Biomedical subjects

M E Fenoglio

Publications and source records attributed to M E Fenoglio.

7 recordsLinked to original sources

PubMed1997

Thoracoscopic excision of mediastinal parathyroid adenomas: a report of two cases and review of the literature.

BACKGROUND: Most abnormal parathyroid glands can be removed through a standard cervical incision; even those in the superior mediastinum. Those located in certain areas of the mediastinum, for example posteriorly or in the aortopulmonic window, historically have required excision through a median sternotomy or thoracotomy. Angioablation is a nonsurgical alternative to management of these lesions. STUDY DESIGN: We present two case reports of mediastinal parathyroid adenomas that were excised thoracoscopically, and review the literature regarding the management of mediastinal parathyroid adenomas. RESULTS: Both patients who underwent precise localization and thoracoscopic excision of their mediastinal parathyroid adenomas had resolution of their hypercalcemia with minimal associated morbidity and shortened recovery periods. CONCLUSIONS: We suggest that thoracoscopic excision of mediastinal parathyroid adenomas is the better means of controlling hypercalcemia secondary to parathyroid adenoma in those patients considered for either median sternotomy, thoracotomy or angiographic ablation where the exact location of the lesion can be established preoperatively.

Adenoma↗

PubMed1997

Axillary lymph node dissection: is it required in T1a breast cancer?

BACKGROUND: Several authors have questioned the need for axillary lymph node dissection in T1a breast cancer (primary tumors 5 mm or less in diameter), although current practice typically includes routine axillary lymph node dissection. STUDY DESIGN: We retrospectively reviewed the records of 2,242 breast cancers in our tumor registries from 1987 to 1994. The incidence of axillary lymph node metastases was determined according to primary breast cancer size. The objective was to determine the need for axillary lymph node dissection in T1a breast cancers, and our data included 74 T1a cancers. Axillary lymph node dissection was performed in 66 of these patients. RESULTS: Axillary lymph node metastases were found in 3 of 66 cases (4.5 percent). We also reviewed several other institutional series of T1a breast cancers and found no statistical difference in the reported axillary lymph node metastases and our data (p < .10). The combined single-institution data included 256 T1a breast cancers and had a 3.9 percent incidence of axillary lymph node metastases. The Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute published data statistically different from ours. From 1977 to 1982, 339 T1a lesions had a 21 percent incidence of axillary lymph node metastases (p < .005), and from 1983 to 1987, 1,491 T1a lesions had an 11 percent metastatic rate (p < .001). We believe that the SEER data is flawed, because SEER results do not require histologic confirmation of axillary lymph node status. CONCLUSIONS: We believe the single-institution rate of 3.9 percent axillary lymph node metastases in T1a breast tumors results from state-of-the-art breast cancer screening and detection of earlier and smaller lesions. Our data support abandoning routine axillary lymph node dissection in T1a breast cancer.

Adult↗

PubMed1996

Laparoscopic fundoplication.

Most reports on laparoscopic fundoplication are from large, tertiary referral medical centers. Presented here is an experience by a single surgeon (M.E.F.) in community hospitals with 74 cases. All patients had esophagitis. All but two patients were Visick grade IV off medication. All patients had an incompetent lower esophageal sphicter. Four with abnormally low esophageal contractions underwent a Toupet procedure; the rest had a Nissen fundoplication. The largest estimated blood loss was 300 cc. One case (1.4%) had to be converted intraoperatively to an open procedure because of bleeding from an iatrogenic liver laceration. There were two minor complications (a urinary tract infection and a pneumothorax) and one death (massive liver necrosis with an otherwise unremarkable post mortem, thus it was felt to be due to anesthesia). The mean length of hospital stay was 2.8 +/- 0.21 days. Eighty-nine percent of the operations totally relieved reflux. Nineteen patients (26%) had mild, early postoperative dysphagia, gas bloat, and/or early satiety. Four patients did not get any improvement in their reflux, three still require chronic medication, and one underwent a redo open fundoplication. Three early patients had severe, new-onset postoperative dysphagia secondary to too tight a fundoplication. Attention must be focused on creating a loose wrap, a "floppy" Nissen by routine division of the short gastric vessels and the use of a large dilator in the esophagus when the fundoplication is constructed. Laparoscopic fundoplication is technically feasible, safe, and effective in a community hospital and does not require a large, tertiary referral medical center.

Adolescent↗

PubMed1996

Laparoscopic versus open appendectomy.

This prospective clinical study was done because our initial retrospective review suggested that laparoscopic appendectomy (LA) offers no significant advantages over open appendectomy (OA) yet is significantly more expensive. From July 1992 to August 1993, 57 patients were approached preoperatively for randomization to either LA (n = 19) or OA (n = 18). There were no statistically significant differences between the LA and OA groups in operative risk: mean age, 28 +/- 2 vs 26 +/- 2 years; percent female, 26% vs 22%; body mass index, 24 +/- 0.8 vs 26 +/- 1.2 kg/m2. All patients were either ASA class I or class II, 78% in each group being class II. The differences between the LA and OA groups in mean operating time required (93 +/- 12 vs 87 +/- 8 minutes), postoperative intramuscular narcotic analgesic usage (24 +/- 6 vs 26 +/- 6 hours), postoperative hospital stay (57 +/- 12 vs 66 +/- 10 hours), and return to normal activity (20 +/- 6 vs 14 +/- 3 days) were also not significant. However, LA was much more expensive because of higher operating room charges. The mean total hospital bill was $4,600 +/- $160 for the LA group and $1,700 +/- $70 for the OA group. This prospective study corroborated our previous analysis. Laparoscopic appendectomy is safe, effective, and expensive and overall has no greatly significant advantages over open appendectomy.

Adolescent↗

PubMed1995

Richter hernia: a rare complication of laparoscopy.

A case of Richter hernia in the umbilical trocar site following laparoscopic cholecystectomy is presented. The fascia was not specifically closed after the laparoscopic cholecystectomy. The Richter hernia presented 2 days later, suffered a delay in diagnosis because of persistence of bowel function and required bowel resection 9 days later. A total of four known postoperative umbilical trocar site hernias, two of which were Richter hernias, have been reported following 1,979 laparoscopic cholecystectomies in two large community hospitals in Colorado: Saint Joseph Hospital in Denver and North Colorado Medical Center in Greeley. Thus, periumbilical trocar site incisional hernias following laparoscopic cholecystectomy are rare but potentially dangerous because of the susceptibility to Richter hernia.

Cholecystectomy, Laparoscopic↗

PubMed1993

Intermittent sequential pneumatic compression in prevention of venous stasis associated with pneumoperitoneum during laparoscopic cholecystectomy.

OBJECTIVES: To determine whether pneumoperitoneum and reverse Trendelenburg's position used during laparoscopy impede common femoral venous flow and whether calf-length intermittent sequential pneumatic compression (ISPC) overcomes this impedance. DESIGN: Using Doppler ultrasonography, peak systolic velocities in the common femoral vein were measured in patients undergoing laparoscopic cholecystectomy with peritoneal insufflation of carbon dioxide. Measurements were obtained during three intervals: preoperatively with the patients in the supine position; after induction of general anesthesia with the patients in the supine position; and after insufflation to 13 to 15 mm Hg with the patients in the 30 degrees reverse Trendelenburg position (both with and without ISPC). Mean arterial pressure and heart rate were obtained concurrently. Measurements of preoperative and postoperative calf and thigh circumferences were obtained. SETTING: A tertiary care center. PATIENT PARTICIPANTS: A consecutive sample of 20 patients 30 to 70 years of age (15 women and five men) who underwent laparoscopic cholecystectomy and met the inclusion criteria. MAIN OUTCOME MEASURES: Peak systolic velocity, mean arterial pressure, heart rate, and calf and thigh circumferences. RESULTS: The combination of pneumoperitoneum to 13 to 15 mm Hg and a 30 degrees reverse Trendelenburg position significantly decreased peak systolic velocity in the common femoral vein from a preoperative mean of 0.24 +/- 0.025 m/s to 0.14 +/- 0.011 m/s, or a 42% decrease. Intermittent sequential pneumatic compression reversed that effect, returning peak systolic velocity to 0.27 +/- 0.021 m/s. The mean difference between preoperative peak systolic velocity and peak systolic velocity with a combination of pneumoperitoneum, reverse Trendelenburg's position, and ISPC was 0.03 +/- 0.03 m/s but was not significant. Anesthesia alone caused a mean increase in preoperative peak systolic velocity from 0.24 +/- 0.025 m/s to 0.3 +/- 0.032 m/s. Mean arterial pressure levels, heart rate, and calf and thigh circumferences did not change significantly. CONCLUSIONS: This study demonstrated a significant reduction in common femoral venous flow during laparoscopic cholecystectomy coincident with pneumoperitoneum and reverse Trendelenburg's position. Intermittent sequential pneumatic compression reversed that effect, returning peak systolic velocity to normal.

Adult↗

PubMed1990

Surgical complications of continuous ambulatory peritoneal dialysis.

Surgical experience with 260 consecutive patients with chronic renal failure receiving continuous ambulatory peritoneal dialysis (CAPD) at one medical center from 1980 to 1989 is reviewed. Patients received CAPD for a mean of 24.2 months (range: 3 days to 91 months). Catheter longevity consistently improved in all but 1 year from 1984 to 1989, as did exit-site and tunnel infections. Of 311 catheters inserted, 151 (49%) required removal, of which 111 (74%) were attributed to peritonitis. Cumulative patient survival was 80%, 60%, and 53% at 1, 2, and 3 years, respectively. Diabetic patients had statistically significant lower survival rates. Additional complications including catheter leakage, catheter malposition, catheter obstruction, and abdominal wall hernias were negligible. Although CAPD is not free from serious complications, our data show remarkable improvement since 1980 in catheter longevity, hospital stay, and infection rates.

Catheters, Indwelling↗