Can we use the bladder to estimate intra-abdominal pressure?
Explore the source record for details and available documents.
Abdomen↗
Biomedical subjects
S Johna
Publications and source records attributed to S Johna.
Carotid endarterectomy for severe asymptomatic carotid stenosis: a perioperative experience at a community hospital.
The purpose of this study was to evaluate the safety and feasibility of carotid endarterectomy (CEA) for severe asymptomatic carotid stenosis in a community setting with direct surgical resident participation. The medical records of all patients who had undergone CEA for severe asymptomatic carotid stenosis between 1989 and 1997 were retrospectively reviewed to ascertain perioperative morbidity and mortality. One hundred forty-seven CEAs were performed on 131 patients over the 8-year interval. Perioperative stroke and death rate was 0 per cent. However, one patient had a postoperative transient ischemic attack, and one patient had vocal cord dysfunction due to vagus nerve injury (1.3%). Three other patients had perioperative complications not directly related to CEA (2.1%). Therefore the total perioperative complication rate of (3.4%) compares favorably with results reported by several large tertiary referral centers. CEA for severe asymptomatic carotid stenosis can be safely performed in a community hospital setting with direct surgical resident participation.
Aged↗
Abdominal compartment syndrome: does intra-cystic pressure reflect actual intra-abdominal pressure? A prospective study in surgical patients.
BACKGROUND: Abdominal compartment syndrome is defined as the adverse physiologic effects of increased intra-abdominal pressure. Prolonged, unrelieved pressure may lead to respiratory compromise, renal impairment, cardiac failure, shock, and death. Abdominal compartment syndrome is diagnosed by measuring intra-cystic pressure as a reflection of intra-abdominal pressure. To examine the validity of the technique, we conducted a prospective study in surgical patients by directly measuring bladder and abdominal pressures simultaneously during laparoscopic cholecystectomy using a previously described technique. RESULTS: In the present model, the bladder had higher baseline pressures than did the abdomen. Measurements across the bladder wall were not identical, but had high positive correlation coefficient when evaluated on an individual basis. Global analysis of the data for all patients showed a weak correlation coefficient. CONCLUSION: In the present study model, intra-cystic pressure did not reflect actual intra-abdominal pressure. In spite of some limitations in the study design, we feel that further research is warranted to identify other possible variables that may play a role in the relationship between the urinary bladder and the abdominal cavity pressures, providing better means for diagnosis of abdominal compartment syndrome.
Journal Article↗
Minimally invasive aortic valve replacement.
During a consecutive 12-month period from January 1996 to January 1997 inclusive, 108 aortic valve replacements were performed by one group of surgeons in two community hospitals The majority of the valve replacements were done in combination with other procedures or were redo surgeries. Thirty-one patients had primary isolated aortic valve replacement. Fourteen patients underwent aortic valve replacement via a standard sternotomy, and seventeen patients underwent aortic valve replacement using a minimally invasive parasternal approach, as described by Dr. Cosgrove. There were no operative deaths in either group; however there was one hospital death in each of the two groups. Blood loss and postoperative pain were less in the minimally invasive group. Although the cross-clamp times were longer in the minimally invasive group, with a mean of 82.7 min as compared with 63.1 min in the standard group, the length of stay was shortened, with a median of 5 days in the minimally invasive group as compared to 7 days in the sternotomy group. In the follow-up which ranges from 4-15 months, all patients in the minimally invasive group were New York Heart Class I or II. Patients with the parasternal incisions are permitted to return to work much earlier than those with a standard sternotomy incision. The decreased blood loss and postoperative pain, combined with the anticipated ease of re-entry via a median sternotomy in the future (should redo aortic valve replacement become necessary), make this approach our procedure of choice in isolated primary aortic valve replacement.
Aged↗
Laparoscopic evaluation of lymphoma.
Surgeons are involved in the diagnosis and staging of patients with lymphoma. Treatment requires accurate information about histologic classification and the extent of disease. While most patients with non-Hodgkin's lymphoma are treated with systemic chemotherapy, the exact stage of disease in patients with Hodgkin's lymphoma may determine the therapy to be used. The use of minimally invasive surgery in surgical staging of patients with Hodgkin's disease has the potential to decrease the morbidity and mortality of the staging procedure in these patients. All of the components of a staging procedure (liver biopsies, splenectomy, lymph node biopsies, and oophoropexy) can be performed laparoscopically. The procedure is performed with the patient in the supine position. After obtaining several liver biopsies, the splenectomy is completed. Lymph nodes are then sampled from the celiac, portal, iliac, and peri-aortic regions. Lymph nodes identified as abnormal on pre-operative imaging studies are identified and excised. While each of these procedures is technically challenging, the laparoscopic conduct of this diagnostic procedure may afford patients decreased post-operative morbidity and mortality.
Biopsy↗
Laparoscopic-assisted lumboperitoneal shunt: a simplified technique.
OBJECTIVES: Lumboperitoneal shunt has been advocated as a better alternative to ventriculoperitoneal shunt in communicating hydrocephalus. To minimize the morbidity of subcutaneous tunneling or an open abdominal wound, we developed a simplified technique for laparoscopy-assisted placement of lumboperitoneal shunts. METHODS: Patients deemed candidates for lumboperitoneal shunts underwent laparoscopy-assisted lumboperitoneal shunt placement. Using a Tuohy needle, the neurosurgeon obtains access to the lumbar subthecal space. Simultaneously, the laparoscopist obtains access to the peritoneal cavity with two 5-mm ports for the take down of the descending colon, clearing the way for the passage of the shunt passer from the back into the peritoneal cavity. RESULTS: Over the last 5 years, 45 patients have undergone laparoscopy-assisted lumboperitoneal shunt placement. Patients have been followed with neuropsychiatric examinations, imaging studies, and repeated neurological examinations. No complications related to the laparoscopy have occurred. Neurosurgical complications included postural headaches caused by overdrainage in 4 patients requiring laparoscopic modification of the shunt slit and in 1 patient with acquired Arnold-Chiari I malformation. CONCLUSION: Laparoscopy-assisted lumboperitoneal shunt offers many advantages over percutaneous ventriculoperitoneal or laparoscopic transabdominal lumboperitoneal shunts. The procedure can be performed in less than 30 minutes by any practicing laparoscopist.
Cerebrospinal Fluid Shunts↗
Video-assisted thoracic surgery: applications and outcome.
Thoracoscopy has been revived and expanded by recent improvements in endoscopic technology. The enhanced application and outcome of VATS (video assisted thoracic surgery) was retrospectively studied. Between 1992 and 1995, 82 patients underwent diagnostic thoracoscopy or interventional VATS. Indications included: shortness of breath with nonspecific x-ray abnormality (45%), pulmonary nodule (25%), pleural effusion/empyema (21%), pneumothorax (14%), and hemoptysis, chronic cough or lung consolidation (5%). Sixty-six (83%) of the procedures were completed thoracoscopically. Eight procedures (10%) required addition of a utility mini-thoracotomy and 6 procedures (7%) were converted to formal thoracotomy. Specific diagnostic and/or therapeutic applications of VATS included: inspection; lysis of adhesions; stapling of blebs; biopsy of lung, pleura, or mediastinal structures; drainage and decortication of empyema; mechanical and chemical pleurodesis; wedge resection; and segmental resection. Diagnosis was established and/or treatment completed in 95% of cases. Pathologic diagnoses included: interstitial pneumonitis (22%), cancer (19%), bullous disease (15%), cocci nodule (9%), and other (18%). There were twenty-two complications (28.9%) and four deaths (4.8%). All four deaths were from causes unrelated to the surgery. The most common complications were: residual pneumothorax or hydrothorax (7), failed pleurodesis (3), and prolonged incisional pain (2). The advantage of reduced chest wall and muscle trauma utilizing VATS as opposed to traditional thoracotomy translates to less patient discomfort. The excellent magnified visualization afforded by VATS offers the opportunity to successfully conduct diagnostic and therapeutic interventions in the chest with equal or better visibility. Our findings suggest that the applicability and success of VATS is greatly expanding and its complication rate is less or, at worst, comparable to traditional thoracotomy.
Adolescent↗
Laparoscopic management of gallbladder disease in children and adolescents.
BACKGROUND: Between July 1991 and April 1996, 40 children and adolescents age 17 or less underwent laparoscopic management of their gallbladder disease. Twenty-eight patients were females and 12 were males. Their average age was 12.7 years (range 2-17 years), and average weight was 50 kilograms, range 12.2-95.9 kilograms. Nine patients had gallstone pancreatitis and seven patients had sickle cell disease. Laparoscopic cholecystectomy was attempted in all patients with or without modifications of the standard technique dictated by the size of the patient. METHODS: The practice of intraoperative cholangiogram varied with the practicing surgeon. Those with clinical or biochemical evidence of common bile duct obstruction underwent preoperative endoscopic retrograde cholangiopancreatography to rule out other causes of hyperbilirubinemia and/or therapy for choledocholithiasis if present. Patients with unsuccessful intraoperative cholangiogram were followed clinically and were subjected to postoperative endoscopic retrograde cholangiopancreatography should they develop clinical or biochemical evidence of common bile duct obstruction. Thirty-six patients were completed laparoscopically (90%). Four patients were converted to open cholecystectomy (10%). Four patients required preoperative endoscopic retrograde cholangiopancreatography and were successfully treated. Postoperative endoscopic retrograde cholangiopancreatography was unsuccessful in one patient who required the procedure because of retained common bile duct stone. Four patients suffered complications (10%). Three patients continued to have abdominal pain that was not helped with surgery. CONCLUSIONS: Based on our experience, laparoscopic cholecystectomy with preoperative endoscopic retrograde cholangiopancreatography if required, is safe and effective in management of gallbladder disease in children and adolescents. However, careful preoperative evaluation is required to avoid persistent postoperative abdominal pain.
Adolescent↗