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Biomedical subjects

A Cuschieri

Publications and source records attributed to A Cuschieri.

At least 19 recordsLinked to original sources
PubMed1992

The utility of diagnostic laparoscopy for abdominal disorders. Audit of 120 patients.

We audited our recent experience with diagnostic laparoscopy performed over a 30-month period on 131 consecutive patients. Laparoscopy was 100% accurate in the diagnosis or exclusion of intra-abdominal malignant neoplasms, and future care decisions were affected by this information. Laparoscopy in the evaluation of chronic abdominal pain yielded positive findings in 47% of cases. The majority of referrals (73%) for the investigation of chronic abdominal pain came from the medical services, whereas the majority of referrals (72%) for the investigation of cancer originated from surgeons. Laparoscopy in the setting of acute abdominal pain yielded useful information that affected patient outcomes in 71% of cases. There were no serious complications in this series. Laparoscopy is a safe and useful diagnostic tool, especially for the diagnosis, staging, or exclusion of cancer.

Abdominal Neoplasms↗
PubMed1992

Laparoscopy in the management of pancreatic cancer: endoscopic cholecystojejunostomy for advanced disease.

Following a period of animal experimentation in pigs, a laparoscopic technique for sutured gastrointestinal and bilioenteric anastomoses was developed and its safety and efficacy tested in chronic experiments. The method involves the construction of a preformed external jamming loop knot and continuous suturing using a specially developed Endoski needle. The technique was used to construct a cholecystojejunostomy in five patients with advanced cancer of the pancreas (four hand-sutured and one stapled/sutured). Four of the patients recovered from the procedure with no complications, minimal postoperative discomfort and complete relief of their jaundice. In one patient relief of jaundice was slow due to blockage of the anastomosis by debris and blood clot; this resolved following removal of the inspissated material. This minimally invasive procedure has the potential for complete palliation with short hospital stay and avoids the hazards of endoscopic stenting such as encrustation and cholangitis.

Aged↗
PubMed1992

Thoracoscopic long oesophageal myotomy for nutcracker oesophagus: initial experience of a new surgical approach.

A thoracoscopic technique is described for the execution of long oesophageal myotomy for nutcracker oesophagus causing odynophagia and non-cardiac chest pain. The technique is based on a multipuncture method and a left thoracoscopic approach. It has been performed on three patients with complete symptomatic relief in the short term, although the follow-up period is short (maximum 12 months). No complications were encountered and discharge from hospital occurred by the fifth day after operation.

Adult↗
PubMed1992

Laparoscopic reduction, crural repair, and fundoplication of large hiatal hernia.

A technique for laparoscopic reduction, crural repair, and total fundoplication for large symptomatic hiatal hernia is described. The procedure entails the mobilization of the esophagogastric junction with crural repair by a continuous suture technique employing a special pre-formed jamming loop knot, followed by total fundoplication that is fixed proximally to the anterior margin of the diaphragmatic hiatus and distally to the esophagogastric junction. The procedure has been performed in eight elderly patients with a good outcome and accelerated recovery to full activity.

Aged↗
PubMed1992

Reversible bile acid changes in bile duct obstruction and its potential for hepatocellular injury.

The etiology of hepatocellular dysfunction resulting from chronic biliary obstruction is not clearly understood. Alterations in bile acid metabolism due to changes in microsomal cytochrome P-450 enzyme activities may have a fundamental role in cholestatic liver injury. This study examines the very early changes in both biliary bile acids and hepatic microsomal cytochrome P-450 content after bile duct obstruction in the rat and the effects of the restoration of bile flow after 3 days of biliary obstruction. We found that early induction of cytochrome P-450 may be a fundamental step in the generation of cholestatic liver injury mediated by hepatotoxic bile acids. The rapid reversal of bile acid changes with reconstituted bile flow indicate that the liver is able to quickly recover when obstruction is relieved. Characterization of this fundamental process may ultimately provide a means of modulation of cholestatic hepatotoxicity.

Animals↗
PubMed1992

Laparoscopic vagotomy. Gimmick or reality?

The use of H2 blockers has led to a virtual demise of elective surgery for the treatment of duodenal ulcers. Some ulcers, however, are resistant to medications, and some patients are weary of continuous medication in the long term. Laparoscopic vagotomy is a promising new form of surgical treatment that could offer an alternative to long-term medication and major open abdominal surgery. Prospective well-documented and detailed studies are needed, however, before an objective evaluation of this procedure can be made.

Catheterization↗
PubMed1992

Sutured laparoscopic cholecystojejunostomy evolved in an animal model.

In a series of acute and chronic experiments conducted in young pigs during a 2-year period, we have evolved a quick knotting technique to start and end a suture line and developed a curved 'Endoski' needle to improve needle passage through the tissues. These have been employed in the construction of cholecystojejunal anastomoses using a semi-closed technique with a single layer (deep seromuscular) of continuous polyglactin sutures. In chronic experiments in pigs, patent well healed bilioenteric anastomoses, which conveyed bile satisfactorily after ligation of the common bile duct, distal to the cystic duct, were achieved. A virtual absence of adhesions in these animals was noted.

Anastomosis, Surgical↗
PubMed1992

Bile acid malabsorption in patients with post-vagotomy diarrhoea.

75SeHCAT scanning was evaluated as a means of detecting bile acid malabsorption in patients with postvagotomy diarrhoea. Seven day 75SeHCAT retention ratios were measured in five patients with unequivocal post-vagotomy diarrhoea. The results were compared with an age matched group of asymptomatic control patients (n = 4) each of whom had previously undergone truncal vagotomy and drainage and a further group of normal volunteers (n = 6). The median 75SeHCAT retention ratios in patients with post-vagotomy diarrhoea was 2% (range 0-9%). In contrast, the median 75SeHCAT retention ratios in asymptomatic controls was 29% (range 26-61%) and 28% (range 19-70%) in normal volunteers. These results demonstrate that there is gross bile salt malabsorption in patients with post-vagotomy diarrhoea and that 75SeHCAT scanning is an effective screening test in these patients.

Adolescent↗
PubMed1992

Adverse influence of fibrin sealant on the healing of high-risk sutured colonic anastomoses.

The effect of fibrin glue sealing on sutured colonic anastomoses was studied using a 'high-risk' colon anastomosis model in the rat. Animals (n = 104) were randomized to have their sutured anastomosis sealed with fibrin glue or left untreated. They were assessed clinically until they were killed on the fourth day after surgery when contrast radiology, detailed post-mortem examination, anastomotic bursting pressure (ABP) and assessment of adhesion formation were performed. The clinical outcome was worse in the glued group (toxic or death from sepsis: 18 versus seven in the non-glued group; P = 0.0354), which also showed a significantly higher moderate to major leak rate (17 versus two in the non-glued group; P = 0.0009). The median ABP was significantly higher in the glued anastomosis group (96 versus 68 cmH2O in the non-glued group; P = 0.0367). Excessive perianastomotic adhesion formation was significantly greater in the glued group. Microscopic examination showed an extremely intense inflammatory reaction in the glued anastomoses compared with that in the untreated group. These results indicate that sealing of a sutured anastomosis with fibrin glue containing an antiproteinase impairs healing the of anastomotic wound, probably by resisting the ingrowth of vascular granulation tissue during the early stages of repair.

Anastomosis, Surgical↗
PubMed1992

Endoscopic oesophagectomy through a right thoracoscopic approach.

A technique of subtotal endoscopic oesophagectomy through the right thoracoscopic approach is described. It has been used in five patients, four with cancer and one with benign motility disorder. The operative blood loss during the endoscopic dissection stage was unmeasurable in four patients and amounted to 300 ml in one. The mean (range) duration of the endoscopic dissection was 3.3 (3.0-4.0) h and of the total procedure was 5.5 (4.5-7.5) h. After the operation, the mean (range) duration of stay in the intensive care unit was 19.5 (16-26) h. From the time of the operation, the mean (range) hospital stay was 11 (8-18) days. One patient developed left vocal cord palsy which prolonged this.

Adult↗
PubMed1991

Laparoscopic cholecystectomy: the Dundee technique.

A total of 61 patients was subjected to laparoscopic cholecystectomy. The procedure was completed in 60 cases and converted to open operation in one (2 per cent). The morbidity rate was low (total 7 per cent, major 2 per cent, blood transfusion rate 5 per cent). The median duration of the laparoscopic cholecystectomy with cholangiography was 135 min (range 65-270 min). The operation took less time to complete in patients with functioning gallbladders than in those with non-functioning fibrotic organs (median 120 versus 175 min). The majority of patients required opiate analgesia despite infiltration of the stab wounds with bupivacaine. The mean (s.d.) hospital stay was 2.9 (1.5) days. The median time to resume work or full activity after discharge was 11 days.

Adult↗
PubMed1991

Long-term follow-up of elderly patients with locoregional breast cancer treated with tamoxifen only.

One hundred and thirteen women aged 70 years or more with locoregional breast cancer were treated with tamoxifen alone as primary treatment. They were followed for a minimum of 5 years. Complete response occurred in 38 women, partial response in 17, no change in 34 and progressive disease in 24. Where progressive disease occurred, or where patients relapsed after an initial response, the most suitable conventional therapy was given. The actuarial 5-year survival rate was 49.4 per cent for all patients and was much higher (92 per cent) in those showing an initial complete response. Seventy patients (61.9 per cent) were not controlled by tamoxifen alone to death or most recent follow-up. Tamoxifen provides an alternative treatment for operable breast cancer in older women in the short term and may be particularly suitable for those with concurrent disease or who are unwilling to undergo surgery. The low morbidity rate from tamoxifen must be balanced against the need to maintain close follow-up. In the medium to long term, sole primary treatment by tamoxifen delays more definitive therapy.

Age Factors↗
PubMed1991

Effect of fibrin glues on the mechanical properties of healing wounds.

Tissue glues are important in clinical practice. Fibrin based glues have many advantages over non-biological adhesives. The optimum formulation of these glues measured by their effect on mechanical properties of healing wounds has not been determined. Using a model involving standard dorsal skin incisions in adult male Wistar rats various glue formulations were compared by varying the fibrinogen, thrombin and factor XIII concentrations. Calcium (40 mumol/ml) and aprotinin (3000 kallidinogenase inactivator units, KIu/ml) concentrations were kept constant. Animals were killed at 8 days and wounds excised. Standard strips of these wounds were mechanically tested using an Instron tensiometer and the stress, strain, elasticity and work required to rupture wounds were calculated. Results indicate that a fibrin glue with a fibrinogen concentration of approximately 39 g/l and a thrombin concentration of 200-600 units/ml with no added factor XIII will result in wounds with significantly increased stress, energy absorption and elasticity values.

Animals↗
PubMed1991

Laparoscopic ligamentum teres (round ligament) cardiopexy.

A technique of laparoscopic ligamentum teres cardiopexy for reflux oesophagitis unresponsive to medical treatment is described. The procedure has been performed on five patients and on postoperative testing has been shown to achieve competence of the lower oesophageal sphincter by lengthening of the intra-abdominal segment, accentuation of the angle of His and elevation of the pressure in the high pressure zone. All the patients have been relieved of their symptoms by the operation and have not sustained any adverse effects but the follow-up period is short.

Adult↗