Biomedical subjects
Publications and source records attributed to A Bickel.
A 21-year-old woman was operated laparoscopically for peritonitis due to penetrating perinephric abscess (PNA). Following correct diagnosis and drainage, a definitive treatment was carried out to drain the intrarenal abscess laparoscopically. Although not the preferred approach, when diagnosed during exploratory laparoscopy for peritonitis, PNA can be successfully treated laparoscopically.
Aspiration of hydatid cysts and instillation of scolicidal fluid as part of the surgical treatment should be done very carefully to prevent any spillage that might cause anaphylaxis and dissemination of the disease. We describe herein a laparoscopic technique for safe aspiration of hydatid cysts of liver by using an assembled large, transparent trocar sleeve with a beveled tip. The method described allows laparoscopic access even to hydatid cysts that are located under the diaphragm.
Explore the source record for details and available documents.
This report presents two cases of totally occluded internal carotid arteries, verified by angiography. In both cases the vessel was recanalised under heparinisation. This was first detected by duplex carotid sonography. Angiographic follow-up showed a high-grade stenosis at the origin of the internal carotid artery. Both female patients were then operated successfully. It is important to consider the possibility of spontaneous recanalisation of an occluded internal carotid artery because there are clear indications for operative treatment in such a case. In case of total occlusion, as a rule no operative treatment is possible.
Explore the source record for details and available documents.
The growth of human cerebral meningiomas depends on various growth factors, including epidermal growth factor (EGF), transforming growth factor (TGF)-alpha and TGF-beta, platelet-derived growth factor (PDGF)-BB, insulin-like growth factor (IGF)-I and IGF-II, and acidic and basic fibroblast growth factors. The latter three have been shown to form autocrine loops that are thought to be a major component of uncontrolled growth in meningioma tissue. Suramin is known to prevent binding of a variety of growth factors to their receptors in mammalian tissue, thus abolishing para- and/or autocrine-mediated cell growth. The authors therefore tested the effect of suramin on the proliferation of cultured human meningioma cells. Suramin (10(-5) to 10(-4) M) significantly inhibited the growth of meningioma cells in culture. The maximum effect observed was with the higher dose (10(-4) M), which resulted in a 40% to 70% reduction in cellular proliferation. This effect was observed in all 15 tumor samples studied and was confirmed by [3H]thymidine uptake. In studies using DNA flow cytometry, suramin inhibited meningioma cell proliferation in five tumor samples by arresting cells in the S and G2/M phases of the cell cycle. Growth factor (EGF, IGF-I, and PDGF-BB)-induced cell proliferation was completely abolished in five tumor samples when 10(-4) M suramin was applied to meningioma cells. Western blot analysis of three tumor samples showed that the intracellular PDGF-BB content of meningioma cells was significantly reduced after treating the cells with 10(-4) M suramin. Binding of iodinated growth factors (that is, [125I]EGF, [125I]IGF-I, and [125I]PDGF-BB) to their receptor sites was prevented by suramin in a dose-dependent manner in 10 meningioma membrane fractions. Lowering of the intracellular PDGF content and prevention of extracellular growth factor receptor binding demonstrates that suramin disrupts autocrine loops and paracrine growth stimulation in meningioma tissue. These data provide evidence that growth of cerebral meningiomas in culture is strongly inhibited by suramin at a concentration of 10(-4) M. Suramin acts as a scavenger neutralizing exogenous growth factors; thus it can interrupt autocrine loops and paracrine stimulation of human meningioma cell growth. The evidence favors suramin as a therapeutic option for controlling meningioma proliferation in patients with inoperable and recurrent high-grade meningiomas.
Explore the source record for details and available documents.
A laparoscopic technique to manage hydatid cyst of the liver is described. The technique is safe and simple and has the advantages of other abdominal laparoscopic operations. It also fulfills the prerequisite of open surgery of hydatid cyst of the liver, namely, the prevention of intraperitoneal spillage of cyst contents. Our technique enables treatment of the residual cyst cavity following aspiration of contents. In the past 15 months, 10 cysts (5-17 cm in diameter) in 6 patients were managed successfully using this approach, with no mortality or short-term recurrence.
Explore the source record for details and available documents.
Subtotal cholecystectomy is a definitive and safe operation to treat diseases of the gallbladder, whenever there are major difficulties in dissection from the liver. Described herein is successful experience with 6 patients using this technique, through the laparoscopic approach. In cases with severe inflammatory changes, gallbladder embedded in liver tissue, and liver cirrhosis, they enabled reduction of operative time and avoidance of excessive bleeding that could have caused the conversion of the laparoscopic approach to open laparotomy.
After laparoscopic resection, the gallbladder must be removed, usually through the umbilical trocar site. Occasionally, there is difficulty in removing the gallbladder from the abdominal cavity due to its large dimensions or its contents. There are two main options to extract the gallbladder in such cases. One is evacuation of its content through the gallbladder neck protruding from the abdominal wall. The second is extension of the periumbilical fascial opening. In the first method, gallbladder content might sometimes spill into the peritoneal cavity or contaminate the incision site. In the second, there might not be enough control concerning the extent of injury caused to the periumbilical abdominal wall during enlargement of the fascial opening. A simple precise and safe method is suggested to enlarge the fascial incision by direct vision using transillumination.
Explore the source record for details and available documents.
A study was conducted over a 23-month period to determine the possibility of early postoperative oral feeding after removal of a nasogastric tube in patients undergoing gastrointestinal operations. One hundred seventy-one patients were prospectively randomized into two groups. The first group began liquid oral intake 4 hours after removal of the tube. The second group began an ordinary solid intake soon after nasogastric tube removal. The criterion to remove the tube was based on normal bowel sounds heard by at least two senior surgeons. There was no significant difference between both groups concerning the occurrence of gastrointestinal disturbances following tube removal. Most of the disorders were observed after lower intestinal tract operations. Nine patients in the first group and seven patients in the second group required reinsertion of a nasogastric tube. We suggest that early solid intake immediately after nasogastric tube removal can safely be used in gastrointestinal operations.
A total of 8 cases of bladder cancer in spinal cord injury men (4 quadriplegics and 4 paraplegics) was seen at 3 medical centers since 1985. All 8 men had a hyperreflexic bladder and 3 of them had associated detrusor-sphincter dyssynergia. Upper tract changes were noted in 4 patients: 2 with distal ureterectasis and 2 with mild hydronephrosis. Only 1 of these men did not have historical films with which to compare results. Histology was transitional cell carcinoma in 6 men and squamous cell carcinoma in 2. Four patients presented with muscle invasion and 1 presented with diffuse carcinoma in situ involving the penile urethra. Three patients presented with superficial transitional cell carcinoma and 2 of them had progression to muscle invasion within 6 and 11 months. All but 2 of the patients with invasive disease underwent a radical operation and urinary diversion. Although followup is short (range 6 to 17 months), 5 patients are well with no evidence of disease and of the 3 who died 2 had no evidence of disease. We found a lower incidence of bladder cancer and a decreased percentage of squamous cell carcinoma than in previous reports, which may reflect an improvement in the lower tract management of these patients. Survival with appropriate bladder cancer treatment appears to correlate well with that of the ambulatory population.
Ureteral catheters are a vital part of the urological armamentarium. We report 2 cases in which the flexible tip portion of an open-end Flexi-Tip ureteral catheter became disjointed from the shaft within the renal collecting system during endourological procedures. The etiology, prevention and management of this complication are discussed.
We report a case of bowel injury as a result of an isolated gunshot wound to the scrotum. Our experience with penetrating scrotal trauma reveals a high rate of associated injuries, the most common being trauma to the soft tissue of the thigh. Our case emphasizes the importance of a thorough preoperative and operative evaluation of patients with penetrating scrotal trauma.
Explore the source record for details and available documents.
Clinical and laboratory studies have documented high susceptibility to pneumococcal infection in asplenic humans and animals. Splenic autotransplantation has been suggested as a method of preserving function. Autotransplantation of irreparably damaged spleens in humans preserved splenic functions. Ten patients operated on for blunt abdominal trauma required unavoidable splenectomy. In each, autotransplantation of the removed spleen (roughly 50 g) was performed. Postoperative studies of splenic functions revealed disappearance of Howell-Jolly bodies from peripheral blood. Levels of IgM, which were initially significantly depressed, returned to normal and there were normal technetium Tc 99m sulfur colloid scans ten weeks after surgery. All patients are alive and healthy. Our data suggest that autotransplantation of spleen is a safe alternative method for preserving splenic function when total splenectomy is mandatory for hemostasis.