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Biomedical subjects

A G Shulman

Publications and source records attributed to A G Shulman.

At least 19 recordsLinked to original sources
PubMed1992

Prosthetic mesh plug repair of femoral and recurrent inguinal hernias: the American experience.

Prosthetic mesh in the form of a plug has been used extensively in the United States for hernia repair. It has been popular for all types of femoral hernias and for the majority of recurrent inguinal hernias. It follows the basic principle of 'tension-free' repair and permits unrestricted postoperative physical activity. The method has resulted in a long-term success rate better than the many modifications of the Bassini repair.

Hernia, Femoral↗
PubMed1992

The safety of mesh repair for primary inguinal hernias: results of 3,019 operations from five diverse surgical sources.

Initial attempts by surgical pioneers to repair hernias with prosthetic mesh met with failure because of faulty materials. As a result, surgeons experienced anxiety about performing this procedure. This anxiety persists, despite the present availability of new, safe patches and sutures. It was the unacceptably high failure rate of standard methods of repair for recurrent hernias that led to the use of plastic screens to bolster such repairs. However, persistent reluctance to use mesh for primary hernioplasty continued. Within the past two decades, true, tension-free patch repair of primary inguinal hernias without suture closure of hernial margins has been examined and clarified, and the technique has been perfected. In 3,019 reported primary inguinal hernias so treated by five different groups, there have been no mesh rejections, a 0.2 per cent recurrence rate, and insignificant incidence of infection. A new era of hernia repair appears to be at hand; therefore, such results warrant a new look at inguinal hernia repair.

Equipment Safety↗
PubMed1991

Twenty questions about hernioplasty.

The twenty most asked and answered questions about advances in hernia surgery are enumerated. These inquiries have been collected over 20 consecutive years of exhibiting at a scientific booth at the American College of Surgeons conventions. The questions generally are concerned with synthetic patches, the use of local anesthesia, and, more recently, the "tension free" hernia repairs. The treatment of hernial sacs, the diagnosis, prevention and treatment of postoperative pain, the Shouldice Clinic repair, the importance of Cooper's ligament, and the cause, prevention, and treatment of recurrences are also examined.

Adult↗
PubMed1990

The 'plug' repair of 1402 recurrent inguinal hernias. 20-year experience.

Since 1968, we have treated virtually all recurrent inguinal hernias by suturing a polypropylene mesh plug into the defect. Treatment of recurrent inguinal hernias by the usual standard methods results in a high rate of failure. This is due to reapproximation under tension of already scarred tissues. The plug is designed to occlude the hernial defect without tension. Several improvements in technique based on extensive experience with this method have been developed. Such repairs result in minimal postoperative discomfort and rapid rehabilitation. This report is based on 1402 operations, with a follow-up of 91% of the patients. There were 1276 patients who were followed up for 3 to 21 years and the recurrence rate was 1.6%. The plug repair for most recurrent inguinal hernias is recommended.

Cicatrix↗
PubMed1990

Heparin and atherosclerosis: an investigative report on the treatment of atherosclerosis.

Both animal and clinical evidence of the special role of long-term low-dose heparin as a preventative of atherosclerosis is presented. Some of the many beneficial effects of heparin aside from its anticoagulant capability are mentioned. Concern about hemorrhage and osteoporosis which can occur when taken in the usual anticoagulant doses does not apply to long-term administration of low-dose heparin. Taken by the intrapulmonary route using an ultrasonic nebulizer weekly or fortnightly, heparin is safe and assures patient compliance. Further clinical trials are strongly indicated.

Aerosols↗
PubMed1990

Use of mesh to prevent recurrence of hernias.

Hernias recur primarily for two reasons: (1) attrition of tissue due to altered collagen metabolism and (2) tension on the suture line. Human tissue alone cannot be used to counteract these causes; a satisfactory prosthesis is needed if results of herniorrhaphy are to improve. We have had a large personal experience with monofilament polypropylene mesh (Marlex), using it to repair more than 5,000 hernias of all types over a period of 25 years. We have found it to be nonallergenic, nononcogenic, and highly resistant to infection. It serves as an effective and permanent barrier to protrusion through the floor of the inguinal canal and is readily incorporated into tissue with virtually no foreign-body reaction. Postoperative discomfort is minimized because there is no tension on the sutures and the operation is easily performed using a local anesthetic. The patient may leave the ambulatory care center within hours and return quickly to unrestricted activity with confidence.

Evaluation Studies as Topic↗
PubMed1989

The tension-free hernioplasty.

Since the first true herniorrhaphy was performed by Bassini over 100 years ago, all modifications and surgical techniques have shared a common disadvantage: suture line tension. The anatomic, physiologic, and pathologic characteristics of hernia recurrence are examined. The prime etiologic factor behind most herniorrhaphy failures is the suturing together, under tension, of structures that are not normally in apposition. With the use of modern mesh prosthetics, it is now possible to repair all hernias without distortion of the normal anatomy and with no suture line tension. The technique is simple, rapid, less painful, and effective, allowing prompt resumption of unrestricted physical activity.

Groin↗
PubMed1988

Cause and prevention of postherniorrhaphy neuralgia: a proposed protocol for treatment.

The cause of severe and persistent neuralgia after hernia surgery is due to sensory nerve crushing. An operative technique has been described that prevents inadvertent crushing or division of the sensory nerves to the groin. With persistent postoperative pain, the offending nerve is usually difficult to identify. A protocol has been suggested to differentiate ilioinguinal from genitocrural causalgia. When the particular nerve is incriminated, its division will ordinarily cure the problem.

Hernia, Inguinal↗
PubMed1987

Pneumoperitoneum complicating coronary bypass surgery: management without laparotomy.

Drainage of the mediastinum or thoracic cavity following bypass surgery is a routine procedure. A case is reported where pneumoperitoneum developed after the surgical procedure with vague abdominal symptoms accompanied by fever and leukocytosis. Because of the possibility of a rupture of an intra-abdominal organ laparoscopy was performed in this very ill patient and laparotomy avoided. Attention is drawn to this particular group of patients with the sequela of pneumoperitoneum in which laparoscopy can solve the diagnostic dilemma.

Aged↗
PubMed1985

Television choledochoscopy.

Present techniques of intraoperative cholangiography and choledochoscopy have not completely solved the problem of the common bile duct stone that is missed. Televised choledochoscopy provides an improved imaging technique which should facilitate stone retrieval. A similar television endoscopic technique has already become standard among orthopedic surgeons performing diagnostic and therapeutic arthroscopy. This equipment can be shared by surgeons specializing in orthopedic or general surgery.

Endoscopy↗
PubMed1974

High bulk diet for diverticular disease of the colon.

In the past century diverticular disease of the colon has changed from being almost unknown to becoming the most common disease of the colon. Studies in Britain indicated that the pathological basis of the disease is a thickening of the colonic musculature, with diverticulosis and diverticulitis developing because of increased intracolonic pressures generated by the thickened colon wall. This pressure can be sharply reduced by increased colonic bulk. Geographical and anthropological data reveal that diverticular disease results from Western civilization's food habits, specifically the reduced fiber content in food. There is evidence that increasing the dietary intake of fiber by the addition of bran can prevent formation of diverticula and relieve the symptoms of established disease. Large scale studies are recommended both as treatment and to further test the validity of this concept.

Animals↗