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Biomedical subjects

E Poulin

Publications and source records attributed to E Poulin.

11 recordsLinked to original sources
PubMed2004

Toward reliable operative assessment: the reliability and feasibility of videotaped assessment of laparoscopic technical skills.

BACKGROUND: Decision making on the competency of surgical trainees to perform laparoscopic procedures has been hampered by the lack of reliable methods to evaluate operative performance. The goal of this study was to develop a feasible and reliable method of evaluation. METHODS: Twenty-nine senior surgical residents were videotaped performing a low anterior resection and a Nissen fundoplication in a pig. Ten blinded laparoscopists rated the videos independently on two scales. Rating time was minimized by allowing raters to fast-forward through the tapes at their discretion. Interrater reliability and the time required to rate a procedure were assessed. RESULTS: Rating time per procedure was a median of 15 min (range, 6-40). The mean interrater reliability for the two scales was 0.74. CONCLUSIONS: The use of videotapes of operations enabled multiple raters to assess a performance reliably and shortened assessment times by 80%. This assessment technique shows potential as a means of evaluating the performance of advanced laparoscopic procedures by surgical trainees.

Clinical Competence↗
PubMed2004

Manipulated variable based PI tuning and detection of poor settings: an industrial experience.

A new method, based on the physical interpretation of the manipulated variable, is developed for tuning of proportional-integral-derivative (PID) controllers and detection of poor settings. This variable is used to set specifications and tune controllers for set-point changes. Here, these specifications are to have a closed-loop time response that is similar to the open-loop time response and a no static error to nonzero mean disturbances acting at the process input. The method is applicable to self-regulating first- and second-order models (overdamped) having stable or unstable zeros as well as delays to integrating first-order processes. For second-order processes, an approximation of equal time constants is used in order to facilitate the identification with step changes and tuning of PI controllers. Results show that the tuning is near optimal even when the time constants are very different. The method has been taught to people with different backgrounds: process engineers, maintenance technicians, production operators, as well as managers. Results have shown better understanding of the possibilities and limitations of process control and improved communication between the different groups.

Journal Article↗
PubMed2001

Combined ecological factors permit classification of developmental patterns in benthic marine invertebrates: a discussion note.

Traditional classifications of developmental patterns of marine benthic invertebrates are based on combinations of embryological (direct or indirect development) and ecological (such as nutritional source or habitat) characteristics. Different schemes have been proposed for different reasons, relating to ecology, evolution and/or development. However, these classifications contain interconnected characters that do not efficiently discriminate between developmental patterns and, thus, do not fully apply to either ecological or embryological studies. An ecological multifactor classification based on three independent two-state characters (pelagic/benthic, free/protected, and feeding/non-feeding) is proposed. It discriminates between eight developmental patterns and can encompass any ecological pattern of development among marine benthic invertebrates.

Journal Article↗
PubMed2001

Growth hormone-releasing hormone (GHRH) and GHRH receptor (GHRH-R) isoform expression in ectopic acromegaly.

Bronchial endocrine neoplasms causing acromegaly due to ectopic production of growth hormone (GH)-releasing hormone (GHRH) have been reported. We describe the case of a 39-year-old man with clinical and biochemical acromegaly. Magnetic resonance imaging revealed an enlarged pituitary, which was confirmed histologically to harbour somatotroph hyperplasia. Further investigations identified a circumscribed central mass in the right lung which was surgically resected and histologically confirmed to be an endocrine tumour with strong immunopositivity for GHRH, synaptophysin and chromogranin; the lesion also exhibited mild positivity for peptide YY, calcitonin gene-related peptide (CGRP), glucagon-like peptide (GLP)-1, corticotrophin-releasing hormone (CRH), tyrosine hydroxylase, vasoactive intestinal peptide (VIP) and enkephalin. S100 protein was identified in stellate cells surrounding nests of epithelial tumour cells. The MIB-1 antibody labelled about 10% of the tumour cells. We established that the tumour not only produced GHRH but the GHRH-receptor (GHRH-R) as well. GHRH and GHRH-R mRNA were identified and the latter was characterized as two variants, a full-length transcript and a truncated splice variant that has been described in human pituitary somatotroph adenomas. We suggest that GHRH expression by this tumour and the presence of its receptor may be responsible for enhanced growth. The expression of a truncated splice variant that is unable to transduce GHRH signalling may be implicated in the less aggressive behaviour of well-differentiated endocrine tumours that produce GHRH compared with small-cell lung carcinomas that are very responsive to GHRH growth stimulation.

Acromegaly↗
PubMed1993

[Splenectomy by celioscopy. Experience of 20 cases].

We describe the clinical course of 20 patients considered for laparoscopic splenectomy. One patient was excluded on the basis of preoperative angiography findings and two (10.5%) were converted to open surgery. The first patient in the series was converted for a hemorrhagic incident and the eight patient, who had a 34 cm spleen, for dissection difficulties. In the remaining 17 patients who successfully underwent laparoscopic splenectomy, no mortality was reported and there were four postoperative complications (23.5%). Mean operating time was 3 h 40 min (135-300 min). After a mean postoperative stay of four days, all patients, except two, were back to normal activities within 2 weeks of hospital discharge. Preoperative splenic artery embolization was begun with the third patient and was found to significantly reduce operative blood loss and make the procedure easier to perform. Laparoscopic splenectomy has become our procedure of choice for elective removal of normal-sized or moderately enlarged spleens.

Adolescent↗
PubMed1993

Laparoscopic splenectomy: clinical experience and the role of preoperative splenic artery embolization.

We describe the clinical course of 12 patients who underwent laparoscopic splenectomy. Two patients were converted to open surgery--the first patient in the series because of a hemorrhagic incident and the eighth, who had a 34-cm spleen, because of dissection difficulties. The remaining patients had no mortality, and perioperative morbidity was 10%. After an average postoperative stay of 3.5 days (range, 2-9), most patients were able to resume normal activities < or = 2 weeks. Use of preoperative splenic artery embolization was begun with the third patient. The technique involved embolization of the spleen with coils placed proximally; and contour emboli, absorbable gelatin sponge, and small coils placed distally, taking care to spare vessels to the tail of the pancreas. A good linear correlation was established between operative blood loss and the percentage of splenic devascularization by preoperative splenic artery embolization (r - 0.8084). Laparoscopic splenectomy is becoming the preferred technique for elective removal of a normal sized or moderately enlarged spleen (< 20 cm long) when hematologic indications are present.

Adolescent↗
PubMed1992

Laparoscopic splenectomy: operative technique and preliminary report.

A technique of laparoscopic splenectomy was developed on animal models and subsequently applied in two human patients. After creation of a 15 mm Hg pneumoperitoneum, five trocars, two with 12-mm diameters, were introduced into the upper abdomen. The spleen was approached directly by dissection of the gastrosplenic ligament. The short gastric vessels and hilar vessels were individually ligated with metallic clips or a surgical stapler, depending on their size. A plastic bag was then introduced into the abdominal cavity and the spleen slipped inside. An umbilical incision measuring 2 to 3 cm was used for extraction after finger fracture of the spleen. After laboratory experience with seven animals, we used this operation on two patients. The first procedure had to be converted to open surgery because of hemorrhage; the second was successfully performed within 4 h. Knowledge of anatomic variations and meticulous surgical technique are necessary for the successful completion of splenic laparoscopic surgery.

Adolescent↗
PubMed1991

Prophylactic nutrition.

The potential clinical benefits of preoperative and postoperative enteral or parenteral nutritional support are reviewed. Special consideration is given to the problem of nutritional support for the cancer patient and to immunonutrition, a new research avenue in modular nutritional treatment. In the absence of uniformly accepted data regarding the use of prophylactic nutritional support, sound clinical judgement is still important. The simplest indications for the use of perioperative nutritional support are the following: patients without nutrition for 7 to 10 days; duration of illness anticipated to be longer than 10 days; malnutrition--more than 10% acute loss of usual body weight.

Enteral Nutrition↗
PubMed1991

[Clinical and hemodynamic evaluation of cholecystectomies performed under laparoscopy].

Hundred patients who underwent laparoscopic cholecystectomy and 25 consecutive patients where multiple hemodynamic parameters were measured were included in the study. The mean operative time was 84 minutes and operative cholangiography was selective. No deaths and five major complications were reported. Months after laparoscopic cholecystectomy, two patients needed open surgery for pathology missed at initial exploration. One patient sustained minor trauma to the biliary tree. Despite generally normal vital signs and few cardiac arrhythmias, cardiac output dropped in many patients during laparoscopic cholecystectomy. This was specially marked at the end of peritoneal insufflation when the Fowler position was assumed, emphasizing the need for close anesthetic monitoring, specially during the first half hour of this procedure.

Adolescent↗
PubMed1982

[Home hyperalimentation through the digestive tract].

There are few reports in the contemporary literature on the use of home hyperalimentation by the enteral route, especitially for intestinally crippled patients. The authors describe five patients who had a total of 78 months of therapy by continuous nasogastric infusion of an elemental diet at home. The majority of the patients had undergone massive bowel resection. Home intravenous hyperalimentation techniques are compared with respect to feasibility, morbidity, cost and psychologic impact for the patient. Because of the differences, the authors suggest that home intravenous hyperalimentation should be reserved for patients who have failed a trial of enteral therapy.

Adult↗