Understanding and optimizing laparoscopic videosystems.
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Humans↗
Biomedical subjects
R Cacchione
Publications and source records attributed to R Cacchione.
Laparoscopic distal pancreatectomy for blunt injury to the pancreas. A case report.
Laparoscopic pancreatic resection has not been reported for traumatic injuries to the pancreas. We present the case of a laparoscopic distal pancreatectomy performed on a 10-year-old boy after he sustained a distal transection of the pancreas due to blunt abdominal trauma. The spleen and its vessels were preserved. The patient was sent home on postoperative day 3 without any postoperative complications. Performing an advanced laparoscopic pancreatic procedure is feasible, in the trauma setting, particularly in children.
Athletic Injuries↗
Incidence of incipient contralateral hernia during laparoscopic hernia repair.
BACKGROUND: In addition to its well-known benefits of decreased postoperative pain and shorter recovery time, laparoscopic hernia repair has the major advantage of allowing the surgeon to explore the side contralateral to the clinically diagnosed hernia. The purpose of this study was to evaluate the incidence of incipient unsuspected contralateral hernia during totally extraperitoneal (TEP) laparoscopic inguinal herniorrhaphy and to analyze the risks and benefits of identifying these hernias at the time of the initial surgery. METHODS: We did a retrospective review of the charts of all of the 724 male patients who underwent laparoscopic TEP repair of 958 groin hernias between September 1991 and September 1999. The initial clinical impression of the existence of unilateral or bilateral hernias was noted and compared to our operative findings. The same surgeon performed all the repairs. Exploration of the contralateral side was performed in a systematic fashion. A second mesh prosthesis was placed if a contralateral hernia was found. RESULTS: Bilateral hernia repair was performed on 234 patients (32. 3%). In 62 of them (11.2%), the contralateral hernia was diagnosed only at the time of the procedure. Operative time ranged from 14 to 185 min (median, 38.6). The operative time for the contralateral exploration ranged from 2 to 5 min (median, 2.8). The rate of complications was 4.1%, but no complications were directly related to the exploration of the asymptomatic side. CONCLUSION: Our study shows that a large number of inguinal hernias are undiagnosed by physical examination (11.2%). Systematic contralateral exploration using the TEP approach is safe and does not greatly increase the operative time. Early identification and repair of a contralateral hernia obviates the need for reoperation, reduces overall costs to the health care system, and eliminates any further work loss for the patient.
Adolescent↗
Combination salvage chemotherapy with MIZE (ifosfamide-mesna, idarubicin and etoposide) for relapsing or refractory lymphoma.
In this study, 54 patients with relapsed or refractory non-Hodgkin's lymphoma (NHL) were treated in a phase II, multicentric trial with ifosfamide-mesna 1500 mg/m2 IV days 1-3, idarubicin 12 mg/m2 IV day 1 and etoposide 100 mg/m2 IV day 1-3 (MIZE). Overall response was 72%; complete response (CR) and partial response (PR) were 46% and 26% respectively. In Stage I-II pts CR was 59% and in Stage III-IV pts CR was 40.5%. Patients who relapsed from an initial CR had a 64% CR rate when treated with MIZE, in contrast to refractory disease's patients who only had 19% CR (p = 0.004). The group of pts that had an objective response (CR + PR) to front line therapy had a 2 year survival rate of 55% compared with none for refractory disease (p = 0.029) after salvage therapy. Median survival for the entire group was 17.5 months. Better survival was seen in pts who were asymptomatic with low levels of LDH, previous CR, non high-grade histology, and limited disease stage at relapse. Toxicity was mainly hematologic: 91.5% had neutropenia, (56.5% grade III-IV), and 9.5% died from infectious complications. Other clinical toxicities including cardiac toxicity were negligible. MIZE chemotherapy was effective in patients with relapsed and refractory lymphoma and showed limited clinical and cardiac toxicity. Myelosupression was the most frequent single toxicity.
Adult↗
[Frozen red blood cells].
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Cryopreservation↗
Synergistic actions of PAF-acether and sodium arachidonate in human platelet aggregation. 1. Studies in normal human platelet rich plasma.
The effect of sodium arachidonate and paf-acether in the activation of human platelet was studied. Concentrations of paf-acether which induced a reversible aggregation in normal human platelet rich plasma (0.029-0.0029 microM) and subthreshold concentrations of sodium arachidonate (0.25-0.35 mM), produced full aggregation when added together. Pre-exposition of platelets to paf-acether that renders them insensitive to paf-acether supresed the synergism. With full aggregation a markedly increase of thromboxane synthesis was detected by RIA. In vitro addition of aspirin (200 micrograms/ml) or indomethacin (12 microM) prevented aggregation and thromboxane formation by the joint action of sodium arachidonate plus paf-acether. Specific inhibition of 12-lipoxygenase by esculetin (10 microM) did not affect the synergistic action of paf-ace-ther and sodium arachidonate. These findings suggest that synergism between both agonists is mediated by active derivatives of arachidonic acid via cyclooxygenase.
Adult↗
Erythrokinetic studies in myelofibrosis: their significance for prognosis.
Eighty-three patients with myelofibrosis have been studied by erythrokinetics and have been followed up until death or for at least 12 months. Because of a large plasma volume the venous haematocrit gives only a poor idea of the red blood cell volume. The red cell survival was reduced in the majority of cases but significant haemolysis was rare. The amount of haemolysis of autologous and isologous red cells was similar, suggesting an extra-corpuscular origin for the haemolysis. Plasma iron turnover was always increased, sometimes markedly, but red cell iron incorporation was reduced in 70% of cases, indicating ineffective erythropoiesis. Surface counting showed an absence on diminution of sacral iron fixation and a rapid and marked splenic uptake in more than 90% of the cases; uptake of iron by the liver occurred in half the cases, usually not very high; iron release from the spleen was absent or reduced in 67% of the cases. The degree of ineffective erythropoiesis as measured by radio-iron incorporation and release by the spleen, the amount of haemolysis, and the red cell volume were strongly correlated with prognosis. These factors enabled a more precise prediction to be made of the clinical outcome in the 2 years following the study, than the clinical data alone. A prospective study might show whether erythrokinetic studies are also useful in determining the choice of treatment.
Aged↗
Blood volume in health and disease.
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Anemia↗
[Practical value of the measurement of red cell volume in anemia].
In most cases of anemia, haematocrit is a good index of the degree of the red blood cell mass decrease; however, in the patients with renal deficiency, hyposideremic anemia, or severe hemolysis, a variable response of the plasma volume to anemia makes any measurement of the hematocrit a poor index of the red cell mass; in patients with splenomegaly, an excess of plasma volume makes any measurement of the treatment. The direct measurement of the red cell mass appears to be useful in clinical practice in many cases with anemia.
Acute Kidney Injury↗
[Practical value of the measurement of red cell volume in polyglobulia].
The practical interest of the direct measurement of the red blood cell volume in clinical haematology remains a matter of discussion. A retrospective study of 385 cases with high haematocrit values shows that the measurement of RBC volume is useful for the diagnosis between true and spurious polycythemia only when the haematocrit value is slightly increased (until 52 p.cent in women and 55 p.cent in men). At the higher values of haematocrit, the direct measurement of the RBC volume does not help for the diagnosis between primitive and secondary polycythemia, but may be useful for the choice of the treatment.
Erythrocytes↗
[Value of measurement of the red cell volume in polyglobulia and anemia. Expression of the results].
As an introduction to the following paper, devoted to the clinical usefulness of the measurement of the red cell volume in polycythemic and anemic states, the mode of expression of the experimental results of red cell volume is discussed. The comparison between the several equations, which try to give a normal value, by taking into account the height and weight of the subjects shows that the differences are very slight between the several estimations. On the contrary, the expression of the red cell volume as a function of the weight only can be the cause of misinterpretation of the measure of the red cell volume, in fat and thin people.
Anemia↗
Methods of evaluating the sequestration site of red cells labelled with 51Cr: a review of 96 cases.
Teh technical conditions for surface counting and the methods for splenic and liver sequestration after injection of 51Cr-labelled cells were studied in 96 patients. A comparative study of different sites of positioning of the detection probes leads us to recommend the mid-line at the third intercostal space for the precordial area, the point of maximum count-rate obtained at each measurement for the splenic area, with the patient in right lateral decubitus position and the probe vertical, and a point situated on the midclavicular line 4 cm above the right costal margin for the liver area. A comparative study of different methods of calculation leads us to recommend the method known as 'excess counts', but with a correction of the gross values based on the evolution of circulating radioactivity and not of the count-rate measured over the precordial area. Measurement of urinary excretion of radioactivity showed that only a minor part was due to the loss of the tracer from the sequestration sites, and that the level varied only slightly between subjects. Thus the loss of tracer does not interfere with the interpretation of external counting data. Much of the disagreement regarding interpretation of the results of external counting in clinical practice is due to technical problems. Standardization of techniques of measurement and interpretation of results, selecting those which this study indicates as the most reliable, would permit better exchange of information between laboratories and clearer conclusions as to the practical use of surface counting.
Chromium Radioisotopes↗