to the operating room. Paired ileostomies were fashioned, which led to the successful localization and resection of the responsible segment of the small intestine.

Endoscopy, Digestive System↗
PubMed1992

The distal course of the sural nerve and its significance for incisions around the lateral hindfoot.

Twenty preserved cadaver limbs were dissected to show the distal course of the sural nerve and the number and site of origin of its branches. The mean position of the main nerve trunk was calculated at various points related to bony landmarks of the fibula and the fifth metatarsal base. Ninety-five percent confidence limits for the course of the main nerve trunk could be described. A fibula incision may damage the nerve if it extends more than 7 mm inferior to the lateral malleolar tip with the foot in equinus. Dorsolateral foot incisions may damage both the main trunk and the major anterior branch.

Aged↗