Biomedical subjects

P Smiley

Publications and source records attributed to P Smiley.

5 recordsLinked to original sources

PubMed1997

Video endoscopic transanal-rectal tumor excision.

BACKGROUND: Transanal resection of benign and selected malignant rectal tumors is a well accepted surgical technique. The use of a stereoscopic microsurgical technique, as originally described by Buess et al in 1984, has been shown to improve the results of standard transanal resection by allowing precise, full thickness resections up to 24 cm from the anal verge. Transanal endoscopic microsurgery (TEM) has failed to gain widespread popularity for two reasons: The proprietary instrument set is expensive and complex ($68,000 and 30 components), and the procedure is difficult to master technically. We present our results with a modification of the TEM instrument that incorporates a standard laparoscope and video camera as well as standard laparoscopic instruments. METHODS: Four surgeons have been trained to date. Details of the training curriculum are presented. The technique of videoendoscopic transanal tumor resection (VTEM) is described. A prospective data base was maintained of all VTEM cases. This was reviewed for this study to determine indications, operative times, complications and outcomes. RESULTS: Four surgeons performed 27 VTEM cases between August 1994 and June 1996. The average age was 69 years and the majority (16) of patients were ASA III. Pre-op diagnosis was benign polyp in 25 patients and adenocarcinoma in 2. Average operating time was 127 minutes (49 to 280 minutes), and was longer during a surgeon's first 5 cases and for lesions more than 16 cm from the anal verge. Operative problems were rare (4%) and post-op complications (incontinence 2, late bleeding 1, adenoma recurrence 1) were seen in 15%. CONCLUSIONS: VTEM can be taught successfully to GI and colorectal surgeons using a format similar to that used for advanced laparoscopic courses. The use of already available laparoscopes and instruments decreases the initial costs of the set-up. Results are good, with low rates of complications and recurrence and a very short hospital stay. The patient benefits from an effective, minimally invasive alternative to open surgery.

Aged↗

PubMed1996

Fyn can partially substitute for Lck in T lymphocyte development.

Lck, a Src family tyrosine kinase, transduces signals important for the development of alphabeta and gammadelta T cells. However, T cell development is only partially compromised in Lck-deficient mice, suggesting that other kinases may also transduce pre-TCR or TCR signals. One candidate is Fyn, a Src kinase coexpressed with Lck in immature and mature T cells. Here we show that T cell development is completely compromised in lck(-/-)fyn(-/-) mice. In addition, we demonstrate that expression of a gain-of-function mutant fyn(T) transgene completely restores production of immature CD4/CD8 double positive thymocytes and gammadelta T cells and improves the representation of CD4 or CD8 single positive thymocytes. These observations reveal that Fyn can subserve some Lck-like functions in T cell development.

Animals↗

PubMed1990

Arthroscopic synovectomy.

This study was undertaken to evaluate the efficacy of knee synovectomy with arthroscopic technique. Nineteen patients with 25 operated knees were studied. All 25 knees had 6-month follow-up, 21 knees had 2-year follow-up, and 14 knees were evaluated at least 4 years after operation. After operation, patients were evaluated using clinical data including pain relief, functional capacity, range of motion, recurrent synovitis, and presence of effusion. Preoperative as well as follow-up weight-bearing radiographs were also studied to assess the results of this procedure. At 6 months' postoperative clinical evaluation, 96% of patients showed good results. At 2 years, 90% of patients were considered to have good results, and at 4 years, 57% of patients continued to do well. Of those knees studied radiographically, 81% showed no progressive radiographic changes at 2 years and 61.5% showed no deterioration at 4 years. Clinical results correlated well with radiographic results. Arthroscopic synovectomy yielded results similar to those previously published for open synovectomy, with less operative and postoperative morbidity.

Adult↗

PubMed1989

Response by the neurotensin systems of the basal ganglia to cocaine treatment.

Multiple administrations of high doses of cocaine had profound effects on the neurotensin (NT) systems of the basal ganglia. Approximately 200-300% increases in striatal content of neurotensin-like immunoreactivity (NTLI) were observed 1-8 h following five doses of 30 mg/kg per dose of cocaine. The effect subsided by 48 h after treatment. Significant changes in striatal NTLI levels were not observed after a single dose of this stimulant. The nigral NT systems appeared to be even more sensitive to cocaine administration. Compared to striatal changes, increases in nigral NTLI content were greater (as much as 455% of control), required lower cocaine doses (20 mg/kg per dose), lasted longer (still elevated to 200% of control after 48 h) and were significant following a single cocaine exposure. The response of the striatal NT systems to cocaine appeared to be mediated principally by dopamine D-1 receptors, while both D-1 and D-2 receptors contributed to the response by the nigral NT projections. Specific dopamine, but not serotonin, uptake blockers caused increases in striatal and nigral NTLI concentrations similar to that seen with cocaine treatments, suggesting that interference with the dopamine uptake carrier complex by cocaine was responsible for its actions on extrapyramidal NT systems.

Animals↗

PubMed1984

Blunt traumatic rupture of the abdominal wall musculature.

Only 38 cases of blunt traumatic rupture of the anterior abdominal wall musculature have been described in the literature to date. We describe a patient who sustained a complete transection of the right and a partial disruption of the left rectus abdominis muscle as well as multiple associated injuries secondary to blunt, crushing trauma. Postoperatively, he experienced several complications and developed a ventral and right flank hernia. The former was repaired with a rectus abdominis muscle flap and polypropylene mesh. The flank hernia was initially repaired with polypropylene mesh and a recurrence was repaired with latissimus dorsi fascia.

Abdominal Muscles↗