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Biomedical subjects

S Post

Publications and source records attributed to S Post.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Manually assisted laparoscopic surgery--realistic evolution of the minimally invasive therapy concept? Initial experiences with the "Endohand"].

The essential limitations of laparoscopic procedures--lack of palpation, problematic retrieval of specimen and anastomosis, etc.--are abolished by the hand of the surgeon, which is inserted into the peritoneal cavity through a mini-laparotomy. While holding the pneumoperitoneum, the hand acts as an intelligent instrument performing surgical exploration, exposition of the field of operation, blunt dissection or intracorporal knot-tying. The mini-laparotomy is used to insert conventional instruments and suture material, as well as for specimen retrieval and anastomosis. Our preliminary experience (3x splenectomy, 2x sigmoid colectomy, 1x anterior resection of rectum, 1x proctocolectomy with J-pouch) shows that even extensive laparoscopic operations are accomplished much more simply. The time spent for such procedures is markedly reduced.

Adult↗
PubMed1996

[The accuracy of angiography and CT angiography of the carotid bifurcation compared to macro-morphological correlation].

PURPOSE: To compare the degree of carotid artery stenosis in angiography and CT angiography with the degree of stenosis measured in an intact eversion endarterectomy specimen. METHODS: Preoperative angiograms (intraarterial DSA, 512 x 512 matrix) and CT-angiograms (24 sec spiral scan, slice thickness 2 mm, pitch 1.5) were taken in 12 patients with symptomatic carotid stenosis. Evaluation of the degree of stenosis was performed according to the NASCET ("distal" degree) and ECST ("local" degree) methods. These data were compared with measurements of the surgical specimens. RESULTS: The median "local" degree of stenosis in angiograms was 81.5% (range: 70-99%), in CT angiograms 83% (59-94%) and in specimens 85.5% (65-96%). The "distal" degree of stenosis was 79% (50-99%) in angiograms, 85.5% (55-99%) in CT angiograms and 81% (52-95%) in specimens. CT angiography slightly overestimated the degree of stenosis compared with the specimen, whereas angiography slightly underestimated the true degree of stenosis. However, these differences were not statistically significant. CONCLUSION: CT angiography is able to predict the degree of internal carotid stenosis when compared with an intact surgical specimen. It is as accurate as the "gold standard" of invasive angiography.

Angiography, Digital Subtraction↗
PubMed1996

The impact of disease pattern, surgical management, and individual surgeons on the risk for relaparotomy for recurrent Crohn's disease.

OBJECTIVE: The authors provide a multivariate analysis of a large single-center experience with limited surgery for Crohn's disease. SUMMARY BACKGROUND DATA: During the past decade, the aim of surgery for Crohn's disease has shifted from radical operation, achieving inflammation-free margins of resection, to "minimal surgery," intended to remove just grossly inflamed tissue or performing strictureplasties. METHODS: Seven hundred ninety-three cases of resection and/or strictureplasty in 689 individuals with histologically verified Crohn's disease were followed for a mean period of 50 months (range, 5-166 months). Two different end points were analyzed: 1) any relaparotomy for recurrent (or persistent) Crohn's disease and 2) relaparotomy for site-specific recurrence. More than 30 variables of patient/disease characteristics and surgical management were included in a proportional hazard model. RESULTS: Five parameters were associated independently with the risk for relaparotomy: increased risk coincided with young age at onset of disease, involvement of jejunum, enterocutaneous fistula, or performed strictureplasty, and decreased risk followed ileocecal resection. Site-specific risks of reoperation were calculated on the basis of 1260 intestinal resections or anastomoses performed in these patients. Young age at onset, duodenal and jejunal involvement, presence of enterocutaneous or perianal fistula, and a single surgeon (of 23) were associated significantly with increased risk of regional recurrence but not strictureplasty or inflammation at margins of resection. CONCLUSIONS: Limited surgery for Crohn's disease is not associated with increased risk of regional recurrence requiring reoperation. However, patients with juvenile onset, proximal small bowel disease, and some types of fistulae are at a considerable risk of experiencing early surgical recurrence.

Adolescent↗
PubMed1996

[The role of reperfusion damage].

Following reperfusion of preserved organ grafts, various pathomechanisms are activated that may impair graft function and viability beyond ischemic damage. This so-called reperfusion injury includes generation of oxygen radicals, recruitment and activation of circulating inflammatory cells, and liberation of numerous mediators acting both locally and systemically. Alterations in microvascular perfusion are of central importance where further graft damage is concerned. The present review covers the current knowledge about the underlying mechanisms, the organ-specific application in the clinical setting, and the possible immunological consequences of reperfusion injury.

Animals↗
PubMed1996

[Laparoscopic diagnosis and therapy of closed traumatic diaphragmatic rupture].

Diagnosis of blunt diaphragmatic rupture is still a challenging problem. This injury is generally treated by direct closure of the defect via a laparotomy or a thoracotomy. As it occurs frequently in severely traumatized patients, we wondered whether those patients could benefit from the well-known advantages of minimally invasive surgery. We report the records of two patients who underwent laparoscopy for blunt diaphragmatic hernia. In both patients, the hernia was laparoscopically closed without opening the abdomen. We did not see any intra- or postoperative complications related to minimally invasive surgery; the postoperative recovery was impressively short. Taking into account the fact that diaphragmatic ruptures are frequently misdiagnosed, we recommend laparoscopy as a useful tool in cases where these injuries may be suspected. In selected patients, primary closure of the defect may be achieved within the same laparoscopy so that laparotomy can be avoided.

Adult↗
PubMed1995

Experience with ileostomy and colostomy in Crohn's disease.

This study involved 746 patients with Crohn's disease treated surgically within a 13-year interval in whom 227 stomas (159 primary, 68 secondary) were created. The main indication (64 per cent) for primary stoma was severe perianal or genital fistulous disease. Revisional surgery for stomal complications was more common following colostomy than ileostomy (31 versus 5 per cent, P < 0.01). Twenty years after the first symptoms of Crohn's disease the cumulative risks of receiving any stoma or a permanent stoma were 41 and 14 per cent respectively. Four parameters were shown by proportional hazards analysis to be independently associated with the risk for any stoma as well as a permanent one; increased risk coincided with rectal inflammation, perianal fistula or abscess, and absence of small intestinal involvement. In addition, long-standing symptomatic disease before the first surgical intervention reduced the risk of a permanent stoma. The long-term chances of closure following temporary stoma were 75 per cent when used for anastomotic protection or avoidance, 79 per cent after postoperative complications, and 40 per cent for perianal or genital fistulas or for rectal inflammation or stenosis. Rectal disease and perianal fistula were the only independent predictors of a low possibility of stoma closure during follow-up.

Abdominal Abscess↗
PubMed1995

Modes of reperfusion in clinical liver transplantation.

A retrospective analysis of 60 orthotopic liver transplantations was performed to elucidate the effect of three types of rinse solutions (Ringer's solution, modified Carolina rinse, and autologous blood) and two types of revascularization (simultaneous vs sequential portal and arterial reperfusion) on various parameters of early postoperative graft function. The only statistically significant association revealed by multivariate analysis was a positive correlation between donor age and SGOT/SGPT peak levels postoperatively. In this limited sample no beneficial properties of Carolina rinse and/or simultaneous arterialization were verified. Despite modifications of reperfusion, there were 2 cases of primary nonfunctioning graft. However, these cases were associated with elderly donors, prolonged cold storage and, in 1 case, marked steatosis. Large-scale prospective trials are required to verify or disprove experimental data on the use of varying modes of reperfusion.

Adolescent↗
PubMed1995

Perioperative blood transfusion does not prevent recurrence in Crohn's disease. A pooled analysis.

The effect of perioperative blood transfusion on the recurrence of Crohn's disease is controversial. Various studies have suggested that perioperative blood transfusions reduce the risk of recurrence; others have failed to find a protective effect. Since all the studies are based on relatively small numbers, we performed a pooled analysis. We contacted the senior authors of seven previously published studies and asked for the original data. Four authors provided their data. The pooled database included 622 patients with a primary and complete resection of macroscopic disease. Recurrence was defined as the need for repeat surgery for disease control. Kaplan-Meier life table analysis was performed. Of the study sample, 366 cases (59%) were female. Disease distribution was as follows: small bowel (47%), small/large bowel (35%), and large bowel only (18%). Three hundred thirty-one patients (53%) received blood in the perioperative period. Mean follow-up was 72.8 months. For the overall sample, the 5-year recurrence rates were 26.9% for the transfused group and 25.2% for the nontransfused (p = 0.456). When the data were stratified by age, gender, disease location, and length of resection, no difference in 5-year recurrence rates between transfused and nontransfused cases could be detected. In this pooled analysis of four retrospective studies on the effect of blood transfusions on the risk of recurrence in Crohn's disease, we were unable to document a protective effect.

Adolescent↗
PubMed1995

[Subjective assessment of quality of life, pain and surgical success after laparotomy for Crohn disease].

239 patients following major surgery for Crohn's disease (mean 8 years after first operation) were interviewed by mailed questionnaire. Main target parameters included reduction of quality of life, intensity/frequency of abdominal pain, and grading of success of the most recent operation for Crohn's disease. These targets were correlated in univariate as well as multivariate statistics with 28 different parameters of general medical history, surgical pretreatment, actual somatic and psychosocial findings. Reduction of quality of life correlated with stool frequency, employment status, rectal involvement, hematochezia, liquid stools, extraintestinal manifestations and time since first operation (all with p < 0.05 in multivariate analysis; listed in decreasing levels of significance). Abdominal pain at time of interview was significantly associated with actual intake of corticosteroids, stool frequency, employment status, extraintestinal manifestations, dietary restrictions, and number of previous operations (other than laparotomies). Regarding success of most recent laparotomy important parameters included stool frequency, intake of corticosteroids, number of previous laparotomies, hematochezia, and history of enterostomy. Overall, parameters of disease activity were found to be more important than characteristics of medical history or previous surgery. Despite marked symptoms in many cases 92% of the patients regarded the most recent laparotomy to be fully or partially successful. The results provide direct and indirect evidence that besides momentary disease activity the individual personality profile may be far more important than type and number of previous surgery in coping with this chronic disease.

Activities of Daily Living↗
PubMed1994

Short-term T cell receptor directed immunotherapy induces organ specific peripheral tolerance in a strongly incompatible rat model.

We analysed the effect of selective alpha/beta-T cell elimination on allograft survival in a strongly histoincompatible DA-->LEWIS rat model by treatment of recipients with the mouse monoclonal antibody R73 two times before and seven times after transplantation. R73 induced virtually indefinite cardiac allograft survival in 44% of six-week-old LEWIS recipients, whereas donor-type skin allografts were rejected within 11 days. The remaining 56% of animals presented a mean cardiac survival time of 41 +/- 13 days. Graft prolongation was age dependent since in ten-week-old animals the survival time was only of 19 +/- 5 days (untreated controls: 7 +/- 1 days). R73 induced a rapid decrease of R73-positive T cells in the peripheral blood from 70% before treatment to 2%. From the fifth day of treatment a gradual T cell recovery was registered. The T cell marker CD5 decreased from 72% to 17% but recovered already from the second day of treatment. Determination of alpha/beta-TCR, CD3 and CD5 density on T cells during R73 therapy showed that the initial T cell decrease was due to T cell elimination, whereas modulation of alpha/beta-TCR was predominant during the following days. Anti-R73 antibodies appeared regularly during the first week of treatment and blocked R73 activity, indicating their anti-idiotypic nature. The present findings show that short-term R73 therapy is able to induce long-lasting allograft survival. This experimental model can be used to study the basis of peripheral organ specific T cell tolerance.

Animals↗
PubMed1994

Depressed phagocytic activity of Kupffer cells after warm ischemia-reperfusion of the liver.

Phagocytic activity of Kupffer cells following hepatic ischemia/reperfusion was studied in 39 livers of male Sprague-Dawley rats by in vivo fluorescence microscopy. Animals were subjected to either 20 min (group B, n = 9) and 60 min left hepatic lobar ischemia (group C, n = 9) or to 20 min of global hepatic ischemia (group D, n = 11). Sham-operated animals without ischemia served as controls (group A, n = 10). After 60 min postischemic reperfusion, fluorescent latex beads (3 x 10(8).kg body wt-1; diameter: 1.1 microns) were injected intra-arterially. The zonal distribution and kinetics of adherence of latex beads were quantified by off-line video analysis. After 20 min of left hepatic lobar ischemia, 50%, 38% and 12% of injected latex beads adhered in zones 1, 2 and 3, respectively, and did not significantly differ from control livers (group A: 57%, 32% and 11%). In contrast, after 60 min of left hepatic lobar ischemia (group C) as well as after 20 min of global hepatic ischemia (group D), a more homogeneous distribution of latex beads adherent in zones 1, 2 and 3 was observed (group C: 48%, 36% and 16%; group D: 48%, 36% and 16%). Kinetic analysis of phagocytosis (% adherence of visible latex beads 1 min and 3 min after injection) showed no significant difference between 20 min left hepatic lobar ischemia (group B: 84% and 95%) and control (group A: 81% and 95%).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

Ischaemic preconditioning by partial occlusion without intermittent reperfusion.

OBJECTIVE: The aim was to investigate whether ischaemic preconditioning can be obtained by a partial coronary artery occlusion without intermittent reperfusion. METHODS: In seven anaesthetised open chest pigs, the flow in the proximal left anterior descending coronary artery was reduced to 30% of baseline during 30 min before the vessel was occluded completely for 60 min (60 min total coronary occlusion, TCO). After 2 h of reperfusion, the area at risk (AR) and infarct size (IS) were determined using standard procedures. Infarct sizes were compared to those observed in control animals (n = 12), which were subjected to 60 min TCO and 2 h reperfusion, and to infarct sizes determined in animals preconditioned by 10 min TCO with either 15 min (n = 10) or 60 min (n = 5) of reperfusion before the 60 min TCO and 2 h reperfusion. In the last three groups of animals, area at risk was varied by occluding the coronary artery or its branches at different sites. RESULTS: In the control animals infarct size was linearly related (r = 0.99, p < 0.001) to the area at risk with a positive intercept on the AR axis: IS/LVmass (x100%) = 0.88 AR/LVmass (x100%)-3.6. At comparable areas at risk, the infarct size of the animals preconditioned with a 10 min TCO was less than for the control animals. For the animals preconditioned with 10 min TCO and 15 min reperfusion, the relationship between infarct size and area at risk was again linear (r = 0.88) and also had a positive intercept on the AR axis: IS/LVmass (x100%) = 0.68 AR/LVmass (x100%)-4.8. All animals with the flow reduction to 30% of baseline immediately preceding the 60 min TCO had infarct sizes smaller (p < 0.05) than predicted from the regression equation for the control animals, but the infarct size limitation could not be simply related to variables such as changes in regional systolic and postsystolic segment length shortening, ATP, or ADP during the partial occlusion period. CONCLUSIONS: Myocardium can be preconditioned with a flow reduction to 30% of baseline for 30 min without intermittent reperfusion (two stage Harris model). The positive intercept on the AR axis of the IS-AR relationship warrants caution of the use of IS/AR as an index for infarct size limitation.

Animals↗