Use of a pedicled omental flap in the treatment of an infected vascular prosthetic graft.
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Blood Vessel Prosthesis↗
Biomedical subjects
A Hubens
Publications and source records attributed to A Hubens.
Use of glycerolized cadaver skin for the treatment of scalds in children.
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Burns↗
The influence of the interaction of sutures with the mucosa on tumour formation at colonic anastomoses in rats.
In order to explore the respective role of wound healing and suture material on metachronous carcinogenesis at colonic lines in rats, tumour yield was studied after the administration of a chemical carcinogen (azoxymethane) at the moment that in one group of rats most of the suture material was still present and crypt cell proliferation elevated, while in another group, no more suture material was present and crypt cell proliferation rate (CCPR) normalized at the anastomotic site. Azoxymethane (15 mg/kg/week, s.c., during 6 weeks) was administered in male Sprague-Dawley rats (n = 105) 8 weeks after the creation of an anastomosis in the ascending and descending colon with either stainless steel sutures (group A, n = 30) or fast-absorption Vicryl (Vicryl Rapide, group B, n = 30). A control group (group C, n = 30) underwent a sham laparotomy before the administration of azoxymethane, while the animals of a fourth group (group D, n = 15) were not operated upon and received no azoxymethane. Twenty-six weeks after the first injection of azoxymethane there was no significant difference in the total colorectal tumour yield in the three operated groups (A, B, C), but a significantly greater proportion of anastomotic tumours (28/68 vs. 13/88, p < 0.01) and more anastomotic tumours per rat (28/23 vs. 13/28, p = 0.01) as well as more rats with anastomotic tumours (16/23 vs. 11/28, p = 0.04) were found in the steel-sutured group (A), compared with the control group (C).(ABSTRACT TRUNCATED AT 250 WORDS)
Anastomosis, Surgical↗
Evaluation of tissue oximetry in perioperative monitoring of colorectal surgery.
Twenty patients undergoing elective colorectal surgery were studied during and after operation by means of tissue oximetry measuring the subcutaneous partial pressure of oxygen (PscO2) and by gastric intramural pH measurement. Mean(s.d.) PscO2 recorded 24 h after surgery was significantly lower than the peroperative value: 14(10) versus 24(14) mmHg, P less than 0.02. The postoperative PscO2 was also significantly lower than that measured in a control group of ten healthy volunteers: 14(10) versus 34(18) mmHg, P less than 0.001. The peroperative PscO2 of the patients who developed a postoperative complication was significantly lower than that of those who had an uneventful postoperative clinical outcome: 16(9) versus 32(14) mmHg, P less than 0.02. The peroperative PscO2 of the patient group with complications was also significantly lower than that of the control group: 16(9) versus 34(18) mmHg, P less than 0.02. The peroperative PscO2 of the group of patients without complications was almost identical to that of the control group. During operation only one patient developed gastric intramural acidosis. Perioperative oxygen debt and the response of subcutaneous tissue oxygen tension to oxygen breathing seemed to correlate better with clinical outcome than gastric wall pH values and the conventional parameters of tissue perfusion.
Adult↗
Effect of nonabsorbable and rapidly absorbable suture material on the cytokinetics of crypt cells in colonic anastomoses in the rat.
The effect of non-absorbable and rapidly absorbable suture material on the cytokinetics of crypt cells was studied in right and left colonic anastomoses in the rat by using stathmokinetic methods. Forty-five male Sprague-Dawley rats were allocated to three groups. In group A (n = 15), colonic anastomoses were performed in the right and left colon using nonabsorbable, stainless steel sutures. Groups B (n = 15) animals had identically located anastomoses but a rapidly absorbable suture material (Vicryl Rapide) was used. Animals of group C (n = 15) acted as controls. Eight weeks postoperatively, the crypt cell production rate (CCPR) was determined after measuring the slope of the metaphase accumulation line. At this time, no suture material was detected in any of group B (Vicryl Rapide) animals, while in group A rats (stainless steel), 79% of the animals had suture material in place. A steel-sutured anastomosis significantly increased the CCPR in the right colon from 6.2 to 10.6 cells/crypt/h and in the left colon from 5.6 to 9.8 cells/crypt/h compared with controls (p less than 0.05). An anastomosis performed with Vicryl Rapide, whether in the proximal or descending colon, did not influence the CCPR when compared with the control group (right 6.4 vs. 6.2 cells/crypt/h; left 4.2 vs. 5.6 cells/crypt/h). The CCPR at steel-sutured anastomoses was significantly higher than the CCPR at the Vicryl Rapide anastomotic site both in the right (10.6 vs. 6.4 cells/crypt/h) as well as in the left colonic sites (9.8 vs. 4.2 cells/crypt/h) (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Anastomosis, Surgical↗
Percutaneous drainage of a pancreatic pseudocyst.
We present a patient who developed a pancreatic pseudocyst after surgery for a retroperitoneal fibrous histiocytoma invading the pancreatic tail. The diagnosis was made on the basis of CT and the tail pseudocyst resolved with percutaneous drainage only.
Adult↗
Assessment of the perfusion in peripheral tissue beds by subcutaneous oximetry and gastric intramucosal pH-metry in elective colorectal surgery.
Gastric intramucosal pH (pHi) and subcutaneous oxygen tension (PscO2) were compared with traditional perfusion parameters in patients undergoing elective colorectal surgery and were related to clinical outcome. Ten patients were studied per- and postoperatively and tissue oximetry studies were also performed in a group of 10 healthy volunteers. The response of PSCO2 to oxygen breathing proved to be the most sensitive predictor of clinical outcome. Of the 10 patients 8 failed to respond to an O2 challenge, while all 10 volunteers in the control group did so. Out of those 8 patients 6 presented with mainly infectious complications while only 3 had an inadequate perioperative urine output and none presented with signs of arterial or of gastric intramural acidosis. The present study suggests a possible relationship between clinical outcome and oxymetric signs of tissue hypoperfusion after O2 challenge in surgical patients, even in the presence of an adequate urine output and a normal gastric wall pH.
Adult↗
Gastric emptying for solids in patients with duodenal ulcer before and after highly selective vagotomy.
In a series of 31 duodenal ulcer patients (23 males and 8 females), who underwent a highly selective vagotomy, gastric emptying characteristics of a solid meal, labeled with [99mTc]stannous colloid, were assessed before, two weeks and six months after operation. The clinical diagnosis was confirmed by endoscopy and x-ray; failure of treatment with H2 antagonists or antacids during 1-18 (mean 5) years was the direct indication for operative treatment. A temporary delay in gastric emptying is noted two weeks after operation (T1/2: 124 vs 57 min). After six months, gastric emptying time has practically normalized. It appears that this is the result of the preservation of the antropyloric vagal nerve supply. In these patients, a 10% recurrence rate is noted, comparable to the results in the literature. Highly selective vagotomy proves to be a safe and effective procedure with few side effects. It does not impair gastric motility.
Adult↗
Some points of interest in the management of rectal cancer.
The author presents the surgeon's viewpoint in the management of rectal cancer outlining the possible contribution of early detection, precise pre-operative evaluation of the tumour extension and the necessity to provide a form of curative and radical treatment while given the best possible quality of life.
Antineoplastic Agents↗
The influence of cholecystectomy on the duodenogastric reflux of bile.
The effect of cholecystectomy on postprandial duodenogastric bile reflux was studied by biliary excretion scintigraphy in a group of 20 patients examined before and after gallbladder removal. Dyspeptic complaints were correlated with the presence of postprandial duodenogastric reflux in 37 patients admitted to the hospital for cholecystectomy. The removal of the gallbladder, whether functional or not, in patients presenting with gallstones, did not seem to influence the occurrence of postprandial duodenogastric bile reflux. Dyspeptic complaints were positively correlated with postprandial gastric reflux. This reflux was observed in 90% of dyspeptic patients, while only 7% of the patients without dyspepsia had reflux. The role of duodenogastric reflux in the production of dyspeptic complaints is open to discussion, but the removal of the gallbladder does not seem to interfere with the occurrence of bile reflux into the stomach after a milk meal.
Adult↗
Reconstruction of the digestive tract after total gastrectomy.
Reconstruction of the digestive tract after total gastrectomy should be safe and give the patient maximal comfort. Dehiscence of the esophago-enteral anastomosis is the main cause of operative mortality. Stapling and jejunoplication procedures offer the best chances of success. A Roux-en-Y esophagojejunostomy is readily carried out in patients with malignant disease, and avoids distressing reflux esophagitis, which constitutes a major cause of morbidity. The construction of a gastric reservoir has been advocated to prevent malnutrition, weight loss and other functional complaints. This matter is still the subject of much debate and requires further prospective studies. A personal retrospective evaluation of 23 patients provided with a Lygidakis pouch after total gastrectomy shows that this procedure can be performed with an acceptable mortality rate (8.7%). The clinical results look promising as most of the patients studied one year after the operation had no functional complaints and their weight had stabilized.
Anastomosis, Roux-en-Y↗
The mesh skin graft--true expansion rate.
Using the mesh graft II dermatome (Zimmer) for split skin graft expansion, the 3 to 1 and 1.5 to 1 expansion rates were evaluated for true clinical expansion. In one hundred and one 1.5 to 1 expanded grafts the actual expansion was 1.2 and in sixty 3 to 1 expanded grafts, it was 1.5.
Burns↗
Prognostic value of gastric intramural pH in surgical intensive care patients.
Gastric intramural pH (pHi), which has been shown to reflect the adequacy of oxygenation in peripheral tissue beds, was measured in acutely ill surgical patients in order to evaluate its value as a prognostic factor and its relation to the sepsis score. Fifty-nine surgical patients were studied on ICU admission. The stomach wall pH was calculated from the PCO2 in gastric juice and arterial bicarbonate concentration using the Henderson-Hasselbalch equation. A fall in tissue pH less than 7.32 was taken as an indication of inadequate tissue oxygenation. Patients with sepsis scores greater than 10 were considered septic. Hospital and short-term (within 72 h of admission) mortality rates were determined. A significantly higher short-term mortality rate was observed in patients having a pHi less than 7.32 (37% vs. 0%, p less than .005). Most (90%) of the septic patients had a pHi less than 7.32. The short-term mortality rate was the highest (50%) in the septic group. In this group also, a linear correlation was found between pHi and the sepsis score (r = -.43, p less than .01). Gastric pHi, however, offered no prediction for the long-term outcome.
Adult↗
Effect of cisapride on the post-cholecystectomy upper gastrointestinal transit time.
For the evaluation of postoperative upper gastrointestinal transit, the breath hydrogen test is a convenient method, which is simple but more reliable than the recording of clinical parameters such as bowel sounds. The test was used to study the effect of cisapride on the postoperative mouth-to-caecum transit time. Twenty patients undergoing cholecystectomy were tested pre-operatively and on the first postoperative day after having received either 10 mg of cisapride i.v. or matching placebo under double-blind conditions. The median preoperative transit time in the placebo group was 45 min, and the median postoperative transit time at least 3 h longer. The postoperative transit time after cisapride dosing was still longer than before the operation but was significantly (p = 0.02) reduced as compared with that after placebo administration.
Adult↗
Anterior gastric stapling combined with posterior truncal vagotomy: an experimental technique for gastric acid reduction.
An operative technique using a mechanical stapling device has been developed to simplify proximal gastric vagotomy. A series of gastric fistula dogs underwent posterior truncal vagotomy and anterior lesser curvature stapling. The basal and pentagastrin-stimulated acid secretion was measured before surgery and 2 weeks and 3 and 9 months after surgery. During the whole period, no change in body weight was noticed. Gastric acid secretion in dogs remained low and stable during the first year after the procedure.
Animals↗
Priorities in abdominal trauma.
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Abdominal Injuries↗
Campylobacter fetus as a cause of acute cholecystitis.
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Acute Disease↗
Isolated unilateral adrenal hemorrhage after a motorcycle race.
A 19-year-old girl presenting with an isolated unilateral adrenal hemorrhage after a motorcycle cross-country race without evidence of direct trauma, is reported. The lesion was diagnosed by abdominal ultrasonography, and treated surgically by thoracolaparotomy. Recovery has resulted. A review of literature shows the rarity of the condition.
Adrenal Gland Diseases↗