Biomedical subjects
Publications and source records attributed to M Miserez.
A preterm infant had methaemoglobulinemia and hemolytic anemia after enteral administration of methylene blue. The dye was administered to exclude a tracheoesophageal fistula. Methylene blue is a noxious product, especially in neonates. It should be considered a potential cause of acquired methemoglobulinemia, even after enteral administration.
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BACKGROUND: In order to combine the advantages of a minimal invasive approach with a retromuscular mesh implantation, we developed an endoscopic totally preperitoneal approach for the treatment of ventral hernias. METHODS: The surgical technique is described with the accent on preoperative marking of mesh surface, the retromuscular insertion of the first trocar, the extraperitoneal dissection, the reduction of the hernia sac, and the choice and insertion of the mesh. RESULTS: Fifteen patients have been operated. Complete reduction of the hernia sac could be accomplished in five. In eight, the peritoneum was incised at the hernia neck. A polypropylene mesh was used in six cases. In the others, ePTFE or a composite mesh was used. Circumferential fixation with a tacker was performed. No major complications were seen. No mesh needed to be removed. One recurrence was seen 5.5 months postoperatively with a median follow-up period of 126 days. CONCLUSIONS: This new endoscopic technique takes advantage of immediate mesh fixation by the peritoneal sac and may avoid the potential complications related to the transabdominal approach and intraabdominal position of the mesh. A further long-term evaluation is necessary.
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A 32-year-old man presented with severe abdominal pain located in the mesogastrium and right hemi-abdomen. A barium transit study showed a tubular structure of 6 cm arising from a bowel loop in the distal ileum, with an intraluminal polypoid mass near the bottom. Diagnosis of a benign lesion within a Meckel's diverticulum was made. Anatomopathology confirmed a Meckel's diverticulum and demonstrated that the polypoid mass was caused by an unusual great ectopic island of gastric mucosa.
This article presents a case of appendicitis 7 years after open appendectomy. Together with the apparent CT findings we discuss the current literature of this issue.
Computed tomography (CT) and ultrasonography (US) have been proposed as non-invasive diagnostic aids in patients with suspected acute appendicitis. Currently, clear guidelines about the indications to use these techniques are lacking. Using the concepts of decision analysis, a model was created to calculate the effectiveness of US and CT in patients with clinically suspected appendicitis. The perspective chosen was the health of individual patients. The model makes use of published data and provides a critical threshold probability (ctp). Decisions in individual cases can be made by comparing ctp with the clinical probability of disease. The calculated ctp-values for US and CT were 0.58 and 0.74, respectively. In other words, on average, US (CT) is indicated only if the expert clinician considers the probability of disease to be smaller than 58% (74%). It is concluded that in patients with suspected acute appendicitis, selective rather than routine use of imaging studies is recommended. The exact value of the decision threshold should be determined in function of the local situation.
Positron emission tomography (PET) with 18F-fluoride was utilized to determine the regional blood flow to the femoral head in early osteonecrosis. Five patients with a history of unilateral hip trauma and a normal contralateral side were selected. Skeletal flow and fluoride uptake in the abnormal and normal hips were compared directly, and the relation between bone blood flow and final outcome, i.e., surgical replacement or conservative treatment, was evaluated. In this pilot study, a flow ratio of at least 2 between the abnormal and normal femoral head was necessary to predict a successful outcome with a conservative regimen. A minimum flow of 0.04 ml/min/ml was measured in one patient whose affected femoral head healed conservatively. Our preliminary study indicates that this type of highly technical investigation appears feasible in clinical practice and permits prediction of the outcome depending upon regional skeletal flow measurements in vivo.
OBJECTIVES: Sarcoplasmic reticulum (SR) Ca2+ uptake, myocardial high energy content and histology were examined in different zones of hearts from patients with ischemic cardiomyopathy. METHODS AND RESULTS: Unfractionated homogenates were prepared from left ventricular samples obtained in three zones of each heart: an infarct-remote zone, an outer peri-infarct zone, and an inner peri-infarct zone. Oxalate-supported 45Ca2+ uptake was measured at 37 degrees C using a filtration method. Maximum rate (Vmax) of uptake in absence or in presence of ryanodine was lower in inner peri-infarct (7.4 +/- 0.7 and 9.5 +/- 0.8 nmol min-1 mg-1 of protein, respectively; mean +/- SEM) and outer peri-infarct tissues (8.8 +/- 0.8 and 12.0 +/- 0.8 nmol min-1 mg-1) than in infarct-remote myocardium (12.7 +/- 2.1 and 15.8 +/- 2.2 nmol min-1 mg-1). The apparent affinity constants for Ca2+ (KCa) as well as the Hill coefficients were not different. Homogenate DNA (1.6 +/- 0.1, 1.6 +/- 0.1 and 1.7 +/- 0.1 mg/g of remote, inner peri-infarct and outer peri-infarct myocardium, respectively) and adenine nucleotides contents (ATP: 15 +/- 1.3, 14 +/- 0.8 and 15 +/- 1.0 mumol/g dry weight, respectively) were similar in all tissues. Fibrosis was increased in inner peri-infarct tissue (37 +/- 6%; vs. 13 +/- 2% and 12 +/- 2% in both remote and outer peri-infarct tissues, respectively), but the number of abnormal cells was not significantly different. CONCLUSION: The decrease of Ca2+ uptake in ischemic cardiomyopathy is not homogeneous in the ventricular wall, and reflects a decreased number/activity of SR Ca(2+)-ATPase, without altered Ca(2+)-affinity or increased Ca2+ leakage through ryanodine receptors.
BACKGROUND/PURPOSE: Endoscopic fetal surgery could help avoid many of the problems associated with open fetal surgery, but the use of multiple ports may be too traumatic to the membranes. The authors describe a single-port technique of tracheoscopic surgery in the fetus. METHODS: Time-dated pregnant ewes (95 to 105 days; term, 145 days) underwent midline laparotomy under general halothane anesthesia. A 5-mm-diameter balloon-tipped cannula was introduced in the uterus by Seldinger technique. A 1.2-mm semirigid mini-endoscope, fitted inside a 9F, 20 degrees curved sheath, was introduced under continuous, low-pressure irrigation, inside the fetus' mouth, and advanced into the trachea. RESULTS: Endotracheal procedures, including temporary (n = 11) and permanent balloon tracheal occlusion (n = 30) and placement of a barbed guide wire for endotracheal occlusion device insertion (n = 12), were performed by introducing a 1-mm diameter instrument alongside the telescope. These were successfully performed in 52 of the 53 fetuses. The rigidity of the telescope allowed controlled access to the pharynx; its curve allowed full tracheobronchial endoscopy with the fetus in utero. CONCLUSIONS: The present technique marries the control and optical quality of a rigid endoscope with the physiological curve only a flexible instrument could offer until now. The types of procedures performed with this technique illustrate its potential as a research tool; the size (1.2-mm diameter), shape, and optical qualities of the telescope should make clinical applications possible.
BACKGROUND: After the first successful laparoscopic closure of a perforated peptic ulcer in 1990, 18 patients with laparoscopic closure were compared to 16 patients with conventional surgery. METHODS: The endpoint adverse events (complications), pain intensity, operation time, fever, leucocytosis, and duration of hospital stay showed no clinically relevant differences. RESULTS: Consumption of analgesics was lower in the laparoscopic group. CONCLUSIONS: Laparoscopic closure of perforated peptic ulcer is technically feasible. The safety of the method and the benefit for the patient need proof by means of a randomized controlled trial.
Under the mandate of the Educational Committee of the European Association of Endoscopic Surgery (E.A.E.S.), three consensus development conferences (CDCs) were performed in order to assess the current status of the endoscopic surgical approaches for the treatment of cholelithiasis, appendicitis, and inguinal hernia. Consensus panels for the different disease states (10-13 members each) selected by the education committee on the basis of members' clinical expertise, academic activity, community influence, and geographical location weighed the evidence on the basis of published results according to the criteria for technology assessment: feasibility, efficacy, effectiveness, economy. Draft statements were prepared, discussed by the panels, and presented at plenary sessions of the 2nd European Congress of the E.A.E.S. in Madrid September 15-17, 1994. Following discussions final consensus statements were formulated to provide specific answers for each topic to a minimum of the following questions: 1. What stage of technological development is the endoscopic surgical procedure at (in September 1994)? 2. Is endoscopic surgery safe and feasible? 3. Is it beneficial to the patients? 4. Who should undergo endoscopic surgery? 5. What are the training recommendations? Laparoscopic cholecystectomy is the procedure of choice for symptomatic cholelithiasis. Laparoscopic appendectomy is presently at the efficacy stage of development, because most of the data on feasibility and safety originate from centers with special interest in endoscopic surgery: it is not yet the gold standard for acute appendicitis. Endoscopic hernia repair is presently a feasible alternative for conventional hernia repair if performed by experienced endoscopic surgeons. It appears to be efficacious in the short-term. The full text of the consensus panel's statements is given in this publication.
The haemodynamic effects of urapidil, an alpha 1-antagonist with central serotoninergic properties, were studied in an experimental canine model of chronic ischaemic heart disease. Global and regional haemodynamic recordings were made in conscious dogs with ameroid-induced single vessel coronary artery occlusion. Three intravenous bolus-infusion doses of urapidil (0.1 mg kg-1 + 0.3 mg min-1; 0.5 mg kg-1 + 1.5 mg min-1; 2.5 mg kg-1 + 7.5 mg min-1) were given on separate occasions in 12 animals. Regional blood flows were measured with radioactively labelled tracer microspheres. The effects of urapidil and dipyridamole, a powerful arteriolar vasodilator, on regional myocardial blood flow distribution to normal and collateral-dependent myocardium were compared. Urapidil caused a dose-dependent reduction of arterial blood pressure. There was moderate tachycardia and decreased left atrial filling pressures at the higher doses. Urapidil was a much weaker coronary vasodilator than dipyridamole. Dipyridamole caused maldistribution of intercoronary and transmural flows (endo-to-epicardial flow ratio in collateral-dependent regions from 1.35 +/- 0.07 to 0.7 +/- 0.13 and flow ratio between collateral-dependent and normal regions from 1.09 +/- 0.03 to 0.57 +/- 0.14). Urapidil preserved blood flow to both regions. Urapidil did not affect systolic wall thickening fraction in normal or ischaemic regions of the heart. Renal (+16%) and splanchnic perfusion (+45%) increased during urapidil infusion. Urapidil preserves myocardial function and perfusion and increases renal and intestinal blood flow in dogs with chronically ischaemic hearts.
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Until 1998, intestinal transplantation (SBT) had not been performed in our region of Flanders, Belgium. Potential SBT activity was not known and selection criteria had not been validated. A multidisciplinary SBT program was launched in 1998. We analyzed requests for SBT and outcomes in these patients whether with or without SBT. Listing for SBT was only considered for patients with irreversible short bowel syndrome who had developed life-threatening complications of total parenteral nutrition, but whose general condition was still thought compatible with surgery and immunosuppression. During the study period 1998 to 2004, one third of the requests for SBT (10/31) were deemed suitable. SBT in this group was lifesaving (100% survival) when performed in time. Mortality in this group without SBT was high (67%). Two thirds of the patients (21/31) did not fulfill the SBT inclusion criteria, either because they were "too moribund" to tolerate transplantation or because they were "too well". This preliminary study emphasized the importance of (1) early referral of potential SBT candidates, (2) adherence to strict criteria for listing patients for SBT, and (3) referral of intestinal donors to procurement organizations.
The rarity of Spigelian hernias and the frequent subtle clinical findings can cause an important delay in diagnosis, especially in obese patients. Furthermore it has a high risk of incarceration. When this occurs, a fast recognition and adequate treatment are necessary. Treatment can be primary suture or mesh repair. More recently, the laparoscopic approach has become more popular. We present two cases of incarcerated Spigelian hernia and we give a review of the literature, with specific attention for the anatomical features and pathogenesis.
Abstract. The management of incidentally found Meckel's diverticulum (MD) remains unclear. The risk for future complications of a non-resected MD must be weighed against the risk of complications for a resected MD in order to justify a prophylactic resection. Morbidity-rates after resection of incidentally found MD are much lower than those after resection of symptomatic MD. Several risk factors which increase the risk for future complications of an asymptomatic MD have been described in the literature. We suggest that an asymptomatic MD should be removed in cases where there is a higher risk of it becoming symptomatic in the future, on condition that the resection can be done with presumed low morbidity. Based on the literature data we propose a scoring system in order to base the decision for surgery on more objective grounds and weighted criteria. This Risk Score is based on 4 risk factors: male sex, patients younger than 45 years, diverticula longer than 2 cm and the presence of a fibrous band. We suggest resection of an asymptomatic MD with a Risk Score of > or = 6 points. A transverse diverticulectomy is preferable in most cases. In short, broad based MD, or in the case of a palpable mass at the base, a wedge-shaped excision is the best alternative.