Modified V-Y advancement technique for mastectomy closure.
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Female↗
Biomedical subjects
R B Kent
Publications and source records attributed to R B Kent.
Enterovaginal fistula as a complication of intraoperative small bowel endoscopy.
Intraoperative endoscopy has been accepted as a method of small bowel evaluation for occult gastrointestinal bleeding. Although methodology of the procedure has been evolving, reported complications have been few, consisting of prolonged ileus, adhesions, submucosal hemorrhage, and serosal injuries. This case report describes an enterovaginal fistula as a complication of intraoperative small bowel endoscopy performed during a total colectomy procedure in a patient with chronic gastrointestinal bleeding, possibly caused by ischemia resulting from pleating of small bowel over the endoscope. This complication may be prevented by use of longer commercially available enteroscopes or by use of an enterotomy to insert the endoscope.
Colonoscopy↗
Villous tumors of the ampulla Vater.
Patients with villous tumors of the ampulla Vater usually present with jaundice, intermittent or constant, but may seek care for abdominal pain, intestinal hemorrhage, or pancreatitis. Because villous tumors may harbor carcinoma in 30 to 50 per cent of cases, appropriate management may require radical resection. We have managed four patients with villous lesions of the ampulla Vater occurring in 1981, 1992, 1993, and 1995. Three were villous (two with malignant change) and one was a villoglandular adenoma. Treatment consisted of local excision with reimplantation of the ducts in one patient, Whipple resection in two patients, and biliopancreatic bypass in one who had distant nodal metastases not resectable for cure. This patient died 18 months after operation of an unrelated disease, but the others were well at last follow-up. The presentation as well as the diagnostic and therapeutic considerations in the management of villous tumors of the ampulla Vater are discussed.
Adenoma, Villous↗
Clostridium perfringens sepsis with intravascular hemolysis following laparoscopic cholecystectomy: a newly reported complication.
Clostridium perfringens sepsis with hemolysis following cholecystectomy is a rare complication that has a very high mortality. The best chance for survival is ensured by early diagnosis, prompt initiation of antibiotics, and hyperbaric oxygen therapy if readily available. To our knowledge, this is the first reported case following laparoscopic cholecystectomy.
Anemia, Hemolytic↗
Preoperative needle-localized parathyroidectomy for persistent secondary hyperparathyroidism.
Several preoperative localization techniques have been developed to assist the surgeon, with varying degrees of accuracy, in identifying the offending gland during reoperative parathyroid surgery. This is a case report of persistent secondary hyperparathyroidism that was treated with preoperative, computed tomography-guided needle localization followed by surgery. The patient underwent successful resection of a hyperplastic fifth parathyroid gland, and her calcium level decreased appropriately postoperatively. This case demonstrates a perioperative localization scheme that reduces operative time, reduces the risk of injury to surrounding structures, and helps to assure cure.
Aged↗
Spilled gallstones--complications of abdominal-wall abscesses. Case report and review of the literature.
Laparoscopic cholecystectomy has become the preferred method for removal of the diseased gallbladder. While its morbidity and mortality rates are lower than those of the open technique, it does have associated complications which may cause significant morbidity. The morbidity associated with spilled gallstones is not well studied and little can be found in the literature on this subject. We encountered a patient who developed abscesses within the abdominal wall following laparoscopic cholecystectomy. We recommend that spilled gallstones be removed when possible and that surgeons be aware of this possible complication.
Abdominal Abscess↗
Systemic calciphylaxis.
Systemic calciphylaxis is a rare, poorly understood syndrome of progressive ischemic necrosis, usually associated with hyperparathyroidism. The combination of hyperparathyroidism, usually secondary or tertiary, and chronic renal failure seems to produce a particular biochemical environment conducive to the development of an unusual progressive form of ischemia. Early recognition and diagnosis, appropriate therapy including wound care, and expeditious parathyroidectomy often will halt the progression of the disease, minimize limb loss, and prevent subsequent sepsis and death.
Calciphylaxis↗
M13 bacteriophage displaying disulfide-constrained microproteins.
A display-phage library (TN2), displaying an 18-residue peptide fused to coat protein III, represents a collection of up to 8.55 x 10(6) peptides encoded by only 1.68 x 10(7) DNA sequences. Each displayed peptide has two fixed cysteine residues (allowing disulfide formation) and six variegated residues, four between the cysteines and one either side of the cysteines. Screening this library against streptavidin (Sv) and the anti-beta-endorphin monoclonal antibody, 3-E7, yielded phage displaying disulfide-constrained microproteins with sequences similar to those published for the linear-peptide display phage. Analysis of selected clones indicated that a disulfide bond is required for high-affinity binding to each of the target proteins. The microproteins selected for binding to Sv and 3-E7 show more stringent sequence specificity than do linear peptides selected for binding to the same targets.
Amino Acid Sequence↗
Control of hemorrhage from a trocar site.
Bleeding from a trocar site may occur while performing laparoscopic procedures. A technique of controlling hemorrhage from a trocar site is described.
Catheterization↗
Jesse B. Leslie 1891-1993.
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History, 20th Century↗
Directed evolution of a protein: selection of potent neutrophil elastase inhibitors displayed on M13 fusion phage.
Inhibitors of human neutrophil elastase were engineered by designing and producing a library of phage-displayed protease inhibitory domains derived from wild-type bovine pancreatic trypsin inhibitor and fractionating the library for binding to the target protease. The affinity of one of the engineered variants for human neutrophil elastase (Kd = 1.0 pM) is 3.6 x 10(6)-fold higher than that of the parental protein and exceeds the highest affinity reported for any reversible human neutrophil elastase inhibitor by 50-fold. Thus the display phage method has allowed us to obtain protein derivatives that exhibit greatly increased affinity for a predetermined target. The technology can be applied to design high-affinity proteins for a wide variety of target molecules.
Amino Acid Sequence↗
Laparoscopic cholecystectomy technique for removal of the gallbladder from the peritoneal cavity.
A new laparoscopic cholecystectomy technique for removing the gallbladder from the peritoneal cavity through the umbilical incision is presented. This method is faster than the traditional technique and eliminates the necessity of transferring the camera from the umbilical port to a second port.
Cholecystectomy, Laparoscopic↗
Laparoscopic retrieval of spilled stones.
Spillage of gallstones during laparoscopic cholecystectomy is occasionally a problem. The use of a finger cut off of a size 9 sterile glove as an intraperitoneal sack facilitates the removal of these stones.
Cholelithiasis↗
One-day hospitalization following modified radical mastectomy.
Postoperative management of patients following modified radical mastectomy has changed dramatically in recent years. Historically, patients usually remained in the hospital with closed suction drainage until the amount of drainage had decreased sufficiently for them to be removed. The feasibility of early discharge on the day following surgery was studied in a prospective manner in 29 consecutive breast cancer patients; 27 underwent unilateral modified radical mastectomy and 2 bilateral mastectomies by a single surgeon. All patients were instructed before surgery about planned early discharge and drain care. Twenty-seven of 29 patients (93.3%) were discharged the day following surgery. However, 2 patients refused discharge and were discharged on postoperative Day Two, and one patient was readmitted for confusion. Drains were removed in the office an average of 5.07 days after surgery. Forty-five per cent of patients developed a seroma that required aspiration at least once. No significant long-term sequela were experienced as a result of early discharge. The average hospital cost was reduced by $2,474.00 or 36 per cent (P less than 0.001) as compared to other surgeons in the same medical center who held to traditional postoperative care. The authors conclude that discharge on the day following surgery for patients undergoing a modified radical mastectomy is safe and cost effective.
Adult↗
Subcutaneous emphysema and hypercarbia following laparoscopic cholecystectomy.
The recent development of laparoscopic cholecystectomy has introduced the technique of laparoscopy to the general surgical community. As increasing numbers of laparoscopic cholecystectomies are performed, increasing numbers of complications directly related to laparoscopy will result. A case of subcutaneous emphysema and hypercarbia without pneumothorax is reported in a patient undergoing laparoscopic cholecystectomy. Etiology, evaluation, and therapy for subcutaneous emphysema associated with laparoscopy are reviewed.
Carbon Dioxide↗
Hemostasis of the gallbladder fossa during laparoscopic cholecystectomy.
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Cellulose, Oxidized↗
Towards less painful local anesthesia.
Local anesthesia, used for numerous procedures in all fields of medicine, has the drawback of providing significant pain upon injection. Twenty-eight volunteers were asked to compare a subcutaneous injection of plain lidocaine with an injection of lidocaine plus bicarbonate. Twenty-four of the twenty-eight volunteers reported less pain with the buffered lidocaine. The dilution of 1 part bicarbonate to 10 parts plain lidocaine produced a solution that was less painful and better tolerated. The local anesthetic lidocaine is used prior to many minor and major surgical procedures. Although it induces adequate anesthesia, the pain of injection is nearly always of considerable discomfort to the patient. There are numerous factors that have been shown to influence the pain of injection. These include speed of injection, size of needle used, area of the body injected, and simply individual patient characteristics. Since lidocaine comes as an acid solution, local tissue irritation is likely the primary source of pain.
Adult↗
Temporal artery biopsy.
Though surgeons have little input in the selection of patients for temporal-artery biopsy, a knowledge of temporal-artery anatomy and the pathophysiology of temporal arteritis is important. All temporal-artery biopsies done at Carraway Methodist Medical Center between January 1980 and January 1985 were reviewed. Seventy-three biopsies were performed on 70 patients and eight (11.4%) were found to have temporal arteritis histologically. One patient was judged to have temporal arteritis clinically, despite a negative biopsy of short length. Six of eight patients with positive biopsies were female, with an average age of 71.7 years. The most common signs and symptoms of those patients with positive biopsies were temporal headache (8/8), elevated erythrocyte sedimentation rate (7/8), temporal tenderness (5/8), jaw claudication (3/8), and visual changes (3/8). All biopsies were done under local anesthesia and there were no complications. With increasing awareness of the segmental nature of the disease, the length of biopsy specimens (formalin treated) increased from an average of 0.4 cm in 1980 to 2.4 cm in 1984. During this time, the positive rate increased from 0 per cent (0/9) to 17 per cent (4/24). A generous biopsy of approximately 5 cm in length of fresh vessel is recommended to confirm the suspected diagnosis of temporal arteritis.
Aged↗