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Biomedical subjects

S Truong

Publications and source records attributed to S Truong.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Endosonography control of percutaneous paracoccygeal drainage of deep pelvic abscesses after rectum resection].

Pelvic abscesses are severe complications after rectal surgery. In recent years, surgical drainage has been edged out by percutaneous drainage techniques. We report our experience with the drainage of postoperative pelvic abscesses via the paracoccygeal route controlled by endosonography. In eight patients the diagnosis of a retrorectal pelvic abscess was established by endosonography and confirmed by endosonographically controlled exploratory puncture. Drainage of the abscesses was performed via the paracoccygeal access route by trocar or Seldinger technique under permanent visual control by endoluminal sonography. Irrigation of the abscess cavity was than performed daily. In all cases drainage was successful without complications. Duration of drainage was 9-14 days with a mean of 10.8 days. In one patient there was a recurrence of the abscess because of early removal of the drainage catheter. Because of its overall availability and its good results, paracoccygeal percutaneous endosonographically controlled drainage seems to be a suitable uncomplicated method for drainage of postoperative pelvic abscesses.

Abdominal Abscess↗
PubMed1997

Endoscopic therapy of benign anastomotic strictures of the colorectum by electroincision and balloon dilatation.

BACKGROUND AND STUDY AIMS: Endoscopic dilatation is the standard therapy for postoperative colorectal anastomotic strictures, although it carries the risk of perforation at the weakest part of the anastomosis. In order to minimize this risk we have developed a combined technique of endoscopic electroincision and hydraulic balloon dilatation. PATIENTS AND METHODS: Thirty-six symptomatic patients with benign colorectal anastomotic strictures were referred for endoscopic electroincision with consecutive balloon dilatation, if the diameter of the anastomosis was less than 12 mm (n = 15) or if the diameter was less than 20 mm and the patient complained of repeated obstructive symptoms under conservative therapy (n = 21). Under direct endoscopic control the scar tissue at the anastomotic line was incised radially with the tip of the polypectomy snare or with a papillotome. Endoscopic hydraulic balloon dilatation was then performed, using a pressure of 35 PSI for three minutes. An endoscopic or radiological control was carried out on the second day, and balloon dilatation was repeated if necessary. RESULTS: The combined technique of electroincision and consecutive balloon dilatation was performed successfully in 35 patients. In only one patient this therapy could not be performed, because of a long stenotic segment, and surgery was necessary. In 24 patients one single dilatation was sufficient after electroincision, whereas six patients required two, and five patients required three consecutive balloon dilatations. There were no severe complications such as bleeding or perforation. Complete follow-up evaluation was possible in 25 patients. In five cases recurrences appeared within the first year; all could be treated successfully by further balloon dilatation. CONCLUSIONS: The combination of endoscopic electroincision and hydraulic balloon dilatation leads to a high long-term clinical success with a minimum of complications. Therefore, in our opinion it is a useful method in the treatment of benign colorectal anastomotic strictures.

Anastomosis, Surgical↗
PubMed1997

[Preoperative spiral CT cholangiography with 3-dimensional surface reconstruction: the anatomical imaging potentials, limits and application strategies].

PURPOSE: Evaluation of CT cholangiography compared to i.v. cholangiography concerning its diagnostic value before laparoscopic cholecystectomy and optimisation of CT cholangiography. METHOD: I.v. and CT cholangiographies of 54 patients were retrospectively evaluated by two radiologists. The time interval between contrast infusion and CT was correlated with the assessment of CT cholangiographies to detect the optimal timing for CT scanning. RESULTS: CT cholangiography was judged to be generally better than i.v. cholangiography. The optimal time interval for CT scanning is between 30 min and 60 min post contrast infusion. CONCLUSION: CT cholangiography should replace the conventional tomograms if i.v. cholangiography does not yield sufficient depiction of the biliary tree. It should be performed within 60 min post contrast infusion. Complete abolishment of i.v. cholangiography is not warranted. This is due to the fact that conventional cholangiography can sufficiently delineate the biliary tree and thereby reduce x-ray exposure and cost compared to initial performance of CT cholangiography.

Adult↗
PubMed1997

[Preoperative diagnosis of laparoscopic cholecystectomy. Is there an indication for routine intravenous cholangiography?].

In a retrospective study including 163 patients we investigated the necessity of i.v. cholangiography in preoperative routine diagnostic workup prior to laparoscopic cholecystectomy. We evaluated the evidence of i.v. cholangiography concerning the anatomy of the biliary system, the evidence of common bile duct or cystic duct stones and the influence on the further therapeutic procedure. While the common bile duct could be demonstrated in 96.3%, the cystic duct could be visualized in only 54.6%. One out of two patients with a short cystic duct was identified. Stones in the gallbladder were recognized in 72.4% of cases, while only two out of three patients with common bile duct stones were diagnosed. In nine cases a deep junction of the cystic duct was found, but there was no influence on further operative procedure. Thus we found no improvement after routine use of i.v. cholangiography concerning the evidence of common bile duct stones or avoidance of intraoperative lesions of the common bile duct. The routine use of i.v. cholangiography prior to laparoscopic cholecystectomy is therefore not justified.

Adolescent↗
PubMed1997

[Preoperative staging of stomach carcinoma with endosonography--fact or fancy?].

From January 1993 till December 1995, a total of 116 consecutive patients with gastric carcinoma were evaluated with endosonography and the results were compared with the histology of the resected specimen. The accuracy rate of the endosonography was 80% for T1 tumors an 83% for T4 tumors, and the sensitivity and specificity in the detection of regional involved lymph nodes were 91% and 84% respectively. Therefore endosonographic staging alone ist not a valuable pretherapeutic procedure to decide about endoscopic therapy in limited and neoadjuvant chemotherapy in extended gastric carcinoma.

Adult↗
PubMed1996

[Palliative therapy of inoperable malignant occlusive jaundice--stent implantation or biliodigestive anastomosis].

For therapy of malignant jaundice different methods are possible: The palliative operative bypass and the monoperative stent implantation by endoscopic or transhepatic procedure. The primary success rate of both methods is similarly high (> 90%). The rate of early complication and the lethality of the stent implantation compared to the operative procedure are lower. The rate of occlusion and incidence of later cholangitis by operative bypass are lower. Postoperative lethality is related to the ASA classification. The preoperative diagnosis of resectability by CT, NMR, angiography and diagnostic laparoscopy has a success rate of maximally 95%. The choice of therapeutic method is therefore related to the general condition of the patient (ASA, staging, duodenal stenosis, expected survival time).

Anastomosis, Surgical↗
PubMed1994

[Todani type I choledochal cyst--diagnosis and surgical therapy].

Ultrasound, ERC and computed tomography are the main preoperative diagnostic procedures of common bile duct cysts. In individual cases the definitive diagnosis can be confirmed only intraoperatively. The high rate of complications and the risk of carcinoma requires a radical surgical treatment.

Adult↗
PubMed1994

[Video thoracoscopic therapy of spontaneous pneumothorax. Technique and initial results].

The acceptance of operative therapy of spontaneous pneumothorax (SPT) has been tempered by the serious trauma of thoracotomy access. Development of videoequipment and miniaturized instruments allows now a thoracoscopic resection of bulla with minimal access. 25 patients with recurrent SPT (n = 15), primary resistant SPT (n = 5), and first SPT (n = 5) were treated from January 1991 thoracoscopically. Bullae resection was performed with an Roeder ligature or an Endo-GIA. Pleurodeses was induced by mechanical irritation or coagulation of the upper thoracic aperture with the argon beamer. Postoperative lung reinflation was rapid and without patchy collapse. The analgetic drug demand was dramatically reduced and patients were mobilised on the 1st postoperative day. Patients were discharged on the 4th postoperative day. Major complication were one hematothorax and one recurrence of SPT. The advantages of the thoracoscopic surgical treatment are rapid full expansion of the lung, decreased postoperative pain, short postoperative hospital stay and early return to normal activity.

Adult↗
PubMed1993

[Animal experiment studies of treatment of benign anastomotic stenosis of the colorectal area by electro-incision and balloon dilatation].

In an experimental study the significance of local electroincision and pressure in endoscopic dilatation therapy of benign colorectal anastomotic stenosis was investigated. A benign anastomotic stenosis was induced in the proximal part of the rectum in 21 pigs and was quantified and classified 12 weeks postoperatively using the stenosis index of McAdam. All stenotic anastomoses were dilated using electroincision (two incisions versus four) and balloon dilatation (230 mmHg versus 460 mmHg). Neither perforation nor severe bleeding occurred in any of the animals. At 24 weeks after the operation the anastomoses were restaged. We found significantly better results after four incisions than after two. After multiple incisions the dilation pressure was of secondary importance. Combined therapy with multiple incisions and balloon dilatation is a safe procedure yielding good results even with low-pressure dilatation.

Anastomosis, Surgical↗
PubMed1993

Computed tomographic cholangiography using spiral scanning and 3D image processing.

Volumetric computed tomography (CT) scans ("spiral CT") were performed after intravenous (i.v.) cholangiography followed by additional 3D surface reconstructions of gallbladder and biliary ducts. 34 patients were investigated prior to cholecystectomy. No allergic adverse reactions were observed. The scan time was 24 s. Contrast enhancement in the extrahepatic bile duct and gallbladder were measured. All CT image series were reviewed independently by four experienced physicians (two radiologists, two surgeons) and compared for quality with conventional cholangiography on a three-point scale. The average rating for the demonstration of the biliary tract was significantly better for spiral CT than for conventional cholangiography (p < 0.01). In all cases sufficient contrast was found in the common bile duct (mean 315 HU). 3D imaging was considered to be helpful for intraoperative orientation during laparoscopic surgery.

Adult↗
PubMed1993

[Value of sonography in diagnosis of uncertain lesions of the abdominal wall and inguinal region].

In a prospective trial we investigated the value of ultrasound in 134 patients with clinical doubtful findings of the abdominal wall and inguinal region. Ultrasound diagnosis was made by predefined criteria. In 105 patients a definite diagnosis was made by means of operative findings, CT, NMR, or puncture. In 40 patients a hernia was found. The sensitivity of ultrasound was 85%, the specifity 93.8%, the positive predictive value as 89.5% and the negative predictive value was 91%. Separating the findings to localisation of the hernia results in highest sensitivity for epigastric hernia (100%) and lowest for crural hernia (72.7%). The specifity for all hernias was more than 96%. Liquid tumors (hematom, serom, abscess) could be differentiated from solid tumors (lymphom, metastatic nodule, lipom). The most frequent course of wrong diagnosis was mixing the different liquid or solid tumors among themselves because of similar sonomorphologic properties. The sensitivity for hematom, serom, abscess, lymphom and metastatic nodule was 87.5%, 100%, 66.6%, 77% and 85.7% respectively. The corresponding specifity was 97.8%, 97.8%, 100%, 96.7% and 98%. Ultrasound was found to be of value for the diagnosis of clinical indeterminal findings of the abdominal wall and inguinal region.

Abdominal Muscles↗
PubMed1992

[Endoscopic therapy of benign anastomotic stenoses in the area of the colon and rectum by electro-incision and balloon dilatation].

21 patients with a severe anastomotic stenosis in the colorectal region were treated with hydraulic balloon dilatation and endoscopic electro-incision. The severity of symptoms directly correlates with the extent of stenosis (degree I phi 13 mm, n = 12; degree II phi 7 mm, n = 6; degree III phi 4 mm, n = 3). All patients with a stenosis of degree I and II were symptom-free after the endoscopic therapy. In 2 of 3 cases the symptoms of stenosis of degree III could clinically be improved after the treatment. The average frequency of dilatation was 1.5 x, complications such as bleeding or perforation were not registered. Animal studies explain anastomotic stenosis through an increased submucosal formation of collagen fibers followed by formation of scars in the anastomosis. The efficiency of electro-incision and balloon dilatation is based on an increased diameter in the anastomotic region without increased formation of new collagen fibers.

Adult↗
PubMed1992

[MR tomography of colorectal diseases with a negative rectal contrast medium].

The potential of the generic kaopectate (Upjohn) as a negative rectal contrast agent in MR imaging was investigated in the assessment of colorectal disease. 45 MR examinations in patients with colorectal disease (colorectal carcinoma 25 patients, inflammatory disease 12 patients, miscellaneous disorders of the colon 8 patients) were evaluated. All examinations were performed with T1 and T2 weighted SE sequences after rectal application of kaopectate. Gd-DTPA enhanced T1 SE sequences were obtained as well. Kaopectate revealed a signal void of the lumen of the large intestine in T1 and T2 weighted SE sequences. Intravenous administration of Gd-DTPA enabled good differentiation of contrast-enhanced malignant or inflammatory tissue and the low signal lumen of the bowels. No side effects were noted.

Adult↗
PubMed1992

[Results of treatment in esophageal cancer].

204 patients were treated for esophageal cancer from 1.1.1986 until 1.6.1992 (carcinoma of the hypopharynx: n = 12, adenocarcinoma of the endobrachyesophagus: n = 82, primary esophageal cancer: n = 110). Out of the primary esophageal cancers 84 tumors (76%) were resected and 24% had palliative endoscopic and/or irradiation therapy. The stage distribution of the resected patients was: stage I: 7.1%, stage IIa: 35.7%, stage IIb: 11.9%, stage III: 33.3%, stage IV: 11.9%. The total morbidity of the resected patients amounted to 32.1%, the 30 days mortality to 7.1%, and the in hospital mortality to 9%. These data show no significant difference to the results of palliative endoscopic procedures (morbidity: 42.3%, mortality: 7.7%). None of the conservatively treated patients survived longer than 12 months whereas resected individuals had a 5-year-survival rate of 20%. The most predictive factors for prognosis were: Depth of tumor invasion (p less than 0.01), R-classification (p less than 0.05), and the lymphonodular status (p less than 0.05). A perioperative irradiation was effective in T3- and T4-tumors.

Adenocarcinoma↗
PubMed1992

[Importance of sonography in diagnosis of ileus. A retrospective study of 459 patients].

In a retrospective trial we investigated the significance of ultrasound in the diagnosis of intestinal obstruction in 459 patients. The overall sensitivity was 93.7%. In paralysis the correct diagnosis was obtained in 98% of all. Mechanical obstruction was identified in 91%. In cases of incomplete mechanical obstruction sensitivity was 89%. The corresponding value for complete obstruction was 95%. In all patients with negative findings on abdominal x-ray (10%) the correct diagnosis was established by ultrasound. Only in 71% of cases ultrasound was successful differentiating small bowel from large bowel obstruction. The underlying cause of ileus was yielded by ultrasound in 45% of the cases. On the basis of our experience ultrasound is proven to be of significant importance in the diagnosis and differentiation of ileus.

Adolescent↗
PubMed1992

[The effects of the carbon dioxide pneumoperitoneum in laparoscopic cholecystectomy on postoperative spontaneous respiration].

Laparoscopic cholecystectomy (LSC) is being performed increasingly often. The carbon dioxide cavity increases end-expiratory carbon dioxide (exCO2), which can be regulated by mechanical ventilation. Because about 20-40% carbon dioxide remains in the patient at the end of surgery, we were interested in its influence on spontaneous respiration. PATIENTS AND METHODS. Fifteen patients classed as ASA 1-2 and undergoing LSC were compared with 15 patients (also ASA 1-2) undergoing laparotomy for cholecystectomy (LAP). All patients had balanced anaesthesia with fentanyl, enflurane, nitrous oxide and vecuronium. After surgery they were extubated when spontaneous respiration and vigilance were adequate. In the next 3 h we continuously determined exCO2 in the expired air through an intranasal catheter, and oxygen saturation (SAT), respiratory rate (RR) and heart rate (HR) using Oscar (Datex) and Ohmeda (Braun) apparatus while the patients were breathing room air. The blood pressure (BP) was determined intermittently. Postoperative pain treatment was standardized. RESULTS. The groups were reduced comparable with respect of the anthropometric data, because the weight was significantly higher in the LAP group. Fentanyl consumption was also significantly higher in the LAP group, reflecting the more pronounced trauma than with LSC. Mean exCO2 was 46 mmHg after LSC and 36 mmHg after LAP (P less than or equal to 0.05), continuously decreasing in the LSC group and increasing in the LAP group to 40 mmHg after 3 h. Mean RR was 18-20.min-1 after LSC and 12-15.min-1 after LAP during this period (P less than or equal to 0.05). There were no differences in SAT (94-96%), HR (75.min-1) and BP (130/80 mmHg). DISCUSSION AND CONCLUSIONS. The remaining carbon dioxide after LSC has important implications for postoperative spontaneous respiration. Probably due to an activation of carbon dioxide receptors, RR is increased to eliminate residual carbon dioxide. This is confirmed by a significantly increased exCO2 compared with that in the LAP group. This effect lasts at least 3 h, exCO2 being comparable in both groups, but RR is still increased after LSC. This different respiratory pattern does not affect SAT, being normal without hypoxic episodes. Cardiovascular parameters were also normal without group differences. We conclude that the carbon dioxide peritoneal cavity has important consequences for postoperative ventilation. Using our anaesthetic technique and postoperative treatment exCO2 reaches normal values after about 3 h due to an increased RR. If other methods, e.g., stronger opioids, which decrease carbon dioxide response are used, this effect may even be prolonged and more pronounced. We are now performing an investigation to evaluate this effect.

Adult↗