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Biomedical subjects

L C Carey

Publications and source records attributed to L C Carey.

At least 19 recordsLinked to original sources
PubMed1992

Colorectal trauma: primary repair or anastomosis with intracolonic bypass vs. ostomy.

This prospective, randomized, controlled study was undertaken to compare primary repair or anastomosis with intracolonic bypass vs. ostomy in severe colon and intraperitoneal rectal injury. Patients were randomized at surgery following confirmation of injury. Data collected included demographics, mechanism and location of injury, trauma score (TS), injury severity score (ISS), penetrating abdominal trauma index (PATI), complications, length of hospital stay, and hospital charges. Twenty-two patients were studied: 11 with intracolonic bypass and 11 controls. The experimental and control groups were statistically similar in demographics and mechanism of injury, severity of injury (TS = 13.8 vs. 12.8; ISS = 27.5 vs. 24.2; PATI = 40.5 vs. 35.0), and complication rate. Length of stay (12.2 days vs. 20.7 days) and charges $27,885 vs. $53,599) tended to be greater in controls, and the comparison did not include subsequent colostomy closure. This study supports intracolonic bypass as a safe alternative to ostomy in severe colon and intraperitoneal rectal trauma.

Adolescent↗
PubMed1992

Pancreaticoduodenectomy.

Few major abdominal operations have undergone the extent of dramatic change as that associated with pancreaticoduodenectomy in the last 20 years. The precipitous drop in the mortality rate most likely has a multifaceted explanation. Possibilities include the concentration of the operations at specialized centers, the improvement in the quality of critical care and anesthesia, and the improvement in the skill and experience of surgeons performing the procedure. Concomitant with the drop in the morality rate has been an increase in the resectability rate, along with the early encouraging evidence of improved long-term survival. However, many aspects of the technical portion of the procedure, particularly the pancreaticojejunostomy, need to be evaluated in prospective trials. The changes in the mortality and resectability rates make the operation more widely available to a larger number of patients, and the effectiveness of pancreaticoduodenectomy even for palliation is now well established.

Humans↗
PubMed1992

A new technique of laparoscopic cholangiography.

With the advent and rapid proliferation of laparoscopic cholecystectomy, numerous techniques and "tips" have been described. Intraoperative cholangiography during laparoscopic cholecystectomy can be tedious, frustrating, and time consuming. Described herein is a technique of intraoperative cholangiography during laparoscopic cholecystectomy which has proven to be easy, fast, and succinct. This method utilizes a rigid cholangiogram catheter which is placed into the peritoneal cavity through a small additional puncture site. This catheter is easily inserted into the cystic duct by extracorporeal manipulation. We suggest this method to surgeons who have shared our prior frustration with intraoperative cholangiography.

Catheterization↗
PubMed1992

Physician review improves hospital DRG reimbursement in injury.

This was a prospective study of all DRG reimbursed trauma patients discharged during an 11-month period. Initial DRGs were assigned by hospital coding specialists (HCS). A surgeon (SURG) subsequently reviewed each chart and assigned DRGs to maximize reimbursement. The data for 244 patients were: age = 36.5 years, Trauma Score (TS) = 13.8, Injury Severity Score (ISS) = 16.9, and length of stay (LOS) = 10.3 days. Total charges for the 244 patients were $4,261,208 with an initial HCS projected reimbursement of $1,687,963. The SURG review resulted in a total projected reimbursement of $1,956,476, an increase of $268,513 in revenue (p less than 0.001). Charges correlated strongly with LOS and ISS. The HCS-coded and SURG-coded reimbursements also correlated positively with LOS and ISS, but to a lesser extent. The SURG review of DRG assignment improved hospital reimbursement for the injured patients. However, this reimbursement fell well below hospital billings.

Abstracting and Indexing↗
PubMed1992

A simple technique for laparoscopic gastrostomy.

While endoscopically placed gastrostomy tubes are routinely simple, they are not always feasible. Endoscopic technique also does not uniformly secure the tube to the abdominal wall, which presents possible complications, including leakage, accidental early tube removal, intraperitoneal catheter migration and necrosis of the stomach or abdominal wall because of excessive traction. Presented herein is a technique that is rapid, simple and eliminates some of these potential complications. The technique is easily combined with other operative procedures, such as tracheostomy, is done under direct vision, can be performed quickly with intravenous sedation and local anesthetic and is a safe method of tube placement for enteral feeding or gastric decompression.

Gastrostomy↗
PubMed1991

Historical review of pancreaticoduodenectomy.

The performance of pancreaticoduodenectomy by Whipple in 1935 demonstrated that the operation was feasible technically and compatible with reasonable function after recovery. From the mid- to late 1940s until the last 10 years, the procedure was condemned by many because of its associated mortality and morbidity. For reasons that are not clear, the risk of pancreaticoduodenectomy in the last 10 years has fallen to less than 10% and in several centers, less than 5%. Postoperative complications have been reduced and blood transfusions are unnecessary in an increasing number of patients. Furthermore, a normal productive life without the need for medication and with no digestive disorder is expected. Seventy-one percent of patients are able to return to their preoperative occupation.

Chronic Disease↗
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↗
PubMed1991

Second-look surgery for colorectal cancer. The second time around.

Eighty-six colorectal cancer patients who entered the Radioimmunoguided Surgery (RIGS) protocol study were evaluated for 2-, 3-, 4-, and 5-year survival following second-look surgical procedures. Strict preoperative evaluation criteria eliminated patients with extra-abdominal tumor involvement. A saturated potassium iodide preparation was given before the intravenous administration of the B72.3 monoclonal antibody (1 mg) radiolabeled with 2 mCi of iodine-125 by the IODOGEN method. Precordial monitoring of the biologic clearance by the handheld, gamma-detecting probe (Neoprobe 1000 instrument) was conducted at weekly intervals until the average count was less than 20 counts in 2 seconds. Once the drug cleared from the blood, surgery was performed. The mean time interval between injection and operation was 24 days, with a range of 21 to 28 days and a median of 23 days. At surgery the abdomen was explored through the traditional methods of palpation and inspection, and the surgeon committed to a planned procedure. The abdomen was then re-explored with the handheld, gamma-detecting probe and the surgeon stated another intraoperative assessment. After using both traditional and RIGS detection methods, the surgeon stated whether his or her surgical plans changed because of the additional intraoperative information provided by the RIGS system. Fifty-three patients (62%) were deemed resectable by the traditional methods of palpation and inspection, but only 40 (47%) were specified as resectable by RIGS exploration. Two-, three-, four-, and five-year survival data could be gathered for each of the three groups: RIGS resectable (n = 40), traditional nonresectable (n = 33), and RIGS nonresectable (n = 13). At 2 years 95% of the resectable, 36% of the traditional nonresectable, and 53% of RIGS nonresectable patients survived. At 3 years 83%, 7%, and 30% of these patients survived, respectively. For the resectable patients, 74% survived at 4 years and 60% at 5 years, with no survivors from either nonresectable group. Use of the RIGS system increased accurate selection of resectable patients undergoing second-look surgery for recurrent colorectal cancer.

Antibodies, Monoclonal↗
PubMed1979

Alterations in gastrointestinal contents induced by elemental diets.

The effects of elemental diets on selected aspects of the rat colon were studied. Forty young male Sprague-Dawley rats were divided into 4 diet groups of 10 rats each: Purina Rat Chow (control); Flexical; Precision L-R; and Vivonex. All diets were fed ad lib to rats housed in pairs in wire-bottom cages. Two weeks after weight stabilization had been achieved all rats were killed and colon contents were collected for culture and short-chain fatty acid analysis on the Perkins-Elsoner 3920 gas chromatograph. Colon fecal butyric/acetic acid ratios of the rats in the 4 groups were: Rat Chow, 2.56; Flexical, 0.28; Precision L-R, 0.16; and Vivonex, 0.26. Bacterial cultures showed increased coliform and enterococcal species in the rats consuming elemental diets.

Acetates↗
PubMed1979

Comparative efficacy of prophylactic cephalothin and cefamandole for elective colon surgery: results of a prospective, randomized, double-blind study.

Thirty-four patients undergoing elective colon resection or anastomosis received either intravenous cephalothin or cefamandole prophylactically and were observed for evidence of intraabdominal or wound infection, or both, postoperatively. The infection rates were 31 and 33 per cent, respectively. Infections were caused predominantly by cephalosporin resistant aerobes and anaerobes. All four bacteremias were caused by members of the B. fragilis group. The overall infection rate (32 per cent) and the frequency of anaerobic bacteremia (12 per cent) observed in this study were much higher than previously reported after cephalosporin prophylaxis for colorectal surgery.

Adenoma↗
PubMed1979

Surgical decision-making in the treatment of pancreatic pseudocysts. Internal versus external drainage.

One hundred patients with documented pancreatic pseudocysts who underwent surgical drainage are reported on. Accurate assessment of the size and location of the pseudocyst using ultrasonography, endoscopic retrograde cholangiopancreatography, angiography, and upper gastrointestinal roentgenography is essential. After diagnosis, the next 4 to 7 weeks is a critical period, after which surgical intervention becomes mandatory if the cyst has not resolved. This period between diagnosis and operation is hazardous and demands close clinical follow-up. When oepration is required, the preferred procedure continues to be internal drainage because it is associated with less morbidity and a lower mortality. However, external drainage appears to be a suitable second choice. Fewer than 10 per cent of the patients in this series who underwent external drainage developed fistulas, and the overall rate of late morbidity was acceptable.

Abscess↗
PubMed1979

Use of Doppler ultrasound in intestinal surgery.

Doppler ultrasonography was used intraoperatively in 117 patients undergoing intestinal anastomosis or enterostomy to determine the adequacy of blood supply at the margins of resection. Doppler findings were compared with clinical assessment of intestinal blood flow by the operating surgeon. In 92 per cent of cases, Doppler signals and clinical observation coincided. However, in five of six cases in which Doppler signals were absent at one margin, the surgeon resected additional intestine, selecting margins within 1 cm of the nearest arterial Doppler signal. All five patients had uneventful healing. In the one case in which the surgeon chose to rely onthe appearance of the bowel despite the absence of Doppler arterial signals, ischemic necrosis of the proximal segment and anastomotic disruption occurred. The technique of Doppler ultrasonography is readily learned, and the instrument is available in most hospitals. Intraoperative use of Doppler ultrasonography can help identify intestine lacking a blood supply adequate to assure viability before changes in the appearance of the bowel alert the surgeon to the problem.

Colon↗
PubMed1979

Use of Doppler ultrasound in intraoperative localization of intestinal arteriovenous malformation.

Precise localization of an intestinal arteriovenous malformation is essential for the complete resection of the lesion. Identification at operation can be difficult, and intraoperative angiography is not without complications. Blood flow within the small vessels of the bowel wall can be easily detected by Doppler ultrasonography, and arterial flow can be distinguished from venous flow. Intraoperative use of the Doppler ultrasound technique localized an AVM in the small intestine. Distinctive flow signals were present over the intestinal AVM which allowed it to be easily differentiated from adjacent normal intestine. Confirmation was secured by measuring the PO2 of blood aspirated from the vein draining the involved segment and comparing it to the PO2 from a vein draining an adjacent segment.

Arteriovenous Malformations↗