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Biomedical subjects

Juan C Cendan

Publications and source records attributed to Juan C Cendan.

8 recordsLinked to original sources
PubMed2006

Laparoscopic repair of a type II endoleak.

A 72-year-old male underwent an uncomplicated endovascular repair of a 6.1-cm infrarenal abdominal aortic aneurysm. Routine follow-up at 18 months postoperatively revealed the presence of a type II endoleak, and that the aneurysm had increased in size. The endoleak was repaired by laparoscopic ligation of the inferior mesenteric artery. A postoperative computerized tomography scan revealed cessation of flow through the inferior mesenteric artery. The patient tolerated the procedure well and was discharged home on the same day.

Aged↗
PubMed2006

Simulation for training with the Autosuture Endo Stitch device.

The rapid development and deployment of novel laparoscopic instruments present the surgical educator and trainee with a significant challenge. Several useful instruments have been particularly difficult to teach the novice. We have developed a platform that allows the combination of the actual instrument handle with a virtual re-creation of the instrument tip. We chose the Autosuture Endo Stitch device as the prototypical instrument because it satisfies our subjective experience of "useful, but hard to teach." A software package was developed to support the re-creation of the needle and suture that accompany the device. The apparatus has haptic capabilities and collision detection so that the needle driver is "aware" of suture and instrument contact. The developed virtual environment allows re-creation of the necessary motion to simulate the instrument, the trainee can use the actual instrument handle, and the system can be altered to accommodate other instruments.

Algorithms↗
PubMed2004

Should decisions on internal mammary lymph node irradiation be based on current lymphoscintigraphy techniques for sentinel lymph node identification?

BACKGROUND: Treatment of internal mammary lymph node (IMN) metastases remains controversial because of the difficulty in predicting involvement, potential treatment-related morbidity, and questionable efficacy. Lymphoscintigraphy with sentinel lymph node biopsy offers a means to identify occult involvement of IMN, allowing appropriate patient selection for IMN treatment. METHODS: The authors retrospectively reviewed 262 lymphoscintigraphies (LS) of 248 patients treated at the University of Florida (Gainesville, FL) between 1998 and 2002. Tumor characteristics were assessed for their value in predicting IMN drainage and their association with IMN radiation. RESULTS: Lymph flow to the IMN was documented with LS in 23 of 262 tumor specimens (9%). Flow to the IMN was not correlated with any of the five factors: tumor location, tumor size, lymphovascular invasion, pathologic lymph node status, and laterality of the involved breast (right vs. left breast). Identification of IMN flow increased from 5.7% to 10.1% with the use of a deep injection technique. IMN radiotherapy was used more frequently in patients with larger tumors (15 of 188 in Tis/T1 vs. 31 of 70 in T2-T4; P<0.0001) and positive lymph nodes (17 of 91 in lymph node-negative patients vs. 28 of 66 in lymph node-positive patients; P<0.0001). In patients with T2N0 tumors (n=32), IMN radiotherapy was used more frequently with medial tumors (5 of 11 [45%]) than with lateral tumors (4 of 21 [19%]). CONCLUSIONS: The incidence of flow to the IMN documented with the current LS technique was low compared with other LS and extended radical mastectomy series. Histopathologic information was obtained for the sentinel IMN when IMN flow was identified on the LS. In the absence of histopathologic information, treatment decisions should continue to be based on clinical factors known to be correlated with occult IMN involvement.

Adult↗
PubMed2004

Breast-conserving therapy (BCT) for early-stage breast cancer.

Several patient and tumor factors go into the decision process to determine whether a breast cancer patient is a good candidate for breast-conserving therapy. The patient must be seen by all disciplines before any therapeutic intervention. When used appropriately, breast-conserving therapy produces maximal disease control and improves quality of life in patients with early-stage breast cancer.

Antineoplastic Agents, Hormonal↗
PubMed2004

Twenty-one cases of aortoenteric fistula: lessons for the general surgeon.

We retrospectively reviewed our experience from 1984 to 2001 with 21 cases of aortoenteric fistula (AEF) in 19 patients. The majority of cases were in men (13 of 19, 68%). One AEF was spontaneous, the other 20 developed after prior vascular reconstruction (95%). The majority of AEF were duodenal (48%) followed by small bowel (38%), colon (10%), and esophageal AEF (5%). The proximal anastomosis of the prior vascular repair was the site of AEF origin in 62 per cent of cases, the distal anastomosis accounted for 19 per cent, and the body of the graft for 14 per cent. The intestinal repair was chosen on a case-by-case basis by the general surgeon and consisted of a simple primary repair in 48 per cent, resection with primary anastomosis in 38 per cent, and patching with pleura or omentum in individual cases. Colostomies were created in the two cases with colonic AEF. The duodenum was excluded in one of 10 duodenal AEF. Six patients (32%) died in the 90 days following surgery. The biggest risk of postoperative death was presentation with sepsis (P = 0.069); interestingly, women were more likely to present with sepsis (P = 0.019) and experienced a disproportionate rate of postoperative death (male 23%, female 50%, P = 0.24). The method used to repair the bowel was linked to a higher rate of postoperative death, and patients that required bowel resection died more frequently (66%) than those who had a simple repair (10%, P = 0.07). Overall mortality with AEF remains high despite routine SICU care. The biggest risk for death is preoperative sepsis. Women presented with sepsis more frequently than men. The method of bowel repair appears to be related to overall survival and along with sepsis is, perhaps, a surrogate for the degree of erosion present at the site of the AEF. Simple bowel repairs were sufficient when technically possible. Duodenal exclusion is not an obligatory adjunct to duodenal repairs.

Aged↗
PubMed2003

Two decades of student career choice at the University of Florida: increasingly a lifestyle decision.

Recently, there has been a decrease in the number of graduating U.S. medical students entering surgical residency. Therefore the purpose of this study was to examine student career choice over the last two decades (1982-2002) at the University of Florida. Residency match and academic performance data for the University of Florida medical school graduates from 1982 through 2002 were obtained from the College of Medicine's Offices of Student Affairs and Education. The percentage of medical students pursuing a career in surgery rose slightly in the 1980s to peak at 22 per cent of the graduating class in 1991 and then steadily declined in the 1990s to 15 per cent in the graduating class of 2002. The percentage of women entering surgical residency has remained relatively constant (20-year mean = 6.41 +/- 0.77) despite a significant increase percentage of women in the graduating class (Class of 1983, 24%; Class of 2002, 55%). The percentage of graduating students entering a primary care residency has remained relatively constant (54.4 +/- 1.24), whereas the number of students pursuing a "lifestyle-friendly" specialty has increased substantially over the last two decades (Class of 1983, 9%; Class of 2002, 22%). In addition the mean overall grade point average of female students entering 'lifestyle-friendly' specialty residencies is significantly higher than the mean overall grade point average of all students entering a surgical residency (3.61 +/- 0.38 versus 3.48 +/- 0.35; P < 0.05). Similar to national trends the percentage of senior medical students entering surgical residency at the University of Florida is gradually declining. Although the percentage of graduating medical students entering primary care has remained relatively constant the number of students following a lifestyle-friendly specialty has steadily increased. A disproportionately low number of graduating female medical students are entering surgical residency. By one measure of academic performance the quality of female graduates entering lifestyle-friendly specialty residencies is superior to that of students entering surgical residency. Lifestyle issues are increasingly important in student career choice decisions.

Career Choice↗
PubMedDate not supplied

Varying blood monocyte and dendritic cell responses after laparoscopic versus open gastric bypass surgery.

BACKGROUND: Laparoscopy may activate innate immunity less than conventional open surgery. This may be important in obese patients who have pre-existing low-grade inflammation. This study examined phenotypic changes in blood monocytes (Mcs) and dendritic cells (DCs) from patients undergoing laparoscopic (L) or open (O) Roux-en-Y gastric bypass (RYGBP) surgery. METHODS: 8 patients (3 male) had blood drawn before and after RYGBP, and on postoperative day (POD) 1, 3, and 28. Mc and DC quantity, phenotype, and activation status were determined by flow cytometry. RESULTS: Mean BMI was 53 +/- 4 and 46 +/- 1, and length of stay was 6.3 +/- 3.2 and 3.5 +/- 0.6 days, in the O (n=4) versus L (n=4) groups, respectively. Postoperative WBC count was 16 +/- 1 x 10(3)/mm3 after O and 10 +/- 1 x 10(3)/mm3 after LRYGBP (P<0.001). This was due to a greater rise in neutrophils and decline in lymphocytes after ORYGBP (P<0.001). Total Mcs increased in both groups at POD 1, but the number of CD18+ Mcs was reduced after ORYGBP (P=0.04). Mc human leukocyte antigen (HLA)-DR expression was lower in CD16+ Mcs after ORYGBP, suggesting decreased capacity to present antigen (P=0.002). Postoperatively, total DCs decreased in both groups, but recovered (P=0.04). The proportion and activation of the tolerogenic DC2 phenotype was lower, whereas the percentage of the ldDC phenotype was higher, in the O group (P=0.006). CONCLUSION: RYGBP changes the quantity and phenotype of circulating blood Mcs and DCs. Although there were overall similarities in the overall response to gastric surgery between open and laparoscopic, there were some notable differences, including a greater reduction in HLA-DR expression and increased number of immature DCs in the ORYGBP group. The findings suggest that RYGBP may have varying immunologic consequences depending upon the surgical procedure employed.

Adult↗