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Biomedical subjects

R E Symmonds

Publications and source records attributed to R E Symmonds.

At least 19 recordsLinked to original sources
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↗
PubMed1988

Current status of genitourinary fistula.

From 1970-1985, 303 women with genitourinary fistulas were seen at the Mayo Clinic. The fistula formed after treatment for benign conditions in 74% of the patients and malignant conditions in 14%; in 12%, we were unable to establish the nature of the condition. Gynecologic surgery was responsible for 82% of the fistulas, obstetric procedures for 8%, various forms of irradiation for 6%, and trauma or fulguration for 4%. In the nonirradiated patient, the ideal time for operative repair was eight to 12 weeks after fistula formation or failed repair. With ureterovaginal fistulas, the patient's general condition and the degree of obstruction of the ureter influenced the time and method of repair. We used a vaginal approach for urethral fistulas and an abdominal one for ureteral repairs. Because of difficulty with adequate exposure and the proximity of the ureter, an abdominal approach was used in 20% of the patients with vesicovaginal fistulas; the remaining 80% were approached vaginally, regardless of size, number, or history of previous repairs. Ninety-two percent of the urethrovaginal fistulas were corrected on the first attempt; the four failures were managed successfully at the second attempt. Ninety-eight percent of the vesicovaginal fistulas were corrected on the first attempt when approached vaginally, and all were managed successfully when approached abdominally, regardless of the number, size, or previous operative attempts.

Female↗
PubMed1988

Presacral tumors in the female: clinical presentation, surgical management, and results.

A relatively infrequent and heterogeneous group of tumors with similar clinical presentation may arise in the presacral space. From 1965-1980, 70 female patients with primary presacral tumors underwent surgical management at the Mayo Clinic. Twenty-three percent had no symptoms, and their tumors were found on routine pelvic examination. Most of the symptoms resulted from compression or obstruction of adjacent organs or from pressure on pelvic nerves or bone. A palpable tumor was found in 65 (93%) of the patients. Computed tomography scan has proved valuable in determining the extent and degree of tumor invasion. The abdominal approach was selected in 39 (56%), transsacral in 20 (28%), abdominal/perineal in six (9%), and transperineal in five (7%). Complications occurred in 22 patients (31%). However, there were no operative deaths. Seventy percent of the tumors were benign, and 30% were malignant. The prognosis for patients with benign tumors was excellent and their symptoms were relieved. All 21 patients with malignant tumors died between three months and four years after surgery. Survival was not prolonged by the use of radiation or chemotherapy.

Adolescent↗
PubMed1987

Management of nonpalpable breast abnormalities.

From January 1982 to June 1986, 444 patients had localization of 500 nonpalpable mammographically suspicious lesions using the Kopans hook wire technique. Four hundred ninety-nine biopsies were performed in 443 patients. Cancer was identified in 12% of the biopsies performed for a suspicious mass or density and in 20% of biopsies performed for suspicious calcifications. Carcinoma was identified in a total of 72 biopsies (14%) performed in 65 patients; 82% of the malignant lesions were invasive. All lesions were small; 76% of the cancers were 1.0 cm or less in diameter. Sixty-two axillary dissections were performed of which seven (11%) had positive nodes. Advantages of preoperative needle localization include precise localization of the lesion, a small incision, and removal of a small amount of breast tissue with no cosmetic deformity. Outpatient biopsy of these lesions can be easily performed under local anesthesia. Identification and treatment of these small preclinical cancers should lead to improved survival from breast cancer.

Adult↗
PubMed1986

Urinary diversion with use of ileal and sigmoid conduits.

Two hundred eighteen patients underwent urinary diversion: 156 with ileal and 62 with sigmoid conduits. There were no significant differences between the two groups regarding frequency of conduit morbidity or patient survival. The ileal conduit is preferred for urinary diversion with anterior exenteration, whereas the sigmoid conduit is preferable for urinary diversion with total exenteration.

Adolescent↗
PubMed1986

The incidence of colon carcinoma complicating ulcerative colitis.

The tendency for development of cancer in patients with ulcerative colitis is well documented. Each physician must take into account the clinical presentation of the patient and the known risk factors and must adapt follow-up and consultation to the patient and family accordingly. Presently, after a 5- to 7-year history of ulcerative colitis, it is reasonable to document mucosal changes with air-contrast barium enema examination and laboratory assessment with carcinoembryonic antigen levels being obtained. If the extent of disease is more limited to the distal colon, then the surveillance should be modified accordingly because the relative risk is reduced. In the future, the addition of histochemical and immunohistologic analysis of mucosal biopsies will result in better criteria for patient selection for surgical intervention. Because of the delay in recognition of a cancerous lesion in patients with ulcerative colitis, a total proctocolectomy is recommended by some after the first decade of disease. Most prefer, however, to continue surveillance of some type. During surveillance, if moderate or severe dysplasia is found, a proctocolectomy should be performed. This mode of surveillance and treatment of patients at risk for developing colonic carcinoma subsequent to ulcerative colitis remains an evolving process. There will be further changes in management following better classification of the neoplastic changes and the discovery of the etiology of the disease process itself.

Colitis, Ulcerative↗
PubMed1985

Palliative exenteration--what, when, and why?

Between 1955 and 1981, 323 pelvic exenterations were performed at the Mayo Clinic. Fifty-nine (18%) were considered retrospectively to be palliative because of pelvic or aortic nodal metastasis, pelvic peritoneal involvement, pelvic wall involvement, bone involvement, or, in two cases, distant metastasis. The survivals were 47% at 2 years and 17% at 5 years. When metastatic nodal disease was found after irradiated pelvic recurrence, the 2- and 5-year survivals were 46% and 23%, respectively. Although exenteration procedures are designed to be curative, the palliative benefits obtained in this group of patients appear to be worthwhile and comparable to those achieved in advanced epithelial ovarian carcinoma for which aggressive surgical management is now strongly advocated.

Bone Neoplasms↗
PubMed1985

Surgical management of complicated diverticulitis.

The majority of patients with acute diverticulitis can be managed medically. Some will have a complication of diverticulitis such as free perforation with peritonitis, abscess formation, obstruction, or fistula formation. Perhaps even a larger number will develop recurrent diverticulitis, which is associated with an increased rate of complications. Although the preoperative diagnosis of these problems may be obvious in many patients, elderly or steroid-treated patients may have few manifestations of significant intra-abdominal disease. Of extreme importance in the management of these complications of diverticulitis is the preoperative resuscitation. Intravascular volume depletion is replaced with intravenous fluids, and intravenous antibiotics are given. At this time, with any of these complications, it is unusual to perform the classic three-stage operation, which includes an initial diverting colostomy and drainage followed by resection of the involved colon and, finally, a colostomy closure as the third stage. The usual treatment now is a two-stage operation with the initial operation being resection of the diseased segment and formation of a colostomy proximally and either a mucous fistula or a Hartmann's pouch distally. The second stage is the colostomy closure. This two-stage approach is indicated in patients with acute diverticulitis complicated by perforation, whether free or confined with abscess formation, and in patients with obstruction or fistula formation in whom a preoperative bowel preparation is not possible. Resection and primary anastomosis should not be performed in the elderly in the emergency setting for complicated diverticulitis. However, this is the procedure of choice in the elective treatment of diverticulitis and its complications in the elderly.

Abscess↗
PubMed1983

Melanoma of the vulva: an update.

During the time interval 1950 through 1980, 48 patients having a mean age of 60.2 years were treated primarily for melanoma of the vulva. In all but one patient, a surgical therapeutic approach was selected, including 40 modified Basset procedures and 23 pelvic lymphadenectomies. The 5-year survival rate of the eligible population was 54%. Although surgical staging according to the classification established by the International Federation of Gynecology and Obstetrics (FIGO) was of minimal value, microstaging, using Clark's and Breslow's stratifications for assessing dermal penetration, was of prognostic significance. Ten-year survival rates associated with Clark's level II, III, IV, and V tumors were 100, 83, 65, and 23%, respectively. Histologic growth patterns (5-year survival rates of 71 and 38% for superficial spreading and nodular melanomas, respectively) and groin nodal metastasis were cogent prognostic factors and indirectly were related to depth of local tumor invasion. Likewise, assessment of treatment failures demonstrated a positive correlation between recurrences (specifically at distant sites) and Clark's level of melanocytic penetration. Because of the unacceptably high (32%) local treatment failure rate despite radical vulvar resection, treatment modifications for vulvar melanoma are imperative.

Adult↗
PubMed1983

Surgery for morbid obesity. Appraisal of old and new techniques.

Morbid obesity is a serious and sometimes lethal disease of unknown etiology. Nonsurgical treatment has not been successful in producing permanent weight loss. Surgical treatment does reliably result in weight loss but is not a cure and is not indicated for all morbidly obese patients. Jejunoileal bypass, the first operation devised for morbid obesity, usually produces excellent weight loss but has high rates of morbidity and mortality. For this reason, it is not currently advised by most surgeons. Gastric bypass reduces morbidity and mortality without compromising weight loss; however, it is technically more difficult than jejunoileal bypass. The newest operations for morbid obesity are variations of gastroplasty. If correctly performed, they will produce satisfactory weight loss with the lowest morbidity rates of all the operations for morbid obesity. However, long-term results for these procedures are not yet available. Therefore, the ideal operative procedure for morbid obesity has yet to be identified.

Humans↗
PubMed1983

Carcinoma of the vulva: analysis of treatment and survival.

The treatment of 224 patients with invasive squamous cell carcinoma of the vulva over a 20-year interval at the Mayo Clinic resulted in an overall survival rate of 75%, compared with 89% for age-matched controls. For patients with stage I disease, 5-year survival was 90%; for those with stages II, III, and IV, it was 81, 68, and 20%, respectively. A precipitous decline in survival rates was noted when metastases to regional nodes were encountered, when lesion size was more than 3 cm, and when histologic dedifferentiation exceeded grade 2. Incorrect clinical staging efforts were observed in 25% of the cases, so the necessity for surgical staging was apparent.

Breast Neoplasms↗
PubMed1982

Carcinoma of the vulva: analysis of treatment failures.

Continuous follow-up of 224 patients treated for primary invasive squamous cell carcinoma of the vulva in a 20-year period (1955 to 1975) at the Mayo Clinic resulted in the detection of recurrent (or persistent) neoplasia in 59 (26%). Rates of treatment failure increased with advancing stage of disease-from 14% for Stage I to 71% for Stage IV. The rate of local vulvar recurrence was 18%, which was about three times greater than the recurrence rates for the groin, pelvis, and distant sites. However, the 1- and 5-year survival rates of 73% and 50%, respectively, after vulvar recurrence were in sharp contrast to the corresponding rates of 34% and 10% for regional or distant recurrence. When 35 patients with central vulvar extension of disease were evaluated, groups at excessive risk for treatment failure (lesions 4 cm or larger inguinal node involvement, or both) were identified and modifications in conventional therapy applicable to these groups were considered.

Aged↗
PubMed1982

Nutritional support of the surgical patient.

Malnutrition, unfortunately, is not uncommon and malnourished patients suffer increased morbidity and mortality from surgery. Identification of protein-calorie deficient patients can be performed rapidly and inexpensively through standard techniques of nutritional assessment. If the gastrointestinal tract is available, safe and economic nutritional support may be provided by mouth or by tube feeding. If the gastrointestinal tract cannot be utilized, total parenteral nutrition (TPN) may be instituted via a central vein, or in selected instances peripheral amino acids, fat emulsions, or both may suffice. When failure of various organs (heart, kidneys, liver) complicates malnutrition and the underlying surgical condition, adequate nutritional support can and should be provided by adjustment of the amount and content of commercially available nutritional formulations. Optimal surgical care demands the identification and appropriate nutritional support of malnourished patients.

Amino Acids↗
PubMed1981

Posthysterectomy enterocele and vaginal vault prolapse.

Of 421 patients with posthysterectomy enterocele and vault prolapse, 190 cases are reported for the first time. These 190 patients had 197 operations, 90% were vaginal procedures and 10% were abdominal-presacral suspension procedures; 88% of the operations provided good vaginal support and a satisfactory result. A vaginal repair is advocated for this condition because it provides an excellent result with minimal exposure of the frequently elderly patient to serious risk or disability. An abdominal-presacral suspension is advised only for those patients who are anxious to preserve vaginal function, in whom there is an inversion of an already much-operated-on, snug vagina.

Adult↗