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Biomedical subjects

D Sleeman

Publications and source records attributed to D Sleeman.

65 records · Page 4Linked to original sources
PubMed1993

A comparison of laparoscopic and traditional appendectomy.

Forty-one serially performed laparoscopic appendectomies were compared to 41 randomly selected traditional open appendectomies performed during the same 18 month period. The average age and sex distribution of the two groups were similar. The pathological diagnoses of acute appendicitis and perforation were similar in both groups. The complication rates were not statistically different in the two groups. There were no complications unique to the laparoscopic group. The hospital stay was considerably shorter for patients undergoing laparoscopic appendectomy (p < .05). Statistical significance was found both in patients with and without perforation.

Adult↗
PubMed1993

Laparoscopy in abdominal gunshot wounds.

The role of laparoscopy in the evaluation of abdominal trauma continues to evolve. It has been successfully used in blunt and penetrating trauma. We report our experience with diagnostic laparoscopy in 28 patients with abdominal gunshot wounds. We found a 100% accuracy and a 0% morbidity in patients with negative laparoscopy. We report a case in which laparoscopy was used to demonstrate an isolated nonbleeding liver injury due to a gunshot wound to the abdomen. Nontherapeutic laparotomy was avoided.

Abdominal Injuries↗
PubMed1990

Miniplate osteosynthesis in cranial skeletal fixation.

The use of miniplate osteosynthesis provides a three-dimensionally stable form of fixation for cranial skeletal defects secondary to trauma or surgery. They are easily contoured and are thus able to support the bone fragments in the correct anatomical position. Miniplates of 0.9 mm thickness are sufficient to provide stable fixation without causing significant displacement of the overlying soft tissues. Plating thus provides excellent stability and cosmesis.

Adolescent↗
PubMed1988

Dental disease, acute sinusitis and the orthopantomogram.

This study was undertaken to determine the incidence of undiagnosed apical disease in acute unilateral sinusitis and to evaluate the role of Orthopantomograms (OPGs). Our results, with an incidence of 10 per cent, are in agreement with the findings of Formby (1960) and we conclude that OPGs are not justified in the routine investigation of acute sinusitis.

Humans↗
PubMedDate not supplied

Percutaneous catheter-directed debridement of infected pancreatic necrosis: results in 20 patients.

PURPOSE: To evaluate the usefulness of transcatheter debridement of infected pancreatic necrosis. MATERIALS AND METHODS: Transcatheter debridement was performed on 20 patients who ranged in age from 20 to 78 years during the 8-year study period. All patients had infected pancreatic necrosis and were hemodynamically stable. Necrosis was defined as nonenhancing pancreatic tissue, as seen on contrast-enhanced computed tomography (CT). Infection was suspected clinically and documented by cultures of the pancreatic fluid at its initial drainage. Debridement was performed in multiple sessions in close succession (duration, 30-120 minutes; mean, 60 minutes) via large-bore catheters with enlarged side holes. Debris was removed with use of suction catheters, stone baskets, and copious amounts of lavage fluid. RESULTS: All patients underwent successful catheter debridement. Success was determined by clinical course, as well as lesion appearance, at fluoroscopy and CT. Patients underwent 7-32 (average, 17) episodes of debridement and stayed 0-36 days (average, 9 days) in the intensive care unit, 13-118 days (average, 42 days) on the regular floor, and spent 0-98 days (average, 32 days) with the catheters as an outpatient. No deaths occurred. CONCLUSION: Percutaneous catheter-directed debridement is a safe and effective treatment and it can be used as the primary means of treatment for the hemodynamically stable patient with infected pancreatic necrosis.

Adult↗
PubMedDate not supplied

Management of hilar bile duct carcinoma.

BACKGROUND/AIMS: Hilar cholangiocarcinoma is a rare tumor with a dismal prognosis. Because proximal bile duct cancers are uncommon, outcomes related to various therapeutic interventions are not well defined. METHODOLOGY: Between 1985 and 1997, 55 patients with bile duct cancers involving the proximal third of the extrahepatic bile ducts were seen. The management of patients with resectable and unresectable disease was retrospectively reviewed. All but four patients were followed until the time of death. RESULTS: Forty patients underwent laparotomy following preoperative assessment of extent of disease and 19 patients (35%) ultimately underwent resection with curative intent. Survival was significantly longer in patients who underwent resection (2-year survival 47% vs. 18%; P = 0.027). Of those patients whose disease was resected, 11 patients received adjuvant radiotherapy. Survival for this group was not significantly different from that seen in patients who did not receive adjuvant radiotherapy. Similarly, in patients with unresectable disease, administration of radiotherapy was not associated with an improved outcome. CONCLUSIONS: Locoregional extent of disease is the greatest problem in cases of proximal bile duct cancers. Resection provides the best hope for long-term survival, but new adjuvant strategies are needed.

Adult↗
PubMedDate not supplied

Thoracoscopy in the evaluation and management of thoracic trauma.

Video-thoracoscopy was used to evaluate and manage patients after thoracic trauma. It was used in 29 patients. Indications included retained hemothorax in 16 patients, empyema in 11, evaluation for the source of thoracic bleeding in 1, and an airleak in 1. The mechanism of injury was blunt trauma in 8 cases, 10 with stab wounds, and 11 with gunshot wounds. In blunt trauma, thoracoscopy was carried out an average of 11.7 days post injury, chest tubes were removed after an average of 7 days post thoracoscopy, and discharge averaged 10.7 days after thoracoscopy. The failure rate was 12.5% with no mortality. In stab wounds, it was carried out an average of 8.8 days post injury, chest tube removal occurred after 6.1 days, and discharge averaged 7.8 days after thoracoscopy. The failure rate was 20% with no mortality. In gunshot wounds, it was carried out an average of 7.5 days after injury, chest tubes were removed after 9.9 days, and discharge averaged 16 days post thoracoscopy. The failure rate was 9% with a mortality of 9%. Overall, the failure rate for thoracoscopy was 13.8% (4/29). The mortality rate was 3.5% (1/29). It was successfully performed up to 30 days post injury. It proved to be effective in the management of empyema, evacuation of clotted hemothorax, and diagnosis of ongoing thoracic bleeding.

Humans↗