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At least 721 records · Page 40Linked to original sources
PubMed1996

Arthroscopic transglenoid suture capsulorrhaphy for anterior shoulder instability.

The role of arthroscopic procedures in the management of glenohumeral stability continues to evolve. Arthroscopic transglenoid suture capsulorrhaphy, as described, is an effective alternative for correcting the pathology of anterior and anteroinferior shoulder instability. The procedure avoids the morbidity associated with open repairs as a result of anterior soft tissue dissection and division of the subscapularis. The procedure, however, is technically demanding. To achieve predictable and reproducible results that approach those seen in comparable patient populations undergoing open Bankart stabilization, recognition of, and addressing, the responsible pathology is essential, as is appropriate patient selection. Based upon experience to date, arthroscopic transglenoid suture capsulorraphy is best indicated for traumatic anterior dislocators with a Bankart lesion and good quality glenohumeral ligaments. Arthroscopic suture capsulorrhaphy is not recommended for patients involved in upper extremity collision sports, those with a large glenoid rim defect, habitual luxators, patients younger than 18 years of age, and for surgeons whose experience with operative arthroscopy of the shoulder is limited. The procedure has an unresolved role, due to lack of sufficient long-term data in acute dislocations, multidirectional instability, those with previously failed open or arthroscopic repairs, and those with generalized joint hyperlaxity. The eventual role of arthroscopic transglenoid suture capsulorrhaphy in the treatment of anterior shoulder instability awaits further studies and technological innovation.

Adolescent↗
PubMedDate not supplied

The relationship of the axillary nerve to arthroscopically placed capsulolabral sutures. An anatomic study.

Ten cadaveric shoulders (mean donor age, 60.5 years) underwent arthroscopic placement of capsulolabral sutures as performed during arthroscopic reconstruction for shoulder instability. In relation to the glenoid face, the sutures were placed anterior, anteroinferior, inferior, posteroinferior, and posterior. All sutures entered the capsule approximately 1 cm away from the glenoid and exited beneath the labrum, and were tied using arthroscopic knot-typing techniques. The shoulders were frozen in the lateral arthroscopic position of approximately 45 degrees of abduction and 20 degrees of flexion and sectioned in the plane of the glenohumeral joint. The axillary nerve was then dissected, and the average distance from the nerve to each suture was found to be 16.7 mm at the anterior position, 12.5 mm at the anteroinferior position, 14.4 mm at the inferior position, 24.1 mm at the posteroinferior position, and 32.3 mm at the posterior position. In no specimen was any suture closer to the axillary nerve than 7 mm. We noted a statistically significant trend for the nerve to lie closest to the anteroinferior suture and gradually recede from the remaining sutures lying more posteriorly. This anatomic study is the first to demonstrate a relatively safe margin for arthroscopic suture placement between the capsule and axillary nerve when these sutures are placed approximately 1 cm from the glenoid rim.

Aged↗
PubMed1977

Carbenoxolone sodium capsules in the treatment of duodenal ulcer. An endoscopic controlled trial.

Eighty-six patients with duodenal ulcer were treated in a multicentre controlled trial with carbenoxolone capsules (Duogastrone, 50 mg four times a day for six weeks) or a placebo. Sixty-nine patients accepted endoscopy at the beginning and end of the treatment. Symptomatic responses and endoscopic improvement were significantly greater in those receiving the active preparation than in those receiving the control capsules, complete, endoscopically assessed, healing being achieved in 65% and 20%, respectively, of individuals having accepted endoscopy, after six weeks' treatment. Side-effects of salt and water retention or hypokalaemia were noted in over a quarter of those receiving the carbenoxolone capsules, but none of the adverse effects was severe enough to necessitate withdrawal of treatment.

Adult↗
PubMed2006

Comparison of esophageal acid exposure at 1 cm and 6 cm above the squamocolumnar junction using the Bravo pH monitoring system.

The aim of this study was to assess the quantitative differences of acid exposure at 1 cm and 6 cm above the squamocolumnar junction (SCJ) using two radiotelemetry pH capsules affixed to the esophageal mucosa. Ten normal subjects and 10 endoscopy-negative gastroesophageal reflux disease (GERD) patients without hiatus hernia (ages 20-54, 12 male) were studied for a 24-h period using the Bravo pH monitoring system. pH capsules were placed 1 cm and 6 cm above the SCJ. Interpretable data for at least 14 h was obtained in 18 of the 20 subjects (9 normal, 9 GERD). Two failures occurred secondary to early capsule dislodgement. Median esophageal acid exposure was significantly increased at 1 cm above the SCJ compared to 6 cm above the SCJ during the total, upright and postprandial time periods in both normal and GERD subjects. During a 2 h postprandial period the esophageal acid exposure was 8-fold greater in GERD subjects and 5-fold greater in normal subjects 1 cm above the SCJ compared to 6 cm above the SCJ. Confident measurement of esophageal acid exposure at a fixed position 1 cm above the SCJ is feasible with the Bravo system. Acid exposure was significantly higher 1 cm above the SCJ compared to 6 cm above the SCJ in both GERD patients and controls. These findings suggest that measurement of acid exposure 1 cm above the SCJ may improve accuracy of pH monitoring by detecting acid reflux events confined to the distal esophagus.

Adult↗
PubMed1987

Gastroscopic localization of a microencapsulated KCl preparation in the human stomach.

A slow release polymer-coated preparation of potassium chloride granules (Micro-K Extencaps) was initially thought not to be associated with gastric mucosal damage. Recent studies have shown that acute gastric ulcers occur with approximately the same frequency as in patients taking wax matrix KCl formulations. The development of acute gastric ulcers was not consistent with the proposed dispersion characteristics of the microencapsulated KCl preparation. The authors therefore endoscopically evaluated the dispersion characteristics of microencapsulated KCl in a double-blind, placebo-controlled study. Subjects received four capsules of Micro-K or matching placebo and endoscopy was performed 30, 60, or 120 min after each drug ingestion. The material was identified with the Olympus HM (high magnification) endoscope and then quantitatively aspirated using the 3.5-mm biopsy channel of the Pentax 34JA endoscope. Microencapsulated KCl particles dispersed poorly and were found adhering to the mucosa and to one another, as a semisolid mass, most frequently in the gastric antrum. In contrast, the placebo (ethyl cellulose) was widely dispersed throughout the stomach. The authors concluded that gastric emptying must be considered in three phases: liquids, solids, and solids which adhere to the mucosa. No unique dispersion characteristics of Micro-K Extencaps were identified, and adherence of the KCl to the gastric mucosa may explain its ability to cause occasional acute gastric ulceration.

Adult↗
PubMedDate not supplied

[Evaluation of small intestine mucosal biopsies obtained simultaneously by suction capsule and endoscopic forceps in children with suspected enteropathy].

The aim of the study was to compare biopsy specimens obtained by suction with those obtained by endoscopy morphometrically and histologically in order to evaluate their adequacy for histological interpretation. For this, 23 children with suspected enteropathy underwent upper gastrointestinal endoscopy. For histological evaluation, biopsies were assessed for orientation, depth, length, presence of Brunner's glands and/or lymphoid follicles and presence of artifact. The mucosa total height and villi height were evaluated for morphometric assessment. The results of all the analysed parameters were not statistically significant, except for the presence of Brunner's glands that were most evident in endoscopic biopsies. Although, the suction capsule biopsies and the endoscopic ones were appropriate for histological interpretation in 91.3% respectively, the difference was not statistically significant. Based on the morphometric analysis, the mucosa total height and the villi height values in both biopsy techniques were not statistically significant different. The small intestine mucosal biopsies obtained by endoscopy compared with those obtained by suction capsule were adequate for histological interpretation.

Adolescent↗
PubMed1988

[Intestinal biopsy: fiberscopy or Watson's capsule?].

We compared the results of 100 fiberendoscopic small bowel biopsies (F) with those of 100 Watson capsule biopsies (W). Three to 6 specimens were obtained during endoscopy. The F biopsy fragments were deeper than the W biopsies (P less than 0.001). The F biopsies were more often located in the duodenum than the W biopsies. The failure rate of the F biopsies (3%) was lower than for the W biopsies (12%): P less than 0.02. Multiple biopsies increased the diagnostic value of fiberendoscopy, which was 85% in our experience versus 77% for Watson capsule. The duration of the endoscopic procedure, available in 15 children, was 6.5 min for 4 to 6 samples, i.e. 1.5 min by specimen. Small bowel fiberendoscopy appears to be a safe and accurate method for performing small bowel biopsies in infants and children.

Adolescent↗
PubMed1997

Anterior interosseus nerve injury following elbow arthroscopy.

Elbow arthroscopy is becoming an increasingly invaluable tool for both evaluation of and treatment of a variety of interarticular disease processes. Case reports have documented radial and posterior interosseus injuries following anterior capsular release. To date, this is the first report of an anterior interosseus nerve injury following arthroscopic surgery of the elbow. Arthroscopic surgery offers unparalleled visualization of the multiple articulations and facets of the elbow. It has been reported as useful for removal of loose bodies, synovectomy, release of arthrofibrosis, and the treatment of osteochondritis dessicans. However, the technique does require thorough knowledge of neurovascular structures about the elbow as well as appreciation of the protective layers including the capsule, brachialis, and brachioradialis muscles. This report documents direct injury to the anterior interosseus branch of the median nerve during an elbow debridement and synovectomy in a 65-year-old patient with rheumatoid arthritis.

Aged↗
PubMed2005

Wireless oesophageal pH monitoring: feasibility, safety and normal values in healthy subjects.

OBJECTIVE: A new wireless technique for oesophageal pH monitoring has recently been introduced (Bravo). To implement this technique in clinical practice, values of normal oesophageal acid exposure need to be defined in a large age- and gender-matched healthy population. The aims of this study were to investigate the feasibility and safety of the wireless technique and to establish normal values for oesophageal acid exposure. MATERIALS AND METHODS: Fifty-seven asymptomatic subjects underwent upper gastrointestinal endoscopy with transoral placement of a radio-transmitting capsule 6 cm above the squamocolumnar junction. Oesophageal acid exposure was monitored via a portable receiver during 48 h. RESULTS: Seven men were excluded from the study: capsule dysfunction in 1 and oesophagitis in 6. Fifty subjects (25 M, 25 F, median age 42 years) were included in the study. The radio-transmitting capsule was successfully attached to the oesophageal mucosa in all cases and there were no complications. During pH monitoring 2 capsules were prematurely detached after 32 and 36 h, respectively. The median percentage time with oesophageal pH of less than 4 was 0.7% on day 1 and 1.0% on day 2 (p = 0.033) and the 95th percentile for the 48-h recordings was 4.4%. CONCLUSIONS: Ambulatory pH monitoring using the Bravo system is feasible and appears to be safe. This is the first study to establish normal values for oesophageal acid exposure in a large age- and gender-matched healthy population and offers a basis for the use of the wireless technique in clinical practice.

Adult↗
PubMed1998

Tensile properties of the knee-joint capsule at an elevated intraarticular pressure.

In order to evaluate the capsular reaction to high intraarticular pressure (IAP) in the knee during arthroscopy, we examined 13 patients admitted for elective surgery with joint infusion to 30, 70, 120 and 170 mmHg IAP (4, 9.3, 16 and 22.7 kPa). The infusion was repeated once, at all IAP levels except 30 mmHg, after 2 min and was recorded for another 2 min. A pressure-time curve was recorded as a combined effect of viscoelastic properties of the capsule and extraarticular fluid absorption. 3 more knee joints were infused directly to 170 mmHg and a pressure-time curve was recorded for 15 min, after which time the joint was reinfused to 170 mmHg in order to estimate the change in joint volume due to absorption or relaxation. In 10 knees, the curves were uniform. At infusion, the pressure curve was almost linear above 70 mmHg. There were no signs of plastic deformation of the joint capsule at pressures below 120 mmHg, while at 170 mmHg there were signs of capsular deformation. At each pressure level, the curve revealed a rapid fall in initial pressure that gradually decreased because of capsular relaxation or fluid absorption. Repeated infusion delayed the fall in pressure, due to increased capsular stiffness. In 3 knees infused directly to 170 mmHg IAP, the slope for the first 2 min of the pressure-time curve did not differ from that found at maximal IAP in knees examined with stepwise increasing pressures. Discontinuity of the capsule, even of puncture size, influenced the pressure/volume correlation considerably. We conclude that at IAP levels of 170 mmHg, there are signs of plastic deformation of the joint capsule. In order to avoid capsular damage, knee arthroscopy should be done at intraarticular pressure levels below 120 mmHg.

Absorption↗
PubMed2006

Endoscopic removal of the wireless pH monitoring capsule in patients with severe discomfort.

BACKGROUND: Few patients have significant symptoms during wireless esophageal pH monitoring, and the capsule typically sloughs spontaneously. Severe discomfort during monitoring can occur that requires endoscopic dislodgement of the capsule. OBJECTIVE: To determine the frequency with which endoscopic capsule dislodgement is required and the outcomes of the intervention. DESIGN: Chart review. SETTING: University-based outpatient endoscopy facility. PATIENTS: A total of 452 consecutive patients undergoing wireless pH monitoring over a 3.5-year period. INTERVENTIONS: Endoscopic dislodgement of the capsule by using nudging with the endoscope tip and cold snare techniques. RESULTS: Eight subjects (1.8%) required endoscopic capsule dislodgement because of severe chest pain or odynophagia (n = 7) or severe foreign-body sensation (n = 1). Chest pain was the initial indication for pH monitoring in 5 (62.5%) of the subjects. Initial nudging with the endoscope tip successfully dislodged 2 capsules; continued nudging produced mucosal stripping in 3 subjects, which required hemostasis in 1. A cold snare was used successfully, without complication, to separate the capsule from stripped mucosa and as a primary removal method in the remainder of subjects. Capsule removal uniformly resulted in marked improvement of discomfort. CONCLUSIONS: Endoscopic removal of the capsule was required in <2% of subjects who underwent wireless pH monitoring. Separation of the capsule from the mucosa with a cold snare may be the preferred method of accomplishing uncomplicated removal.

Adult↗
PubMed2004

Chronic diarrhea.

Explore the source record for details and available documents.

Capsules↗
PubMedDate not supplied

Glenohumeral joint translation after arthroscopic, nonablative, thermal capsuloplasty with a laser.

The purpose of this study was to determine whether there are changes in anterior and posterior glenohumeral translation after arthroscopic, nonablative, thermal capsuloplasty with a laser. Two anteriorly and two posteriorly directed loads were sequentially applied to the humerus of nine cadaveric glenohumeral joints, and anterior and posterior translation of the humerus on the glenoid was measured. The glenoid was rigidly fixed, and the glenohumeral joint was positioned simulating 90 degrees of shoulder abduction and 90 degrees of external rotation. Using the holmium:yttrium-aluminum-garnet laser, thermal energy was then applied to the anterior capsuloligamentous structures and anterior and posterior translation measurements were then repeated. The results showed a significant reduction in anterior and posterior translation after laser anterior capsuloplasty. Anterior translation decreased from 10.9 +/- 2.0 mm (mean +/- SEM) to 6.4 +/- 1.5 mm with the 15-N load; and from 13.4 +/- 2.1 mm to 8.9 +/- 1.8 mm with the 20-N load. Posterior translation decreased from 7.2 +/- 1.2 mm to 4.4 +/- 0.6 mm with the 15-N load and from 10.4 +/- 1.4 mm to 6.5 +/- 0.9 mm with the 20-N load. These results indicate that the holmium:yttrium-aluminum-garnet laser can be used to decrease glenohumeral joint translation and may be an effective treatment for glenohumeral joint instability.

Aged↗
PubMed1992

Esophageal ulceration following doxycycline ingestion.

Esophageal ulceration occasionally occurs in patients taking doxycycline capsules or tablets. In the case described here, examination of biopsy specimens obtained at endoscopy showed polarizable matrix material in the ulcer bed, thus confirming the diagnosis.

Adult↗