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Biomedical subjects

R G Moore

Publications and source records attributed to R G Moore.

At least 55 records · Page 3Linked to original sources
PubMed1997

Retroperitoneoscopic renal biopsy in extremely obese patients.

OBJECTIVES: Retroperitoneoscopic renal biopsy can be technically challenging in extremely obese patients because of loss of surgical landmarks and difficulty in identifying the kidney within retroperitoneal adipose tissue. We present our experience with retroperitoneoscopic renal biopsy in extremely obese patients and describe our surgical technique. METHODS: We performed retroperitoneoscopic renal biopsies on 8 extremely obese patients (body mass index greater than 40). Mean patient weight was 144.3 kg. Three patients presented with acute renal failure and 5 presented with nephrotic range proteinuria. Retroperitoneoscopic renal biopsy was indicated based on extreme obesity alone in 3 patients, 2 patients had failed previous attempts at percutaneous biopsy, 1 patient had a solitary kidney, 1 patient required chronic anticoagulation, and 1 patient was a Jehovah's Witness. Intraoperative ultrasonography and an anatomic approach facilitated the dissection and identification of the kidney. RESULTS: All eight retroperitoneoscopic renal biopsies were completed successfully without complication and all patients were discharged within 24 hours of the procedure. Sufficient tissue for pathologic diagnosis was obtained in all cases. Mean operating room time was 153 minutes and mean estimated blood loss was 71 mL. The patients returned to normal activity at a mean of 1.8 weeks. CONCLUSIONS: With the use of intraoperative ultrasonography and a systematic, anatomic approach, retroperitoneoscopic renal biopsy can be successfully completed in extremely obese patients. This procedure can be reliably performed on an outpatient basis with minimal morbidity and should be considered a viable alternative to open renal biopsy.

Adult↗
PubMed1997

Effect of laparoscopic pelvic lymph node dissection on the natural history of D1 (T1-3, N1-3, M0) prostate cancer.

OBJECTIVES: Reports of abdominal wall tumor implantation after laparoscopic procedures have raised questions regarding the safety of laparoscopic surgery when applied to patients with malignancies. Our objective was to determine if laparoscopic pelvic lymph node dissection (LPLND) had a negative effect on tumor behavior and clinical outcome in men with Stage T1-3, N1-3, M0 (D1) prostate cancer. METHODS: Fifty-two men were retrospectively identified at four institutions who had pelvic nodes positive for metastatic prostate adenocarcinoma at LPLND and at least 1 year of follow-up. Operative and clinical records were reviewed to determine morbidity, adjuvant treatment, onset of hormone-resistant disease, and survival. RESULTS: During a mean follow-up of 3.1 years, there were no cases of trocar site tumor implantation. There were four perioperative complications, including enterotomy, epigastric vessel injury, abscess, and symptomatic lymphocele formation. There were three deaths from prostate cancer (5.8%) occurring 3 to 4 years after LPLND. For the 45 men treated with early androgen ablation, the 5-year biochemical prostate-specific antigen and clinical progression free rates were 45% and 55%, respectively. CONCLUSIONS: Abdominal wall tumor implantation after LPLND for prostate cancer was not demonstrated, even in patients who developed hormone-resistant disease. LPLND in men with Stage D1 disease did not alter short-term disease progression. Longer follow-up in a larger cohort is necessary to determine if LPLND will have an impact on the 5 and 10-year disease progression and survival rates for patients with Stage D1 prostate cancer.

Disease Progression↗
PubMed1997

Digital radiographic imaging transfer: comparison with plain radiographs.

Advances in digital imaging and computer display technology have allowed development of clinical teleradiographic systems. There are limited data assessing the effectiveness of such systems when applied to urologic pathology. In an effort to appraise the effectiveness of teleradiology in identifying renal calculi, the accuracy of findings on transmitted radiographic images were compared with those made when viewing the actual plain film. Plain films (KUB) were obtained from 26 patients who presented to the radiology department to rule out urinary calculous disease. The films were digitalized by a radiograph scanner into ARCNEMA-2 file format, compressed by a NASA algorithm, and transferred via a 28.8-kbps modern over standard telephone lines to a remote section 25 miles away, where they were decompressed and viewed on a 1600 x 1200-pixel monitor. Two attending urologists and two endourologic fellows were randomized to read either the transmitted image or the original radiograph with minimal clinical history provided. Of the 26 plain radiographic films, 24 were correctly interpreted by the fellows and 25 by the attending physicians (92% and 96% accuracy, respectively) for a total accuracy of 94% with no statistical difference (p = 0.16). After compression, all but one of the digital images were transferred successfully. The attending physicians correctly interpreted 24 of the 25 digital images (96%), whereas the fellows were correct on 21 interpretations (84%), resulting in a total 90% accuracy with a significant difference between the groups (p < or = 0.04). Overall, no statistical difference between the interpretations of the plain film and the digital image was revealed (p = 0.21). Using available technology, KUB images can be transmitted to a remote site, and the location of a stone can be determined correctly. Higher accuracy is demonstrated by experienced surgeons.

Algorithms↗
PubMed1997

Controlled acute and follow-up trial of cognitive therapy and pharmacotherapy in out-patients with recurrent depression.

BACKGROUND: We report a randomised controlled trial, in both the acute and maintenance stage of treatment, in 75 out-patients with recurrent major depression. METHOD: Patients were allocated to three groups: 16 weeks of acute treatment and two years' maintenance treatment in the following way: antidepressants and maintenance antidepressants; cognitive therapy and maintenance cognitive therapy; antidepressants and maintenance cognitive therapy. Both completers' and end-point data were analysed. RESULTS: In the acute phase of treatment, all patients improved significantly and there was no significant difference among treatments, or in the pattern of improvement over time. In the maintenance stage of treatment, patients kept improving over time in all three groups and there was no significant difference among treatments. Cognitive therapy was consistently superior to medication. CONCLUSIONS: The results indicate that maintenance cognitive therapy has a similar prophylactic effect to maintenance medication and is a viable option for maintenance after acute treatment with medication in recurrent depression.

Adult↗
PubMed1997

The role of laparoscopy in the treatment of renal and ureteral calculi.

PURPOSE: We assessed the efficacy of laparoscopy in the treatment of renal and ureteral stones. MATERIALS AND METHODS: Laparoscopic stone extraction was attempted in 11 men and 6 women 22 to 75 years old, including 6 with ureteral and 11 with renal calculi. Of the renal stones 9 were associated with a concomitant pathological condition requiring surgery. Four patients had multiple stones (2 to 93) and stone size ranged from 2 to 60 mm. (mean 15.6). RESULTS: Stones from 15 of 17 patients were removed successfully via laparoscopic techniques. Operative time ranged from 2.33 to 6.35 hours (mean 4.9). Prolonged operating times were associated with ancillary or failed procedures. Blood loss ranged from 20 to 350 ml. (mean 132.9), narcotic requirement from 0 to 100 mg. morphine (mean 26) and hospital stay from 1 to 15 days (mean 4.5). The 3 postoperative complications included prolonged ileus (2) and a retroperitoneal urinoma requiring secondary drainage. CONCLUSIONS: Laparoscopic stone removal is safe and feasible. Indications for this approach include urinary stones associated with an anatomical abnormality requiring urinary tract reconstruction and calculi for which other minimally invasive therapies failed.

Adult↗
PubMed1997

The role of computerized tomography in the evaluation of complications after laparoscopic urological surgery.

PURPOSE: Radiographic evaluation may be necessary to assess the possible complications of laparoscopic procedures. We undertook a retrospective review to determine the indications for and findings of computerized tomography (CT) in symptomatic patients after urologic laparoscopic surgery. MATERIALS AND METHODS: Of 400 laparoscopic urological procedures performed between July 1993 and September 1996, 20 patients (5%) had postoperative symptomatology that could not be explained by physical exam or routine clinical studies. An abdominal CT scan was obtained (1 to 120 days after the procedure) to help determine a diagnosis. CT findings were correlated with the indication for the study and clinical followup. RESULTS: The indications for CT were unexplained pain, fever, leukocytosis or falling hematocrit. Thirteen patients had significant findings related to their surgery that were identified by CT. In 2 cases, we identified pathology unrelated to the surgery. Therefore, CT identified a symptom-related diagnosis in 75% of patients (15 of 20). Each scan for decreasing hematocrit demonstrated a hematoma. In all patients with unexplained fever or leukocytosis, CT revealed the cause. CT evaluation of atypical postoperative pain demonstrated a pathological cause in 58% (7 of 12). Percutaneous or laparoscopic surgical intervention was required in 4 of 20 patients. In 8 patients scanned by postoperative day 6, intraperitoneal or retroperitoneal gas was identified in 3 who had an abdominal incision made for intact specimen removal and in 1 with a perforated ulcer. CONCLUSIONS: CT after urologic laparoscopy is indicated in patients with significant clinical findings in whom routine examination and tests are not diagnostic. CT can reliably identify postoperative bleeding, urinary leak or obstruction and can also detect nonurinary pathology.

Adult↗
PubMed1997

Improving the treatment of depression in primary care: problems and prospects.

Previous work has succeeded in improving the recognition of depression by general practitioners. This is likely to be of most benefit when it results in effective treatment. Factors compromising the effectiveness of pharmacological treatments include non-compliance, non-response, and relapse of depression. Psychological therapies, such as cognitive therapy, are effective and may prevent relapse, but are not available to the majority of depressed patients seen in primary care. Existing evidence demonstrates that primary care staff can be trained in effective psychological interventions for depression, but interventions need to be developed which are sufficiently brief to be incorporated into routine treatment. Consistent provision of information about depression, coping strategies, and sources of support may improve compliance with treatment and subsequent outcome.

Antidepressive Agents↗
PubMed1996

Telementoring of laparoscopic procedures: initial clinical experience.

BACKGROUND: To assess the feasibility of telementoring, a clinical telepresence system was developed. METHODS: Telementoring was attempted in 14 advanced and 9 basic urologic laparoscopic procedures. The remote surgeon located in a control room (> 1,000 feet from operating room) supervised an inexperienced surgeon. Mentoring was accomplished with real-time video images, two-way audio communication, a robotic arm used to control the videoendoscope, and a telestrator. The patient outcome, complications, and operative time were assessed and compared to patients undergoing matched procedures in which the experienced surgeon was working side by side with the primary surgeon. RESULTS: The overall telementoring success rate was 95.6% (22/23 cases) with no increase in complications. Telementoring of a laparoscopic radical nephrectomy failed secondary to improper positioning of the robotic arm. Operative times compared between telementored and traditionally mentored procedures were not statistically different for basic procedures but were longer for advanced cases. CONCLUSIONS: Telementoring of laparoscopic procedures is safe and feasible. Further clinical studies are needed prior to implementing telementoring in surgical training.

Education, Medical↗
PubMed1996

Laparoscopic pyeloplasty.

Thirteen patients underwent laparoscopic dismembered pyeloplasty at our institution. The operative time ranged from 4 to 8 (mean 5.4) hours with minimal blood loss. Two patients developed transient edema necessitating temporary drainage. The mean requirement for morphine postoperatively was 32 mg. At a mean follow-up of 13 months, all patients demonstrated both symptomatic and radiographic relief of obstruction. Laparoscopic dismembered pyeloplasty appears to be an effective minimally invasive alternative to treat symptomatic ureteropelvic junction obstruction.

Female↗
PubMed1996

Laparoscopic repair of enterocele.

The repair of an enterocele has classically been via a transvaginal or open abdominal route. With the availability of minimally invasive procedures, we applied established laparoscopic techniques to enterocele repair. Three women with a history of hysterectomy had a symptomatic enterocele as well as a cystocele or rectocele. Each underwent a transperitoneal laparoscopic enterocele repair prior to a transvaginal rectocele or cystocele repair or laparoscopic colposuspension. Using three trocars and transvaginal digital manipulation, the enterocele was reduced and repaired utilizing a modified Moschocowitz technique. The cul-de-sac was obliterated by approximating the posterior vaginal fascia to the anterior wall of the rectum with a running suture. There was no operative morbidity. The average length of stay was 3.3 days. All patients were asymptomatic with no enterocele recurrence identified during a mean follow-up of 10.5 (range 7-15) months. Laparoscopic enterocele repair is a feasible surgical procedure with minimal morbidity. A larger series with longer follow-up is necessary before the efficacy and proper indications for this minimally invasive procedure are determined.

Aged↗
PubMed1996

Complications of extraperitoneal balloon dilation.

The success of balloon dissection techniques has given laparoscopic surgeons the option of a direct extraperitoneal approach to urologic disease. Unfortunately, these techniques are not without risks. We report on four cases of complications secondary to balloon dilation. In two instances, balloon misplacement caused dissection between muscle layers. This resulted in conversion to an open procedure in one instance and to a postoperative flank hernia in another. Balloon rupture with loose fragments occurred in two patients. In one of these cases, the peritoneum was lacerated, with balloon fragments displaced within the peritoneal cavity.

Adult↗
PubMed1996

High-intensity focused ultrasound ablation of rabbit kidney tumors.

High-intensity focused ultrasound (HIFU) is a noninvasive surgical technique in which ultrasound energy is delivered transcutaneously to a discrete area within the body. This energy can result in a well-defined zone of cellular death within the targeted tissue. We used HIFU in an effort to ablate rabbit VX-2 kidney tumors. A tumor cell suspension was injected into a renal segmental artery (Phase 1, nine rabbits) or directly into the lower pole parenchyma (Phase 2, nine rabbits). After a 2-week incubation period, open direct contact (Phase 1) or transcutaneous ablation (Phase 2) was performed. In Phase 1, after sonablation, there was pathologic evidence of tissue destruction in nine animals, and seven had both gross and histologic evidence of tumor ablation. There was sharp demarcation between viable and ablated tissue. In Phase 2, pathologic evidence of kidney ablation was seen in seven of nine animals. However, only two rabbits showed the well-demarcated effects of ablation in the tumor. High-intensity focused ultrasound can be effective at causing cell death in renal tumors and surrounding renal tissue. However, with the present ultrasound technology, imaging of renal lesions in the rabbit model is not adequate to consistently localize and completely ablate tumor.

Animals↗
PubMed1996

Laparoscopic live donor nephrectomy: the initial 3 cases.

PURPOSE: Successful laparoscopic live donor nephrectomy in 3 patients is described. MATERIALS AND METHODS: The procedures were performed completely laparoscopically and the kidneys were extracted via 8 cm. infraumbilical incisions. RESULTS: In all 3 cases warm ischemic time was less than 5 minutes, and the renal vessels and ureter of the harvested kidneys were of adequate length for routine transplantation. Donors required minimal postoperative parenteral analgesia and were discharged home 1 to 3 days after the procedure. All harvested kidneys were successfully transplanted, and functioned well initially and at hospital discharge. CONCLUSIONS: Laparoscopic live donor nephrectomy may be an alternative surgical modality to conventional open nephrectomy. Advantages include less postoperative pain, shorter hospital stay and convalescence, and a more desirable cosmetic result. Additionally, these advantages may encourage more individuals to consider live donation, resulting in an increase in organ supply.

Adult↗
PubMed1996

Venous dissection injuries during laparoscopic urological surgery.

PURPOSE: The incidence of major venous dissection injuries during laparoscopic procedures is assessed and recommendations are made for management. MATERIALS AND METHODS: We evaluated our experience with all major intra-abdominal injuries occurring during 274 consecutive laparoscopic procedures performed within a 4-year period. Five patients (1.7%) had a total of 6 major vascular injuries, including gonadal vein avulsion in 1 case, lumbar vein avulsion in 1 and a tear in the inferior vena cava in 4. Two patients sustained inferior vena caval injuries during nephrectomy because of adhesions from previous surgery and 1 of them had 2 venacavotomies. RESULTS: All vascular injuries were venous and 5 of the 6 major vessel injuries were treated successfully endoscopically via intracorporeal suturing techniques. The injury requiring open repair was a gonadal vessel avulsion that occurred during retroperitoneal lymph node dissection early in our laparoscopic experience. Major vessel injuries were more likely to occur during complex laparoscopic procedures in patients who had undergone previous ipsilateral retroperitoneal surgery. CONCLUSIONS: In select situations new techniques can allow for safe endoscopic control and repair of venous injuries during laparoscopic surgery.

Adult↗
PubMed1996

Telesurgical consultation.

PURPOSE: We evaluated the feasibility of "telesurgical" consultation during laparoscopic surgery. Telesurgical consultation is a distinct application of telemedicine in which a surgeon at a primary operating site can consult another experienced surgeon or colleague for complex and/or unexpected problems encountered during surgery. MATERIALS AND METHODS: Telesurgical consultation was used in 6 complex laparoscopic cases, including upper pole nephrectomy, diagnostic laparoscopy with inguinal hernia repair, orchiectomy, gastric augmentation with bladder suspension, bladder reconstruction and ureteral lithotomy. RESULTS: In each case an experienced laparoscopic surgeon at the primary operative site consulted a surgical specialist at the remote site who had expertise in the particular procedure being performed. All procedures were accomplished successfully without intraoperative or post-operative complications. CONCLUSIONS: Complex laparoscopic procedures that normally require a surgical specialist can be performed successfully by an experienced laparoscopic surgeon consulting a remote specialist via the tele-operative system.

Adolescent↗