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PubMed1980

Arthroscopy in acute trauma of the knee joint.

Even in massive hemarthrosis, arthroscopy of the acutely injured knee joint can be performed. The procedure is indicated in all cases where clinical findings and radiography cannot establish a clear diagnosis or a clear indication for operation. Hemarthrosis of unknown origin should be investigated in every case. An additional indication for arthroscopy is planned arthroscopic operation. In a series of 1000 arthroscopies, the examination was performed in 76 patients in the acute stage after trauma. In most knee joints several injuries were found; the most frequent being tears of the menisci, cartilage lesions, ruptures of the anterior cruciate ligament and tears of the joint capsule. 24 cases were treated by arthroscopic operation: 13 partial meniscectomies were performed in acute blocking of the knee and in 8 cases a detached chondral or osteochondral fragment was removed. 29 cases required arthrotomy. Post-operative morbidity of arthroscopic operation is surprisingly low. Patients were not hospitalized for diagnostic or operative arthroscopy.

Cartilage, Articular↗
PubMed1979

Correlative evaluation of angiography and pancreatoductography in relation to surgery for cancer of the pancreas.

The results of preoperative angiograms and pancreatoductograms in 37 patients with cancer of the pancreas were correlated with each other, with the findings at laparotomy, and with survival times. Tumors which could not be detected by arteriography and/or pancreatography were resectable, except for those located in the uncinate process. Among the resectable tumors, those which were identified only by pancreatography were confined mostly to the parenchyma of the pancreas and were nearly 2 cm in size. Those patients were expected to have a long survival after total pancreatectomy. In contrast, those tumors which were diagnosed only by arteriography arose from the subcapsular portion of the gland or the uncinate process and showed macroscopic invasion to the capsule of the pancreas. These tumors, recurred within 1 year, despite total pancreatectomy. The resectable tumors showing both vascular and ductal invasion were more than 3 cm in size and extended far beyond the capsule of the gland, and patients with these tumors died within 1 year after operation. In this group no difference in survival time was seen among those treated by the Whipple procedure, those by total pancreatectomy, or those by resection of the total pancreas and the portal vein.

Adult↗
PubMed1999

The 13C urea breath test in the diagnosis of Helicobacter pylori infection.

The urea breath test (UBT) is one of the most important non-invasive methods for detecting Helicobacter pylori infection. The test exploits the hydrolysis of orally administered urea by the enzyme urease, which H pylori produces in large quantities. Urea is hydrolysed to ammonia and carbon dioxide, which diffuses into the blood and is excreted by the lungs. Isotopically labelled CO2 can be detected in breath using various methods. Labelling urea with 13C is becoming increasingly popular because this non-radioactive isotope is innocuous and can be safely used in children and women of childbearing age. Breath samples can also be sent by post or courier to remote analysis centres. The test is easy to perform and can be repeated as often as required in the same patient. A meal must be given to increase the contact time between the tracer and the H pylori urease inside the stomach. The test has been simplified to the point that two breath samples collected before and 30 minutes after the ingestion of urea in a liquid form suffice to provide reliable diagnostic information. The cost of producing 13C-urea is high, but it may be possible to reduce the dosage further by administering it in capsule form. An isotope ratio mass spectrometer (IRMS) is generally used to measure 13C enrichment in breath samples, but this machine is expensive. In order to reduce this cost, new and cheaper equipment based on non-dispersive, isotope selective, infrared spectroscopy (NDIRS) and laser assisted ratio analysis (LARA) have recently been developed. These are valid alternatives to IRMS although they cannot process the same large number of breath samples simultaneously. These promising advances will certainly promote the wider use of the 13C-UBT, which is especially useful for epidemiological studies in children and adults, for screening patients before endoscopy, and for assessing the efficacy of eradication regimens.

Breath Tests↗
PubMedDate not supplied

A clinical case of duodenal gastrointestinal stromal tumor with a peculiarity in the surgical approach.

We describe a case of duodenal, third portion, segmental resection for gastrointestinal stromal tumor. A 76-year-old man was referred for gastrointestinal bleeding, dyspnea and asthenia. Esophagogastroduodenoscopy showed a duodenal bleeding fistula. Computerized tomography demonstrated a retroperitoneal mass that compressed and displaced forward the third duodenal tract. Segmental resection of the third portion of the duodenum with a subtotal gastrectomy was performed. The patient was reconstructed with a termino-terminal duodenal anastomosis of the second and the fourth tract and with a Roux-en-Y gastrojejunum anastomosis. There were no postoperative complications. This duodenectomy procedure could be useful as a less extensive resection for duodenal gastrointestinal stromal tumor located in the third portion of the duodenum when the tumor is well capsulated, when the surrounding structures are not infiltrated and when there are no vascular difficulties. The technique reduces the morbidity and mortality correlated with duodenocefalopancreasectomy and improves postsurgical quality of life without worsening the risk of recurrence.

Aged↗
PubMed2002

Staged endoscopic operation for large pituitary adenomas.

The advantages of endoscopic transnasal pituitary surgery include a panoramic view of the area and easy reoperation. Based on this, we performed a planned staged operation in two cases of large pituitary adenomas, extending to the suprasellar lesion, using the endoscopic transnasal trans-sphenoidal approach via both nostrils. In the initial operation, a tumour mass was from the intrasellar region, however, that part of it in contact with the tumour capsule was left intact for prevention of peri-operative injury. The residual mass descended into the sellar floor at the second operation, and was easily resected with no complications. A staged operation by the endoscopic transnasal approach, although it requires two operations, is thought to be a safe and efficient procedure for the removal of large pituitary tumours.

Adenoma↗
PubMed2003

Medication-induced oesophageal disorders.

Medication-induced oesophageal distress and injury have become increasingly common conditions. First, smooth muscle relaxants may worsen or produce symptoms of pre-existing gastro-oesophageal reflux disease; notable examples include certain calcium antagonists (nifedipine), nitrates, sildenafil, nicotine, theophylline, and substances with antimuscarinic potential. Second, drugs with local toxicity may produce de novo damage including inflammation, strictures, ulcers, and bleeding. Notorious examples are alendronate, certain antibiotics including tetracyclines and clindamycin, all NSAIDs/aspirin, quinidine, potassium chloride, and ferrous sulfate. Cyclooxygenase-2 inhibitors may be devoid of such toxicity, but may damage the mucosa by interfering with regenerative cell proliferation. The galenic formulation can modulate the risk of oesophageal injury. For this reason, medicines containing the same potentially toxic ingredient may be less exchangeable than commonly thought. Diagnostic gold standard is endoscopy. The best treatment is removal of the offending drug and supportive care. Prevention requires a re-appraisal of the drug's indication and adherence to guidelines of optimal drug intake including ingestion in an upright position and swallowing with enough fluid. The clinical relevance of drug-induced oesophageal injury and the feasibility of therapeutic alternatives are individually addressed.

Administration, Oral↗
PubMed2000

Inflammatory fibroid polyp of the esophagus.

The case of a 76-year-old woman with a submucosal tumor of the esophagus, whose principal symptoms were dysphagia and epigastric/retrosternal pain, is reported here. Endoscopy, barium swallow and a CAT scan all pointed to extramucosal localization. The lesion was located in the lower esophagus lying on the stomach fundus. An ulcer in the region of the cardia complicated the tumor. Two sets of conventional biopsies failed to detect malignancy, only inflammation and intestinal metaplasia were seen in the specimens of the mucosa surrounding the ulcer. The endoscopic ultrasonographic findings were an indistinct margin, hypoechogenicity, homogeneous appearance and location within the second and third echographic layer. The surgical resection of the tumor was complemented by an anterior partial fundoplication. The histologic study revealed an inflammatory fibroid polyp, which is a rare, benign, non-capsulated submucosal lesion composed mainly of loose connective tissue and vessels, with an eosinophilic inflammatory component. This lesion is seldom found in the esophagus.

Aged↗
PubMed1997

Isolated tears of the triangular fibrocartilage: management by early arthroscopic repair.

To evaluate the efficacy of arthroscopic repair of the triangular fibrocartilage complex (TFCC) tears treated within 4 months after injury, functional outcome after repair was determined following arthroscopic repair in 24 patients. The patients' average age was 31 years (range, 22-38 years); the average follow-up period was 34 months (range, 26-48 months). All patients had wrist pain limiting their participation in work prior to surgery. Patients with central attrition tears identified by arthroscopy were excluded from the study. Twenty-three patients had a preoperative arthrogram. Twelve of the patients with positive arthrogram findings had an avulsion of the TFCC from the sigmoid notch (Palmer type 1D tears). Of the eleven patients with negative arthrograms, 10 had ulnar tears in capsular attachments of the TFCC. The ulna variance averaged 0.2 mm +/- 0.6 mm. Separate arthroscopic techniques were developed for reattaching the TFCC to the radius (nine patients) versus to the peripheral capsule on the volar or ulnar side of the wrist (eight patients). Postoperatively, there was a significant relief of pain (p < .01). Postoperative range of motion averaged 89% +/- 9% SD of the contralateral side, and grip strength averaged 85% +/- 20% SD of the contralateral side. Thirteen of the 19 patients returning to work did so in their original jobs.

Adult↗
PubMed1998

A new guide system for posteromedial portal in arthroscopic knee surgery.

A view through the posteromedial portal is necessary to observe the posterior portion of the knee joint such as the tibial attachment of the posterior cruciate ligament (PCL) or the posterior horn of the medial meniscus, which is barely, visible through anterior portals. Especially in arthroscopic PCL reconstruction, the arthroscopic view through the posteromedial portal is indispensable for boring a tibial bone tunnel that is correctly sited. However, it is difficult to create this portal safely without cartilaginous or meniscal damage. We have produced new guidelines to facilitate the process of creating the posteromedial portal even by inexperienced hands. With a cannulated K-wire and a cannulated rod with sharp teeth, the joint capsule of the posteromedial corner can be penetrated safely with or without viewing the posteromedial corner through the anterolateral portal. Based on our experience of using this guide system, we believe it will be a great help to many orthopaedic surgeons in performing various types of arthroscopic surgery, not only for PCL reconstruction but also for arthroscopic synovectomy.

Arthroscopes↗
PubMed1987

CO2 laser laparoscopy in infertile women with endometriosis and women with adnexal adhesions.

One hundred twenty-four infertile women either with endometriosis (n = 70) or with adnexal adhesions (n = 54) were treated with the carbon dioxide laser used laparoscopically and were followed for 18 months. Removal of endometriotic implants, vaporization of endometrioma capsules, and lysis of adnexal adhesions was accomplished. Postoperative pregnancy rates were as follows: 57% for patients with endometriosis (mild, 62%; moderate, 52%; severe, 42%) and 57% for patients with adnexal adhesions. No serious complications requiring laparotomy were encountered. When performed, second-look laparoscopy confirmed efficient removal of endometriosis.

Biopsy↗
PubMed1999

Endoscopic treatment of symptomatic septum pellucidum cysts: with some preliminary observations on the ultrastructure of the cyst wall: two technical case reports.

OBJECTIVE AND IMPORTANCE: We describe two patients with symptomatic septum pellucidum cysts managed by endoscopic fenestration. In each case, tissue from the cyst wall was studied to define the origin of the cyst wall and fluid. CLINICAL PRESENTATION: The patients, a 6-year-old boy and a 42-year-old man, each presented with headaches and a syncopal episode. Imaging studies demonstrated large septum pellucidum cysts with obstruction of the foramina of Monro. INTERVENTION: The patients underwent endoscopic transventricular cyst fenestration with a 4-mm steerable fiberscope. The fenestrations were created to allow communication with the right and left lateral ventricles. In one patient, adhesions between the cyst wall and the foramen of Monro were lysed with endoscopic monopolar cautery. Tissue from the cyst walls was removed for examination by electron microscopy. Postoperatively, the headaches and syncopal episodes resolved in both patients. CONCLUSION: Endoscopic fenestration of symptomatic septum pellucidum cysts produces immediate relief of the mass effect of the cyst and resolution of associated symptoms. Cannulation of the lateral ventricle before cyst fenestration prevents inadvertent injury to the fornices, thalamus, internal capsule, caudate nucleus, and septal and thalamostriate veins. The endoscopic approach allows the surgeon to ensure communication within the ventricular system, thus avoiding placement of a shunt. Preliminary ultrastructural analysis indicates that the cyst walls derive from the septum pellucidum rather than the choroid plexus or arachnoid. The cellular machinery necessary for fluid secretion was identified in some specimens.

Adult↗
PubMed1982

Ambulatory monitoring of oesophageal pH in reflux oesophagitis using a portable radiotelemetry system.

Gastro-oesophageal reflux has been assessed in 10 symptomatic patients and 10 asymptomatic normal subjects during a study period of 24 hours at work and in the home using a newly developed pH sensitive radiotelemetry capsule and a portable receiving system. Oesophageal pH was continuously monitored by the tethered radiotelemetry capsule and recorded with a portable receiver and a 24-hour cassette recorder, allowing the patient complete freedom of movement so that ambulatory studies could be undertaken during a normal working day. The number and duration of reflux episodes was greater in symptomatic patients than normal subjects during 24-hour studies at home (p less than 0.002). In both groups, reflux occurred more during the day than at night (p less than 0.01). Patients refluxed significantly more at home than when they were in hospital (p less than 0.01). Ambulatory outpatient oesophageal pH monitoring may be useful in the management of patients with atypical symptoms and may demonstrate significant reflux when inpatient investigations and endoscopy findings show minimal abnormality.

Adult↗
PubMed1983

Effects of fenbufen, indomethacin, naproxen, and placebo on gastric mucosa of normal volunteers. A comparative endoscopic and photographic evaluation.

The effects of fenbufen (1,000 mg a day), indomethacin (150 mg a day), naproxen (750 mg a day), and placebo on gastric mucosa were determined by endoscopy and recorded photographically. One hundred normal subjects, randomly divided into equal, parallel-treatment groups, were given the drugs in divided daily doses for seven consecutive days. The results revealed that the effects of fenbufen on gastric mucosa were significantly (p less than or equal to 0.05) less than those of either naproxen or indomethacin and not statistically different from those observed with placebo.

Adult↗
PubMed1988

YAG laser treatment of early carcinoma of the prostate.

We describe our initial experience of a method which develops the role of endoscopic surgery in the treatment of early prostatic carcinoma. An "extended" transurethral resection of the prostate (TURP) under ultrasound control reduces the prostatic tissue to a thin residual capsule suitable for subsequent transmural coagulation by endoscopic YAG laser. Twenty patients with early disease were entered into the pilot study. Three were excluded after staging (2 T0a and 1 with positive nodes on pelvioscopy-T2 N1 M0); 17 received a full course of treatment. Mean follow-up was 6 months (range 1-14). Two early patients with excessive residual tissue had initially positive biopsies and underwent second treatments with subsequently negative biopsies. Two patients continue to have positive biopsies and the rest are negative. No tumour has progressed and complications have been minimal. One patient experienced reduced frequency of erections and 1 required bladder neck incision for symptomatic bladder neck stenosis at routine follow-up endoscopy. There were no other effects on either potency or continence.

Adult↗
PubMed2001

Endoscopic vitreoretinal surgery for complicated proliferative diabetic retinopathy.

PURPOSE: To evaluate the indication for endoscopic vitreoretinal surgery in proliferative diabetic retinopathy (PDR). METHODS: Chart review of consecutive cases of vitreoretinal surgery for PDR performed by one of the authors (Y.L.F.) over a 2-year period. RESULTS: Endoscopic vitreoretinal surgery was performed in 8 of 41 (19.5%) eyes. The surgical indications were small pupil (3), hyphema (3), pseudophakia with fibrotic posterior capsule (1), and pars plana neovascularization with anterior tractional retinal detachment (6). CONCLUSION: Endoscopic vitreoretinal surgery, by enhancing the visualization of the retroirideal space, is a useful technique in PDR with opaque ocular media and/or neovascularization of the pars plana and ciliary body.

Adult↗
PubMed1994

Evaluation of polydimethylsiloxane as an alternative in the endoscopic treatment of vesicoureteral reflux.

Endoscopic correction of vesicoureteral reflux is an attractive alternative to open repair. In terms of effectiveness and long-term successful results polytetrafluoroethylene (Polytef) is the most reliable injectable product. However, legitimate concerns regarding particle migration still exist for polytetrafluoroethylene. Polydimethylsiloxane (Macroplastique) was evaluated as an alternative to polytetrafluoroethylene. Seven mongrel female dogs underwent endoscopic suburothelial injections of 0.35 to 0.50 cc polydimethylsiloxane paste by the O'Donnell technique to a unilateral nonrefluxing ureteral orifice. To facilitate migratory surveillance the paste was mixed with 57carbon monoxide radiolabeled 80 microns. microspheres and injected in 5 of the 7 animals. Animals were sacrificed at 1, 3 and 6-month intervals. All major organs were retrieved and processed. After intensive histological evaluation the remaining tissue underwent dissolution and centrifugation in sodium hypochlorite. The resulting insoluble pellet was further analyzed. In dogs injected with radiolabeled paste tissue samples and insoluble pellets of each organ system were analyzed for gamma counts. Smears of the insoluble pellets of all animals were examined on light and phase contrast microscopy. At autopsy no gross abnormalities were noted. Tissue reaction at injection sites revealed a well encapsulated foreign body reaction with predominantly giant cells, fibroblasts and collagen deposition. Limited local migration of polydimethylsiloxane particles into the periureteral lymphatics of 1 animal sacrificed at 1 month was noted and a single particle visually indistinguishable from polydimethylsiloxane also was found within the splenic capsule. The endoscopic procedure in this animal was complicated in that 2 separate injections were required and histological evaluation confirmed that the injections were performed uniquely deep into the bladder muscularis. Radioactive counts and dissolution of all major organ systems demonstrated no migration in the remaining 6 animals. Endoscopic subureteral injection of polydimethylsiloxane is technically feasible, and it may prove to be biocompatible and without risk of distant migration if injected correctly.

Animals↗
PubMedDate not supplied

[Acute renal insufficiency after endoscopic surgery of the prostate and urethra].

The authors report 7 cases of acute renal failure after prostatic (6 cases) and urethral (1 case) endoscopic surgery from May 1987 to March 1988, corresponding to 3.9% of total endoscopic prostatic resections achieved in the same period. Benign prostatic hyperplasia was the finding in all cases of prostatic resection. The middle weight of adenomas was 40g. Intraoperative hypotension was observed in 5 cases (71%), severe bleeding in the immediate postoperative in 1 (14%), perforation of prostatic capsule in 2 (33%) and surgical time longer than 1 hour in 3 (42%). It was concluded that acute renal failure was caused by one or more of the following factors: preoperative dehydration in old patients with a possible previous renal lesion; prolonged surgical time (more than 1 hour), excessive bleeding, prolonged intraoperative hypotension and use of potentially nephrotoxic drug.

Acute Kidney Injury↗
PubMedDate not supplied

Epiglottic augmentation in the horse.

Epiglottic augmentation with injectable bovine collagen or an autogenous or allogenous auricular cartilage graft was performed in 12 horses with endoscopically and radiographically normal epiglottises. The grafting procedures were easy to perform and did not cause apparent discomfort. Cartilage graft extrusion or resorption may have occurred, but was not seen by endoscopy and lateral laryngeal radiography. Only collagen implants remained evident endoscopically, as smooth round submucosal bulges ventral to the epiglottic cartilage. Two horses with collagen implants, and all horses with cartilage autografts and allografts, were euthanatized at week 16. One horse with a collagen implant was euthanatized at week 4 and one at week 6. The epiglottis appeared thickened in three horses with collagen implants, two horses with autogenous grafts, and three horses with allogenous grafts. Pharyngeal lymphoid tissue was hyperplastic in two horses with autografts and three horses with allografts, but not in horses with collagen implants. Collagen grafts persisted as one or two smooth bulges 8 mm in diameter. Collagen incited a brisk foreign body reaction that was surrounded by a fibrous connective tissue capsule. Epiglottises of the horses with collagen implants were significantly thicker 20 mm from the tip than those of normal horses and horses with allografts. Cartilage graft incorporation was not evident grossly and was seen on microscopic examination in only one autograft. Thickening was caused by submucosal fibrosis.

Animals↗