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Biomedical subjects

R C Dinsmore

Publications and source records attributed to R C Dinsmore.

9 recordsLinked to original sources
PubMed2001

Idiopathic spontaneous intraperitoneal hemorrhage: a clinical update on abdominal apoplexy in the year 2001.

Idiopathic spontaneous intraperitoneal hemorrhage is a rare and often fatal condition that has been historically referred to as abdominal apoplexy. The presentation varies widely, and preoperative diagnosis is seldom obtained. Immediate surgical exploration remains the treatment of choice. At the time of exploration a through examination of the visceral arteries and solid organs should be done, as these are common sites for intra-abdominal bleeding. Often the site of hemorrhage cannot be localized at time of surgery despite thorough exploration. Today a postoperative diagnosis can often be confirmed and treated with interventional radiology. In rare cases the site of bleeding remains unknown despite intraoperative exploration and radiographic studies.

Abdominal Pain↗
PubMed2001

Tensile strength of wound closure with cyanoacrylate glue.

2-Octyl cyanoacrylate tissue adhesive is increasingly being used for closure of traumatic lacerations. Data regarding the strength of incisions closed with 2-octyl cyanoacrylate are limited. We compared the strength of disruption of closure with glue with that of more conventional methods of wound closure. Segments of fresh porcine skin measuring 3.5 x 10 cm were approximated by one of four methods: 1) 2-octyl cyanoacrylate glue, 2) surgical staples, 3) 0.5 inch Steri-Strips, and 4) interrupted 4-0 poliglecaprone 25 sutures in a subcuticular fashion. Fifteen specimens were used to test each type of closure. The strength of closure was tested on an Instron 4502 tensionometer. The peak force required for disruption of the closure was recorded and the strength of the closure was compared. Staples provided the strongest closure. Skin glue proved superior to Steri-Strips but inferior to stapled closure. The difference between skin glue and suture closure was not statistically significant (P = 0.12). Patterns of failure differed between the groups. Skin glue failed because of disruption of the skin-glue interface. 2-Octyl cyanoacrylate glue provides a wound closure that is similar to closure with an interrupted subcuticular absorbable suture. This study validates the clinical use of skin glue for closure of surgical incisions. The technique should be used with caution in areas of the body that are subject to tension.

Animals↗
PubMed2000

Prevention of adhesions to polypropylene mesh in a traumatized bowel model.

BACKGROUND: Polypropylene mesh (PPM) is an effective material for the repair of abdominal wall defects, but has a tendency to induce dense adhesions when in contact with viscera. Seprafilm (Genzyme Corp, Cambridge, MA), a bioresorbable membrane, has been shown to reduce adhesion formation after midline closures in humans and to PPM in animals. Given the increased inflammatory response expected with surgical trauma, its efficacy under surgical conditions has been questioned. STUDY DESIGN: A prospective, randomized, blinded study was conducted using a rabbit model. Standardized abdominal wall defects were created in three groups of New Zealand white rabbits. The cecum was deserosalized to simulate the effects of trauma. The abdominal defect was then repaired with PPM. In the control group, no Seprafilm was used. In the first experimental group Seprafilm was placed between the mesh and the abdominal viscera. In the second experimental group Seprafilm was placed over the deserosalized area and between the mesh and abdominal viscera. Animals were sacrificed at 30 days and adhesions were categorized and quantified using digital image analysis of inked specimens. The strength of incorporation was also determined. RESULTS: The formation of adhesions between the viscera and mesh repair was dramatically reduced in both experimental groups compared with the control group. The incidence of visceral adhesions was reduced by 80% in the single film group (p = 0.0004) and 90% in the double film group (p = 0.00008). The reduction in surface area of adhesions was 96.4% in the single film group (p = 0.000019) and 99.4% in the double film group (p = 0.00002). Omental adhesions were reduced by 30% but this did not achieve statistical significance. Strength of incorporation was not adversely affected in either group. CONCLUSIONS: Seprafilm is highly effective in preventing adhesions to PPM. This effect was not diminished by the presence of visceral trauma and its resultant inflammatory response. The use of Seprafilm does not adversely affect tissue incorporation. Clinical trials are warranted to determine if the protective effects of Seprafilm demonstrated in this study are applicable in the clinical setting.

Abdominal Muscles↗
PubMed2000

Basic skin flaps for the general surgeon: a teaching method.

BACKGROUND: Teaching residents the design and creation of skin flaps is challenging because the use of skin flaps is not common enough during the course of a typical residency to provide a broad experience base. METHODS: A 12 x 12-inch board with a 1/8-inch foam rubber covering was designed to provide for the creation of four flaps and one Z-plasty. A lecture and practical exercise were used to teach basic techniques. Performance was measured by preexamination and postexamination, as well as by a resident satisfaction survey. RESULTS: Mean scores improved by 45%. The resident survey revealed an average subjective rating was 4.7 on a scale of 1 to 5. All residents rated this format superior to traditional lecture instruction. Total cost to provide laboratory experience for 16 residents was $50. Materials can be recovered and reused at a cost of $0.40 each. CONCLUSIONS: The materials developed provided an effective, inexpensive nonbiologic model for teaching preoperative skills.

Audiovisual Aids↗
PubMed2000

Effect of fibrin glue on lymphatic drainage after modified radical mastectomy: a prospective randomized trial.

Fibrin as a tissue sealant has been used since the turn of the century for hemostasis. The development of cryoprecipitate and the resultant availability of higher concentrations of fibrinogen have led to a resurgence of interest in this material. Fibrin glue has since been shown to be effective for numerous applications throughout the field of surgery. Animal studies have shown fibrin glue to be effective at reducing drain output after mastectomy. Human studies, however, have been equivocal. Our objectives were to determine whether the use of fibrin glue would decrease lymphatic drainage after modified radical mastectomy and subsequently reduce time to drain removal. A prospective randomized trial was conducted consisting of 27 women. All women received modified radical mastectomy. At the completion of the mastectomy they were randomized to receive either standard closure or the application of fibrin glue before standard closure. Patients were then monitored for daily drain output, time to drain removal, and wound complications. A total of 14 women received fibrin glue and 13 received no glue. Those patients receiving fibrin glue had a significantly higher average drain output than patients who did not receive glue (1308 vs 754 cm3; P = 0.012). Time to drain removal was also increased by 4 days, although this did not reach statistical significance. The overall complication rate was higher for the fibrin glue group, although again, this did not reach significance. The application of fibrin glue significantly increased drain total drain output after modified radical mastectomy. Time to drain removal was increased as was the complication rate. On the basis of these data fibrin glue cannot be recommended for routine use in modified radical mastectomy.

Breast Neoplasms↗
PubMed1999

Endoscopic removal of a knotted nasogastric tube lodged in the posterior nasopharynx.

The complication of knotting nasogastric (NG) tubes on removal occurs infrequently with small diameter feeding tubes. Knotting of large caliber NG tubes is even more uncommon. We describe our experience in one such case, which was further complicated by the inability to visualize the NG tube in the posterior pharynx for removal through the mouth. We also review the literature and discuss risk factors.

Endoscopy↗
PubMed1999

Prevention of adhesions to polypropylene mesh in a rabbit model.

The purpose of this study was to develop a quantitative model for evaluating adhesion formation and to determine whether Seprafilm (HAL-F) bioresorbable membrane (Genzyme Corp., Cambridge, MA) is effective in preventing adhesions to polypropylene mesh (PPM). PPM has been shown to be an effective material for the repair of abdominal wall defects. One disadvantage of PPM is its tendency to form dense adhesions when in contact with abdominal viscera. HAL-F, a sodium hyaluronate/carboxymethylcellulose absorbable membrane, has been shown to prevent adhesion formation after midline closures. Its efficacy in preventing adhesions to PPM has not been examined previously. A 5 x 7-cm anterior abdominal wall defect was created in 24 New Zealand White rabbits. This defect was then repaired with PPM. In the experimental group, a 5 x 7-cm piece of HAL-F was placed between the mesh and the abdominal viscera. At 30 days, the animals were killed and adhesions were categorized and quantified using digital image analysis of inked specimens. The strength of mesh incorporation into surrounding tissues was also examined using an Instron tensiometer. The formation of adhesions between the viscera and mesh repair was significantly reduced by the use of HAL-F. The surface area involved for bowel adhesions was reduced 94 per cent (P = 0.00132). The strength of incorporation was not adversely affected. HAL-F is highly effective in preventing adhesions to PPM, without adversely effecting the strength of mesh incorporation.

Abdominal Muscles↗
PubMed1995

Understanding surgical knot security: a proposal to standardize the literature.

BACKGROUND: There is very little published data concerning the knot handling properties of suture materials. The few studies that are available on this subject contain discrepancies in nomenclature, testing methods, and in the type of data reported. To date, there has been no effort to present what is currently known concerning knot security in a unified format. STUDY DESIGN: A review of the literature was conducted to determine what is currently known concerning surgical knots, the efficiency of these knots, testing techniques, and nomenclature. The structures of common surgical knots were analyzed and their relationships determined. The results of the various studies were analyzed and a summary of existing data was prepared. RESULTS: Based on current literature and a thorough analysis of surgical knots, a standard method for testing knot efficiency and a standard nomenclature were proposed. Suture security has been shown to be strongly influenced by the type of knot used. Knots in which the second throw contains two turns are most efficient. CONCLUSIONS: Existing studies have demonstrated a strong variation in the efficiency of different surgical knots. Standards for testing and nomenclature have been presented. Effort now needs to be directed in three areas: simulating in vivo conditions, testing knots under these conditions, and determining the factors that make some suture materials more efficient in knot holding than others.

Humans↗