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Biomedical subjects

Leslie Wise

Publications and source records attributed to Leslie Wise.

15 recordsLinked to original sources
PubMed2005

Safety of contrast venography prior to caval interruption in patients with renal insufficiency.

We undertook this study to determine whether the use of contrast venography would adversely affect renal function in patients with renal insufficiency requiring caval interruption. We conducted a retrospective review of all inferior vena cava (IVC) filters inserted at our institution over a 2-year period (January 2002 to January 2004). The indication for caval interruption, insertion technique, type of filter used, pre- and postintervention creatinine level, and the presence of diabetes and hypertension were analyzed. A total of 282 IVC filters were inserted, with 38 of them placed in patients with renal insufficiency as defined by a serum creatinine level of > 1.5 mg/dL. Contrast venography with 15 to 30 mL of iohexol (Omnipaque 300) was used in all cases, and no special measures other than proper hydration were used for renal protection. All filters were successfully deployed. The mean +/- SD preintervention creatinine level was 2.38 +/- 0.79 mg/dL. The mean +/- SD postintervention creatinine levels at 2 and 30 days were 2.26 +/- 0.45 mg/dL and 2.12 +/- 0.94 mg/dL, respectively. No patients required hemodialysis following caval interruption, and no adverse effect on renal function was noted. Contrast venography accurately delineates venous anatomy and facilitates proper caval filter placement with no apparent adverse effect on renal function. We believe contrast venography is safe even in the presence of renal insufficiency.

Adult↗
PubMed2004

Elevated liver enzymes following open Roux-en-Y gastric bypass for morbid obesity - does timing of liver retraction affect the rise in the levels of transaminases?

BACKGROUND: Liver retraction in open Roux-en-Y gastric bypass (RYGBP) for morbid obesity may cause an elevation in liver transaminase levels postoperatively. This study attempts to ascertain whether timing of placement of the liver retractor would have any effect on the degree of derangement of the liver function tests. METHODS: 12 patients undergoing open RYGBP were prospectively randomized into 2 groups. One group had the liver retractor applied early on in the operation, and had the gastric pouch constructed first, followed by construction of the jejunojejunostomy and Roux-en-Y gastrojejunostomy. The second group had the jejunojejunostomy performed first, followed by placement of the liver retractor to allow construction of the gastric pouch and Roux-en-Y gastro-jejunostomy. Liver function tests were monitored postoperatively in both groups, and these were then statistically analyzed with respect to the duration of liver retraction. RESULTS: Delayed liver retraction resulted in statistically significantly smaller increases in aspartate transaminase (AST) and alanine transaminase (ALT) compared with early liver retraction. AST levels returned to normal values within 1 week in both groups of patients. ALT levels returned to normal values within 1 week in the delayed liver retraction group, whereas levels took >1 week to return to normal in the early liver retraction group. CONCLUSIONS: Liver retraction causes abnormal transaminase levels following open RYGBP. Delayed liver retraction results in less rise in the AST and ALT levels compared with early liver retraction. Surgeons should construct the Roux-en-Y limb and jejunoje junostomy first, before proceeding with construction of the gastric pouch and gastrojejunostomy, thereby decreasing the duration of liver retraction and consequent relative liver ischemia.

Gastric Bypass↗
PubMed2003

Mini-laparotomy cholecystectomy in the era of laparoscopic cholecystectomy: a community-based hospital perspective.

Laparoscopic cholecystectomy is clearly the gold standard for symptomatic cholelithiasis. Open cholecystectomy is now reserved for difficult and problematic cases. The purpose of this paper is to propose that mini-laparotomy cholecystectomy (minicholecystectomy) can be as effective as laparoscopic cholecystectomy. This paper compares the two techniques in well-matched patients. In addition mastery of this technique is practical and rewarding and should be part of the repertoire of the general surgeon. We conducted a retrospective review of the experience of a single surgeon at a community-based teaching hospital over a 2-year period for minicholecystectomy and laparoscopic cholecystectomy. Sixty-six patients were matched for age, sex, body surface area, and Acute Physiology and Chronic Health Evaluation II score. The absolute cost was lower for the minicholecystectomy group than for the laparoscopic cholecystectomy group. The operating room times were not significantly different in the two groups (P value 0.79). The average length of stay and the average amount of intramuscular analgesia required for the two groups were also not significantly different (P values 0.69 and 0.35, respectively). Although subjective postoperative satisfaction was equal for both groups the minicholecystectomy group had no complications whereas the laparoscopic group had two (myocardial infarction and cystic duct stump leak) complications. We conclude that minicholecystectomy can be used as a viable alternative to laparoscopic cholecystectomy especially in patients who cannot tolerate laparoscopic procedures and in areas where cost containment is critical.

Adult↗
PubMed2002

One hundred citation classics in general surgical journals.

The number of times an article is cited in scientific journals reflects its impact on a specific biomedical field or specialty and reflects the impact of the authors' creativity. Our objective was to identify and analyze the characteristics of the 100 most frequently cited articles published in journals dedicated to general surgery and its close subspecialties. Using the database (1945-1995) of the Science Citation Index of the Institute for Scientific Information, 1500 articles cited 100 times and more were identified and the top 100 articles selected for further analysis. The 100 articles were published between 1931 and 1990, with more than two-thirds of them published after 1960. The mean number of citations per article was 405, (range 278-1013). Altogether, 84 of the articles originated from North America (USA 78, Canada 6) and the UK (12). New York State led the list of U.S. states with 14, and Harvard and Columbia University led the list of institutions with 6 articles each. The 100 articles were published in 10 surgical journals led by the Annals of Surgery (n = 40), followed by Surgery (n = 15), Archives of Surgery (n = 12), Surgery, Gynecology and Obstetrics (n = 11), and British Journal of Surgery (n = 10). A total of 80 of the articles reported clinical experiences, 6 were clinical review articles, and 14 dealt with basic science. Eighteen articles reported a new surgical technique and six a prosthetic device. Gastrointestinal surgery and trauma and critical care led the list of the surgical fields, each with 25 articles, followed by vascular surgery (n = 15). Thirty-four persons authored two or more of the top-cited articles. This list of the top-cited papers identifies seminal contributions and their originators, facilitating the understanding and discourse of modern surgical history and offering surgeons hints about what makes a contribution a "top-cited classic." To produce such a "classic" the surgeon and his or her group must come up with a clinical or nonclinical innovation, observation, or discovery that has a long-standing effect on the way we practice-be it operative or nonoperative. Based on our findings, to be well cited such a contribution should be published in the English language in a high-impact journal. Moreover, it is more likely to resonant loudly if it originates from a North American or British "ivory tower."

Authorship↗
PubMedDate not supplied

Finding the best abdominal closure: an evidence-based review of the literature.

BACKGROUND: Despite advances in surgical technique and materials, abdominal fascial closure has remained a procedure that often reflects a surgeon's personal preference with a reliance on tradition and anecdotal experience. The value of a particular abdominal fascial closure technique may be measured by the incidence of early and late wound complications, and the best abdominal closure technique should be fast, easy, and cost-effective, while preventing both early and late complications. This study addresses the closure of the vertical midline laparotomy incision. DATA SOURCES: A MEDLINE (National Library of Medicine, Bethesda, Maryland) search was performed. All articles related to abdominal fascia closure published from 1966 to 2003 were included in the review. CONCLUSIONS: Careful analysis of the current surgical literature, including 4 recently published meta-analyses, indicates that a consistent conclusion can be made regarding an optimal technique. That technique involves mass closure, incorporating all of the layers of the abdominal wall (except skin) as 1 structure, in a simple running technique, using #1 or #2 absorbable monofilament suture material with a suture length to wound length ratio of 4 to 1.

Abdominal Wall↗
PubMedDate not supplied

When should we order a CT scan and when should we rely on the results to diagnose an acute appendicitis?

OBJECTIVE: The objective of this study was to retrospectively analyze the last 100 consecutive emergency appendectomies performed in the authors' institution, which is a community-based teaching hospital, and look at the accuracy of the CT scan in the diagnosis of acute appendicitis. DESIGN: Retrospective clinical study. SETTING: A 600-bed community-based teaching hospital. METHODS: The last 100 consecutive emergency appendectomies, which were performed at New York Methodist Hospital in 2004, were retrospectively analyzed. The collected data included the demographics of the patients, relevant history, physical examination, laboratory and radiological tests, and pathology results. The statistical analyses were performed using the JMP version 3.2 software (SAS Institute Inc., Cary, North Carolina). An alpha value of 0.05 was used in all statistical analyses, and p values were considered as being statistically significant at or below the alpha value of 0.05. RESULTS: There was no statistically significant correlation between the acute appendicitis and some of the typical presenting symptoms and signs of acute appendicitis (rebound tenderness, low-grade fever, elevated white blood cell count, and anorexia). The sensitivity, specificity, positive predictive value, and negative predictive value of the CT scan in this retrospective analysis were 96%, 75%, 98.5%, and 50%, respectively, with an overall efficiency of 95%. However, the sensitivity, specificity, positive predictive value, and negative predictive value of the CT scan increased after reevaluation of the false-positive, false-negative, and inconclusive CT results by an experienced radiologist in a blind fashion (97%, 100%, 100%, and 71%, respectively). The correlation between the CT scan and the pathology result was statistically significant when the CT result was positive or negative (p = 0.0001). CONCLUSION: The CT scan is indicated when the clinical presentation is equivocal, and it will be helpful if the result is positive or interpreted as negative only by an experienced radiology attending.

Acute Disease↗
PubMedDate not supplied

Early lap-band erosion associated with colonic inflammation: a case report and literature review.

INTRODUCTION: Laparoscopic adjustable gastric banding is an effective and safe surgical modality for the treatment of morbid obesity. Erosion of the band into the stomach has been reported. No reports are available on erosion of the Lap-Band following diverticulitis of the colon. CASE REPORT: A 31-year-old female with a body mass index (BMI) of 52 underwent an uneventful laparoscopic Lap-Band placement. Postoperative contrast study revealed good positioning of the band and no evidence of leakage. The patient's recovery was uneventful except for an elevated temperature of 101.5 degrees F that was attributed to her atelectasis. She had lost 52 lbs. and remained asymptomatic for 3 months. Following this period of successful weight loss, she presented with complaints of abdominal pain for 3 days associated with diarrhea of 7 days' duration. A Gastrografin contrast study showed no evidence of a leak or band slippage but erosion was suspected. Upper endoscopy confirmed erosion of the band into the stomach. Computed tomography (CT) of the abdomen revealed thickening of the sigmoid and descending colon with mesenteric fat stranding consistent with diverticulitis. Laparoscopic removal of the Lap-Band system was performed. CONCLUSION: We postulate that colonic diverticulitis could have been a precipitating factor in the development of band erosion. Intraabdominal sepsis resulting in subacute infection of the Lab-Band system may be the underlying factor.

Adult↗