Biomedical subjects

H J Asbun

Publications and source records attributed to H J Asbun.

7 recordsLinked to original sources

PubMed1992

Sigmoid volvulus in the high altitude of the Andes. Review of 230 cases.

Sigmoid volvulus (SV) is uncommon in the United States. Little has been published in the English literature about the high incidence of SV among rural areas of the Bolivian and Peruvian Andes at 13,000 feet above sea level. A review of 230 cases of SV in a Bolivian hospital is presented. SV accounted for 79 percent of all intestinal obstructions. Nonoperative reduction was attempted in all patients except those with peritonitis. Nonoperative reduction alone was performed in 31 percent of the patients, and 69 percent underwent surgical intervention, 66 percent as an emergency and 3 percent electively. Surgical treatment consisted of sigmoidectomy and primary anastomosis (50 percent), Hartmann's procedure (12 percent), and operative detorsion with sigmoid plication (38 percent). Overall mortality was 13.5 percent. Fifty-seven of the surgically treated patients developed significant complications. The etiology of SV is unclear. High altitude, along with other etiologic factors, may play an important role in SV. To our knowledge, this series represents the highest incidence of SV in bowel obstruction.

Adolescent↗

PubMed1992

Credentialing in laparoscopic surgery: a survey of physicians.

Laparoscopic surgery is now established as a major advance in modern surgery. Assurance of adequate training and credentialing is still a significant problem. Using laparoscopic cholecystectomy as an example, a survey was conducted to assess what criteria surgeons deem necessary for training and credentialing in a laparoscopic procedure. One hundred and forty-nine questionnaires were completed by surgeons from academic and private practice. A total of 110 (74%) surgeons consider that a course involving a hands-on animal lab should be required. Ninety-two (84%) of them answered that a preceptorship also should be required (average of 6.42 as surgeon and 5.86 as assistant). Ninety-nine (66%) responders believe that a surgeon should serve a probationary period (average of 11.6 cases) with review of morbidity, prior to being given full privileges. No statistical difference was found when comparing the answers of academic surgeons with private practitioners or between surgeons who had performed laparoscopic cholecystectomy and those who had not.

Cholecystectomy↗

PubMed1992

Leiomyosarcoma of the rectum.

Leiomyosarcoma of the rectum is a rare entity. Approximately 150 cases have been described in the literature. Differentiation from its benign counterpart, leiomyoma, and other connective-tissue tumors is often difficult, but it is important because each tumor has an entirely different prognosis. The case of a patient in whom an 11 x 5.5 cm leiomyosarcoma of the rectum was surgically excised by abdominoperineal resection is presented. Literature review shows disagreement over the therapeutic approach, most likely due to the lack of a large series of patients with this disease. At present, a selective treatment approach appears to be the most advocated. Lesions less than 2.5 cm in size and limited to the bowel wall can still be treated by wide local excision. More radical surgical resection is indicated for larger tumors and those extending outside the bowel wall.

Aged↗

PubMed1991

Thymic carcinoid.

Carcinoid of the thymus is a rare neoplasm. Differentiation from thymoma is important because they have entirely different prognosis. A patient in whom a 19 x 18 x 12 cm carcinoid tumor of the thymus was surgically removed is presented. The tumor metastasized to peritracheal and internal mammary nodes, and invaded the SVC, pleura, lung, and pericardium. This is apparently the largest reported tumor of its kind. Prior to induction of anesthesia cardiopulmonary bypass and rigid bronchoscopy were readily available. Awake intubation was utilized. Even though long-term prognosis is poor, an aggressive surgical approach and adjuvant radiotherapy may achieve extended survival with excellent quality of life. Central aspects of the disease as well as pivotal therapeutic points are discussed.

Adult↗

PubMed1990

Intra-abdominal seatbelt injury.

The use of seatbelts has significantly decreased the mortality and morbidity of injuries caused by motor vehicle accidents. We present eight patients who sustained severe intra-abdominal injuries peculiar to the use of the seatbelt. Serious injuries to the bowel and mesentery may be present without early symptoms or physical signs and neither CT scanning nor diagnostic peritoneal lavage is fully reliable or accurate in finding the injury. Prompt diagnosis may be difficult and requires a high index of suspicion as well as a determined approach that may include exploratory celiotomy. The presence of a seatbelt sign across the abdomen is not incontrovertible evidence that a laparotomy must be done, but its presence should create a high index of suspicion for serious visceral injury. Delay in diagnosis significantly increases morbidity and is associated with high mortality rates.

Abdominal Injuries↗

PubMedDate not supplied

Simplified perioperative management in vertical banded gastroplasty.

Vertical Banded Gastroplasty (VBG) is the most commonly performed weight loss operation in the United States and is of proven adjunctive benefit in the treatment of morbid obesity. In an attempt to reduce the hospital related complications associated with morbidly obese patients we simplified the perioperative management of 244 patients undergoing VBG. Our goals were early feeding, early ambulation and a short hospital stay. Neither nasogastric tube nor Foley catheter was used after surgery. Mean postoperative stay was 3.24 +/- 0.8. Forty-one patients (16.8%) developed significant complications. Only two of these had a nosocomial complication (0.8%). The remaining 39 patients had technical complications not related to the protocol of simplified perioperative care. Short hospital stay and simplified perioperative management are feasible and safe for the large majority of patients undergoing VBG and may, in fact, significantly decrease the nosocomial morbidity common to this type of patients.

Adult↗

PubMedDate not supplied

Small bowel obstruction and its management.

We present a retrospective analysis of 105 instances of small bowel obstruction (SBO) in 80 patients admitted to our hospital over a ten year period. Adhesions accounted for 73% of the cases and secondary involvement by malignancy for 13%. Appendectomy, colorectal and other pelvic procedures were the most frequent surgical antecedents responsible for the adhesions. In the 86% of cases with a temperature over 100 degrees F there was significant morbidity, mortality and/or strangulation, and this sign also foretold a prolonged hospital stay. Leukocytosis, when present along with abdominal tenderness also predicted a prolonged hospital stay. Strangulation occurred in 4.7% of the instances and was accompanied by at least one of the "classical symptoms". Fourty-five percent of the instances were successfully managed by conservative measures alone, whereas 55% had had surgical treatment. The mean hospital stay for all cases was 15.3 days. The morbidity rate for this series was 21% with a mortality of 3.8%. The largest single cause of death was related to malignant disease (three of four cases). When post-operative adhesions were the etiology, the hospital stay was 8.5 +/- 1.3 days for those treated with conservative measures compared with 16.5 +/- 1.8 days for those in whom a surgical procedure was performed (p less than 0.0001). This latter group also has a higher morbidity (32% compared to 5% for the non-operative group).

Adult↗