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Biomedical subjects

M J Mooney

Publications and source records attributed to M J Mooney.

12 recordsLinked to original sources
PubMed1998

Hand-assisted laparoscopic sigmoidectomy for diverticulitis.

BACKGROUND: Sigmoid colectomy for diverticular disease, a routine procedure when performed using standard open methods, can prove much more challenging using minimum access techniques. Hand-assisted laparoscopic colectomy is a new technique that reportedly has a minimum learning curve, yet retains the benefits of a laparoscopic procedure. The purpose of this study was to perform and then prospectively to evaluate the outcome of this procedure on patients needing elective sigmoidectomy for diverticular disease. METHODS: Hand-assisted laparoscopic sigmoidectomy was performed on all patients undergoing elective sigmoidectomy for diverticular disease between January 18, 1996, and November 21, 1996. RESULTS: The study group consisted of six men and three women. Age averaged 50.8 (range, 39-66) years, weight averaged 183 (range, 150-224) pounds, and operation time averaged 3 hours and 42 minutes (range, 3-5 hours). No cases were converted to open methods. There were two minor postoperative complications (bleeding from the staple line, 1 patient; urinary retention, 1 patient; 22 percent). Resumption of flatus (which was the indication to start the patient on an oral diet) occurred between one and three (average, 1.44) days postoperatively. Patients were discharged from the hospital between one and three (average, 2.1) days postoperatively. Primary surgeon responsibility was distributed among four different surgeons, of which only the lead author previously had performed laparoscopic colectomy at this institution. CONCLUSIONS: Hand-assisted laparoscopic sigmoidectomy is a procedure that has a minimum learning curve, yet retains the benefits of a laparoscopic procedure.

Adult↗
PubMed1997

Coronary flow in a prosthetic aorto-coronary bypass graft: first report of Possis Perma-Flow graft physiology in a patient.

The coronary physiology of a prosthetic Perma-Flow coronary bypass graft conduit is demonstrated in the first patient at 1-yr follow-up. Coronary blood flow velocity was measured in the body of the graft and into the side-to-side anastomosis to the first diagonal branch. This case report demonstrates the first information on the coronary and prosthetic graft flow in a patient with atherosclerotic coronary disease.

Aged↗
PubMed1996

Monitoring and correction of multiple scatter during clinical Compton scatter densitometry measurements.

A system for monitoring multiple scatter during a clinical Compton scatter densitometry measurement of bone density is described. Multiple scatter from the measurement site was measured using a supplementary collimated detector positioned so that only multiply scattered photons could enter the detector. The data from the detector were used to form a multiple-scatter correction factor (mcf) to correct for the bias attributed to multiple scatter. The results of experimental and computer simulations are presented which demonstrate the relationship between the multiple-scatter reading and calculated mcf values. The influence of bone size on the values of mcf in large measurement sites, such as the femoral neck, was shown to be negligible. A simulation was used to produce a visualization of the multiple scatter in order to ascertain the optimum position of the supplementary detector. This technique was shown to be a rapid and accurate method of measuring the multiple-scatter bias and suitable for use during clinical CSD measurements.

Bone and Bones↗
PubMed1995

Insurance adjudication favoring prophylactic surgery in hereditary breast-ovarian cancer syndrome.

Insurance payment to cover costs of prophylactic surgery is occasionally denied to patients who may be at inordinately high risk for hereditary cancer. We describe a 43-year-old woman from a hereditary breast-ovarian cancer (HBOC) family which showed linkage to BRCA1 and who was at inordinately high risk for cancer but who was denied insurance coverage for prophylactic oophorectomy, despite strong recommendations by her gynecologist and a cancer geneticist-medical oncologist. The insurance company claimed that the surgery was not medically necessary because the woman's condition (hereditary cancer predisposition) was not an illness. A summary judgment issued by the Douglas County (Nebraska) District Court ruled in favor of the denial decision of Blue Cross/Blue Shield. But on appeal, the Nebraska Supreme Court offered the conclusion that the patient did in fact require this prophylactic surgery and overruled the District Court's decision for denial. The litigation provides the basis for this case report and may provide a precedent for insurance coverage for patients at high risk for hereditary forms of cancer.

Adult↗
PubMed1995

Duplex-guided compression of iatrogenic femoral pseudoaneurysms.

BACKGROUND: Iatrogenic pseudoaneurysms are a major complication following percutaneous cannulations of the femoral artery. Surgical repair has been the traditional treatment modality. Recent reports have introduced duplex-guided compression as a means of nonoperative management of these injuries. We proposed to determine if duplex-guided compression of femoral pseudoaneurysms could be successfully performed, could be done without complication, and could maintain thrombosis on long-term follow-up. STUDY DESIGN: All patients presenting with large groin hematomas following invasive percutaneous femoral artery procedures over a seven-month period were studied using color-flow duplex analysis. Six pseudoaneurysms were discovered and successfully treated with duplex-guided compression. All patients were then followed-up prospectively with both early and long-term repeat duplex analysis. RESULTS: All patients were rescanned 72 hours later and the pseudoaneurysms remained thrombosed. Upon returning for long-term follow-up examination, patients again had duplex confirmation of thrombosis, with a mean follow-up time of 21 months (range, five to 29 months). No complications attributable to this technique have been noted. CONCLUSIONS: This study confirms the clinical usefulness of duplex-guided compression in the evaluation and treatment of iatrogenic femoral pseudoaneurysms.

Adult↗
PubMed1993

Hepatic adenoma presenting as a right lower quadrant mass.

Most patients with hepatic cell adenomas present dramatically with an acute abdominal crisis associated with hemorrhage and an upper abdominal mass. We present an unusual case of hepatic cell adenoma presenting as a right lower quadrant mass and review the current literature concerning this tumor.

Abdomen, Acute↗
PubMed1992

Photon absorption measurements of bone density in the presence of scattered radiation.

Bone density measurements are frequently carried out using photon absorptiometry techniques. The analysis of data collected in this way depends upon scatter-free detector signals. In practice the detector and source collimation lead to high levels of scattered radiation being detected. An analysis of the problem using photon transport computer models has shown that the current systems are reasonably insensitive to the scatter contribution except where patient changes occur over a long series of measurements or where new results taken with DEXA are compared with those taken on older systems such as DPA. This is frequently the case since the major body of data related to serial bone density measurements has been achieved with DPA. Inclusion of scattered radiation in the bone density calculations can lead to a 0.5-3.5% reduction between system types. Patient size changes could lead to a reduction in bone density of 0.5% (femoral neck measurement) to 1% (lumbar spine measurement).

Absorptiometry, Photon↗
PubMed1991

Laparoscopic cholecystectomy: use and preparation for Operation Desert Shield.

While stationed at Winn army hospital, Fort Stewart, Georgia as backfill surgeons during the initial stages of Operation Desert Shield, we performed eight laparoscopic cholecystectomies (LC) over a 2 1/2 week period. Our patients included four active duty soldiers, three dependents, and one retiree. There were no complications. The average hospital stay was 2 days, and the average time to return to duty was 10 days for LC compared to 5 and 30 days, respectively, with standard cholecystectomy (SC). Performing LC whenever possible can return soldiers back to duty in one-third the time and greatly reduce health care costs by reducing the hospital stay.

Cholecystectomy↗
PubMed1989

Spectral studies of the Ca2+-dependent interaction of trifluoperazine with S100b.

S100b is a calcium-binding protein that will bind to many calmodulin target molecules in a Ca2+-dependent manner. In order to study the Ca2+-dependent binding properties of S100b, its interaction with a calmodulin antagonist, trifluoperazine (TFP), was investigated using [19F]- and [1H]-NMR and UV-difference spectroscopy. It was estimated from [19F]-NMR that in the absence of Ca2+, the k1/2 value of TFP was 130 microM, while its k1/2 value decreased to 28 microM in the presence of Ca2+. The addition of KCl was not antagonistic to the Ca2+-dependent interaction of TFP to S100b. The chemical exchange rate of TFP with Ca2+-bound S100b was estimated to be 9 x 10(2) sec-1. By comparison with TFP-calmodulin exchange rates, it is suggested that the TFP-binding site on S100b is structurally different from its binding sites on calmodulin. Proton NMR resonance broadening in the range 6.8-7.2 ppm, corresponding to phenylalanine nuclei of S100b, indicates that these residues may be involved in TFP binding. Addition of Ca2+ to a 1:1 mixture of S100b and TFP resulted in a red-shifted UV-difference spectrum, while no significant difference spectrum was detected when Mg2+ was added to a S100b-TFP solution. Thus, we suggest that Ca2+ induces the exposure of a hydrophobic domain on S100b containing one or more phenylalanine residues that will bind TFP but that this domain is different from the hydrophobic domain on calmodulin.

Calcium-Binding Proteins↗
PubMed1989

Routine cholecystectomy in the morbidly obese.

Proven disease is generally considered a sound indication for cholecystectomy. However, incidental removal of a gallbladder with unproven pathology is controversial. The morbidly obese, however, constitute a group at especially high risk for the development of gallbladder disease, with possible greater risk immediately after weight reduction procedures. In our series of 51 consecutive patients undergoing vertical banded gastroplasty (VBG), the gallbladder was routinely removed regardless of symptomatology or results of a preoperative workup. Two patients declined cholecystectomy. Twelve patients (24.4%) had undergone cholecystectomy for symptomatic stones prior to their VBG. Of the remaining 37 subjects, there was a 73% overall incidence of disease: 11 (29.7%) had cholelithiasis, 11 (29.7%) had cholesterolosis alone, three (8.1%) had chronic cholecystitis with cholesterolosis, and two (5.4%) had chronic cholecystitis alone; only 10 (27%) had normal findings. These results, when added to evidence demonstrating a high incidence of postoperative gallbladder disease in those not receiving cholecystectomy, suggest that routine cholecystectomy be considered in all morbidly obese patients undergoing VBG or similar procedures.

Cholecystectomy↗
PubMedDate not supplied

T-tube placement during laparoscopic cholecystectomy.

The management of common bile duct stones during laparoscopic cholecystectomy can pose a challenge to the surgeon as no definitive management plan is universally accepted at this time. We present a case where a common bile duct exploration was performed through a choledochotomy, describing how the t-tube was placed.

Adult↗