PubMed Health⌕ Search

Biomedical subjects

A G Nagy

Publications and source records attributed to A G Nagy.

32 records · Page 2Linked to original sources
PubMed1992

Laparoscopic cholecystectomy: trans-Canada experience with 2201 cases.

The authors carried out a prospective review of the initial and consecutive experience with laparoscopic cholecystectomy of 58 surgeons from 31 teaching and nonteaching institutions throughout Canada. The perioperative morbidity of 2201 cases is described, with special attention to iatrogenic complications. The data suggest that complications, including bile-duct injury, are not frequent. Pneumonia and wound infection rates appear lower than after open surgery. There were no deaths. Laparoscopic cholecystectomy is replacing open cholecystectomy for the management of symptomatic cholelithiasis.

Adolescent↗
PubMed1990

Palliative treatment of advanced colorectal carcinoma with the YAG laser.

The Nd-YAG laser was used to provide palliative treatment for eight patients (two women and six men), ranging in age from 53 to 76 years, who had locally advanced colorectal cancer. The main indications for treatment were obstruction, bleeding and copious rectal mucus discharge. Only one complication, a Staphylococcus aureus infection, followed the treatment; the infection was easily controlled. The laser treatment was considered to ease the symptoms in five patients, but survival was not influenced by the treatment. This form of palliation must be evaluated in larger numbers of patients to assess its real value in advanced colorectal cancer.

Aged↗
PubMed1989

Abdominal injuries associated with the use of seatbelts.

The mandatory use of seatbelts has become commonplace in Canada, and such legislation was adopted by the province of British Columbia in 1977. This has provided us with an opportunity to study the effects of seatbelt restraints on accident victims, particularly concerning abdominal injuries. Five hundred sixty-two patient charts were reviewed during a 3-year period. Documented use of seatbelts was found in 126 cases. Thirty-six of these patients underwent laparotomy and form the basis of this study. Compared with previously reported figures for blunt abdominal trauma, there was a high incidence of gastrointestinal injuries (67 percent). In addition, associated lumbar spine injuries were found in a large proportion of patients (19 percent, p less than 0.005). We found an increased risk of spinal injury in patients wearing a lap versus a three-point belt.

Abdominal Injuries↗
PubMed1989

Diagnostic laparoscopy.

This report examines the value of laparoscopy as a diagnostic aid to one general surgeon. Seventy-seven consecutive patients who underwent this procedure are reported. In 31 patients, laparoscopy was performed for assessment of the cause of acute abdominal pain. Diagnosis was achieved in 28 patients (90 percent) and laparotomy was avoided in 17 (55 percent). Assessment of chronic abdominal pain in 11 patients yielded a diagnostic accuracy in 9 (82 percent) and laparotomy was avoided in 7 (64 percent). In 11 patients with abdominal trauma, diagnostic accuracy was 91 percent (10 of 11 patients) and laparotomy was not required in 6 (54 percent). In 21 patients with intraabdominal malignancy, 14 (67 percent) were accurately assessed, and in 8 (38 percent) formal exploration was spared. Three patients with obscure causes of ascites and jaundice were all accurately assessed without need for laparotomy. Based on our data, we believe the reports in the literature are reproducible by any abdominal surgeon who uses laparoscopy as a diagnostic aid in their practice.

Abdomen↗
PubMed1989

Cecal diverticulitis.

Cecal diverticulitis is an uncommon entity. Its operative treatment represents 0.2% of procedures performed for an acute abdomen. The clinical presentation is often indistinguishable from acute appendicitis. At operation, it may be confused with cecal carcinoma. The surgeon must be aware of this condition and be prepared to choose the most appropriate treatment. Local excision has been advocated as the treatment of choice. The authors review 18 cases seen over a 10-year period. In no case was the correct diagnosis made preoperatively. Intraoperatively, a correct diagnosis was made in 12 of the 18. Carcinoma was the next most frequent intraoperative diagnosis (four cases). Twelve of the 18 patients were treated by standard or limited right hemicolectomy. One patient died early in the series of sepsis caused by a perforated diverticulum and one patient had a life-threatening complication. Right hemicolectomy appears to be a safe and effective treatment option for cecal diverticulitis.

Acute Disease↗
PubMed1988

Preservation of the spleen using human fibrin seal.

Because of the spleen's role in host defence and the recognition of overwhelming post-splenectomy sepsis, the current aim of treatment for splenic injuries is to preserve the spleen. A number of hemostatic agents have been used in an effort to control bleeding but have not proved satisfactory. The authors report the results of an experiment using a two-component fibrin seal on injured rabbit spleens. In female rabbits a longitudinal laceration of the entire spleen was made. After 2 1/2 minutes of continuous hemorrhaging, the spleens were either not treated (5 rabbits) or treated by splenectomy suture repair or fibrin-seal repair. Hemoglobin values were measured preoperatively and 3 days postoperatively. The greatest number of deaths within 14 days occurred in the untreated group. There was no difference in death rate between the treated groups; similarly, there was no difference in blood loss or fall in hemoglobin values. Fewer adhesions formed in the fibrin-seal group than in the others (p less than 0.02). Histopathological examination revealed a greater fibrinoblastic response in the spleens treated with fibrin seal than in the other groups. The authors believe that fibrin seal is an effective and safe hemostatic agent applicable to splenic parenchymal injuries, and that it promotes wound healing and suppresses adhesion formation.

Animals↗
PubMed1987

Diagnosis and treatment of choledochocele complicated by choledocholithiasis (case report).

We report a case of choledochocele associated with choledocholithiasis. The patient became symptomatic when a gallstone was trapped within the choledochocele, causing intermittent biliary obstruction. Endoscopic retrograde cholangiography (ERC) provided the diagnosis and endoscopic sphincterotomy was performed for definite nonoperative treatment. The lesion could not be identified on ultrasound even after its demonstration by ERC. The importance of direct cholangiography in the diagnosis of a choledochocele is discussed.

Aged↗
PubMed1987

Segmental biliary obstruction: false-negative diagnosis with direct cholangiography without US guidance.

Segmental intrahepatic ductal obstruction with calculi can be a significant cause of acute cholangitis that may remain entirely undetected on a routine, "blind" direct cholangiogram. Ultrasonography (US) or computed tomography can demonstrate isolated intrahepatic ductal dilatation with or without calculi. US, in particular, can be used to direct the needle puncture for percutaneous transhepatic cholangiography (PTC) and thus enable the differential diagnosis and appropriate therapy to be determined. Four cases are reported in which US-guided PTC enabled confirmation of the diagnosis of acute cholangitis secondary to segmental biliary obstruction and intrahepatic calculi. In two the correct diagnosis could not be made with initial blind direct cholangiography, and in the other two, US and US-guided PTC were performed initially.

Acute Disease↗
PubMed1987

Obstructive jaundice and cholangitis due to choledocholithiasis: treatment by extracorporeal shock-wave lithotripsy.

Endoscopic shock-wave lithotripsy, although now the standard treatment of urolithiasis, has only recently been applied to cholelithiasis. The authors describe the case of an 88-year-old man, a high-risk patient with choledocholithiasis, in whom endoscopic stone extraction after sphincterotomy failed. Extracorporeal shock-wave lithotripsy was used for noninvasive stone fragmentation and the fragments were passed without complication.

Aged↗
PubMedDate not supplied

Blunt bowel and mesenteric injury: diagnostic performance of CT signs.

PURPOSE: Our goal was to determine the sensitivity and specificity of various CT signs of blunt bowel and mesenteric injury. METHOD: The CT findings of 31 patients with blunt abdominal trauma were retrospectively assessed by three observers in consensus. All patients had laparotomy within 24 h of CT. The study group consisted of 19 patients with surgically proven bowel and/or mesenteric injury. The control group consisted of 12 traumatized patients who had no bowel or mesenteric injury. The CT signs assessed were presence, location, and extent of intraperitoneal fluid, extraluminal air, bowel wall thickening, bowel wall discontinuity, mesenteric streaking, and mesenteric hematoma. RESULTS: In the 12 cases of bowel injury (9 transmural injury, 3 partial thickness injury), the CT sign of bowel wall thickening had sensitivity of 50% and specificity of 84% and the CT sign of bowel wall discontinuity had sensitivity of 58% and specificity of 95%. Extraluminal air was a specific but relatively insensitive sign of transmural bowel injury (sensitivity 44%, specificity 100%). In the 13 patients with mesenteric injuries, the CT sign of mesenteric hematoma had sensitivity of 54% and specificity of 94%. Isolated mesenteric streaking was a less specific sign of mesenteric injury (sensitivity 77%, specificity 44%). The finding of peritoneal fluid with no visible solid organ injury was a useful sign of bowel or mesenteric injury, occurring in 11 of 19 (58%) study patients and none of the controls (p < 0.001). CONCLUSION: Bowel wall thickening, bowel wall discontinuity, extraluminal air, and mesenteric hematoma are reasonably specific CT signs of bowel and mesenteric injury following blunt abdominal trauma. The presence of a moderate to large volume of intraperitoneal fluid without visible solid organ injury is an important sign of bowel or mesenteric injury.

Abdominal Injuries↗