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Biomedical subjects

L K Nathanson

Publications and source records attributed to L K Nathanson.

At least 19 recordsLinked to original sources
PubMed2001

The poor quality of information about laparoscopy on the World Wide Web as indexed by popular search engines.

BACKGROUND: This study was undertaken to determine the quality of information on the Internet regarding laparoscopy. METHODS: Four popular World Wide Web search engines were used with the key word "laparoscopy." Advertisements, patient- or physician-directed information, and controversial material were noted. RESULTS: A total of 14,030 Web pages were found, but only 104 were unique Web sites. The majority of the sites were duplicate pages, subpages within a main Web page, or dead links. Twenty-eight of the 104 pages had a medical product for sale, 26 were patient-directed, 23 were written by a physician or group of physicians, and six represented corporations. The remaining 21 were "miscellaneous." The 46 pages containing educational material were critically reviewed. At least one of the senior authors found that 32 of the pages contained controversial or misleading statements. All of the three senior authors (LKN, NAO, GAF) independently agreed that 17 of the 46 pages contained controversial information. CONCLUSION: The World Wide Web is not a reliable source for patient or physician information about laparoscopy. Authenticating medical information on the World Wide Web is a difficult task, and no government or surgical society has taken the lead in regulating what is presented as fact on the World Wide Web.

Abstracting and Indexing↗
PubMed2000

Effects of simvastatin on hepatic cholesterol metabolism, bile lithogenicity and bile acid hydrophobicity in patients with gallstones.

BACKGROUND AND AIMS: There is limited information available on the effects of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors on hepatic and biliary cholesterol metabolism in patients with gallstones. The aims of this study were to determine the effect of simvastatin on the regulatory elements of cholesterol metabolism that determine the concentrations of cholesterol in plasma and bile. METHODS: Thirty-one gallstone patients were enrolled in the study; 17 were treated with 20 mg simvastatin daily for 3 weeks prior to cholecystectomy and 14 served as controls. Samples of blood, liver, gall-bladder bile and bile from the common bile duct (CBD) were collected and analysed. RESULTS: The plasma cholesterol (-30%), triacylglycerol (-23%) and low-density lipoprotein (LDL) cholesterol (-42%) concentrations were significantly lowered by simvastatin treatment, as was the plasma lathosterol: cholesterol (-70%), which reflects whole-body cholesterol synthesis. Despite these changes, the hepatic LDL receptor protein and LDL receptor activity in circulating mononuclear cells were similar in both groups. There were no differences in the plasma phytosterol: cholesterol, which reflects the intestinal cholesterol absorption capacity or in the activity of hepatic acyl-coenzyme A: cholesterol acyltransferase. There were however, lower cholesterol concentrations in CBD (-68%) and gall bladder (-41%) bile, and decreased lithogenic (-47%) and bile acid hydrophobicity (-22%) indices of CBD bile in the simvastatin group. CONCLUSIONS: These data indicate that simvastatin reduced plasma and biliary cholesterol levels primarily by reducing cholesterol synthesis. The reduction in CBD bile lithogenicity and bile acid hydrophobicity by simvastatin suggests that this agent may be useful for people who have early stages of cholesterol gallstone development and in whom a choleretic effect is required.

Adult↗
PubMed1999

Laparoscopic gastric banding for morbid obesity. Surgical outcome in 335 cases.

BACKGROUND: Morbid obesity occurs in 2-5% of the population of Europe, Australia, and the United States and is becoming more common. Open surgical techniques, such as vertical banded gastroplasty and other divisional procedures in the stomach, have led to long-term weight reduction as well as an amelioration of the attendant medical problems in approximately two-thirds of patients. MATERIALS AND METHODS: A total of 335 patients with a median age of 41 years underwent gastric banding. We emphasized the need for long-term maintenance and follow-up. The indications for surgery comprised a body mass index >35, a stated desire to undergo the procedure, and a full understanding of all possible complications. RESULTS: All patients have needed band adjustments of 1-4 ml over the course of their follow-up. No patient had increased his or her weight during the follow-up, and only three patients have not enjoyed sustained weight loss. CONCLUSIONS: Laparoscopic gastric banding has much to recommend it. Certainly in the short term, its results in terms of effectiveness of weight loss are at least as good as those of any open procedure. Longer follow-up will show whether this weight loss is maintainable. The procedure is technically demanding, and the major prerequisite of satisfactory performance of this surgery is laparoscopic experience.

Adult↗
PubMed1999

Spray of phospholipid powder reduces peritoneal adhesions in rabbits.

BACKGROUND: The possible effects of peritoneal dialysis and a combination of two exogenous phospholipids, dipalmitoylphosphatidylcholine (DPPC) and phosphatidylglycerol (PG), on experimentally induced intraperitoneal adhesion formation in rabbits were compared. METHODS: Fifty New Zealand rabbits equally divided in five groups underwent a midline laparotomy to create a right iliac fossa 5 x 1 cm parietal peritoneal defect and a matching defect over the adjacent large bowel. In 10 control rabbits (group I) the abdominal wound was closed without any further intervention. Twenty rabbits forming groups II and III underwent two sessions of peritoneal dialysis, one following abdominal closure and the second 24 h later, through a catheter placed at surgery. Rabbits in group III received an intraperitoneal injection of DPPC and PG after each session of dialysis. In 10 animals (group IV) a DPPC gel was applied to the defect over the large bowel and in 10 animals (group V) the peritoneal cavity was sprayed with a 'puff of DPPC:PG (7:3) powder prior to abdominal closure. All the animals were killed a week after the laparotomy to assess the extent of adhesion formation. RESULTS: The formation of adhesions was reduced in all the groups compared to the controls but a statistically significant difference was observed only in the group receiving the intraperitoneal 'puff' of DPPC:PG powder. CONCLUSION: A combination of DPPC and PG sprayed as a 'puff' intraperitoneally reduces experimentally induced peritoneal adhesions in rabbits.

1,2-Dipalmitoylphosphatidylcholine↗
PubMed1996

Laparoscopic-assisted colorectal surgery. Lessons learned from 240 consecutive patients.

PURPOSE: To audit the development and outcomes of laparoscopic colorectal surgery at the Royal Brisbane Hospital. METHODS: Since July 1991, laparoscopic-assisted colectomy for benign and malignant colorectal disease has been performed on more than 300 patients at the Royal Brisbane Hospital. This paper summarizes the outcome for the first 240 patients who underwent a laparoscopic colorectal procedure. All laparoscopic data were collected prospectively, and for selected studies, data were compared with open surgical controls. RESULTS: Nineteen patients required open conversion (7.9 percent). There was a significant decrease in wound infection rates in patients having a laparoscopic-assisted colectomy (3.6 percent) compared with historical controls (7.9 percent) (P < 0.05; chi-squared). There were five anastomotic leaks, five laparotomies for postoperative adhesive obstruction, and four perioperative deaths. A total of 103 patients had a procedure for colorectal cancer. Of the 79 potentially curative procedures, there have been 5 (6.3 percent) recurrences to date. CONCLUSION: The overall morbidity and mortality in this series seem to be acceptable compared with that of open procedures.

Colonic Diseases↗
PubMed1994

Intraoperative cholangiography during laparoscopic cholecystectomy. Routine vs selective policy.

An audit of routine intraoperative cholangiography in a consecutive series of 496 patients undergoing laparoscopic cholecystectomy has been performed. Cannulation of the cystic duct was possible in 483 patients (97%). The use of portable, digitized C-arm fluorocholangiography was vastly superior to the employment of a mobile x-ray machine and static films in terms of reduced time to carry out the procedure and total abolition of unsatisfactory radiological exposure of the biliary tract. Repeat of the procedure was necessary in 22% of cases when the mobile x-ray equipment was used. Aside from the detection of unsuspected stones in 18 patients (3.9%), routine intraoperative cholangiography identified four patients (0.8%) whose management would undoubtedly have been disadvantaged if intraoperative cholangiography had not been performed.

Bile Ducts↗
PubMed1994

Minimal access gastroduodenal surgery.

Considerable advances are occurring in the application of laparoscopic techniques to gastrointestinal and hepatobiliary disorders. Following studies in experimental animals, surgeons with an interest in gastroduodenal disease have now introduced laparoscopic techniques into current surgical practice. Elective intervention for peptic ulcer disease is currently being established, particularly in patients with proven negative Helicobacter pylori (HP) status, or when eradication has proved unsuccessful with various drug regimens. In addition, emergency laparoscopic intervention for perforation is gaining acceptance, with or without a definitive anti-ulcer procedure. Therapeutic endoscopy for bleeding peptic ulcer may well be followed by anti-ulcer laparoscopic surgery in selected patients. Laparoscopic techniques have been utilized for the treatment of Mallory Weiss tear, congenital hypertrophic pyloric stenosis, Dieulafoy's lesion, gastric trauma or volvulus and benign gastric tumours. More ergonomic instruments are required before laparoscopic gastric resection becomes more widely acceptable. It is essential that objective evaluation of variations on vagotomy themes be undertaken in prospective clinical trials and that the safety and efficacy of gastric resection procedures be substantiated if this renaissance is to revolutionize gastroduodenal surgical practice.

Animals↗
PubMed1994

Laparoscopic nephrectomy for benign renal disease.

OBJECTIVE: To perform nephrectomies in patients with benign renal conditions using laparoscopic techniques. PATIENTS AND METHODS: A total of five patients with benign renal conditions were treated. Three of the patients were morbidly obese. The operative technique was similar to a transperitoneal nephrectomy and was performed through four to six abdominal ports. Initial dissection involved mobilization of the overlying right colon to expose the retroperitoneum. Early identification of the inferior vena cava and ureter was critical to subsequent dissection and particularly to the exposure of the renal vessels. These vessels were controlled by either Endo-GIA staples (Autosuture Co., USA) or vicryl ties and haemaclips prior to division. After control of the vascular pedicle the kidney was mobilized within Gerota's fascia and removed. RESULTS: In three patients the procedure was performed entirely laparoscopically with retrieval of the kidneys through dilated abdominal port sites. Small incisions were necessary in the remaining two patients--one with a grossly hydronephrotic kidney and the other, a morbidly obese woman with co-existing cholelithiasis, treated laparoscopically also had an epigastric hernia which was repaired using a 5 cm incision through which her kidney and gall-bladder were removed. Operative times ranged from 2 to 4 1/2 h. Narcotic analgesia was required in two cases and the median post-operative stay was 2 days. A superficial skin infection in one patient was the only post-operative complication. CONCLUSION: Laparoscopy appears to have a definite role in the selective removal of kidneys for benign renal disease. Based on our experience this technique is particularly useful in the obese patient--reducing post-operative pain and allowing early mobilization, discharge from hospital and resumption of normal activities.

Adult↗
PubMed1993

Laparoscopic cholecyst-jejunostomy and gastroenterostomy for malignant disease.

The technique of videolaparoscopic surgical bypass for malignant obstruction of the distal common bile duct and duodenum is described as it has evolved since 1991. The techniques available include anastomosis of jejunum to the gallbladder and stomach by suture, staples or a combination of the two techniques. The present criteria for patient selection for these palliative approaches, alone or in combination with ERCP stenting, are discussed. Early clinical experience in several small series of patients treated by this laparoscopic approach suggests rapid recovery will be added to the proven reliability of these open palliative bypass techniques.

Cholangiography↗
PubMed1993

Videothoracoscopic primary repair of early distal oesophageal perforation.

Distal oesophageal perforation following dilation of oesophageal strictures or achalasia is usually recognized soon after the event. Treatment of two patients with perforation resulting from vigorous achalasia, diagnosed within hours of the procedure, was approached by videothoracoscopic exposure and successful primary repair was achieved in both instances. Details relating to patient preparation and operative technique are presented. Both patients recovered, with normal diet being tolerated by the seventh day after surgery, were discharged on day eight and 10 and returned to normal activities within 3 weeks of surgery. The technique presented is apparently well suited to distal oesophageal perforations diagnosed early, when primary closure can be achieved safely, and significantly improves patient recovery after this often iatrogenic injury.

Adult↗
PubMed1992

The utility of diagnostic laparoscopy for abdominal disorders. Audit of 120 patients.

We audited our recent experience with diagnostic laparoscopy performed over a 30-month period on 131 consecutive patients. Laparoscopy was 100% accurate in the diagnosis or exclusion of intra-abdominal malignant neoplasms, and future care decisions were affected by this information. Laparoscopy in the evaluation of chronic abdominal pain yielded positive findings in 47% of cases. The majority of referrals (73%) for the investigation of chronic abdominal pain came from the medical services, whereas the majority of referrals (72%) for the investigation of cancer originated from surgeons. Laparoscopy in the setting of acute abdominal pain yielded useful information that affected patient outcomes in 71% of cases. There were no serious complications in this series. Laparoscopy is a safe and useful diagnostic tool, especially for the diagnosis, staging, or exclusion of cancer.

Abdominal Neoplasms↗
PubMed1992

Thoracoscopic long oesophageal myotomy for nutcracker oesophagus: initial experience of a new surgical approach.

A thoracoscopic technique is described for the execution of long oesophageal myotomy for nutcracker oesophagus causing odynophagia and non-cardiac chest pain. The technique is based on a multipuncture method and a left thoracoscopic approach. It has been performed on three patients with complete symptomatic relief in the short term, although the follow-up period is short (maximum 12 months). No complications were encountered and discharge from hospital occurred by the fifth day after operation.

Adult↗
PubMed1992

Laparoscopic reduction, crural repair, and fundoplication of large hiatal hernia.

A technique for laparoscopic reduction, crural repair, and total fundoplication for large symptomatic hiatal hernia is described. The procedure entails the mobilization of the esophagogastric junction with crural repair by a continuous suture technique employing a special pre-formed jamming loop knot, followed by total fundoplication that is fixed proximally to the anterior margin of the diaphragmatic hiatus and distally to the esophagogastric junction. The procedure has been performed in eight elderly patients with a good outcome and accelerated recovery to full activity.

Aged↗
PubMed1992

Single dose ceftriaxone as prophylaxis for sepsis in colorectal surgery.

During the period May 1986 to July 1989, a prospective, double blind, randomized trial of antibiotic prophylaxis in colorectal surgery was undertaken at the Royal Brisbane Hospital. Three hundred and thirty patients were considered eligible for the trial. Three regimens were compared: a combination of 2 g ceftriaxone and 1 g metronidazole; a single dose of 2 g ceftriaxone; or 1 g cefazolin and 1 g metronidazole, as antibacterial prophylaxis in colorectal surgery. Fifty patients were excluded from analysis. The overall incidence of wound sepsis was 7.9% (22 patients). There was no statistical difference in the incidence of wound infections between the three groups. The presence of drains and the non-performance of a bowel anastomosis at the time of surgery predisposed patients to wound infection. Staphylococcus aureus or Staphylococcus epidermidis were the cause of wound infection in 16 cases. Patients in the cefazolin and metronidazole group had a significantly higher number of postoperative urinary tract and respiratory tract infections than the other two groups combined (P less than 0.01). There did not appear to be any change in sensitivity patterns to ceftriaxone during the 3 year trial. During the 3 year period of the study, ceftriaxone was found to be a safe and effective drug in antibacterial prophylaxis in colorectal surgery.

Cefazolin↗
PubMed1992

Sutured laparoscopic cholecystojejunostomy evolved in an animal model.

In a series of acute and chronic experiments conducted in young pigs during a 2-year period, we have evolved a quick knotting technique to start and end a suture line and developed a curved 'Endoski' needle to improve needle passage through the tissues. These have been employed in the construction of cholecystojejunal anastomoses using a semi-closed technique with a single layer (deep seromuscular) of continuous polyglactin sutures. In chronic experiments in pigs, patent well healed bilioenteric anastomoses, which conveyed bile satisfactorily after ligation of the common bile duct, distal to the cystic duct, were achieved. A virtual absence of adhesions in these animals was noted.

Anastomosis, Surgical↗
PubMed1991

Laparoscopic cholecystectomy: the Dundee technique.

A total of 61 patients was subjected to laparoscopic cholecystectomy. The procedure was completed in 60 cases and converted to open operation in one (2 per cent). The morbidity rate was low (total 7 per cent, major 2 per cent, blood transfusion rate 5 per cent). The median duration of the laparoscopic cholecystectomy with cholangiography was 135 min (range 65-270 min). The operation took less time to complete in patients with functioning gallbladders than in those with non-functioning fibrotic organs (median 120 versus 175 min). The majority of patients required opiate analgesia despite infiltration of the stab wounds with bupivacaine. The mean (s.d.) hospital stay was 2.9 (1.5) days. The median time to resume work or full activity after discharge was 11 days.

Adult↗