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Biomedical subjects

J Rosenberg

Publications and source records attributed to J Rosenberg.

At least 19 recordsLinked to original sources
PubMed2006

Vaccination with melanoma lysate-pulsed dendritic cells, of patients with advanced colorectal carcinoma: report from a phase I study.

Immune therapy have shown new and exciting perspectives for cancer treatment. Aim of our study was to evaluate toxicity and possible adverse effects from vaccination of patients with advanced colorectal cancer with autologous dendritic cells (DC) pulsed with lysate from a newly developed melanoma cell line, DDM-1.13. Six patients were enrolled in the phase I trial. Autologous DCs were generated in vitro from peripheral blood monocytes in the presence of granulocyte-macrophage colony-stimulating factor (GM-CSF) and interleukin-4 (IL-4). DCs were pulsed with melanoma cell lysate from a cloned and selected melanoma cell line enriched in expression of MAGE-A antigens and deficient in expression of melanoma differentiation antigens: tyrosinase, MART-1 and gp100. Vaccinations were administered intradermally on the proximal thigh with a total of five given vaccines at 2 weeks intervals. Each vaccine contained 3-5 x 10(6) DCs. Five of the six patients received all five vaccines. The treatment was well tolerated in all patients without any observed vaccine-correlated adverse effects. Treatment with this DC-based cancer vaccine proved safe and non-toxic.

Adult↗
PubMed2004

Biological tissue adhesive for mesh-application in pigs: an experimental study.

BACKGROUND: Tissue damage during herniotomy may attribute to postoperative complications including chronic pain, bleeding and infection. Thus the aim of this study was to evaluate a due and simple operative procedure with intraperitoneal application of mesh with glue in an experimental model prior to use in humans. METHOD: Laparoscopic insertion of a mesh was performed in three pigs. The meshes were fixed with a collagen glue. The pigs were sacrificed after 8 weeks and macroscopic and microscopic evaluation of the meshes, were performed. RESULTS: The intraperitoneal placed meshes did not migrate through the study period, and there was no sign of inflammation in surrounding tissue or adhesions around the meshes. CONCLUSIONS: If these findings can be applied to human inguinal herniotomy, this may lead to significant fewer complications including development of acute and chronic pain, formation of seroma and infection. Furthermore the operation technique is very simple.

Animals↗
PubMed2004

A comparative study of skills in virtual laparoscopy and endoscopy.

BACKGROUND: The present study was designed to investigate whether there is a correlation between manual skills in laparoscopic procedures and manual skills in flexible endoscopy. METHODS: In a prospective study using laparoscopy and endoscopy simulators (MIST-VR, and GI-Mentor II), 24 consecutive subjects (gastrointestinal surgeons, novice and experienced gastroenterologists, and untrained subjects) were asked to perform laparoscopic and endoscopic tasks. Their performance was assessed by the simulators' software and by observers blinded to the levels of subjects' experience. Performance in experienced vs inexperienced subjects was compared. Score pairs of three parameters--time, errors, and economy of movement--were also compared. RESULTS: Experienced subjects performed significantly better than inexperienced subjects on both tasks in terms of time, errors, and economy of movement (p < 0.05). All three performance parameters in laparoscopy and endoscopy correlated significantly (p < 0.02). CONCLUSION: Both simulators can distinguish between experienced and inexperienced subjects. Observed skills in simulated laparoscopy correlate with skills in simulated flexible endoscopy. This finding may have an impact on the design of training programs involving both procedures.

Clinical Competence↗
PubMed2004

Relationship between nocturnal hypoxaemia, tachycardia and myocardial ischaemia after major abdominal surgery.

BACKGROUND: Episodic hypoxaemia, cardiac arrhythmias, and myocardial ischaemia may be related after major abdominal surgery. METHODS: We studied 52 patients on the second and third nights after major abdominal operations, using continuous pulse oximetry and Holter ECG. We recorded the amount of time spent with oxygen saturation values less than 90, 85, and 80% during the night, and noted episodes of hypoxaemia, tachycardia, bradycardia, and ST-segment changes. RESULTS: In 87 study nights there were 2403 (individual range 1-229) episodes of hypoxaemia, 3509 (individual range 1-234) episodes of tachycardia, and 265 (individual range 1-73) episodes of ST segment deviation. Of the 52 patients, 50 had episodes of hypoxaemia and tachycardia, and 19 patients had one or more episodes of ST segment deviation. For 38% of the episodes of ST deviation, there was an episode of hypoxaemia at the same time and in 16% there was an episode of tachycardia. ST deviation was only noted in 4% of the episodes of hypoxaemia and in 1% of the episodes of tachycardia. CONCLUSION: Episodes of hypoxaemia and tachycardia frequently occur together after surgery but are rarely associated with ST deviation. Hypoxaemia or tachycardia is often present at the same time as ST deviation occurs.

Abdomen↗
PubMed2004

Randomized clinical trial of virtual reality simulation for laparoscopic skills training.

BACKGROUND: This study examined the impact of virtual reality (VR) surgical simulation on improvement of psychomotor skills relevant to the performance of laparoscopic cholecystectomy. METHODS: Sixteen surgical trainees performed a laparoscopic cholecystectomy on patients in the operating room (OR). The participants were then randomized to receive VR training (ten repetitions of all six tasks on the Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR)) or no training. Subsequently, all subjects performed a further laparoscopic cholecystectomy in the OR. Both operative procedures were recorded on videotape, and assessed by two independent and blinded observers using predefined objective criteria. Time to complete the procedure, error score and economy of movement score were assessed during the laparoscopic procedure in the OR. RESULTS: No differences in baseline variables were found between the two groups. Surgeons who received VR training performed laparoscopic cholecystectomy significantly faster than the control group (P=0.021). Furthermore, those who had VR training showed significantly greater improvement in error (P=0.003) and economy of movement (P=0.003) scores. CONCLUSION: Surgeons who received VR simulator training showed significantly greater improvement in performance in the OR than those in the control group. VR surgical simulation is therefore a valid tool for training of laparoscopic psychomotor skills and could be incorporated into surgical training programmes.

Cholecystectomy, Laparoscopic↗
PubMed2004

Randomized clinical trial comparing an oral carbohydrate beverage with placebo before laparoscopic cholecystectomy.

BACKGROUND: Preoperative oral carbohydrate can attenuate postoperative insulin resistance and catabolism, and may have the potential to improve postoperative recovery. There are no data from randomized studies on postoperative clinical outcome after specific surgical procedures. This study evaluated the clinical effects of a preoperative carbohydrate beverage in patients undergoing laparoscopic cholecystectomy. METHODS: Ninety-four patients undergoing laparoscopic cholecystectomy were included in a randomized clinical trial. Patients were randomized to receive 800 ml of an iso-osmolar 12.5 per cent carbohydrate-rich beverage the evening before operation (100 g carbohydrate) and another 400 ml (50 g carbohydrate) 2 h before initiation of anaesthesia, or the same volume of a placebo beverage. The primary endpoint was general well-being the day after operation. Patients were evaluated from 5 days before to 5 days after operation. Daily scores of general well-being, fatigue, appetite and pain, computerized measurements of physical activity and sleep (actigraphy), and subjective sleep quality were recorded. Nausea and vomiting were assessed twice within the first 24 h after surgery. RESULTS: Data from 86 patients were available for statistical analysis, 43 in each treatment group. No significant intergroup differences in general well-being or any other outcome variable were found. CONCLUSION: A preoperative carbohydrate beverage did not improve clinical outcome after laparoscopic cholecystectomy.

Administration, Oral↗
PubMed2004

Prospective analysis of convalescence and early pain after uncomplicated laparoscopic fundoplication.

BACKGROUND: The aim of this study was to define factors that limit a short period of convalescence and to characterize the pain experienced after laparoscopic fundoplication. METHODS: This prospective study included 60 consecutive patients who underwent uncomplicated laparoscopic Nissen fundoplication for gastro-oesophageal reflux disease. Patients were recommended to convalesce for 2 days after operation. Duration of convalescence, dysphagia, fatigue, nausea, vomiting and different pain components were registered daily during the first week and on days 10 and 30 after fundoplication. RESULTS: Thirty-nine patients took a median of 13 (range 3-41) days off work and 60 stayed away from recreational activity for a median of 4 (range 1-22) days. Pain, fatigue and plans made before operation were the main contributors to prolonged convalescence. Some 30-40 per cent of the patients reported moderate or severe dysphagia during the study period. Fatigue scores were significantly increased for 6 days after surgery (P < 0 . 001). Visceral pain dominated over incisional and shoulder pain throughout the study. At day 30, 17 per cent of the patients reported moderate or severe visceral pain. CONCLUSION: Pain and dysphagia are significant problems after uncomplicated total laparoscopic fundoplication. The time taken off work and away from recreational activity exceeded the recommended 2 days of convalescence, justifying further efforts to optimize early clinical outcome after total laparoscopic fundoplication.

Adult↗
PubMed2004

Dome down laparosonic cholecystectomy.

BACKGROUND AND AIMS: In cases of cholecystitis or other difficult situations conversion to laparotomy may be necessary. Furthermore, some cases of bile duct injury may be caused by anatomical variations and/or injuries caused by electrocautery. A new laparoscopic technique using a fundus-first technique with ultrasonic dissection ("dome down laparosonic cholecystectomy") may potentially solve these problems. MATERIAL AND METHODS: Twenty non-selected and consecutive patients with gallstone disease had laparoscopic cholecystectomy by the laparosonic dome down technique. Effect parameters were operative findings, duration of surgery and clinical course. RESULTS: Six patients had fibrotic chronic cholecystitis and one had acute cholecystitis. Three patients had intraoperative cholangiography because of elevated liver enzymes. All operations were completed by the intended laparosonic dome down technique. Median duration of surgery in the 20 patients was 35 minutes (range 20-60). Median duration of surgery in the first 5 patients was 55 minutes (35-60), and in the last 15 patients it was 30 minutes (20-50). All patients had uneventful clinical courses with a median hospital stay of 0 days (0-1). CONCLUSIONS: The technique was easy to learn and this new operative technique seems promising especially in cases of inflammation or fibrosis.

Adult↗
PubMed2003

Impact of hand dominance, gender, and experience with computer games on performance in virtual reality laparoscopy.

BACKGROUND: The impact of gender and hand dominance on operative performance may be a subject of prejudice among surgeons, reportedly leading to discrimination and lack of professional promotion. However, very little objective evidence is available yet on the matter. This study was conducted to identify factors that influence surgeons' performance, as measured by a virtual reality computer simulator for laparoscopic surgery. METHODS: This study included 25 surgical residents who had limited experience with laparoscopic surgery, having performed fewer than 10 laparoscopic cholecystectomies. The participants were registered according to their gender, hand dominance, and experience with computer games. All of the participants performed 10 repetitions of the six tasks on the Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) within 1 month. Assessment of laparoscopic skills was based on three parameters measured by the simulator: time, errors, and economy of hand movement. RESULTS: Differences in performance existed between the compared groups. Men completed the tasks in less time than women ( p = 0.01, Mann-Whitney test), but there was no statistical difference between the genders in the number of errors and unnecessary movements. Individuals with right hand dominance performed fewer unnecessary movements ( p = 0.045, Mann-Whitney test), and there was a trend toward better results in terms of time and errors among the residence with right hand dominance than among those with left dominance. Users of computer games made fewer errors than nonusers ( p = 0.035, Mann-Whitney test). CONCLUSIONS: The study provides objective evidence of a difference in laparoscopic skills between surgeons differing gender, hand dominance, and computer experience. These results may influence the future development of training program for laparoscopic surgery. They also pose a challenge to individuals responsible for the selection and training of the residents.

Adult↗
PubMed2002

Accelerated postoperative recovery programme after colonic resection improves physical performance, pulmonary function and body composition.

BACKGROUND: Postoperative organ dysfunction contributes to morbidity, hospital stay and convalescence. Multimodal rehabilitation with epidural analgesia, early oral feeding, mobilization and laxative use after colonic resection has reduced ileus and hospital stay. METHODS: Fourteen patients receiving conventional care (group 1) and 14 patients who had multimodal rehabilitation (group 2) were studied before and 8 days after colonic resection. Outcome measures included postoperative mobilization, body composition by whole-body dual X-ray absorptiometry, cardiovascular response to treadmill exercise, pulmonary function and nocturnal oxygen saturation. RESULTS: Defaecation occurred earlier (median day 1 versus day 4) and hospital stay was shorter (median 2 versus 12 days) in patients who had multimodal treatment. Lean body and fat mass decreased in group 1 but not in group 2. Exercise performance decreased by 44 per cent in group 1 but was unchanged in group 2. A postoperative increase in heart rate (HR) response to exercise was avoided in group 2. Pulmonary function decreased in group 1 but not in group 2. There was less nocturnal postoperative hypoxaemia in group 2. Cardiac demand-supply (HR/oxygen saturation ratio) increased in group 1 but not in group 2. CONCLUSION: Multimodal rehabilitation prevents reduction in lean body mass, pulmonary function, oxygenation and cardiovascular response to exercise after colonic surgery.

Aged↗
PubMed2002

Endoscopic retrograde cholangiopancreatography causes reduced myocardial blood flow.

BACKGROUND AND STUDY AIMS: Previous studies have shown that up to 50% of healthy patients may develop ST-segment changes during upper gastrointestinal endoscopy. The aim of the study was to evaluate myocardial blood flow in patients during endoscopic retrograde cholangiopancreatography (ERCP). PATIENTS AND METHODS: 11 patients scheduled for ERCP were monitored with a Holter tape recorder and underwent myocardial perfusion scintigraphies, to evaluate myocardial perfusion at rest and during ERCP. RESULTS: Ten patients completed the study. Eight patients had no sign of myocardial ischemia with either of the two methods, while two patients developed signs of ischemia during ERCP with both the Holter tape recording and on myocardial scintigraphy (P = 0.02). CONCLUSIONS: Patients undergoing ERCP may develop true myocardial ischemia with reduced myocardial blood flow. Although this is a small-scale study, these findings strongly support the use of alternative methods for diagnostic evaluation of the pancreatic duct and biliary tree.

Aged↗
PubMed2002

Interobserver agreement in ultrasound examination of the biliary tract.

PURPOSE: To prospectively evaluate the interobserver agreement in US examination of the gallbladder and the biliary tract performed by an experienced and a novice radiologist. MATERIAL AND METHODS: Fifty consecutive patients underwent US examination because of clinically suspected gallstones. The examination was performed by a consultant and a trainee radiologist on the same day. The following outcome measures were registered: presence of gallstones, filling of the gallbladder, thickness of the gallbladder wall, splitting of the gallbladder wall, fluid around the gallbladder, diameter of the common bile duct (CBD), and presence of CBD stones. RESULTS: None of the radiologists observed CBD stones or fluid around the gallbladder. The CBD was clearly distinguished by both observers in all patients. There was good agreement in the conclusions of the two radiologists regarding the presence of gallbladder stones and substantial agreement regarding the filling of the gallbladder and splitting of the gallbladder wall. Significant difference existed in the measurements by the two radiologists regarding the thickness of the gallbladder wall and the diameter of the CBD. CONCLUSION: The novice radiologist's expertise in the primary diagnosis of uncomplicated gallstone disease was as good as the one provided by the experienced colleague. The significant interobserver difference in the measurements of the thickness of the gallbladder wall and the CBD diameter might indicate that assessment of these parameters requires extensive practise and the opinion of an experienced colleague must be sought in cases where complications are suspected.

Adolescent↗
PubMed2002

CT- and MR colonography.

BACKGROUND: Colorectal cancer is the second most frequent cancer and adenomas are widely accepted as precursors to colorectal cancer. Diagnosis and removal of adenomas are recommended to reduce cancer incidence and mortality. The current diagnostic methods include sigmoidoscopy and colonoscopy. Lately, CT- and MR colonography have emerged as non-invasive methods for colon imaging. METHODS: At present, CTC and MRC require bowel preparation. However, preliminary studies have been carried out without colon preparation. After the colon has been filled with air or contrast, the patient is scanned in the supine and prone positions. Data are then downloaded to a workstation for post processing and image-analysis. RESULTS: Results have shown a high sensitivity and specificity for polyps > or = 10 mm, comparable to the sensitivity of conventional colonoscopy and superior to double contrast barium enema. CONCLUSIONS: With the exponential development in computer processing power, CT- and MR colonography holds the promise for future colon examination with the advantages of non-invasiveness, no need for sedation, and probably no bowel preparation. A major disadvantage, however, is the radiation dose during CT colonography. Future developments with the use of "intelligent" computers, better resolution and faster examinations will make CT and/or MR colonography realistic options to replace conventional diagnostic colonoscopy.

Adenoma↗
PubMed2001

Microlaparoscopic vs conventional laparoscopic cholecystectomy: a prospective randomized double-blind trial.

BACKGROUND: Downsizing the port incisions may reduce pain after laparoscopic cholecystectomy. METHODS: In a double-blind controlled study, 60 patients were randomized to undergo either microlaparoscopic cholecystectomy using one 10-mm and three 3.5-mm trocars (3.5-mm LC) or traditional laparoscopic cholecystectomy using two 10-mm and two 5-mm trocars (LC). Incisional pain at each port incision and overall pain were recorded for 1 week after the operation. Fatigue, nausea and vomiting, pulmonary function, and cosmetic results were also measured. RESULTS: Data from 52 patients were analyzed; eight patients were excluded from the study for various reasons. One patient was converted from 3.5-mm LC to LC due to technical problems with the 3.5-mm optic. In the 3.5-mm LC group (n = 25), incisional pain was significantly decreased in the 1st postoperative week as compared with the LC group (n = 27) (p <0.01). In both groups, pain scores at the supraumbilical 10-mm port were significantly higher compared with other port sites (p <0.05). The cosmetic results were significantly better in the 3.5-mm LC group (p <0.01). There were no significant differences in any of the other variables. CONCLUSION: The use of 3.5-mm trocars is feasible in LC, and it both reduces incisional pain and improves the cosmetic result.

Anesthesia↗
PubMed2001

Sealing of cystic duct with bipolar electrocoagulation.

BACKGROUND: The cystic duct leakage rate is still high. The aim of this study was to evaluate an alternative technique for securing the cystic duct using the Ligasure vessel sealing system. METHODS: Eight pigs were included in this pilot study. We performed a cholecystectomy, using the Ligasure system to sealing the cystic duct and artery. The pigs were killed 8 days after operation, and specimens of the cystic duct and common bile duct were removed for pathologic examination. RESULTS: There were no clinical complications other than two superficial wound infections. The sealing of the cystic duct and artery were both macroscopically and microscopically 100% sufficient. The maximum extension of the coagulative process in the sealed ducts was 0.25 mm on each side of the sealed area. CONCLUSIONS: The Ligasure system seems promising for securing the cystic duct and artery during cholecystectomy. Future studies should evaluate safety with this technique on a larger scale.

Animals↗
PubMed2001

[Gallbladder polyps].

Polyps in the gall bladder are detected in 4-5% of the population and most of them are benign. However, they can be premalignant and the prognosis for gall bladder carcinoma is still poor. As with other cancers, treatment at an early stage is therefore, considered essential to improve the prognosis. Because of the very low morbidity after laparoscopic cholecystectomy we recommend laparoscopic cholecystectomy when a polyp in the gall bladder is detected by ultrasonography. A wait and see attitude with repeated ultrasonography twice a year may be chosen, if there are contra-indications to laparoscopic cholecystectomy. If the lesion increases in size, cholecystectomy should be performed.

Gallbladder Neoplasms↗