Showing papers by "Guy J. Maddern published in 1992"

Malignant cells are collected on circular staplers.

Abstract: Anastomotic recurrence after resection of colorectal carcinoma has been attributed to insufficient clearance, migration of tumor cells into lymphatics, or implantation of exfoliated malignant cells during anastomosis. We studied 10 patients submitting to low anterior resection for cancer 6 to 16 cm (mean, 12.6 cm) from the anal verge. The anastomosis was performed with a circular stapler introduced transanally into the rectum using the established technique. No lavage of the rectal stump with a cytotoxic agent was conducted before the anastomosis was performed. Having completed the anastomosis, the stapler and the doughnuts were washed with saline, which was collected for cytologic examination. The doughnuts were then examined histologically; all were tumor free. In 9 of the 10 cases, malignant cells were identified in the centrifuged saline. It may be that malignant cells collected by the stapler are implanted during anastomosis and cause subsequent anastomotic recurrence.

Appendiceal mucoceles and pseudomyxoma peritonei.

Abstract: Mucoceles of the appendix and associated pseudomyxoma peritonei are a heterogeneous group comprising various histopathologic lesions with differing prognoses. Between 1983 and 1990, we treated eight patients with appendiceal mucocele, three cystadenomas and five cystadenocarcinomas, three of which had accompanying pseudomyxoma peritonei. All patients were more than 50 years of age. Women outnumbered men by seven to one. Preoperative diagnosis was acute appendicitis or appendiceal abscess in all instances of mucocele unaccompanied by pseudomyxoma peritonei. Ultrasound of the abdomen, together with paracentesis, diagnosed pseudomyxoma peritonei in two of three patients. Elevated carcinoembryonic antigen levels were found in six of the eight patients and monitoring of this parameter was useful in the early detection of the two recurrences observed. The three patients with cystadenomas remain free of disease after appendectomy. Of the five patients treated for cystadenocarcinoma by right colectomy, two underwent reoperation after recurrence of disease. One patient died 41 months later of intestinal obstruction caused by pseudomyxoma peritonei. Pseudomyxoma peritonei significantly decreases survival of patients with appendiceal mucocele. In these patients, aggressive initial surgical management, repeated if need be, is indicated.

Fatal ascaris pancreatitis: an uncommon problem in the west.

Abstract: Gastrointestinal parasites, although an uncommon cause of biliary and pancreatic problems in western medicine, can produce fatal complications. A Swiss patient presented with acute pancreatitis, with no evidence of gall stones or history of alcohol abuse. He died after a short fulminant illness. At necropsy, an Ascaris lumbracoides was found impacted within the ampulla of Vater and serves as a reminder that non-indigenous causes of biliary tract obstruction should not be overlooked.

Femoropopliteal artery occlusion: clinical experience with the Kensey catheter.

Abstract: In 25 patients, 12 with acute-subacute and 13 with chronic extensive femoropopliteal artery occlusions (mean length, 8 cm), a prospective study was performed after application of the Kensey catheter and subsequent performance of percutaneous transluminal angioplasty (PTA). Passage through the occlusion with the Kensey catheter failed in five patients because of the presence of dissections. As confirmed at angiography, free flow through the obstruction and the runoff bed could be restored with the Kensey catheter, guide wires, balloon dilation, and thrombus aspiration and/or thrombolysis in 24 of the 25 patients (96%). In five patients, peripheral embolisms occurred after application of the Kensey or balloon catheter. Cumulative patency rates, according to findings of a noninvasive examination, were 80% at 3 days, 59% at 6 months, and 38% at 12 months after performance of the combined interventions. Thus, the results obtained with use of this new device have not proved superior to previously reported resul...

Distribution of peptide-containing nerve fibers in the gastric musculature of patients undergoing surgery for gastroesophageal reflux.

Abstract: The distribution of nerve fibers and cell bodies reactive for the peptides enkephalin, neuropeptide Y, substance P, and vasoactive intestinal peptide were studied in biopsies of external muscle taken from the gastric body and antrum of 17 patients undergoing surgery for gastroesophageal reflux, and in regions of healthy stomach resected as part of gastric cancer operations. The results were correlated with preoperative measurements of liquid and solid emptying from the stomach in the patients with gastro-esophageal reflux. In three cases, no delay was detected in either liquid or solid emptying, and the distribution of peptide immunoreactive fibers in the external muscle was similar to that of healthy muscle. In 14 cases, the emptying of either liquids or solids or both was delayed, and in eight of these clearcut changes in the distribution of peptide-immunoreactive fibers occurred. In six cases, the number of enkephalin-immunoreactive fibers was fewer than normal in the biopsy from the gastric body (in one of these samples the number of substance P-immunoreactive fibers was also reduced). In another cae, the number of substance P-immunoreactive fibers in the antrum was reduced, and in another the number of vasoactive intestinal peptide and neuropeptide Y-immunoreactive fibers in the antral biopsy was reduced. It is concluded that in patients with gastroesophageal reflux who have delayed gastric emptying, a proportion demonstrate abnormalities of the peptide-immunoreactive fibers that innervate the gastric external muscle.

[A new fluid-jet dissector in hepatobiliary surgery].

Abstract: Increasing experience with major hepatic resections has stimulated the development of improved resectional techniques and tools. The authors describe a recently developed high pressure, high velocity water jet which offers significant advantages over previously developed methods like ultrasonic dissectors and low pressure water jet machines. The pressure of the system is significantly elevated (between 200 and 600 Bars) and the ejection speed is over 300 m/sec. although the flux remains low. It has been successfully used in 22 major hepatic resections (2 left hepatectomy, 4 extended left, 3 right, 8 extended right and 5 segmental resections) and also during 6 peripheral biliodigestive bypasses (3 segment III bypasses and 3 peripheral segment III bypasses). The blood loss was low and the visibility excellent. The amount of fluid required by the instrument was small reducing the risk of complications. Previous report demonstrated that the water jets are more effective when compared with ultrasound dissectors. The technical characteristic of the new high pressure water jet improves on those intrinsic qualities allowing a more rapid dissection of both fibrous and normal parenchyma and simplifying the use of the instrument. The authors conclude that the new high pressure, high velocity water jet is an effective tool for biliodigestive surgery.

Outcome of Diffuse Faecal and Purulent Peritonitis following Colonic Perforation

Abstract: The mortality from faecal or purulent peritonitis following colonic perforation has been reported to be between 15 and 40%. These reports extend over many years and cannot take into account the influe