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Biomedical subjects

W G Mouton

Publications and source records attributed to W G Mouton.

13 recordsLinked to original sources
PubMed2005

A randomised trial of ultrasonic dissection versus electrocoagulation to reduce lymphatic complications after surgery for recurrent sapheno-femoral incompetence.

OBJECTIVE: Prospectively to compare lymphatic drainage after ultrasonic dissection, an electrocoagulation technique and sharp dissection in the groin during surgery for recurrent sapheno-femoral incompetence. DESIGN: Prospective, randomised study comparing three surgical techniques. METHODS: Thirty-six consecutive patients undergoing surgery for recurrent sapheno-femoral incompetence were randomised. Twelve patients underwent dissection with ultrasound, 12 with electrocoagulation and 12 controls had sharp dissection with ligation of scar and lymphatic tissue using absorbable suture material. RESULTS: The mean drain output per patient was 13.5 ml in the ultrasonic group, 15.4 ml in the electrocoagulation group and 8.3 ml in the suture ligation group. Six minor cases of lymphatic leakage occurred in the ultrasonic group. This resulted in no clinical problem. There were no other significant differences between the three groups. CONCLUSIONS: There is no detectable advantage for the use of ultrasound or electrocoagulation in recurrent saphenous high ligation compared to sharp dissection.

Adult↗
PubMed2005

Follow-up after deep venous thrombosis in azygos continuation.

BACKGROUND: To determine the sequelae of patients after deep venous thrombosis inpatients with azygos continuation defined as agenesis of the inferior vena cava with collateral flow. PATIENTS AND METHODS: Five patients post deep venous thrombosis in the context of azygos continuation were followed up clinically and with colour duplex ultrasonography. RESULTS: All five patients had to our knowledge after the initial deep venous thrombosis no further thromboembolic events. Three patients after isolated iliac thromboses are symptom free or nearly symptom free, two after more extended thromboses still sufferfrom venous claudication. Four patients are without anticoagulation, one patient is permanently orally anticoagulated. CONCLUSIONS: Azygos continuation may not influence the risk of recurrent venous thrombo-embolism nor the outcome of a deep venous thrombosis. Careful deep venous thrombosis prophylaxis in patients with azygos continuation may be sufficient when a risk factor is present but conclusions lack due to the small numbers of patients of enough supportive data.

Adult↗
PubMed2003

Morbidity in superficial thrombophlebitis and its potential surgical prevention.

Thrombophlebitis is a common condition which can lead to deep venous thrombosis (DVT) and subsequent pulmonary embolism (PE). Thrombophlebitis can reach the deep venous system via the long or short saphenous vein or via perforating veins. Between the 1st of January 1999 and the 31st of December 2000 a total of 17 cases of superficial (or ascending) thrombophlebitis closer than 5 cm to the deep venous system were surgically treated in our clinic. 14 times the long saphenous vein was affected and 3 times the short-saphenous vein. The age of the nine females and seven males ranged from 31 to 77 (mean of 54.6) years. Duplex ultrasound was performed in all patients. In the case of a deep venous thrombosis (four cases) a computer tomography scan (CT) of the pelvis and abdomen was performed to define the extension of DVT. In all 17 (100%) cases a high ligation (crossectomy) and in four (23.5%) cases a venous thrombectomy was performed. In all of these four cases the DVT was limited to the common femoral vein. In all seventeen procedures including venous thrombectomy there was no mortality and no relevant morbidity. Mean hospitalization time was 3.1 days for crossectomy with thrombectomy, and 1.8 days for crossectomy alone. Follow-up has been so far uneventful (mean follow-up time being 12 months in the case of a DVT). In the literature there is no clear concept of how to treat, conservatively or operatively, ascending thrombophlebitis. The surgical procedure can be performed under local anesthesia, and it is safe and efficient.

Adult↗
PubMed2001

A randomized controlled trial to determine the effect of humidified carbon dioxide (CO2) insufflation on postoperative pain following thoracoscopic procedures.

BACKGROUND: It has previously been shown that the insufflation of humidified gas during laparoscopy results in less postoperative pain than is observed following the use of dry gas. Experimental evidence also suggests that dry gas insufflation during thoracoscopy results in greater structural injury to the pleura than occurs with the use of humidified gas. The present study was designed to determine the effect of humidified gas insufflation on postoperative pain following thoracoscopic procedures. METHODS: Forty consecutive patients were prospectively randomized. Twenty patients were insufflated with humidified carbon dioxide (CO(2)), and 20 control patients received standard dry CO(2). RESULTS: The patients' analogue pain score was significantly lower following humidified gas insufflation compared to dry gas insufflation when assessed at 6 h postoperatively, as well as on the 1st, 2nd, 3rd, and 14th postoperative days. The postoperative morphine consumption was lower in the humidified group than it was in the control group. The incidence of respiratory complications was identical for both groups. CONCLUSION: The use of humidified gas appears to reduce postoperative pain but not the rate of respiratory complications.

Anesthesia, Inhalation↗
PubMed2001

Proximalized lateral tunnel for the bypass to the dorsalis pedis artery -- a safe way to go.

BACKGROUND: Wound complications associated with bypass grafting to the dorsalis pedis artery are frequent, and threaten the viability of the bypass and the limb. METHODS: The long saphenous vein can be tunneled from its bed down the lateral side of the anterior margin of the tibia for subsequent anastomosis with the dorsalis pedis artery. CONCLUSION: The proximalized lateral tunnel for the bypass to the dorsalis pedis artery has the advantage of protecting the bypass graft from exposure if the patient develops wound breakdown.

Anastomosis, Surgical↗
PubMed1999

Bronchial anatomy and single-lung ventilation in the pig.

PURPOSE: To explore why two pigs died in the course of a study in which a double-lumen tube (DLT) was used to achieve single-lung ventilation, the bronchial anatomy of all six pigs involved in the study was examined at autopsy. METHODS: Autopsy involved examination of the lungs in situ and subsequent dissection of the lung tissue from the lobular bronchi. RESULTS: All six pigs were found to have an apical lobe (or lobular) bronchus arising from the trachea. In three it was on the right, as is usual in pigs, and in three, including the two that died, it was on the left. The mainstem bronchi to both lungs were short in all pigs, with major segmental bronchi arising just distal to the carina. CONCLUSION: The bronchial anatomy of the pig is such that the inflated cuffs of commercially available DLTs may cause partial or complete obstruction of the apical bronchi of one or both lungs, regardless of the side of the tracheal bronchus. The transmission of the resulting breath sounds across the narrow pig thorax can make auscultation unhelpful in assisting with optimal tube placement.

Animals↗
PubMed1999

A randomized controlled trial assessing the benefit of humidified insufflation gas during laparoscopic surgery.

BACKGROUND: We conducted a randomized controlled trial during laparoscopic cholecystectomy to determine the extent of heat preservation and postoperative pain reduction using humidified carbon dioxide (CO2) gas insufflation instead of standard dry insufflation gas. METHODS: Forty consecutive patients were randomized. Twenty patients received humidified CO2, and 20 control patients received standard CO2 insufflation. A sample of 16 patients from each group was evaluated for postoperative pain levels. RESULTS: No adverse effects from the humidification of insufflated gas were observed. There was no significant difference in core body temperature between the two groups for this brief operation. Pain, as assessed by the Analogue Pain Score (APS) was significantly less for the group with humidified gas insufflation than for the control group at 6 h postoperatively as well as on the 1st, 2nd, and 3rd postoperative day and at follow-up 10 days after the operation. In the humidified group, the mean time to return to normal activities was significantly less-5.9 days, as compared to 10.9 days in the control group. CONCLUSIONS: The use of humidified insufflation gas reduces postoperative pain following laparoscopic cholecystectomy, but except for these relatively brief procedures, the heat-preserving effect of humidified gas insufflation is not significant.

Adult↗
PubMed1999

A randomized controlled trial to determine the effects of humidified carbon dioxide insufflation during thoracoscopy.

BACKGROUND: The humidification of gas insufflated during laparoscopy can reduce the degree of postoperative hypothermia and may result in less peritoneal reaction and less postoperative pain. The present study was designed to determine whether the beneficial effects of humidified gas insufflation also applied to thoracoscopy. METHODS: Six pigs were each studied on three separate occasions with insufflation into the right thoracic cavity of either humidified gas, standard dry gas, or with no insufflation (control procedure). Core body temperature was recorded every 15 min, and biopsies of the parietal pleura were taken at the end of each study for electron microscopy. RESULTS: Humidification of insufflated gas significantly minimized the fall in core temperature during the procedure. Electron microscopy showed that dry gas insufflation resulted in greater structural injury to the pleura than humidified gas insufflation. CONCLUSIONS: The potential benefits of humidifying insufflation gas during thoracoscopy warrant its evaluation in the clinical setting.

Analysis of Variance↗
PubMed1999

Pain after laparoscopy.

BACKGROUND: In the context of the much-heralded advantages of laparoscopic surgery, it can be easy to overlook postlaparoscopy pain as a serious problem, yet as many as 80% of patients will require opioid analgesia. It generally is accepted that pain after laparoscopy is multifactorial, and the surgeon is in a unique position to influence many of the putative causes by relatively minor changes in technique. METHODS: This article reviews the relevant literature concerning the topic of pain after laparoscopy. RESULTS: The following factors, in varying degrees, have been implicated in postlaparoscopy pain: distension-induced neuropraxia of the phrenic nerves, acid intraperitoneal milieu during the operation, residual intra-abdominal gas after laparoscopy, humidity of the insufflated gas, volume of the insufflated gas, wound size, presence of drains, anesthetic drugs and their postoperation effects, and sociocultural and individual factors. CONCLUSIONS: On the basis of the factors implicated in postlaparoscopy pain, the following recommendations can be made in an attempt to reduce such pain: emphathically consider each patients' unique sociocultural and individual pain experience; inject port sites with local anesthesia at the start of the operation; keep intra-abdominal pressure during pneumoperitoneum below 15 mmHg, avoiding pressure peaks and prolonged insufflation; use humidified gas at body temperature if available; use nonsteroidal anti-inflammatory drugs at the time of induction; attempt to evacuate all intraperitoneal gas at the end of the operation; and use drains only when required, rather than as a routine.

Humans↗
PubMed1999

Rationale and intended use for the Veress needle: a translation of the original descriptive article.

The technical development of equipment in the last decade has resulted in a rapid expansion in the range of procedures capable of being performed safely by a laparoscopic technique. For many procedures, the first step is induction of a pneumoperitoneum. This has inherent danger, and there is disagreement on the preferred technique. The Veress needle is an instrument developed in the 1930s that has continued to be used into the 1990s. In view of the controversy about its present role, the authors reviewed the article that provided the original description of the needle. This review demonstrates that the designer had a clear intention for its use and an understanding of the hazards involved. In his hands, the complications were few. A translation of the article from German into English is provided.

Equipment Design↗
PubMed1998

Looking back to the advent of modern endoscopy: 150th birthday of Maximilian Nitze.

This year, 1998, marks the 150th anniversary of the birthday of Maximilian Nitze (1848-1906), a German scientist responsible for the initiation of modern endoscopy: He integrated two of his ideas in the construction of the first functional cystoscope. Nitze realized that the field of view during endoscopy could be enlarged by the use of an optical system, and that the light source should be placed on the tip of the instrument. He presented this cystoscope on October 2, 1877 for the first time, at age 28 years.

Cystoscopes↗
PubMed1998

A large duplication cyst of the stomach in an adult presenting as pancreatic pseudocyst.

Intestinal duplication is a rare congenital disease. It appears throughout the gastrointestinal tract, especially in the ileum. Here we describe the rare case of a gastric duplication cyst in a 59-year-old patient. Diagnostic findings and surgical therapy are discussed. Gastric duplications in adults are extremely rare, and diagnosis is often missed. Symptoms are unspecified pain in the upper abdomen, vomiting and fever, with some patients having weight loss. Complications are rare. Chronic infections and ruptures are described. For diagnosis, CT scan with oral contrast is preferred. Endoscopy is negative in most cases. Therapy is surgery. Local excision of a small wall of gastric mucosa is sufficient in most cases, but sometimes a subtotal gastrectomy is necessary.

Cysts↗