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At least 19 recordsLinked to original sources
PubMed1986

[Laparotomy indications in pelvic fractures].

Infra-umbilical abdominal section concomitant with peritoneal lavage was applied to 74 patients with pelvic fracture and has proved to be helpful in early diagnosis of intra-abdominal organ injuries. However, the percentage of falsely positive results was found to be as high as 17.3 per cent, in the context of pelvic fractures. This has been attributable to the fact that the pelvic floor is likely to be elevated by the haematoma caused by a pelvic fracture, and the syringe may thus get accidentally into the haematoma.

Fractures, Bone↗
PubMed1977

The influence of stress and stress hormones on the transplantability of a non-immunogenic syngeneic murine tumor.

Quantitative transplantation assays of a syngeneic murine adenocarcinoma have been used to investigate the effects of stress hormones and tumor take probability. Cortisol, injected intraperitoneally one hour before and 3 hours after tumor cells, caused a dose dependent reduction of TD50 (number of tumor cells required for 50% takes) by factors of from 4 at a total dose 4 microng/g to 68 at 400 microng/g. ACTH, given at 0.2 I.U. daily for 9 days spanning the time of tumor cell injection, reduced the TD50 2.5-fold, indicating that the peak gluco-corticoid level achieved, rather than its duration, was of greater significance. Adrenaline, while much less effective than cortisol, produced an 8-fold reduction in TD50 at its maximum tolerable dose. The effect of cortisol simulated that of whole body irradiation (WBI), and while both these agents depress immune reactivity, evidence is presented to suggest that immunological mechanisms are not responsible for their effect. WBI constitutes a systemic stress, and the demonstration that surgical trauma (laparotomy) could also reduce the TD50 for this tumor suggested that both might act via endogenous glucocorticoids. However, the failure of prior total adrenalectomy of mice to abrogate the effect of either WBI or laparotomy indicated that stress hormones were not essential intermediaries. It is concluded that both stress hormones, especially glucocorticoids, and stressful procedures acting independently of stress hormones, can facilitate tumor transplantation.

Adrenal Glands↗
PubMed2000

Barrier agents for preventing adhesions after surgery for subfertility.

BACKGROUND: Pelvic adhesions can be the result of inflamation, endometriosis or surgical trauma. Prevention of postoperative adhesions (either new or reoccurance) has been postulated by using barriers to prevent two surfaces being in contact. When pelvic surgery is being undertaken strategies to reduce pelvic adhesions occurring may be undertaken and these include barrier agents which are placed between the pelvic structures. Two synthetic barriers with differential characteristics are commercially available: oxidised regenerated cellulose (Interceed) and polytetrafluoroethylene (PTFC) (GoreTex). OBJECTIVES: The objective of this review was to assess the effect of mechanical barriers (materials interposed between pelvic structures to prevent adherence of serosal surfaces) used during pelvic surgery in women of reproductive age on pregnancy rates, pelvic pain, or postoperative adhesion reformation. SEARCH STRATEGY: The Cochrane Menstrual Disorders and Subfertility Group specialised register of controlled clinical trials was undertaken. In addition, companies were contacted for unpublished trials. SELECTION CRITERIA: Randomised controlled trials or controlled clinical trials of barriers versus no treatment or other barriers in women undergoing fertility preserving pelvic surgery. DATA COLLECTION AND ANALYSIS: Reviewers assessed eligibility and trial quality. MAIN RESULTS: 15 randomised controlled trials were included. Five trials randomised patients while the remainder randomised pelvic organs. Laparoscopy was the primary surgical technique in six trials while the remaining trials were laparotomy. Indications for surgery included myomectomy (five trials), ovarian surgery (four trials), pelvic adhesions (six trials), endometriosis (two trials) and mixed (one trial). Thirteen trials assessed Interceed versus no treatment, two assessed Interceed versus Gore-Tex, one trial assessed Gore-Tex versus no treatment, and one trial assessed Seprafilm versus no treatment. No study reported pregnancy or reduction in pain as an outcome. The use of Interceed in women was associated with reduced incidence of pelvic adhesion formation, both new formation and re-formation following laparoscopic surgery and after laparotomy. Gore-Tex was more effective than no barrier or Interceed in preventing adhesion formation. There was limited evidence that Seprafilm was effective in preventing adhesion formation in women following myomectomy. REVIEWER'S CONCLUSIONS: The absorbable adhesion barrier Interceed reduces the incidence of adhesion formation, both new formation and re-formation, at laparoscopy and laparotomy, but there are insufficient data to support its use to improve pregnancy rates. Gore-Tex may be superior to Interceed in preventing adhesion formation but its usefulness is limited by the need for suturing and later removal. There was no evidence of effectiveness of Seprafilm in preventing adhesion formation.

Cellulose, Oxidized↗
PubMed1994

A method for radiologic-assisted gastrostomy when percutaneous endoscopic gastrostomy is contraindicated.

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) has been established as a faster and safer procedure than open surgical gastrostomy. It cannot be done, however, for many patients with partially obstructing pharyngeal or esophageal carcinoma, previous gastrectomy, upper abdominal surgery, or bowel distension from distal obstruction. PATIENTS AND METHODS: We attempted percutaneous radiologic-assisted gastrostomy (RAG) in 231 patients referred for gastrostomy, 38 of whom had a relative contraindication for PEG. The procedure involves passing, under radiologic guidance, an orogastric inflation tube that contains a snare. We used a 5-inch long, 18-gauge needle to transabdominally insert a wire into the stomach, avoiding loops of bowel visualized by air contrast. Retrieving the transabdominal wire by snare allowed retrograde passage of the gastrostomy tube as done in standard PEG. RESULTS: The procedure was successful in 230 of 231 cases, including 37 of the 38 patients with contraindications. We could not gain gastric access in 1 patient with a 75% gastrectomy. Overall, 6 patients developed complications and 1 died. There was no procedure-related morbidity or mortality in the patients with contraindications to PEG who underwent successful RAG. Subsequent laparotomy indicated tube passage through the liver in 2 of these cases and small bowel mesentery in 1 case without clinical problems. We performed a percutaneous jejunostomy in the efferent limb of the gastrojejunostomy in 1 patient with a previous gastrectomy. CONCLUSION: The snare technique is simpler and faster than the usual radiologic gastropexy technique, and safer than an endoscopic procedure. It has become our procedure of choice for gaining gastric access.

Adolescent↗
PubMed1999

Life-threatening haemorrhage following obturator artery injury during transurethral bladder surgery: a sequel of an unsuccessful obturator nerve block.

In spite of prior blockade of the obturator nerve with 1% mepivacaine (8 ml) utilizing a nerve stimulator, violent leg jerking was evoked during transurethral electroresection of a bladder tumour approximately 1 h after the blockade in a 68-year-old man. The patient became severely hypotensive immediately following the jerking, and a large lower abdominal swelling concurrently developed. The urgent laparotomy indicated that the left obturator artery was severely injured by the resectoscope associated with the bladder perforation, causing acute massive haemorrhage. The patient recovered uneventfully after adequate surgery. Investigation of the literature suggested that both our nerve stimulation technique and anatomical approach were appropriate. It was therefore unlikely that our block resulted in failure because of an inappropriate site for deposition of the anaesthetic. However, consensus does not appear to have been obtained as to the concentration and volume of the anaesthetic necessary for prevention of the obturator nerve stimulation during the transurethral procedures. The concentration and volume of mepivacaine we used might have been too low and/or small, respectively, to profoundly block all the motor neuron fibres of the nerve. Alternatively, stimulation of the obturator nerve might occur because of the presence of some anatomical variant, such as the accessory obturator nerve or its abnormal branching. In conclusion, some uncertainty appears to exist in the effectiveness of the local anaesthetic blockade of the obturator nerve. In order to attain profound blockade of the motor neuron fibres of the obturator nerve and thereby prevent the thigh-adductor muscle contraction which can lead to life-threatening situations, we recommend, even with a nerve stimulator, to use a larger volume of a higher concentration of local anaesthetic with a longer duration in the obturator nerve block for the transurethral procedures.

Aged↗
PubMed1991

Liver lacerations--a marker of severe but sometimes subtle intra-abdominal injuries in adults.

Experience with conservative management of solid viscus injuries from abdominal trauma in children has produced the impetus for a similar management in adults. To explore the implications of such a policy, we reviewed the records of 82 patients with hepatic injuries noted at laparotomy. Indications for laparotomy were positive findings on diagnostic peritoneal lavage (DPL) or CT scan, or a history of penetrating trauma. The liver injuries were graded according to severity: grade I, 19 patients; grade II, 20 patients (low severity = LS); grade III, 14 patients; grade IV, 6 patients (high severity = HS). Twenty-three injuries were not classified by the operating surgeon. Of the 53 patients with blunt hepatic trauma, 23 (43%) had concomitant injuries that required operative intervention. Twenty-nine patients had penetrating liver injuries. Fourteen (48%) had associated injuries requiring intervention. Patients most likely to have nonoperative management, those with grade I and grade II liver injuries (LS), comprised 48 of the total. In this subgroup there were 26 (54.2%) associated injuries requiring operative intervention. Shock could not be used as a factor to differentiate patients not requiring operative intervention. Nineteen of the LS patients requiring operative intervention secondary to associated injury were never in shock. In adult trauma victims positive DPL findings secondary to minor hepatic injuries that might not require operative intervention serve as a marker for associated injuries that do require operation. The risk of nonoperative management of hepatic injuries based upon radiologic diagnosis is not the result of complications from the hepatic injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗
PubMed1997

Colonic obstruction and perforation related to heavy Trichuris trichiura infestation.

Heavy Trichuris trichiura infestation is rare in developed countries, and complications requiring surgical intervention have been described rarely in human trichuriasis. A case of colonic obstruction and perforation related to heavy whip-worm infection is described in an 84 year old woman. The woman was admitted to hospital because of a chest infection. Two days after admission she suffered nausea and vomiting followed a day later by bowel stoppage. Laparotomy indicated intestinal obstruction by a tumour. A partial right sided ileocolectomy was performed. Pathological examination of the resected bowel revealed heavy infestation with T trichiura causing a pseudotumour following a proliferative inflammatory response.

Aged↗
PubMed1984

Spleen structure in Hodgkin disease: ultrasonic characterization. Work in progress.

Ultrasonic waveforms backscattered from human spleens in vivo were recorded for 10 normal subjects and 21 patients with Hodgkin lymphoma prior to staging laparotomy. A measure of the structure of splenic tissue, the "mean scatterer spacing" was calculated for each subject from the recorded data. Comparison of these measurements with the results of staging laparotomy indicated that spleens involved with lymphoma are generally characterized by increased scatterer spacing compared with normal splenic tissue. The observed histologic differences between normal and lymphomatous spleens appear to account for the measured differences in tissue structure.

Adult↗
PubMed1987

Characterization of oestrus and timed collection of oocytes in the grey short-tailed opossum, Monodelphis domestica.

A system of test-pairing was used to detect reproductive behaviour in the grey short-tailed opossum. This enabled timing and characterization of the development of pro-oestrous and oestrous behaviour, and facilitated collection of ovulated and unovulated oocytes. Oestrus was induced 8.5 days (n = 80, 95% confidence limits 7.56-9.21) after the introduction of a male. Timed examination of the ovaries by laparotomy indicated that ovulation occurred 14-16 h after the first onset of oestrous behaviour. The development of follicles was linked to pro-oestrous behaviour, and ovulation occurred in the absence of copulation. Vaginal exfoliative cytology indicated that pro-oestrous behaviour was associated with an increasing number of keratinized epithelial cells, and at the time of maximum receptivity to males, a heavy infiltration of polymorphonuclear leucocytes was seen. Oocytes were typically marsupial: large (approximately 250 microns in diameter), with a yolky vitellus and thin zona pellucida. An average of 6 oocytes were ovulated per ovary.

Animals↗
PubMed1997

Blunt abdominal trauma in children: impact of CT on operative and nonoperative management.

OBJECTIVE: The purpose of this study was to evaluate the impact of CT on operative management of children examined after blunt abdominal trauma. SUBJECTS AND METHODS: Fifteen-hundred consecutive children who sustained blunt abdominal trauma were prospectively examined with CT. CT findings and the decision for operative or nonoperative management were recorded prospectively. In the children who underwent laparotomy, indications for operative intervention as determined by the attending trauma surgeon and surgical findings were also recorded. RESULTS: Three hundred eighty-eight (26%) of the CT scans had abnormal findings: solid viscus injury, 286; other CT abnormality, 102. Twenty (7%) of 286 children with a solid viscus injury and 25 (83%) of 30 children with a hollow viscus injury underwent therapeutic laparotomy. Abnormalities seen on CT were noted in all 20 children with solid viscus injury and 24 of 25 children with hollow viscus injury who underwent therapeutic laparotomy. The decision for laparotomy was based on CT findings in five (25%) of 20 children with solid viscus injury and 17 (68%) of 25 children with hollow viscus injury. Eleven hundred twelve children (74%) had normal findings on CT. Only one of these children later required laparotomy. CONCLUSION: CT rarely influenced the decision for operative intervention in children who sustained blunt abdominal trauma. CT findings affected the decision for operative intervention in most children with hollow viscus injury; however, CT findings affected such a decision in only a small subset of children with solid viscus injury. Normal abdominal CT findings strongly predicted a lack of subsequent deterioration requiring operative intervention.

Abdominal Injuries↗
PubMed1997

[Surgical handling of primary hepatic carcinoma with severe cirrhosis and portal hypertension].

Four hundred and ninety eight cases of primary hepatic carcinoma (PHC) were discovered complicating with cirrhosis in 608 PHC cases during 1974-1994. 63 cases of them were with severe cirrhosis and portal hypertension (10.4%). Laparotomy indication was evaluated according to Child's grade and image data such as BUS and CT etc. Operative extension should be limited as segment or wedge hepatectomy or semi-hepatic artery chemo-embolization. Splenic artery ligation plus venous ligalion of cardiac region of stomach were applied to portal hypertension and hypersplenism. Frusemide, antacid and insulin were used in the perioperation period. Three-year survival rate was 57%. It is considered that splenic artery ligation instead of splenectomy is the first choice for preventing and treating hypersplenism and digestive tract bleeding in PHC with severe cirrhosis.

Adult↗
PubMed1992

[Ultrasonographic finding of hemoperitoneum and indication for laparotomy in blunt abdominal trauma].

The usefulness of the ultrasonography (US) for the indication for laparotomy was evaluated. I analyzed 200 blunt trauma patients who took US exams at my emergency center immediately after admission. Ninety-five percent of patients with hemodynamic instability, whose hemoperitoneum was revealed by US, underwent laparotomy. No negative laparotomy was performed in those patients. Only 5.4% of US hemoperitoneum-negative patients with stable hemodynamics required laparotomy because of peritoneal irritation or the evidence of traumatic diaphragmatic hernia. US hemoperitoneum-positive patients with stable hemodynamics were treated selectively, and 46% of such patients eventually underwent laparotomy, depending on findings of serial US, CT, DPL and Intravenous urogram. In two third of them laparotomy was indicated because of serial US showing the appearance or increase in hemoperitoneum. The maximum width of echo free space in Morison's pouch became more than 10 mm in the all exams when the laparotomy was indicated. I believe that US finding of hemoperitoneum should be an integral part of evaluating laparotomy indications in blunt abdominal trauma.

Abdominal Injuries↗
PubMed1991

[Pregnancy in a non-communicating rudimentary uterine cavity. Presentation of a case in a multipara].

A case of pregnancy in a rudimentary uterine horn is presented. The pregnancy developed asymptomatically until the 14th week when spontaneous rupture of the uterine horn occurred. The diagnosis was made at laparotomy indicated for hypovolemic shock due to intraperitoneal hemorrhage. The pathologic study of uterine horn showed a normally developed fetus and the placental tissues protruding at the rupture site of horn. The purpose of this paper is analysis of fecundation, implantation and the type of endometrium of the rudimentary uterine horn.

Abdomen, Acute↗
PubMed1988

[Mesocoloplasty of sigmoid volvulus. An alternative to colonic resection].

Based on 4 operations, the authors stress the value of intestinal preservation in subjects with poor general suffering from volvulus or with signs of sigmoid torsion by means of mesocolonoplasty. The technical simplicity of this operation allows it to be proposed in the course of laparotomies indicated for any other abdominal pathology.

Aged↗
PubMed1988

Routine clinical application of the lymphocyte fluorescence polarization test for malignant disease.

The technique of Lymphocyte Fluorescence Polarization (LFP) can confirm or exclude the presence of malignant disease. The results from tests on a total of 566 subjects showed a false-positive rate of 3.8% and a false-negative rate of 2.2%. The LFP test has been used as an aid in the differential diagnosis of patients whose symptoms are not typical of primary or recurrent malignant disease. In over 40 such cases there has been total agreement between the LFP results and subsequent clinical or pathological investigations. The LFP Test has been used to monitor the response of cancer patients to various therapeutic regimes. Ovarian cancer patients giving negative LFP results after treatment with Cisplatin have been found free of disease at laparotomy, indicating that LFP may be an acceptable alternative to the surgical investigation. The LFP test has been shown to provide information of much value in the management of patients with malignant disease.

Adult↗
PubMed1977

Staging laparotomy with splenectomy in Hodgkin's disease.

The series includes 91 patients with Hodgkin's disease who underwent a staging laparotomy with splenectomy during the years 1971-1976, in 82% of them as part of the initial evaluation before therapy. Positive abdominal lymph nodes were found in 29% of the patients, a positive spleen in 37%, and a positive liver in 10%. Follow-up of patients who lacked abdominal involvement at laparotomy indicate that sampling error was only of marginal importance. Evaluation of the therapeutic implications of the operation indicated that 41% of the patients benefited from the procedure; 31% by changing stage and 10% by changing radiation therapy port. Five patients had minor surgical complications. The mortality rate was nil.

Abdominal Neoplasms↗