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Biomedical subjects

R C Frazee

Publications and source records attributed to R C Frazee.

14 recordsLinked to original sources
PubMed1992

Ileorectostomy in the older patient.

Surgeons have always been wary of performing abdominal colectomy and ileorectostomy in the older patient for fear of excessive stool frequency and fecal incontinence. Thirty-two patients, aged 60 years or over, underwent abdominal colectomy and ileorectostomy and were closely questioned regarding their preoperative, early postoperative, and late postoperative bowel habits. These patients were compared with a group of age- and sex-matched controls who had undergone right hemicolectomy. In both groups, the ileocecal valve had been resected, but only the ileorectostomy group had the entire colon resected. Immediately after ileorectostomy, patients underwent an average increase in bowel movements of 3.6 movements per day. This gradually decreased over time, so that, after five years, older patients with ileorectostomy had an average of 1.5 more bowel movements per day than they had had preoperatively. There were similar increases in the right hemicolectomy patient group: 0.9 bowel movements per day immediately after right hemicolectomy and 0.2 bowel movements per day after five years. Incontinence was an uncommon problem in both groups. This study suggests that elderly patients undergoing abdominal colectomy and ileorectostomy have an increase in daily bowel movements, which is not solely attributable to the loss of the right colon. However, it is a procedure that is well tolerated, with a low risk of incontinence and only a mild increase in stool frequency.

Aged↗
PubMed1992

Prospective, randomized trial of inpatient vs. outpatient bowel preparation for elective colorectal surgery.

A prospective, randomized trial of inpatient vs. outpatient bowel preparation for elective colorectal surgery was performed in 100 consecutive patients. Bowel preparation was standardized for both groups and consisted of 4 liters of Colyte (Reed & Carnrick, Piscataway, NJ) and oral neomycin and Flagyl (G. D. Searle & Co., Skokie, IL) the day before surgery. Patients were randomized into four subcategories: ileocolostomy, colocolostomy, abdominal perineal resection, and other. Tap water enemas were administered on the morning of surgery to ensure and adequate mechanical preparation. Ninety-six percent of the inpatient group and 97 percent of the outpatient group were able to drink three-fourths or more of the oral lavage preparation (P = 0.789, Fisher's exact text). A mean of 2.26 tap water enemas was required to achieve clear returns for the inpatient group, compared with 2.28 tap water enemas for the outpatient group (P = 0.221, Fisher's exact test). The adequacy of the bowel preparation as graded by the primary surgeon was good (84 percent), fair (12 percent), and poor (4 percent) in the outpatient group (P = 0.673, Fisher's exact test). Wound infection developed in 4 percent of the inpatient group and 4 percent of the outpatient group (P = 1.0, Fisher's exact test). Anastomotic leak of intra-abdominal abscess was seen in one patient in each group (P = 1.0, Fisher's exact test). We conclude that outpatient bowel preparation is as effective as inpatient bowel preparation for elective colorectal surgery and offers the advantage of cost savings and shorter hospitalization.

Adult↗
PubMed1992

What are the contraindications for laparoscopic cholecystectomy?

Acute cholecystitis, morbid obesity, and previous upper abdominal surgery have been reported as relative contraindications to laparoscopic cholecystectomy. An analysis of 706 laparoscopic cholecystectomies performed at our institution was undertaken to determine if these relative contraindications led to increased morbidity, an increased rate of conversion to the open technique, or longer operating time. One hundred ninety-seven patients demonstrated one or more relative contraindications to laparoscopic cholecystectomy. Morbidity was not increased in patients with these risk factors, but conversion to open cholecystectomy was required in a greater percentage of patients with acute cholecystitis. We favor an attempt at laparoscopic cholecystectomy in patients with these risk factors; however, they should be counseled as to the increased risk of conversion to open cholecystectomy in the presence of acute cholecystitis.

Abdomen↗
PubMed1992

Gastric lymphoma treatment. Medical versus surgical.

The treatment of gastric lymphoma is an area of ongoing controversy. Surgical resection has been the standard therapy. Recent advances, however, have been developed in other treatment modalities. A comparison of treatment options is presented.

Humans↗
PubMed1992

Laparoscopically assisted resection of a colonic lipoma.

Laparoscopic excision of a lipoma of the sigmoid colon is described. The patient's postoperative recovery was rapid and similar to that experienced in patients undergoing laparoscopic cholecystectomy and appendectomy. He enjoyed the benefit of complete surgical excision of his disease while foregoing the postoperative discomfort and morbidity of open celiotomy. Because the majority of lipomas are submucosal, endoscopic removal carries an inherently high risk. For those lesions amenable to it, laparoscopic colotomy and excision offers a viable alternative to open laparotomy excision of colonic lipomas and polyps in general.

Adult↗
PubMed1992

Surgical treatment of radiation enteritis.

Radiation enteritis is a progressive, disease process that causes intestinal fibrosis and obliterative endarteritis, which results in significant morbidity and mortality. The authors' clinical experience involving 20 patients over a 22-year period from 1967 through 1989 who underwent various surgical procedures to alleviate chronic symptoms secondary to radiation enteritis is described. Eight men and 12 women with a mean age of 52 years (24 to 81 years) underwent a total of 27 procedures for complications of radiation enteritis. Radiation therapy was delivered for treatment of gynecologic malignancies (55%), colorectal cancer (20%), prostate malignancies (10%), and others (15%). The mean average dose of radiation delivered was 5,514 rads with a range of 2,613 to 7,000 rads. The interval from radiation treatment to time of surgery averaged 9 years. Operative procedures consisted of 12 resection and primary anastomosis procedures and 15 resections with stoma creation. Formation of a stoma was used in patients with more severe disease. The 30-day operative mortality was 0% and morbidity was 55%. There were no anastomotic leaks or intra-abdominal abscesses. The authors conclude that resection and primary anastomosis can safely be performed in selected patients but that judicious use of stoma formation can avoid major mortality and morbidity associated with surgery in this setting.

Adult↗
PubMed1991

Laparoscopic cholecystectomy: a multicenter study.

Laparoscopic cholecystectomy has been developed as an alternative to open cholecystectomy for the treatment of symptomatic cholelithiasis. A collaborative study of 261 patients undergoing laparoscopic cholecystectomy at three Texas institutions was performed to determine the effectiveness and safety of this technique. There were 65 males and 196 females with a mean age of 49 years (range 17-94 years). Acute cholecystitis was present in 38 patients and chronic cholecystitis in 223 patients. Mean length of surgery was 80 minutes (20 min to 4 hr). Fifteen patients were converted to the open technique intraoperatively due to bleeding, adhesions, or difficulty of dissection. There were no perioperative deaths and morbidity was 3% including urinary retention, small bowel obstruction, arrhythmia, wound infection, and bile leakage. There were no common duct injuries. Hospitalization ranged from outpatient surgery to 7 postoperative days with a mean of 1.2 days. We conclude that laparoscopic cholecystectomy can be performed safely and with low morbidity and offers shorter hospitalization and postoperative recovery.

Adolescent↗
PubMed1991

Open versus laparoscopic cholecystectomy. A comparison of postoperative pulmonary function.

Upper abdominal surgery is associated with characteristic changes in pulmonary function which increase the risk of lower lobe atelectasis. Sixteen patients undergoing open cholecystectomy and 20 patients undergoing laparoscopic cholecystectomy were prospectively evaluated by pulmonary function tests (forced vital capacity [FVC], forced expiratory volume [FEV-1], and forced expiratory flow [FEF] 25% to 75%) before operation and on the morning after surgery to determine if the laparoscopic technique lessens the pulmonary risk. Fraction of the baseline pulmonary function was calculated by dividing the postoperative pulmonary function by the preoperative pulmonary function and multiplying by 100%. Postoperative FVC measured 52% of preoperative function for open cholecystectomy and 73% for laparoscopic cholecystectomy (p = 0.002). Postoperative FEV-1 measured 53% of baseline function for open cholecystectomy and 72% for laparoscopic cholecystectomy (p = 0.006). Postoperative FEF 25% to 75% measured 53% for open cholecystectomy and 81% for laparoscopic cholecystectomy (p = 0.07). It is concluded that laparoscopic cholecystectomy offers improved pulmonary function compared to the open technique.

Adult↗
PubMed1989

Acute acalculous cholecystitis.

Acute acalculous cholecystitis occurs infrequently, but the incidence seems to be increasing. Its attendant high associated morbidity and mortality dictate prompt diagnosis. Diagnosing this condition is often difficult because of the patient's debilitated medical condition and the limitations of biliary imaging techniques. During a 5-year study period (1981 through 1986), 20 patients underwent assessment and treatment for acute acalculous cholecystitis at our institution. This observation suggests an increase in incidence in comparison with a previously reported review of 28 such patients during a 16-year period at our institution. Initial treatment consisted of cholecystectomy in 18 patients, and percutaneous transhepatic cholecystostomy was successfully used in the other 2 patients. The postoperative mortality and morbidity for these 20 patients were 30% and 55%, respectively. Percutaneous transhepatic cholecystostomy should be explored further as a treatment option for acute acalculous cholecystitis.

Acute Disease↗
PubMed1989

Cholecystectomy with concomitant exploration of the common bile duct.

One hundred and four patients undergoing concomitant cholecystectomy and exploration of the common bile duct were retrospectively reviewed. Exploration of the common bile duct retrieved stones in only 17 patients, all of whom had clearly positive findings from operative cholangiography. Of 87 patients who had negative results 57 underwent exploration of the common bile duct on the basis of clinical factors and 21 on the basis of equivocal cholangiographic findings.

Adult↗
PubMed1988

Volvulus of the small intestine.

At the Mayo Clinic, six patients with primary volvulus and 51 with secondary volvulus were treated during a 10-year period. Volvulus of the small intestine must be considered when a patient presents with small-bowel obstruction, and early operative intervention should be undertaken to prevent vascular compromise.

Acute Disease↗
PubMed1987

Barium-impregnated fibrin glue: application to a bleeding duodenal sinus.

A 64-year-old man with Crohn's disease who had undergone repair of an ileovesical fistula and ileoileostomy had numerous postoperative complications related to sepsis and wound healing. Subsequently, upper gastrointestinal bleeding developed, and the site was identified as a duodenal sinus. Medical management was unsuccessful in controlling the bleeding. Because of the considerable risk associated with reoperation in this seriously ill patient, approval was obtained from the Food and Drug Administration to use fibrin glue in an attempt to prevent further bleeding. The glue was mixed with barium and placed in the duodenal sinus under endoscopic guidance. The barium-impregnated glue facilitated follow-up surveillance with abdominal roentgenography. The patient had no further gastrointestinal bleeding. Further clinical and experimental studies should be conducted to determine the mechanism of action and the efficacy of this application of fibrin glue.

Aprotinin↗
PubMed1986

Objective evaluation of blunt cardiac trauma.

Serum creatine kinase isoenzyme (CK-MB) screening followed by two-dimensional echocardiography (2-DE) was used for the assessment of possible cardiac injury in victims of blunt trauma with acute thoracic or rapid deceleration injury. Of 291 victims evaluated acutely, 58 (20%) had a CK-MB fraction evident within 24 hours after injury. Sixty per cent (35/58) were diagnosed as having 'cardiac concussion' (normal 2-DE) and 40% (23/58) as having 'cardiac contusion' (abnormal 2-DE). 2-DE abnormalities most often involved the right ventricle and were characterized by dyskinesis. Only one of 35 concussion patients (3%) and nine of 23 contusion patients (39%) manifested cardiac arrhythmias within 72 hours after injury (p less than 0.006). Distinction between concussion and contusion has enabled development of a rational acute management protocol. A total of 70 patients with documented blunt cardiac injury (58 evaluated acutely, nine dead on arrival or died in the emergency room, and three delayed presentations) seen at this institution over 4 years are reported, illustrating the full spectrum of blunt cardiac injury.

Accidents, Traffic↗