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Biomedical subjects

B R Kurtz

Publications and source records attributed to B R Kurtz.

15 recordsLinked to original sources
PubMed1994

Laparoscopic assisted vaginal hysterectomy: one group's experience.

Laparoscopic assisted vaginal hysterectomy (LAVH) has been reported worldwide. We report our experience with LAVH in 51 patients, 23 with the laparoscopic stapling device, 12 with a combination of stapler and bipolar coagulation, and 16 by bipolar coagulation exclusively. No operations were converted to laparotomy, and there were few minor complications. Average operating time was 1 h and 38 min. Hospital stay averaged 2.2 days. Average hospital costs were greater for the stapling devices ($7815.00) compared with bipolar coagulation ($7150.00). Postoperative patient satisfaction was high (96%), with high resolution of the symptoms (94%). We conclude that LAVH is a safe, effective operation in selected cases and may be a valid alternative to abdominal hysterectomy.

Adult↗
PubMed1993

Laparoscopic presacral neurectomy vs neurotomy: use of the argon beam coagulator compared to conventional technique.

Presacral neurectomy is effective treatment for dysmenorrhea and midline pelvic pain. Conventional laparoscopic techniques describe retroperitoneal dissection to excise retroperitoneal nerve tissue. The argon beam coagulator (ABC) can be used laparoscopically to hemostatically ablate and thus separate the presacral tissues down to the periosteum without dissecting or excising tissue. In 32 patients undergoing laparoscopic presacral neurectomy, 17 were performed with conventional methods, and 15 patients underwent ABC neurotomy only, without dissection or excision. Postoperative pain reduction was the same in both groups (73% vs 75%), with average anesthesia time 64 min for ABC neurotomy vs 92 min with conventional techniques. One major vascular complication requiring immediate laparotomy occurred in the ABC group. When properly applied laparoscopically, the ABC is an effective tool to rapidly coagulate and separate the presacral nerves with minimal smoke, excellent visualization, and no retroperitoneal dissection.

Adult↗
PubMed1993

Laparoscopic myomectomy using the argon beam coagulator.

Fourteen patients with symptomatic uterine fibroids underwent laparoscopic myomectomy using the argon beam coagulator (ABC). The ABC provides conventional unipolar coagulating current in a nontouch technique, which aids in dissection of the myoma in a hemostatic fashion. Minimal smoke production yields excellent visualization. Fibroids ranged from 2 cm to 6 cm, and eight of the patients had multiple fibroids removed. There were no intraoperative complications and there was minimal operative blood loss. The ABC is a safe and effective tool for laparoscopic removal of symptomatic uterine fibroids.

Female↗
PubMed1993

Laparoscopically assisted vaginal hysterectomy. The initial Nashville, Tennessee, experience.

It is now possible to begin a difficult hysterectomy via laparoscopy with or without adnexal removal and then complete the operation vaginally. We report our successful experience with laparoscopically assisted vaginal hysterectomy in 62 of 68 patients. Techniques used for hemostatic separation of the uterus and adnexal pedicles included an automatic laparoscopic stapling device (49 cases), bipolar coagulation with sharp transection (11) and combined techniques (2). Minor complications occurred in four patients. Six patients had their operations converted from laparoscopy to laparotomy because of significant adhesions (three), large fibroids (two) and poor access due to obesity (one). The use of a stapling device required less anesthesia time (1 hour, 57 minutes, vs. 3 hours, 43 minutes), a smaller blood loss (145 vs. 247 mL) and shorter hospital stays (2.53 vs. 2.75 days) than did laparoscopic bipolar coagulation. However, the average hospital costs were greater for disposable automatic stapling devices and trocars when compared to bipolar coagulation techniques ($9,310 vs. $6,227). Postoperative patient satisfaction with the operation was high (98%), with a high rate of symptom resolution (95%). Laparoscopically assisted vaginal hysterectomy is a safe, effective operation in selected cases and may soon become a common alternative to abdominal hysterectomy in certain cases.

Adult↗
PubMed1993

Incarcerated incisional hernia after laparoscopy. A case report.

A woman who had undergone operative laparoscopy with myomectomy, appendectomy and coagulation of endometriosis was readmitted on postoperative day 3 with a small bowel obstruction. At laparotomy she was found to have an incarcerated loop of small bowel through a 12-mm trocar site in the left midabdomen. A bowel resection was not required. The defect was closed, and the patient recovered without difficulty. Two points should be made about avoiding hernias, especially through a larger trocar site. First, the trocar sheath should be opened to room air during its removal to avoid creating a vacuum and pulling a loop of bowel into the incision. Second, the fascia should be closed after removal of larger trocars. This can be accomplished during direct visualization through the laparoscope prior to removal of the pneumoperitoneum to avoid placing the suture through the bowel.

Adult↗
PubMed1992

Laparoscopic oophorectomy: comparative study of ligatures, bipolar coagulation, and automatic stapling devices.

OBJECTIVE: We assessed laparoscopic oophorectomy using three techniques. METHODS: From January 1989 to October 1991, 65 patients underwent laparoscopic oophorectomy using three techniques: bipolar coagulation, pretied ligature placement, and automatic stapling devices. The patients were aged 18-57 years and had the indications of pain, ovarian endometriosis, adhesions, unilateral blocked tubes, breast cancer, and recurrent benign ovarian cysts. The primary method of adnexal removal involved the automatic stapling device in 17, bipolar coagulation in 30, and pretied ligatures in 18. RESULTS: Total anesthesia time ranged from 45-123 minutes, with means of 77 minutes for pretied ligatures, 84 minutes for bipolar coagulation, and 84 minutes for automatic stapling devices. Sixty-two patients were discharged within 23 hours, two stayed two nights, and one stayed three nights. Rectus muscle bleeding and hematoma formation were the only complications in this series. CONCLUSION: All three methods of laparoscopic oophorectomy are effective, with similar operative times and uniformly good results for the patients.

Adult↗
PubMed1992

Hysteroscopic endometrial ablation using the rollerball electrode.

OBJECTIVE: To assess the efficacy of hysteroscopic endometrial ablation with the rollerball resectoscope. METHODS: From April 1989 to March 1991, 64 women underwent hysteroscopic endometrial ablation using electrosurgery. Telephone follow-up was obtained for 61 patients at least 6 months after the procedure. The majority of patients requested endometrial ablation because of irregular heavy menses, and two patients presented with postmenopausal bleeding. All patients had preoperative endometrial sampling that demonstrated benign endometrial histology. Five women had previous endometrial ablation with the Nd:YAG laser, with persistent bleeding. Eight patients had endometrial polyps and six had submucous fibroids that were resected at the time of hysteroscopic ablation. RESULTS: The average operative time was 31.6 minutes, and an average of 304 mL of distending medium was absorbed during the procedure. Complications included one uterine perforation in a patient who had a previous Nd:YAG ablation, and one epidural anesthetic complication. At follow-up, 18 women (29.5%) reported amenorrhea, 16 (26.2%) reported spotting, 21 (34.4%) reported decreased menstrual flow, four (6.6%) had no change, and two (3.3%) noted increased flow. Subjectively, 49 patients (80.3%) reported a satisfactory outcome. Of the 12 who were not satisfied, seven underwent a repeat ablation with satisfactory results, four chose hysterectomy, and one elected not to have further therapy. CONCLUSION: Endometrial ablation with the rollerball electrode is a safe, excellent method of management in women with excessive menstrual flow and provides a cost-effective, minimally invasive alternative to hysterectomy.

Adult↗
PubMed1991

Laser laparoscopic management of large endometriomas.

Forty-seven patients underwent laser laparoscopic management of endometriomas from 3 to 12 cm in diameter. Eighteen patients had infertility, 15 had pelvic pain, and 14 had both. The types of laser used were the carbon dioxide, argon, and potassium-titanyl-phosphate. There were no surgical complications. Twelve of 32 patients with infertility achieved pregnancy after the initial procedure. Subsequently, 2 patients conceived after a second-look procedure. Twenty-three of 30 patients with pelvic pain reported improvement or resolution. We confirm the efficacy of operative laparoscopy using lasers in the management of large ovarian endometriomas.

Adult↗
PubMed1991

The use of an automatic stapling device for laparoscopic appendectomy.

Laparoscopic appendectomy, for years performed only occasionally, is becoming more common with the increasing interest by both general surgeons and gynecologists in "minimally invasive surgery." A recently available automatic laparoscopic stapling system (the MULTI-FIRE ENDO GIA 30) claims to make laparoscopic appendectomy technically easier to perform. The technique of laparoscopic appendectomy using this automatic stapling device was evaluated in ten patients and compared with our previous laparoscopic techniques. The MULTI-FIRE ENDO GIA passes through a 12-mm trocar and allows placement of two triple-staggered lines of titanium staples with a simultaneous cut. Using this technique, operating time for laparoscopic appendectomy was reduced from an average of 30 to a minimum of 5 minutes. With this technique, no appendiceal contents leaked intraperitoneally. The larger trocar allowed easier removal of the separated appendix with minimal dissection of the mesoappendix. Indications for appendectomy included endometriosis of the appendix (three), fixation to the right tube or ovary (three), early acute appendicitis (two), and elective removal (two). There were no immediate or late complications. Our preliminary experience with the MULTI-FIRE ENDO GIA 30 stapler suggests that it is a safe, easy, and rapid method of removing the appendix laparoscopically.

Adult↗
PubMed1988

Divergent correlations of circulating dehydroepiandrosterone sulfate and testosterone with insulin levels and insulin receptor binding.

We evaluated the insulin response to a standard oral glucose tolerance test (OGTT) and in vitro insulin binding to erythrocytes (RBC) in 26 women from 3 groups: Group NW, normal women (n = 11); Group DS, women (n = 9) with elevated serum DHEAS concentrations, greater than 400 micrograms/dl (greater than 10.84 mumol/L); and Group IR, women (n = 6) with elevated basal plasma insulin concentrations (IRI). There was a significant linear correlation between the area under the insulin response curve (IRI-AUC) and serum testosterone (T) (r = 0.78, p = 0.0001). Using stepwise multiple linear regression, IRI-AUC was characterized as a function of both serum T and DHEAS; positively with T and negatively with DHEAS. In vitro (n = 17), there was a positive correlation between RBC-insulin binding and serum DHEAS (r = 0.54, p = 0.029) and a negative correlation between RBC-binding and T (r = -0.57, p = 0.017). We conclude that DHEAS may enhance insulin binding and action and that DHEAS and T have divergent functional relationships with IRI. DHEAS and T may therefore exert opposing effects on insulin secretion and action.

Dehydroepiandrosterone↗
PubMed1987

Reduction of hyperinsulinemia and insulin resistance by opiate receptor blockade in the polycystic ovary syndrome with acanthosis nigricans.

We previously reported that circulating beta-endorphin levels are increased in obese hirsute women and that plasma immunoreactive insulin (IRI) levels are increased in proportion to the degree of hyperandrogenism in women with the polycystic ovary (PCO) syndrome. We, therefore, tested the hypothesis that endogenous opiates are at least partially responsible for the hyperinsulinemia and insulin resistance in this syndrome. In the first study, acute naloxone administration significantly reduced the plasma IRI response and IRI/glucose ratio in three euglycemic obese women with PCO and acanthosis nigricans (AN) and marked insulin resistance, but did not alter the glucose response. Naloxone had no effect on these parameters in the normal weight control subjects. In the second study, nalmefene, a new, orally active opiate antagonist, reduced IRI and the IRI/glucose ratio in four women with PCO-AN and marked hyperinsulinemia in a randomized, double blind, crossover protocol. We conclude that endogenous opiates are at least partially responsible for the hyperinsulinemia and insulin resistance in PCO-AN.

Acanthosis Nigricans↗
PubMed1987

Maintenance of normal circulating levels of delta 4-androstenedione and dehydroepiandrosterone in simple obesity despite increased metabolic clearance rates: evidence for a servo-control mechanism.

To study the effect of obesity on the metabolism of adrenal androgens not bound to testosterone-estradiol-binding globulin, the MCRs of delta 4-androstenedione (A) and dehydroepiandrosterone (DHEA) were determined using constant infusion of unlabeled steroids to steady state in 8 normal weight and 19 obese nonhirsute eumenorrheic women. The blood production rates (PR) were calculated as the product of the MCR and the 24-h integrated serum concentrations (IC). The mean MCR and PR of A and DHEA were significantly higher in the obese women than in the normal weight women. There was, however, no difference in the mean IC of each androgen in the 2 groups. The MCR and PR of A and DHEA were each correlated with the body mass index (BMI; kilograms per m2). The MCR and PR of A and the MCR of DHEA were also correlated with the ratio of waist circumference to hip circumference (WHR). However, the PR of DHEA was not correlated with WHR. There was no correlation between the IC of either androgen and BMI or WHR. However, partial correlation analysis revealed that correction of the BMI for WHR resulted in a significant negative correlation between BMI and IC of A. We conclude that the MCR and PR of A and DHEA were increased in obese nonhirsute eumenorrheic women; there was a strong correlation between BMI and the MCR and PR of A and DHEA; upper segment obesity, as measured by WHR, was correlated with the MCR and PR of A and the MCR of DHEA, but not with the PR of DHEA; and circulating DHEA and A were maintained at normal levels in the obese eumenorrheic women despite an increase in the MCR, which suggests that a servo-mechanism is operative which registers the body size and adjusts the PR according to the MCR.

Adult↗
PubMed1986

Relative sensitivity and responsivity of serum cortisol and two adrenal androgens to alpha-adrenocorticotropin-(1-24) in normal and obese, nonhirsute, eumenorrheic women.

The alpha ACTH-(1-24) threshold dose and the response slope were determined for cortisol (F), delta 4-androstenedione (A), and dehydroepiandrosterone (DHEA) in 10 normal and 16 obese eumenorrheic nonhirsute women matched for age. Each woman received 1 mg dexamethasone at 2300 h and again at 0700 h the next morning. At 0700 h, a continuous alpha ACTH-(1-24) infusion was begun at an initial dose of 30 ng/1.5 m2 body surface area X hr. The ACTH infusion rate was doubled every hour for 5 consecutive h to a maximum dose of 480 ng/1.5 m2 X h. Blood samples were collected for steroid assays before the infusion and at the end of each hour. The ACTH threshold dose was defined as the dose that produced a steroid response significantly above the basal level. The ACTH threshold dose for serum F and DHEA stimulation was not different between the groups, but the threshold dose for A was significantly lower in the obese women. Basal and stimulated serum DHEA to F ratios were significantly higher in the obese women. In both groups, the mean F response slope was significantly higher than that for DHEA, which in turn, was significantly higher than that for A. The mean DHEA response slope was significantly greater in the obese women. The F and A response slopes were not different between the groups. We conclude that the relative responsivity of the steroids to ACTH was the same in both groups: F greater than DHEA greater than A; in the obese women, the ACTH threshold dose for F stimulation was lower (greater sensitivity) than for DHEA or A stimulation; and in the obese women, the ACTH threshold dose for A was significantly lower (increased sensitivity) and the slope of the DHEA response to ACTH was steeper (greater responsivity) than in normal women.

Adrenal Cortex Function Tests↗