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Biomedical subjects

J M Lomano

Publications and source records attributed to J M Lomano.

8 recordsLinked to original sources
PubMed1991

Safety and efficacy of laparoscopic cholecystectomy. A prospective analysis of 100 initial patients.

Laparoscopic cholecystectomy quickly emerged as an alternative to open cholecystectomy. However its safety, efficacy, and morbidity have yet to be fully evaluated. During the first 6 months of 1990, we performed 100 consecutive laparoscopic cholecystectomies with no deaths and a morbidity rate of 8% (8 of 100 patients; 4 major, 4 minor). There were 81 women and 19 men, with a mean age of 46.1 years (range, 17 to 84 years). All patients had a preoperative history consistent with symptomatic biliary tract disease, and most had proved gallstones by sonography. This included four patients with acute cholecystitis. Mean operating time improved significantly from month 1 to month 6 (122 +/- 45.4 minutes versus 78.5 +/- 30 minutes, respectively), indicating a rapid learning curve. Mean hospital stay was 27.6 hours, reflecting a policy of overnight stay. Postoperative narcotic requirements were limited to oral or no medications in more than 70% of patients. A regular diet was tolerated by 83% of the patients by the morning following the procedure. Median time of return to full activity was 12.8 +/- 6.8 days after operation. In addition analysis of the hospital costs of these 100 cases demonstrates a modest cost advantage over standard open cholecystectomy (n = 58) (mean, $3620.25 +/- $1005.00 versus $4251.76 +/- $988.00). There was one minor bile duct injury requiring laparotomy and t-tube insertion, two postoperative bile collections, and one clinical diagnosis of a retained stone that passed spontaneously. Four patients required conversion to open cholecystectomy because of technical difficulties with the dissection. Although there is a significant learning curve, laparoscopic cholecystectomy is a safe and effective procedure that can be performed with minimal risk. Laparoscopic cholecystectomy should be performed by surgeons who are trained in biliary surgery and knowledgeable in biliary anatomy, and, as with all operations, it should be performed with meticulous attention to technique.

Adolescent↗
PubMed1988

Dragging technique versus blanching technique for endometrial ablation with the Nd:YAG laser in the treatment of chronic menorrhagia.

Endometrial ablation performed with the Nd:YAG laser was developed to treat patients with chronic menorrhagia as an alternative to hysterectomy. The original dragging technique may result in an obscured operating field and fluid overload. This study compares results of endometrial ablation performed in 62 patients. The first 17 procedures were performed by use of the dragging technique; the last 45 procedures were performed with a blanching technique. Both procedures were performed at the same institution and by the same surgeon. Sixty-five percent of patients undergoing the blanching technique became amenorrheic after the procedure versus 12% of those undergoing the dragging technique. Moreover, the blanching technique required less time, fewer joules of energy, and resulted in less fluid absorption by the patient. The blanching technique is apparently more effective, easier to accomplish, and safer for the patient than the dragging technique.

Adult↗
PubMed1987

Nd:YAG laser ablation of early pelvic endometriosis: a report of 61 cases.

Sixty-one patients with mild or moderate endometriosis were treated with the Nd:YAG laser between May 1983 and March 1986. During the follow-up period, 31 patients received no supplemental medical treatment. Ten patients were given danazol, five for recurrence of pain and five because of the extent of the disease. Sixteen patients were given oral contraceptives, 12 for birth control and four for pain. Four patients received danazol plus oral contraceptives as concurrent therapy. Overall, symptoms improved following surgery for 45 patients (74%); two patients (3%) reported a worsening of symptoms, while 12 patients (20%) reported no change in their symptoms. The overall improvement rate was 65% for those receiving no hormonal treatment, 70% for those on danazol, 94% for those on oral contraceptives, and 75% for those on both contraceptives and danazol. This latter finding, however, is not significant because of the small patient sampling. Nevertheless, these findings reflect the benefit of laser ablation of early-stage pelvic endometriosis with or without the concurrent use of conservative medical therapy.

Endometriosis↗
PubMed1986

Photocoagulation of the endometrium with the Nd:YAG laser for the treatment of menorrhagia. A report of ten cases.

Nd-YAG laser photocoagulation was performed on ten patients with chronic menorrhagia in an attempt to either decrease the menstrual flow sufficiently to obviate the need for hysterectomy or to obtain amenorrhea. The entire endometrial lining was treated, from the fundus down to 4 cm from the external cervical os. A blanching technique was accomplished by holding the fiber tip 5-10 mm from the endometrial surface. Patients were followed for an average of 12 months. All noted a marked reduction in the amount of menstrual flow; two became amenorrheic. One patient subsequently underwent hysterectomy for a preexisting uterine prolapse and progressive symptoms of dyspareunia and pelvic pain.

Adult↗
PubMed1985

Photocoagulation of early pelvic endometriosis with the Nd: YAG laser through the laparoscope.

Our prospective study evaluated the efficacy of the Nd:YAG laser (MMB-AT MediLas 2) for early-stage clinical endometriosis. Patients with suspected endometriosis underwent diagnostic laparoscopy, and if mild or moderate pelvic endometriosis was discovered, the lesions were treated with the Nd:YAG laser at a power setting of 20 w with intermittent, one- to three-second exposures. All the patients are being treated postoperatively with danazol (800 mg/day) for three to nine months. At this writing, 14 of 24 patients selected for laparoscopy were eligible for treatment with the Nd:YAG laser. Six weeks after treatment all the patients reported relief of their initial symptoms. To date, two patients have had repeat laparoscopy after Nd:YAG photocoagulation of mild endometriotic lesions. Neither patient had evidence of disease at the second laparoscopy.

Combined Modality Therapy↗