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At least 361 records · Page 20Linked to original sources

PubMed2001

Video-assisted neck exploration for primary and secondary hyperparathyroidism: initial experience.

BACKGROUND: Minimally invasive surgery (MIS) for primary hyperparathyroidism includes unilateral neck exploration, access via a totally endoscopic approach, and access via a video-assisted procedure. We report herein our initial experience with the video-assisted neck exploration procedure for primary (PHPT) and secondary hyperparathyroidism (SHPT). METHODS: Between June 1999 and May 2000, 35 patients were selected for PHPT (n = 25) and SHPT (n = 10). In all cases, video-assisted neck exploration was performed under general anesthesia, leading to selective adenoma removal in PHPT or subtotal parathyroid resection in SHPT. Patient selection was based on the preoperative localization studies (ultrasonography and sestamibi scintigraphy). RESULTS: Five of the 25 patients operated on for PHPT (20%) and three of the 10 patients who underwent surgery for SHPT (30 %) were converted to a conventional surgical technique. The mean operative times in PHPT and SHPT were 48.9 +/- 18.7 min and 136.8 +/- 18.7 min, respectively. The recurrent laryngeal nerve was identified in 45% of the patients. The median size and weight of the resected parathyroid glands were 1.8 cm (range, 0.9-2.5) and 1 g (range, 0.5-7), respectively. The length of skin incision was 24 +/- 1.2 mm. All but one patient are currently cured, with a median follow-up of 6 months (range, 2-13). Postoperative complications included hematoma and transient hoarseness in one patient each (2.85%). The median pain intensity, based on the visual analogue scale (VAS) method, as measured at postoperative day 1 was 0.5 (range, 0-3.6). In the PHPT group, the postoperative hospital stay was

Adult↗

PubMed1997

Transcystic biliary decompression after direct laparoscopic exploration of the common bile duct.

BACKGROUND: A purpose-designed transcystic common bile duct (CBD) decompression cannula is described for use as an alternative to T-tube insertion following laparoscopic direct CBD exploration. This permits safe primary closure of the choledochotomy. METHODS: Following direct supraduodenal laparoscopic clearance of large common bile duct stones, the biliary decompression cannula is inserted percutaneously inside its peel-away sheet over a guide-wire into the CBD via the cystic duct. When in place, the cannula is secured to the cystic duct by two catgut extracorporeal Roeder knots and the choledochotomy is then closed. The terminal multiperforated S-shaped segment of the Cuschieri biliary decompression cannula prevents postoperative dislodgement. RESULTS: Transcystic decompression of the extrahepatic biliary tract using the Cuschieri cannula has been used in 12 patients who underwent laparoscopic supraduodenal CBD exploration for large or occluding stones. There was no instance of postoperative dislodgement of the cannula and all patients had effective drainage of the common bile duct (average 300 ml bile per 24 h). The procedure was uncomplicated in all but one patient who developed self-limiting leakage from the CBD suture line in the early postoperative period. The median hospital stay after surgery was 4 days, with a range of 3 to 10 days. The cystic duct decompression cannula was capped and sealed under an occlusive dressing at the time of discharge. Removal of the cannula was carried out without any complications as a day case 11-16 days after surgery. CONCLUSIONS: Transcystic biliary decompression is safe and effective. The experience with is use indicates that compared to T-tube drainage, transcystic decompression may accelerate recovery and reduce the hospital stay in patients following laparoscopic direct exploration of the CBD. Its insertion is less technically demanding than placing a T-tube through the choledochotomy. Transcystic decompression with complete primary closure of the CBD realizes the full benefits of the single-stage management of common bile duct calculi and permits confirmation of complete stone clearance after surgery.

Aged↗

PubMed1998

Laparoscopic endobiliary stenting as an adjunct to common bile duct exploration.

BACKGROUND: The management of common bile duct stones (CBDS) in the era of operative laparoscopy is evolving. Several minimally invasive techniques to remove CBDS have been described, including preoperative endoscopic retrograde cholangiopancreatography (ERCP), postoperative ERCP, lithotripsy, laparoscopic transcystic common bile duct exploration, and laparoscopic choledochotomy with common bile duct exploration (CBDE). Because of the risks and limitations of these procedures, we utilize laparoscopically placed endobiliary stents as an adjunct to CBDE. METHODS: Sixteen patients underwent laparoscopic common bile duct exploration (LCBDE) by either choledochotomy or the transcystic technique with placement of endobiliary stents. These patients were identified during laparoscopic cholecystectomy as having occult choledocholithiasis, using routine dynamic intraoperative cholangiography. RESULTS: CBDS were successfully removed in all patients as demonstrated by completion cholangiography and intraoperative choledochoscopy. Eighty percent of patients were discharged the following day; the first three patients in this series were observed for 48 h prior to discharge. No patient required T-tube placement and closed suction drains were removed the morning after surgery. Stents were removed endoscopically at 1 month. Six- to 30-month follow-up demonstrates no complications to date. CONCLUSIONS: Laparoscopic endobiliary stenting reduces operative morbidity, eliminates the complications of T-tubes, and allows patients to return to unrestricted activity quickly. We recommend laparoscopically placed endobiliary stents in patients undergoing LCBDE.

Cholangiography↗

PubMed1998

Laparoscopic common bile duct exploration by choledochotomy. An effective and efficient method of treatment of choledocholithiasis.

BACKGROUND: Management of cholelithiasis and choledocholithiasis usually requires two separate teams-the gastroenterologist/surgical endoscopist and the laparoscopic surgical team. This requires two separate procedures that potentially increase the overall morbidity and cost. Laparoscopic common bile duct exploration by choledochotomy (LCBDE-C) averts this problem with a single approach. METHODS: In 1990-1991, unsuspected stones found at laparoscopy with intraoperative cholangiogram done routinely underwent postoperative ERCP. Residual stones had been found after ERCP in 16 of 22 preoperative ERCP patients and we began to seek an alternative technique. Laparoscopic common bile duct exploration by choledochotomy has achieved a high rate of success. RESULTS: Technically successful LCBDE-C has been accomplished in 143 of 148 patients (96.6%). Retained bile duct stones have been found on postoperative cholangiogram in three patients (2.0%), all of which have been successfully removed by postoperative ERCP. Thus 140 or 148 patients had their bile duct successfully cleaned by the one-step technique alone (94.6%). CONCLUSIONS: We believe that most laparoscopic surgeons who have acquired the skills of intracorporeal suturing can be successful at laparoscopic common bile duct exploration by choledochotomy. The disadvantage of T-tube presence will likely be eliminated by future developments with intraoperative antegrade sphincterotomy-like procedures, but the ability to see both proximal and distal biliary tree with the choledochotomy in all cases seems to offer more than adequate results at this point in the evolution of the laparoscopic approach to calculus biliary tract disease.

Adult↗

PubMed1997

Surgical treatment of thoracic outlet compression syndromes. II. Supraclavicular exploration and vascular reconstruction.

Supraclavicular exploration has become a widely utilized, versatile, and effective approach in the treatment of thoracic outlet compression syndromes. It is applicable to neurogenic, arterial, and venous form of TOS. Although certain aspects of the surgical anatomy are quite familiar to most vascular surgeons, considerable attention must be given to the details of this procedure to avoid inadequate decompression, serious injury, or predictable causes of recurrent compression. Supraclavicular exploration and its variations provide an excellent approach to the entire spectrum of problems encountered in patients with TOS, and in many centers it has superceded the transaxillary approach previously popularized for these disorders. Because supraclavicular exploration for TOS involves a number of unique technical considerations and because it is typically applied to a difficult clinical problem outside the routine experience of most vascular surgeons, it should be undertaken only with appropriate training and interest in the comprehensive management of patients with TOS.

Blood Vessel Prosthesis↗

PubMed2004

Behavioral characterization of wild derived male mice (Mus musculus musculus) of the PWD/Ph inbred strain: high exploration compared to C57BL/6J.

PWD/Ph is an inbred mouse strain derived from wild mice trapped in central Czech Republic. These mice are of the Mus musculus musculus subspecies, whose ancestors separated from those of Mus musculus domesticus about one million years ago. There is a high degree of variation in the genomic sequence and a wide range of phenotypes between PWD/Ph and standard laboratory inbred mouse strains, the genomes of which are principally Mus musculus domesticus in origin, making PWD/Ph mice an useful resource for complex trait research. As a first step in taking advantage of this resource, a preliminary characterization of the behavior of PWD/Ph mice was performed. Groups of 10 PWD/Ph and C57BL/6J male mice were tested in the open field, novel object exploration task and Morris water maze. PWD/Ph were marginally more anxious than C57BL/6J mice in the open field but subsequently displayed much higher levels of exploration and lower anxiety than C57BL/6J mice following introduction of a novel object. As C57BL/6J itself is rated as highly explorative among classical inbred strains, PWD/Ph probably represents an extreme among mouse strains for this specific behavior. PWD/Ph and C57BL/6J mice differed in their water escape training profiles in the Morris water maze, perhaps reflecting different motivational factors. However, there were no differences in overall cognitive ability (spatial learning) as both groups learned to find the hidden platform and performed equally well when the location of the platform was changed. This is the first quantification of the behavior of PWD/Ph mice and the results are promising for the potential of the consomic panel currently being generated with PWD/Ph and C57BL/6J as a tool for the molecular dissection of behavior.

Animals↗

PubMed2006

Matching FCE activities and work demands: an explorative study.

OBJECTIVES: to explore to what extent the standardized Isernhagen Work Systems Functional Capacity Evaluation (IWS FCE) can be matched with observed work demands in workers with chronic low back pain, and, secondly, to explore whether this match can predict sick leave in the year after rehabilitation treatment. METHODS: An explorative prognostic cohort study with a one-year follow-up (four, eight and twelve months after baseline) was performed (n = 18). Demographics, back complaints and FCE performance were assessed at baseline. In addition, a workplace assessment (WPA) was performed. Eleven FCE activities were matched with work demands. Sick leave associated with low back pain and physical and psychosocial work demands were assessed during follow-up. RESULTS: Seven activities could be directly matched with WPA data. (Carrying, pushing, pulling, crouching, kneeling, static forward bending, and dynamic bending and rotating.) For some workers, difficulties existed in matching three of the activities (pushing, pulling and crouching). One activity (lifting) could indirectly be matched with WPA data. One activity (walking) could not be matched with WPA data. Two activities (sitting, standing) were excluded from analyses due to practical limitations. No relation was found between FCE performance, work demands, and sick leave during follow-up. CONCLUSIONS: Seven FCE activities could be directly matched with work demands. However, not all observed work demands could be matched with IWS FCE activities in the eighteen occupations studied. This quantitative and standardized way of assessing work-related disability is not sufficient to predict work ability and sick leave at the present time.

Adult↗

PubMed1993

Extracting object properties through haptic exploration.

This paper reviews some of our recent research on haptic exploration, perception and recognition of multidimensional objects. We begin by considering the nature of manual exploration in terms of the characteristics of various exploratory procedures (EPs) or stereotypical patterns of hand movements. Next, we explore their consequences for the sequence of EPs selected, for the relative cognitive salience of material versus geometric properties, and for dimensional integration. Finally, we discuss several applications of our research programme to the development of tangible graphics displays for the blind, autonomous and teleoperated haptic robotic systems, and food evaluation in the food industry.

Attention↗

PubMed1990

Selective approach to sternal closure after exploration for hemorrhage following coronary artery bypass.

Thirty-six (4.6%) patients required exploration for hemorrhage after 788 coronary artery bypass grafting procedures. Twenty-three (64%) patients with a specific site of bleeding that was surgically controlled or with improving coagulopathy were managed by immediate sternal closure. Continued hemorrhage or tamponade necessitated reexploration in 5 of these patients. All 5 patients were then treated by open sternotomy and delayed sternal closure. There were no deaths or sternal wound infections in this subgroup. Thirteen (36%) patients explored for hemorrhage were initially treated by open sternotomy and delayed sternal closure because of ongoing coagulopathy with refractory bleeding. Twelve patients recovered without further complication. One patient died 30 days after delayed sternal closure. There were no sternal wound infections. This experience supports a selective approach to sternal closure after exploration for hemorrhage following coronary artery bypass grafting. Immediate closure is recommended if a specific site of bleeding can be located and corrected. However, in the presence of refractory hemorrhage due to coagulopathy, delayed sternal closure should be considered to avoid the subsequent morbidity of continued bleeding, including cardiac tamponade, multiple reexplorations with sternal trauma, and retained mediastinal hematoma.

Adult↗

PubMed1985

Comparative effects of infusions of 6-hydroxydopamine into nucleus accumbens and anterolateral hypothalamus induced by 6-hydroxydopamine on the response to dopamine agonists, body weight, locomotor activity and measures of exploration in the rat.

Groups of rats received infusions of 6-hydroxydopamine (6-OHDA) into the nucleus accumbens or anterolateral hypothalamus with 6-hydroxydopamine (6-OHDA), or sham operations. Body weight was monitored for 28 days after the infusion, after which rats were first tested in an exploration choice-box and then underwent a series of pharmacological challenges. At this time after the operation, rats which had received 6-OHDA in the nucleus accumbens showed neither loss of body weight, deficit in exploration, nor hypokinesia, but sustained an 80% reduction in dopamine levels in the nucleus accumbens. Locomotion was decreased in response to 1.5 mg/kg (i.p.) of d-amphetamine but increased following 0.1 mg/kg (s.c.) of apomorphine; stereotyped responses to larger doses were unaltered. By contrast, rats which had received 6-OHDA in the anterolateral hypothalamus lesions lost substantial amounts of body weight and were hypoactive. Although both locomotor and stereotypy responses to d-amphetamine were abolished, these responses were enhanced in response to apomorphine. Consistent with this, regional assay using high pressure liquid chromatography (HPLC) showed profound loss of dopamine in the caudate-putamen as well as in the nucleus accumbens and frontal cortex. It seems unlikely that the reductions in exploration previously reported after lesions of the mesolimbicocortical dopamine system at the level of anterolateral hypothalamus induced by 6-OHDA are either behaviourally specific or result solely from depletion of dopamine with the nucleus accumbens and frontal cortex.

Animals↗

PubMed1988

Influence of oestrogen on spontaneous and diazepam-induced exploration of rats in an elevated plus maze.

An elevated plus-maze, used to identify anxiolytic effects of drugs (Pellow et al., 1985), reflected as increased open-arm exploration, was employed in cycling and ovariectomised rats, to determine the effect of diazepam on the cycle and, after ovariectomy, to investigate possible influences of treatment with oestradiol (10 or 100 micrograms/kg, s.c.) (acute: 1 day or subchronic: 3 days) to ovariectomised rats on the effect of diazepam (1 mg/kg, i.p.), studied 3, 24 and 72 hr after cessation of treatment. Cycling females, exhibiting 3 consecutive 4-day oestrous cycles and ovariectomised rats, 15 days after surgery, were used. There was a tendency for increased open-arm exploration by rats in proestrous and diestrous, as compared to the other phases of the cycle and to ovariectomised rats. Rats treated 24 hr after subchronic treatment with oestradiol also exhibited increased open-arm exploration. The anti-anxiety effect of diazepam was clearly shown in oestrous and metestrous but not in proestrous, diestrous or in ovariectomised rats. The effect of diazepam was abolished in rats tested 3 hr after acute small doses of estradiol and attenuated in rats tested 24 hr after subchronic administration of the hormone. The results suggest that oestradiol, administered in physiological doses, may have an inhibitory effect on the diazepam-induced anxiolysis.

Animals↗

PubMed1984

Exploration of the pineal region: observations and results.

Experience with direct exploration of the pineal region in 22 consecutive patients is reported. Of these cases, mass lesions with obstructive hydrocephalus were found in 19; the remaining 3 had arteriovenous malformations of the pineal region. Of the 19 mass lesions, 5 (26%) were benign and curable. Although a preliminary shunt was routinely provided in all patients with obstructive hydrocephalus before exploration of the pineal region, the condition of five (26%) worsened after the shunt operation, requiring emergency decompression of the pineal tumor. A transtentorial approach through a right occipital craniotomy was uniformly employed in all cases. Overall mortality was less than 5%. These observations and results support the policy of direct exploration of all lesions in the pineal region.

Adolescent↗

PubMed1989

Surgical exploration before computed tomography scanning in children with traumatic tentorial herniation.

Seventeen consecutive children with early clinical signs of tentorial herniation after head injury underwent immediate burr-hole exploration before computed tomography scanning. In nine children (53%), a subdural hematoma was discovered and immediately evacuated. In one, a small intracerebral hemorrhage was diagnosed by intraoperative ultrasonography. Postoperative studies showed that no intraaxial or extraaxial hematoma was missed by surgical exploration. Nine children (53%) survived; eight (47%) died. The survival rate was higher among patients with a mass lesion than among those without. Seven children had a good recovery, and two were moderately disabled (mean follow-up, 15.2 months). We conclude that a significant proportion of head-injured children with clinical signs of tentorial herniation have extraaxial hematomas that can be readily identified and evacuated by immediate surgical exploration. The survival rate and extent of recovery in children appear to be better than in similarly injured adults.

Adolescent↗

PubMed1976

Complications of renal cyst exploration versus renal mass aspiration.

This report presents a comparison of the complications of surgical exploration with unroofing and renal cyst puncture. Two hundred fifty-five patients were operated on, with a mortality rate of 1 per cent and a morbidity rate of 28 per cent. The complications in 63 patients examined by mass aspiration included a morbidity rate of 6.4 per cent and no mortality. The possibilities of over-looking carcinomas through cyst aspiration are weighed against the demonstrated morbidity of surgical exploration and found to be much less significant. The authors recommend that an asymptomatic renal mass that radiographically appears to be a cyst and is unaccompanied by urine changes or clinical stigmata of renal neoplasia be treated by cyst aspiration and not subjected to surgical exploration.

Diagnosis, Differential↗

PubMed1978

ACTH, but not corticosterone impairs habituation and reduces exploration.

The habituation of an orienting response to auditory stimuli was impaired in rats by the administration of ACTH1-24. This impairment is unlikely to be due to the action of corticosterone because of the time course of the effect, because injected corticosterone had no effect on hibituation and because the peptide fragment ACTH4-10, which does not release corticosterone, also impaired habituation. Both ACTH1-24 and ACTH4-10 reduced the level of exploration measured in a holeboard, but corticosterone had no significant effect. However ACTH did not impair habituation and exploration, thus providing further evidence that there are different mechanisms underlying habituation of orienting and habituation of exploration.

Adrenocorticotropic Hormone↗

PubMed1982

Maze exploration in juvenile rats treated with corticosteroids during development.

The possibility of permanent damage to brain function after developmental corticosteroid treatment has been raised in connection with therapeutic use of potent synthetic corticosteroids during the period of brain development in the human fetus and infant. In the present study, brain function was evaluated in rats treated during brain development with triamcinolone acetonide (TAC). A subtoxic dose (0.9 mg/kg), which did not retard growth, was used. TAC treatment at two periods of post-embryonic brain development (day 0 and day 10 postnatal) led to deviations from normal exploration strategies in a radial maze. Treatment on day 16 gestation was effective only in males. Neonatal TAC-treatment also affected spontaneous alternation in a T-maze. Measures which reflected arousal-activity levels during behavioral tests, such as time to initiate exploration and time to complete exploration, were not affected by treatment. These results suggest that the development of complex brain function in rats can be altered by subtoxic corticosteroid treatment in the perinatal period.

Aging↗

PubMed1995

Effect of chronic piracetam on age-related changes of cross-maze exploration in mice.

Normal aging is known to deteriorate memory, spatial orientation, and perceptual recognition. Experiment 1 examined behavioral manifestations of aging by using a cross-maze exploration test in 2-, 6-, and 10-month-old hybrid mice (CBA x C57BL). A decrease in explorative patrolling and an increase in arm reentries, a latency to start and a total time of exploration were found in 10-month-old mice. In Experiment 2, administration of the cognition enhancer piracetam (2-oxo-1-pirrolidone acetamide) (400 mg/kg, IP, once a day for 10 days) enhanced arm patrolling and decreased reentries in 10-month-old mice to the level displayed by the 2-month-old animals. The results suggest that the cross-maze test may be useful for a preliminary screening of antisenescent drugs.

Aging↗

PubMed1993

Medical concerns for exploration-class missions.

The Space Exploration Initiative will challenge life scientists with a diverse set of crew medical risks. The varied sources of this cumulative risk are identified and briefly discussed in terms of risk assessment and preliminary plans for risk management. The roles of Space Station Freedom and other flight programs are discussed in the context of exploration medical objectives; and the significant differences between Space Station era (second generation) and exploration medical support systems (third generation) are reviewed.

Aerospace Medicine↗