Biomedical subjects

J D Sedlack

Publications and source records attributed to J D Sedlack.

5 recordsLinked to original sources

PubMed1996

Laparoscopic knot security.

The security of several types of laparoscopic and open knots and varying suture materials was tested in an attempt to improve suture and knot selection for advanced laparoscopic procedures. Six different types of knots and five suture materials were tested. All sutures were of 2-0 size, and laparoscopic knots were tied using a pelvic trainer. A typical number of square throws was used for each suture. Stress was gradually applied by withdrawing the ends of a manual digital tensiometer until either the knot slipped or the suture parted. The maximum stress withstood by the knot-suture complex was recorded, as was whether the knot was secure (i.e., whether the knot held until the suture broke). The data were analyzed using analysis of variance to compare the knot security of the various knot types and the different sutures using a given knot. No significant difference was found in security or stress resistance between laparoscopic square and open square knots or in the Dacron, polypropylene, and expand polytetrafluoroethylene (ePTFE) extracorporeal and intracorporeal knots, with the exception of ePTFE intracorporeal knots, which were significantly less secure (p = 0.028). Silk suture was significantly less secure than all the other sutures tested for all knots tested (p < 0.0001). The Roeder's and Fisherman's knots were the least secure of all laparoscopic knots in all sutures tested (p < 0.0001), with the exception of polyglactin tied with a fisherman's knot, which was as secure as the extracorporeal and intracorporeal polyglactin knots. These experiments showed laparoscopic square knots to be as secure as open square knots; removing the operating finger from the knot does not seem to affect the security of a well-tied square knot. Furthermore, of the permanent sutures tested, there was no substantive difference in the security of laparoscopic intracorporeally and extracorporeally tied knots, except that ePTFE was more secure when tied with extracorporeal throws. Our data also suggest that silk is not as secure as other permanent suture materials.

Humans↗

PubMed1990

Primary hepatocellular carcinoma: hospital based epidemiologic study.

From 1968-1985 a series of thirty-seven patients with primary hepatocellular carcinoma was collected from the tumor registry of the Fairfax County Hospital, in the metropolitan Washington, D.C. area. These patients were found to have a mean age at diagnosis of sixty-two (males) to sixty-six (females). Thirty per cent of patients were previously cirrhotic and nineteen per cent had a history of viral hepatitis. There were no patients with documented birth control pill or steroid use. The most common presenting symptoms were anorexia and right upper quadrant pain. Liver-spleen scan was the most commonly used diagnostic study, but by the 1980's CT scanning was usually diagnostic. Both alkaline phosphatase and serum glutamyloxalotransferase were reliably elevated in twenty-six of twenty-eight and twenty-one of twenty-four patients respectively. Forty-eight per cent of patients with tumor histology reported had multicentric tumors, thirty-eight per cent had nodular tumors, and fourteen per cent had diffuse disease. Survival was as dismal in this as in other studies with a mean of seventy-nine days. No significant difference was noted between cirrhotic and non-cirrhotic patients. Chemotherapy and radiation therapy did not significantly impact upon survival. Finally, a cohort analysis was done and a possibly significant peak in incidence of primary hepatocellular carcinoma was seen in men born from about 1911 through 1920. The authors noted that these males were in the group of draft eligible persons for World War II and questioned a link between veteran status and later development of HCC.

Adult↗

PubMed1990

Primary hyperparathyroidism in patients with renal stones.

There has been an observed decline in the incidence of renal stones in patients with primary hyperparathyroidism. Some believe that this is related to earlier surgical intervention. Two studies from the 1950s examined the reverse questions to determine the prevalence of primary hyperparathyroidism in patients with renal stones. This report examined 1,500 consecutive patients treated by lithotripsy seen at the Georgetown University Medical Center and found, using the historical criterion for diagnosis of hyperparathyroidism (a serum calcium level of 10.5 milligrams per deciliter or greater) that the prevalence had decreased significantly from 8.0 per cent to our level of 3.02 per cent. Neither age nor sex contributed significantly to this decrease, and there were significantly more calcium stones than in the previous studies. Using an elevated calcium level with an elevated chloride to phosphate ratio as criteria for a diagnosis of probable primary hyperparathyroidism, a true prevalence of 1.65 per cent (+/- 0.6 per cent) was found. We believe that there has been a significant decrease in the frequency of primary hyperparathyroidism in the general population of patients with renal stones.

Calcium↗

PubMed1989

Perforation complicating rifampin-associated pseudomembranous enteritis.

An 18-year-old man developed a perforated jejunum while receiving rifampin antituberculous chemotherapy. The perforations were located within longitudinal ulcers characteristic of pseudomembranous enterocolitis. Pseudomembranous inflammation was limited to the small intestine. The absence of colonic involvement delayed establishment of the diagnosis. Successful surgical intervention consisting of small-bowel resection with primary anastomosis was accomplished for this rare and potentially fatal complication of antituberculous chemotherapy.

Adolescent↗

PubMed1983

A decline in carcinoma of the stomach. A diagnostic artifact?

During the past 50 years or more, a dramatic decline in the mortality from gastric carcinoma has been observed in virtually every country in the world, including the United States. Some investigators suspect that this decline is due to refinements in the diagnosis and classification of abdominal malignancies rather than being a true decline in the incidence of gastric cancer. Because the record system in Rochester, Minnesota, ensures the identification of virtually every patient in the local population with a serious illness, and the level of diagnosis is high, it seemed appropriate to study the incidence and long-term trends of gastric cancer in this community. Trend analysis for the period 1935 through 1979 revealed a consistent decline in the incidence of gastric carcinoma whether death certificates as the sole source of cases were included or not. Analysis of either all clinically confirmed or only tissue-confirmed cases revealed a statistically significant decrease in stomach carcinoma throughout the study period. These declines were observed even if only the more recent periods (1955 through 1979) were examined. The reasons for this finding remain obscure, but the study suggests that improvements in diagnostic accuracy alone cannot account for this remarkable downward trend in gastric malignancy.

Adolescent↗