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Biomedical subjects

M Kurzer

Publications and source records attributed to M Kurzer.

At least 19 recordsLinked to original sources
PubMed2004

Tension-free mesh repair of umbilical hernia as a day case using local anaesthesia.

BACKGROUND: Umbilical hernias are a common surgical problem with a high recurrence rate using conventional suture techniques. This prospective study examined the feasibility of tension-free mesh repair as a day case using local anaesthetic (LA) for all primary umbilical hernias. METHOD: Fifty-four patients (eight women) were operated on; 49 using LA. Through a periumbilical skin incision the margins of the sac were freed from the edges of the defect, and a space was made in the extraperitoneal plane. In defects <3 cm in diameter, a cone of polypropylene (pp) mesh was inserted and attached with nonabsorbable sutures. In defects >3 cm, a flat piece of pp mesh was inserted into the extraperitoneal space as a sublay. No attempt was made to close the fascial defect. RESULTS: Postoperative pain was graded as mild ( n=37) and moderate ( n=17). No patient had severe postoperative pain. Seven superficial wound infections responded to oral antibiotics. In no case it was necessary to remove the mesh. There were no other complications. Patients were recalled between 2 and 6 years postopertively-mean follow-up 43 months (28- 67). There were no recurrences. CONCLUSION: Umbilical hernia repair can be carried out safely and securely under LA with a tension-free mesh technique (cone or a sublay patch) with a low morbidity, negligible recurrence rate, and a high degree of patient satisfaction. It should be the procedure of choice for all such hernias.

Adult↗
PubMed2002

Prospective study of open preperitoneal mesh repair for recurrent inguinal hernia.

BACKGROUND: Recurrent inguinal hernia presents a significant clinical problem with high re-recurrence and complication rates, particularly when an anterior approach is used. This study evaluated the open preperitoneal approach for repair of recurrent inguinal hernia. METHODS: This was a prospective cohort study of 101 consecutive patients with 114 recurrent inguinal hernias. All were operated on using an open preperitoneal technique and prosthetic mesh by the method of Stoppa or Wantz. Follow-up was at 2-6 weeks, 15 and between 42 and 54 months. RESULTS: There were no major complications. There was one infection and one case of retention of urine. There were no testicular complications. There were five recurrences, all within 6 months of operation, four of which were among the first 20 cases. Modifications to the original technique were made, and one recurrence occurred in the remaining 81 patients (1 per cent) or 106 hernias (1 per cent). CONCLUSION: Preperitoneal mesh repair gives results far superior to those of the commonly used anterior approach. It is safer and easier to learn than laparoscopic repair and is the procedure of choice for complex multirecurrent inguinal hernia.

Adult↗
PubMed1998

The Lichtenstein repair.

The description of the Lichtenstein tension-free mesh repair 12 years ago opened a new era in groin hernia repair. Without the risk for severe morbidity, it can be readily carried out on patients previously considered unsuitable for hernia repair. Fears of complications related to mesh implantation have proved to be without foundation. As a local anesthetic outpatient procedure without the need for complex and expensive instrumentation, combined with the ability of patients to return to work in a short time, overall costs can be kept to a minimum without in any way compromising the safety or the long-term success of the procedure.

Adolescent↗
PubMed1995

Tension-free mesh hernia repair: review of 1098 cases using local anaesthesia in a day unit.

The technical problems, early complications and short-term results of a tension-free method of 1098 inguinal hernia repairs in 1017 patients have been assessed. The operation was conducted under local anaesthesia, and the inguinal canal floor was reinforced by a polypropylene mesh. Patients were discharged home the same day. There was no mortality, no urinary complications and one case of venous thrombosis. There was one recurrence after a primary hernia repair and two patients have developed recurrences after repair of a recurrent hernia. The overall sepsis rate was 0.9% and 1% of patients had persistent neuralgia. No prosthesis required removal. In all, 49.6% of office workers returned to work in 1 week or less and 61% of manual workers in 2 weeks or less. The major advantages of the tension-free mesh repair under local anaesthesia are simplicity, substantial cost savings and very low rates of complications.

Adolescent↗
PubMed1993

[Not Available].

Explore the source record for details and available documents.

Anatomy↗
PubMed1989

Ability of a benign tumor to decrease spontaneous food intake and body weight in rats.

Malignant tumors induce anorexia and decrease spontaneous food intake and weight loss. Whether these effects are in part due to the tumor's physical size was investigated by inducing a benign cystic tumor mass with carrageenan in rats and then studying them for 21 days. Forty-two control rats were given subcutaneous injection of 3 ml of normal saline. Fifty-six study rats were given 3 ml of a 1.5% carrageenan solution subcutaneously, both in the right flank. Daily spontaneous food intake, body weight, and tumor weight were measured. Eight study and six control rats were randomly sacrificed on days 1, 3, 5, 7, 10, 14, and 21. Blood was obtained by cardiac puncture for albumin determination, and the tumor, carcass, liver, and spleen were removed and weighed. Tumor and tissue samples were histologically examined. All rats injected with carrageenan developed a benign cystic tumor mass. Early cystic wall consisted mainly of foamy macrophages with a light lymphoplasmacytic chronic inflammatory infiltrate and moderate vascularization. At day 21, cystic wall was more compact. The vasculature had collapsed and there were more pronounced fibroblastic response and collagen bundles. Average tumor weight by day 21 was 41 g. Average spontaneous food intake was depressed by about 15% from day 8 on in study rats as compared to controls. A significant decrease in carcass weight of 15.2% was observed in study as compared to control rats at day 21. Serum albumin was significantly decreased in study rats after day 5. Liver weight was significantly lower and spleen weight higher in study rats as compared to controls. These data suggest that some characteristics associated with cancer anorexia can be found in the absence of malignancy.

Animals↗
PubMed1989

Natural killer cell activity in rats infused with Intralipid.

The effect of Intralipid on the natural killer (NK) cell activity of healthy male Fisher 344 adult rats was investigated. They were cannulated via the right jugular vein and continuously infused for five days with: normal saline plus heparin, 5% Intralipid plus heparin, or 10% Intralipid plus heparin. Control groups comprised of cannulated rats receiving no infusion and rats undergoing no operative procedures. Following the five-day infusion, rats were exsanguinated under ether anesthesia and mononuclear cells (MNC) harvested from the peripheral blood. NK activity was measured in a standard four hour 51Cr release assay against YAC-1 target cells. NK cell activity in rats infused with 5% Intralipid did not differ significantly from rats in both control groups or rats infused with saline. Infusion of rats with 10% Intralipid resulted in a significant increase in NK activity compared with all other groups.

Animals↗
PubMed1988

Amino acid profiles in tumor-bearing and pair-fed nontumor-bearing malnourished rats.

To investigate the metabolic and organ changes accompanying growth of a malignant tumor, ten male Fisher 344 rats weighing 150 to 200 g were inoculated subcutaneously with 10(6) viable MCA sarcoma cells (tumor-bearing). Ten other rats (controls) were similarly inoculated with saline. Both groups were allowed food and water ad libitum. An additional ten rats (pair-fed) were inoculated with saline and fed the same mean daily food intake as the tumor-bearing rats. Thirty-five days after inoculation the rats were killed by exsanguination. Livers, spleens, and tumors were weighed, and amino acid profiles and biochemical parameters were measured. Liver and spleen weights in tumor-bearing rats were significantly greater than control rats (P less than 0.05 and P less than 0.01, respectively). Liver weight in pair-fed rats was significantly less than control rats (P less than 0.01), but spleen weight was greater (P less than 0.01). Amino acid profiles of tumor-bearing rats and pair-fed rats were different from each other and from those of control rats. Branched-chain amino acids were lowest in tumor-bearing rats and significantly different from control and pair-fed rats. Lysine was significantly higher (P less than 0.01) and arginine significantly lower (P less than 0.05) in tumor-bearing rats compared with control rats. These different plasma amino acid profiles and changes in serum biochemistry of cachectic tumor-bearing rats compared with malnourished pair-fed rats suggest specific tumor effects on host metabolism not mediated solely by anorexia.

Amino Acids↗
PubMed1988

Indomethacin decreases carrageenan-induced peritoneal adhesions.

For evaluation of a rat intra-abdominal adhesion model, 48 study rats were each given an intraperitoneal injection of 1 ml of 1.5% carrageenan solution and 48 control rats were each given 1 ml of sterile saline solution. Thereafter, 6 control and 6 study rats were killed on days 2, 3, 4, 5, 7, 9, 14, and 21 for assessment of the temporal nature of adhesion formation. No peritoneal reaction or adhesions occurred from saline solution. Carrageenan induced a generalized peritonitis between days 2 and 7. The frequency of adhesions from day 5 onward was 66%. The effects of celiotomy and of systemic indomethacin on carrageenan-induced adhesion formation were then examined. Rats underwent a standardized celiotomy and, on closure of the abdomen, received either an intraperitoneal injection of saline solution (n = 72) or an intraperitoneal injection of carrageenan solution (n = 96). Both groups were then randomized to receive either no indomethacin (IND-0), a single preoperative dose of indomethacin (IND-1), or four perioperative doses of indomethacin (IND-4). Then, 2, 5, 14, and 21 days later, rats from each group were killed, the extent of intraperitoneal adhesions was assessed, and the nature of any adhesions was histologically examined. Celiotomy plus intraperitoneal saline solution produced no adhesions. Celiotomy plus intraperitoneal carrageenan solution (IND-0) significantly increased adhesions to 83%. Preoperatively and perioperatively administered indomethacin significantly decreased the adhesion formation rate to 49%.

Abdomen↗
PubMed1986

Cancer and protein metabolism.

We have reviewed the data that indicate that protein depletion is an important problem in cancer patients. An incomplete, yet useful, idea of the underlying mechanisms emerges. Further, we have seen that the provision of nutritional support may have a beneficial effect on patients with cancer, and we have explored areas of recent advances in nutritional formulation as regards energy and nitrogen source. Finally, data regarding micronutrients affecting nitrogen metabolism were reviewed. The extent to which tumor metabolism and changes secondary to the tumor-bearing state are influenced by micronutrients is not known. Traditional regimens based on the requirements of normal subjects or noncancer patients may not be relevant to the metabolic needs of the cancer patient. This could explain in part the failure of nutritional intervention trials to demonstrate a consistent benefit of nutritional support to the cancer patient. Further information regarding micronutrient needs in normal humans and cancer-bearing patients and their utilization by malignant tumors will have to be obtained.

Animals↗
PubMed1983

Preoperative staging of lung cancer: accuracy of computed tomography versus mediastinoscopy.

Forty-four patients coming to surgery for carcinoma of the bronchus underwent preoperative staging of the mediastinum by computed tomography (CT scanning) and surgical exploration of the mediastinum by cervical mediastinoscopy or left anterior mediastinotomy or both. Where mediastinal nodes were affected the sensitivity and specificity of computed tomography was inferior to that of mediastinoscopy (57% and 85% versus 71% and 100%). The sensitivity of computed tomography in predicting mediastinal invasion was superior to that of mediastinoscopy (77% v 46%), especially in the case of lower-lobe tumours (67% v 17%). Mediastinoscopy had the considerable advantage of 100% specificity. In the assessment of hilar lymphadenopathy computed tomography had a sensitivity of 38% and a specificity of 64%. In cases where computed tomography showed a normal mediastinum or enlargement of the hilar glands only, mediastinal exploration conferred no additional information and could have been omitted. A computed tomography scan showing mediastinal abnormality is an indication for mediastinoscopy and not a contraindication to surgery. In 23 patients computed tomography showed some abnormality of the mediastinum, confirmed at mediastinoscopy in 12 cases. The remaining 11 patients underwent thoracotomy, resection being carried out in nine. Postsurgical staging showed that six of these tumours were N0 lesions without invasion; in two further N0 cases there was a minor degree of mediastinal invasion which did not prevent resection, and the remaining tumour was N1 without invasion.

Aged↗