Endoscopic sphincterotomy and cholecystectomy.
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Cholecystectomy↗
Biomedical subjects
R E Leach
Publications and source records attributed to R E Leach.
Selective embryo reduction of an interstitial heterotopic gestation.
A case of combined interstitial and intrauterine pregnancy is described. The sonographic finding of a thick myometrial bridge separating a twin pregnancy may be unique to heterotopic cornual pregnancies and is illustrated. The method of selective embryo reduction with potassium chloride to terminate the interstitial pregnancy without damage to the intrauterine pregnancy is also described. The intrauterine pregnancy continued successfully to term.
Adult↗
Long-term results of surgical management of Achilles tendinitis in runners.
Achilles tendinitis is a common occurrence in long-distance runners. Although most respond well to conservative therapy, there are some who require operative intervention. The short-term results of surgical treatment are good, with a success rate more than 85%. The authors present nine successful long-term results in runners. However, in two of the runners who continued to compete and train at long distances, symptoms recurred. Reoperations were performed to permit successful running careers for five and nine years. Runners resumed their careers after the second operation by supervised training and long-distance, competitive activities.
Achilles Tendon↗
The senior tennis player.
Mature athletes playing tennis can sustain both acute and chronic injuries. A number of the injuries are related to a gradual loss of flexibility and strength. Much of this is reversible with properly directed conditioning and rehabilitative programs.
Aged↗
Plantar fasciitis. Etiology, treatment, surgical results, and review of the literature.
Plantar fasciitis is a common orthopedic syndrome among athletes and nonathletes. The etiology of the pain is multifactorial but usually involves inflammation and degeneration of the plantar fascia origin. The majority of patients will respond to conservative measures. Surgical treatment is reserved for those patients who do not respond. A complete plantar fascia release is performed through a medial longitudinal incision. Prominent heel spurs and degenerated areas in the plantar fascia are resected. Of 27 surgically treated cases followed from one to three years, satisfactory results were obtained in 24 cases. Histologically, localized fibrosis or granulomatous changes or both were noted in several cases.
Adolescent↗
Reduction of postoperative adhesions in the rat uterine horn model with poloxamer 407.
Adjuvants shown to have significant adhesion prevention capabilities have been based on barrier separation of deperitonealized surfaces. We investigated the adhesion prevention properties of poloxamer 407. This polyol, in the proper concentration, is fluid at room temperature and becomes a firm gel at body temperature. The prevention of postoperative adhesions was evaluated in the rat uterine horn model. Twenty-two rats underwent bilateral surgical injury to the uterine horn and the parietal peritoneum. A random side was treated with a 30% solution of poloxamer 407. Twenty-one days later the animals were sacrificed and evaluated for the presence of adhesions. A highly significant reduction in adhesion formation was documented on the treated side.
Animals↗
Absence of antisperm antibodies and factors influencing sperm motility in the cul-de-sac fluid of women with endometriosis.
No detrimental effect on sperm motility characteristics by PF from women with low-stage endometriosis was documented when incubated for 3 to 6 hours. Although 1 of 31 women with endometriosis possessed IgA and IgG to sperm in her PF, its significance remains undetermined.
Antibodies↗
Management of ectopic pregnancy.
Risk factors for ectopic pregnancy include previous ectopic pregnancy, current intrauterine device use, prior fallopian tube surgery, previous pelvic inflammatory disease and a prior history of infertility. Abdominal pain is the most common symptom, followed by amenorrhea or vaginal bleeding, nausea, vomiting, syncope and dizziness. Referred shoulder pain following the onset of abdominal pain is characteristic of intraperitoneal bleeding and, in the appropriate clinical setting, strongly suggests a ruptured ectopic pregnancy. A coordinated evaluation includes measurement of serum human chorionic gonadotropin concentration and transabdominal or, preferably, transvaginal ultrasonography. Treatment is primarily by one of a variety of surgical techniques. Medical therapy with methotrexate or other drugs is currently under investigation.
Chorionic Gonadotropin↗
The role of closed reduction in tibial shaft fractures.
Although several methods of treating difficult tibial shaft fractures have been introduced in the past few decades, closed reduction remains the cornerstone of treatment. The physician must be able to recognize those tibial fractures suitable for treatment by this method, as opposed to fractures that have the potential to cause problems and would be better handled initially by other means. Properly performed, closed reduction in conjunction with early weight bearing accomplishes the goals of solid bony union, normal function, and a cosmetically acceptable appearance. This nonoperative approach avoids the potential morbidity associated with surgery and has been shown to give excellent results in the hands of a number of different physicians.
Casts, Surgical↗
Modern management of ectopic pregnancy.
The modern management of ectopic pregnancy has been influenced greatly by recent advances in human chorionic gonadotropin determination and ultrasound. Serum progesterone determination holds promise as a means of identifying abnormal gestations. Early diagnosis of tubal pregnancies has prompted conservative surgical treatment and the use of medical therapy in selected cases. Because of the improvement in diagnostic aids and conservative treatment, we are documenting a change in epidemiologic profiles. The incidence of ectopic pregnancy has increased, with a concomitant decrease in mortality. Fertility after conservative surgical procedures appears improved over that with radical treatment. However, women with ectopic pregnancies continue to have reduced fertility potential.
Chorionic Gonadotropin↗
Reconstruction of malunited fractures of the lateral malleolus.
The cases of twenty-six patients who had a reconstructive surgical procedure for treatment of a malunion of a displaced fracture of the fibula were evaluated. In these patients, who had pain, swelling of the ankle, and stiffness at an average of six years after the injury, the malunions were classified radiographically as either occult (eighteen patients) or overt (eight patients). An occult malunion was one in which the talus remained in its normal position, but the lateral malleolus showed residual displacement, characterized by external rotation and shortening. In an overt malunion, there were similar changes in the lateral malleolus, but the talus was displaced. All of the patients were treated by osteotomy of the lateral malleolus to correct the external rotation and shortening, to reduce the lateral subluxation of the anterior aspect of the tibiofibular joint, and to restore the stability of the talus. At an average follow-up of seven years (range, six months to eleven years), twenty of the twenty-six patients were able to resume the preinjury level of activity; three had improvement in the ability to walk and in the level of functional activity, although they still had intermittent pain; and three had not benefited from the procedure.
Adolescent↗
Leg and foot injuries in racquet sports.
Injuries to the lower extremity are common in racquet sports. The acute injuries usually respond well to treatment. Chronic injuries may require more patience and sometimes a change of playing habits on the part of the player. Some chronic injuries will respond well to operative intervention but most will do well with conservative care.
Achilles Tendon↗
Immunological characterization and quantitation of bovine vitamin K-dependent proteins.
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Animals↗
Cholestasis: current concepts and techniques.
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Bile Acids and Salts↗
Endoscopic retrograde choledochopancreatography.
Endoscopic retrograde choledochopancreatography (ERCP) was attempted in 77 patients. Of 33 patients suspected of having bilitary tract disease, ductograms were obtained in 21. Of 56 patients suspected of having pancreatic disease, ductograms were obtained in 35. Since 12 patients were thought to have disease of both ductal systems, the total number of suspected ducts exceeds the number of patients. It is concluded that ERCP is a valuable diagnostic tool in the evaluation of pancreatic or biliary tract disease. Additional data from a prospective study are necessary to determine its clinical relevance.
Amylases↗
Pitfalls of proximal tibial osteotomy.
Proximal tibial osteotomy for degenerative genu varus and valgus has an excellent success rate with proper patient selection and technical proficiency. The following are some infrequently recognized pitfalls. Excessive bone loss prevents two plateau weight-bearing after osteotomy, introduces a "teeter effect," and is therefore a contraindication. Patellofemoral arthritis may produce symptoms, particularly on stair climbing and necessitate secondary surgery. Varus and planning indicates postoperative articular surface obliquity in excess of 10 to 15 degrees another type of reconstruction is indicated. Secure fixation, closing wedge osteotomy, and non-displacement of the d-stal fragment prevent loss of correction. Peroneal nerve palsy may be avoided by careful surgical technique and postoperative dressings. Cracking the apical cortex and visualization of the plateau fragment will usually prevent fracture.
Arthritis↗