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Glenn IC, Abdulhai S, Lally PA, Schlager A. Early CDH repair on ECMO: Improved survival but no decrease in ECMO duration (A CDH Study Group Investigation). J Pediatr Surg 2019; 54:2038-2043. [PMID: 30898400 DOI: 10.1016/j.jpedsurg.2019.01.063] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 12/22/2018] [Accepted: 01/09/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE "Early on-ECMO" repair of CDH entails repair within 48-72 h of cannulation in an effort to optimize pulmonary physiology, shorten ECMO duration, and, ultimately, improve survival. This study evaluated the effect of early on-ECMO repair as compared to leaving patients unrepaired during ECMO. METHODS The CDH Study Group database was queried for CDH patients requiring ECMO who either underwent repair within the first 72 h after cannulation or remained unrepaired on ECMO. Primary outcomes were survival to decannulation and ECMO duration. RESULTS A total of 248 patients underwent early repair and 922 remained unrepaired on ECMO. The early repair group had increased risk factors for poor outcomes, including higher odds of cardiac defects and thoracic liver location, and lower odds of hernia sac presence. Nonetheless, ECMO survival for the early repair group was 87.1% compared to 78.4% in the unrepaired group (p = 0.002). However, the early repair group had a longer median ECMO duration than the unrepaired group (240.6 vs 196.8 h, p = 0.001). CONCLUSION While early ECMO repair does not shorten ECMO duration, it results in increased survival to decannulation as compared to those unrepaired on ECMO. This suggests that there may be a physiologic benefit leading to increased ECMO survival in a subset of patients undergoing on-ECMO repair over those designated to undergo post-ECMO repair. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Ian C Glenn
- Akron Children's Hospital, Department of Surgery, Akron, OH
| | | | - Pamela A Lally
- The University of Texas McGovern Medical School, Department of Pediatric Surgery and Children's Memorial Hermann Hospital, Houston, TX.
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Glenn IC, Abdulhai S, McNinch NL, Lally PA, Ponsky TA, Schlager A. Evaluating the utility of the "late ECMO repair": a congenital diaphragmatic hernia study group investigation. Pediatr Surg Int 2018; 34:721-726. [PMID: 29808279 DOI: 10.1007/s00383-018-4283-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE Optimal timing of congenital diaphragmatic hernia (CDH) repair in patients requiring extracorporeal membrane oxygenation (ECMO) remains controversial. The "late ECMO repair" is an approach where the patient, once deemed stable for decannulation, is repaired while still on ECMO to enable expeditious return to ECMO if surgery induces instability. The goal of this study was to investigate the potential benefit of this approach by evaluating the rate of return to ECMO after repair. METHODS The CDH Study Group database was used to analyze CDH patients requiring ECMO support. The primary outcome was return to ECMO within 72 h of CDH repair among those repaired following ECMO decannulation ("post-ECMO" patients). Secondary outcomes were death within 72 h of repair and cumulative death and return to ECMO rate. RESULTS A total of 668 patients were repaired post-ECMO decannulation. Six patients (0.9%) in the post-ECMO group required return to ECMO within 72 h of surgery and a total of 19 (2.8%) died or returned to ECMO within 72 h of surgery. CONCLUSION The rate of return to ECMO and death following CDH repair is extremely low and does not justify the risks inherent to "on-ECMO" repair. Patients stable to come off ECMO should undergo repair after decannulation.
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Affiliation(s)
- Ian C Glenn
- Department of Surgery, Akron Children's Hospital, 1 Perkins Sq, Ste 8400, Akron, OH, 44308, USA
| | - Sophia Abdulhai
- Department of Surgery, Akron Children's Hospital, 1 Perkins Sq, Ste 8400, Akron, OH, 44308, USA
| | - Neil L McNinch
- Akron Children's Hospital, Rebecca D. Considine Research Institute, 130 W. Exchange St, Akron, OH, 44302, USA
| | - Pamela A Lally
- Department of Pediatric Surgery and Children's Memorial Hermann Hospital, The University of Texas McGovern Medical School, Suite 5.258, 6431 Fannin Street, Houston, TX, 77030, USA
| | - Todd A Ponsky
- Department of Surgery, Akron Children's Hospital, 1 Perkins Sq, Ste 8400, Akron, OH, 44308, USA
| | - Avraham Schlager
- Department of Surgery, Akron Children's Hospital, 1 Perkins Sq, Ste 8400, Akron, OH, 44308, USA.
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Schlager A, Arps K, Siddharthan R, Glenn I, Hill SJ, Wulkan ML, Keene SD, Clifton MS. Thoracoscopic Repair of Congenital Diaphragmatic Hernia After Extracorporeal Membrane Oxygenation: Feasibility and Outcomes. J Laparoendosc Adv Surg Tech A 2018; 28:774-779. [PMID: 29641364 DOI: 10.1089/lap.2016.0583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Thoracoscopic repair of congenital diaphragmatic hernia (CDH) has been associated with faster recovery, earlier extubation, and decreased morbidity. Nevertheless, thoracoscopic repair is rarely attempted in the post-extracorporeal membrane oxygenation (ECMO) patient. Commonly cited reasons for not attempting thoracoscopy include concerns that the patients' respiratory status is too tenuous to tolerate insufflation pressures or that presumed defect size is so large that it precludes thoracoscopic repair. Our purpose is to review our experience with post-ECMO thoracoscopic CDH repair and evaluate the success of this approach. METHODS We performed retrospective analysis of attempted thoracoscopic CDH repairs after ECMO decannulation at our institution from 2001 to 2015. Primary outcome was rate of conversion. Secondary outcomes were intraoperative end-tidal CO2, time to extubation, and rate of recurrence. RESULTS We identified 21 post-ECMO patients in whom thoracoscopic CDH repair was attempted. Thoracoscopic repair was successfully completed in 28%. No patients had reported intolerance to insufflation at 3-7 mmHg. Average end-tidal CO2 at 15 operative minutes was 36.9 mmHg in the thoracoscopic group versus 50.7 mmHg in the open group and at 60 minutes was 34.25 mmHg versus 45.6 mmHg, respectively. One patient in the thoracoscopic group died and 1 experienced a large pneumothorax. In the converted group there was one clinically significant pneumothorax and three pleural effusions. Survivors after thoracoscopy were extubated an average of 5.6 ± 2.6 days after surgery versus 19.4 ± 10 days in the converted group (P < .05). Recurrence rates at last follow-up were equal between the two groups at 20%. CONCLUSIONS Thoracoscopic CDH repair is both safe and feasible after ECMO with no increase in operative morbidity or mortality. Insufflation pressures of 3-7 mmHg are well tolerated without undue increase in end-tidal CO2. When compared to conversion cases, thoracoscopic repair is associated with significantly decreased time to extubation with no difference in recurrence.
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Affiliation(s)
| | - Kelly Arps
- 2 Department of Surgery, Emory University/Children's Healthcare of Atlanta , Atlanta, Georgia
| | - Ragavan Siddharthan
- 3 Department of Surgery, Oregon Health and Sciences University , Portland, Oregon
| | - Ian Glenn
- 1 Akron Children's Hospital , Akron, Ohio
| | - Sarah J Hill
- 2 Department of Surgery, Emory University/Children's Healthcare of Atlanta , Atlanta, Georgia
| | - Mark L Wulkan
- 2 Department of Surgery, Emory University/Children's Healthcare of Atlanta , Atlanta, Georgia
| | - Sarah D Keene
- 2 Department of Surgery, Emory University/Children's Healthcare of Atlanta , Atlanta, Georgia
| | - Matthew S Clifton
- 2 Department of Surgery, Emory University/Children's Healthcare of Atlanta , Atlanta, Georgia
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Short HL, Clifton MS, Arps K, Travers C, Loewen J, Schlager A. The “Flat Diaphragm”: Does the Degree of Curvature of the Diaphragm on Postoperative X-Ray Predict Congenital Diaphragmatic Hernia Recurrence? J Laparoendosc Adv Surg Tech A 2018; 28:476-480. [DOI: 10.1089/lap.2017.0228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Heather L. Short
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Matthew S. Clifton
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Kelly Arps
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Curtis Travers
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Jonathan Loewen
- Division of Pediatric Radiology, Department of Radiology, Emory University School of Medicine, Atlanta, Georgia
| | - Avraham Schlager
- Division of Pediatric Surgery, Akron Children's Hospital, Akron, Ohio
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Abdulhai S, Glenn IC, McNinch NL, Ponsky TA, Schlager A. Current Practices in the Management of Congenital Diaphragmatic Hernia Patients Requiring Extracorporeal Membrane Oxygenation: Results of an International Survey of Pediatric Surgeons. J Laparoendosc Adv Surg Tech A 2017; 28:606-609. [PMID: 29237145 DOI: 10.1089/lap.2017.0296] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION There is little consensus on optimal management for congenital diaphragmatic hernia extracorporeal membrane oxygenation (CDH ECMO) patients. Meaningful comparisons of the various approaches have been limited due to the low number of cases in institutions. In addition, the multidisciplinary reliance and rigid institutional framework of ECMO serve to further limit exposure to alternative practices. The goal of this study is to survey the international pediatric surgery community to describe the current practice trends. METHODS A survey was electronically distributed to the international pediatric surgical community. The results were evaluated using statistical analysis. RESULTS A total of 123 pediatric surgeons completed the survey, of whom 89% work at institutions offering both venoatrial (VA) and venovenous (VV) ECMO. Although 69% perform VA ECMO for CDH, only 46% felt VA was the "optimal method." Among VV proponents, 21% believe the rate of VV to VA conversion to be <5% and 16% believe it to be >30% compared with 0% and 40% in VA proponents. Distribution of timing of repair: 46% post-ECMO repair, 22% early ECMO repair, 15% whenever stabilized on ECMO, and 14% late ECMO repair. Sixty-four percent (71/111) would perform an ECMO CDH repair in the unweanable patient and 27% (30/111) report successful decannulation after repair of a patient who was unweanable on ECMO for 2 weeks. Ninety-two percent do not perform exit-to-ECMO. CONCLUSION There are significant practice variations in the management of CDH ECMO. Majority of pediatric surgeons perform VA ECMO in CDH patients; however, a significant percentage of those believe VV to be more optimal. This discrepancy is not accounted for by the VA-only institutions. Although post-ECMO CDH repair is the most common approach, the majority would perform a repair "on ECMO" if the patient was unweanable. In addition, although many pediatric surgeons believe the "last ditch repair" for the unweanable patient to be futile, 27% have reported success. Exit-to-ECMO for CDH remains a minority practice.
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Affiliation(s)
- Sophia Abdulhai
- Department of Pediatric Surgery, Akron Children's Hospital , Akron, Ohio
| | - Ian C Glenn
- Department of Pediatric Surgery, Akron Children's Hospital , Akron, Ohio
| | - Neil L McNinch
- Department of Pediatric Surgery, Akron Children's Hospital , Akron, Ohio
| | - Todd A Ponsky
- Department of Pediatric Surgery, Akron Children's Hospital , Akron, Ohio
| | - Avraham Schlager
- Department of Pediatric Surgery, Akron Children's Hospital , Akron, Ohio
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Schlager A, Pressl B, Laiho K, Suchomel H, Kamp M, Höfling S, Schneider C, Weihs G. Temporally versatile polarization entanglement from Bragg reflection waveguides. Opt Lett 2017; 42:2102-2105. [PMID: 28569855 DOI: 10.1364/ol.42.002102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 05/03/2017] [Indexed: 06/07/2023]
Abstract
Bragg reflection waveguides emitting broadband parametric downconversion (PDC) have been proven to be well suited for the on-chip generation of polarization entanglement in a straightforward fashion [Sci. Rep.3, 2314 (2013)SRWSDA2045-232210.1038/srep02314]. Here, we investigate how the properties of the created states can be modified by controlling the relative temporal delay between the pair of photons created via PDC. Our results offer an easily accessible approach for changing the coherence of the polarization entanglement, in other words, to tune the phase of the off-diagonal elements of the density matrix. Furthermore, we provide valuable insight into the engineering of these states directly at the source.
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Schlager A, Arps K, Siddharthan R, Clifton MS. Tube Thoracostomy at the Time of Congenital Diaphragmatic Hernia Repair: Reassessing the Risks and Benefits. J Laparoendosc Adv Surg Tech A 2017; 27:311-317. [DOI: 10.1089/lap.2016.0233] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Kelly Arps
- Emory University/Children's Healthcare of Atlanta, Department of Surgery, Atlanta, Georgia
| | - Ragavan Siddharthan
- Oregon Health and Science University, Department of Surgery, Portland, Oregon
| | - Matthew S. Clifton
- Emory University/Children's Healthcare of Atlanta, Department of Surgery, Atlanta, Georgia
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Laiho K, Pressl B, Schlager A, Suchomel H, Kamp M, Höfling S, Schneider C, Weihs G. Uncovering dispersion properties in semiconductor waveguides to study photon-pair generation. Nanotechnology 2016; 27:434003. [PMID: 27659042 DOI: 10.1088/0957-4484/27/43/434003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We investigate the dispersion properties of ridge Bragg-reflection waveguides to deduce their phasematching characteristics. These are crucial for exploiting them as sources of parametric down-conversion (PDC). In order to estimate the phasematching bandwidth we first determine the group refractive indices of the interacting modes via Fabry-Perot experiments in two distant wavelength regions. Second, by measuring the spectra of the emitted PDC photons, we gain access to their group index dispersion. Our results offer a simple approach for determining the PDC process parameters in the spectral domain, and provide important feedback for designing such sources, especially in the broadband case.
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Affiliation(s)
- K Laiho
- Institut für Experimentalphysik, Universität Innsbruck, Technikerstraße 25, 6020 Innsbruck, Austria
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Bruns NE, Glenn IC, McNinch NL, Arps K, Ponsky TA, Schlager A. Approach to Recurrent Congenital Diaphragmatic Hernia: Results of an International Survey. J Laparoendosc Adv Surg Tech A 2016; 26:925-929. [PMID: 27705081 DOI: 10.1089/lap.2016.0247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Although recurrence remains one of the most feared complications following congenital diaphragmatic hernia (CDH) repair, there are minimal data on the optimal surgical approach to these complex situations. The purpose of this study was to survey the international pediatric surgery community to ascertain practice patterns for both minimally invasive (MIS) and open approaches for recurrent CDH. MATERIALS AND METHODS A survey was e-mailed to members of an online community of pediatric surgeons. The questionnaire elicited surgeons' clinical experience, the continent in which they practice, and their surgical approach (laparotomy, thoracotomy, laparoscopy, or thoracoscopy) to five clinical cases, including initial and recurrent Bochdalek hernias. Fisher's exact test and chi-square test were used for statistical analysis. RESULTS Two-hundred eighty pediatric surgeons responded to the survey. In total, 52.1% of surgeons chose an MIS approach for an initial repair of left CDH with the younger surgeons more likely to use an MIS approach. For the recurrence scenarios, 42.5%-55.5% of these surgeons would attempt an MIS repair after a recurrence. Specifically, thoracoscopy was favored over laparoscopy following both prior laparotomy (30.0% versus 7.5%) and prior right thoracoscopy (26.4% versus 10.0%), less favored following thoracotomy (9.3% versus 18.9%), and relatively similar proportions following prior left thoracoscopy (17.5% versus 16.4%). Laparotomy was the preferred open approach both for initial presentation and all recurrence scenarios. Among surgeons who would treat initial CDH with an open procedure, between 10.4% and 17.9% would switch to an MIS approach, most commonly after prior failed laparotomy. CONCLUSIONS Approximately half surgeons who approach initial left CDH in an MIS manner would attempt an MIS approach for recurrence. The tendency to approach CDH recurrence from the opposite body cavity as the initial repair clearly impacted the surgical approach. This was particularly pronounced for MIS repairs, whereas for open approach, laparotomy remained, by far, the most popular in all scenarios.
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Affiliation(s)
- Nicholas E Bruns
- 1 Division of Pediatric Surgery, Akron Children's Hospital , Akron, Ohio
| | - Ian C Glenn
- 1 Division of Pediatric Surgery, Akron Children's Hospital , Akron, Ohio
| | - Neil L McNinch
- 2 Rebecca D. Considine Research Institute , Akron Children's Hospital, Akron, Ohio
| | - Kelly Arps
- 3 Emory University School of Medicine , Atlanta, Georgia
| | - Todd A Ponsky
- 1 Division of Pediatric Surgery, Akron Children's Hospital , Akron, Ohio
| | - Avraham Schlager
- 1 Division of Pediatric Surgery, Akron Children's Hospital , Akron, Ohio
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Schlager A, Arps K, Siddharthan R, Rajdev P, Heiss KF. The "omega" jejunostomy tube: A preferred alternative for postpyloric feeding access. J Pediatr Surg 2016; 51:260-3. [PMID: 26681348 DOI: 10.1016/j.jpedsurg.2015.10.073] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 10/30/2015] [Indexed: 10/22/2022]
Abstract
AIM We present our technique for construction of the "Omega Jejunostomy" (OJ), a novel method of postpyloric feeding using a pouched-jejunal loop capable of accommodating a balloon gastrostomy button. We describe potential indications for the procedure and outcomes in a complex patient population. MATERIALS AND METHODS We retrospectively reviewed records of patients who underwent an OJ at our institution between 2005 and 2014. Primary outcomes include operating time, length of hospital stay, time to feeding goals, and postoperative complications. RESULTS We identified 12 children (6 males) with multiple comorbidities who underwent OJ procedures. The median age at surgery was 11years (range 3months-23years). Eleven patients had failed previous alternative feeding access or antireflux procedures. All patients eventually reached their feeding goals. Eight were at goal feeds in <10days. Two achieved goal feeds <1month, one <4months, and one within 7months. There was one OJ failure because of fistula formation requiring surgical revision, and one child was treated successfully but died of unrelated causes. Four children eventually transitioned to PO or G-tube feeds, and six were tolerating feeds via OJ at last follow-up (8-74months). CONCLUSIONS OJ provides a durable alternative to gastrojejunostomy tube for patients who are poor candidates for or have failed Nissen fundoplication. It is technically easier to perform than a gastroesophageal disconnect procedure, has minimal surgical comorbidities, and can provide durable feeding access and achievement of goal feeds in a complex and refractory patient subset.
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Affiliation(s)
| | - Kelly Arps
- Emory University Department of Surgery, USA
| | | | | | - Kurt F Heiss
- Emory University/Children's Healthcare of Atlanta, USA
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Schlager A, Siddharthan RV, Santore MT, Balci O, Clifton MS, Heiss KF. Single-Incision Total Proctocolectomy and Ileal Pouch Anal Anastomosis in Pediatric Patients: Lessons Learned. J Laparoendosc Adv Surg Tech A 2015; 25:782-5. [DOI: 10.1089/lap.2014.0368] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Avraham Schlager
- Department of Pediatric Surgery, Emory University, Atlanta, Georgia
| | | | | | - Ozlem Balci
- Department of Pediatric Surgery, Emory University, Atlanta, Georgia
| | | | - Kurt F. Heiss
- Department of Pediatric Surgery, Emory University, Atlanta, Georgia
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Abstract
Background. Laparoendoscopic single-site sleeve gastrectomy is gaining acceptance. However, totally natural orifice translumenal endoscopic surgery (NOTES) in morbidly obese patients is still controversial due to safety and technical issues. To this end, we have developed a technique for sleeve gastrectomy in which the surgical field view is achieved through transgastric approach and the operating channel will eventually be through the vagina to form a dual lumen totally NOTES procedure for sleeve gastrectomy. As a step toward this approach, we performed a single abdominal incision in order to simulate the transvaginal route. This study is another step toward combined transvaginal and transgastric totally NOTES sleeve gastrectomy. Methods and Procedures. A combined NOTES and single trocar sleeve gastrectomy was performed on 8 porcine animal models. The endoscope was inserted through the gastric wall and served as the vision source for the procedure. A second endoscope was inserted via the transabdominal trocar together with the surgical instruments. Results. Sleeve gastrectomy was performed on 8 porcine models. The operative time for the first procedure was 5 hours, but after determining the technique, the time was reduced by half. Conclusion. Combined NOTES and single trocar sleeve gastrectomy is feasible in a porcine model. We achieved an excellent view of the surgical field through the transgastric approach. We believe that in the near future, combining the transgastric visualization of the surgical field together with a transvaginal approach may enable performing a total NOTES sleeve gastrectomy procedure. This hypothesis will be studied in further animal experiments before implementation in humans.
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Affiliation(s)
- Ram Elazary
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | | | - Abed Khalaileh
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Yoav Mintz
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Aigner F, Augustin F, Kaufmann C, Schlager A, Ulmer H, Pratschke J, Schmid T. Prospective, randomized-controlled trial comparing postoperative pain after plug and patch open repair with totally extraperitoneal inguinal hernia repair. Hernia 2013; 18:237-42. [PMID: 23775532 DOI: 10.1007/s10029-013-1123-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 06/08/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this study was to compare postoperative pain between the open tension-free plug and patch (PP) technique and the totally extraperitoneal patch (TEP) hernioplasty. METHODS One hundred and fifty-four male patients with unilateral inguinal hernia were randomized to undergo PP and TEP from 2005 to 2009. Pain assessment was conducted using the numerical rating scale (NRS) and the McGill Pain Questionnaire preoperatively, 6, 12 and 24 months postoperatively. All patients received the same analgesic regimen and documented pain in a NRS-based 4-week diary. RESULTS Of the 154 patients 77 underwent TEP and 77 PP. Median follow-up was 3.8 years. One recurrent hernia was observed in the TEP and two in the PP group (p = 0.56). Median preoperative NRS scores were 2 and 2, 0.3 and 0.4 at 6 months, 0.1 and 0.3 at 12 months, 0.2 and 0.1 at 24 months postoperatively in the PP and TEP groups, respectively (p > 0.05). Data from the 4-week pain diaries revealed significant differences in pain intensity between the two different techniques from the second postoperative week (p < 0.05). Patients in the PP group required more additional analgesics on day four and five postoperatively (p = 0.037 and 0.015, respectively). CONCLUSIONS Our data favor the TEP technique concerning postoperative pain as primary endpoint between tension-free PP and TEP hernia repair.
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Affiliation(s)
- F Aigner
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria,
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Abu Gazala M, Shussman N, Abu Gazala S, Schlager A, Elazary R, Ponomernco O, Khalaila A, Rivkind AI, Mintz Y. Miniature Camera for Enhanced Visualization for Single-Port Surgery and NOTES. J Laparoendosc Adv Surg Tech A 2012. [DOI: 10.1089/lap.2012.0124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mahmoud Abu Gazala
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Noam Shussman
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Samir Abu Gazala
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Avraham Schlager
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ram Elazary
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Oleg Ponomernco
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Abed Khalaila
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Avraham I. Rivkind
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yoav Mintz
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Shussman N, Abu Gazala M, Schlager A, Elazary R, Khalaileh A, Zamir G, Kushnir D, Rivkind AI, Mintz Y. Laparoscopic Infrared Imaging—The Future Vascular Map. J Laparoendosc Adv Surg Tech A 2011; 21:797-801. [DOI: 10.1089/lap.2010.0474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Noam Shussman
- Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Mahmoud Abu Gazala
- Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Avraham Schlager
- Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Department of Surgery, New York University, New York, New York
| | - Ram Elazary
- Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Abed Khalaileh
- Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Gideon Zamir
- Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - David Kushnir
- Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Avraham I. Rivkind
- Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Yoav Mintz
- Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Elazary R, Abu-Gazala M, Schlager A, Khalaileh A, Shussman N, Rivkind AI, Mintz Y. Trans-fascial laparoscopic mesh fixation: a procedural comparison using the standard suture passer versus iMESH stitcher™ device. Hernia 2011; 15:321-4. [PMID: 21259027 DOI: 10.1007/s10029-011-0789-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 01/09/2011] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Laparoscopic mesh repair has become an increasingly common method for repairing incisional hernias. The current method for fixating mesh to the abdominal wall includes tacking the mesh to the peritoneum and fascia and suturing the mesh to the fascia with trans-fascial sutures. The iMESH Stitcher™ is a stitching device developed to both simplify and expedite this procedure by passing the suture from one arm of the iMESH stitcher™ to the other. The device enables a stitch to be created in three quick moves using only one hand. We compared both the efficacy and procedure time of trans-fascial mesh fixation when performed with the iMESH stitcher™ as compared to the standard suture passer method. METHODS A mesh patch was installed on the internal abdominal wall of two pigs. Surgical residents and Medical students were participants in the study and were trained in both techniques. Each participant was asked to perform six fixations with each technique. The procedural time required for both fixation techniques was recorded. Participants were asked to assess subjectively the relative difficulty of each technique on a scale of 1-10 (10 = most difficult). RESULTS Sixteen residents and students performed a total of 12 mesh fixations, each performing 6 fixations with each technique. Average mesh fixation suture time using the suture passer technique was 44 s for residents and 47 s for students. Average fixation suture time using the iMESH stitcherTM was 17 s for residents and 15 s for students. The average difficulty score for the suture passer technique was 6.1 as compared to 2.9 with iMESH stitcher™. CONCLUSION Trans-fascial fixation with the iMESH Stitcher™ took significantly less time than the standard suture passer method. The iMESH Stitcher™ significantly simplifies the procedure of transfascial fixation and potentially reduces technical difficulties.
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Affiliation(s)
- R Elazary
- Department of Surgery, Hadassah-Hebrew University Medical Center, Campus Ein-Kerem, PO Box 12000, 91120, Jerusalem, Israel.
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Elazary R, Khalaileh A, Shussman N, Schlager A, Horgan S, Talamini MA, Rivkind AI, Mintz Y. [Surgery without incisions--the third generation of surgery]. Harefuah 2011; 150:25-69. [PMID: 21449152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In the past, abdominal surgery mandated a large abdominal wall incision. The minimal invasive surgery techniques including Laparoscopy, created an option for performing intraabdominal surgery through small incisions. In this article, the authors present new surgical techniques: the natural orifice trans-luminal endoscopic surgery (NOTES], and the singLe incision laparoscopic surgery (SILS). It seems that these evolving techniques are the third generation of surgery.
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Abstract
BACKGROUND AND STUDY AIMS Nasogastric intubation, one of the most widely utilized therapeutic procedures in medical practice, is associated with trauma, pain, and discomfort, which can occur both at insertion and during the indwelling phase. Although lubricating jelly is useful during the insertion phase, insertion can still cause great discomfort. Furthermore, the jelly is rapidly absorbed and therefore is unable to decrease the friction between the tissues and the tube during the indwelling phase of the nasogastric tube. The aim of this study was to test a device, the NG-Shield, that generates surface acoustic waves on the surfaces of the nasogastric tube to reduce contact time and thus friction between the nasogastric tube and body tissues. PATIENT AND METHODS Twenty-four healthy volunteers were enrolled in a single-center, crossover, blinded study, in which a nasogastric tube was inserted and left indwelling for 6 hours. Throughout the indwelling period the device was activated and deactivated alternately every hour, and the volunteers were questioned every hour about their pain and discomfort levels as well as grading pain and discomfort upon insertion and removal of the nasogastric tube. Pain and discomfort levels were compared between active and nonactive phases of the device. RESULTS The activated NG-Shield was found to reduce both pain and discomfort significantly in both the nose and throat throughout the indwelling phase. CONCLUSIONS The NG-Shield is a safe and effective device for reducing pain and discomfort associated with an indwelling nasogastric tube.
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Affiliation(s)
- A Schlager
- Department of Surgery, New York University Medical Center, New York, New York, USA
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Schlager A, Khalaileh A, Mintz Y, Abu Gazala M, Globerman A, Ilani N, Rivkind AI, Salpeter S, Dor Y, Zamir G. A mouse model for sleeve gastrectomy: applications for diabetes research. Microsurgery 2010; 31:66-71. [PMID: 20734435 DOI: 10.1002/micr.20797] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Accepted: 04/11/2010] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Discovery of enhanced glucose tolerance following bariatric surgery has sparked renewed interest in the investigation of unchartered underlying pathways of glucose homeostasis. Delineation of this pathway may ultimately be the first step in the creation of a novel therapy for type II diabetes. Nevertheless, the technical complexity and formidable nature of these surgeries coupled with the fragile nature of small rodents has made the creation of a mouse model to study these effects incredibly challenging. We have created a simplified sleeve gastrectomy mouse model to study the effects of bariatric surgery on glucose tolerance and beta cell proliferation. METHODS Nineteen mice were randomized to undergo either sleeve gastrectomy (SG) (9) or sham operation (SH) (10). Weight and serum glucose were measured three times weekly and serum insulin measurements and pancreatic harvest were performed at the time of sacrifice. Five mice from each group were sacrificed after one week and the remainder sacrificed after one month. RESULTS Survival of mice was 100% for both groups. The SG group demonstrated an initial drop in weight and serum glucose as compared to SH, which normalized by one month following surgery. Serum insulin levels and rate of beta cell proliferation were similar in both groups after one week and one month. CONCLUSION The simplified sleeve gastrectomy is a technically straightforward, low-mortality technique for creating a bariatric mouse model which most faithfully replicates bariatric surgery performed in humans. This model can be a valuable tool to investigate the glucose tolerance and beta cell effects of bariatric surgery.
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Affiliation(s)
- Avraham Schlager
- Department of Surgery, New York University Medical Center, NY, USA.
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Shussman N, Schlager A, Elazary R, Khalaileh A, Keidar A, Talamini M, Horgan S, Rivkind AI, Mintz Y. Single-incision laparoscopic cholecystectomy: lessons learned for success. Surg Endosc 2010; 25:404-7. [PMID: 20607565 PMCID: PMC3032176 DOI: 10.1007/s00464-010-1179-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2009] [Accepted: 03/04/2010] [Indexed: 01/21/2023]
Affiliation(s)
- Noam Shussman
- Department of General Surgery and Trauma Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
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Schlager A, Khalaileh A, Zamir G, Mintz Y, Jacob H, Rivkind AI. An endoscopic repair option for acquired esophagorespiratory fistulas. J Laparoendosc Adv Surg Tech A 2010; 20:465-8. [PMID: 20565303 DOI: 10.1089/lap.2010.0208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Benign acquired esophagorespiratory fistulas (BERFs) represent a broad spectrum of anatomic pathology presenting in a wide variety of clinical settings. These fistulas can lead to severe respiratory compromise and rarely close spontaneously. Surgical fistula closure has been the traditional therapeutic approach, but is associated with significant morbidity and mortality. The recent advent of endoscopic technologies suggests that minimally invasive procedures may offer a safe alternative to surgery for the treatment of esophagorespiratory fistulas. In this article, we present our experience in treating complex benign esophagorespiratory fistulas of diverse etiologies utilizing a primarily minimal invasive, endoscopic, or combined surgical and endoscopic approaches. Our experience demonstrates that an endoscopic-based approach is safe and technically feasible and can, potentially, spare a subset of patients from open surgery. A multidisciplinary decision-making process, based on individualized parameters, is a prerequisite for a successful outcome.
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Affiliation(s)
- Avraham Schlager
- Department of General Surgery, New York University Hospital, New York, New York 10016, USA.
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Abu-Gazala S, Schlager A, Elazary R, Keidar A, Appelbaum L, Rivkind AI, Khalaileh A, Abu-Gazala M, Merhav H. Revascularization of the celiac and superior mesenteric arteries after operative injury using both splenic artery and saphenous graft. Ann Vasc Surg 2010; 24:693.e1-4. [PMID: 20471785 DOI: 10.1016/j.avsg.2009.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2009] [Accepted: 10/27/2009] [Indexed: 10/19/2022]
Abstract
We report a case of iatrogenic resection of both the superior mesenteric artery (SMA) and celiac artery during left nephrectomy and adrenalectomy. A 47-year-old woman was diagnosed with a large adrenal tumor and underwent a laparoscopic left adrenalectomy that was converted to open adrenalectomy and nephrectomy as a result of a bulky tumor. Both the SMA and celiac artery were inadvertently cut at their origin because of adherence of the tumor to the aorta. Both arteries were revascularized by anastomosing the distal splenic artery to the aorta after performing splenectomy to revascularize the celiac circulation and using an autologous saphenous vein graft to revascularize the SMA. The patient had no postoperative complications. To our knowledge, this is the first description of use of the splenic artery for celiac revascularization.
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Affiliation(s)
- Samir Abu-Gazala
- Dept of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Elazary R, Abu-Gazala M, Schlager A, Shussman N, Rivkind AI, Bloom AI. Therapeutic angiography for giant bleeding gastro-duodenal artery pseudoaneurysm. World J Gastroenterol 2010; 16:1670-2. [PMID: 20355248 PMCID: PMC2848378 DOI: 10.3748/wjg.v16.i13.1670] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We present the case of an 18-year-old female transferred to our center from an outside hospital due to persistent gastrointestinal bleeding. Two weeks prior to her transfer she underwent duodenal omentopexy for a perforated duodenal peptic ulcer. The patient underwent a computed tomography angiogram which identified the source of bleeding as a giant gastro-duodenal artery (GDA) pseudoaneurysm. The patient was taken to interventional radiology where successful microcoil embolization was performed. We present this rare case of a giant GDA pseudoaneurysm together with imaging and a review of the medical literature regarding prevalence, etiology and treatment options for visceral arterial aneurysms.
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Schlager A, Khalaileh A, Shussman N, Elazary R, Keidar A, Pikarsky AJ, Ben-Shushan A, Shibolet O, Horgan S, Talamini M, Zamir G, Rivkind AI, Mintz Y. Providing more through less: current methods of retraction in SIMIS and NOTES cholecystectomy. Surg Endosc 2009; 24:1542-6. [PMID: 20035352 DOI: 10.1007/s00464-009-0807-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Accepted: 10/20/2009] [Indexed: 01/07/2023]
Abstract
BACKGROUND As the field of minimally invasive surgery continues to develop, surgeons are confronted with the challenge of performing conventional laparoscopic surgeries through fewer incisions while maintaining the same degree of safety and surgical efficiency. Most of these methods involve elimination of the ports previously designated for retraction. As a result, minimally invasive surgeons have been forced to develop minimally invasive and ingenious methods for providing adequate retraction for these procedures. Herein we present our experience using endoloops and internal retractors to provide retraction during Single Incision Minimally Invasive Surgery (SIMIS) and Natural Orifice Transluminal Endoscopic Surgery (NOTES) cholecystectomy. We also present a review of the alternative retraction methods currently being employed for these surgeries. METHODS SIMIS was performed on 20 patients and NOTES was performed on 5 patients at our institution. Endoloops or internal retractors were used to provide retraction for all SIMIS procedures. Internal retractors provided retraction for all NOTES procedures. RESULTS Successful cholecystectomy was accomplished in all cases. One SIMIS surgery required conversion to standard laparoscopy due to complex anatomy. There were no intraoperative complications. Although adequate retraction was accomplished in all cases, the internal retractors were found to provide superior and more versatile retraction compared to that of endoloops. CONCLUSION Adequate retraction greatly simplifies SIMIS and NOTES surgery. Endograb internal retractors were easy to use and were found to provide optimal retraction and exposure during these procedures without complications.
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Affiliation(s)
- Avraham Schlager
- Department of Surgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem, 91120, Israel.
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Elazary R, Schlager A, Khalaileh A, Appelbaum L, Bala M, Abu-Gazala M, Khatib A, Neuman T, Rivkind AI, Almogy G. Malignant Appendiceal GIST: Case Report and Review of the Literature. J Gastrointest Cancer 2009; 41:9-12. [DOI: 10.1007/s12029-009-9113-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Elazary R, Schlager A, Appelbaum L, Zamir G, Nir I. Renal clear cell carcinoma emerging in a transplanted kidney 3 years after return to dialysis. Case report and review of the literature. NDT Plus 2009; 2:476-8. [PMID: 25949384 PMCID: PMC4421318 DOI: 10.1093/ndtplus/sfp106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 07/16/2009] [Indexed: 11/14/2022] Open
Abstract
We present a female patient with end-stage renal disease who was referred to the emergency department with sudden, excruciating pain over the right lower abdomen and flank. Radiologic evaluation following admission revealed a mass, solid in nature, located at the upper pole of the transplanted kidney. The patient was treated with empiric antibiotics and analgesics, and her symptoms subsided over the course of the week. Based on the clinical course and radiological findings, a self-limiting, spontaneous haemorrhage was thought to be the cause of the patient's symptoms. Nevertheless, background malignancy could not be ruled out. Therefore, an interval, elective graft nephrectomy was scheduled. Pathology confirmed the diagnosis of renal clear cell carcinoma.
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Affiliation(s)
- Ram Elazary
- Department of Surgery and Transplantation Unit , Hadassah-Hebrew University Medical Center , Ein-Kerem, Jerusalem , Israel
| | - Avraham Schlager
- Departement of Surgery , New York University Hospital , New York, NY , USA
| | - Liat Appelbaum
- Department of Radiology , Hadassah-Hebrew University Medical Center , Ein-Kerem, Jerusalem , Israel
| | - Gideon Zamir
- Department of Surgery and Transplantation Unit , Hadassah-Hebrew University Medical Center , Ein-Kerem, Jerusalem , Israel
| | - Itzhak Nir
- Department of Surgery and Transplantation Unit , Hadassah-Hebrew University Medical Center , Ein-Kerem, Jerusalem , Israel
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Khalaileh A, Adileh M, Schlager A, Abu-Gazala S, Abu-Gazalah S, Mintz Y, Rivkind AI, Keidar A. Image of the month. Incarcerated paracecal hernia. ACTA ACUST UNITED AC 2009; 144:975-6. [PMID: 19841369 DOI: 10.1001/archsurg.2009.171-a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Abed Khalaileh
- Department of Surgery, Hadassah Hebrew Medical Center, Jerusalem, Israel
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Schlager A, Unger JG, Schnabel F. Does the recurrence of pregnancy-associated breast cancer during subsequent pregnancy 10 years after mastectomy support the unique hormonal milieu of pregnancy as a cause of tumorigenesis? A case and literature review. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-3058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Abstract #3058
We report a case of pregnancy-associated chest wall recurrence of breast adenocarcinoma 10 years following mastectomy and reconstruction for initial pregnancy-associated breast cancer (PABC). This represents the first reported case in the literature of a pregnancy-associated recurrence of pregnancy-associated breast cancer. The patient had no episodes of recurrent breast cancer during the interim 10 years, and only experienced a recurrence with a rapidly growing left chest mass during the subsequent pregnancy. Thus, the possibility that the malignancy may have been triggered by the pregnancy cannot be ignored.
 Although prior studies following breast cancer patients and their subsequent pregnancy have not shown an increase risk of recurrence, these studies were performed in “all comers” with breast cancer, and would not have had the statistical power to distinguish a small subset of patients with an increased risk, such as PABC patients. As a result, these patients have been assumed to be at no greater risk for recurrence with pregnancy and have been advised as such.
 It is reasonable to assume that PABC patients may, in fact, represent a unique subset of breast cancer patients with the unique hormonal milieu of pregnancy playing a mechanistic role in the propagation and proliferation of the disease. In this case a patient with prior PABC had a rapidly growing progesterone receptor positive breast cancer during a subsequent pregnancy. Further, studies have indicated that there is a possibility that the hormone status of women during pregnancy may in fact lead to a change in tumor characteristics, and therefore their risks. This instance would support the concern and represent the sentinel report describing a new subset of breast cancer with a unique spectrum of risk factors.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3058.
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Affiliation(s)
- A Schlager
- 1 General Surgery, NYU Medical Center, NY, NY
| | - JG Unger
- 1 General Surgery, NYU Medical Center, NY, NY
| | - F Schnabel
- 1 General Surgery, NYU Medical Center, NY, NY
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Abstract
Internal hernia, the protrusion of a viscus through a peritoneal or mesenteric aperture, is a rare cause of small bowel obstruction. We report the clinical presentation, surgical management, and outcomes of one of the largest series of nonbariatric internal hernias. Ten-year retrospective review of patients at our institution yielded 49 cases of internal hernias. Majority of patients presented with symptoms of acute (75%) or intermittent (22%) small bowel obstruction. While 16% of CT scans were suspicious for internal hernia, in no cases the preoperative diagnosis of internal hernia was made. The most frequent internal hernias were transmesenteric (57.0%) and 34 hernias (69%) were caused by previous surgery. All internal hernias were reduced and the defects were repaired. Compromised bowel was present in 22 cases and 11 patients underwent small bowel resection. The mean postoperative hospitalization was 10.9 days. The overall mortality rate from our series is 2%, and the morbidity rate is 12%. Transmesenteric hernias, as complications of previous surgeries, are the most prevalent internal hernias. Preoperative diagnosis of internal hernia is extremely difficult because of the nonspecific clinical presentation. However, if discovered promptly, internal hernias can be repaired with acceptable morbidity and mortality.
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Affiliation(s)
- Saber Ghiassi
- Department of Surgery, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1259, New York, NY 10029, USA
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Abstract
PURPOSE This study was designed to evaluate the management of anastomotic leaks and assess the impact of outpatient leak presentation on clinical outcome. METHODS Thirty-eight patients with clinical anastomotic leaks from 1,684 adult patients undergoing large and small intestinal anastomosis in a tertiary referral center between January 1, 2003 and September 1, 2005 were studied. All pediatric patients and adult patients with esophageal and gastric leaks were excluded. Charts were reviewed for information on anastomotic leak management, discharge status before leak presentation, length of stay, readmissions, and mortality. RESULTS The overall leak rate was 2.3 percent. Eighty-seven percent of patients (n = 33) were managed operatively. Forty-two percent of patients (n = 16) were discharged after initial operation and presented as outpatients with anastomotic leak. The discharge and inpatient groups were comparable in respect to total length of stay (26.9 vs. 33.4 days) and number of readmissions (2 vs. 1.5). The overall mortality of 5 percent (n = 2) originated from the discharge group. A greater percentage of discharge patients required intensive care unit stays for more than two weeks (25 vs. 14 percent) and very long hospital admissions lasting more than two months (31 vs. 9 percent). A smaller percentage of the discharge group patients had their ostomies reversed (31 vs. 50 percent). CONCLUSIONS The primary management of clinical anastomotic leak remains intestinal diversion. Although length of stay was shorter in the discharge group, the number of patients who experienced significant intensive care unit stays and very long hospital stays was greater. Within the discharge group, mortality was higher and fewer patients had their ostomies reversed.
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Affiliation(s)
- John C Byrn
- Department of Surgery, The Mount Sinai School of Medicine, New York, NY 10029, USA
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Schlager A, Altchek A, Kalir T, Deligdisch L, Weber KJ. Mesenteric fibromatosis masquerading as an ovarian neoplasm twenty years after Chernobyl radiation exposure. Gynecol Oncol 2006; 102:587-9. [PMID: 16678243 DOI: 10.1016/j.ygyno.2006.03.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Revised: 03/14/2006] [Accepted: 03/15/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND Since their initial description in 1832, desmoid tumors have been reported to occur in virtually every part of the body. Intra-abdominal desmoid tumors, or mesenteric fibromatosis, are often associated with Familial Adenomatous Polyposis mutation in a syndrome known as Gardner's Syndrome. Although sporadic cases of desmoid tumors do occur, unlike Gardner's Syndrome, they predominantly occur extra-abdominally. CASE Case report of a 61-year-old female who presented with two months of abdominal pain, progressive lower abdominal distension and a 10-15 pound weight gain accompanied by one week of urinary hesitancy and frequency. Patient underwent a diagnostic workup for an ovarian neoplasm, but was found at surgery to have mesentric fibromatosis. CONCLUSION Although uncommon, mesentric fibromatosis must be considered in the differential diagnosis when evaluating a patient with an abdominal mass of unknown origin.
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Bale R, Schlager A, Laimer I, Jakober R, Lang T, Hinterleither C, Knoflach M, Jaschke W. Computerunterstützte Radiofrequenzablation des Ganglion Gasseri bei Patienten mit Trigeminusneuralgie. ROFO-FORTSCHR RONTG 2005. [DOI: 10.1055/s-2005-868282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Siedentopf C, Haala I, Koppelstätter F, Verius M, Golaszewski S, Schikora D, Felber S, Schlager A. Placebo-Laser kontrollierte, Computer gesteuerte Doppelblind-Untersuchung – neue Ansätze für die Akupunktur-Grundlagenforschung. Deutsche Zeitschrift für Akupunktur 2005. [DOI: 10.1078/0415-6412-00091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Golaszewski SM, Siedentopf CM, Koppelstaetter F, Rhomberg P, Guendisch GM, Schlager A, Gallasch E, Eisner W, Felber SR, Mottaghy FM. Modulatory effects on human sensorimotor cortex by whole-hand afferent electrical stimulation. Neurology 2004; 62:2262-9. [PMID: 15210892 DOI: 10.1212/wnl.62.12.2262] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the effect of electrical stimulation of the nerve afferents of the hand on cortical activity elicited by whole-hand subthreshold stimulation for sensation in healthy human subjects. METHODS Ten healthy volunteers were studied using BOLD-fMRI with 1) a test motor-task with finger-to-thumb tapping of the left hand, 2) a whole-hand afferent electrical stimulation of the left hand below the sensory level for sensation for 30 minutes, 3) a second fMRI run with the same paradigm as in the test motor-task immediately after electrical stimulation, and 4) a final identical fMRI run 2 hours post-stimulation to test the cortical changes induced by electrical stimulation. Experiments were carried out on a 1.5 T MR scanner and for fMRI echoplanar sequences were used. Data analysis was performed with SPM99. RESULTS An increase of movement-related responses was seen within the primary motor and primary somatosensory areas of both hemispheres when comparing the test motor-task with the motor-task after electrical stimulation relative to the baseline or sham stimulation. Two hours post-stimulation the modulatory effects of mesh-glove stimulation diminished to baseline level except within the contralateral primary motor region. CONCLUSIONS The increased BOLD response spatially localized within the sensorimotor cortex reflects an increase in neuronal activity that may provide augmented neuronal excitability.
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Affiliation(s)
- S M Golaszewski
- Department of Neurology, University Hospital of Graz, Austria.
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Greiner A, Rantner B, Greiner K, Kronenberg F, Schocke M, Neuhauser B, Bodner J, Fraedrich G, Schlager A. Neuropathic pain after femoropopliteal bypass surgery. J Vasc Surg 2004; 39:1284-7. [PMID: 15192570 DOI: 10.1016/j.jvs.2004.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This retrospective study was performed to investigate prolonged postoperative pain in the area of the proximal or distal scar or the bypass tunnel after femoropopliteal bypass surgery to treat symptomatic peripheral arterial disease. PATIENTS AND METHODS Ninety-three patients with peripheral arterial disease who underwent femoropopliteal bypass surgery between January 2000 and December 2002 were included in the study. The short-form McGill Pain Questionnaire was used to score pain. Ultrasound examination of the soft tissue around the graft was performed to exclude other pathologic conditions responsible for pain, such as inflammatory processes, perigraft reactions, swollen lymph nodes, and hematomas. RESULTS Pain in at least one scar existed in 22 patients on average 13.9 +/- 9.8 months after surgery. In 10 patients pain existed simultaneously along the inguinal scar and the above-knee or below-knee scar. Pain along the bypass tunnel was experienced by seven patients. Most patients had mild to moderate pain. The mean numeric ranking score of pain severity in patients with pain was 4.2 +/- 2.3. The occurrence of prolonged postoperative pain was not associated with age, gender, diabetes, indication for surgery, material or type of bypass, number of preceding operations, or postoperative wound complications. Only follow-up time after femoropopliteal bypass surgery tended to be lower in patients with pain compared with those without pain. CONCLUSION Prolonged postoperative neuropathic pain along the distal and proximal incision or the bypass tunnel exists in one fourth of patients after femoropopliteal bypass surgery. Patients should be informed of this kind of complication before surgery. The results of our study justify further investigations of the origin and treatment of this pain, to find effective methods to reduce the incidence of prolonged postoperative pain after femoropopliteal bypass surgery.
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Affiliation(s)
- A Greiner
- Department of Vascular Surgery, Leopold Franzens University Hospital Innsbruck, Anichstrasse 35, A-1060 Innsbruck, Austria.
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Siedentopf C, Golaszewski S, Haala I, Mottaghy F, Felber S, Schlager A. Die funktionelle Magnetresonanz-Tomographie in der Akupunkturforschung. Deutsche Zeitschrift für Akupunktur 2004. [DOI: 10.1078/0415-6412-00067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Radmayr C, Schlager A, Studen M, Bartsch G. Prospective randomized trial using laser acupuncture versus desmopressin in the treatment of nocturnal enuresis. Eur Urol 2001; 40:201-5. [PMID: 11528199 DOI: 10.1159/000049773] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Several treatment modalities for children suffering from monosymptomatic nocturnal enuresis are available, but desmopressin is a well-established option. On the other hand, alternative nonpharmacological therapies such as laser acupuncture are more frequently requested by the parents. To our knowledge, there is no prospective randomized trial which evaluated the efficacy of such an alternative approach in comparison with the widespread use of desmopressin. METHODS Forty children aged over 5 years presenting with primary nocturnal enuresis underwent a previous evaluation of their voiding function to assure normal voiding patterns and a high nighttime urine production. Then the children were randomized into two groups: group A children were treated with desmopressin alone, and group B children underwent laser acupuncture. All children were investigated after a minimum follow-up period of 6 month to evaluate the duration of the response. RESULTS The children of both groups had an initial mean frequency of 5.5 wet nights per week. After a minimum follow-up period of 6 months reevaluation revealed a complete success rate of 75% in the desmopressin-treated group. Additional 10% of the children had a reduction of their wet nights of more than 50%. On the other hand, 6 months after laser acupuncture, 65% of the randomized children were completely dry. Another 10% had a reduction of the enuresis frequency of more than 50% per week. 20% of the children in the desmopressin-treated group did not respond at all as compared with 15% in the acupuncture-treated group. Statistical evaluation revealed no significant differences among the response rates in both groups. CONCLUSION Im comparison with pharmacological therapy using desmopressin, our study shows that laser acupuncture should be taken into account as an alternative, noninvasive, painless, cost-effective, and short-term therapy for children with primary nocturnal enuresis in case of a normal bladder function and high nighttime urine production. Success rates indicated no statistically significant differences between the well-established desmopressin therapy and the alternative laser acupuncture.
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Affiliation(s)
- C Radmayr
- Department of Urology, University of Innsbruck, Austria.
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Schlager A, Kronberger P, Petschke F, Ulmer H. Low-power laser light in the healing of burns: a comparison between two different wavelengths (635 nm and 690 nm) and a placebo group. Lasers Surg Med 2000; 27:39-42. [PMID: 10918291 DOI: 10.1002/1096-9101(2000)27:1<39::aid-lsm5>3.0.co;2-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVE Studies on the influence of low-power laser light on wound healing have shown inconsistent results, or, as in the case of burns, are very scarce. We have studied the effects of two different low-power diode laser lights on the healing of burns in rats. STUDY DESIGN/MATERIALS AND METHODS Thirty rats were burned on both flanks and randomly allocated to one of three study groups. In group A, both wounds remained untreated; in groups B and C, one wound each was irradiated with 635 nm or 690 nm laser light (1.5 J/cm(2)), whereas the other wound remained untreated. Diameter, redness, and edema of the wounds were examined daily. RESULTS Between and within groups, diameter, redness, and edema of the wounds were similar throughout the entire observation period. Irradiation of the burns did not accelerate wound healing when compared with control wounds. CONCLUSION We conclude that neither 690 nm nor 635 nm low-power laser light produced any beneficial effects on the healing processes of burns in rats.
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Affiliation(s)
- A Schlager
- Department of Anesthesia and General Intensive Care Medicine, Division of Anesthesia, the Leopold Franzens University of Innsbruck, Austria.
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Abstract
A double-blind, randomized, placebo-controlled study was conducted to investigate the effectiveness of Korean hand acupuncture in preventing postoperative vomiting in children scheduled for strabismus surgery. In one group, acupressure was performed 30 min before induction of anaesthesia by applying an acupressure disc onto the Korean hand acupuncture point K-K9; the disc remained in situ for at least 24 h. The second group functioned as placebo group. The treatment groups did not differ with regard to patient characteristics, surgical procedure and anaesthetic administered. In the acupressure group, the incidence of vomiting was significantly lower (20%) than in the placebo group (68%). We conclude that Korean hand acupressure of the acupuncture point K-K9 is an effective method for reducing postoperative vomiting in children after strabismus repair.
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Affiliation(s)
- A Schlager
- Department of Anaesthesia and Intensive Care Medicine, Leopold-Franzens-University of Innsbruck, Austria
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Margreiter J, Schlager A, Balogh A, Maier H, Balogh D, Lindner KH, Fuchs D, Schobersberger W. Exogenous neopterin causes cardiac contractile dysfunction in the isolated perfused rat heart. J Mol Cell Cardiol 2000; 32:1265-74. [PMID: 10860768 DOI: 10.1006/jmcc.2000.1160] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Neopterin is known in humans as a sensitive marker for diseases associated with increased activity of the cellular immune system. Recent studies report neopterin also to exhibit distinct effects: neopterin induces inducible nitric oxide synthase expression in rat vascular smooth muscle cells and activates translocation of nuclear factor- kappa B. Neopterin may also induce oxidative stress causing apoptotic cell death, or superinduce tumor necrosis factor- alpha -mediated apoptosis. Observing these effects in cell cultures, we were interested in possible consequences of neopterin on cardiac function in the isolated perfused rat heart. The influence of neopterin in three different concentrations (10 micromol/l, 50 micromol/l, 100 micromol/l) on cardiac contractility parameters and coronary vascular resistance were studied in 67 male Sprague-Dawley rats using the temperature-controlled and pressure-constant Langendorff apparatus with retrograde perfusion of the aorta with a Krebs-Henseleit buffer. Treatment with 100 micromol/l neopterin resulted in a significant decrease in coronary flow and cardiac contractility. Coronary flow decreased from 15.2 to 9.5 ml/min (P=0.002), left ventricular pressure from 80 to 52 mmHg (P=0. 002), rate of pressure fall from 1605 to 923 mmHg/s (P=0.001) and rate of pressure rise from 2862 to 1709 mmHg/s (P=0.001). Concentrations lower than 100 micromol/l neopterin had no significant effect on cardiac function. Our study demonstrates a considerable influence of exogenous neopterin on cardiac performance in the Langendorff model of isolated perfused rat hearts. This has to be considered a potential pathogenic factor of cardiac disturbances in diseases in which high concentrations of neopterin are released due to immune activation. At present the exact mechanism remains unclear.
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Affiliation(s)
- J Margreiter
- Department of Anesthesia and Intensive Care Medicine, The Leopold-Franzens University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.
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Schlager A, Luger TJ. Oxygen application by a nasal probe prevents hypoxia but not rebreathing of carbon dioxide in patients undergoing eye surgery under local anaesthesia. Br J Ophthalmol 2000; 84:399-402. [PMID: 10729298 PMCID: PMC1723433 DOI: 10.1136/bjo.84.4.399] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIM Hypoxia and carbon dioxide rebreathing are potential problems during eye surgery in spontaneously breathing patients. The aim of the present study was to determine effectiveness of nasal application of oxygen to prevent hypoxia and carbon dioxide accumulation in spontaneously breathing patients undergoing cataract surgery. METHODS Oxygenation and carbon dioxide rebreathing were examined in 40 elderly patients using two different methods of oxygen supply-nasal v ambient air-with a constant flow of 2 l/min. Partial pressure of carbon dioxide under ophthalmic drapes, transcutaneous pressure of carbon dioxide, and the respiratory rate were measured during 25 minutes while oxygen was supplied via a nasal cannula or into the ambient air under the drapes. RESULTS In both groups carbon dioxide accumulation under the drapes, carbon dioxide rebreathing, tachypnoea, and an increase in peripheral oxygen saturation occurred. No significant differences were found between the two methods. CONCLUSION Nasal application of oxygen prevented hypoxia but did not prevent carbon dioxide accumulation in patients undergoing eye surgery under retrobulbar anaesthesia. Additionally, as a side effect when using nasal probes, irritation of the nose was described in half of the patients investigated.
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Affiliation(s)
- A Schlager
- Department of Anaesthesia and General Intensive Care Medicine, Division of Anaesthesia, The Leopold Franzens University of Innsbruck, Austria
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Abstract
Recent investigations have reported contradictory results on the influence of low-power laser light on wound healing. Low-power laser with a power output of 250 mW and an emitted laser light of 670 nm have been insufficiently investigated to date. The effect of a 250-mW/670-nm laser light on the healing of burning wounds in rats was investigated. Thirty rats were burned on both flanks. One wound was irradiated with 670-nm laser light (2 J/cm2), whereas the other side remained untreated. Macroscopic evaluation of the wounds was performed daily; 10, 20, and 30 days after burning, 10 rats were killed and the wounds histologically evaluated. Neither macroscopic nor histologic examination of the irradiated wound showed accelerated wound healing when compared with control wounds. In the present study, irradiation of burns with a 250-mW/670-nm laser light produced no beneficial effects on wound-healing processes.
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Affiliation(s)
- A Schlager
- Department of Anesthesia and General Intensive Care Medicine, Leopold Franzens University of Innsbruck, Austria.
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Abstract
We have investigated the effectiveness of rectally administered dimenhydrinate on postoperative vomiting in children undergoing strabismus surgery, in a double-blind, randomized, placebo-controlled study. In one group, dimenhydrinate 50 mg was administered rectally 30 min before starting anaesthesia, whereas in the control group, placebo suppositories were given. Children who received dimenhydrinate showed a significantly (P < 0.001) lower incidence of vomiting (15%) than those in the control group (75%). We conclude that rectal administration of dimenhydrinate is an effective means of reducing postoperative vomiting in children undergoing strabismus surgery.
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Affiliation(s)
- A Schlager
- Department of Anaesthesia and Intensive Care Medicine, Leopold Franzens University of Innsbruck, Austria
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Luger TJ, Lorenz IH, Grabner-Weiss C, Schlager A, Kolbitsch C, Keller C, Gassner M. Effect of fluvoxamine on sufentanil antinociception and tolerance under chronic intravenous infusion in rats. Pharmacol Toxicol 1999; 85:263-8. [PMID: 10628901 DOI: 10.1111/j.1600-0773.1999.tb02020.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Fluvoxamine, a selective serotonin reuptake inhibitor (SSRI), significantly potentiates analgesia when administered in animals together with opioids. The aim of the present study was to investigate the effects of fluvoxamine on sufentanil antinociception and tolerance. Following animal care committee approval, the effects of continuous infusions of fluvoxamine and sufentanil were studied in behavioural tests (hot-plate test, tail-flick test, catalepsy test) in Sprague-Dawley rats with a jugular vein catheter. Saline was administered as a control. The time-effect curves for continuous intravenous sufentanil indicate dose-related antinociception and rapid development of tolerance in the hot-plate and tail-flick tests. Co-administration of fluvoxamine with continuous sufentanil enhances antinociception and attenuates development of tolerance, most clearly seen in the tail-flick test. Fluvoxamine alone and saline were not effective. No animal showed catalepsy. As a side effect we observed a marked loss of body weight. The IC50 values of sufentanil binding with and without fluvoxamine addition are 0.56+/-0.17 nM and 0.3+/-0.15 nM, respectively, indicating no direct effect on the occupancy of sufentanil on the mu-receptor by this serotonin reuptake inhibitor. In conclusion, we were able to show that the combination of an opioid with an SSRI at low doses improves analgesia and decreases development of tolerance in nociceptive tests in rats. The clinical implications of these promising results in an animal model, however, await further investigation.
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Affiliation(s)
- T J Luger
- Department of Anaesthesia and Intensive Care Medicine, The Leopold-Franzens-University of Innsbruck, Austria.
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Schlager A. Heat trapped under paper and plastic ophthalmic drapes during eye surgery using local anesthesia. J Cataract Refract Surg 1999; 25:1532-4. [PMID: 10569171 DOI: 10.1016/s0886-3350(99)00245-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess whether heat trapped under ophthalmic drapes is responsible for patient reports of being hot during cataract surgery using local anesthesia. SETTING Departments of Anaesthesia and Intensive Care Medicine and of Ophthalmology and Optometry, Innsbruck University Hospital, Innsbruck, Austria. METHODS In a prospective, randomized, single-blind study, the temperature in the ambient air under 2 types of paper drapes (Group A: Barrier Ophthalmology Drape, Johnson & Johnson; Group B: Steri Drape 1062, 3M) and a plastic drape (Group C: cotton drape + Steri Drape 1024, 3M) was measured for 25 minutes in 60 patients having cataract surgery under local anesthesia. RESULTS Three minutes after the patient's head was draped, the mean temperature under the drape began to increase significantly: Group A, 25.7 degrees C +/- 0.3 degree C (SD) to 29.17 degrees C +/- 0.9 degree C (P < or = .001); Group B, 25.87 degrees C +/- 0.4 degree C to 29.41 degrees C +/- 0.9 degree C (P < or = .001); Group C, 25.8 degrees C +/- 0.35 degree C to 29.4 degrees C +/- 0.6 degree C (P < or = .001). It continued to increase in all groups as the operation continued. No significant differences in temperature were observed among the 3 drape types studied. Subjective thermal discomfort was reported by 35% to 40% of patients. CONCLUSION Paper drapes did not cause less heat from being trapped than the plastic drape. Trapped heat may impair the comfort of patients having eye surgery under local anesthesia.
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Affiliation(s)
- A Schlager
- Department of Anaesthesia and General Intensive Care Medicine, Innsbruck, Austria
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Abstract
A new flexible support for ophthalmic drapes with the possibility of continuous oxygen supplementation was designed for use in patients undergoing eye surgery under local anesthesia. This new equipment is easy to handle and prevents contact between the patient's face and the ophthalmic drape. To prevent hypoxia of spontaneously breathing patients, the ambient air under the drapes can be supplemented with oxygen using this new equipment and no other devices. The equipment described here is advantageous for practical use in patients undergoing eye surgery under retrobulbar anesthesia.
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Affiliation(s)
- A Schlager
- Department of Anesthesia and General Intensive Care Medicine, The Leopold Franzens University of Innsbruck, Austria.
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Abstract
BACKGROUND Carbon dioxide concentration under ophthalmic drapes increases during eye surgery under local anaesthesia. A new prototype has been designed which combines continuous suction of carbon dioxide enriched air and continuous oxygen insufflation under ophthalmic drapes to prevent carbon dioxide accumulation in spontaneously breathing patients undergoing cataract surgery. METHODS In a prospective randomised single blind study the effectiveness of this new prototype was examined in 50 unpremedicated elderly patients. In 25 patients suction was applied under ophthalmic drapes, whereas in the other 25 patients no suction was used. In all cases oxygen was insufflated under the drapes at a constant flow of 2 l/min. Carbon dioxide concentration in the ambient air surrounding the patient's head under ophthalmic drapes, transcutaneous partial pressure of carbon dioxide, respiratory rate, and oxygen saturation were measured. RESULTS Carbon dioxide concentration under the drapes, transcutaneous partial pressure of carbon dioxide, and respiratory rate remained unchanged in the suction group, whereas in the non-suction group these values increased significantly. Oxygen saturation rose significantly in both groups without differences between the groups. CONCLUSION Application of this new prototype for continuous aspiration of carbon dioxide enriched air prevents carbon dioxide rebreathing and subsequent hypercapnia associated with an elevated respiratory rate. This new equipment may therefore be useful in patients undergoing ophthalmic surgery under retrobulbar anaesthesia.
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Affiliation(s)
- A Schlager
- Department of Anaesthesia and General Intensive Care Medicine, Division of Anaesthesia, The Leopold Franzens University of Innsbruck, Austria
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Schlager A, Furtner B, Mitterschiffthaler G. Acute obstruction during manual ventilation caused by an end-tidal rubber cap in the reservoir bag. Anesth Analg 1999; 89:804-5. [PMID: 10475337 DOI: 10.1097/00000539-199909000-00063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Carbon dioxide accumulation under ophthalmic drapes is caused by their impaired permeability to exhaled carbon dioxide in spontaneously breathing patients. Three different ophthalmic drapes were examined under clinical conditions. Sixty unpremedicated patients of each gender, aged over 60 years and with an ASA status of I-III undergoing cataract surgery under retrobulbar anaesthesia were included in the study. Patients with known pulmonary diseases were excluded. The patients were divided into three groups of 20 patients each. In all groups, oxygen was insufflated under the drapes at a constant flow of 21.min-1. Carbon dioxide concentration in the inspired air, transcutaneous carbon dioxide pressures, respiratory rate and oxygen saturation by pulse oximetry were measured. Accumulation of carbon dioxide under the drapes, increase of partial pressure of transcutaneous carbon dioxide and hyperventilation were observed in all three groups. An oxygen supply of 21.min-1 prevented hypoxaemia but not hypercapnia. Therefore, producers of ophthalmic drapes are encouraged to look for further ways to increase the carbon dioxide permeability of their drapes with the aim of reducing carbon dioxide accumulation and hyperventilation in spontaneously breathing patients undergoing eye surgery.
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Affiliation(s)
- A Schlager
- Department of Anaesthesia and General Intensive Care Medicine, Division of Anaesthesia, The Leopold Franzens University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
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Schlager A. [Acupuncture in prevention of postoperative nausea and vomiting]. Wien Med Wochenschr 1999; 148:454-6. [PMID: 10025044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
In this review the effectiveness of the acupuncture point Pericard 6 (P 6) on postoperative nausea and vomiting (PONV) is described. Use of the acupuncture, acupressure as well as the laser stimulation of P 6 proved as efficient prophylaxis of PONV in numerous studies. These methods are free of side effects and represent therefore a good alternative to the pharmacological prophylaxis and treatment of PONV.
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Affiliation(s)
- A Schlager
- Abteilung für Anästhesie, Universitätsklinik für Anästhesie und Allgemeine Intensivmedizin, Innsbruck.
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