Biomedical subjects
J F Donovan
Publications and source records attributed to J F Donovan.
Laparoscopic nephrectomy in crossed fused renal ectopia.
Operative laparoscopy offers the patient a minimally invasive alternative to open surgery. We have recently performed a laparoscopic nephrectomy of the upper moiety of a crossed fused renal ectopia. The procedure lasted approximately six hours, and the patient was discharged on postoperative day 3. He was able to resume normal physical activity in one week. This case demonstrates the advantages of minimally invasive surgery.
Laparoscopic surgical training: effectiveness and impact on urological surgical practice patterns.
Urological interest in laparoscopic surgical techniques has dramatically increased during the last several years. However, the extent to which these methods are being used and the impact of training courses on clinical use are unclear. We assessed urologist practice patterns subsequent to a formal training course in urological laparoscopic surgery. On 5 dates between January and October 1991, a total of 163 urologists participated in a 2-day, university sponsored, laparoscopic surgery training seminar. Instruction consisted of 8 hours of didactic lectures including 2 live video cases, 4.5 hours of simulation and 4.5 hours in a live animal laboratory. Three months after the course the participants were mailed a questionnaire inquiring as to the interval laparoscopic surgery experience. Practice demographics, additional training, equipment availability, number of laparoscopic surgery candidates identified, percentage of overall surgical case load, patient inquiries, cases performed and complications were assessed by the questionnaire. Descriptive and correlative information was then derived from the data set. A total of 105 course participants (64%) responded to the questionnaire and 64 had engaged in some form of additional training following the course. During the 3 months since course completion respondents had identified an average of 4 candidates for laparoscopic surgery, which represented a mean of 2.5% of the total case load. Specific patient inquiries averaged less than 1 per physician within 3 months. During this same interval respondents had performed a total of 156 laparoscopic procedures (1.7 per urologist). Of the participants 45% had not performed their first case and 32% had performed more than 1 laparoscopic procedure. A total of 11 complications was reported (7.2%) and in 7 instances the surgeon was required to convert to an open approach. Veress needle placement was perceived as the most difficult aspect of the technique (22% of the respondents). Training subsequent to the course was the best predictor of clinical use. Of those who responded 88% believed that their future use of laparoscopy would increase. This survey suggests that subsequent to training, laparoscopic techniques are being rapidly and safely used by urologists. However, in the current state of development the impact of laparoscopic surgery on global urological practice patterns appears to be small.
Laparoscopic partial nephrectomy: initial case report for benign disease.
On February 12, 1992, a laparoscopic partial nephrectomy was performed on a woman with a lower-pole caliceal diverticulum containing a stone. By incorporating the laparoscopic argon beam coagulator and a tourniquet device, the procedure was completed in 6 hours and 10 minutes. The postoperative course and period of convalescence was markedly improved over that expected from open surgery. This laparoscopic intervention demonstrates the expanding horizons of minimally invasive surgery and the remarkable development of new laparoscopic devices.
Ligating varicoceles through the laparoscope.
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Laparoscopic varix ligation.
Varicocele, dilated veins in the pampiniform plexus, is frequently a contributing factor in male infertility. We performed outpatient laparoscopic varix ligation in 14 patients (5 bilaterally) with clinically evident varices and persistent oligospermia and/or asthenospermia. The spermatic artery was identified and preserved in all but 1 varix ligation. Mean interval to resumption of preoperative activity levels was 3.4 days. On average, patients consumed 8.4 tablets of acetaminophen (325 mg.) with codeine (30 mg.) during the recovery period. The procedure is effective and decreases postoperative morbidity.
Transport properties of an in situ jejunal reservoir in dogs.
To evaluate partial or total replacement of renal function using gut, we measured in vivo transport of nitrogen metabolites, electrolytes, and water into a jejunal segment configured as a continent reservoir in the dog. Reservoir contents were sampled and analyzed at serial time intervals during a 3-h period after instillation of solution containing (in mM) 40 NaCl, 10 NaHCO3, 220 mannitol, pH 8.5, without or with added urease. At 10 min postinstillation, the amount of urea in the solution without added urease was 3-5 times greater than in the presence of added urease, but accumulation of NH4+ was 14-21 times greater in the solution containing added urease, giving a luminal NH4+ concentration up to 10,000 times that of plasma. In the absence of urease, HCO3- concentration fell to 0, and pH declined to 6 at 3 h; in the presence of urease, HCO3- concentration was 4.5 mM, and pH was 7.8 at 3 h. We conclude 1) urea is secreted by the reservoir; 2) H+ is secreted and/or formed in the reservoir; 3) in the presence of urease, urea hydrolyzed to NH3 is converted to NH4+ by H+ and trapped in the lumen; and 4) in the urease solution, H+ binding by NH3 preserves luminal HCO3-, maintaining the initial pH. Thus the continent jejunal reservoir may supplement or replace impaired renal function.
Laparoscopic varicocelectomy.
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Urological laparoscopic surgery.
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Comparison of concurrent pregnancy rates for in-vitro fertilization--embryo transfer, pronuclear stage embryo transfer and gamete intra-fallopian transfer.
Concurrent pregnancy and implantation (sacs/embryos transferred) rates were compared for 84, 77 and 49 cases of in-vitro fertilization-embryo transfer (IVF-ET), pronuclear stage embryo transfer (PROST) and gamete intra-Fallopian transfer (GIFT), respectively. All cases reported occurred during an 18-month interval since the initiation of PROST by our programme. Leuprolide acetate was used with follicle stimulating hormone and human menopausal gonadotrophin for follicular stimulation of all but donor oocyte cases (n = 9). Clinical pregnancy (per transfer) and implantation rates were significantly higher (P less than 0.03) for PROST (52.4%, 20.2%) in comparison with IVF-ET (26.9%, 11.4%). Rates for GIFT (48.9%, 18.4%) were not significantly higher (P = 0.10, 0.14) than for IVF-ET. This was probably due to the lower number of GIFT than PROST procedures performed. The total pregnancy rate for GIFT (biochemical, ectopic and clinical combined) was significantly greater (P less than 0.05) than for IVF-ET. Pregnancy and implantation rates for PROST and GIFT were similar. These results support the use of PROST rather than IVF-ET for all cases in which the woman has one functional Fallopian tube. Furthermore, to maintain equivalent rates of pregnancy with PROST and GIFT, it is suggested that GIFT should not be used for cases of male-factor infertility without first documenting normal rates of in-vitro fertilization with PROST.
Comparison of motility stimulants for cryopreserved human semen.
Caffeine, pentoxifylline, 2-deoxyadenosine, cyclic adenosine monophosphate (cAMP), relaxin, adenosine, kallikrein, and calcium were compared for their ability to stimulate motility of cryopreserved sperm. Caffeine, pentoxifylline, and 2-deoxyadenosine significantly increased the percentage of motile sperm at 15, 30, 45, and 60 minutes after administration. Sperm velocity was significantly increased by caffeine at 0, 15, 30, and 45 minutes, and by pentoxifylline at 0, 45, and 60 minutes. Consistent stimulation was not observed for other chemicals. Caffeine, pentoxifylline, and 2-deoxyadenosine were then examined for their ability to provide motility stimulation after removal with washing. With the exception of caffeine, percent motility and velocity for stimulated and untreated sperm were similar after washing. A significant reduction in motility was observed at 48 hours after washing for caffeine. The percentage of hamster oocytes penetrated at 24 hours after washing was significantly reduced for caffeine, 2-deoxyadenosine, and pentoxifylline combined with 2-deoxyadenosine. Pentoxifylline-treated sperm showed no reduction in fertilizing capacity. These results indicate that, of the chemicals examined, pentoxifylline is superior for motility stimulation of cryopreserved sperm.
Construction of the intestinal stoma with an intraluminal stapling device.
We have used the intraluminal circular stapler to facilitate construction of the intestinal conduit stoma. We have encountered no complications related to the stapled stoma construction technique in 8 patients. The stoma is circular, uniform in size and is fitted easily with an appliance. The circular staple line provides a watertight seal that prevents contamination of the subcutaneous tissues. The technique is rapid, reliable and reproducible.
The therapy of genital trauma by dog bite.
Genital trauma by dog bite rarely is reported. We present 2 cases of dog bite to the external genitalia involving male infants. Rabies precautions, tetanus prophylaxis and antimicrobial therapy are reviewed. Both children required surgical debridement and split thickness skin grafts for repair. Since pediatric genital trauma may be the result of negligence or even deliberate abuse, a thorough investigation of the child's environment is mandatory in such situations.
Sequential mitogen stimulation of peripheral blood lymphocytes from chickens inoculated with infectious bursal disease virus.
Chickens were inoculated wih the pathogenic Edgar strain of infectious bursal disease virus at 1 week, 2 weeks, or 1 day of age. In the 3 experiments, phytohemagglutinin stimulation of peripheral blood lymphocytes was significantly decreased on day 3 or 4 after inoculation. Subsequently, on days 7 through 21, stimulations were similar between lymphocytes from inoculated birds and those from control birds. Pokeweed mitogen stimulation was affected minimally in virus-inoculated chickens. In each experiment, on day 7, the spontaneous [3H]thymidine uptake was greater in nonstimulated lymphocyte cultures from inoculated chickens than in such cultures from control chickens. In an additional experiment, chickens 1 week of age were exposed to a pathogenic vaccinal virus given in their water. The vaccinal virus exposure resulted in significant decrease of phytohemagglutinin stimulation of lymphocytes on days 3 and 7 of the experiment. A significant decrease in pokeweed mitogen stimulation was observed on day 10 after inoculation.
Traumatic inferior vena caval obstruction.
A 57-year-old male sustained an injury to the supradiaphragmatic portion of the inferior vena cava, which presented as progressive lower extremity thrombophlebitis culminating in thrombosis of his inferior vena cava. The indications for operative intervention centered around impaired renal, hepatic, and intestinal circulation. Extracorporeal circulation permitted extraction of the clot and repair of the injury.
Nursing care study: A patient with an abdominal aneurysm.
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Metabolic intestinal surgery. Its complications and management.
From November 1970 to August 1974 small intestinal bypass was performed in 475 patients for morbid obesity with an operative mortality of 1.6%. Immediate postoperative complications were superficial wound infection (17 patients), pulmonary complications (seven patients), cardiac complications (five patients), wound dehiscence (nine patients), intestinal tract fistula (four patients), and miscellaneous complications (14 patients). Delayed complications included hypokalemia (28%), hypocalcemia (9%), anemia (11%), calcium oxalate urinary calculi (6%), gout (2%), and hepatic failure (1.4%). Fourteen patients died of late complications. Ventral incisional hernia occurred in 3% of the patients; failure to lose sufficient weight in 21%, all but one occurring in patients with end-to-side shunts. Thirteen end-to-side shunts have been converted to end-to-end shunts because of insufficient weight loss. A team concept is important in the handling of the morbidly obese. Small bowel bypass is effective in producing sustained weight reduction in these patients. Careful and continued study of these patients for the rest of their lives is of paramount importance.