Biomedical subjects

S A Lord

Publications and source records attributed to S A Lord.

6 recordsLinked to original sources

PubMed1996

Laparoscopic resections for colorectal carcinoma. A three-year experience.

UNLABELLED: Laparoscopic resection for carcinoma of the colon and rectum is currently under intense scrutiny. PURPOSE: The purpose of this study is to review our three-year experience of laparoscopic surgery for colon and rectal carcinoma. METHODS: From October 1991 to September 1994, 76 laparoscopic procedures were performed for colorectal neoplasia (32 males and 44 females; mean age, 69 years). Fifty-five procedures were done for carcinoma, 16 for large polyps, and five for diversion in patients with unresectable cancer. For resectable tumors, the average size was 4 cm; staging was as follows: Dukes A, 10 patients; Dukes B1, 11; Dukes B2, 18; Dukes C1, 1; Dukes C2, 9; and Dukes D, 8. Fourteen cases (25 percent) that were converted to open procedures were compared with the 41 cases that were completed laparoscopically for differences in tumor size, surgical margins, number of lymph nodes harvested, length of hospital stay, and evidence of recurrence. Procedures completed laparoscopically were then compared with a group of open controls completed during the same time period. RESULTS: During the first six months, the conversion rate was 32 percent but dropped to 8 percent in the last six months. There were a total of 19 complications (25 percent), of which 8 (14 percent) were directly related to the laparoscopic technique. The mean number of lymph nodes harvested in laparoscopic resection for carcinoma was 8.5, and the average closest tumor margin was 4.5 cm. When laparoscopic resections were compared with converted and standard open colectomies, there was no significant difference in tumor margins or numbers of nodes resected. Length of stay was significantly shorter for anterior resections completed laparoscopically than for converted or conventional colectomies. Although this was also the trend for right hemicolectomies, it did not reach statistical significance. Mean follow-up of the group completed laparoscopically was 16.7 months, during which there was one recurrence. There were no trocar site recurrences. CONCLUSIONS: This early experience seems to indicate that laparoscopic surgery for colorectal carcinoma does not per se compromise surgical oncologic principles and encourages us to continue our critical appraisal of this technique.

Colectomy↗

PubMed1996

Sigmoid volvulus in pregnancy.

During pregnancy, intestinal obstruction due to sigmoid volvulus is extremely rare. Only 73 cases have been reported. A 24-year-old black woman, gravida 2, para 1, presented during Week 36 of an otherwise uneventful pregnancy, with intermittent abdominal pain and constipation, and no history of nausea, vomiting, fever, chills, previous medical problems, or prior abdominal surgery. Her previous pregnancy was a spontaneous vaginal delivery of a normal full-term neonate. On examination, she was afebrile, with abdominal tenderness. Laboratory studies revealed elevated WBC count of 13,500. She was admitted and given a Fleet enema, with no result or change in abdominal pain. Pain worsened; reexamination of her cervix revealed 3 cm dilation. After Pitocin augmentation, a viable male infant with Apgars of 7 and 9 was delivered. Postpartum, abdominal pain continued, with worsening abdominal distention. Radiograph revealed a massively distended colon. Physical examination 12 hours postdelivery indicated peritonitis. Exploratory laparotomy revealed volvulated, gangernous, massively distended sigmoid colon. The sigmoid colon was resected and Hartmann's colostomy performed. She was discharged on postoperative Day 4. Sigmoid volvulus complicating pregnancy is an uncommon and potentially devastating development that should be suspected with worsening abdominal pain and evidence of bowel obstruction. Prompt intervention is necessary to minimize maternal and fetal morbidity.

Adult↗

PubMed1996

Percutaneous endoscopic gastrostomy with T-bar fixation in children.

Percutaneous endoscopic gastrostomy (PEG) with the Ponsky "pull" technique has been the standard technique for pediatric gastrostomy tube placement since 1979. We evaluated safety and efficacy of PEG with the "push" technique and T-bar fixation. We reviewed PEGs performed in pediatric patients (< or = 17 years) over a 31-month period, excluding patients with previous abdominal surgery. We evaluated age, indications, location, time, and complications. Endoscopy was performed, the stomach insufflated, and the anterior abdominal wall transilluminated. T-bar fasteners were inserted percutaneously under endoscopic control. Fasteners were ejected from the needle tip with a stylet and secured. A 14 or 18 French gastrostomy tube was placed through the center of previously placed T-bar fasteners by using a modified Seldinger technique. Fifteen children (mean age, 9 years) underwent the procedure for the need for long-term enteral alimentation (severe closed head injury) (n = 7), for progressive neurologic dysfunction with feeding disorder (n = 7), or for failure to thrive (cystic fibrosis) (n = 1). No significant major postoperative complications occurred. The technique proved safe and effective for gastrostomy in children.

Adolescent↗

PubMed1994

Unilateral galactocele following augmentation mammoplasty.

Development of unilateral galactoceles following breast augmentation is reported in 2 young females. Both galactoceles were drained and cultured. In 1 patient the implant was removed and a delayed reinsertion was undertaken. In the second patient the implant was replaced at the time of the drainage procedure. Culture and sensitivity in 1 patient showed no growth and in the second patient revealed Staphylococcus aureus. Although the cause is unknown, galactocele formation may be due to manipulation of breast tissue during surgery. The use of oral contraceptives may also play a role in this process. Hormonal suppression of lactation and removal of the implants may be indicated in these patients. Consideration should be also given to the use of systemic antibiotics directed toward skin pathogens.

Adult↗

PubMed1994

Thyroglossal duct carcinoma.

The thyroid gland originates from the foramen cecum, and by 7 weeks gestation, descends ventrally in the midline of the neck. During its descent, a patent diverticulum, the thyroglossal duct, connects the gland to the base of the tongue. While the duct normally closes by the tenth gestational week, it is not uncommon to have all or a portion of the duct remain patent as a thyroglossal duct cyst or sinus. While these cysts are relatively common, thyroglossal duct carcinomas are very uncommon. They are generally of two types: squamous cell carcinoma arising from metaplastic columnar cells, and thyrogenic carcinoma arising from thyroembryonic rests in the duct or cyst. We report one case of each. The squamous cell carcinoma was resected via the Sistrunk procedure with no evidence of recurrence over a 10-year follow-up. The thyrogenic carcinoma (papillary type) was resected via the Sistrunk procedure with subsequent total thyroidectomy.

Adenocarcinoma, Papillary↗

PubMedDate not supplied

Airway control in trauma patients with cervical spine fractures.

INTRODUCTION: Proper airway control in trauma patients who have sustained cervical spine fracture remains controversial. PURPOSE: This study was undertaken to survey the preferred methods of airway management in cervical spine fracture (CSF) patients, to evaluate the experience of handling such patients at a level-I trauma center, and to contrast the findings with recommendations of the American College of Surgeons Committee on Trauma. HYPOTHESIS: The methods used for control of the airway in patients with fractures of their cervical spine support the recommendation of the American College of Surgeons (ACS) Committee on Trauma. METHODS: The study consisted of two parts: 1) a survey; and 2) a retrospective study. Survey questionnaires were sent to 199 members of the Eastern Association for the Surgery of Trauma and to 161 anesthesiology training programs throughout the United States. Three resuscitation scenarios were posed: 1) Elective airway--CSF--breathing spontaneously, stable vital signs; 2) Urgent airway--CSF--breathing spontaneously, unstable vital signs; and 3) Emergent airway--CSF--apneic, unstable. In addition, a three-year retrospective study was conducted at a level-I trauma center to determine the method of airway control in patients with cervical spine fractures. RESULTS: Responses to the questionnaires were received from 101 trauma surgeons (TS) and 58 anesthesiologists (ANESTH). Respondents indicated their preference of airway methods: Elective airway: Nasotracheal intubation: TS 69%, ANESTH 53%. Orotracheal intubation: TS and ANESTH 27%. Surgical airway: TS 4%. Intubation with fiberoptic bronchoscope (FOB): ANESTH 20%. Urgent airway: Nasotracheal intubation: TS 48%, ANESTH 38%. Orotracheal intubation: TS 47%, ANESTH 45%. Surgical airway: TS 4%. FOB: ANESTH 16%. Emergent airway: Orotracheal intubation: TS 81%, ANESTH 78%. Surgical Airway: TS 19%, ANESTH 7%. FOB: ANESTH 15%. The retrospective review at the trauma center indicated that 102 patients with CSF were admitted; 62 required intubation: four (6%) on the scene, seven (11%) en route, five (8%) in the emergency department, 42 (67%) in the operating room, and four (6%) on the general surgery floor. Airway control methods used were nasotracheal: 14 (22%); orotracheal: 27 (43%); FOB: 17 (27%); tracheostomy: one (2%); unknown: three (4%). No progression of the neurological status resulted from intubation. CONCLUSION: The choice of airway control in the trauma patient with CSF differs between anesthesiologists and surgeons. However, the method selected does not have an adverse affect on neurological status as long as in-line stabilization is maintained. The methods available are safe, effective, and acceptable. The recommendations of the American College of Surgeons Committee on Trauma for airway control with suspected cervical spine injury are useful. The technique utilized is dependent upon the judgment and experience of the intubator.

Anesthesiology↗