Search PubMed⌕ Search

Biomedical subjects

S J Shapiro

Publications and source records attributed to S J Shapiro.

At least 19 recordsLinked to original sources
PubMed1996

The use of a modular skills center for the maintenance of laparoscopic skills.

BACKGROUND: A reliable method supplying graduated experience and practice is needed to develop and refine laparoscopic skills. The laparoscopic surgeon, like the microvascular surgeon, must have ongoing training to refine and maintain his or her skills. METHODS: The authors describe a new modular training unit. The unit consists of a box with a built-in television camera, a light source, and a rotating platform. A videotape recorder with a timing device documents the actual "operating time" required for the various exercises. The first phase of training consists of a basic skills board. This initial phase enhances the use of dominant and nondominant hand motor activity. RESULTS: The surgeon then progresses to lifelike models (biliary, suturing, hernia, gynecologic) to simulate the human operative setting. Ten surgeons spent 5 h each working with the module. The specific exercises were recorded and timed. Their progress is described. CONCLUSIONS: The modular laparoscopic skills center is an integral part of any laparoscopic educational program. It facilitates the acquisition and maintenance of laparoscopic skills.

Adult↗
PubMed1995

Carcinoma of the anal canal.

From 1975 to 1990 65 patients with carcinoma of the anal canal received radiation therapy alone or in conjunction with other modalities. Follow-up ranged from 12 to 171 months (mean: 59 months; median: 44 months). Actuarial disease-free survival (including salvage surgery) for T1-3 N0 lesions was 88% +/- 7% at 10 years. This was independent of T stage (91% for T1, 88% for T2, and 100% for T3). Disease-free survival was significantly worse for T1-3 N+ lesions (52% +/- 23% disease-free at 10 years, P = .025) and T4 lesions (0/8 disease free by 21 months, P < .001). Of the 57 patients with T1-3 lesions, 46 received low to moderate doses of radiation (< or = 5,000 cGy) in conjunction with infusional 5FU based chemotherapy. These were reviewed for treatment related factors. Among patients treated with low to moderate dose chemoradiotherapy the local control (including salvage surgery) was excellent: 100% for T1 lesions and 88% +/- 6% for T2, 3 lesions. There was a suggestion that increasing the dose of radiation to the tumor may reduce the need for surgery for T2, 3 lesions. For T2, 3 lesions the local control excluding surgery was 63% +/- 12% with 3,000 cGy plus chemotherapy, as opposed to 77% +/- 11% with 4,000-5,000 Gy (mean 4,600 cGy) plus chemotherapy. The most important factor for posttreatment toxicity was the addition of pelvic surgery to chemotherapy and radiotherapy. Eighteen patients who received chemoradiotherapy either had a history of prior pelvic surgery (five cases) or underwent APR following chemotherapy (13 cases). There were a total of nine grade 3 or 4 complications (including all five cases of small bowel obstruction) in this group. There was a significantly lower (P = .04) incidence of complications in the remaining patients: 2/47 (4%). It should be noted that no patient required a colostomy for management of treatment sequelae, the interventions taken were all successful in managing complications, and no complication was fatal. Nonetheless these results suggest that, for some T3 and T2 lesions, measures which reduce the need for salvage surgery might improve overall quality of life by reducing complications, although it may prove difficult to demonstrate an improvement in the excellent disease-free survival. In addition, measures should be taken to reduce the volume of irradiated bowel if a patient has a history of prior pelvic surgery.

Adult↗
PubMed1995

The laparoscopic learning curve.

To characterize the learning curve for laparoscopic cholecystectomy, we compared the first 47 cases (group A), which were performed by two senior attending surgeons who assisted each other when the procedure was introduced into clinical practice (1990-1991), with the first 46 cases (group R) performed by two surgical chief residents who were assisted by members of the teaching faculty in 1992-1993. The patient groups were comparable in terms of age, sex, and anesthetic class, but pathologically proven acute cholecystitis was more common in group R (33% vs. 9%; p < 0.005). To analyze operative procedures and outcomes, we compared operative time, frequency of successful operative cholangiography (attempted in all cases), frequency of conversion to open cholecystectomy, major complication rate, and days of postoperative stay for all patients and for those without complications. Of these parameters, only operative time for nonacute cases differed significantly between the groups (144 min for group A vs. 114 min for group R; p < 0.05). Complications in group A included one ductal injury and one case of postoperative pancreatitis; group R had one ductal injury and two cases of postoperative bleeding. We conclude that (a) the learning curve has similar structure for senior surgeons and resident trainees; and (b) the resident learning curve is not hazardous when teaching assistants are trained in the procedure, which has implications for safe instruction and proctoring of residents and staff.

Acute Disease↗
PubMed1994

The laparoscopic hernia trainer. The role of a life-like trainer in laparoendoscopic education.

The safe and effective performance of laparoscopic inguinal hernia repair requires a working knowledge of pre-peritoneal anatomy. Most surgeons are unfamiliar with the retro-peritoneal view of the groin. A model has been developed which allows surgeons to learn pre-peritoneal anatomy, to practice laparoscopic inguinal herniorrhaphy and to assess their repairs. This model is a valuable laparoendoscopic educational tool.

General Surgery↗
PubMed1994

Laparoscopic cholecystectomy in the first trimester of pregnancy.

Symptomatic biliary tract disease in the pregnant patient has always been problematical. The advent and widespread application of laparoscopic cholecystectomy has led to a re-evaluation of the role of surgery in this clinical situation. We report on the use of laparoscopic cholecystectomy on a patient in the first trimester of pregnancy.

Acute Disease↗
PubMed1993

Laparoscopic excision of a mesenteric cyst.

Benign abdominal cystic tumors are rare. They include retroperitoneal, mesenteric, and omental cysts. Most of these lesions present with vague abdominal pain and nausea. Less commonly they will present with bowel obstruction due to external compression. The diagnosis of these tumors is by abdominal ultrasound or computed tomography. Surgical enucleation is the treatment of choice. Laparoscopic surgical techniques are replacing or complimenting open abdominal surgical procedures. As the indications for these techniques increase, newer applications will arise. Presented here is a case of laparoscopic excision of a mesenteric cyst.

Adult↗
PubMed1991

Squamous cell carcinoma of the anal canal.

Between 1979 and 1988, 33 patients with squamous cell carcinoma of the anal canal were treated with chemoradiation. There were 24 women and 9 men, from 37 to 90 years of age (median: 63 years). Complete tumor regression occurred in 29 of the 33 patients (88%), only one of whom later developed recurrence. In the other four patients, there was persistent tumor after 3 months; three of these patients died within 2 years; and one is alive with distant metastases 2 years later. During the first 5 years of the study, seven patients with complete tumor regression underwent planned abdominoperineal resection following chemoradiation. Four of the abdominoperineal resection specimens were free of tumor, but three were not. These three patients, who had abdominoperineal resection within 3 months of chemoradiation, are disease-free. Ten of the 29 patients who had complete tumor regression had biopsies of the primary site 3 months after treatment. All biopsies were negative for residual carcinoma. At present, 26 patients (79%) are alive and disease-free from 2 to 10 years post-treatment (median: 4 years). Two patients died of unrelated causes, four of cancer, and one is alive with cancer. Complications of the chemoradiation required surgical intervention in two patients, and two others developed severe hematologic toxicity, for a complication rate of 12% (4 of 33 patients). There was no treatment-related mortality. These results support the efficacy of chemoradiation treatment for carcinoma of the anal canal. They suggest that abdominoperineal resection no longer need be part of the planned initial management, and that posttreatment biopsy of the primary site is unnecessary, unless palpable or visible abnormalities are present 3 months after treatment.

Adult↗
PubMed1991

Laparoscopic exploration of the common bile duct: experience in 16 selected patients.

The authors' initial experience with transcystic duct and direct laparoscopic approaches to the exploration of the common bile duct is reported. The technique requires standard laparoscopic equipment, specialized endoscopes, and instruments developed for urologic stone manipulations. After cholangiography confirmed the presence of common bile duct stones, common duct stone extraction was performed in 16 selected patients age 20-88 years. Stones ranged in size from 1 mm to 30 mm and they were unsuspected in 60% of the patients. Five patients had normal liver function tests and only 3 had clinical evidence of jaundice. Ductal exploration and stone extraction was successful in all 16 patients. One patient required a direct laparoscopic ductal exploration due to the presence of a common hepatic duct stone and the anatomy of the cystic duct. No major complications or deaths were observed in this series. Appropriately trained surgeons can safely and effectively perform laparoscopic common bile duct exploration and stone extraction in selected patients.

Adult↗
PubMed1990

Carcinoma of the prostate stage B and C: lack of influence of duration of radiotherapy on tumor control and treatment morbidity.

Between 1966 and 1985, 542 of 585 patients with histologically confirmed carcinoma of the prostate, Stages B and C, were treated with definitive radiation therapy to a minimum of 6300 cGy. There were 191 Stage B patients and 351 Stage C patients. The median tumor dose for Stage B patients was 6957 cGy and for Stage C patients 7020 cGy. Daily fractions of 180 to 200 cGy were given 4 or 5 times per week with occasional rest periods of several days, usually because of side effects of radiation therapy. The minimum follow-up time was 3 years; maximum follow-up was 16.0 years, and the median was 4.8 years. In this analysis, within each stage, patients were divided into four groups based on the number of treatment days: less than or equal to 56 days (8 weeks), 57 to 63 days (9 weeks), 64 to 70 days (10 weeks), and greater than 70 days. The distribution of Stage B and Stage C patients by histologic grade and duration of therapy is fairly even within each group. The influence of duration of radiotherapy on actuarial survival, progression-free survival, pelvic control, and incidence of complications was analyzed, and no statistical difference among the four groups of patients was found. The scatterplots of pelvic failure by radiation dose and duration of radiotherapy for both Stage B and C prostate carcinoma patients did not show a correlation between failure rate and duration of radiotherapy. Tumor histologic grade did not influence the incidence of pelvic failure. In summary, within the dose range used in this analysis the overall length of radiation treatment time did not seem to affect the clinical outcome of patients with Stage B and C prostate carcinoma.

Adenocarcinoma↗
PubMed1990

Prospective study of long-term pulmonary manifestations of mantle irradiation.

Given the high cure rate of patients with Hodgkin's disease, the complications related to therapy take on great significance. Mantle irradiation to the thorax is used in virtually all patients with early stage Hodgkin's disease. Prior studies of patients receiving mantle irradiation demonstrated short-term (up to 24 months) abnormalities of pulmonary function. In the present study, we prospectively studied 13 patients for up to 60 months after irradiation only with serial pulmonary function tests, arterial blood gas tests, diffusing capacity of carbon monoxide, chest radiographs, and ventilation-perfusion scans. No respiratory symptoms attributable to therapy were noted. Frequent radiographic changes (62%) were found consisting of apical fibrosis, paramediastinal fibrosis, or pleural thickening. Two patients developed an asymptomatic spontaneous pneumothorax that resolved with conservative management. Ventilation-perfusion scans often (73%) revealed decreased perfusion to the lung apices with associated ventilatory deficits in one-half of these patients. Patients with intrathoracic disease had decreased lung volumes prior to therapy, and lung volumes did not change following irradiation. Lung mechanics were normal throughout the study. Gas exchange at rest was normal in patients with extrathoracic disease. Patients with intrathoracic disease often presented with an abnormal arterial PO2 and widened alveolar-arterial partial pressure gradient for oxygen. However, these parameters normalized by 9 months after therapy. Despite the frequent development of radiographic and V/Q scan abnormalities in the lung apices, patients tolerated mantle radiotherapy remarkably well. In fact, patients with intrathoracic disease demonstrated improved gas exchange at rest following therapy.

Adolescent↗
PubMed1990

External irradiation of epithelial skin cancer.

A total of 339 consecutively treated, biopsy proven squamous and basal cell carcinomas of the skin treated from January 1966 to December 1986 were retrospectively analyzed to determine the patterns of local recurrence. There were 242 basal cell carcinomas, 92 squamous cell carcinomas, and 5 variants of squamous cell carcinoma in various locations. Radiotherapy was the initial treatment modality in 212 patients and 127 were treated after failing initial surgical excision. Lymph nodes were involved in 1/242 patients (.4%) with basal cell carcinoma, 14/92 patients (15%) with initially treated squamous cell carcinoma, and 20/51 (39%) with recurrent squamous cell lesions. Distant metastasis was found in one patient. Superficial X rays were given to 187 patients, electrons to 57 patients, megavoltage photons to 15, and a combination of modalities to the remainder. Overall local tumor control was achieved in 292 of 339 patients (86%), 220 of 242 (91%) with basal cell and 73 of 97 (75%) with squamous cell carcinoma. Tumor control was closely related to the size of the primary lesion. For lesions less than 1 cm tumor control was 97% (86/89) for basal cell and 91% (21/23) for squamous cell carcinoma. For 1 to 5 cm, tumor control was 87% (116/133) for basal cell and 76% (39/51) for squamous cell carcinoma and for lesions greater than 5 cm, the tumor control was 87% (13 of 15) and 56% (9/16), respectively. Tumor control was related to the modality used to treat the patient in spite of stratification of primary lesion size. For superficial X rays, tumor control was 98% (81/83) for lesions less than 1 cm, 93% (94/101) for lesions 1-5 cm and 100% (5/5) for lesions greater than 5 cm. For electrons tumor control was 88% (14/16), 72% (23/32), and 78% (7/9), respectively. For mixed beams tumor control was 90% (9/10), 76% (32/42), and 64% (9/14), respectively, and for 60Co-4 MV X rays, tumor control was 100% (3/3), 67% (6/9), and 33% (1/3), respectively. Cosmesis and complications were analyzed in 261 patients. An excellent or good cosmetic result was found in 92% (239/261) of the patients. There were 8 of 261 patients (3.1%) with fair and 19 of 261 (7.3%) with poor cosmesis. Cosmesis had an inverse relation to the primary lesion size with 97 of 99 patients (98%) with tumors 1 cm or less, 123 of 140 patients (88%) with lesions 1 to 5 cm and 13 of 16 patients (82%) with larger tumors having excellent or good cosmetic results. Cosmesis is also related to treatment modality.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1990

Evaluation of serologic and cellular immune responses of cattle to a nonlipopolysaccharide antigen from Brucella abortus.

Cows naturally infected with Brucella abortus developed antibody (Ab) responses to a nonlipopolysaccharide antigen (NLA) purified from B abortus strain 1119-3. Sera from strain 19-vaccinated cows did not have detectable amounts of Ab. Weak lymphoproliferative responses to NLA were observed in blood mononuclear cell suspensions obtained from infected cows. There was no evidence of NLA-specific lymphoproliferation in cell suspensions from healthy cows. Nonlipopolysaccharide antigen binding to bovine blood mononuclear cells was observed by antigen-consumption assays and direct binding of radiolabeled antigen. Cells from infected cows bound less NLA than did cells from healthy cows when assays were conducted with intact blood mononuclear cell preparations (monocytes plus lymphocytes). Monocytes obtained from any group did not bind NLA. Purified B lymphocytes from infected and healthy vaccinated cows bound about 3 times more NLA than did T lymphocytes, but there were no apparent differences between the 2 groups in extent of binding. Results of the study indicate that bovine lymphocytes have binding sites for a NLA purified from B abortus strain 1119-3.

Animals↗
PubMed1989

Management of sequelae of chest irradiation.

High-dosage irradiation is an important component in the treatment of patients with lung cancer. While most patients tolerate therapy well, certain changes can be expected in their bodies. The authors review these effects and offer suggestions for their management.

Humans↗
PubMed1982

Changes in susceptibility to cytotoxic antibody among tumor cells surviving exposure to chemotherapeutic agents.

We determined that myeloma cells which survived drug treatment had an altered sensitivity to cytotoxic antibody. The effects of several chemotherapeutic agents differing in drug action were compared. The antiserum was directed against viral determinants on the surface of S107 myeloma cells. This antiserum was then used to inhibit the colony formation of drug-treated myeloma cells. Tumor cells were treated with melphalan (200 ng/ml), methotrexate (40 ng/ml), actinomycin D (5 ng/ml), or 0.5 mM thymidine for 24 hr and then washed and resuspended in fresh medium. On various days after drug treatment, aliquots of these cells were exposed to complement and dilutions of antiserum and then cloned in soft agar in order to quantify the degree of antibody-mediated inhibition. Melphalan, methotrexate, and thymidine caused a severalfold increased resistance of the tumor cells to the antiserum during the first 1 or 2 days after drug treatment. During the following days, however, myeloma cells showed markedly increased susceptibility to the antiserum. The biphasic effect of methotrexate or thymidine treatment was similar to that previously observed after melphalan treatment and differed from the effect of actinomycin D. Actinomycin D caused only an increased susceptibility of the tumor cells to the antibody for a period of 4 to 5 days immediately following drug treatment. Our studies indicate that several chemotherapeutic drugs at concentrations comparable to those used in humans have long-lasting antagonistic as well as synergistic effects on the sensitivity of tumor cells to antibody and complement, depending on the particular drug used and on the time interval between drug exposure and subsequent treatment with antibody. These results suggest a model for evaluating the use of antibody in the elimination of malignant cells which, despite exposure to chemotherapy, remain clonogenic and proliferative.

Animals↗
PubMed1981

Microfibrillar collagen hemostatic pledgets.

The use of topical microfibrillar collagen hemostatic agents is increasing in many areas of clinical surgery. We have developed a method of preparing the hemostatic agent by which a pledget is formed in a syringe. This gives it a firm consistency and allows easier handling and application and can be done at the operating room table.

Collagen↗
PubMed1980

Partial splenectomy for nonparasitic splenic cysts.

Four cases of partial splenectomy for large, nonparasitic splenic cysts are described. In all four patients it was possible to successfully preserve most of the splenic parenchyma. With the increasing realization of the importance of splenic function, the feasibility of this operative approach to splenic cysts is proposed.

Adult↗