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Biomedical subjects

W D Widmann

Publications and source records attributed to W D Widmann.

At least 19 recordsLinked to original sources
PubMed2002

Persistent post-laparoscopy pneumoperitoneum.

BACKGROUND: Persistent pneumoperitoneum after a laparoscopic operation can represent either residual postoperative pneumoperitoneum or free intraperitoneal gas released from the gastrointestinal tract. This animal study was conducted to better characterize the extent and duration of postoperative pneumoperitoneum as detected by computed tomography (CT). METHODS: Five pigs underwent cholecystectomy, four laparoscopically and one open. All pigs were followed serially with upright chest radiographs and abdominal CT scans beginning immediately postoperatively and continuing daily until resolution of pneumoperitoneum as detected by both imaging modalities. All radiographs and CT scans were reviewed by dedicated radiologists who reported the extent and duration of pneumoperitoneum in a blinded fashion. RESULTS: Pneumoperitoneum resolved on upright chest radiographs in all five pigs by or on postoperative day 1. Serial CT scans demonstrated that the laparoscopic group had either resolution of pneumoperitoneum or minimal persistence of free intraperitoneal gas by postoperative day 2. In contrast, the single pig in the open group had CT evidence of persistent pneumoperitoneum through postoperative day 6. CONCLUSIONS: In the pig model, small pockets of free intraperitoneal gas detected by CT scanning are expected to resolve by postoperative day 2 following laparoscopic surgery. Persistence of pneumoperitoneum beyond this interval is abnormal and may represent a perforated viscus. Whereas a prospective CT imaging study in humans is not ethically feasible, we believe that parallel conclusions between the pig and human may be drawn.

Abdominal Pain↗
PubMed1998

Does lining polypropylene with polyglactin mesh reduce intraperitoneal adhesions?

A method that appears to reduce the rate of adhesion formation between intraperitoneal viscera and prosthetic mesh is the placement of absorbable mesh between nonabsorbable mesh and intraperitoneal viscera. In this study, polyglactin mesh was compared with nonabsorbable polypropylene mesh (Marlex). Forty-seven Sprague-Dawley rats were divided into four groups: 1) control, 2) polyglactin (Vicryl), 3) polypropylene mesh, and 4) polyglactin-lined polypropylene mesh. All rats that underwent mesh placement had midline laparotomy with anastamosis of mesh to fascial borders. Controls underwent midline laparotomy and closure only. Groups were then studied at 1, 2, and 3 months, respectively, to determine the degree of adhesion formation. Gross inspection was performed by a blinded researcher with numerical rank given based on the number of adhesions observed: 0, none; 1, mild; 2, moderate; and 3, severe. The data showed that rats in group 3 (polypropylene only) had significant adhesions at 3 months, with average numerical score of 2.75. Polyglactin and polyglactin/polypropylene groups had similar scores of 1.5 each. Control groups predictably showed little adhesion formation, with average score of 0.25. Based on these data, it is observed that lining polypropylene mesh with absorbable polyglactin mesh can reduce adhesion formation to nonabsorbable mesh. The difference in degree of adhesions is most notable at 3 months. This technique may be an important adjunct to reduce the clinical sequelae of intraperitoneal adhesions.

Abdominal Muscles↗
PubMed1996

Empyema from lost gallstones: a thoracic complication of laparoscopic cholecystectomy.

Laparoscopic cholecystectomy may result in lost (dropped) gallstones. Such stones may precipitate abdominal abscesses including subphrenic abscesses. In our case, the abscess eroded through the diaphragm causing an empyema 17 months after the laparoscopic cholecystectomy. Treatment included decortication, drainage, and removal of the stones.

Abdominal Abscess↗
PubMed1996

Mesh insertion as an aid for pleurodesis.

With the application of video-assisted thoracic surgery (VATS) for the treatment of pneumothorax, there has been an increase in the failure rate of treatment because of inadequate pleurodesis. We sought to determine whether mesh insertion into the pleural cavity with or without pleural abrasion results in predictable pleurodesis appropriate for clinical trial as an adjunct to VATS treatment of pneumothorax. There have been no prior studies on the use of absorbable or nonabsorbable mesh in the thoracic cavity. The effects of intra-thoracic absorbable polyglactin (Vicryl) and non-absorbable polypropylene (Marlex) mesh were studied in rats. Polyglactin without abrasion caused filmy adhesions in 5/5, 1/7, and 0/5 rats studied at 1, 2, and 3 months. Polypropylene incites an extensive and dense pleural reaction not suitable for clinical use becaues it induces a fibrothorax. Pleural abrasion alone caused variable adhesions studied at 3-4 months (4/6 none, 1/6 filmy, 1/6 firm). Polyglactin plus pleural abrasion resulted in appropriate firm adhesions in 7/8 rats studied at 3-4 months with 1/8 showing filmy adhesions. Polyglactin alone results in transient filmy adhesions. Pleural abrasion alone results in inadequate pleural symphysis. However, when absorbable mesh insertion is coupled with pleural abrasion, appropriate pleurodesis is predictably achieved. Clinical application of polyglactin mesh insertion with pleural abrasion as an adjunct in the VATS treatment of pneumothorax has begun and has been successful.

Absorbable Implants↗
PubMed1995

Technical elements of successful laparoscopic cholangiography as defined by radiographic criteria.

OBJECTIVE: To define the elements of successful laparoscopic cholangiography. DESIGN: Retrospective review of 130 consecutive patients who underwent laparoscopic cholangiography. SETTING: Community hospital with a surgical residency. PATIENTS: Thirty-four males and 96 females, aged 16 to 86 years, with acute and chronic cholecystitis. INTERVENTION: Laparoscopic cholecystectomy during intraoperative cholangiography. MAIN OUTCOME MEASURE: A cholangiogram that satisfactorily delineates biliary anatomy as defined by accepted radiologic criteria. RESULTS: A successful laparoscopic cholangiogram was obtained in 98.5% of the study group. CONCLUSION: A safe and reliable technique to obtain a laparoscopic cholangiogram is described and validated using accepted radiologic criteria.

Adolescent↗
PubMed1987

Paradoxical embolism to the superior mesenteric artery.

Paradoxical embolism occurs when venous thrombi embolize into the systemic arterial circulation by passage of clots through an intracardiac septal defect. This paper describes a case of paradoxical embolism to the superior mesenteric artery in a patient with recent myocardial infarction and pulmonary embolism. This phenomenon was first described in 1877 (Cohnheim, 1877) and many case reports have followed but most of these have been autopsy findings. We emphasize that this diagnosis should be suspected in all patients who suffer systemic arterial emboli without any evidence of left heart origin and/or in association with pulmonary emboli. One author has reviewed 19 cases since 1930, most of which were reported in the past 15 years (Johnson, 1951). This probably reflects an increased awareness of the diagnosis and more sophisticated diagnostic modalities. It also raises the possibility that paradoxical embolism may be more common than originally believed.

Embolism↗
PubMed1987

An improved double-lumen biliary catheter for cholangiography.

A double-lumen biliary catheter was developed to aid in the performance of cholangiography and bile duct stone extraction. A prototype catheter was used in four cadavers. Excellent cholangiograms were obtained and a cryoprecipitate coagulum easily formed in the bile ducts without waste. Extraction of the coagulum from the bile ducts was aided by use of the catheter. The catheter also can aid in routine balloon catheter bile duct stone extraction, and thus is useful for both diagnosis and treatment of bile duct stones.

Catheterization↗
PubMed1987

Failure of conservative management of splenic rupture in a patient with mononucleosis.

"Conservative" management of splenic rupture in patients with mononucleosis has not been adequately evaluated because of its infrequent occurrence. Splenic rupture can be lethal in this setting and is the most common cause of death from mononucleosis. We report a case of spontaneous splenic rupture in a young girl with mononucleosis. The initial management was nonoperative but because of recurrent pain and rebleeding, a splenectomy was later performed. We do not recommend observation of splenic rupture in patients with mononucleosis because of the danger of delayed hemorrhage.

Adolescent↗
PubMed1987

Bronchopleural fistulas after pneumonectomy. A problem with surgical stapling.

After multiple reports demonstrating excellent results and improved healing of the bronchial stump in cases of pneumonectomy performed with standard reusable parallel firing stapling devices, there has been an isolated report from Europe of increased incidence of bronchopleural fistulas with the use of the modified reusable hinged stapling device. Our report confirms and extends that observation. Review of 42 successive pneumonectomies revealed one case of bronchopleural fistula with the use of the standard reusable parallel firing stapling device; there were six cases of bronchopleural fistulas in 36 successive pneumonectomies performed with the modified hinged stapling device (four with reusable and two with disposable instruments). Improperly formed staples were identified by x-ray examination or reoperation. We recommend that only the standard reusable parallel firing stapling devices be used for bronchial closure in pneumonectomy.

Bronchial Fistula↗