PubMed Health⌕ Search

Biomedical subjects

R Ger

Publications and source records attributed to R Ger.

At least 37 records · Page 2Linked to original sources
PubMed1990

Management of indirect inguinal hernias by laparoscopic closure of the neck of the sac.

Fifteen animals with indirect inguinal hernias were treated by closure of the abdominal opening of the patent processus vaginalis by the application of staples laparoscopically. The satisfactory results confirm those obtained in a previous study, where similar openings found during laparotomy for abdominal surgery were closed by the application of metal clips. Laparoscopic closure of the abdominal opening of a hernial sac may have advantages over the present operative management.

Animals↗
PubMed1989

Surgical anatomy of the liver.

Vital intrahepatic structures, especially the large veins, are of special concern to the surgeon. These intrahepatic structures are seldom taught or displayed in anatomy courses, and illustrations are often presented with the posterior surface of the liver facing the viewer, an aspect seldom seen by the surgeon. In this article, the topographical anatomy of the liver is described in a manner most useful to the practicing surgeon. For this purpose, specimens were specifically prepared to demonstrate the vascular anatomy.

Bile Ducts↗
PubMed1988

The importance of intraluminal anastomotic fecal contact and peritonitis in colonic anastomotic leakages. An experimental study.

An experimental, randomized, prospective study was performed in 64 dogs to evaluate the effect of fecal loading, solely, or in combination with induced peritonitis, on colonic anastomosis. The animals, none of which had bowel preparations, were randomized into four groups. Group I underwent sigmoid resection and standard open end-to-end anastomosis; Group II underwent sigmoid resection and an intracolonic bypass procedure; Group III underwent experimentally induced fecal peritonitis, sigmoid resection, and anastomosis; Group IV underwent induction of fecal peritonitis, sigmoid resection and an intracolonic bypass procedure. Using Fisher's exact test, results indicate a more statistically significant increased leak rate in Group III than in Group II (P = .04), and Group III than in Group IV (P = .03), but no statistically significant anastomotic leak rate between the peritonitis (III and IV) and the nonperitonitis (I and II) groups. A very significant statistical increase in leak rate (P = .002) was observed when comparing the 25 percent leak rate of Groups I and III (anastomosis subjected to fecal contact) with the 0 percent leak rate of Groups II and IV (anastomosis excluded from fecal contact) regardless of the peritonitis. This study suggests that the intraluminal contact of fecal loading at the colonic anastomosis is a more significant factor in anastomotic complications due to dehiscences than peritonitis per se. It follows, therefore, that if feces can be excluded from intraluminal contact with an anastomotic site, an anastomosis can be safely performed even in the presence of treated peritonitis.

Anastomosis, Surgical↗
PubMed1988

Surgical anatomy of the pelvis.

The bony constituents of the pelvis and their padding muscles and fasciae have been described. The anatomy of the pelvic colon and rectum have been approached from a clinical and surgical point of view. The genitourinary system is presented as it is related to diseases of, and operations on, the colorectum.

Anal Canal↗
PubMed1988

Splenic preservation with the use of a stapling instrument: a preliminary communication.

Observation, ligation of the splenic artery, repair of the spleen by simple suturing with or without the use of hemostatic agents, omentum, an absorbable net or ladder, and partial splenectomy have all been proposed as a means of preserving the injured spleen. A new technique of partial splenectomy with the use of a stapling instrument is presented. The instrument has been used with success experimentally in dogs and in two patients.

Accidents, Traffic↗
PubMed1988

An aid to axillary dissection.

Abduction facilitates axillary dissection. Full abduction with the hand behind the head permits maximal operative exposure. This is due to the posterior axillary wall passing anteriorly and displacing the axillary contents into a superficial position. This movement is demonstrated roentgenographically.

Arm↗
PubMed1987

Developmental retroperitoneal cysts of the pelvis. A review.

Retroperitoneal cysts have been classified into traumatic, infective, degenerative, neoplastic, and developmental, according to their origin. This paper focuses on the developmental variety of retroperitoneal pelvic cysts, particularly those of mesothelial, mesonephric, or paramesonephric origin. Their clinical presentations depend on their location; they may be mesenteric, parovarian, or vaginal. The pathogenesis and embryologic, diagnostic, and therapeutic aspects are reviewed and a case report is presented.

Cysts↗
PubMed1987

The treatment of perforated diverticulitis by one-stage intracolonic bypass procedure.

The one-stage intracolonic bypass procedure prevents gastrointestinal secretions and fecal content from coming in contact with an anastomotic site without interrupting the intraluminal continuity of the fecal flow from proximal to distal colon. This can be achieved by the intraluminal implantation of a soft, pliable tube above the anastomotic site. Previous clinical and experimental data have indicated that the intracolonic bypass procedure can protect an anastomosis in the presence of maximal colonic loading, gross dehiscences, or fecal peritonitis. This report presents 28 patients with perforated diverticulitis, all of whom were treated by one-stage intracolonic bypass procedures. Ten of the 28 patients had peritonitis, and 18 had pericolic abscesses. Results indicate no deaths and no anastomotic leakages. Three patients (10.7%) had a complicated postoperative course. One patient with fecal peritonitis had prolonged ileus and a pulmonary effusion, and one had a myocardial infarction. Both of these patients responded to medical therapy. Another patient had a wound infection. The hospital stay ranged from 10 to 18 postoperative days. All patients passed the tubes spontaneously 2 to 3 weeks after operation. The one-stage intracolonic bypass procedure can be recommended as a viable alternative to the two- or three-stage procedures commonly used for perforated diverticulitis.

Abscess↗
PubMed1986

Mucosal destruction and regeneration of the colon by local hyperthermia. An experimental preliminary study.

An experimental model has been developed to produce colonic mucosal destruction followed by regeneration. The canine model consists of a defunctioned portion of the large intestine which has been subjected to water at a temperature of 125 degrees F for 7 hours. Colonic specimens were harvested at different periods of up to six weeks and studied macro- and microscopically. It has been shown that it is possible to achieve significant mucosal destruction and regeneration. Possible adaptation to clinical states is presented and discussed.

Absorption↗
PubMed1986

Perineal transanal colonic resection: an experimental study.

Experimental data have led to the conclusion that a transanal partial or subtotal colonic resection can safely be performed in the dog without entering the peritoneal cavity. The techniques of intussusception of the colon at the anus and resection of the colon at the perineum with modified use of the EEATM stapler are presented.

Anal Canal↗
PubMed1986

The fate of transposed immature muscle and its clinical application.

Transposition of muscles with their intact neurovascular bundles is a well-accepted procedure in the adult with a predictable outcome. The fate of transposed immature muscle, however, has not been studied. For this reason, muscles were transposed in three 6-week-old puppies and harvested when the puppies were 6 months old. The developing normal and transposed muscles were studied using serial biopsies, electromyography, and histochemical methods, and the growth in bulk was assessed by serial radiography and measurements of length, breadth, height, and weight of the muscles at death. As judged by these criteria, the transposed muscle developed normally. A patient with prune-belly syndrome, treated by muscle transpositions from thigh to abdomen with satisfactory results, is also described.

Aging↗
PubMed1986

Gross anatomy in medical education.

The present state of human gross anatomy in medical education can generally be characterized as the presentation of a large bolus of information that is swallowed and only partly digested during the first year of medical school. The subject is often taught in a depth beyond that which would be relevant to all physicians irrespective of their future professional careers. This condition has resulted from adaptive adjustments to the escalating discrepancy between a rapidly expanding knowledge base in science and technology and the relatively fixed time period for education of a physician. Initially, traditional courses retained their comprehensive character, and new information was simply piled on top of existing departmental offerings. It soon became obvious that there would have to be a reduction in time devoted to established courses and a reciprocal expansion of time to accommodate newly developing sciences. Such adjustments were painful and often led to conflicts about what comprises essential knowledge in medical education. Thus, the curriculum time devoted to human gross anatomy has been significantly reduced to accommodate new knowledge in cellular and sub-cellular structures and other disciplines. That common foundation of knowledge, skills, values, and attitudes essential to all physicians regardless of specialty is ever-changing and often debated by medical school faculty members. However, two facts are generally agreed upon: that today's medical student with a broad but perhaps thin base in science and limited direct clinical experience is not competent upon graduation to assume patient care responsibilities without supervision and that as a result, the formal education of a physician has expanded into the graduate domain.(ABSTRACT TRUNCATED AT 250 WORDS)

Anatomy↗
PubMed1986

The clinical anatomy of the intrinsic muscles of the sole of the foot.

Lesions of the foot are common and occur at all ages. In the young, congenital nervous anomalies may be responsible. In adolescence, diabetic patients suffer frequently, and in the elderly both diabetes and arteriosclerosis take their toll. A method in the management of ulcers of the foot is by the transposition of muscle/s into the defect/s with or without the use of skin grafts to the muscle. To perform these procedures, a knowledge of the applied anatomy of the intrinsic muscles is required. Traditionally, the muscles of the sole of the foot have always been described in four layers, but it is more pragmatic to divide them into peripheral and central groups. The peripheral muscles, one long and one short, lie on each border of the foot and reach the proximal phalanges of the digits only. The central muscles are more numerous as they occupy the spaces formed by the longitudinal and transverse arches. Except for one muscle that runs obliquely and transversely to support the transverse arch, the central muscles run longitudinally, and are placed one on top of another, the superficial muscles reaching the intermediate phalanges and the deeper muscles, the distal phalanges.

Foot↗
PubMed1986

Anastomosis of intracolonic bypass tube by the use of EEA stapler. An experimental study.

The intracolonic bypass is a procedure that prevents the gastrointestinal secretions and fecal contents from coming in contact with an anastomotic closure site without interrupting the intraluminal continuity of the fecal flow from proximal to distal colon. Experimental and clinical data have indicated that the intracolonic bypass can protect such an intestinal anastomosis in the presence of a maximal colonic loading, dehiscences and fecal peritonitis. An experimental technique of implanting an intracolonic bypass tube with the EEA stapler in the colon is described.

Animals↗
PubMed1985

Prevention of major amputations in the diabetic patient.

Five of six major amputations of the lower extremity involve diabetic patients. It should be possible to reduce the number of major amputations by substituting reconstructive for destructive surgery, by radical local surgical debridement, by achieving healing of chronic foot lesions, by the early diagnosis of spread of infections from foot to leg, by limiting minor amputations, by improving the blood supply, and by providing a continuum of care by experienced personnel who supervise the foot status of the patient on an ongoing basis. In my experience, the application of these principles over the past seven years has precluded major amputation in the treatment of 48 diabetic patients with serious lower extremity lesions.

Adult↗