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Biomedical subjects

G M Larson

Publications and source records attributed to G M Larson.

At least 37 records · Page 2Linked to original sources
PubMed1995

Laparoscopy for abdominal emergencies.

The role of laparoscopy has been reviewed for these conditions: abdominal trauma, acute abdomen, abdominal pain of uncertain etiology, appendicitis and the acute abdomen in the intensive care unit patient. Laparoscopy should only be performed in trauma patients who are hemodynamically stable and who have some evidence for abdominal injury, such as a positive peritoneal lavage or a positive CT scan. Laparoscopy is an excellent procedure for determining whether a knife or missile has penetrated the peritoneum. For penetrating wounds in the chest and upper abdomen, laparoscopy also allows excellent evaluation of the diaphragm. In blunt trauma, laparoscopy identifies the majority of injuries, but there has been a 5-15% incidence of missed injuries to the small bowel and colon. The acute abdomen is generally caused by perforation, acute inflammation or intestinal obstruction. Of the various types of perforation, diagnostic and therapeutic laparoscopy is most applicable for duodenal perforation. Acute perforation of the stomach and colon should probably be treated by standard open techniques. For acute inflammatory disorders, laparoscopy is an excellent diagnostic tool and can also provide definitive treatment in the form of drainage of an abscess or appendectomy. The role of laparoscopy for ileus and bowel obstruction is controversial; some surgeons advocate diagnostic laparoscopy and treatment, while many others still consider bowel obstruction and abdominal distention to be contra-indications. Finally, there are the intensive care unit patients in whom an acute intraabdominal process is suspected. Laparoscopy in such patients alters the clinical management in about 50% of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen, Acute↗
PubMed1993

Impact of multiple risk factors and ranitidine prophylaxis on the development of stress-related upper gastrointestinal bleeding: a prospective, multicenter, double-blind, randomized trial. The Ranitidine Head Injury Study Group.

OBJECTIVES: To evaluate the impact of risk factors on the development of stress-related upper gastrointestinal bleeding in severe head injury patients randomized to treatment with a 6.25 mg/hr continuous ranitidine infusion or placebo. DESIGN: Prospective, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. SETTING: Ten intensive care units in the United States. PATIENTS: Patients with severe head injury, defined as having a Glasgow Coma Score of < or = 10, were eligible for enrollment. INTERVENTIONS: Ranitidine 6.25 mg/hr or saline placebo was administered by continuous infusion for a maximum of 5 days. MEASUREMENTS AND MAIN RESULTS: Patients were evaluated every 8 hrs for the presence of stress-related upper gastrointestinal bleeding. Bleeding developed in 15 (19%) of 81 placebo-treated patients vs. three (3%) of 86 ranitidine-treated patients (p = .002). None of the individual risk factors had a significant effect on bleeding frequency. No bleeding occurred in the four patients with one risk factor. Placebo bleeding rates in patients with 2, 3 to 5, and > 5 risk factors were 20%, 20%, and 18%, respectively. For the ranitidine-treated patients, bleeding was reported in 0%, 5%, and 0% in the 2, 3 to 5, and > 5 risk factor subgroups, respectively. Pneumonia occurred in 19% of the placebo-treated patients vs. 14% in the ranitidine treatment group. CONCLUSIONS: The full risk to develop stress-related upper gastrointestinal bleeding was realized when two risk factors were present concomitantly. The presence of additional risk factors did not increase the occurrence of bleeding. A continuous infusion of ranitidine at 6.25 mg/hr provided significant protection from bleeding, regardless of the number of risk factors present.

Adult↗
PubMed1993

Vasoactive intestinal polypeptide reduces hydrochloric acid-induced duodenal mucosal permeability.

The duodenum in anesthetized rats was perfused with HCl, and mucosal integrity was assessed by measuring the clearance of 51Cr-labeled EDTA from blood to lumen and/or by morphological examination (lesion score). Duodenal blood flow was determined by laser Doppler flowmetry and luminal alkalinization as well as H+ disappearance by backtitration. Intravenous infusion of vasoactive intestinal polypeptide (VIP; 13.5 micrograms.kg-1.h-1) increased luminal alkalinization threefold and decreased clearance of 51Cr-EDTA by 50%. VIP also decreased arterial blood pressure and induced a small and irregular decrease in duodenal blood flow. Perfusion with 10 mM HCl increased clearance of 51Cr-EDTA 2.1-fold, but the lesion score was not different from that in saline-perfused animals. Perfusion with 20 mM HCl increased clearance of 51Cr-EDTA four-fold and induced a greater lesion score than did 10 mM. Perfusion with either 10 or 20 mM HCl did not affect the duodenal blood flow. VIP reduced the rise in clearance of 51Cr-EDTA in response to 10 mM but not that to 20 mM HCl. Intravenous injection of prazosin (50 micrograms/kg) decreased luminal alkalinization, clearance of 51Cr-EDTA, blood pressure, and duodenal blood flow. In prazosin-pretreated rats, perfusion with 10 mM HCl increased clearance of 51Cr-EDTA 2.6-fold, and the lesion score was greater in this group than in animals infused with VIP. A positive linear correlation was obtained between HCO3- secretion and the mean rate of H+ disappearance.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Use of endoscopic retrograde cholangiopancreatography in the management of biliary complications after laparoscopic cholecystectomy.

BACKGROUND: Current options in the management of bile duct injuries caused by laparoscopic cholecystectomy include diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) and open laparotomy with direct repair. The goal of this review was to clarify the role and evaluate the potential of endoscopic techniques to diagnose and treat bile duct injuries. METHODS: The records of all patients undergoing biliary tract surgery at our hospitals for the period from December 1989 to February 1993 were reviewed. Twenty-five patients were identified with bile duct injuries during laparoscopic cholecystectomy. RESULTS: ERCP was performed for diagnostic or therapeutic purposes in 22 of the 25 patients; successful opacification of the biliary tree was achieved in 21 (95%) of the 22 patients. In these 21 patients the location and nature of the injury were identified correctly in 19 (90%). In six of the 25 cases, interventional ERCP was used as the primary treatment of these injuries. Successful treatment was achieved in five (83%) of the six cases, although laparotomy was required in two to drain the abscess cavity better. Open surgical repair was performed as the primary treatment in the remaining 19 patients. Interventional ERCP with stenting was required in six and transhepatic stenting in one of these patients as an adjunctive treatment for stricture or persistent fistula. Six (86%) of these seven patients have been treated successfully to date in this manner. CONCLUSIONS: ERCP is a uniquely helpful diagnostic and therapeutic technique in the management of laparoscopic biliary complications. Open surgical repair remains the procedure of choice for patients with loss of bile duct tissue or long complex strictures. ERCP with sphincterotomy, balloon dilatation, and stenting is an accepted alternative approach for bile leaks (fistulas) and treatment of shorter strictures resulting from either the initial laparoscopic injury or the initial repair.

Adolescent↗
PubMed1992

Multipractice analysis of laparoscopic cholecystectomy in 1,983 patients.

We analyzed the results of laparoscopic cholecystectomy in 1,983 patients from a variety of practice settings in order to evaluate a large, cross-sectional experience for this new procedure. Twenty general surgeons from 9 clinics in 4 states examined the records and outcome of their laparoscopic cholecystectomy patients through March 1991. In 88 patients (4.5%), the operation was converted to an open procedure, usually because of marked inflammation and unclear anatomy. A total of 644 cases were performed with laser dissection and 1,339 with cautery, and the results of these 2 methods were similar. There were 41 complications. Reoperation for repair was necessary in 18 patients, including 5 with common duct injuries, and, to date, the outcome has been good in each patient. Seventy-six patients (3.8%) have had recognized common duct stones; these were removed preoperatively by endoscopic sphincterotomy (ERS) in 20 patients, during cholecystectomy in 46 patients, and postoperatively by ERS in 4 patients. In six patients, common duct stones became apparent 1 to 4 months after cholecystectomy. We conclude that trained general surgeons can perform laparoscopic cholecystectomy safely with risks comparable to those for conventional open cholecystectomy.

Adolescent↗
PubMed1992

Epidermal growth factor accelerates connective tissue wound healing in the perforated rat mesentery.

Epidermal growth factor (EGF) has been reported to stimulate healing of wounds in skin, cornea, and gastric mucosa. In the present study, we further investigate the effect of endogenous and exogenous EGF in healing of connective tissue wounds using the rat perforated mesentery model. Healing of mesenteric perforations is accomplished by the connective tissue fibroblasts since there are no interfering variables such as interactions of epithelial cells, desiccation, or foreign materials such as sutures or subcutaneous implants. We performed laparotomy in 114 adult male Sprague-Dawley rats and made 20 standardized perforations in the mesentery of each rat with a scalpel. Rats were randomly assigned to five groups. Group I received no treatment after surgery; Group II received intraperitoneal injections of phosphate-buffered saline (PBS) after surgery and then twice daily for the following 3 days; Group III received 10 micrograms of EGF in the PBS injections according to the same regimen as Group II; Group IV had sham exploration of the submandibular salivary glands; and Group V animals had excision of the submandibular glands 3 days before laparotomy to deprive the main source of EGF in rat. On Days 4 through 10 after surgery rats were sacrificed and the percentage of perforations in each rat which were closed was determined. The curves for the time course of wound closure for Groups IV and V were not different indicating that endogenous submandibular EGF does not play a role in healing of mesenteric wounds.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

Interruption of professional and home activity after laparoscopic cholecystectomy among French and American patients.

With a laparoscopic approach, patients can undergo cholecystectomy with a shorter hospitalization, minimal pain, and quicker recovery. It has not been demonstrated, however, that patients actually return to work after laparoscopic cholecystectomy faster than the traditional 4- to 6-week absence from work after a standard open procedure. A survey of 104 French and 84 American patients undergoing laparoscopic cholecystectomy revealed that postoperative discomfort was completely resolved in 2 weeks in 73% of French and 93% of American patients. All but 11 French and 5 American patients were back to normal home activities by 2 weeks after the operation. Of the 35 American and 40 French patients who had professional activity outside the home, 63% and 25%, respectively, returned to work within 14 days. Five (14%) of the American patients and 12 (30%) of the French patients returned to work 4 weeks or more after the operation. The amount of physical activity on the job correlated with the period off work, but, interestingly, at least six patients with very hard physical activity at work (including construction workers) were able to return to full work activity within 1 week. These data suggest that early return to work is possible and that pain resolves quickly after laparoscopic cholecystectomy. The economic benefit of having patients back on the job quickly, however, may be less than expected until cultural norms change with regard to leave of absence after major surgery.

Activities of Daily Living↗
PubMed1991

Endoscopically placed nasoenteral feeding tubes. Indications and techniques.

We reviewed indications, techniques, and results for endoscopic placement of nasoenteral feeding tubes by analyzing records of 29 hospitalized patients who had undergone 41 tube placements. Indications included gastric stasis after gastric surgery (11 patients), gastroparesis and reflux or both in critically ill trauma patients (10), stricture secondary to vertical banded gastroplasty (3), and partial gastric outlet obstruction (5). Two endoscopic techniques were used. The guidewire method in which a flexible, Silastic feeding tube is advanced over the guidewire to the desired site had 82 per cent success (22 of 27). Adjunct fluoroscopy achieved a 94 per cent success rate (17 of 18); success without fluoroscopy was 56 per cent (5 of 9). The pull-along method attached a suture to the feeding tube tip which was grasped with forceps and moved to the correct location (93% success; 13 of 14). Fluoroscopy was not used with this method. Feeding tubes were successfully placed in 35 of 41 attempts (85%) in 27 of 29 patients. Failures were caused by an inability to intubate the efferent limb of a gastrojejunostomy (2) and unrecognized guidewire movement (4). Tube use ranged from one day to six months. We conclude that endoscopic placement of nasoenteral feeding tubes is an effective means to establish a route for enteral nutrition in selected patients.

Endoscopy, Digestive System↗
PubMed1990

Abdominal pain from intestinal duplication.

Intestinal duplication is a rare cause of abdominal pain in adults, and may elude diagnosis prior to exploratory laparotomy. We describe a 20-year-old man who had severe abdominal pain with an ileal duplication complicated by a penetrating ulcer within ectopic gastric mucosa.

Abdomen, Acute↗
PubMed1990

Choledochoscopy and common bile duct exploration.

Common bile duct (CBD) exploration is often indicated when cholecystectomy is performed for gallstone disease. Choledochoscopy may help to decrease the incidence of retained common duct stones. The present study reviews 97 consecutive CBD exploration cases performed between 1980 and 1988, in order to evaluate the authors' experience with flexible choledochoscopy and CBD exploration. Fifty-nine patients had CBD exploration plus flexible choledochoscopy and 38 underwent CBD exploration alone. Retained stones were found postoperatively in ten per cent of the patients who had only CBD exploration versus four per cent in the choledochoscopy group. The retained stones in five patients were later removed by percutaneous basket retrieval (3), flush irrigation (1), and choledochoscopy (1). Flexible choledochoscopy detected additional stones after routine CBD exploration in 12 patients, clarified T-tube cholangiograms in four patients, and aided stone extraction in two patients. For these reasons, and because choledochoscopy was associated with a lower incidence of retained stones, the authors believe this procedure is a worthwhile addition in most cases of CBD exploration.

Cholecystectomy↗
PubMed1989

The alkaline shift in gastric pH after cholecystectomy.

Previous studies using cholescintigraphy and measurement of bile salts in gastric juice have demonstrated that duodenogastric reflux is increased after cholecystectomy, a factor that may contribute to postoperative complaints in some patients. We studied 24-hour continuous gastric pH in healthy subjects, patients with cholelithiasis, and patients who had undergone cholecystectomy. Cholecystectomy decreased the percentage of time that gastric pH is below 2 and increased the time it is above 4 and 6. Furthermore, there was a greater increase in the more alkaline pH values in patients who were symptomatic than in those who were asymptomatic. The results demonstrated that cholecystectomy is associated with an alkaline shift in the 24-hour gastric pH profile that is most marked in symptomatic patients. This suggests that gastric alkaline episodes may be related to some postcholecystectomy symptoms.

Adolescent↗
PubMed1989

Delayed gastric ulcer healing after extirpation of submandibular glands is sex-dependent.

This study examines the effect of excision of the submandibular salivary glands, the main source of epidermal growth factor (EGF), and the role of gender on the healing of acetic acid-induced gastric ulcers in rats. In male rats excision of the submandibular glands delayed ulcer healing. At 15 and 25 days the unhealed ulcer areas were significantly larger in the sialoadenectomy group than in control animals, and fewer completely healed ulcers were seen in this group at 25 days. Ulcer healing in female rats was slower. At day 25 ulcers were healed in 12% of female rats with intact salivary glands, compared with 68% in males. Female rats also showed larger unhealed ulcer areas after sialoadenectomy than controls. We conclude that removal of the main source of EGF in the gastrointestinal tract is associated with a delay in healing of gastric ulcers. The significant difference in healing observed between female and male rats may be influenced by the known androgenic regulation of EGF production in the salivary glands.

Animals↗
PubMed1989

Colonoscopic decompression for pseudo-obstruction of the colon.

The purpose of this report was to review the authors' experience with colonoscopy as a method of treating patients with acute colonic distention. For the period 1981-1987, 19 patients at two teaching hospitals met the selection criteria for this study. In terms of measurable decompression of a colon distention, colonoscopy was successful in 89 per cent of patients, although 41 per cent required repeat endoscopic decompression during their hospital stay. The procedure failed in two patients (11%) and operative decompression was necessary. The authors have found that colonoscopy is a useful procedure for determining the cause of progressive colon distention and for providing safe and effective treatment.

Adult↗
PubMed1988

Balloon dilatation of anastomotic strictures.

Our experience with balloon dilatation of postoperative anastomotic strictures is reported herein. Six patients with strictures not responsive or accessible to standard bougie techniques were selected for balloon dilatation. A guidewire was passed through the stricture with an endoscope (four patients) or with fluoroscopic guidance alone (two patients). Balloon catheters were then advanced over the guidewire and distended with a water-contrast mixture. Sufficient pressure was applied to efface the stricture indentation of the balloon. Since August 1984, we have performed 12 dilatations in these six patients. We dilated four strictures to 20 mm and two strictures to 15 mm. With the exception of stenosis due to edema caused by cancer or radiation, balloon dilatation is an effective treatment of tight upper gastrointestinal tract strictures that have not responded to standard dilatation techniques.

Anastomosis, Surgical↗
PubMed1988

Management of recurrent duodenal ulcer disease.

The purpose of this project was to evaluate the medical and surgical treatment of patients with recurrent peptic ulcer disease and to determine whether the addition of cimetidine has altered the treatment outcome. The authors studied 42 patients with recurrent ulcers after duodenal ulcer surgery. Four patients underwent emergency operation for ulcer-related complications, while 38 patients received medical therapy including cimetidine as initial treatment. Medical therapy achieved good results in 18 of 38 patients (47%). The remaining 20 patients either were treated surgically (14) or are still symptomatic. Four of the 18 patients managed operatively had a second recurrent ulcer (22%). There were no deaths. Thirty-two of the original 42 patients (76%) were helped by the treatment. It was concluded that cimetidine has improved medical therapy compared with historical controls but that operative treatment is indicated in about one-half of patients with recurrent peptic ulcer disease.

Anti-Ulcer Agents↗
PubMed1988

The effect of an intragastric balloon on weight loss, gastric acid secretion, and serum peptide levels.

The results of our preliminary experience with the gastric balloon program for weight loss in morbidly obese patients are reported. In a pilot project, we measured gastric-acid secretion, gastrin and cholecystokinin (CCK) levels in ten patients before and during balloon therapy in a study of the impact of the balloon on gastric physiology. Gastric-acid secretion tended to decrease following balloon treatment, while gastrin and CCK levels were unchanged suggesting that weight loss is achieved by mechanisms, which are not mediated by gastrin or CCK. The balloon program was then expanded to a group of 29 patients who met the criteria. They were followed for a period of 4 months. Average weight loss for the group was 31 +/- 4 pounds for a monthly average of 8 pounds. The main complications were gastric ulcers in four patients and a small-bowel obstruction in one patient. Satisfactory weight loss was achieved in 80 per cent of patients, but this benefit must be balanced against a relatively high incidence (17%) of side effects, some of which were quite serious. Therefore, the gastric balloon program should still be considered experimental.

Adult↗
PubMed1988

Evaluation of endoscopy training in a general surgery residency.

To evaluate the gastrointestinal endoscopy training program, a survey of the 33 former chief residents, who finished our program in 1981-1986, was conducted. All 33 graduates responded; 22 graduates are general surgeons, 11 completed or are completing training in a surgical specialty. Eighteen of the 22 general surgeons routinely perform endoscopy in their practice. Graduates in cities with a population greater than 250,000 are as likely to perform endoscopy as the surgeons who live in smaller communities. Ninety one per cent consider endoscopy training to have been an important part of their surgical training. Based on this assessment, endoscopy training is an important part of a general-surgery residency.

Colonoscopy↗