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Biomedical subjects

M Anvari

Publications and source records attributed to M Anvari.

At least 37 records · Page 2Linked to original sources
PubMed2001

Treatment of inguinodynia after laparoscopic herniorrhaphy: a combined laparoscopic and fluoroscopic approach to the removal of helical tackers.

Laparoscopic inguinal herniorrhaphy has become a popular operation for the treatment of inguinal hernia. However, injury and entrapment of the cutaneous nerves of the lumbar plexus by the staples or tackers used for mesh fixation have been described. Laparoscopic removal of the staples or tackers in the inguinal region has been attempted with variable success. The success of the laparoscopic approach for removal of helical tackers in particular is sometimes limited by the fact that the offending tackers are deeply embedded in the preperitoneal tissues and not readily located with a simple laparoscopic view. The authors report a case in which fluoroscopy was used to help identify tackers that could not be visualized laparoscopically. The neuralgia disappeared after successful removal of the offending tackers with no neurologic deficit. Liberal use of fluoroscopic guidance in the laparoscopic removal of helical tackers in similar cases is recommended.

Fluoroscopy↗
PubMed2001

Postprandial bloating after laparoscopic Nissen fundoplication.

OBJECTIVE: To evaluate the prevalence and possible contributing factors to postprandial bloating in patients having chronic gastroesophageal reflux disease (GERD) before and after laparoscopic Nissen fundoplication. DESIGN: A prospective cohort study. SETTING: A tertiary care teaching hospital. PATIENTS: Five hundred and seventy-eight patients with proven GERD. INTERVENTION: Laparoscopic Nissen fundoplication. OUTCOME MEASURES: Symptom severity scores for postprandial bloating and dysphagia, esophageal motility and 24-hour pH measurement before and at 6 months, 2 years and 5 years after laparoscopic Nissen fundoplication. RESULTS: Of the 598 patients, 436 (73%) reported some postprandial bloating before the procedure. The symptom score for bloating significantly improved after surgery (p < 0.0001). There were no significant differences in the lower esophageal sphincter basal pressures or 24-hour pH scores between those who reported improvement or worsening of their postprandial bloating. At 6 months after surgery, 54% of patients experienced postprandial bloating; of these, 49% reported improvement, 21% reported worsening and 30% reported no change in bloating symptoms compared with the preoperative state. Of the patients who reported worsening of postprandial bloating 6 months after surgery, 86 were reassessed 2 years after surgery and 71% reported improvement of this symptom over this time interval. CONCLUSIONS: Bloating is a common symptom in patients who suffer from chronic GERD. Laparoscopic Nissen fundoplication lessens the severity of this symptom in most patients. In a small subgroup of patients, antireflux surgery may exacerbate the bloating, but this improves over time.

Deglutition Disorders↗
PubMed2000

Determinants of occurrence and volume of transpyloric flow during gastric emptying of liquids in dogs: importance of vagal input.

The precise factors and their relative contributions that lead to individual flow pulses across the pylorus during liquid gastric emptying remain unclear. Our objective was to determine the factors leading to individual flow pulses, their relative contributions and the role of the vagus nerve in their modulation. Proximal gastric tone had a strong positive correlation with the volume of the corresponding transpyloric flow pulse whereas pyloric tone had an inverse correlation. Antral contractions were associated with the presence but not the volume of the pulse. Acute vagal blockade retarded emptying via loss of proximal gastric tone and increased outflow resistance and loss of propagating antral pressure waves. In conclusion, the major determinants of the volume of pulsatile transpyloric flow are proximal gastric and pyloric tone. The vagus nerve plays a key role in regulating both proximal gastric and pyloric tone as well as moderating propagating antral contractions.

Animals↗
PubMed2000

Lipid-laden macrophages in induced sputum are a marker of oropharyngeal reflux and possible gastric aspiration.

The diagnostic properties of a "lipid index" of macrophages in induced sputum as a noninvasive marker of aspiration of acidic gastric contents were evaluated. In a cross-sectional study, 33 subjects (17 with symptoms suggestive of gastrooesophageal reflux) with normal chest radiographs and no symptoms of aspiration or sinus disease, underwent dual-channel 24-h ambulatory oesophageal pH recording and sputum induction. Oropharyngeal reflux, defined as at least one episode of a fall in pH to <4 at the upper oesophageal electrode, was considered indicative of aspiration of acidic gastric contents ("gold standard"). An index for the presence of intracellular lipid in sputum macrophages, detected by oil red O stain, was obtained. The sensitivity, specificity and predictive values of this "lipid index" were calculated. The "lipid index" could be calculated in 29 of 33 samples with high interobserver repeatability (intraclass correlation coefficient 0.96). Twenty subjects showed oropharyngeal reflux and nine did not. The median "lipid index" in subjects with oropharyngeal reflux (24.5) was significantly greater than that in those without reflux (1.0) (p<0.001). A "lipid index" of 7.0 had a sensitivity of 90%, a specificity of 89%, a positive predictive value of 95% and a negative predictive value of 80%. A "lipid index" of 7.0 in the macrophages of induced sputum is a good marker of oropharyngeal reflux.

Adult↗
PubMed2000

Nitrergic and cholinergic vagal pathways involved in the regulation of canine proximal gastric tone: an in vivo study.

To better understand the relationship between cholinergic and nitrergic (NO) innervation in the regulation of proximal gastric (fundic) tone in vivo, the effects of nitric oxide synthase blockade on fundic tone were studied in conscious dogs using vagal cooling and an electronic barostat. Vagal cooling, atropine (0.05 mg kg-1 i. v. bolus) and hexamethonium (1 mg kg-1 i.v. bolus) all markedly decreased fundic tone as reflected by increased intragastric volume, indicating a significant contribution of vagal and enteric cholinergic pathways to the maintenance of canine fundic tone. Administration of L-NNA (10 mg kg-1 i.v. bolus) increased fundic tone and the effects of L-NNA were completely prevented by prior vagal cooling or atropine administration, but not by pretreatment with hexamethonium. The relaxation effects of neurally derived NO appear primarily related to inhibition of ongoing vagal cholinergic activity. The data are consistent with the primary site of action of nitrergic mechanisms on gastric fundic tone in conscious dogs being at a presynaptic site on vagal cholinergic efferent nerves.

Animals↗
PubMed2000

Reproducibility, validity, and responsiveness of a disease-specific symptom questionnaire for gastroesophageal reflux disease.

The purpose of this study was to establish the reproducibility, validity, and responsiveness of a symptom questionnaire to assess patients with gastroesophageal reflux disease (GERD). A total of 300 patients with GERD completed questionnaires before and 6 months after laparoscopic Nissen fundoplication. Forty-six GERD patients who continued on omeprazole served as controls. Lower esophageal sphincter pressure, 24-h pH, and quality of life (SF36) were measured at baseline and follow-up. Reproducibility was calculated as an intraclass correlation coefficient (ICC) from a repeated-measures analysis of variance on symptom scores (SS) on two consecutive days. Validity was established by correlating SS with 24-h pH and SF36 scores. Responsiveness was calculated as the the ratio of the mean paired difference in score in the surgical group to the within-subject variability in control subjects. Reproducibility was very high, as revealed by an ICC of 0.92. Strong correlations between SS and SF36 scores at baseline and after surgery demonstrated high cross-sectional validity. Correlation between change in SS and change in pH, SF36 pain, general health, and physical health scores demonstrated longitudinal validity. The mean (95% confidence interval) paired differences in SS were 25.6 (23.7, 27.5) in the study and 2.0 (-3.2, 7.3) in the control groups, and the responsive index was 1.0. The estimated minimally important clinical difference was 7. We conclude that the symptom score is a reproducible, valid, and responsive instrument for assessing symptoms caused by GERD.

Anti-Ulcer Agents↗
PubMed1999

Laparoscopic vs. open abdominoperineal resection for cancer.

PURPOSE: The aim of this study was to compare the safety and efficacy of laparoscopic abdominoperineal resection and open abdominoperineal resection for cancer. METHODS: Records of 194 patients who underwent laparoscopic abdominoperineal resection (42 patients) or open abdominoperineal resection (152 patients) at three institutions between 1991 and 1997 were reviewed. Follow-up was through office charts, American College of Surgeons cancer registry, or telephone contact. Tumors included (laparoscopic abdominoperineal resection and open abdominoperineal resection, respectively) adenocarcinoma (86 and 92 percent), squamous (12 and 7 percent), and gastrointestinal stromal (2 and 1.4 percent) types; Stages I (17 and 26 percent), II (24 and 33 percent), III (43 and 32 percent), and IV (14 and 9 percent); and those with invasion of pelvic structures (14 and 16 percent). RESULTS: Laparoscopic abdominoperineal resection was converted to open abdominoperineal resection in 21 percent because of vessel injury (33 percent), poor exposure (22 percent), adhesions (22 percent), inguinal hernia (11 percent), or radiation fibrosis (11 percent). Perineal infections occurred more often in the laparoscopic abdominoperineal resection group (24 vs. 8 percent; P=0.02). Late stoma complications were similar. Mean hospital stay was shorter after laparoscopic abdominoperineal resection (7 vs. 12 days). Radial margins were positive in 12 percent of laparoscopic abdominoperineal resection and 12.5 percent of open abdominoperineal resection specimens. Tumor recurrence was similar for both local (19 and 14 percent) and distant (38 and 26 percent) recurrence. Survival rates were similar by Kaplan-Meier curves, with median follow-up of 19 and 24 months, respectively (P=0.22; log rank). CONCLUSION: Laparoscopic abdominoperineal resection can be performed safely and results in a shorter hospital stay. A randomized, prospective trial is needed to determine the long-term outcome of cancer treatment.

Adenocarcinoma↗
PubMed1999

Laparoscopic Heller's myotomy or botulinum toxin injection for management of esophageal achalasia. Patient choice and treatment outcomes.

BACKGROUND: Esophageal achalasia is a rare disease in which degenerating parasympathetic innervation of the lower esophageal sphincter (LES) leads to unopposed sympathetic tone and failure to relax on deglutition, resulting in a range of symptoms for the patient, most notably dysphagia, chest pain, regurgitation, and weight loss. Laparoscopic Heller's esophagomyotomy (Lap-HM) and botulinum toxin (BoTox) injection into the LES are two recently described methods for treating achalasia. No comparison of laparoscopic Heller's myotomy and botulinum toxin has yet been presented. METHODS: A total of 22 patients (15 men, 7 women; mean age, 57.9 years) diagnosed with idiopathic esophageal achalasia were given a choice of treatment modality: Lap-HM or BoTox. Patients were prospectively assessed before and after treatment with esophageal manometry, barium swallow roentgenography, and dysphagia score. Patients' preferences and treatment efficacy were evaluated. RESULTS: Of the 22 patients, 18 (81.8%) chose BoTox and 4 (18.2%) chose Lap-HM. Five patients in the BoTox group opted for Lap-HM a mean of 565 +/- 212 days after the first injection, having received a median of four (range, 3-5) injections. Both BoTox and Lap-HM were effective in improving dysphagia score: before BoTox (median, 7; range, 0-10) and 2 months afterward (median, 2; range, 0-6) (p < 0. 01); before Lap-HM (median, 9; range, 7-10) and 6 months afterward (median, 1.5; range, 0-4) (p < 0.05). Both methods also effectively reduced lower esophageal sphincter (LES) nadir pressure: before BoTox (mean mmHg, 22 +/- 9) and 2 months afterward (mean mmHg, 15 +/- 7) (p < 0.05); before Lap-HM (mean mmHg, 24 +/- 10) and 6 months afterward (mean mmHg, 3 +/- 4) (p < 0.05). However, only Lap-HM produced a significant reduction in LES basal pressure before (mean mmHg, 34 +/- 7) and afterward (mean mmHg, 3 +/- 3) (p < 0.01) and increased esophageal barium clearance (mean percentage of barium retained in esophagus at 5 min before (97% +/- 6%) and afterward (23% +/- 45%) (p < 0.05). CONCLUSIONS: BoTox injection and Lap-HM both significantly reduce achalasia symptoms, but only Lap-HM improves esophageal clearance of barium. BoTox injection is the most popular treatment method from a patient perspective, although symptom recurrence or failure rates are high. Lap-HM is favored by younger patients and is equally effective after BoTox therapy failure.

Adult↗
PubMed1999

Laparoscopic pancreatic surgery.

BACKGROUND: Potential applications for laparoscopic surgery in pancreatic disease include (1) staging of pancreatic malignancies; (2) palliation of pancreatic malignancies; (3) pancreatic resections for benign and malignant disease; and (4) pancreatic drainage procedures. METHODS: A review of the literature is presented. In addition, original data on a series of 5 laparoscopic pancreatic distal resections and 10 laparoscopic cystogastrostomies are presented. RESULTS AND CONCLUSIONS: Laparoscopy may have a role in the staging of patients with pancreatic malignancies; however, with high-quality preoperative imaging, the percentage of patients who will benefit from laparoscopy may be as low as 5%. For palliation, both cholecystoenterostomy and choledochoenterostomy can be performed laparoscopically. The former is technically straightforward but has a higher failure rate; the latter is technically difficult and currently not suitable for widespread adoption. Laparoscopic gastroenterostomy is a straightforward means of palliating gastrointestinal obstruction. Patients appear to benefit from laparoscopic distal pancreatic resection but not from laparoscopic pancreaticoduodenectomy. Patients appear to benefit from laparoscopic pseudocyst decompression.

Humans↗
PubMed1999

Role of laparoscopic antireflux surgery in the management of chronic GERD symptoms.

Since the application of minimally invasive techniques to antireflux surgery eight years ago, there has been a rapid increase in the use of laparoscopic antireflux surgery. It is increasingly used as an alternative to long term medical therapy with proton pump inhibitors. The factors responsible for the rapid popularity of this procedure are reviewed, and the choice of techniques, current indications and available literature on the outcomes of these procedures are discussed.

Chronic Disease↗
PubMed1999

Laparoscopic cholecystectomy for gallbladder dyskinesia: clinical outcome and patient satisfaction.

The clinical outcome of laparoscopic cholecystectomy in 63 patients with gallbladder dyskinesia (GD) and 60 patients with proven gallstone (GS) disease was compared. Patients were contacted to determine the extent of symptom relief and satisfaction after surgery. Patients with GD underwent significantly more diagnostic procedures than patients with GS and were found to have higher prevalence of other gastrointestinal motor disorders. Only 47% of patients with GD became completely asymptomatic after surgery, compared with 81% of patients with GS (p = 0.002). This was reflected in the satisfaction scores, which were 79% and 91%, respectively (p < 0.01). There was a significant difference in pathologic findings among the two groups; chronic cholecystitis was more frequently found in the GS group and the incidence of normal gallbladder was higher in the GD group. It is concluded that patients with GD have a good response to laparoscopic cholecystectomy, but they commonly experience continuing gastrointestinal symptoms related to other gastrointestinal motor disorders.

Adolescent↗
PubMed1998

Esophageal and lower esophageal sphincter pressure profiles 6 and 24 months after laparoscopic fundoplication and their association with postoperative dysphagia.

BACKGROUND: It has been suggested that antireflux surgery may cause an improvement in esophageal motor function (EMF) and lead to reduced postoperative dysphagia. METHODS: We evaluated the changes in dysphagia symptom scores and esophageal and lower esophageal sphincter (LES) pressures in patients before (n = 381), at 6 months (n = 260), and at 24 months (n = 97) after laparoscopic fundoplication. RESULTS: There was a significant increase in LES basal and nadir pressure following surgery in all patients and an improvement in EMF only in patients with poor preoperative esophageal motor function. A total of 76% of the patients reported no dysphagia or an improved dysphagia score 6 and 24 months after surgery. This improvement was more marked in patients with poor EMF. An improvement in EMF did not correlate with the improvement in dysphagia score reported by other patients. Patients with increased dysphagia scores 2 years after surgery had significantly higher LES basal and nadir pressures as compared to other patients. CONCLUSIONS: Laparoscopic Nissen fundoplication is associated with an overall reduction in dysphagia scores and leads to an improvement in esophageal motor function in patients with poor preoperative esophageal motility. Tightness and inadequate relaxation of the wrap during swallowing may be a determinant of long-term dysphagia.

Deglutition Disorders↗
PubMed1998

Effects of GLP-1 on gastric emptying, antropyloric motility, and transpyloric flow in response to a nonnutrient liquid.

Glucagon-like polypeptide 1 (GLP-1) may be a major enterogastrone, slowing gastric emptying when released by intestinal nutrients. In six conscious dogs, we studied the effects of GLP-1, on antropyloric motility, gastric emptying, and transpyloric flow after instillation of 500 ml of saline into the stomach. The meal was given and recordings were started 15 min after intravenous bolus and infusion of either saline or three different doses of GLP-1. Intravenous GLP-1 produced a dose-related retardation of gastric emptying associated with a decrease in the number and volume of flow pulses in comparison to saline. This change in transpyloric flow was associated with an inhibition of antropyloric pressure waves, a stimulation of isolated pyloric pressure waves, and an increase in basal pyloric tone induced by intravenous GLP-1 infusion. Our findings show that GLP-1 has a potent dose-dependent inhibitory effect on transpyloric flow and gastric emptying. This effect is temporally associated with inhibition of antral "pumping" and stimulation of pyloric "braking" mechanisms.

Animals↗
PubMed1998

Role of nitric oxide mechanisms in control of pyloric motility and transpyloric flow of liquids in conscious dogs.

The role of nitric oxide (NO) mechanisms in control of pyloric function and transpyloric flow were investigated in six conscious dogs. Antropyloroduodenal motility, transpyloric flow, and gastric emptying were measured 15 min after intravenous injection of 100 ml of either saline, L-arginine (50 mg/kg), L-NNA (5 mg/kg), or L-arginine (50 mg/kg) followed by L-NNA (5 mg/kg). Infusion of L-NNA was associated with retardation of gastric emptying (65 +/- 6%) in the first 30 min, in comparison to the saline (90 +/- 3%) or L-arginine (90 +/- 2%). This effect was prevented by infusion of L-arginine prior to L-NNA, after which 89 +/- 3% of the liquid emptied in 30 min. There was a significant reduction (P < 0.05) in the number and volume of flow pulses, and an increase in pyloric tone (P < 0.05) after L-NNA in comparison to the other three test conditions. There were no differences, however, in the number of antropyloric or isolated pyloric pressure waves under the four conditions. Our findings suggest that NO mechanisms influence gastric emptying and transpyloric flow of nonnutrient liquids by altering the pyloric tone, thus increasing resistance to flow.

Animals↗
PubMed1998

Laparoscopic Nissen fundoplication: two-year comprehensive follow-up of a technique of minimal paraesophageal dissection.

OBJECTIVE: To provide a comprehensive follow-up of 381 patients after laparoscopic Nissen fundoplication (LNF) using a technique of minimal paraesophageal dissection. METHODS: Patients underwent a 24-hour pH recording, esophageal manometry, and symptom score assessment for six symptoms of gastroesophageal reflux disease preoperatively. To date, 260 patients have undergone repeat studies at 6 months and 108 patients at 2 years. RESULTS: LNF was associated with a significant (p < 0.0001) increase in the lower esophageal sphincter (LES) pressure and a significant (p < 0.0001) drop in duration of acid reflux in 24 hours and symptom score 6 and 24 months after surgery when compared to preoperative values. Twelve patients (3%) have experienced recurrence of reflux symptoms, 8 presenting in the first 6 months and 4 by the second year after surgery, but only 1 has required repeat surgery. The incidence of clinical dysphagia was found to be 1.3% of the patient group. CONCLUSIONS: LNF remains an effective antireflux procedure at 2 years. Most recurrences occur early, and there is no significant deterioration in the high-pressure zone at the LES, the percentage reflux in 24 hours, or symptom control between 6 months and 2 years after surgery, suggesting that the long-term results should be satisfactory.

Dissection↗
PubMed1998

Gastro-oesophageal reflux related cough and its response to laparoscopic fundoplication.

BACKGROUND: This study was designed to determine prospectively the rate of cough before and after laparoscopic Nissen fundoplication performed for the control of gastro-oesophageal reflux disease. METHODS: One hundred and ninety five consecutive patients (76 men) of mean (SD) age 46.9 (14.1) years with proven gastro-oesophageal reflux disease, who were either on long term omeprazole (n = 187) or who had not responded to a trial of omeprazole (n = 8), took part in the study which was carried out in a university teaching hospital that included a regional respiratory referral centre. Patients underwent oesophageal manometry, 24 hour oesophageal pH testing, and symptom score evaluation by an independent observer before and six months after laparoscopic Nissen fundoplication. RESULTS: One hundred and thirty three patients presented with reflux symptoms and 62 with respiratory symptoms; 68% of patients complained of cough before surgery (86% with respiratory symptoms, 60% with gastrointestinal symptoms). The percentage reflux time in 24 hours fell significantly (p < 0.0001) from a mean (SD) of 9.38 (10.99)% to 1.22 (2.92)%, lower oesophageal sphincter tone rose significantly (p < 0.0001) from a mean (SD) of 7.71 (5.90) mm Hg to 21.74 (10.84) mm Hg, and the cough score fell from a median value of 8.0 (IQR 12.0) to 0 (IQR 3) following surgery. Of the patients with cough, 51% were cough free after surgery and 31% improved. The patients with respiratory symptoms had a higher cough score before (median 12.0 (IQR 5.5) versus 4.0 (IQR 8.75), p < 0.0001) and after surgery (median 1 (7.5) versus 0.0 (IQR 1.0), p = 0.0045) than those with gastrointestinal symptoms. CONCLUSIONS: Patients who present to gastroenterologists with severe reflux commonly complain of cough. Laparoscopic Nissen fundoplication is effective in the control of cough in patients with gastro-oesophageal reflux disease, with or without primary respiratory disease.

Adolescent↗
PubMed1998

Endoscopic transanal rectal stricturoplasty.

This is a report of the techniques used and the outcome in two patients who underwent endoscopic transanal rectal stricturoplasty. Both patients had rectal strictures at the site of previous colorectal stapled anastomosis, and had failed to respond to balloon dilatation. The stricturoplasties were carried out with the use of a laparoscopic linear cutter passed transanally. In one patient a colonoscope was used to visualize the stricture, whereas in the second patient a laparoscope (passed transanally) was used. The operating times were 65 and 59 min, respectively. There were no complications, and both patients were discharged the next day. Both patients are asymptomatic after 9 and 7 months of follow-up. A colonoscopy carried out at 6 months has shown patent anastomosis in both patients. Endoscopic transanal rectal stricturoplasty is a safe and effective technique in dealing with benign rectal strictures and can be performed in an outpatient basis.

Anal Canal↗