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Results for “PERITONEOSCOPY”

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At least 325 records · Page 18Linked to original sources

PubMed1986

Estimated hepatic oxygen consumption in patients with chronic liver diseases as assessed by organ reflectance spectrophotometry.

We investigated the estimated hepatic oxygen consumption by reflectance spectrophotometry during peritoneoscopy and the rate of in vitro oxygen consumption of liver slices obtained by liver biopsy using the oxygen electrode apparatus in patients with chronic liver diseases. The estimated hepatic oxygen consumption decreased concomitantly with the decrease in blood supply, expressed as the regional hepatic blood hemoglobin concentration, and it was significantly decreased in cirrhosis compared to chronic hepatitis. The estimated hepatic oxygen consumption also was significantly correlated with the serum albumin level, 15-min retention rate of indocyanine green, and prothrombin time. There was no correlation between the estimated hepatic oxygen consumption calculated from the reflectance spectra and the rate of in vitro oxygen consumption measured by the oxygen electrode apparatus. Most cirrhotic liver slices had a respiratory rate comparable to that in chronic hepatitis. Thus, it is concluded that the reduction of estimated hepatic oxygen consumption in cirrhosis of the liver is mainly due to the reduction of oxygen supply secondary to the decrease of hepatic blood flow.

Adult↗

PubMed1985

Influence of ranitidine on hepatic blood flow assessed by organ-reflectance spectrophotometer and pulse-Doppler ultrasonic flowmeter.

The influence of the intravenous injection of ranitidine (50 mg) on hepatic hemodynamics was investigated in normal subjects and patients with chronic liver disease. Using the organ-reflectance spectrophotometer, the regional hepatic blood hemoglobin concentration (delta Er569-650), an indicator of the regional hepatic blood flow, and the oxygen saturation of hemoglobin in the regional hepatic tissue (So2) were measured in patients with chronic liver disease after ranitidine injection under peritoneoscopy. With the pulse-Doppler ultrasonic flowmeter, the portal blood flow was measured in patients with chronic liver disease and normal subjects. There were no significant changes in the regional hepatic blood flow, the oxygen saturation of hemoglobin, and the portal blood flow after the intravenous injection of ranitidine. Thus, it is concluded that usual dose of ranitidine has no significant influence on the hepatic blood flow and that it can be prescribed without reducing the hepatic blood flow.

Adult↗

PubMed1990

Primary peritoneal sarcoidosis.

A 14-year-old male was admitted for the evaluation of tense exudative ascites. Despite thorough evaluation, the diagnosis remained cryptic until peritoneoscopy revealed diffuse studding of the entire visualized peritoneum with multiple miliary nodules, and peritoneal biopsy demonstrated multiple noncaseating epithelioid granulomas. After other causes were excluded, a diagnosis of sarcoidosis was considered and confirmed with classic endobronchial findings at bronchoscopy. Involvement of the peritoneum with sarcoidosis is rare and, to our knowledge, only one other case describes this as the initial manifestation of this disease.

Adolescent↗

PubMed1994

A case of Aspergillus fumigatus peritonitis complicating liver transplantation.

A 55-year-old male underwent orthotopic liver transplantation for sub-fulminant hepatitis B/delta infection superimposed on probable genetic hemochromatosis with early cirrhosis. Pre-operatively, he demonstrated serologic evidence of cytomegalovirus reactivation and developed cytomegalovirus viremia when ganciclovir was discontinued post-operatively. His post-operative course was complicated by chronic ductopenic rejection, biliary anastomotic leak, and persistent confusion and malaise. At the time of laparotomy for repair of the bile leak, nodular peritoneal lesions were noted, with biopsy and culture showing angioinvasive Aspergillus fumigatus. Despite administration of amphotericin B, the patient continued to have culture-confirmed evidence of infection at follow-up peritoneoscopy. Oral itraconazole was begun, but the patient died of liver failure secondary to progressive ductolpenic rejection. At autopsy, Aspergillus organisms were seen in histologic sections taken from the small bowel; there was no evidence of disseminated disease.

Aspergillus fumigatus↗

PubMed1987

Tuberculous peritonitis in children.

Five cases of tuberculous peritonitis are presented with clinical and radiological features. The diagnosis was based on clinical and radiological findings. Peritoneoscopy and laparatomy was not performed in any of the cases. All the patients responded well to the anti-tubercular therapy.

Child↗

PubMed1991

Long-term intermittent administration of interferon-alpha in patients with chronic non-A, non-B hepatitis.

IFN-alpha was administered intermittently over a 6 month period in 39 patients with chronic non-A, non-B hepatitis confirmed by peritoneoscopy and liver biopsy. Three million units of IFN-alpha were administered 3 times a week for the first 6 months then twice, then once a week. In 26 patients (67%), GPT decreased and remained within the normal range during the course of administration, and in 9 patients (23%) GPT remained normal for over 6 months after the discontinuation of IFN-alpha. There was no significant difference of efficacy among 3 groups liver histology groups (CPH, CAH-2A, and CAH-2B), but GPT decreased significantly in patients with sporadic hepatitis compared to patients with a history of blood transfusion. Furthermore, GPT decreased significantly in patients with a history of a blood transfusion within the preceding 2 years compared to patients with a history of a blood transfusion over 7 years ago. GPT increased markedly after an early tapering to 2 doses weekly, but it did not increase after a 6 month administration. In conclusion, the long-term administration of 300 million unit IFN-alpha, 3 times weekly for 6 months, about 2.5 hundred million units in total, is thought to be an effective way to control chronic NANB hepatitis.

Adult↗

PubMed2006

Transgastric endoscopic splenectomy: is it possible?

BACKGROUND: We have previously reported the feasibility of diagnostic and therapeutic peritoneoscopy including liver biopsy, gastrojejunostomy, and tubal ligation by an oral transgastric approach. We present results of per-oral transgastric splenectomy in a porcine model. The goal of this study was to determine the technical feasibility of per-oral transgastric splenectomy using a flexible endoscope. METHODS: We performed acute experiments on 50-kg pigs. All animals were fed liquids for 3 days prior to procedure. The procedures were performed under general anesthesia with endotracheal intubation. The flexible endoscope was passed per orally into the stomach and puncture of the gastric wall was performed with a needle knife. The puncture was extended to create a 1.5-cm incision using a pull-type sphincterotome, and a double-channel endoscope was advanced into the peritoneal cavity. The peritoneal cavity was insufflated with air through the endoscope. The spleen was visualized. The splenic vessels were ligated with endoscopic loops and clips, and then mesentery was dissected using electrocautery. RESULTS: Endoscopic splenectomy was performed on six pigs. There were no complications during gastric incision and entrance into the peritoneal cavity. Visualization of the spleen and other intraperitoneal organs was very good. Ligation of the splenic vessels and mobilization of the spleen were achieved using commercially available devices and endoscopic accessories. CONCLUSIONS: Transgastric endoscopic splenectomy in a porcine model appears technically feasible. Additional long-term survival experiments are planned.

Animals↗

PubMed1982

Natural history of dysgerminoma.

Data on 56 patients with pure dysgerminoma are discussed. Forty-nine patients were classified as having new disease or were to have reassessment of disease, and seven cases were to be restaged (one with and six without clinical evidence of disease). Of new and reassessment cases, 44 patients underwent lymphography, 16 underwent peritoneoscopy with diaphragmatic inspection and 30 had peritoneal cytologic testing performed. Positive lymphography resulted in restaging in 31.6% of patients. Diaphragmatic inspection was always negative. Peritoneal cytologic testing was positive for malignant cells in three patients and worsened the stage in one. Pathologic staging of disease was as follows: Stage IA, 24; Stage IB, one Stage IC, one; Stage III peritoneal disease, two. Stage III retroperitoneal disease, 12; Stage III peritoneal and retroperitoneal disease; four. The 5-year relapse-free survival rates were 91% in patients with pathologic Stages IA, IB, and IC; 74% in those with Stage III retroperitoneal disease, and 24% in patients with Stage III peritoneal disease or peritoneal plus retroperitoneal disease. The results indicate that the prognosis is excellent for patients with Stage I and Stage III retroperitoneal disease whereas peritoneal involvement is associated with a poor prognosis.

Adolescent↗

PubMed1978

The role of percutaneous liver biopsy in the pretreatment evaluation of pancreatic adenocarcinoma.

Percutaneous liver biopsies were performed on twenty-two patients with locally unresectable adenocarcinoma of the exocrine pancreas within a median of six weeks of laparotomy. Three patients (13 per cent) had positive biopsies obtained either blindly or at peritoneoscopy. Of these three patients, two had elevations in either alkaline phosphatase, direct bilirubin, or hepatic transaminase levels, and one of these two patients had an abnormal liver-spleen scintigram. Liver biopsies are recommended for all patients being evaluated for pancreatic resection either pre- or intraoperatively.

Adenocarcinoma↗

PubMed1991

Ultrasonic tissue characterization of chronic liver disease using cepstral analysis.

To evaluate the morphological changes in chronic liver disease by means of ultrasonography, cepstral analysis was applied to the ultrasonic waveforms obtained with a 10-MHz transducer during peritoneoscopy. Assuming that liver tissue was a collection of semiregularly arrayed small scatters of ultrasound, the spaces between scatterers of the liver could be measured by means of cepstral analysis. From the distribution of the spaces between scatterers, two statistical parameters, mode and kurtosis, were determined for each patient. The mode of spaces between scatterers for liver cirrhosis was significantly larger than that for chronic hepatitis and nonspecific change. The mode of spaces between scatterers was correlated with the size of hepatic lobules or nodules. The kurtosis of spaces between scatterers for chronic hepatitis and liver cirrhosis was significantly smaller than that for nonspecific change. As a preliminary study for noninvasive application of this technique, cepstral analysis was also applied to the ultrasonogram obtained through the abdominal wall with a 3.5-MHz transducer. The results obtained with a 3.5-MHz transducer were correlated well with those obtained with a 10-MHz transducer. These results suggest the possibility of noninvasive evaluation of the structural changes in chronic liver disease.

Chronic Disease↗

PubMed1983

Improving peritoneoscopic staging of patients with solid tumors.

Peritoneoscopy and guided needle biopsy were carried out as the staging procedure in patients with solid tumors. The disease was disseminated in 379 patients with various tumor types and limited in 109 with breast cancer and malignant melanoma. Adequate liver biopsies were obtained in all cases. Macroscopic liver tumors were demonstrated in 96 patients. Eleven additional patients had peritoneal or mesenteric tumors with normal livers. Attempts were made to improve the yield of positive findings of the procedure. The cytologic examination of cells adhering to the needle after biopsy or optimizing visualization of the liver surface by using a fiberoptic gastroscope did not answer this purpose. A 7.2% increase in liver tumor detection was obtained by taking 4-6 biopsies at random or towards deep palpated nodules in macroscopically normal livers. The data, although difficult to interpret in terms of accuracy of the method, suggest that in solid tumors random samplings of normal livers could contribute to the diagnosis of otherwise undetectable liver metastases.

Biopsy, Needle↗

PubMed1986

Influence of surgical resection prior to chemotherapy on the long-term results in small cell lung cancer. A study of 150 operable patients.

The effect of surgical resection, prior to chemotherapy, on the long-term results obtained in treatment of operable patients with small cell lung cancer (SCC) was evaluated in a consecutive series of 874 patients treated with intensive combination chemotherapy with or without irradiation between 1973 and 1981. Evaluation of disease stage and operability was based on broncho-mediastinoscopy, chest X-ray, bone marrow examination, peritoneoscopy with liver biopsy and lung function tests. The same staging procedures were applied for restaging performed after 18 months of chemotherapy. The series comprised 440 patients with extensive disease and 437 with limited disease of whom 150 were regarded operable. Fifty-four operable patients received no thoracotomy because the treatment policy of SCC did not include surgery at the hospitals from which they were referred. These patients served as a reference with which data on operated patients were compared. Resections were performed in 52 patients while 44 were regarded to be irresectable at the thoracotomy. Thirty-six resections were regarded histologically complete while 16 patients proved to have microscopic (9 pts) or macroscopic (7 pts) residual tumor. The number and per cent of 30 months disease-free survivors in the various categories of the 874 patients were as follows: Completely resected, 12/36 patients (33%); Resected with residual tumor, 2/16 (12.5%); Operable but non-operated, 7/54 (13%); Irresectable, 3/44 (6.8%); Non-operable patients with limited disease, 15/284 (5.3%) and with extensive disease, 11/440 (2.5%). The similarity between rates of long-term survival observed in resected patients with residual tumor and operable, non-operated patients suggests that resection, per se, has no significant influence on long-term results in SCC. The relatively high rate of long-term survival in completely resected patients may therefore primarily be a result of early stage disease at the initiation of chemotherapy.

Carcinoma, Small Cell↗

PubMed2006

Peroral transgastric organ resection: a feasibility study in pigs.

BACKGROUND: The feasibility of peroral transgastric peritoneoscopy, liver biopsy, and tubal ligation has been demonstrated in prior animal studies. This approach has the potential to reduce postoperative morbidity. OBJECTIVE: To explore the technical challenges and complications of performing a transgastric organ resection. DESIGN: Two-week animal survival study. INTERVENTIONS: Five female Yorkshire pigs underwent peroral transgastric partial hysterectomy. With the animals under general anesthesia, a sterile esophageal overtube was placed and a gastric antibiotic lavage was performed. Subsequently, a needle-knife and through-the-scope dilating balloon were used to make an anterior gastric wall incision through which a therapeutic gastroscope was advanced into the peritoneal cavity. Endoscopes and instruments previously had been disinfected in a 2.4% glutaraldehyde bath or were disposable. An endoloop and polypectomy snare were used to resect a portion of the uterus, which was removed through the mouth. Gastric incision closure was attempted with endoclips. After 2 weeks of observation, necropsy was performed. RESULTS: Transgastric partial hysterectomy was performed on all 5 animals. One animal became lethargic and febrile, so necropsy was performed on day 4. An incompletely closed gastric incision and suppurative peritonitis were found. A second animal developed a fever; necropsy performed on day 14 revealed a gastric abscess at the incision site and scattered abdominal pus. No complications were encountered in the 3 remaining animals, and necropsy revealed well-healed gastric incisions and no evidence of peritonitis. CONCLUSION: Endoscopic transgastric partial hysterectomy is technically feasible in a porcine model. Strict sterility seems mandatory but cannot always be assured. Incomplete closure of the gastric incision may lead to significant complications.

Animals↗

PubMed2006

Robotic repair of vesicovaginal fistula: case series of five patients.

OBJECTIVES: To describe a technique of robotic repair of vesicovaginal fistula (VVF) and present our experience with 5 such patients. METHODS: A total of 5 patients were diagnosed with posthysterectomy (n = 4) or postmyomectomy (n = 1) VVF. All patients were first treated conservatively with continuous drainage using a Foley catheter without any success. After 12 weeks, these patients underwent robotic repair of the VVF. The steps of the technique of robotic repair are (a) vaginoscopy, (b) cystoscopy, (c) bilateral ureteral catheterization, (d) placement of ports for robotic repair, (e) peritoneoscopy, (f) lysis of adhesions, (g) incision of the bladder and cystotomy in reverse tennis racquet fashion encircling the fistula, (h) excision and freshening of the fistulous margins after complete separation of the bladder from the vagina, (i) closure of the vaginal opening horizontally and bladder opening vertically with interrupted Vicryl sutures, and, finally, (j) interposition of the omentum between these suture lines. RESULTS: Fistula repair was successful in all cases, with a mean operative time (from cystoscopy to the end of the procedure) of 233 minutes (range 150 to 330) and estimated blood loss of less than 70 mL. The length of hospital stay was a mean of 5 days (range 4 to 7). The Foley catheter was removed on the 10th postoperative day after voiding cystourethrography. At 6 months of follow-up, these patients continued to void normally without any recurrence of VVF. CONCLUSIONS: These data suggest that robot-assisted VVF repair is feasible and results in lower morbidity, a shorter hospital stay, and a quicker recovery. The minimally invasive approach of robot-assisted VVF repair may be a more attractive option for patients with VVF.

Adult↗

PubMed1981

Hysterosalpingo-radionuclide scintigraphy (HERS).

A radionuclide procedure, hysterosalpingo-radionuclide scintigraphy (HERS), was designed to evaluate the migration of a particulate radioactive tracer from the vagina to the peritoneal cavity and ovaries as well as to image and functionally outline the patency of the pathways between these two extremes of the female reproductive system. Technetium-99m human albumin microspheres (99mTc-HAM) were deposited in the posterior fornices of patients who were divided into two specific groups. Group I consisted of patients who were to undergo different elective gynecologic operations, in which besides obtaining sequential images, radioactivity levels were measured in the removed organs and tissues. Group II consisted of patients referred by the Infertility Clinic for evaluation of their reproductive system pathways patency. In this latter group, HERS was compared with contrast hysterosalpingography (HSG) and peritoneoscopy (PCP). The results obtained from measurements of radioactivity levels on the removed surgical specimens and comparison with other conventional gynecologic diagnostic procedures provide accurate evidence of the migration of 99mTc-HAM from the vagina, through the uterus and tubes, to the peritoneal cavity and ovaries, and show that HERS is a simple noninvasive method for functionally imaging and assessing the patency of the female reproductive system pathways.

Female↗

PubMed1992

Frontiers of operative laparoscopy: a review and critique of the evidence.

OBJECTIVE: This report reviews the evidence supporting the use of operative laparoscopy for a number of expanded indications in gynecology. STUDY DESIGN: Studies published in English were identified through a Medline search back to 1966 for literature listed under the medical subject heading of "peritoneoscopy"; this search was supplemented by reviews of reference lists and discussions with experts. RESULTS: Fair evidence exists to recommend use of laparoscopy for ectopic pregnancy, ovarian biopsy, and treatment of polycystic ovarian syndrome resistant to clomiphene citrate therapy. Evidence concerning other indications is inadequate to allow recommendations. CONCLUSIONS: Mechanisms are urgently needed to evaluate surgical innovations in gynecology with the same degree of scientific rigor currently afforded medical innovations. Without surgical technology assessment, the current double standards in gynecologic therapy will persist.

Abscess↗

PubMed2005

Peroral transgastric endoscopic ligation of fallopian tubes with long-term survival in a porcine model.

BACKGROUND: We have previously reported the feasibility and safety of the peroral transgastric endoscopic approach for diagnostic peritoneoscopy, liver biopsy, and gastrojejunostomy with long-term survival in a porcine model. This approach eliminates incisions of the abdominal wall, providing a less invasive alternative to diagnostic and therapeutic laparoscopy. We now report successful performance of peroral endoscopic transgastric ligation of Fallopian tubes with long-term survival in a porcine model. METHODS: Six female 50-kg pigs had general anesthesia and irrigation of the stomach with an antibiotic solution. Gastric puncture was performed with needleknife electrocautery followed by balloon dilatation of the tract with 20-mm TTS dilating balloon (Microvasive). A standard upper endoscope that underwent high-level disinfection and gas sterilzation was advanced into the peritoneal cavity through a sterile overtube. Both Fallopian tubes were identified and one was ligated using Olympus Endoloops. The other patent tube served as a control. Tubal patency was evaluated by hysterosalpingogram before and after ligation. After a follow-up period of 2-3 weeks, the pigs were sacrificed for postmortem examination. RESULTS: The Fallopian tubes were easily accessed, identified and ligated in all 6 pigs. In each pig, fluoroscopy confirmed complete obstruction of the ligated tube with preserved patency of the other tube. All pigs survived well and ate heartily without any ill-effects. Postmortem examination did not reveal any peritonitis or intra-abdominal adhesions. The Endoloops were in place with complete obstruction of the ligated tubes and patency of the controls. Histopathologic examination of the tubes showed chronic inflammatory infiltrates without abscesses. CONCLUSIONS: The peroral endoscopic transgastric approach to ligation of the Fallopian tubes with long-term survival is technically feasible and safe in a porcine model. The endoscopic transgastric approach to the peritoneal cavity has potential for a wide array of diagnostic and therapeutic procedures.

Animals↗

PubMed1987

Peritoneoscopic findings in 203 patients with Opisthorchis viverrini infection.

A study was conducted to determine the value of peritoneoscopy in the diagnosis of opisthorchiasis. Peritoneoscopic findings in 203 proven cases of Opisthorchis viverrini infection are presented. The authors found that cholangiocarcinoma is frequently encountered in patients presenting with prolonged jaundice and hepatomegaly as well as with the peritoneoscopic findings of dilated superficial intrahepatic bile ducts, a bile-stained liver surface and a markedly enlarged gallbladder.

Adult↗