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Biomedical subjects

J M Sackier

Publications and source records attributed to J M Sackier.

At least 73 records · Page 4Linked to original sources
PubMed1990

Prospective comparative study of cefotetan with piperacillin for prophylaxis against infection in elective colorectal surgery.

This study compared one dose of cefotetan with three doses of piperacillin as prophylaxis against wound infection in 153 patients undergoing elective colorectal surgery. The patients were randomized into two groups: the first received 2 g cefotetan intravenously with induction of anaesthesia (n = 75), and the second received three doses of 2 g piperacillin (n = 78). Wound infection was defined as the presence of an abscess or discharging pus from the wound. In the cefotetan group there were 14 (19%) wound infections and 13 (17%) in the piperacillin group. There were three septic deaths, one in the cefotetan group and two in the piperacillin group. Both groups were comparable with regard to age, sex, nature of pathology and pre- and perioperative risk factors. No significant haematological or biochemical abnormalities were detected. The only adverse reaction was one patient who had an allergic reaction (rash) to piperacillin. These data suggest that single-dose cefotetan is as effective as triple-dose piperacillin in prophylaxis against infection in elective colorectal surgery.

Cefotetan↗
PubMed1989

Primary rectal lymphoma and malignant lymphomatous polyposis. Two cases illustrating current methods in diagnosis and management.

Two cases of colorectal lymphoma are presented. Preoperative histologic diagnosis is difficult and examination of the fresh specimen using immunocytochemical and gene rearrangement techniques are necessary to establish the precise nature of the lesion. Surgical excision is the mainstay of treatment for localized lymphoma of the colorectum and chemotherapy for malignant lymphomatous polyposis.

Aged↗
PubMed1989

Kinetics, quantitative analysis and radioimmunolocalization using indium-111-HMFG1 monoclonal antibody in patients with breast cancer.

HMFG1 tumour associated monoclonal antibody IgG1 and F(ab')2 fragments were radiolabelled with indium-111 and used to study patients with breast cancer. In vitro and in vivo stability of the radiolabelled antibodies was shown to be satisfactory. Thirty patients with primary breast cancer underwent tumour resection and quantitative evaluation of the radioactivity in the tumour and normal tissues following administration of specific and non-specific antibodies. The mean tumour uptake of HMFG1 F(ab')2 fragments at 24 h was significantly higher (P less than 0.05) than the intact IgG but at 48 h there was no difference. The mean tumour uptake with the specific antibody was higher than the non-specific antibody of the same subclass (P less than 0.05). Lymph node metastases showed higher antibody uptake than the corresponding primary tumours (P less than 0.05). Fifteen patients with primary or metastatic breast cancer were investigated by external body scintigraphy using HMFG1 F(ab')2 fragments. Successful localisation was observed in approximately 50% of the primary and metastatic lesions with no false positive results. All the patients had observable concentration of 111In in the liver (20% of the injected dose), the kidneys and the spleen. Following i.v. administration, F(ab')2 fragments cleared from the blood more rapidly than the intact IgG. We conclude that HMFG1 F(ab')2 fragments can localise specifically and faster than intact IgG in breast cancer but the sensitivity of the radioimmunoscintigraphy is relatively low. This method needs further improvement before becoming clinically useful for detecting and staging breast cancer.

Adult↗
PubMed1989

Reappraisal of partial ileal bypass for the treatment of familial hypercholesterolemia.

Eleven patients with heterozygous familial hypercholesterolemia (type IIa) were treated by partial ileal bypass. Postoperatively, mean total cholesterol levels fell by 26% at 1 month, and then rose steadily to 20% below preoperative levels of 20-24 months. The rise in cholesterol levels was due in part to an increase in high density lipoprotein (HDL) cholesterol with a resultant improvement in the HDL:LDL ratio (LDL, low density lipoprotein). Five patients had refractory hypercholesterolemia and were treated with lovastatin. One of them was treated with a combination of lovastatin and LDL-apheresis. All patients experienced diarrhea which improved with time, but two patients required reversal of their bypass for intractable gas bloat syndrome. Each received lovastatin to control recrudescence of hypercholesterolamia following reversal. Ten patients are alive and well, but one patient died after a myocardial infarction 55 months postoperatively. The advent of lovastatin and other HMG COA reductase inhibitors is likely to decrease the use of partial ileal bypass to treat familial hypercholesterolemia.

Adult↗
PubMed1988

Ulcerative colitis and polyposis coli. Surgical options.

Until a medical cure for ulcerative colitis is available, it is up to the surgeon to provide a solution. With the wealth of experience now available, the operation of ileal pouch with anal anastomosis must be considered as an option in treating the young or well-motivated patient. Screening of families in whom polyposis coli has been found can prevent colon cancer developing. For this group of patients, who may be totally asymptomatic, to be able to offer a reconstructive operation may make it easier for such patients to accept colectomy. The value of consultation between medical and surgical gastroenterologists in order to time surgery is vital, and an exact histologic diagnosis in inflammatory bowel disease may prevent the potential disaster of constructing an ileal pouch in a patient with Crohn's disease. The construction of a pouch is not difficult, being made up of several familiar surgical steps in an unfamiliar setting. However, it is a long operation, frequently taking more than 4 hours, and mucosal protectomy can be rather awkward. For these reasons and the problems with patient counseling, we believe ileal pouch with anal anastomosis operations should be performed at referral centers. We still have to decide on the best type of pouch to use, but it is encouraging that better antibiotics, safer anesthesia, and new techniques such as the intraluminal bypass tube and rectal sleeve dissection have helped to make this operation more successful for a greater number of patients.

Anastomosis, Surgical↗
PubMed1988

Cystic pneumatosis in coeliac disease.

This report presents a patient with proximal small bowel cystic pneumatosis associated with poorly controlled coeliac disease and pseudo-obstruction. Cystic pneumatosis is rare in the proximal small bowel and we can find no report of its occurrence in association with coeliac disease.

Aged↗
PubMed1987

The treatment of perforated diverticulitis by one-stage intracolonic bypass procedure.

The one-stage intracolonic bypass procedure prevents gastrointestinal secretions and fecal content from coming in contact with an anastomotic site without interrupting the intraluminal continuity of the fecal flow from proximal to distal colon. This can be achieved by the intraluminal implantation of a soft, pliable tube above the anastomotic site. Previous clinical and experimental data have indicated that the intracolonic bypass procedure can protect an anastomosis in the presence of maximal colonic loading, gross dehiscences, or fecal peritonitis. This report presents 28 patients with perforated diverticulitis, all of whom were treated by one-stage intracolonic bypass procedures. Ten of the 28 patients had peritonitis, and 18 had pericolic abscesses. Results indicate no deaths and no anastomotic leakages. Three patients (10.7%) had a complicated postoperative course. One patient with fecal peritonitis had prolonged ileus and a pulmonary effusion, and one had a myocardial infarction. Both of these patients responded to medical therapy. Another patient had a wound infection. The hospital stay ranged from 10 to 18 postoperative days. All patients passed the tubes spontaneously 2 to 3 weeks after operation. The one-stage intracolonic bypass procedure can be recommended as a viable alternative to the two- or three-stage procedures commonly used for perforated diverticulitis.

Abscess↗
PubMedDate not supplied

Laparoscopic cecopexy for cecal volvulus. Case report and a review of the literature.

A case of intermittent cecal volvulus in an immunocompromised patient is presented. This patient, whose bowel was viable, was managed successfully by laparoscopic cecopexy. As a clinical entity, cecal volvulus usually presents as either an unrelenting process, culminating in gangrenous bowel, or as an intermittent, recurrent condition with spontaneous resolution but which also may lead to loss of intestinal viability. Surgical management is required in almost every case; however, a review of the literature reveals considerable controversy as to what constitutes the best operation for cases in which the bowel is viable. The most appropriate operation is usually dictated by the clinical circumstances, and in many settings cecopexy is a satisfactory choice of procedure; resection is obviated, bowel need not be opened, and the operation can be performed laparoscopically relatively rapidly.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Laparoscopy in the emergency setting.

Laparoscopy has been available for 90 years and was actively undertaken by the gynecologists. Today the vast majority of gynecological procedures are performed by this route. Despite the efforts of a few enthusiastic surgeons, the general surgical community did not incorporate laparoscopy into their armamentarium until the advent of laparoscopic cholecystectomy. However, this endoscopic technique has much to contribute, especially in the setting of emergency care. It is of value in formulating a treatment algorithm and in avoiding unnecessary laparotomy in both blunt and penetrating trauma. Laparoscopy helps to define the nature of obscure abdominal diagnoses, avoids unnecessary appendectomy, and provides the window of opportunity for surgery in mesenteric ischemia due to either arterial or venous thrombosis or embolus. It is also of value in patients with pain or fever of unknown origin, displaced gastrostomy or dialysis tubes, and in the rare patient with gastrointestinal bleeding where other diagnostic modalities have been unable to yield the diagnosis. In this article the instrumentation and techniques will be outlined and the role of laparoscopy in each of the above situations will be detailed. As with all surgical procedures, it is vital that the surgeon be well-trained and knowledgeable about the correct use of the technique, its possible pitfalls and how to avoid them, as well as knowing the contraindications.

Abdominal Injuries↗
PubMedDate not supplied

Gastric adenocarcinoma associated with isolated granulomatous gastritis.

BACKGROUND: Granulomatous gastritis is a rarely observed pathological diagnosis. This condition often mimics gastric adenocarcinoma clinically, resulting in gastric resection. However, granulomatous gastritis has long been viewed as a benign process not observed in association with adenocarcinoma of the stomach. This article describes a patient with granulomatous gastritis occurring in close proximity to an area of superficially invading gastric adenocarcinoma. METHODS: Acid-fast stains, fungal stains, standard cultures, tuberculosis cultures, and a VDRL serum test were all obtained. Both upper endoscopy and colonoscopy were performed. Chest radiographs were taken and pulmonary consultation was obtained. RESULTS: The gastric samples obtained from resection showed no evidence of foreign body reaction. The acid-fast stains, fungal stains, cultures, and VDRL were all negative. Endoscopic exams did not show granulomatous inflammation in any other part of the gastrointestinal tract. No pulmonary disease was evident on radiographic or pulmonary exam. CONCLUSION: Isolated granulomatous gastritis is a diagnosis of exclusion. The findings in this patient do not support a diagnosis of Crohn's disease, tuberculosis, sarcoidosis, syphilis, histoplasmosis, berylliosis, or foreign-body reaction. This is a unique case suggesting an association between isolated granulomatous gastritis and metaplastic mucosal changes.

Adenocarcinoma↗
PubMedDate not supplied

The rotary gallstone lithotrite to aid gallbladder extraction in laparoscopic cholecystectomy.

During laparoscopic cholecystectomy, a large stone burden may cause difficulty when extracting the gallbladder through the abdominal wall. Currently, the alternatives available to the surgeon include increasing the incision, removing stones singly, or utilizing complex fragmentation techniques like the pulsed dye laser. We have employed an electromechanical rotary gallstone lithotrite (RGL) to fragment stones to an aspiratable size. Initially, cholesterol spheres were pulverized in a latex balloon to demonstrate the efficacy of the device. Then, human gallstones were placed in the balloon and reduced to fragments less than or equal to 1 mm from initial sizes of 4-24 mm. Human stones were then inserted in ex vivo porcine gallbladders in a controlled experiment and treated with the device. Ten out of 12 tests were completed within 30 s; one test required 49 s and one 105 s to achieve complete fragmentation. Blinded histological evaluation demonstrated that tissue abrasion caused by use of the device would not interfere with the diagnosis of unsuspected malignancy. Clinical trials have now commenced under the auspices of the hospital ethical committee.

Animals↗
PubMedDate not supplied

Complications of laparoscopy and thoracoscopy.

Laparoscopy was first performed at the turn of the century, but it was not until the introduction of laparoscopic cholecystectomy that the procedure became widely adopted by general surgeons. Since then, traditional open procedures, including cholecystectomy, exploratory laparotomy, colectomy, hernia repair, and appendectomy, are being widely performed laparoscopically. The advantages of laparoscopic surgery, including less postoperative pain due to smaller surgical incisions, shorter hospital stay, quicker return to preoperative activity, and superior cosmesis, resulted in widespread popularity with both surgeons and patients. In certain situations, the traditional method may be superior to the laparoscopic approach, as may be the case with laparoscopic hernia repair. It is difficult to justify converting a local, extraperitoneal, 45-minute, outpatient inguinal hernia repair in a virgin groin into a general anesthetic, transperitoneal, 2-hour plus, possibly inpatient laparoscopic procedure with the implantation of mesh. However, data may indicate that this operation does indeed have benefits. We must, therefore, carefully study such new operations. With the advent of a new surgical procedure, both surgeons and anesthesiologists must be familiar with the various complications unique to this technique. If recognized early, potentially life-threatening complications, including gas embolization and tension pneumothorax, can be corrected.

Carbon Dioxide↗