The American College of Obstetricians and Gynecologists (ACOG) has issued a report on vaginitis (ACOG Technical Bulletin no. 226). The report discusses the vaginal ecosystem, evaluation of the vagina, candidal vaginitis, bacterial vaginosis and Trichomo
By Frederic D. Burg, M.D., et al. Pp. 894. Price: $75. W. B. Saunders Company, Curtis Center, Independence Square West, Philadelphia, PA 19106-3399, 1996.Gellis and Kagan's Current Pediatric Therapy is written and designed as a text to be consult
Edited by John Noble, M.D. Pp. 1952. Price, $99.95. Mosby-Year Book, Inc., 11830 Westline Industrial Dr., St. Louis, MO 63146, 1996.After waiting nine years, Mosby has now published the second edition of Textbook of Primary Care Medicine. This mi
Only five to 10 years ago, most physicians would have dismissed alternative medicine as a fad or a fringe of medicine that was perhaps a remnant of the '60s pop culture. Now, not only is the public showing heightened interest in alternative medicine but
Chronic pelvic pain--noncyclic pain that persists for more than six months and alters lifestyle and behavior--is a significant cause of discomfort, anxiety, physician office visits and surgery. In the United States, chronic pelvic pain annually accounts
The seven categories of alternative medicine, as established by the National Institutes of Health Office of Alternative Medicine, are mind-body interventions, bioelectromagnetic therapies, alternative systems of medical practice, manual healing methods,
Chronic pelvic pain in women may involve more than the gynecologic organ systems. Urologic, gastrointestinal, musculoskeletal and psychiatric disease processes may be contributing factors, the majority of which can be treated medically. A thorough histo
A basic approach to the patient presenting with acute monoarthritis includes a careful history, a physical examination and a selected battery of laboratory tests and radiographs. Because of the possibility of septic joint, rapid assessment and treatment
Uncommon headache syndromes can be classified into two broad categories: (1) urgent conditions, including subarachnoid hemorrhage, giant cell arteritis and bacterial meningitis, and (2) special syndromes, such as cluster headache, migraine with aura and
The etiology of primary nocturnal enuresis remains somewhat controversial but may include genetic factors, decreased functional bladder capacity, increased diuresis at night, and constipation. Deep sleep and emotional illness usually play only a minimal
Date: August, 1991
Laparoscopic techniques are being applied to an increasing number of surgical procedures that traditionally involved laparotomy. Katkhouda and Mouiel describe their experience with a new procedure using laparoscopy for selective vagotomy in the treatment of chronic duodenal ulcer. They performed a modified truncal right vagotomy and anterior lesser curvature seromyotomy under videocoelioscopy in 10 patients in a hospital in France.
The technique involves using laparoscopic instruments to identify and divide the right vagus nerve and perform a seromyotomy of the anterior lesser curvature of the stomach (see figure). Because the examining laparoscope is attached to a magnifying video camera, the vagus nerve and blood vessels are more easily identified with this technique than with direct visualization during conventional laparotomy. Following nerve division, a seromyotomy is carried out at a distance of 1.5 cm from the lesser curvature and is extended to 6 cm from the pyloric muscle. Methylene blue dye is instilled into the gastric pouch to detect any mucosal perforation during seromyotomy. The seromyotomy is then sealed with either a fibrin preparation or is sutured with an overcast seam.
The 10 patients undergoing the procedure ranged in age from 19 to 54 years (mean age: 32 years). All of the patients had longstanding duodenal Ulcer, with a mean duration of symptoms of 3.8 years. The mean number of ulcer recurrences after medical treatment was 2.8.
In all of the patients, a satisfactory reduction in acid production was achieved, even after stimulation with insulin. The mean duration of the procedure was 60 minutes. No morbidity or mortality occurred. All of the patients were able to return to work within 10 days. Two months after surgery, nine patients had complete healing of the ulcer, and one had a small ulcer scar. None of the patients had abdominal complaints.
The authors believe that the new surgical technique is safe and effective in the treatment of chronic duodenal ulcer. The procedure will reduce postoperative pain and discomfort and will allow patients to rapidly return to normal activities. The authors caution that potential candidates must be carefully selected and that the surgical team must be prepared to convert the procedure to laparotomy if difficulties are encountered. (American Journal of Surgery, March 1991, vol. 161, p. 361.)
COPYRIGHT 1991 American Academy of Family PhysiciansCOPYRIGHT 2004 Gale Group