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Biomedical subjects

P M Go

Publications and source records attributed to P M Go.

At least 55 records · Page 3Linked to original sources
PubMed1994

Surgical anatomy of the interior inguinal region. Consequences for laparoscopic hernia repair.

Exploration and placement of staplers in the internal inguinal region during laparoscopic hernia repair may sever blood vessels or nerves. Lesions of specific structures may be associated with such complications as hematomas and impaired sensibility in defined areas. Therefore, the course and topography of blood vessels and nerves in the preperitoneal tissue in this region were studied. Six human preserved male cadavers were dissected. Unsafe areas for stapling were described. An adjustment of the technique of laparoscopic hernia repair to circumvent these complications is proposed.

Cadaver↗
PubMed1994

Bile duct injury during laparoscopic and conventional cholecystectomy.

It has been suggested that the risk of injury to the bile duct is higher after laparoscopic cholecystectomy than after conventional cholecystectomy. The results of previous studies on laparoscopic cholecystectomy showed no difference but they were limited (positive) selections from highly specialized centers. Thus, a questionnaire was sent to all surgical departments in The Netherlands to analyze the number of repair procedures for bile duct injury, the techniques and complications of this treatment and the number of cholecystectomies performed during 1991 to determine the "actual" risk of bile duct injury. The response was 88.4 percent (122 of 138 centers). A total of 11,712 cholecystectomies were performed, of which 2,932 were laparoscopic and 8,780 were conventional. Thirty-two bile duct injuries resulted from laparoscopic cholecystectomy (1.09 percent) and 45 resulted from conventional cholecystectomy (0.51 percent) (p < 0.001). Thirty-six injuries (46.7 percent) were detected during the procedure or within 24 hours and 41 (53.2 percent) after a mean period of ten days. The bile duct lesion consisted of transection in 35 patients (45.5 percent), a stenosis or clips in 17 patients (22.1 percent) and a lesion with bile leakage in 25 patients (32.5 percent). The repair procedure included primary closure or end to end anastomosis in 33 patients (42.8 percent) and hepatojejunostomy in 31 patients (40.2 percent). Hepatojejunostomy was performed upon 17 percent of the injuries detected early and in 61 percent of the injuries detected after a delay. Complications were found in 31.1 percent and the mortality rate was 7.8 percent. In summary, the risk of bile duct injury after laparoscopic cholecystectomy was significantly (p < 0.001) higher than after conventional cholecystectomy, which was probably related to the relative inexperience (all units from one country). The risk of bile duct injury after conventional cholecystectomy was slightly higher than that found in literature, which probably reflects the fact that we studied the number of "repair procedures" instead of registration of complications (injury). Repair procedures for lesion detected after a delay are more complicated (hepatojejunostomy) than for the injury detected early.

Cholecystectomy↗
PubMed1993

Laparoscopic cholecystectomy in The Netherlands.

Laparoscopic cholecystectomy was introduced into the Netherlands in the Spring of 1990. The aim of this study was to evaluate the results of the procedure in Dutch hospitals over the first 2 years to obtain some insight into its safety and efficacy in general surgical practice. A written questionnaire was sent to all 138 Dutch surgical institutions enquiring about conversion rate, complications (with emphasis on mortality rate and common bile duct injuries), operating time and hospital stay. The surgeons' opinions were also sought on possible contraindications such as previous operation, bile duct stones and cholecystitis, as were their estimations of the percentage of patients in their practice eligible for laparoscopic cholecystectomy. Data were obtained for 6076 laparoscopic cholecystectomies; the response rate was 100 per cent. Conversion to open cholecystectomy was necessary in 413 patients (6.8 per cent), mostly because of adhesions, cholecystitis, haemorrhage and unclear anatomy. Postoperative complications were reported in 260 patients (4.3 per cent). There were seven deaths (0.12 per cent) and 52 (0.86 per cent) bile duct injuries, of which 20 were recognized during laparoscopy. The mean operating time for the ten most recent patients in each institute was 70 (range 30-180) min and the mean hospital stay 4.5 (range 2-8) days. Previous lower abdominal operations were not considered to be a contraindication by 96 per cent of surgeons, whereas previous upper abdominal procedures were regarded as a contraindication by 66 per cent. After successful clearance of the bile duct at endoscopic retrograde cholangiopancreatography, only 12 per cent would perform an open procedure. Moderate cholecystitis was not considered a contraindication to laparoscopic cholecystectomy by 71 per cent of surgeons, but severe cholecystitis was a reason for open cholecystectomy for 83 per cent. In most surgical practices 70-80 per cent of patients were considered to be eligible for the laparoscopic procedure. In conclusion, laparoscopic cholecystectomy has gained rapid acceptance in the Netherlands. Although the number of bile duct injuries is high, the findings of this general survey are similar to those from highly specialized centres and match the overall results of conventional cholecystectomy.

Bile Ducts↗
PubMed1992

[Laparoscopic cholecystectomy in The Netherlands: early national results].

The results of laparoscopic cholecystectomy in 58 of the 66 hospitals in which surgeons introduced this method after attending a practical course are evaluated. Data of 546 patients were collected. The indication for laparoscopic surgery was symptomatic gallstone disease without evidence of common bile duct stones, cholecystitis or previous upper abdominal surgery. In 70% of the 58 hospitals fewer than 10 laparoscopic cholecystectomies were performed nine months after the first practical course because of shortage of equipment. The mean age was 50 years (range 20-80) with a male:female ratio of 1:4. The average operation time was 95 minutes. In 8.2% of the patients the laparoscopic procedure was converted to laparotomy. Adhesions, cholecystitis or difficulty in recognition of the anatomy was responsible for the conversion in 31 of the 45 patients. In the remaining 14 patients bleeding or bile leakage during the procedure compelled the surgeon to perform a laparotomy. One patient died because of bleeding from the cystic artery. Eleven patients underwent laparotomy postoperatively because of bleeding (3), bile leakage (6) and lesion of the ductus choledochus (2). Minor complications occurred in 30 patients. Laparoscopic cholecystectomy is expanding rapidly in the Netherlands. The early results are encouraging, although the experience is limited. Further registration is necessary to be able to compare the results of laparoscopic cholecystectomy more critically with those of conventional cholecystectomy.

Adult↗
PubMed1992

Scintigraphic diagnosis of bile leakage after laparoscopic cholecystectomy. A prospective study.

To assess the role of Tc-99m IDA cholescintigraphy in diagnosing bile leakage and bile obstruction after laparoscopic cholecystectomy, 51 studies were performed in 51 patients on the first postoperative day. Two different radioactive bile acid analogs were used, Tc-99m HIDA and Tc-99m trimethylbromo IDA. Scintigraphic findings were correlated with the clinical conditions. Results of seven out of 51 cholescintigrams were abnormal, showing accumulations of activity in the right paracolic gutter. Of these seven patients, only three had clinical symptoms consisting of more than normal postoperative abdominal pain and peritoneal irritation. The other four patients had minimal abnormal accumulation in the right paracolic gutter and showed no clinical signs postoperatively. Complete common bile duct obstruction or other bile duct-related complications, except for bile leakage, were not observed. Cholescintigraphy is feasible for the early detection of bile leakage and bile flow obstruction after laparoscopic cholecystectomy in patients with increased postoperative abdominal discomfort.

Bile Duct Diseases↗
PubMed1991

The argon beam coagulator provides rapid hemostasis of experimental hepatic and splenic hemorrhage in anticoagulated dogs.

The argon beam coagulator (ABC) delivers radiofrequency electrical energy to tissue across a jet of argon gas, providing noncontact, monopolar, electrothermal hemostasis. This study compared the efficacy of the ABC with conventional techniques for control of traumatic hepatic and splenic hemorrhage. Standardized lacerations were made to the liver and spleen of 6 heparinized dogs. Control of bleeding was attempted with the ABC (150 W), the Nd:YAG laser (90 W, noncontact), horizontal mattress suture, microcrystalline collagen, and regenerated cellulose. If bleeding had not been controlled within 3 minutes, coagulation was attempted with the ABC in order to prevent exsanguination. Tissue from both the liver and spleen was assessed histologically for damage induced by the ABC. Delayed injury and early healing after ABC coagulation was studied in six additional dogs killed 1 and 3 weeks postoperatively. The ABC stopped bleeding from 25/25 hepatic lacerations in 48 +/- 8 seconds (mean +/- SEM) and from 18/18 splenic lacerations in 28 +/- 3 seconds. The Nd:YAG laser, mattress sutures, and topical hemostatic agents failed to control bleeding in 14 of 15 applications after 3 minutes. The ABC successfully salvaged all failures in less than 1 minute. The depth of splenic and hepatic thermal injury with the ABC ranged from 2 to 7 mm and was proportional to the duration of application. Postoperatively wound healing progressed normally without bleeding or infection at the coagulation site. The ABC appears to be a excellent instrument for achieving hemostasis in solid organ injury, and may be especially valuable in managing patients with coagulation deficits.

Animals↗
PubMed1991

Application of charge-coupled device technology for measurement of laser light and fluorescence distribution in tumors for photodynamic therapy.

Laser and fluorescence light distributions with applications for photodynamic therapy were measured in mouse tumors using a non-invasive electronic optical imaging system. The system consists of a liquid-nitrogen-cooled, charge-coupled-device (CCD) array camera under computer control with 576 x 384 detection elements having dimensions of 23 microns x 23 microns. The available dynamic range of the array is approx. 10(3), and the effective wavelength range is 400-1000 nm. An interstitially placed cylindrical diffusing optical fiber was used to provide tumor illumination. The light distribution pattern from the fiber was determined by immersing the cylindrical diffusing tip in a fluorescing solution and recording the emission image. Fluorescence imaging facilitates an accurate measurement of light intensity distribution while avoiding problems associated with the directional nature of other detection methods used with diffusing fibers. Radiation-induced fibrosarcoma tumors on C3H mice were grown to about 1 cm diameter for in vivo recording of light distribution from the tumor volume and for determination of effective light penetration distance at 18 wavelengths in the range 458-995 nm. Endogenous tumor fluorescence and Photofrin II fluorescence intensity were measured over the wavelength range 585-725 nm to investigate the possible application of CCD imaging technology for drug distribution measurements. Model experiments were begun to evaluate the relative importance of potential distortions of light distribution measurements using this approach.

Animals↗
PubMed1991

The value of laboratory tests in patients suspected of acute appendicitis.

The clinical usefulness of laboratory tests was examined in 258 patients admitted to the emergency room with the general practitioner's tentative diagnosis, acute appendicitis. Acute appendectomy was performed on 91 patients. Histological examination of the appendix confirmed the diagnosis in 69 cases (acute appendicitis 20, phlegmonous appendicitis 36, perforation 13). Seven patients with appendicular infiltrate were not subjected to operation but the diagnosis was clear from clinical examination. On close examination/operation by the surgical team, 96 admitted patients were excluded from the primary diagnosis, acute appendicitis, and served as a control group. Receiver Operation Characteristic curves (ROC-curves) showed that the sensitivity and specificity and hence diagnostic efficiency for total white blood cell count, number of segmented leukocytes and C-reactive protein concentration for the detection of acute appendicitis were higher than for erythrocyte sedimentation rate, alpha 1-antiproteinase concentration and body temperature. We observed that when all three parameters, C-reactive protein, white blood cell count and segmented leukocytes, are within the normal range the diagnosis, acute appendicitis is highly unlikely. The diagnostic value of the different laboratory parameters appears, moreover, to be highly dependent on the degree of inflammation/perforation and the development of appendicular infiltration. However, diagnostic efficiency can be improved, and unnecessary surgery prevented, by performance of an appropriately selected combination of laboratory tests combined with evaluation of clinical symptoms.

Acute Disease↗
PubMed1990

[Breast carcinoma in women younger than 30 years].

Breast cancer is rare in females younger than 30 years. In a retrospective study of 25 women the effects of the early age on diagnosis, treatment and prognosis were investigated. In 21 women there was a clinical or radiological suspicion of carcinoma. Nevertheless, a delay in diagnosis was found in 9 of the 21 patients. In 16 patients stage I tumour was found, in 7 stage II, in I stage III and in I stage IV. After an average follow-up period of 68 months, 20 patients had no tumour recurrence. Tumour stage, treatment and prognosis were comparable with the characteristics reported for other age groups.

Adult↗
PubMed1990

Laser photodynamic therapy for papilloma viral lesions.

Photodynamic therapy was tested for its therapeutic efficacy in eradicating rabbit papilloma warts. The wild-type viral warts suspension was used to induce treatable papilloma warts in the cutaneous tissue of Dutch Belted rabbits. The photosensitizing agents used intravenously were Photofrin II at 10 mg/kg of body weight and Chlorin e6 monoethylene diamine monohydrochloric acid (Chlorin e6 med HCl) at 1 mg/kg of body weight. The lasers used were an argon-dye laser at 628 and 655 nm and a gold vapor laser at 628 nm. The irradiances of 25 to 180 mW/cm2 were applied topically with an end-on lens optical fiber with total radiant doses of 7.5 to 54 J/cm2. Photofrin II and the argon-dye laser at the highest light dosage (54 J/cm2) and Chlorin e6 monoethylene diamine monohydrochloride administered 2 hours before argon-dye laser irradiation at 655 nm at the highest light dosage (54 J/cm2) produced wart regression. Total wart regression without recurrence was achieved with Photofrin II and the gold vapor laser at all light dosages. The difference observed between the argon-dye laser and the gold vapor laser might be explained by the pulsed nature of the gold vapor laser, with its high-peak powers, some 5000 x the average measured light dose. In this model, the smaller, less cornified lesions were more effectively treated with photodynamic therapy.

Animals↗
PubMed1988

Microbial flora and bile acid metabolism in patients with an ileal reservoir.

Bacterial flora of ileum effluent and bile acid metabolism were investigated in 11 patients 11-44 months after construction of a Kock's continent ileostomy. Bacteriologic investigation showed significantly more microorganisms per millilitre (p less than 0.01) and a more colon-like flora--that is, anaerobic microorganisms (p less than 0.001)--in ileum effluent of continent ileostomy patients than in ileum effluent of patients with a conventional ileostomy. The reabsorptive capacity of the reservoir mucosa was tested by direct introduction of a radioactively labelled conjugated bile acid, 23-75Se-25-homotaurocholic acid (SeHCAT), into the ileal pouch. After 4 h, 90% of the SeHCAT activity had been reabsorbed from the reservoir. Quantitative and differential analysis of bile acids in the ileum effluent showed unconjugated and predominantly primary (88%) bile acids, suggesting a minimal influence of bacterial flora on bile acid metabolism. Moreover, total bile acid loss appeared to be within normal limits.

Adult↗
PubMed1988

Anatomic and functional results of surgical repair after total perineal rupture at delivery.

Laceration of the perineum during delivery might sever the anal sphincter and result in discomfort, pain and even anal incontinence. We reviewed the degree of incontinence after repair of the anal sphincter in 20 female patients with complete third degree lacerations after delivery. In addition, anal manometry was performed upon seven patients. The resting and squeeze pressures were measured. At the same time, single needle electromyography of the external sphincter muscle was recorded. An uneventful recovery was found in all patients. This was confirmed by restoration of the anal pressures of voluntary and involuntary control within low to low normal limits indicating an almost complete anatomic recovery of the anal sphincter complex. Three patients had complaints of incontinence. These complaints were often neglected by both the obstetrician and patient. In these patients, anal manometric measurements together with single needle electromyography of the external anal sphincter muscle were not useful diagnostic methods for determining anal incontinence.

Adult↗