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S Eubanks

Publications and source records attributed to S Eubanks.

At least 19 recordsLinked to original sources
PubMed1999

Expression, folding, and thermodynamic properties of the bovine oxytocin-neurophysin precursor: relationships to the intermolecular oxytocin-neurophysin complex.

Earlier thermodynamic studies of the intermolecular interactions between mature oxytocin and neurophysin, and of the effects of these interactions on neurophysin folding, raised questions about the intramolecular interactions of oxytocin with neurophysin within their common precursor. To address this issue, the disulfide-rich precursor of oxytocin-associated bovine neurophysin was expressed in Escherichia coli and folded in vitro to yield milligram quantities of purified protein; evidence of significant impediments to yield resulting from damage to Cys residues is presented. The inefficiency associated with the refolding of reduced mature neurophysin in the presence of oxytocin was found not to be alleviated in the precursor. Consistent with this, the effects of pH on the spectroscopic properties of the precursor and on the relative stabilities of the precursor and mature neurophysin to guanidine denaturation indicated that noncovalent intramolecular bonding between oxytocin and neurophysin in the precursor had only a small thermodynamic advantage over the corresponding bonding in the intermolecular complex. Loss of the principal interactions between hormone and protein, and of the enhanced stability of the precursor relative to that of the mature unliganded protein, occurred reversibly upon increasing the pH, with a midpoint at pH 10. Correlation of these results with evidence from NMR studies of structural differences between the precursor and the intermolecular complex, which persist beyond the pH 10 transition, suggests that the covalent attachment of the hormone in the precursor necessitates a conformational change in its neurophysin segment and leads to properties of the system that are distinct from those of either the liganded or unliganded mature protein.

Animals↗
PubMed1999

Laparoscopic biliary and enteric bypass.

Very few patients with a periampullary neoplasm present with resectable disease. Consequently, various operative and non-operative techniques have been developed to palliate patients with unresectable periampullary disease. Laparoscopic biliary (cholecystojejunostomy) and enteric bypass (gastrojejunostomy) are reasonable options as compared to their open counterparts for operative palliation. However, only a limited number of carefully selected patients meet selection criteria for laparoscopic palliation.

Bile Duct Neoplasms↗
PubMed1999

Preface

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Journal Article↗
PubMed1999

Diagnostic laparoscopy outside of the operating room.

Laparoscopy is increasingly being used as a diagnostic technique to characterize intraperitoneal processes. This technique can be highly informative when applied in settings such as the intensive care unit, the emergency room, the trauma bay, and the office. Diagnostic laparoscopy is an excellent method to evaluate intraperitoneal processes and should be part of the general surgeon's armamentarium of skills. In this paper, the technique of diagnostic laparoscopy and its role outside of the operating room setting is reviewed. Diagnostic laparoscopy is also compared with other diagnostic modalities.

Contraindications↗
PubMed1997

Laparoscopic ventral and incisional hernioplasty.

BACKGROUND: While the first laparoscopic ventral hernia repair was reported in 1992, there have been no studies comparing laparoscopic to conventional ventral herniorrhaphy. METHODS: Twenty-one ventral hernias repaired laparoscopically are compared to a similar group of 16 patients undergoing traditional open repair during a 2-year period. Operative and hospital courses along with outcomes and cost analysis are analyzed. RESULTS: There was no statistical difference between groups in number of previous abdominal operations, prior hernia repairs, and comorbidities. Patients undergoing open repair were older with larger fascial defects. Open repairs had a shorter operative time as compared to the laparoscopic group, but statistically longer postoperative stays and costs. Postoperative complications occurred in 31% of the open group and 23% of the laparoscopic group. There were two recurrences in each group. CONCLUSIONS: Laparoscopic herniorrhaphy is as safe and effective as the traditional open technique with shorter length of stay and decreased hospital costs.

Adult↗
PubMed1997

Pneumonia I and Pneumonia II Projects.

The need for timely and efficient treatment is assuming even greater significance, with pneumonia discharges increasing from 5,862 in 1992 to 7,870 in 1994. These two projects, involving a total of 13 hospitals, evaluated the timeliness of antibiotic administration for pneumonia patients. Baseline data revealed opportunities for improving process of care at all hospitals. After implementation of improvement plans, the majority of hospitals increased the percentage of patients receiving antibiotics within four hours of admission. This evaluation of the antibiotic delivery system can also be adapted to other diagnoses and medications.

Anti-Bacterial Agents↗
PubMed1997

Laparoscopic colectomy. Prospects and problems.

This article provides a fundamental review of laparoscopic colectomies. An overview of the physiology of laparascopic procedures is given as an introduction to the rationale of laparoscopic colectomies. A review of the current published literature including indications and an overview of laparoscopic bowel procedures for malignant diseases are presented.

Anastomosis, Surgical↗
PubMed1996

Low insertion of hepatic segmental duct VII-VIII is an important cause of major biliary injury or misdiagnosis.

BACKGROUND: The importance of variant anatomy is only mentioned generally in most articles in this era of laparoscopic cholecystectomy. We report a series of 14 patients in whom a seemingly low insertion of hepatic segmental duct VII-VIII was clinically important. METHODS: The patients were managed at Duke University Medical Center. Two intraoperative videotapes of injury were reviewed. RESULTS: Three categories of patients were identified: 6 patients who had injury in association with another major injury to the biliary system, 7 patients who had an isolated VII-VIII system injury, and 1 patient with a Klatskin tumor in whom the unobstructed variant duct was stented. After appropriate evaluation, all patients were successfully treated. Several lawsuits resulted, even when the injury was seemingly minor. Symptoms developed in all patients who filed lawsuits, but none in those who did not. CONCLUSION: Appreciation of the VII-VIII biliary variant can lead to avoidance of injury or to a successful repair. The injury can easily occur despite "normal" cholangiography. Successful clinical outcome does not necessarily correlate with freedom from lawsuits.

Bile Duct Neoplasms↗
PubMed1996

Laparoscopic radical prostatectomy in the canine model.

The purpose of this study was to determine the feasibility of performing laparoscopic radical prostatectomy in a canine model. Laparoscopic radical prostatectomy was performed on six adult male canines. A new endoscopic needle driver was used to construct a secure vesicourethral anastomosis. Average operative time required to complete the procedure was 304 min (range 270-345 min). Dissection of the prostate gland took an average of 67 min (range 35-90 min), and construction of the vesicourethral anastomosis took 154 min (rage 80-240 min). There were no intraoperative complications and only one postoperative complication (anastomotic leak). Five of the six animals recovered uneventfully from the procedure, and their foley catheters were removed 10-14 days postoperatively after a retrograde cystourethrogram demonstrated an intact vesicourethral anastomosis. Four (80%) of the surviving animals were clinically continent within 10 days after catheter removal. Post mortem examination confirmed that the vesicourethral anastomosis was intact with no evidence of urine extravasation. These data demonstrate the feasibility of laparoscopic radical prostatectomy in a canine model, and suggest that additional work with this technique should be continued to develop its potential clinical application.

Animals↗
PubMed1996

Mechanisms of gastric and esophageal perforations during laparoscopic Nissen fundoplication.

OBJECTIVE: The purpose of this study was to determine possible mechanisms of 17 gastric and esophageal perforations that occurred during laparoscopic Nissen fundoplication. METHODS: Specific details of each perforation relating to mechanism of injury, surgeon experience, diagnosis, treatment, and outcome were obtained. For each perforation, an attempt was made to accurately determine the mechanism of perforation. RESULTS: Three mechanisms accounted for the 17 perforations, the majority of which occurred within the first ten laparoscopic Nissen fundoplications performed by the surgeon. Ten perforations resulted from injuries related to improper retroesophageal dissection, five occurred during passage of the bougie dilator or nasogastric tube, and two occurred after surgery secondary to suture pullthrough. Six patients received a delayed diagnosis, which adversely affected outcome. Most of the perforations were successfully managed by primary closure and wrap to include the repair. Morbidity was significantly increased for perforations recognized late. One death, attributed to sepsis, occurred in association with a delay in diagnosis. CONCLUSIONS: Gastric and esophageal perforations are serious complications of the new laparoscopic method of Nissen fundoplication. The mechanisms of these complications are specifically related to limitations of the laparoscopic technique. Prevention of these potentially lethal complications requires a full understanding of the detailed anatomy of the gastroesophageal region and awareness of the recognized mechanisms of perforation.

Adult↗
PubMed1995

Laparoscopic diagnosis and treatment of Morgagni hernia.

The application of new minimally invasive techniques in the diagnosis and treatment of surgically correctable diseases continues to produce impressive results. Herniae of the Foramen of Morgagni are unusual abdominal wall defects which have historically been difficult to diagnose. Interestingly, laparoscopy was utilized for the diagnosis and repair of three such herniae during a 5-month period. All of these repairs were performed by one primary author in conjunction with co-authors. In this report we will review this rare hernia and report our technique of repair. We believe that an aggressive approach to diagnostic laparoscopy may produce cost-effective solutions to old and new intraabdominal problems.

Adult↗
PubMed1995

Endoscopic surgery of the upper extremity.

Endoscopic techniques for surgery of the upper extremity show great promise based on recent discoveries of anatomic tissue planes. These planes can be dissected using new technology consisting of endoscopic balloons that create optical cavities that permit "incisionless" surgery. This article contains a review of the anatomic principles, new surgical technology, and development of endoscopic tools, as well as an example of endoscopic tissue expansion placement for soft-tissue augmentation in the upper extremity. Endoscopic techniques as they relate to fractures, synovectomy, and peripheral nerve decompression are discussed.

Arm↗
PubMed1995

1525 laparoscopic cholecystectomies without biliary injury: a single institution's experience.

Laparoscopic Cholecystectomy (LC) has become the preferred treatment of gallbladder disease. The indications for LC remain unchanged from those for open cholecystectomy (OC). A total of 1525 patients underwent LC at Georgia Baptist Medical Center between December 1989 and December 1992. The procedure was completed in 1,492 patients (97.8%) and required conversion to OC in 33 patients (2.2%). Selective intraoperative cholangiography was used in 165 patients (10.8%). Overall morbidity was 4.06%, and there were four deaths not operatively related, for a 0.26% mortality rate. There have been no biliary ductal injuries. The average hospital stay was 0.82 days, with 37.4% of the patients going home as true outpatients and 44.5% going home on postop Day one. Most published series on LC report a small incidence of biliary injury. We feel that with meticulous dissection of the cystic duct and use of selective intraoperative cholangiography to define unsure anatomy, biliary injury can be minimized.

Biliary Tract↗
PubMed1994

Improved technique of laparoscopic nephrectomy for multicystic dysplastic kidney.

We report removal of a multicystic dysplastic kidney with a laparoscopic technique that uses only three trocar sites. Additionally, we have found placement of a ureteral catheter and full mechanical and antibacterial bowel cleansing unnecessary. The role of this surgery in the management of multicystic dysplastic kidney is discussed.

Child, Preschool↗
PubMed1994

An institutional review of the management of choledocholithiasis in 1616 patients undergoing laparoscopic cholecystectomy.

At Georgia Baptist Medical Center, 1616 patients underwent laparoscopic cholecystectomy between December 1989 and December 1992; and 103 perioperative endoscopic retrograde cholangiopancreatography (ERCP) procedures were performed, 79 preoperative and 24 postoperative. Endoscopic sphincterotomy with stone extraction was performed in 49 patients (4.7%). Normal ERCP was noted in 46 patients (44%), four patients failed stone extraction preoperatively, and two patients failed extraction postoperatively (5.7%). Four patients had small stones (< 2 mm) managed expectantly without sphincterotomy. Ten laparoscopic common bile duct explorations and eight open common bile duct explorations were performed without retained stones after these procedures. The incidence of detected choledocholithiasis requiring intervention was 4.4 per cent, which is significantly lower than the published incidence of 8 to 15 per cent. It is assumed that a higher percentage of stones may have been detected with liberal or routine use of cholangiography. The clinical significance of these potentially missed stones have not been manifest in our series to date. The authors believe that although improved patient selection may lower the percentage of normal ERCP, this combination of minimally invasive techniques provides a satisfactory approach to choledocholithiasis.

Cholangiography↗
PubMed1993

Is laparoscopic herniorrhaphy an effective alternative to open hernia repair?

While the inguinal approach to hernia repair remains the standard of care, laparoscopic hernia repair techniques are rapidly evolving. The first 102 laparoscopic hernia repairs were reviewed. Reported herein are the types of hernias repaired, length of hospital stay, early recurrence rate, complications, and assessment of postoperative pain. The long-term recurrence rate has yet to be determined. From these results, it is felt that in select patients, laparoscopic hernia repair is an effective surgical alternative in the treatment of inguinal hernia.

Activities of Daily Living↗