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Biomedical subjects

D W Larson

Publications and source records attributed to D W Larson.

9 recordsLinked to original sources
PubMed2005

Surgical management of intestinal malrotation in adults: comparative results for open and laparoscopic Ladd procedures.

BACKGROUND: This study aimed to characterize the clinical features of intestinal malrotation in adults, and to compare the results for the open and laparoscopic Ladd procedures. METHODS: Between 1984 and 2003, 21 adult patients with a mean age of 36 years (range, 14-89 years) were surgically treated for intestinal malrotation. The clinical data collected included age, gender, presenting symptoms, diagnostic tests, type of operation, operative time, narcotic requirement, time to oral intake, length of hospital stay, and outcome. The groups (open vs laparoscopic) were comparatively analyzed using two-sample t-tests and Wilcoxon rank sum tests. RESULTS: The two groups were similar in terms of age, clinical presentation, and diagnostic tests performed. The most common presenting symptoms were chronic abdominal pain, nausea, and repeated vomiting. Upper gastrointestinal barium studies (UGI/SBFT) were diagnostic for all patients with malrotation as compared with computed tomography (CT) scanning, which was falsely negative in 25% of patients. A total of 21 patients underwent the Ladd procedure, either open (n = 10) or laparoscopic (n = 11). Three laparoscopic procedures were converted to open. Overall, the laparoscopic group resumed oral intake earlier than the open group (1.8 vs 2.7 days; p = 0.092), had a shorter hospital stay (4.0 vs. 6.1 days; p = 0.050), and required less intravenous narcotics on postoperative day 1 (4.9 vs 48.5 mg; p = 0.002). The laparoscopic group underwent a longer operation (194 vs 143 min; p = 0.053). Sixteen of eighteen patients available for follow-up reported complete resolution of symptoms, 2 felt greatly improved. No patient required a second operation related to volvulus or recurrent symptoms. CONCLUSIONS: The laparoscopic Ladd procedure is feasible, safe, and as effective as the standard open Ladd procedure for the treatment of adults who have intestinal malrotation without midgut volvulus. Patients also benefit from this minimally invasive approach, as manifested by an earlier oral intake, a decreased need for intravenous narcotics, and an earlier discharge from the hospital.

Adolescent↗
PubMed2005

Total laparoscopic proctocolectomy with Brooke ileostomy: a novel incisionless surgical treatment for patients with ulcerative colitis.

BACKGROUND: This report describes the clinical benefits and safety of a novel (incisionless) laparoscopic operation for chronic ulcerative colitis. METHODS: The medical records for four patients with the diagnosis of chronic ulcerative colitis who underwent "incisionless" laparoscopic proctocolectomy with Brooke ileostomy were reviewed. A novel technique was used for successfully performance of four total proctocloectomies with end ileostomies that did not require abdominal incisions. The clinical outcomes measured included time to oral intake, time to ostomy output, operative time, postoperative and intraoperative complications, estimated blood loss, and length of stay. RESULTS: All the patients recovered without incident intraoperatively and postoperatively. The operative times ranged from 330 to 550 min. Postoperative findings included median time to oral intake (2 days), median time to ileostomy output (2 days), and median length of stay (4 days). CONCLUSION: This case series demonstrates that an incisionless approach to chronic ulocerative colitis for patients who desire an end ileostomy may be feasible and safe, offering patients short-term recovery and cosmetic benefits.

Aged↗
PubMed2001

The paradox of great longevity in a short-lived tree species.

Thuja occidentalis is a tree species that was once thought to be relatively short-lived (80 years). Up until 10 years ago maximum ages were considered to be near 400 years, but such trees were thought to be rare. Research along the cliffs of the Niagara Escarpment has altered this view. Exceptionally slow-growing trees of this species have been found with ring counts to 1653 years and estimated ages to 1890 years. Senescence is slow or absent. Injury and death is due to rockfall and sporadic severe drought that kills small sectors of the trees by exposing and killing the roots. Experiments in which colored dyes are infused into roots show that each tree is composed of hydraulically independent units that allow mortality in one part of the 'individual' with little negative effect on the remaining parts of the tree. The trees are small, so environmental loadings of ice, snow, and wind are low. Slow growth of the trees results in a much greater mechanical strength in the wood. Together these properties increase the ability of the cedars to persist on cliffs for long periods of time. The paradox of great longevity in this 'short-lived' tree species is explained by slow growth that minimizes maintenance and repair costs while maximizing durability and strength, combined with an internal architecture that creates functionally independent units within each tree.

Aging↗
PubMed1996

Carcinoid tumors of the orbit: a dilemma of diagnosis and treatment.

Carcinoid tumors arise from the gastrointestinal tract or the bronchial tree, and tumors of either origin produce symptoms locally or secrete amines that produce a carcinoid syndrome systemically. Metastatic carcinoid tumors to the orbit are rare and, thus, present a special problem in diagnosis and treatment. We describe a case of metastatic orbital carcinoid that presented itself 6 years prior to the discovery of the primary ileal lesion. This case report describes the unusual presentation, reviews previously published data, and addresses controversial opinions regarding therapy.

Carcinoid Tumor↗
PubMed1980

Assertion training: effectiveness in the treatment of depression.

Assigned depressed outpatients (N = 32) to either group assertion training or "traditional" group psychotherapy. The results showed that over a relatively short period of time, assertion training was more effective than traditional psychotherapy in increasing self-reported assertiveness and in alleviating depression.

Assertiveness↗
PubMedDate not supplied

Laparoscopic surgery for colorectal cancer: the state of the art.

Laparoscopic techniques have expanded since their introduction 15 years ago. The laparoscopic approach for colorectal surgery has been slower to develop than other fields of surgery. However, this approach does provide significant benefits for colorectal resection, although concerns regarding the ability to satisfy oncological criteria have restricted its use in the past. This review studies the published data on the use of laparoscopic surgery for colorectal cancer including the short- and long-term outcomes. New long-term outcome data is now available which is likely to encourage the use of this technique for colon cancer resection. Laparoscopic rectal cancer resection is also discussed including the more limited outcome data that is available.

Clinical Competence↗
PubMedDate not supplied

The role of electrolyte in lesion size using an irrigated radiofrequency electrode.

Multiple attempts have been made to eliminate atrial fibrillation by performing the surgical maze procedure with radiofrequency energy. Currently, this is limited because of the risk of atrial perforation and the lack of transmural penetration. Saline irrigation has been investigated as a method of radiofrequency cautery tip cooling to prevent rapid temperature and impedance rises, which have been shown to lead to perforation or decreased radiofrequency penetration after eschar formation. There are few data on the influence that different types of electrolyte irrigation solutions have on lesion depth. Using a novel hollow cautery pen, we infused either an electrolyte solution (0.9%, 3%, 14.6%, or 23.4% sodium chloride), a nonelectrolyte solution (1.5% glycine), or no irrigation to produce 819 lesions on 14 left ventricles in swine using radiofrequency energy (450+/-10 kHz) applied at two output settings (20 and 75 watts). The nonelectrolyte solution increased lesion depth compared with no infusion at 20 watts but produced shallower lesion depths compared with electrolyte solutions at 75 watts. Compared with the other electrolyte solutions, the 0.9% sodium chloride solution produced the deepest lesions (3.34+/-0.06 mm) at 75 watts (p < 0.001). As the concentration of electrolyte increased, lesion depth decreased unless generator output increased. Formation of eschar and tissue destruction was seen in the noninfusion and nonelectrolyte groups but not in the electrolyte group. A conductive media coupled with radiofrequency energy allowed for greater lesion depth than irrigated cooling with a nonelectrolyte solution or no irrigation. There was an inverse relationship between electrolyte concentration and lesion depth. We conclude that the concentration of electrolyte irrigant is an important consideration when choosing a solution to improve transmural penetration and decrease the risk of tissue destruction from radiofrequency energy.

Animals↗