Biomedical subjects
Publications and source records attributed to M A Memon.
Extramucosal lesions of the esophagus compose a small but clinically important group of diagnoses presenting as stenosis. Because of their infrequency, they can present a diagnostic dilemma in patients with dysphagia, odynophagia, or radiologic abnormalities on imaging studies. Definitive management is frequently conservative, consisting of reassurance; definitive surgical management, however, may be necessary.
Massive bleeding from an appendiceal stump is extremely rare and typically requires emergency laparotomy and resection. We describe a case of severe gastrointestinal hemorrhage from an inverted appendiceal stump in a 20-year-old man 1 year after appendectomy. This was successfully managed by an urgent totally intracorporeal laparoscopic cecectomy. The patient benefited from the laparoscopic excision and made an uneventful and speedy postoperative recovery. The postoperative discomfort, morbidity, and long hospitalization typically associated with laparotomy were avoided. For appendiceal stump bleeding, totally intracorporeal laparoscopic excision offers a viable alternative to open laparotomy.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
BACKGROUND: Carcinoid or neuroendocrine tumors of the gastrointestinal tract, although characteristically indolent, are also quite heterogeneous both with respect to histologic and endocrine features and with respect to clinical presentation and behavior. PURPOSE: This study was undertaken to review and summarize the current literature on classification controversies, site-specific carcinoid presentation and behavior, and diagnostic and management strategies for primary and advanced carcinoid tumors and the carcinoid syndrome. RESULTS: For carcinoid tumors, oncologic results depend on the location of the primary tumor, extent of locoregional and metastatic disease, functioning status of the tumor, and the feasibility of complete surgical extirpation. Whereas favorable survival rates are typically observed for appendiceal and rectal primaries, less favorable rates are often observed for colonic and ileal tumors. A search for additional tumors is generally advised because multiple carcinoids and second neoplasms are not uncommon. Because of the indolent nature of the tumor and because these therapies have been shown to improve quality and quantity of life, otherwise fit patients with advanced carcinoid disease should be treated with aggressive medical and surgical therapies. Development of a malignant carcinoid syndrome indicates the presence of a functionally active carcinoid tumor and portends a poor prognosis. CONCLUSION: Gastrointestinal carcinoids, although malignant, behave differently from other carcinomas. Results are highly variable and must be individualized according to the site of the primary tumor, extent of spread, and general condition of the patient. A prolongation of quality life can often be accomplished through aggressive medical and surgical therapies.
The value of mechanical bowel preparation for elective left sided colorectal surgery is debatable. This retrospective study evaluates the incidence of wound infection, wound dehiscence, abdominal/pelvic collections and anastomotic dehiscence between patients who received mechanical bowel preparation [MBP] (n = 61) and those who did not (n = 75). The case notes of 136 consecutive patients undergoing elective left sided colorectal surgery over a three year period in a district general hospital were reviewed. The incidence of infective and anastomotic complications between the two groups was not significantly different. There were two post-operative deaths, both in patients receiving MBP. We therefore conclude that the role of MBP in the era of systemic antibiotics must be questioned. A prospective randomised multicenter trial recruiting an adequate number of patients undergoing elective left sided colorectal procedures would clarify this long standing debate. Note: Presented at the Spring Meeting of the Minnesota Surgical Society in Rochester, Minnesota, USA, May, 1996 and to the American Society of Colon and Rectal Surgeons (ASCRS), Seattle, Washington, June 1996, and published in abstract form in Diseases of the Colon and Rectum (1996) 39:A47.
The improvement in surgical decision-making for patients with abdominal pain but an uncertain diagnosis using DL has now been shown to decrease both negative and nontherapeutic laparotomy rates. Once the diagnosis is established, DL can be taken a step further in many cases, as therapeutic intervention via laparoscopy is possible for a number of these conditions without resorting to a laparotomy. Conditions amenable to therapeutic laparoscopy include appendicitis, perforated peptic ulcer, diverticulitis, small bowel obstruction, acute cholecystitis, diaphragmatic rupture, and splenic or hepatic injuries, to name but a few. However, a number of unanswered questions remain such as: Who should perform emergency laparoscopic procedures? What should the selection criteria be? What are the cost implications? and Is patient outcome actually better with laparoscopy? Only randomized controlled trials can answer these questions. Until such data are available, it is important that common sense prevail. Laparoscopy should be incorporated into the general surgeon's armamentarium for the management of patients with abdominal pain as just another tool to be used selectively when indicated. It is also important that new technologies be carefully evaluated in an unbiased manner under strict protocol so that objective data can be obtained which can be used to devise guidelines for safe and effective use of new devices.
A 5-yr-old female llama was presented by its owner for an elective abortion. The llama was accidentally bred to an unknown, and possibly related, male about 2.5 mo prior to presentation. The pregnancy was first confirmed by ultrasonography then cloprostenol (150 microg im) was administered once. Cloprostenol, an analogue of prostaglandin F2alpha, was chosen in preference to natural PGF2alpha due to reported adverse reactions in llamas to this abortifacient. Blood serum progesterone levels decreased rapidly from 5.7 to < 0.2 ng/ml at 0 to 60 h post injection, respectively. The aborted fetus was expelled at approximately 108 h after the injection. Twenty days post abortion the llama was rebred. At 27 and 87 d post breeding, pregnancy was indicated first by male refusal and then by elevated serum progesterone concentrations and was confirmed by ultrasonography. Following a 355 d gestation period, a male cria was born. This case provides evidence that an abortion can be induced with cloprostenol without an adverse effect on future fertility in the llama.
This report describes a laparoscopic approach for the treatment of a benign gastric mass. A 15-year-old female presented with recurrent epigastric pain. Preoperative endoscopic and x-ray evaluation demonstrated a submucosal tumor of the greater curvature. The patient underwent a laparoscopic resection of a heterotopic pancreatic tumor in the stomach. A description of our technique and a review of the pathophysiologic features of this disease is included.
Explore the source record for details and available documents.
Laparoscopic appendicectomy (LA), has failed to gain unequivocal acceptance by the general surgical community as an alternative to open appendicectomy (OA). This is because the early postoperative recovery leading to quicker hospital discharge, which led to the worldwide acceptance of laparoscopic cholecystectomy, has not been universally seen with LA. Moreover, in the majority of the published series of LAs, there seems to be a trend towards an increased incidence of intra-abdominal abscesses. However, laparoscopy is superior to the 'watch and wait' policy where the diagnosis of appendicitis is questionable. Furthermore, since a large incision can be avoided by using the LA technique in obese patients, the incidence of postoperative morbidity can be reduced considerably. Nevertheless, before endorsing routine and widespread use of LA, it is essential that this technique is critically evaluated in well-designed, controlled, randomised trials, showing clearly the major benefits to the patient in terms of quicker hospital discharge, reduced postoperative pain, decreased wound infection and early return to full activities. Laparoscopic appendicectomy will never replace all open appendicectomies, but should become an alternative in certain groups of patients.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
A granulosa cell tumor was found in a dog with clinical signs of persistent estrus that began 6 years after ovariohysterectomy had been performed. The tumor was diagnosed by use of ultrasonography, provocative testing with human chorionic gonadotropin, and exploratory laparotomy. Hyperestrogenism from functional tumor cells caused bone marrow suppression and endocrine alopecia. Successful treatment included tumor removal, blood transfusions, and antibiotic administration.
A 6-year-old Nubian doe was evaluated because of slowly progressive abdominal enlargement of 1 month's duration. Five days prior to examination at our hospital, the doe was examined by a local veterinarian. False pregnancy was suspected, and 10 mg of prostaglandin F2 alpha was injected IM. Abdominal distention did not decrease, and the doe did not develop a vaginal discharge. An additional 10 mg of prostaglandin and 24 mg of dexamethasone were injected IM, about 80 hours after the first injection, again without any apparent effect. On arrival at our hospital, the doe was in sternal recumbency and was too weak to stand unassisted. Its abdomen was distended. The body of the uterus and part of 1 uterine horn could be examined by means of transrectal ultrasonography, both appeared normal. The doe was admitted to the hospital, but its condition worsened, and it died during the night. Postmortem examination revealed approximately 30 L of clear, pale, straw-colored fluid in the peritoneal cavity. The caudal pole of the left ovary contained an indistinct, firm, slightly raised, gray-tan mass. The final diagnosis was mucinous adenocarcinoma of the ovary metastatic to the partietal peritoneum, pericardium, and lungs. In adult female goats with bilateral abdominal distention, hydrometra associated with false pregnancy should always be considered; however, if there is no response to prostaglandin administration, distention is more likely to be a result of ascites.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.