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Biomedical subjects

R J Rosenthal

Publications and source records attributed to R J Rosenthal.

At least 19 recordsLinked to original sources
PubMed2006

Direct visual insertion of primary trocar and avoidance of fascial closure with laparoscopic Roux-en-Y gastric bypass.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (RYGBP) has been used increasingly more often in the past 10 years. The authors summarize their experience and safety/complications data based on 849 laparoscopic RYGBP procedures. They also evaluate the use of the Endopath trocar in terms of trocar-site hernias, bowel obstruction, and elimination of time-consuming fascial closure. METHODS: From July 2000 to December 2003, 849 laparoscopic RYGBP procedures were performed using a bladeless, 12-mm, visual entry trocar. The patients' average body mass index (BMI) was 53.2 kg/m2. The trocar ports (n = 3,744) were not closed. Perioperative and postoperative assessments were performed. RESULTS: In this study, 74% of the patients were retained for follow-up evaluation (mean, 10 months). Among these patients, no intraoperative bowel or vascular injuries, no mortality, and two trocar-site hernias (0.2%) were found. At 1 year, the mean excess weight loss was 73.4%. CONCLUSIONS: The Endopath trocar system shows a trend toward reducing trocar-site hernias, decreasing bowel obstruction, and eliminating the need for time-consuming fascial closure, although further studies are needed to confirm these findings.

Adult↗
PubMed2002

Is gastroscopy still a valid diagnostic tool in detecting gastric MALT lymphomas? A dilemma beyond the eye. Mucosa-associated lymphoid tissue.

BACKGROUND: Primary gastric lymphomas are distinct entities with an indolent clinical course and biologic behavior. They account for 2-8% of all gastric malignancies. We conducted this study to evaluate the role of gastroscopy as the principal diagnostic method in detecting gastric MALT lymphomas. METHODS: Sixty-three consecutive patients with gastric MALT lymphomas, who were evaluated and treated at our institution between January 1978 and December 1997, are retrospectively reviewed. There were 36 males and 27 females, with a mean age of 53 years (range 20-80 years). All patients underwent the standard diagnostic evaluation, including gastroscopy and biopsy. Patients were staged according to revised Musshof modification of the Ann Arbor classification system, whereas histological evaluation was made according to the Isaacson classification system for gastric MALT lymphomas. RESULTS: According to endoscopic findings, the antrum harbored the neoplasm in 31 patients (49%), the body in 38% (24 patients), and the fundus in 4% (3 patients), whereas in 5 patients (8%) the neoplasm occupied the entire stomach. The macroscopic appearance was not in most cases pathognomonic of the disease. Three macroscopic patterns were recognized at endoscopy: (a) the ulcerative in 51% (32 patients), (b) the polypoid in 33% (21 patients) and (c) the diffuse infiltrative in 16% (10 patients). The neoplasm was characterized as a benign disease in 24 patients (38%), with malignancy being suspected in 62% (39 patients). Endoscopy displayed a sensitivity of 61% in detecting malignancy; however, the sensitivity dropped to 27% when endoscopic diagnosis of non-Hodgkin's lymphoma was hypothesized. CONCLUSIONS: Although the impact of gastroscopy as a diagnostic tool in the patients of our study was of limited value, due to the nonspecific gross pattern of gastric MALT lymphomas, it should be maintained in the diagnostic intervention of the upper GI tract pathologies.

Adult↗
PubMed2002

Laparoscopic resection of ectopic pancreas in the gastric antrum: case report and literature review.

We report a case of ectopic pancreas tissue in the gastric wall that was removed using a minimally invasive approach. The patient was a 46-year-old obese woman who presented with fatigue, weakness, abdominal discomfort, and guaiac-positive stools. Laboratory analysis showed iron deficiency anemia. Preoperative endoscopy revealed a submucosal lesion in the gastric antrum. Intraoperative upper endoscopy clearly located the lesion at the antrum. The lesion was marked with India ink, allowing it to be identified easily at laparoscopy. A laparoscopic wedge resection of the gastric antrum was performed. The patient had an uneventful recovery. We believe that this is a valid treatment option for this benign condition.

Choristoma↗
PubMed2001

Laparoscopic cholecystectomy performed under regional anesthesia in patients with chronic obstructive pulmonary disease.

BACKGROUND: Laparoscopic cholecystectomy has been successfully performed using epidural anesthesia. We evaluated our experience with this surgical approach in high-risk patients. METHODS: We present the results of 29 patients with gallstones who, between 1998 and 1999, underwent laparoscopic cholecystectomy with epidural anesthesia. All but 1 patient had chronic obstructive pulmonary disease. RESULTS: All 29 surgeries were successfully completed via laparoscopy and with the patients under epidural anesthesia. No patient required endotracheal intubation during surgery or pain medication afterward. Postoperatively, 1 patient developed a wound infection and 3 patients developed urinary retention. At last follow-up (12 months postop), all patients were in good health. CONCLUSION: In this series, laparoscopic cholecystectomy was feasible under epidural anesthesia and it eliminated the need for postoperative analgesia. We believe that this approach should be considered for patients who require biliary surgery but who are not good candidates for general anesthesia due to cardiorespiratory problems.

Adult↗
PubMed2001

Laparoscopic transabdominal suspension sutures.

A limited number of access ports used in laparoscopic surgery may impair the ability of the surgeon to achieve adequate retraction and exposure, or to stabilize "moving targets" while operating on nonfixed organs. Solutions such as adding more ports or using a hand-assisted technique have the disadvantages of being more invasive, possibly creating a cumbersome situation of multiple instruments in a limited working space. We describe a useful technique for retraction and stabilization with the use of temporary sutures that pass through the abdominal wall. Although not new, this technique is not widely known or used, and laparoscopic surgeons may find it useful for a variety of applications.

Abdominal Muscles↗
PubMed2001

[Laparoscopic surgical of the liver and bile ducts].

The liver, gallbladder, bile ducts, and spleen are the least mobile organs in the upper abdomen. Thus, the laparoscopic approach is commonly used to manage a variety of pathologies related to these organs [5, 10, 60, 78]. Compared with conventional "open" surgery, minimally invasive surgery reduces postoperative pain and discomfort, lowers morbidity rates, promotes early mobilization, decreases recovery time and length of stay, and improves cosmetic results. In addition, the surgical results of laparoscopic surgery are as good as or better than those of conventional surgery [5]. This paper reviews the advances in laparoscopic surgery, and describes current patient selection practices and laparoscopic surgical techniques for benign liver cysts and tumors and biliary tract diseases.

Bile Duct Diseases↗
PubMed2001

[Laparoscopic splenectomy: new techniques and indications].

Over the recent years laparoscopic splenectomy has become the preferred approach for the treatment of many conditions requiring splenic removal. At first limited to small spleens and to benign hematologic disorders, this procedure is now used for a variety of indications. Enlarged spleens are possible to be removed laparoscopically, although this is still a demanding procedure. Two factors facilitated the technique and contributed to its wide acceptance: 1) Change in the technique originally used, by positioning the patient in right lateral decubitus, and approaching the spleen from a postero-lateral direction. 2) The development of new technologies to dissect and divide tissues and vessels, including the ultrasonic shears and the laparoscopic linear stapler. In this article we review the current indications for laparoscopic splenectomy, as well as the techniques to accomplish this procedure.

Humans↗
PubMed2001

The additive effect of neurotransmitter genes in pathological gambling.

As access to gambling increases there is a corresponding increase in the frequency of addiction to gambling, known as pathological gambling. Studies have shown that a number of different neurotransmitters are affected in pathological gamblers and that genetic factors play a role. Polymorphisms at 31 different genes involved in dopamine, serotonin, norepinephrine, GABA and neurotransmitters were genotyped in 139 pathological gamblers and 139 age, race, and sex-matched controls. Multivariate regression analysis was used with the presence or absence of pathological gambling as the dependent variable, and the 31 coded genes as the independent variables. Fifteen genes were included in the regression equation. The most significant were the DRD2, DRD4, DAT1, TPH, ADRA2C, NMDA1, and PS1 genes. The r(2) or fraction of the variance was less than 0.02 for most genes. Dopamine, serotonin, and norepinephrine genes contributed approximately equally to the risk for pathological gambling. These results indicate that genes influencing a range of brain functions play an additive role as risk factors for pathological gambling. Multi-gene profiles in specific individuals may be of assistance in choosing the appropriate treatment.

Adult↗
PubMed2001

Bedside laparoscopy in the ICU: report of four cases.

BACKGROUND: Patients in the intensive care unit (ICU) may suffer from life-threatening abdominal pathologies, which may necessitate a surgical intervention. Diagnosis may be difficult, as deep sedation and analgesia often mask symptoms, and physical examination is unreliable. Imaging studies are not accurate enough, and exploratory laparotomy carries significant morbidity and mortality rates in this patient population. The unstable patient is difficult to mobilize to the imaging department or to the operating room. Bedside laparoscopy may overcome these difficulties. PATIENTS AND METHODS: We describe our initial experience with the use of bedside laparoscopy in critical patients with suspected abdominal pathology. The procedure was performed in four patients over a 4-month period and completed in all four. RESULTS: The findings were: turbid fluid consistent with viscus perforation in a patient with unexplained sepsis after cardiac surgery, sterile hemorrhagic fluid in a patient with malignancy and thrombotic thrombocytopenia purpura, a retroperitoneal mass from which biopsies were taken in a patient with sudden respiratory failure, and abdominal abscess in a patient after bowel resection for mesenteric embolism. None of these patients had a laparotomy after the laparoscopy. Patients 1 and 4 died a few hours after the procedure from sepsis, and patients 2 and 3 died several days later. CONCLUSION: Bedside laparoscopy in the ICU is feasible, informative, and accurate. It has a role in diagnosing abdominal pathologies and planning further treatment. It may avert a nontherapeutic laparotomy. Unfortunately, the prognosis in these patients is poor. Earlier use of this diagnostic modality may improve patient outcome.

Abdominal Abscess↗
PubMed2001

Closure of laparoscopic trocar site wounds with cyanoacrylate tissue glue: a simple technical solution.

Cyanoacrylate-based tissue glue has been widely used for many years around the world, and was recently approved for use in the United States, mainly for skin cuts and lacerations. Other applications were described, in different surgical situations. Although ideal for small, clean incisions, its use in laparoscopic surgery is currently limited. Over a year period, 100 patients with more 250 trocar site wounds had their wounds glued using histoacryl. Infection rate was extremely low (one case), and partial dehiscence of the wound happened in two patients, where wound edge approximation was not optimal. Cosmetic results were excellent and patient satisfaction was high, as no sutures had to be removed. Glue application is easy and quick, with no risk of needle sticks, and it is a viable option for laparoscopic wound closure.

Cyanoacrylates↗
PubMed2001

Laparoscopy for gastric tumors.

A decade after the introduction of therapeutic laparoscopy, the use of laparoscopic gastric surgery is becoming accepted. While still evolving, currently available techniques and equipment are already sufficient for performing most ablative and reconstructive procedures. Despite feasibility, problems such as procedural complexity, long operative time, and high cost may negate the advantages of earlier and easier recovery. At present, these procedures are limited to highly trained laparoscopic surgeons, but they may become more prevalent among the next generations of surgeons, due to constant changes in surgical training and education. The question of laparoscopic curative treatment of malignant gastric tumors has not been answered. Diagnostic laparoscopy for staging is effective and widely practiced, but gastric resections are mostly limited to benign lesions. Currently, early malignant lesions are laparoscopically treated mainly in Japan, whereas more advanced lesions are laparoscopically resected in only a few centers around the world. Full endorsement of these procedures, by randomized controlled trials, although desirable, is unlikely soon, due to the technical complexity and low prevalence of these pathologies in western countries.

Gastrectomy↗
PubMed2001

Adverse hemodynamic effects of intraabdominal pressure- is it all in the head?

BACKGROUND: Elevated intraabdominal pressure (IAP) is observed in various clinical situations, the most common of which are severe abdominal trauma and laparoscopic surgery. Extreme pressures may lead to Abdominal Compartment Syndrome (ACS), but even with lower pressures adverse effects are apparent. The cardiovascular system, the respiratory system, the kidneys and the visceral circulation are all affected, but the exact physiological mechanism is not well defined. AIMS: To discuss possible mechanisms which explain the observed hemodynamic effects of increased IAP. METHODS: Large animal model observations and review of current literature regarding the correlation between IAP and intracranial pressure (ICP). RESULTS: It was shown that the elevation of abdominal pressure leads to elevation of ICP. Transfer of pressure through the central venous system or by the cerebrospinal fluid (CSF) has been proposed as an explanation. In response to elevated ICP, various stress hormones are secreted by the central nervous system, including vasoconstricting agents such as vasopressin and catecholamines. It is hypothesized that the central nervous system is the link between the increased abdominal pressure and its adverse hemodynamic effects. This may be a protective mechanism of the brain, aimed to increase the mean arterial pressure when the ICP is elevated, in order to preserve the cerebral perfusion pressure. CONCLUSION: ICP is elevated in response to IAP elevation, and may be responsible for its adverse hemodynamic effects. Antagonists to vasopressin may have a role in the treatment of this condition.

Abdomen↗
PubMed2000

Mechanisms of systemic hypertension during acute elevation of intraabdominal pressure.

INTRODUCTION: In previous studies we described mechanisms by which acute elevation of the intraabdominal pressure (IAP) induces intracranial hypertension (ICHTN). Here we sought to define the role of ICHTN in mediating systemic hypertension (HTN) during CO(2) pneumoperitoneum (PNP). METHODS: Six large animals (swine) were hyperventilated to buffer hypercarbia. Intracranial pressure (ICP) was monitored with a Camino intraparenchymal ICP monitoring system. A Foley catheter was introduced intracranially via a separate burr hole. At phase 1, changes in ICP, central venous pressure (CVP), and mean arterial pressure (MAP) were recorded during periods of CO(2) PNP at IAP levels of 15, 20, 25, and 30 mm Hg. At phase 2, ICHTN was produced directly by inflating the intracranial balloon to the same ICP levels that had been measured in phase 1 for each degree of IAP. CVP and MAP were recorded. Repeated measures analysis of variance was applied. RESULTS: At phase 1, the mean DeltaCVP, DeltaICP, and DeltaMAP increased relative to the degree of IAP (P = 0.0001, 0.0004, and 0.024, respectively). At phase 2, the increments in DeltaMAP were significant (P = 0.024) and in the same direction and amplitude as at phase 1. CONCLUSIONS: In this study, increasing the IAP with CO(2) PNP with a consequent increase of ICP and direct manipulation of the ICP produced a comparable systemic HTN. We believe that this further supports our hypothesis: Elevated IAP produces an immediate increase in the CVP, which impairs venous drainage from the central nervous system (CNS), increases the ICP, and initiates a CNS-mediated response and systemic HTN.

Abdomen↗
PubMed2000

A review of technical and clinical aspects of biliary laser lithotripsy.

OBJECTIVE: This paper reviews the current use of laser techniques for the treatment of biliary stones. BACKGROUND DATA: Biliary stones may pose a special problem when access to them is limited, when previous attempts of removal have failed, or when a less invasive option than surgery is needed. The availability of various laser sources and the adaptation of the technology for safe use in the biliary system make the use of laser energy for stone fragmentation possible. METHODS: Current literature is reviewed concerning the use of laser for biliary lithotripsy, including experimental data and experience with human series. Technology, indications, alternatives, and cumulative world experience are discussed. CONCLUSIONS: Recent technical advances have made the use of laser energy for fragmentation of biliary calculi possible. It is a valid option for treatment of "difficult" stones, when other methods have failed or as a primary treatment in certain situations. The technical complexity and the high cost limit its use for specialized centers.

Cholelithiasis↗
PubMed1999

Studies of the 48 bp repeat polymorphism of the DRD4 gene in impulsive, compulsive, addictive behaviors: Tourette syndrome, ADHD, pathological gambling, and substance abuse.

Prior studies have reported an association between the presence of the 7 repeat allele of the 48 bp repeat polymorphism of the third cytoplasmic loop of the dopamine D4 receptor gene (DRD4) and novelty seeking behaviors, attention deficit hyperactivity disorder (ADHD), Tourette syndrome (TS), pathological gambling, and substance abuse. However, other studies have failed to replicate some of these observations. To determine whether we could replicate these associations we genotyped 737 individuals from four different groups of control subjects, and 707 index subjects from four different groups of impulsive, compulsive addictive behaviors including substance abuse, pathological gambling, TS, and ADHD. Chi-square analysis of those carrying the 7 allele versus non-7 allele carriers was not significant for any of the groups using a Bonferroni corrected alpha of.0125. However, chi-square analysis of those carrying any 5 to 8 allele versus noncarriers was significant for pathological gambling (p <.0001), ADHD (p </=.01) and the total index group (p </=.0004). When the comparison included all 7 alleles the results were significant for gamblers (p <.0001), TS (p </=.003), ADHD (p </=.003), and the total group (p </=.0002). There was a significant increase in the frequency of heterozygosity versus homozygosity for all alleles for pathological gamblers (p </=.0031) and the total index group (p </=.0015), suggesting that heterosis played a role. In the substance abuse subjects a quantitative summary variable for the severity of drug dependence, based on the Addiction Severity Index, showed that the scores varied by increasing severity across the following genotypes: 44 </= heterozygotes </= 77 </= 22. Studies of other quantitative traits indicated an important role for the 2 allele and the 22, 24, and 27 genotypes. All studies indicated that the role of the DRD4 gene in impulsive, compulsive, addictive behaviors is more complex than a sole focus on the 7 versus non-7 alleles.

Alleles↗
PubMed1999

Causes of arterial hypertension and splachnic ischemia during acute elevations in intra-abdominal pressure with CO2 pneumoperitoneum: a complex central nervous system mediated response.

The application of laparoscopic technique has gained popularity in the past decade. Numerous studies have qualified and quantified the systemic impact of acutely elevated intra-abdominal pressure during pneumoperitoneum at time of laparoscopy. The major hemodynamic effects are increased central venous pressure, increased systemic vascular resistance and systemic hypertension. Reductions in splanchnic and renal blood flow have also been documented, but the clinical significance of these observations is not clear and required further investigation. In our previous work we demonstrated intracranial hypertension secondary to acute elevation in intra-abdominal pressure and described the pathophysiology. Elevated intra-abdominal pressure during induced pneumoperitomeum can serve as a basic model for other disease processes which are characterized by acute or chronic abdominal hypertension. Here we review the current literature and describe our own experience to suggest a unifying model, with emphasis on the key role of the central nervous system in mediating the systemic response to increased intra-abdominal pressure.

Central Nervous System↗