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Biomedical subjects

M A Carlson

Publications and source records attributed to M A Carlson.

At least 19 recordsLinked to original sources
PubMed1997

Prosthetic reinforcement of posterior cruroplasty during laparoscopic hiatal herniorrhaphy.

Symptomatic gastroesophageal reflux after Nissen fundoplication may occur if the wrap herniates into the thorax. In an attempt to prevent recurrent hiatal hernia we employed polytetrafluoroethylene (PTFE) mesh reinforcement of posterior cruroplasty during laparoscopic Nissen fundoplication and hiatal herniorrhaphy. Three patients with symptomatic gastroesophageal reflux and a large (>==8 cm) hiatal defect underwent laparoscopic posterior cruroplasty and Nissen fundoplication. The cruroplasty was reinforced with a PTFE onlay. No perioperative complications occurred, and in follow-up (<==11 months) the patients are doing well. When repairing a large defect of the esophageal hiatus during fundoplication, the surgeon may consider reinforcement of the repair with PTFE mesh.

Fundoplication↗
PubMed1997

Canine intestinal myoelectric activity after open versus laparoscopically assisted right hemicolectomy.

BACKGROUND: It is a common belief that a laparoscopic procedure results in a shorter duration of postoperative ileus compared with the equivalent open procedure. This study was undertaken to determine whether laparoscopically assisted right hemicolectomy in the dog results in a shorter duration of ileus compared with open right hemicolectomy. METHODS: Eight bipolar serosal electrodes (4 on the small bowel, 4 on the left colon) were implanted in each dog (n = 10). Three weeks after electrode implantation baseline recording was made for 5 days; then 5 dogs underwent laparoscopically assisted right hemicolectomy and 5 underwent open right hemicolectomy. Myoelectric activity was recorded continuously for 72 hours postoperatively. Tracings were analyzed for the time of reappearance, duration, migration velocity, and cycle length of phase 2, phase 3, and the migrating colonic complex. The criteria used for the resolution of postoperative ileus were the return of phase 2, phase 3, and the migrating colonic complex. RESULTS: All dogs had temporary loss of organized myoelectric activity postoperatively. The mean reappearance time (minutes +/- standard deviation) for phase 3 was 857 +/- 574 versus 761 +/- 600; the phase 2 reappearance time was 1,845 +/- 610 versus 1,590 +/- 668; and the migrating colonic complex reappearance time was 534 +/- 365 versus 572 +/- 552, open versus laparoscopically assisted right hemicolectomy, respectively. The times were not different (Wilcoxon rank sum test, P > 0.05). The time required for phase 3, phase 2, and the migrating colonic complex to attain preoperative configuration also was not different between the open and laparoscopically assisted group. CONCLUSION: Myoelectric resolution of postoperative ileus did not occur earlier in the dog undergoing laparoscopically assisted right hemicolectomy compared to the dog undergoing open right hemicolectomy. This data does not support the hypothesis that a laparoscopically assisted colectomy results in a shorter duration of postoperative ileus than the equivalent open procedure.

Animals↗
PubMed1997

Urinary adenosine excretion in patients receiving amphotericin B.

BACKGROUND: Intravenous amphotericin B (AMB) administration in animals causes renal vasoconstriction, ischemia, and oliguria that may result in irreversible renal injury; the mechanism of AMB nephrotoxicity may be similar in human beings. Adenosine is excreted in urine by the ischemic kidney. We hypothesized that adenosine excretion and oliguria would be a marker for patients who later would manifest AMB-associated renal insufficiency and that pre-AMB saline administration (which ameliorates AMB nephrotoxicity) would negate the change in adenosine excretion and urine output. METHODS: Twenty hospitalized patients being treated at the direction of their attending physician and who were receiving AMB (15 to 75 mg intravenously) had urine collected for 1 hour before and for 2 hours during AMB infusion. Eleven patients received normal saline solution (500 ml intravenously) before the AMB infusion; the other nine formed the comparator group. An aliquot of each urine collection was precipitated with perchloric acid to remove protein and cellular elements and centrifuged, and the supernatant was assayed for adenosine by using high-pressure liquid chromatography. RESULTS: Infusion of AMB was associated with a decrease in mean urine output both in patients who received saline solution (245 before versus 149 ml/hr during AMB infusion, p = 0.04) and in patients in comparator group (139 versus 89 ml/hr, p = 0.027). The mean urinary adenosine excretion was unchanged in the saline-loaded group (0.1354 before versus 0.1255 mmol/hr during drug infusion, p = 0.25) and was decreased in the comparator group (0.2276 versus 0.1127 mmol/hr, p = 0.01). Development of renal insufficiency did not correlate with the change in urine output or adenosine excretion. CONCLUSIONS: AMB infusion in human beings results in decreased urine output and decreased adenosine excretion. The latter effect is prevented by a pre-AMB saline load. The changes in urine output and adenosine excretion are not predictive of the development of renal insufficiency.

Adenosine↗
PubMed1997

Acute wound failure.

The causes and treatment of acute failure of the abdominal incision are reviewed, along with a summary of studies on fascial healing. Emphasis is placed on taking large bites of tissue during closure to prevent dehiscence. Patient-related risk factors are viewed as less important in the causation of wound failure.

Abdomen↗
PubMed1997

Minimally invasive ventral herniorrhaphy.

Three types of minimally invasive ventral herniorrhaphies were performed in eight patients: primary repair with sutures (1 case), single-layer prosthesis repair with polytetrafluoroethylene (4 cases), and bilayer prosthesis repair with polytetrafluoroethylene and polypropylene (3 cases). One patient undergoing the bilayer repair developed a small hematoma in the subcutaneous tissue at the site of the repair, which resolved without intervention. There were no other complications, and no recurrence was noted in follow-up of 14 to 20 months.

Follow-Up Studies↗
PubMed1997

Laparoscopic highly selective vagotomy.

Laparoscopic highly selective (anterior and posterior) vagotomy was performed in 11 patients for duodenal ulcer (n = 10) and duodenal ulcer with prepyloric ulcer (n = 1). All patients were endoscoped both pre- and postoperatively. There were no perioperative complications. The average operating time was 3.2+/-0.4 hours and the average hospital stay was 1.7+/-0.2 day (range 1 to 3 days). None of the patients required parenteral narcotics postoperatively. The patients have been followed for 6 months to 5 years after operation. All ulcers healed as demonstrated by endoscopy. There was one recurrence at 9 months in a patient who had a prepyloric ulcer preoperatively. The recurrence was treated successfully with medication. There has been no other long-term morbidity. Laparoscopic highly selective vagotomy is feasible, safe, requires a brief hospital stay, and produces short-term results comparable with open surgery.

Duodenal Ulcer↗
PubMed1997

Laparoscopic redo Nissen fundoplication.

Nine patients underwent redo laparoscopic Nissen fundoplication because of failed primary laparoscopic antireflux procedure. Symptoms prior to reoperation included heartburn (n = 5), dysphagia (n = 2), dysphagia and heartburn (n = 1), and early satiety and epigastric pain (n = 1). Endoscopic and radiologic findings prior to reoperation included esophagitis (n = 6), reflux (n = 6), stenosis (n = 2), and hiatal hernia (n = 1). Findings at reoperation included fundoplication positioned on the stomach (n = 5); a disrupted cruroplasty (n = 1); gastric volvulus (n = 1); and an excessively tight wrap (n = 1) or cruroplasty (n = 1). Reconstruction of the fundoplication was performed according to accepted principles for this procedure. All patients were discharged within 2 days after the redo procedure. Follow-up time is 4-14 months. Preoperative symptoms were relieved in all patients and all antireflux medication have been discontinued. Routine postoperative esophagram and endoscopy demonstrated intact repair and without gastroesophageal reflux or stenosis. Reoperative laparoscopic Nissen fundoplication is feasible and effective.

Adult↗
PubMed1995

Laparoscopic versus conventional fundoplication.

The operative and short-term results of 29 patients who had an open fundoplication were compared to 36 patients who had a laparoscopic fundoplication. The operative time was 2.8 +/- 0.4 and 3.1 +/- 0.3 h for the open and laparoscopic procedure, respectively. The length of hospital stay was 9.2 +/- 0.7 days for the open and 1.8 +/- 0.2 days for the laparoscopic. There were five complications in the open group and one in the laparoscopic group. The follow-up period was 3-32 months and all patients had a barium swallow and esophago-gastroduodenoscopy (EGD) for postoperative evaluation. All patients had resolution of esophagitis on follow-up endoscopy, were free of reflux symptoms, and no longer required antireflux medication. Laparoscopic Nissen fundoplication has an operative time that is comparable to the open procedure. The complication rate for laparoscopic fundoplication is acceptable. Patients undergoing a laparoscopic fundoplication have a shorter hospital stay compared to patients with an open procedure. The short-term outcome for the laparoscopic fundoplication group was excellent.

Adult↗
PubMed1995

Laparoscopic gastric bypass in a porcine model.

Gastric bypass and vertical banded gastroplasty are the two procedures used most frequently in the treatment of morbid obesity. In a pilot study, we used a porcine model in which laparoscopic gastric stapling and Roux-en-Y gastrojejunostomy were accomplished.

Anastomosis, Roux-en-Y↗
PubMed1995

Ventral hernia and other complications of 1,000 midline incisions.

We report the outcome in 1,079 consecutive clean or clean-contaminated midline abdominal incisions closed with running 0-loop nylon suture after both elective and emergency operations done between 1984 and 1991. Postoperatively, 79 patients were lost to follow-up, resulting in 1,000 having long-term follow-up. Mean follow-up among these patients was 22 months. Early wound complications included subcutaneous wound infection (18), deep wound infection (17), dehiscence (13), fistula (2), and suture sinus (2). A ventral hernia developed in 42 (4.2%) cases during follow-up. By chi-square analysis, wound infection, dehiscence, class of clean-contaminated wound, patient age > 65, or previous midline abdominal incision were not identified as risk factors for development of a ventral hernia. Reuse of a previous midline incision in combination with any wound infection was associated with an increased risk of subsequent ventral hernia (stepwise regression). In our experience, running closure of a vertical midline abdominal wound has not been associated with an excessive incidence of wound complications or of ventral hernia.

Chi-Square Distribution↗
PubMed1995

Polyglyconate (Maxon) versus nylon suture in midline abdominal incision closure: a prospective randomized trial.

A prospective, randomized comparison of nylon versus polyglyconate (Maxon) looped suture in running mass closure of midline abdominal incisions was conducted in 225 patients. In the nylon group, 91 patients were evaluable at 2-year follow up; in the polyglyconate group, 80 patients were evaluable at follow up. Eleven patients (4 nylon and 7 polyglyconate) developed a ventral hernia. Three of the nylon and none of the polyglyconate sutured patients had a dehiscence. There was no significant difference in the overall rate of ventral hernia and dehiscence between the two suture groups. Running mass closure of midline abdominal wounds yielded satisfactory results with both of the suture materials studied.

Elective Surgical Procedures↗
PubMed1994

Depression and memory narrative type.

Research with autobiographical memories has distinguished between memory narratives of specific events and summaries of many events blended together. Depression has been associated with a reduced ability to retrieve and orally relate specific positive memories. This study explored the hedonic bias in memory through collection of written autobiographical memories from 90 nonclinical college students whose mood was assessed for depression. Participants with higher depression scores recalled significantly more summary memories in response to a request for a positive self-defining memory than did participants with lower depression scores. There were no significant differences in the number of single-event and summary memories when participants were asked for a negative memory. We used J. A. Singer and K. H. Moffitt's (1991-1992) scoring system to distinguish between summarized and specific memory narratives.

Adolescent↗
PubMed1994

Laparoscopic repair of a penetrating injury to the diaphragm: a case report.

A traumatic diaphragmatic hernia that appears late may have a fatal outcome. Traditionally, the most sensitive diagnostic modality for diaphragmatic injuries has been laparotomy. This results in unnecessary laparotomies. Laparoscopy is now an alternative method for the diagnosis and treatment of numerous intraabdominal disorders. We present a case of a penetrating diaphragmatic injury that was diagnosed and repaired via the laparoscope.

Adult↗
PubMed1993

Routine or selective intraoperative cholangiography in laparoscopic cholecystectomy.

The routine versus selective use of intraoperative cholangiography has been the subject of debate for some time. Most authors currently advocate routine intraoperative cholangiography with laparoscopic cholecystectomy. The authors report their experience with the selective and routine utilization of intraoperative cholangiography at two institutions. At institution A, 155 laparoscopic cholecystectomies were attempted, and 21 cholangiograms were performed (based on preoperative criteria of ultrasound, liver function tests, and history of jaundice, or intraoperative anatomical uncertainty). At institution B, 164 laparoscopic cholecystectomies were attempted and 127 cholangiograms were performed (a routine intraoperative cholangiography policy). At institution A, there were no common bile duct injuries but there was one retained stone. At institution B, there was one common bile duct injury and no retained stones. The patient with the retained stone from institution A had a preoperative indication (total bilirubin = 4.4 mg/dl) for a cholangiogram, but it was not performed due to technical difficulties. This patient later required endoscopic sphincterotomy with stone extraction. One patient at institution B had a choledochotomy which was detected by intraoperative cholangiography (IOC). This was managed with a T-tube. The selective use of cholangiograms in laparoscopic cholecystectomy will not yield a higher incidence of common bile duct injuries or retained stones compared to routine use. Further, a cholangiogram may not necessarily prevent choledochotomy but can prevent extension of common bile duct injury. Thus, it should always be performed when there is anatomic uncertainty.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1993

Myoelectric motility patterns following open versus laparoscopic cholecystectomy.

Laparoscopic surgery is associated with a lack of postoperative ileus. To determine if differences exist in postoperative motility patterns, 8 dogs were instrumented with bipolar electrodes 10-14 days prior to open (n = 4) or laparoscopic (n = 4) cholecystectomy. In both groups, Phase II activity disappeared in the first 24 h after operation. The appearance of the migrating myoelectric complex in the small intestine and the migrating colonic complex were used as criteria for recovery from postoperative ileus. Postoperative migrating myoelectric complex cycle length, migrating myoelectric complex, migration velocity, and colonic spike bursts/hour were also measured. No statistically significant differences were observed between groups in study parameters examined. Postoperative myoelectric motility patterns in dogs undergoing open versus laparoscopic cholecystectomy are not different. Other factors may be responsible for the rapid return to oral intake following laparoscopic cholecystectomy.

Animals↗