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Biomedical subjects

D Sleeman

Publications and source records attributed to D Sleeman.

At least 55 records · Page 3Linked to original sources
PubMed1996

Penetrating trauma secondary to heterotopic ossification in a laparatomy scar: a case report.

Heterotopic ossification is a common complication of numerous procedures, including abdominal operation, but traumatic perforation by such ossification is extremely rare. A 45-year-old man suffered traumatic perforation of the jejunum by ossification in a laparotomy scar. The diagnosis was made only at operation. The calcified mass was completely excised and the patient made a smooth recovery. The authors caution that the ossification may recur, and they recommend that such ossifications be removed electively if they are symptomatic or if their morphology is such that any viscera are at risk of perforation.

Cicatrix↗
PubMed1996

Oral surgery at St. Mary's Hospital, Chapelizod. A quarter century experience of day-case oral surgery.

To mark the first quarter century of the existence of the Oral Surgery unit at St. Mary's Hospital, Chapelizod, an audit was undertaken. Twenty-nine thousand, three hundred and seventy-four (29,374) entries in the operations register were analysed, examining annual totals, categories of operation, the changing patterns of anaesthesia, including cancellations on the day, and the evolution of a true day-case service. The results showed a decline in total numbers and in some operation categories. The most striking reductions were in extractions of carious teeth and in preprosthetic surgery. The most marked increase was in surgery for impacted teeth. While general anaesthesia remains the most commonly used form of anaesthesia, there has been an increased utilisation of sedation. Since the earlier years the number of patients requiring admission post-operatively has steadily decreased but more patients have been cancelled on the day of operation. Most of the changes described reflect the influence of health care economics and the effects of fluoridation.

Ambulatory Surgical Procedures↗
PubMed1995

Day case oral surgery: a review of 25 years experience at the Dublin Dental Hospital.

A retrospective analysis of the changing work-load at the Dublin Dental Hospital oral surgery day case unit was undertaken. This involved 26,697 operations performed during the 25-year period 1968-1992. The results show how the practice of oral surgery has changed over this time. Annual totals ranged from 766 to 1549 operations. While most categories of operations remained largely unchanged, the removal of impacted third molars increased from 10.5% of the annual total to 57.0%. Routine extractions of permanent teeth decreased from 53.9% of the annual total to 18.0%.

Ambulatory Surgical Procedures↗
PubMed1995

Acalculous cholecystitis: the use of diagnostic laparoscopy.

Acalculous cholecystitis (AC) carries a high mortality in the critically ill patient. This is partly due to the delay in its diagnosis. Clinical diagnostic examinations are often misleading. The purpose of our study was to evaluate the use of laparoscopy as a diagnostic tool in the evaluation of the critically ill patient suspected of having AC. From May 1993 to January 1994, we evaluated 10 critically ill patients. Mean age was 56 years (range 17-90 years). Nine of the patients were trauma victims (8 blunt, 1 penetrating). The other patient was postcoronary bypass surgery. The laparoscopy was done after a mean of 15 days (range 6-54 days) after ICU admission. All patients were receiving ventilatory support, and all patients had elevated temperatures of greater than 38.5 degrees C. Five patients had abdominal tenderness, and 6 had elevated liver function tests (LFT). Six laparoscopies were done under local anesthesia and IV sedation at the bedside, and 4 were done in the operating room. All patients tolerated the procedure well with no complications. The laparoscopic findings were gangrenous cholecystitis in 2 patients. They both underwent laparoscopic cholecystectomies in the operating room. We elected to drain a very distended gallbladder in 1 patient, who eventually was found to have an empyema of the chest. The other 7 examinations were normal. Six of these patients recovered and were discharged. Our results suggest that laparoscopy can be used in the diagnosis of acalculous cholecystitis. Its positive and negative findings are valuable in the treatment of the critically ill. It can be done safely at the bedside.

Adolescent↗
PubMed1995

Laparoscopic repair of a gunshot wound to the diaphragm: a case report.

The application of laparoscopy to the surgery of trauma is rapidly expanding. We report a case of laparoscopic repair of a gunshot wound to the right diaphragm. We discuss a technique for repair, as well as a method to create and maintain pneumoperitoneum while avoiding tension pneumothorax.

Adult↗
PubMed1995

Open versus laparoscopic appendectomy. A prospective randomized comparison.

OBJECTIVE: The authors compare open and laparoscopic appendectomy in a randomized fashion with regard to length of operation, complications, hospital stay, and recovery time. METHODS: Adult patients (older than 14 years of age) with the diagnosis of acute appendicitis were randomized to either open or laparoscopic appendectomy over a 9-month period. All patients received preoperative antibiotics. The operative time was calculated as beginning with the incision and ending when the wound was fully closed. Patients that were converted from laparoscopic to open appendectomy were considered a separate group. Return to normal activity and work were determined by questioning during postoperative clinic, telephone, or mailed questionnaire. RESULTS: There was a total of 169 patients randomized, 88 to the open and 81 to the laparoscopic group. The groups were similar demographically. Of the 81 laparoscopic patients, 13 (16%) were converted to open. In the open group, 70 patients (79.5%) had acute appendicitis and 21 (23.9%) had perforative appendicitis. In the laparoscopic group, 62 patients (76.5%) had acute appendicitis and 10 (12.3%) had perforative appendicitis. There was no statistical difference in the return to activity or work between the laparoscopic and open groups. The operative time was significantly longer in the laparoscopic group (102.2 minutes vs. 81.7 minutes, p < 0.01). The hospital stay of 2.2 days in the laparoscopic group and 4.3 days in the open group was statistically (p = 0.007). There was no difference in the hospital stay for those with acute appendicitis (1.89 days vs. 2.61 days, p = 0.067) compared with those with a normal appendix but with pelvic inflammatory disease (1.1 days vs. 2.3 days, p = 0.11). There was a significant difference in patients with perforative appendicitis (1.5 days vs. 9.5 days, p < 0.01). The hospital cost for patients having laparoscopic appendectomy was $6077 and for an open appendectomy $7227 (p = 0.164). There were no increased complications associated with the laparoscopic technique. CONCLUSION: Laparoscopic appendectomy is comparable to open appendectomy with regard to complications, hospital stay, cost, return to activity, and return to work. There was a greater operative time involved with the laparoscopic technique. Laparoscopic appendectomy does not offer any significant benefit over the open approach for the routine patient with appendicitis.

Adult↗
PubMed1995

Negative laparotomy in abdominal gunshot wounds: potential impact of laparoscopy.

OBJECTIVE: To evaluate the morbidity and hospital stay resultant from negative exploratory laparotomy (NL) for abdominal gunshot wounds (ABGSWs) and the potential impact the use of diagnostic laparoscopy (DL) could have on these variables. DESIGN: A retrospective study was conducted. MATERIALS AND METHODS: The charts of all patients with ABGSWs over a 4-year period were reviewed. Data was collected on injuries, rate of NL, morbidity and hospital stay. This was compared to a subsequent group of patients with ABGSWs managed with a DL protocol. MEASUREMENTS AND MAIN RESULTS: Over a 4-year period, 817 patients had exploratory laparotomy (EL) for ABGSWs. The NL rate was 12.4% (101 of 817); 69 of these patients had no associated injury or other procedures. They had a 22% morbidity and an average hospital stay of 5.1 days. Subsequently, 85 patients with ABGSWs underwent DL. This group was similar to the EL group and would have undergone EL prior to the introduction of DL at our institution. In this group, 34 patients had no associated injury or other procedures. They had a 3% morbidity, and their average hospital stay was 1.4 days. The morbidity and hospital stay were statistically significantly reduced (p < 0.01) in patients with negative DL versus NL. CONCLUSIONS: These data demonstrate that NL is associated with a high morbidity and long hospital stay. The use of DL can reduce the rate of NL, and result in lower morbidity and shorter hospital stay in patients with ABGSWs.

Abdominal Injuries↗
PubMed1995

Laparoscopy in 121 consecutive patients with abdominal gunshot wounds.

OBJECTIVE: The purpose of this study was to evaluate the sensitivity, specificity, and predictive value of diagnostic laparoscopy (DL) in a large group of stable patients with abdominal gunshot wounds (ABGSWs). DESIGN: This study was a prospective case series developed by management protocol. MATERIALS AND METHODS: In a 2 1/2-year period, DL was performed in 121 consecutive patients who were hemodynamically stable with ABGSWs and met protocol criteria. This represented 18% of all patients with ABGSWs seen in this period at the Ryder Trauma Center. The evaluation was conducted to determine peritoneal violation, the presence of intra-abdominal blood, and the need for exploration. MEASUREMENTS AND MAIN RESULTS: There were 42 (35%) positive and 79 (65%) negative DLs. In patients with positive DL, 39 (92.8%) had exploratory laparotomy. In this group, 32 (82%) had therapeutic laparotomy, 6 (15.4%) had nontherapeutic laparotomy, and 1 (2.5%) had a negative laparotomy. In this patient, DL was felt to be inadequate by the attending surgeon, although no penetration or intraperitoneal blood were present, and a negative laparotomy was done. This represents a failure rate of 0.8%. There were 3 (7.2%) positive DLs, in whom laparotomy was not performed. These patients had isolated nonbleeding liver injuries, and nontherapeutic laparotomy was successfully avoided. The negative DL group was divided into 47 patients (60%) with isolated ABGSWs, and 32 patients (40%) with associated injuries, mostly orthopedic and thoracic. There were no false-negative DLs and no delayed laparotomies in these 121 patients. There was no mortality in this study group. The sensitivity for peritoneal penetration was 100%, and the specificity was 98.7%. The positive predictive value was 97.6%, and the negative predictive value was 100%. In deciding on need for laparotomy (i.e., injury requiring repair), DL had a positive predictive value of 82%; more importantly, the negative predictive value was 100%. CONCLUSIONS: In stable patients with ABGSWs and questionable intra-abdominal injury, DL can be safely used. It is highly sensitive and specific. It can effectively reduce the incidence of negative and nontherapeutic laparotomies, and the overall morbidity and hospital stay in this group of patients.

Abdominal Injuries↗
PubMed1995

Reclosure of the open abdomen.

BACKGROUND: The open abdomen technique for the treatment of diffuse peritonitis has gained acceptance. Our approach has been to use the zipper technique with daily irrigations. Once the abdominal problem has resolved, the mesh and zipper are removed. Surgeons are reluctant to reoperate on patients with such prior treatment because of the anticipation of a hostile abdomen. Our study is a retrospective review of 12 patients who were treated with the open abdomen technique. At a later date, they underwent elective reoperation. STUDY DESIGN: The charts of 12 patients were reviewed. After initial injury, the patients were in the surgical intensive care unit. Reoperations were performed nine months (mean) after discharge from this facility. The reasons for reoperation were closure of enteric fistula (five patients) and closure of an ostomy (seven patients). The abdominal wall was reconstructed in nine patients. In the other three patients, the abdomen was entered through a lateral incision and the bowel was reanastomosed. RESULTS: All of the patients survived. There were five complications. Two patients had ischemic skin grafts successfully treated by hyperbaric oxygen therapy (HBO). Two patients had ischemic skin flaps that were covering mesh. They responded to HBO with minimal slough of superficial tissue. One patient had a low output fistula that closed after two weeks of total parenteral nutrition. CONCLUSIONS: A history of an open abdomen is not a contraindication to later operation. Bowel continuity can be restored and abdominal wall reconstruction can be performed safely. This can be done as early as three to four months after recovery from the original injury.

Abdomen, Acute↗
PubMed1994

Laparoscopic-assisted colostomy closure after Hartmann's procedure.

PURPOSE: The aim of the study was to review our experience with colostomy closure after Hartmann's procedure and the possible impact of laparoscopic colostomy closure. METHODS: A retrospective review of hospital stay after colostomy closure by laparotomy in the last four years was conducted. A chart review of patients undergoing laparoscopic colostomy closure after Hartmann's procedure since the introduction of operative laparoscopy at our institution was also done. RESULTS: One hundred twenty patients had colostomy closure carried out by the trauma service at the University of Miami/Jackson Memorial Hospital. In thirty-seven patients, colostomy closure was associated with other surgical procedures such as ventral herniorrhaphy, delayed closure of the open abdomen, ureteroneocytostomy, and so forth, or they underwent loop colostomy closure. These patients were excluded from further review. Sixty-five patients underwent reversal of Hartmann's procedure by laparotomy. They had an average hospital stay of 9.5 days (range, 6 to 34 days). This group of patients had colostomy closure prior to the introduction of operative laparoscopy in our institution. With increased laparoscopy experience, laparoscopically assisted Hartmann's reversal has been attempted in 18 patients and completed in 14 patients. The average hospital stay in the laparoscopically completed group was 6.3 days (range, 4 to 10 days). This group had a 0 percent mortality and a 14.3 percent morbidity. This compares favorably to recently reported series of colostomy closure by laparotomy. CONCLUSION: Laparoscopically assisted Hartmann's reversal results in comparable morbidity, but may be associated with shorter hospital stay when compared with laparotomy.

Adult↗
PubMed1994

Closure of radial forearm free flap defect using full-thickness skin from the anterior abdominal wall.

One of the major problems associated with the radial forearm free flap is donor site morbidity. Traditionally the defect is repaired using a split-thickness skin graft which gives poor coverage of the underlying structures, is unsightly, and in the long term may result in marked scarring. There is also morbidity associated with the skin graft donor site. We describe an alternative technique for closure of the donor site using full-thickness skin from the anterior abdominal wall. We believe this technique reduces not only donor site morbidity but also morbidity at the graft site.

Abdominal Muscles↗
PubMed1994

Laparoscopic assisted colorectal surgery.

Forty-nine consecutive patients underwent laparoscopic assisted colorectal surgery for benign and malignant lesions of the colon. Thirty-eight of the 49 operations (78%) were completed successfully with laparoscopic assistance. A large tumor bulk or dense adhesions were the most common reasons for conversion to laparotomy. Twenty-eight of the 38 patients (74%) in the laparoscopically completed group were tolerating a diet by postoperative day 2, and 31 (82%) passed flatus or a bowel movement by the third postoperative day. The mean postoperative hospital stay for this group was 4.8 days, which compared very favorably to that reported in the literature for traditional open colorectal operations. Twelve patients developed complications, for a 24% morbidity in the series. However, only 3 (6%) of these complications were related to the laparoscopic part of the procedure. Inspection of the pathologic specimens revealed adequate margins and a lymph node harvest that averaged 11 nodes per specimen. We concluded that laparoscopic assisted colorectal surgery is a safe and feasible technique, which may be associated with a faster return of bowel activity and a shorter hospital stay. Although the extent of resection appears comparable to that of laparotomy, it is too early to assess long-term outcome when it is applied in the treatment of malignancy.

Adult↗
PubMed1994

Videothoracoscopy in trauma: early experience.

We present a series in which videothoracoscopy was used to evaluate and manage patients after thoracic trauma. We used this technique in 11 patients with thoracic injuries. We describe 5 representative cases. It was used successfully in 10 of 11 patients. Indications included evaluation of ongoing hemothorax, evacuation of clotted hemothorax and empyema, and decortication for persistent airleak. Etiologies included blunt trauma, stab wounds, and gunshot wounds.

Adult↗
PubMed1994

Can ultrasound replace diagnostic peritoneal lavage in the assessment of blunt trauma?

Diagnostic peritoneal lavage (DPL) and computed tomography (CT) are the primary diagnostic modalities in the evaluation of patients with suspected blunt abdominal trauma (BAT). Diagnostic peritoneal lavage is fast and accurate but associated with complications. Computed tomography is also accurate, yet requires that patients be stable and transportable. A prospective study was designed to determine the utility of emergency ultrasound (US) studies in the initial assessment of BAT. Two hundred acutely injured patients with suspected BAT were evaluated with US. Patients were eligible for the study if they met trauma criteria and had suspected BAT. Subsequently, without knowledge of the US results, DPL or CT was performed. Ultrasound showed a sensitivity of 83%, a specificity of 100%, and an accuracy of 97% in detecting intra-abdominal injuries. Six injuries were missed but only one was felt to be significant. If US had been used in all 200 patients, 199 would have had appropriate care. We conclude US is reliable in the detection of free intraperitoneal fluid and may be used in place of DPL or CT.

Abdominal Injuries↗
PubMed1994

Management of lower extremity arterial trauma.

Extremity vascular trauma is common in most urban trauma centers and controversy remains about the optimal management of arterial injuries. We examined the records of 188 patients who had lower extremity arterial trauma from September 1987 to April 1992 to help clarify these issues. There were 142 (75.5%) gunshot wounds, 18 (9.6%) stab wounds, 5 (2.7%) shotgun wounds, and 23 (12.2%) patients with blunt trauma. There were 43 (22.9%) associated venous injuries. There were 10 repair failures in the acute postoperative period. There were no repair failures for the iliac artery. Three failures involved the superficial femoral artery (SFA), six were popliteal, and one tibial. Vein and polytetrafluoroethylene (PTFE) grafts were used to repair the SFA with equal success. Repair of the popliteal artery with PTFE failed in four of five cases, while vein grafts failed in only 2 of 19 cases (p < 0.01). Graft failure was associated with blunt trauma in 8 of 23 patients (35%), and always resulted in amputation. Penetrating injuries accounted for only 2 of 165 (1.2%) failures and were successfully redone with no amputations. Venous injury was present in all SFA failures. Popliteal vein injury was present in two PTFE and two vein grafts that failed. There were no infections of vein or PTFE grafts. In conclusion, PTFE and vein have equal graft patency for the repair of the iliac and femoral arteries. However, the patency of PTFE was significantly worse in the popliteal location. Vein grafts should be used for repair of this vessel. Graft failure and amputation were more common with popliteal and tibial injuries from blunt mechanisms.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Laparoscopic treatment of colovesical fistulas: technique and report of two cases.

Colovesical fistulas are a serious complication of diverticular disease. Management by one-stage resection and anastomosis has resulted in lower morbidity and shorter hospital stay. Nevertheless, hospital time remains long, approaching an average of 2-3 weeks. Here we describe our technique of laparoscopic approach to colovesical fistulas. Our initial experience suggests that this is a safe operation with minimal pain, absent ileus, and a short postoperative stay.

Adult↗