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Biomedical subjects

C T Frantzides

Publications and source records attributed to C T Frantzides.

At least 37 records · Page 2Linked to original sources
PubMed1997

Laparoscopic highly selective vagotomy.

Laparoscopic highly selective (anterior and posterior) vagotomy was performed in 11 patients for duodenal ulcer (n = 10) and duodenal ulcer with prepyloric ulcer (n = 1). All patients were endoscoped both pre- and postoperatively. There were no perioperative complications. The average operating time was 3.2+/-0.4 hours and the average hospital stay was 1.7+/-0.2 day (range 1 to 3 days). None of the patients required parenteral narcotics postoperatively. The patients have been followed for 6 months to 5 years after operation. All ulcers healed as demonstrated by endoscopy. There was one recurrence at 9 months in a patient who had a prepyloric ulcer preoperatively. The recurrence was treated successfully with medication. There has been no other long-term morbidity. Laparoscopic highly selective vagotomy is feasible, safe, requires a brief hospital stay, and produces short-term results comparable with open surgery.

Duodenal Ulcer↗
PubMed1997

Laparoscopic redo Nissen fundoplication.

Nine patients underwent redo laparoscopic Nissen fundoplication because of failed primary laparoscopic antireflux procedure. Symptoms prior to reoperation included heartburn (n = 5), dysphagia (n = 2), dysphagia and heartburn (n = 1), and early satiety and epigastric pain (n = 1). Endoscopic and radiologic findings prior to reoperation included esophagitis (n = 6), reflux (n = 6), stenosis (n = 2), and hiatal hernia (n = 1). Findings at reoperation included fundoplication positioned on the stomach (n = 5); a disrupted cruroplasty (n = 1); gastric volvulus (n = 1); and an excessively tight wrap (n = 1) or cruroplasty (n = 1). Reconstruction of the fundoplication was performed according to accepted principles for this procedure. All patients were discharged within 2 days after the redo procedure. Follow-up time is 4-14 months. Preoperative symptoms were relieved in all patients and all antireflux medication have been discontinued. Routine postoperative esophagram and endoscopy demonstrated intact repair and without gastroesophageal reflux or stenosis. Reoperative laparoscopic Nissen fundoplication is feasible and effective.

Adult↗
PubMed1996

Penetration of ciprofloxacin and fleroxacin into biliary tract.

Forty patients with chronic cholecystitis or cholelithiasis were prospectively randomized for therapy with either ciprofloxacin or fleroxacin to study the penetration of these two agents into gallbladder tissue, plasma, and bile. Patients received a 3-day course of ciprofloxacin (500 mg twice a day) or fleroxacin (400 mg once daily) and were subdivided into four groups reflecting intraoperative sample collection at 4, 7, 14, and 25 to 26 h following the last quinolone dose. Mean concentrations in plasma for ciprofloxacin and fleroxacin at 4 and 25 to 26 h postdose were 2.5 and 10 micrograms/ml and 0.3 and 1.8 micrograms/ml, respectively. The concentrations of ciprofloxacin and fleroxacin in bile and gallbladder wall tissue at 25 to 26 h postdose were 4.5 and 8.6 micrograms/ml and 1.2 and 4.4 micrograms/ml, respectively. Both agents demonstrate rapid tissue penetration with persistence at levels appropriate for treatment of biliary pathogens.

Adolescent↗
PubMed1995

Laparoscopic versus conventional fundoplication.

The operative and short-term results of 29 patients who had an open fundoplication were compared to 36 patients who had a laparoscopic fundoplication. The operative time was 2.8 +/- 0.4 and 3.1 +/- 0.3 h for the open and laparoscopic procedure, respectively. The length of hospital stay was 9.2 +/- 0.7 days for the open and 1.8 +/- 0.2 days for the laparoscopic. There were five complications in the open group and one in the laparoscopic group. The follow-up period was 3-32 months and all patients had a barium swallow and esophago-gastroduodenoscopy (EGD) for postoperative evaluation. All patients had resolution of esophagitis on follow-up endoscopy, were free of reflux symptoms, and no longer required antireflux medication. Laparoscopic Nissen fundoplication has an operative time that is comparable to the open procedure. The complication rate for laparoscopic fundoplication is acceptable. Patients undergoing a laparoscopic fundoplication have a shorter hospital stay compared to patients with an open procedure. The short-term outcome for the laparoscopic fundoplication group was excellent.

Adult↗
PubMed1995

Laparoscopic gastric bypass in a porcine model.

Gastric bypass and vertical banded gastroplasty are the two procedures used most frequently in the treatment of morbid obesity. In a pilot study, we used a porcine model in which laparoscopic gastric stapling and Roux-en-Y gastrojejunostomy were accomplished.

Anastomosis, Roux-en-Y↗
PubMed1995

Nonopioid analgesics shorten the duration of postoperative ileus.

Morphine inhibits propagating and stimulates nonpropagating colon contractions in monkeys and humans. The use of morphine or other opioids that inhibit propulsive contractions prolongs postoperative ileus. In contrast, ketorolac tromethamine, a nonsteroidal analgesic, has no effect on colon contractions in monkeys. In 14 patients having elective abdominal operations, bipolar electrodes were implanted on the right (n = 13) and left (n = 10) colon. Group A (n = 8) received ketorolac, 30 mg IM q6h, for pain relief. Group B (n = 6) needed supplemental morphine, 2-10 mg IV or IM, plus ketorolac to control their pain. Myoelectric activity was recorded from each subject on postop Days 1-5 and analyzed by computer for electrical control activity (ECA), short and long electrical response activity (ERA), and propagation of long ERA. There was a difference between the two groups in return of propagated long ERA bursts that correlated with clinical recovery from postoperative ileus. Postoperative analgesia with ketorolac resulted in faster resolution of ileus compared to morphine plus ketorolac because opioid-induced motor abnormalities in the colon were avoided.

Adult↗
PubMed1995

Methods of assessing motility of the digestive system in children.

The study of gastrointestinal motility in children has evolved during the past 25 years. Miniaturization of tools for collecting data has created opportunities to study the maturation of gastrointestinal motility patterns in infants and complaints of abdominal pain, nausea, diarrhea, constipation and distention in children. Available methods, indications for testing, and data evaluation of pediatric esophageal, gastrointestinal, and colonic motility and manometric tests are discussed.

Catheterization↗
PubMed1994

Laparoscopic repair of a penetrating injury to the diaphragm: a case report.

A traumatic diaphragmatic hernia that appears late may have a fatal outcome. Traditionally, the most sensitive diagnostic modality for diaphragmatic injuries has been laparotomy. This results in unnecessary laparotomies. Laparoscopy is now an alternative method for the diagnosis and treatment of numerous intraabdominal disorders. We present a case of a penetrating diaphragmatic injury that was diagnosed and repaired via the laparoscope.

Adult↗
PubMed1994

A reevaluation of antibiotic prophylaxis in laparoscopic cholecystectomy.

Antibiotic prophylaxis for cholecystectomy, although somewhat controversial, is nevertheless a routine component of surgical care. With the advent of laparoscopic cholecystectomy, this routine practice of antibiotic prophylaxis needs to be reevaluated. The present investigation was undertaken to determine the incidence of postsurgical infection in patients receiving antibiotic prophylaxis compared with patients receiving chlorhexidine gluconate scrub the evening before surgery. A total of 448 patients were enrolled in the study. Thirty-two of these patients were excluded because of the presence of intrinsic risk factors for infection. Two hundred twenty-eight patients received antibiotic prophylaxis, and 188 patients were enrolled in the non-antibiotic group. A total of 14 infections occurred in the antibiotic prophylaxis group, whereas no infections occurred in the chlorhexidine group. These results suggest that meticulous antiseptic skin cleansing is sufficient for prevention of postsurgical infection following laparoscopic cholecystectomy. Antibiotic prophylaxis should be used only in those patients exhibiting intrinsic risk factors, such as cholecystitis.

Administration, Cutaneous↗
PubMed1993

Small bowel myoelectric activity in peritonitis.

Peritonitis is associated clinically with paralytic ileus, but the physiologic mechanisms of the effects of peritonitis on bowel myoelectric activity have not been explored. Bipolar electrodes were inserted into the rats, and myoelectric control recordings were obtained for 4 h/d for 5 consecutive days. Peritonitis was then induced, and myoelectric recordings were again obtained. Each animal served as its own control. Prior to induction of peritonitis (control), phase I, II, and III myoelectric activity was present in all recordings. The cycle duration of the migrating myoelectric complex was 17.17 +/- 0.39 minutes, and the migration velocity of phase III was 0.61 +/- 0.02 cm/min. The most striking feature during peritonitis was the complete inhibition of phase II activity. Phase III activity, however, was present with a cycle duration of 16.69 +/- 0.42 minutes. This study shows that some features of intestinal myoelectric activity (phase III) are preserved during episodes of peritonitis, and others are changed (phase I) or lost (phase II). Disappearance of phase II activity in this type of ileus emphasizes its importance in normal small bowel motility.

Animals↗
PubMed1993

Routine or selective intraoperative cholangiography in laparoscopic cholecystectomy.

The routine versus selective use of intraoperative cholangiography has been the subject of debate for some time. Most authors currently advocate routine intraoperative cholangiography with laparoscopic cholecystectomy. The authors report their experience with the selective and routine utilization of intraoperative cholangiography at two institutions. At institution A, 155 laparoscopic cholecystectomies were attempted, and 21 cholangiograms were performed (based on preoperative criteria of ultrasound, liver function tests, and history of jaundice, or intraoperative anatomical uncertainty). At institution B, 164 laparoscopic cholecystectomies were attempted and 127 cholangiograms were performed (a routine intraoperative cholangiography policy). At institution A, there were no common bile duct injuries but there was one retained stone. At institution B, there was one common bile duct injury and no retained stones. The patient with the retained stone from institution A had a preoperative indication (total bilirubin = 4.4 mg/dl) for a cholangiogram, but it was not performed due to technical difficulties. This patient later required endoscopic sphincterotomy with stone extraction. One patient at institution B had a choledochotomy which was detected by intraoperative cholangiography (IOC). This was managed with a T-tube. The selective use of cholangiograms in laparoscopic cholecystectomy will not yield a higher incidence of common bile duct injuries or retained stones compared to routine use. Further, a cholangiogram may not necessarily prevent choledochotomy but can prevent extension of common bile duct injury. Thus, it should always be performed when there is anatomic uncertainty.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1993

Myoelectric motility patterns following open versus laparoscopic cholecystectomy.

Laparoscopic surgery is associated with a lack of postoperative ileus. To determine if differences exist in postoperative motility patterns, 8 dogs were instrumented with bipolar electrodes 10-14 days prior to open (n = 4) or laparoscopic (n = 4) cholecystectomy. In both groups, Phase II activity disappeared in the first 24 h after operation. The appearance of the migrating myoelectric complex in the small intestine and the migrating colonic complex were used as criteria for recovery from postoperative ileus. Postoperative migrating myoelectric complex cycle length, migrating myoelectric complex, migration velocity, and colonic spike bursts/hour were also measured. No statistically significant differences were observed between groups in study parameters examined. Postoperative myoelectric motility patterns in dogs undergoing open versus laparoscopic cholecystectomy are not different. Other factors may be responsible for the rapid return to oral intake following laparoscopic cholecystectomy.

Animals↗
PubMed1993

A burr-like device to facilitate temporary abdominal closure in planned multiple laparotomies.

OBJECTIVE: To describe and test a method for temporary closure of the abdomen. DESIGN: Open laboratory and clinical studies. SETTING: Department of Surgery, Medical College of Wisconsin, USA. SUBJECTS: 11 patients who underwent planned relaparotomy. MATERIAL: The burr consists of two adherent sheets of polyamide and polypropylene, which may be trimmed to accommodate any wound. One sheet consists of micro-mushrooms, the second of multiple slings. The two sheets stick to each other upon pressure and can easily be separated to open the wound. INTERVENTION: Planned relaparotomy or staged abdominal repair. OUTCOME MEASURES: Measurements of tensile strength and microbiological cultures. RESULTS: The shearing force required to separate the burr is 150 +/- 27 N/5 cm2 when gas sterilized and 77 +/- 11 N/5 cm2 when used in five subsequent laparotomies. No adverse microbiological effects were seen. CONCLUSION: The artificial burr can be used for temporary closure of the abdomen. It circumvents the problems that occur with zip fasteners, Marlex mesh, slide fasteners, and towel clips.

Abdomen↗
PubMed1993

Laparoscopic closure of gastric stab wounds: a case report.

For years laparoscopy has been used selectively in the diagnosis of blunt and penetrating injuries to the abdomen. Recent advances in instrumentation have taken laparoscopy beyond its limited role in diagnosis. Use of the laparoscope for therapeutic intervention in selected cases of abdominal trauma is now possible. Here we report the use of laparoscopic techniques to diagnose and treat two stab wounds to the anterior wall of the stomach.

Adult↗