Biomedical subjects
Publications and source records attributed to R E Kusminsky.
An endolaparoscopic technique to perform a proctopexy is reported. This procedure appears to be ideally suited for this approach and, furthermore, it can be performed safely and effectively. Long-term predictions of morbidity, mortality and recurrence rates cannot yet be made, but those parameters might not be different from what would be expected with the open approach.
Traditionally, cancer of the prostate has been staged by digital exam, ultrasound, CT scan, bone scan, prostatic acid phosphatase (PAP), and prostate specific antigen (PSA) determinations. These methods commonly lead to understaging, resulting in surgical or radiation therapy of questionable benefit. Pathologic staging, even though reliable and accurate, requires laparotomy with its associated morbidity and lengthy hospitalization/recovery period. Following national trends, we have recently introduced the technique of Laparoscopic Pelvic Lymph Node Dissection (LPND) at our institution. In July 1990 we performed the first LPND at CAMC (Memorial Division). This report details our experience with the first three patients treated in this manner and suggest that the procedure can be performed safely, effectively, and with a significant reduction in morbidity, thus allowing the surgeon to obtain an adequate specimen for pathologic staging. Possible cost containment, minimal discomfort, and little scarring are other advantages that appeal to both patients and surgeons alike.
In recent months, the technique of Laparoscopic Laser Cholecystectomy (LLC) was introduced at our institution. A small series is presented here involving 14 patients, seven of whom underwent LLC and seven in which a "mini-lap" cholecystectomy was performed. Symptomatic cholelithiasis was the indication for surgery in all cases, and operative cholangiograms were employed in 12 patients. Comparisons are made regarding length of hospitalization, recovery time and operative time. An improved recovery period is indeed demonstrated with LLC allowing return to normal activities and employment much sooner than with an open cholecystectomy. We suggest that, though some prudence and caution is advised, this appears to be a safe and feasible adjunct in the treatment of cholelithiasis.
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Since 1872, 168 rectal leiomyomas have been reported in the world literature. Their incidence, therefore, is very low. It is estimated that one leiomyoma may be seen for every 2,000 or more rectal tumors. Those leiomyomas located in the anal canal and sphincter are the rarest. A case is reported here that appears to be the eleventh in such a location. The incidence of these lesions is highest between the ages of 40 and 59 years. Most patients have a combination of symptoms rather than a single one, the most frequent of these being the presence of a mass, bleeding, and constipation. Almost always, the chain of events that leads to the diagnosis starts when the tumor is discovered by digital examination of the rectum. The lack of reliable criteria of malignancy and the marked tendency to recur shown by these tumors are the two main problems the surgeon faces when selecting the operative procedure to be used. We believe that those tumors with an original size of 5 cm or more in largest diameter are the ones that have shown the highest tendency to recur, mostly as sarcomas. Therefore it is thought that these lesions should be treated radically from the beginning, especially when they recur. More adequate follow-up studies are needed.