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Biomedical subjects

M Gagner

Publications and source records attributed to M Gagner.

At least 109 records · Page 6Linked to original sources
PubMed1994

Effects of posture on the coordination of respiration and swallowing.

1. Although a pause in respiration during swallowing is a feature common to all mammals, inhibition usually occurs during expiration in adult humans and during inspiration in most other species. We tested the hypothesis that this difference is due, at least in part, to the position of the body while feeding. 2. The coordination of respiration and swallowing was studied in adult human subjects in two body positions; upright, which is typically human, and on hands and knees, which is similar to the feeding posture of most other animal species. 3. Our major finding was that the respiratory phase in which swallowing occurred was significantly related to posture. Swallows tended to occur late in the expiratory phase while feeding upright, but during early expiration while on all fours. 4. We speculate that the phase of respiration in which swallowing occurs changes with posture to compensate for the alterations in the mechanical properties of the upper body.

Animals↗
PubMed1994

Diaphragmatic and abdominal muscle activity after endoscopic cholecystectomy.

We studied diaphragmatic and abdominal muscle activity immediately and 16 h after laparoscopic cholecystectomy (LAPC). Tidal volumes (VT), partitioning of VT between the rib cage and the abdomen, and esophageal, gastric, and transdiaphragmatic pressures were recorded for 5 min every 15 min up to 90 min after the end of anesthesia in 10 young patients submitted to an elective LAPC. All had chest radiographs in full inspiration and expiration as well as lung function tests (LFTs) before and 16 h after surgery. In 5 of the 10 patients, thoracoabdominal patterns of breathing were also measured before both LFTs. After LAPC, VT did not change. There was no significant shift from abdominal to thoracic respiration. No paradoxical respiration developed. Functional residual capacity (FRC) and residual volume (RV) remained normal. However, all measures of LFTs requiring maximum inspiratory effort decreased up to 20%. Tonic and phasic activity of the abdominal muscle appeared early in the recovery period and disappeared after 75 min. The diaphragm adjusted to this additional load so that VT remained constant. These results indicate that diaphragm function is intact during quiet breathing after LAPC, but slightly reduced when maximum effort is needed. However, this represents a net gain over the changes previously described after classic "open" cholecystectomy (OC).

Abdominal Muscles↗
PubMed1994

[Variations of body composition by bioelectric impedancemetry after major surgery].

Body water variations are traditionally measured postoperatively by fluid balance and body weight. Bioelectrical impedance assessment permits the evaluation of body composition, i.e., lean body mass, body fat and total body water. We compared the traditional method (body weight and fluid balance) with bioelectrical impedance assessment while estimating body water. Body weight, fluid balance, resistance, reactance, lean body mass, body fat, total body water, triceps skinfold and total protein blood level were measured prospectively (preop, and on days 1, 3 and 5 postop) in 30 patients admitted for major surgery (thoracic, abdominal or vascular). The results suggest that body composition changed significantly with time (p < .05); in all 3 surgical groups. There was a low correlation between total body water measured by bioelectrical Impedance and fluid balance. Bioelectrical impedance assessment is sensitive to body water changes but appears to overestimate these variations compared to the traditional method.

Blood Proteins↗
PubMed1993

Ultrasonic mucosectomy of the gallbladder. A histological analysis.

The Cavitron Ultrasonic Surgical Aspirator (CUSA) may be used to remove mucosa of organs of the gastro-intestinal tract. A histological analysis was performed on gallbladders treated with a CUSA-mucosectomy to assess the extent and degree of mucosectomy and to evaluate parietal damage. The histological studies performed on three specimens of chronic cholecystitis revealed a complete mucosectomy except in areas where Rokitansky-Aschof sinuses were present. There was no evidence of parietal damage. The CUSA may be used to remove the mucosa of gallbladders without injury to other layers, and may have a potential application in procedures such as mucosal cholecystectomy.

Cholecystitis↗
PubMed1993

Routine operative cholangiography during laparoscopic cholecystectomy: feasibility and value in 107 patients.

OBJECTIVE: Laparoscopic cholecystectomy is becoming a popular alternative to open cholecystectomy. However, the technical aspects of this new procedure increase the risk of injuring the bile ducts. The purpose of this study was to determine the feasibility and value of performing cholangiography during laparoscopic cholecystectomy. MATERIALS AND METHODS: We retrospectively reviewed the clinical and operative cholangiographic findings of the first 107 patients undergoing laparoscopic cholecystectomy at Hôtel-Dieu de Montréal between August 1990 and August 1991. RESULTS: Operative cholangiography was attempted in 98% of patients; the success rate was 71%. Eight anatomic anomalies of the biliary tract that were of surgical importance were found as well as 10 cases of stones in the common bile duct, eight of which were unsuspected. No biliary tract injuries occurred. With experience, surgical cannulation of the cystic duct for injection of contrast material can be done quickly without major difficulty, and cholangiograms of excellent diagnostic quality can be obtained. CONCLUSION: Our results show that operative cholangiography is feasible and useful in patients undergoing laparoscopic cholecystectomy.

Bile Ducts↗
PubMed1993

Early experience with laparoscopic approach for adrenalectomy.

BACKGROUND: Adrenalectomy performed by a posterior or transabdominal approach causes substantial postoperative pain. The purpose of this study was to evaluate laparoscopy as a potential approach for adrenalectomy. METHODS: We performed 25 consecutive laparoscopic adrenalectomies on 22 patients from April 1, 1992, to March 30, 1993. Laparoscopic surgery was performed by using a lateral decubitus flank approach with four 11 mm trocars. RESULTS: Twelve right and 13 left adrenal glands were removed in a mean time of 2.3 hours. Three patients underwent bilateral adrenalectomies in a mean time of 5.3 hours. The 15 women and 7 men range in age from 31 to 60 years (mean, 42 years). The adrenal gland diseases were nonfunctional adenoma (seven), pheochromocytoma (five), Cushing's disease (four), Cushing's adenoma (four), primary aldosteronism (two), dehydroepiandrostenedione sulfate hypersecretion (one), angiomyolipoma (one), and medullary cyst (one). Average tumor size was 4.1 cm (range, 1 to 15 cm). Laparoscopic adrenalectomy was successful in 96% of patients, with one patient requiring a laparotomy because of inadequate exposure. The median postoperative stay was 4 days (range, 2 to 19), with a mean of five narcotic injections. There were no deaths, and morbidity was minor. CONCLUSIONS: Laparoscopy can be used successfully for adrenalectomy. It produces less postoperative pain and rapid return to normal activity. It may be the preferred method for removing most adrenal gland lesions that require operation.

Adrenal Gland Diseases↗
PubMed1992

Intra-abdominal sepsis and adrenergic receptor response.

This study measured the adrenergic receptor response of 13 patients with severe intra-abdominal sepsis, who required laparotomy and an open abdominal closure with Marlex mesh. The source of the sepsis was gram-negative organisms of intestinal origin. There were seven survivors and six nonsurvivors. When the patients were stratified into survivors and nonsurvivors, the Septic Severity Score, the APACHE II score, the Acute Physiological Score, and the Glasgow Coma Scale score results were not significantly different between groups. The alpha-2 and beta-1 adrenergic receptor responses were measured in the adipose tissue of the abdominal wall and the small bowel mesentery on day 1 of admission to the intensive care unit. The results demonstrated that the alpha-2 and beta-1 receptors of the nonsurvivors had a significantly decreased receptor response with desensitization and down regulation. The alpha-2 and beta-1 receptors of the survivors had an increased response with hypersensitization and up regulation. This study indicates that the adrenergic receptor pattern is distinctly different between survivors and nonsurvivors with severe abdominal gram-negative sepsis. The pattern differences occurred early (within 24 hours) when the patients had similar physiologic profiles. It is concluded that adrenergic receptor response may be a biologic indicator of the magnitude of the septic injury and a predictor of outcome.

Adipose Tissue↗
PubMed1991

Pylorus-preserving pancreatoduodenectomy--technical aspects.

Pylorus-preserving pancreatododenectomy is the resection of choice for patients with carcinoma of the head of the pancreas and periampullary area and for certain patients with chronic pancreatitis. Preoperative preparation, operative technique, and results are discussed.

Duodenum↗
PubMed1991

Hepatobiliary anomalies associated with polysplenia syndrome.

The report of a 29-year-old woman with polysplenia syndrome, Crohn's disease, and bilateral cataracts is presented. The patient was noted to have a right-sided stomach and small bowel, Crohn's ileitis, and a left-sided colon. Results of roentgenography of the chest and echocardiography were consistent with a diagnosis of hypoplasia of the inferior vena cava with azygos continuation. The patient underwent laparotomy with cholecystectomy, exploration of the common bile duct, and choledochoscopy for cholelithiasis, choledocholithiasis, and chronic cholecystitis. Laparotomy revealed a liver that had two lobes, each with the morphologic appearance of the left lobe. The gallbladder was centrally located. T-tube cholangiography revealed a quadruplication of the intrahepatic biliary ducts. To our knowledge, this patient is the only known adult with this syndrome in whom cholangiography demonstrated isomerism of the biliary tree. A review of the literature on this subject is given with emphasis on biliary anomalies.

Abnormalities, Multiple↗
PubMed1991

Surgical management of nonparasitic cystic liver disease.

We report clinical features, surgical management, recurrences, and follow-up study of 12 patients with simple hepatic cyst, 11 patients with polycystic liver disease, and 19 patients with cystadenoma who were surgically treated over a 25-year period. The median age of patients was 48 years, and 37 women and 5 men were in the series. The most common presenting symptom and physical finding were chronic abdominal pain and tenderness in the right upper quadrant. The most commonly associated disease was polycystic kidney disease, which was an associated finding in 5 of the 11 patients with polycystic liver disease (45%). The most valuable diagnostic studies in all groups were computed tomography and ultrasonography. The location of the disease was bilobar in patients with polycystic liver disease, with a right lobe predominance in 18% of patients. The right lobe was also predominant in 83% of patients with simple hepatic cyst and 58% of patients with cystadenoma. Of all solitary cystic lesions in the left lobe, 75% of them were cystadenomas. Of the 66 surgical procedures performed, aspiration was associated with a failure rate of 100%; partial excision, a failure rate of 61%; and total excision and liver resection, a failure rate of 0%. Orthotopic liver transplantation was performed in three patients and was associated with two early deaths. Partial excision relieved symptoms in three patients (43%) with polycystic liver disease. Total excision, enucleation, or liver resection with cyst(s) is the treatment of choice for non-parasitic cystic lesions of the liver.

Adult↗
PubMed1991

Value of preoperative physiologic assessment in outcome of patients undergoing major surgical procedures.

The preoperative physiologic assessment of patients undergoing elective major upper-abdominal surgery defines the operative risk in an objective manner. This assessment helps to identify patients who are at higher risk during certain types of abdominal procedures. Elderly patients with a combination of chronic diseases and physiologic derangements are at higher risk for the development of postoperative complications and operative death. The APACHE II score is an easy and objective tool that can be used preoperatively. In our study, patients with a high score (greater than or equal to 8) had the highest rate of postoperative complications (46%) and operative death (13%).

Abdomen↗
PubMed1991

Analysis of morbidity and mortality rates in right hepatectomy with the preoperative APACHE II score.

Morbidity and mortality rates in 70 patients who underwent major liver resection for liver tumors (primary and metastatic) were determined and correlated with the preoperative APACHE II score. Patients were divided into three groups according to their preoperative APACHE II score: low (0 to 3), mid (4 to 7), and high (8 and above). A higher score was closely correlated with increased postoperative morbidity and operative mortality rates. The group with low scores had a postoperative morbidity rate of 34% and a mortality rate of 0%, the group with mid scores had a postoperative morbidity rate of 54% and a mortality rate of 3%, and the group with high scores had a postoperative morbidity rate of 80% and a mortality rate of 20%. Age did not correlate with morbidity. It was therefore postulated that morbidity and mortality rates were related to the combination of points for abnormal physiologic variables and points for chronic health, or APACHE II score minus points for age. As the combination of these points increases the postoperative morbidity and operative mortality rates increase significantly (from 24% in the 0-point group to 69% in the greater than or equal to 3-point group). Also the two deaths occurred in the group with 3 or more points. The preoperative APACHE II score may be used by clinicians to evaluate before surgery the risk of postoperative morbidity and death in elective major liver surgery.

Adult↗
PubMed1990

Resective operations for biliary carcinoma.

Records of 25 consecutive patients who underwent resection for proximal bile duct tumor (3 extended right hepatic lobectomies, 6 left hepatic lobectomies, 16 skeletonization resections) and records of 21 patients who underwent pancreatoduodenectomy for distal bile duct carcinoma were reviewed to assess the value of resective therapy. The operative mortality rate for patients with resected proximal bile duct tumor was 4 per cent (0 per cent for liver resection) and that of distal bile duct tumor, 4.6 per cent. The 3- and 5-year actuarial survival rates for patients with proximal bile duct tumor were 44 per cent and 35 per cent, respectively; all except one patient eventually died of disease. Survival was better for patients who had curative resection (margins microscopically free of tumor). The 5-year actuarial survival rate for patients with distal bile duct carcinoma was 58 +/- 12 (SE) per cent, with patients who had negative nodes surviving longer than patients with positive nodes. When major hepatic resection and pancreatoduodenectomy can be performed in selected patients with low operative mortality, patients with bile duct carcinoma should be assessed by an experienced hepatobiliary multidisciplinary group before a decision is made in favor of palliative, endoscopic, or percutaneous techniques because surgical resection appears to offer the best possible long-term survival and probably the best quality of palliation.

Actuarial Analysis↗
PubMed1990

Surgical aspects of sclerosing cholangitis. Results in 178 patients.

Of 178 patients with sclerosing cholangitis treated since 1950, 88 patients had associated inflammatory bowel disease, 72 had no such history, and 18 had iatrogenic injury or stone disease. A total of 233 biliary operations were performed, with a 75% rate of temporary improvement after initial operation. Subsequent operations resulted in a lower success rate and a higher mortality rate. Radiologic findings included predominant extrahepatic, intrahepatic, and diffuse disease in 29%, 28%, and 43% of patients, respectively; no survival differences were noted. Seventy-five of one hundred three deaths (73%) were related to liver failure, bleeding, or sepsis. Of 14 patients undergoing portosystemic shunt, 13 died of surgical complications or related disease. Orthotopic liver transplantation was performed in 16 patients and resulted in eight deaths, mainly in patients who had previously undergone extensive surgical treatment. No survival differences were seen between the patients with inflammatory bowel disease, those without the condition, or those who had colectomy. Surgical treatment in patients with sclerosing cholangitis should be minimized. Orthotopic liver transplantation should be offered as the treatment of choice for patients with portal hypertension, refractory cholangitis, advanced cirrhosis, or progressive liver failure.

Adolescent↗
PubMed1990

Failure of ascitic fluid replacement for prevention of coagulopathy post peritoneovenous shunt. Case report.

A case of successive coagulopathies post peritoneovenous shunt in the same patient is presented. These coagulopathies occurred after a LeVeen valve insertion with ascitic fluid evacuation, and after reopening the shunt with ascitic fluid evacuation, with the peritoneal cavity washed and replaced with normal saline solution. This case illustrates the fact that peritoneal lavage and the replacement of the ascites with normal saline decrease the severity of the coagulopathy but do not prevent it completely. Peritoneal lavage and ascitic fluid replacement when a LeVeen valve is inserted, should be performed in selected cases, especially those who had a recently treated bacterial peritonitis.

Ascitic Fluid↗
PubMed1990

Preoperative chest x-ray films in elective surgery: a valid screening tool.

The authors reviewed retrospectively 1000 patients who had a preoperative chest x-ray film made and who underwent elective surgery. Results showed that 5.8% of women and 10.5% of men (7.4% of all patients) had an abnormal preoperative chest x-ray film. These abnormalities were much more frequent (30%) in patients over 50 years of age than in younger patients (3%). Of the 74 patients whose films revealed abnormalities, 68 (92%) had a history or symptoms of cardiorespiratory disease. Of the six patients with x-ray film abnormalities but without symptoms or a pertinent history, none had a change in clinical outcome because of radiography. Guidelines are recommended for selectively ordering preoperative chest x-rays in surgical patients.

Adolescent↗