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Biomedical subjects

A Durst

Publications and source records attributed to A Durst.

At least 19 recordsLinked to original sources
PubMed2004

Preoperative and postoperative levels of interleukin-6 in patients with acute appendicitis: comparison between open and laparoscopic appendectomy.

BACKGROUND: Cytokine interleukin-6 (IL-6) is an early marker of systemic inflammatory response and tissue damage. This study aimed to evaluate the levels of IL-6 after open and laparoscopic appendectomy to compare the degree of surgical stress associated with these procedures. METHODS: The levels of IL-6 were measured pre- and postoperatively in the plasma of 37 consecutive patients with a diagnosis of acute appendicitis. After preoperative randomization, 22 patients underwent open appendectomy, and 15 patients underwent laparoscopic appendectomy. RESULTS: The preoperative concentrations of IL-6 were 7.2 +/- 5.6 pg/ml in the open appendectomy group, as compared with 12.1 +/- 9.7 pg/ml in the laparoscopic appendectomy group (p < 0.05). The postoperative levels were 16.9 +/- 15.7 and 23.2 +/- 19.4 pg/ml, respectively. The mean postoperative to preoperative ratio of IL-6 was slightly higher for open (2.7 +/- 2.4) than for laparoscopic (2.3 +/- 1.6) appendectomy, but the difference did not reach statistical significance. CONCLUSION: The operative stress in open as compared with laparoscopic appendectomy is not reflected by circulating levels of IL-6.

Acute Disease↗
PubMed2001

Brief clinical report: duodenal laceration presenting as massive hematemesis and multiple intraabdominal abscesses after laparoscopic cholecystectomy.

SUMMARY: Laparoscopic cholecystectomy is considered the gold standard for gallstone disease. Nevertheless, possible severe complications must not be underestimated. Bowel injuries are uncommon, but they are one of the most lethal technical complications of laparoscopic surgery. These injuries were commonly unrecognized at the time of procedures and were diagnosed later when the patients experienced sepsis, peritonitis, intraabdominal abscess, or enterocutaneous fistula. Although duodenal lacerations have been reported with laparoscopic cholecystectomies, they seem to be rare; approximately 30 such cases have been documented previously in the English literature. We report the case of a patient with thermal duodenal injury caused by elective laparoscopic cholecystectomy at an outside center presenting as massive hematemesis and multiple intraabdominal abscesses on the ninth postoperative day. The diagnosis and management of this rare complication of laparoscopic cholecystectomy are described, and the literature is reviewed.

Abdominal Abscess↗
PubMed2000

Laparoscopic cholecystectomy: what does affect the outcome? A retrospective multifactorial regression analysis.

BACKGROUND: The association between various factors and the postoperative outcome has not been thoroughly studied in laparoscopic cholecystectomy (LC). The aim of this retrospective study was to determine which factors significantly affect patients outcome after LC. METHODS: The medical and operative records of all consecutive patients who underwent LC at our institution from 1991 to 1996 were reviewed. The effect of age, medical and surgical history, duration of procedure, and setup (urgent or elective) on the postoperative complication rate and on the length of postoperative hospital stay (LOS) were analyzed using multiple linear regression and logistic regression analysis. Overall, 601 patients were included in the study. RESULTS: The factors that significantly prolonged LOS were age (p = 0.0145), acute cholecystitis (p = 0.0006), history of ischemic heart disease (p = 0.0332), and duration of procedure (p < 0.0001). A significantly higher postoperative morbidity rate was noted in patients who had a procedure longer then 2 h than in patients whose surgery required less the 2 h (13.6% vs 3.6%, respectively; p < 0.0001). Similarly, higher morbidity was noted in elderly patients than in younger patients (16% vs 6.1%; p = 0.0005). Other factors that significantly increased postoperative morbidity included acute cholecystitis (p = 0.023), a history of cholangitis (p = 0.018), and diabetes (p = 0.05). CONCLUSIONS: According to this study, advanced age, longer duration of procedure, and acute cholecystitis significantly increase both the postoperative morbidity and the LOS. History of ischemic heart disease significantly increases LOS, but does not increase morbidity after LC.

Adolescent↗
PubMed1997

Surgery in Israel.

The evolution and development of surgery in Israel reflects the influence of its dramatic historical events. The immigration of surgeons, particularly since the fourth decade of the 20th century, highly contributed to the framework of modern surgery. Medical education occurs at 4 medical schools, in Jerusalem, Tel Aviv, Haifa, and Beer Sheva, and postgraduate surgical training takes place in all public hospitals, most of which are university hospitals or have university-affiliated departments, and is controlled by the Scientific Council of the Israel Medical Association (Tel Aviv). Health care is provided by 4 health insurance funds and has been recently influenced by the National Health Insurance Bill and the Bill of Patient's Rights. Surgical standards are high and similar to the very best of Western countries. The geographical location of Israel in the Middle East, surrounded by hostile Arab countries, has dramatically influenced the development of Israeli surgery. The practice of surgery ranges from full-time service in state and insurance-funded mostly academic hospitals, to private part-time clinics for wealthy and insured patients. Surgical training occurs only in departments accredited by the Scientific Council, which are mostly affiliated with the 4 medical schools. A surgical residency in Israel usually requires 6 years, and its guidelines and regulations are elaborated and recommended by the Israel Surgical Society and controlled by the Scientific Council. Most Israeli surgeons were trained in Israeli hospitals, but a substantial number of surgeons immigrated to the country, especially from eastern Europe.

Curriculum↗
PubMed1995

[Kidney transplantation from living, related donors].

Kidney transplantation is the best treatment for selected end-stage renal patients. The shortage of cadaveric organs for transplantation has led to the development of a protocol for kidney transplantation from living, related donors. In the past 20 years, 58 living, related kidney transplantations were done in our department. Mean patient age was 30 +/- 10 (SD) years and mean donor age was 36 +/- 10. There were 34 transplantations between brothers or sisters, 15 from parent to child, 4 between cousins, 4 between spouses and 1 from son to father. Mean follow-up time was 4 years. 1 and 5 years after transplantation, patient survival rates were 85% and 80%, respectively, graft survival rates were 85% and 75%. The introduction of cyclosporin-A as an immunosuppressive agent in 1985 led to improvement in graft survival rates: from 77% and 51% after 1 and 5 years, respectively, to 88% and 84%. No correlation between HLA match or patient's age and graft survival rates was found. We conclude that living, related donor transplantation is effective for suitable cases of end-stage renal disease. It should be recommended to patients who have a healthy, interested family member.

Adult↗
PubMed1995

Pancreaticojejunostomy versus controlled pancreaticocutaneous fistula in pancreaticoduodenectomy for periampullary carcinoma.

BACKGROUND: Anastomotic leak of the pancreaticojejunostomy is a major cause of morbidity and mortality following pancreaticoduodenectomy. Reports have described a large variety of techniques for performing this anastomosis and managing the pancreatic stump. In an attempt to obviate the pancreaticojejunostomy, we prospectively studied the technique of ligating the pancreatic duct and using external drains to create a temporary controlled pancreaticocutaneous fistula. PATIENTS AND METHODS: Thirty-five consecutive patients who were to undergo pancreaticoduodenectomy for periampullary carcinoma were prospectively randomized to one of two groups: pancreaticojejunostomy (PJ) (n = 18) or controlled pancreaticocutaneous fistula (CPF) (n = 17). The groups were well matched for age, sex, coexisting medical illnesses, type of tumor, and preoperative condition. Except for the management of the pancreatic remnant, all patients in both groups underwent an identical procedure. Major morbidity, length of hospitalization, duration of the controlled pancreatic fistula, and mortality were analyzed over a mean follow-up interval of 26 months (range 5 months to 7.5 years). RESULTS: The CPF group experienced lower overall operative morbidity rates than the PJ group (24% versus 56%, P < 0.01). Two patients (11%) in the PJ group and none in the CPF group died (P = NS). Half the morbidity in the PJ group and both mortalities were related to anastomotic leak. The CPF and PJ groups left the hospital after mean stays of 26.4 and 42.2 days respectively (< 0.01). CONCLUSIONS: Compared to pancreaticojejunal anastomosis, creation of a temporary controlled pancreaticocutaneous fistula in patients who undergo pancreaticoduodenectomy for periampullary malignancy has no appreciable risk. It is associated with reduced morbidity and shorter length of hospitalization.

Adult↗
PubMed1993

Subtotal colectomy with primary ileocolonic anastomosis for obstructing carcinoma of the left colon: valid option for elderly high risk patients.

During a period of 4 years, 20 patients with obstructing carcinoma of the left colon were treated by subtotal colectomy with primary ileocolonic anastomosis. Thirteen patients (65%) were 65 years of age or older. All patients presented to the emergency room with large bowel obstruction. Twelve patients (age > 65) suffered other systemic diseases (chronic obstructive pulmonary disease, ischemic heart disease, morbid obesity), placing them in a high risk category. The mortality rate was 5% (1/20), 7.6% if only high risk patients are considered. The one-stage procedure in the treatment of obstructing carcinoma of the left colon offers the patient a number of advantages over stage intervention elimination of colostomy, namely removal of occult lesions in the resected colon, shorter hospitalization and low morbidity and mortality. We found this procedure to be a valid option also in the elderly (> 65) high risk patient. Metastatic disease in our view is not a contraindication, since the elimination of colostomy will improve the quality of life of these patients.

Adult↗
PubMed1991

Safety of surgical procedures performed by residents.

The outcome of surgical procedures on the gallbladder performed by surgical residents in a university hospital was compared with the outcome of those performed by the attending staff. More than 60% of the operations (643/1084) were done by residents under the direct supervision of the attending surgeon. We found no differences in the rate of technical complications, postoperative morbidity and mortality, or length of hospitalization between the two groups. Thus, resident surgery under appropriate guidance is safe and does not compromise the quality of patient care or operative outcome.

Cholecystectomy↗
PubMed1989

[Repair of large abdominal wall defects with expanded polytetrafluoroethylene].

Most abdominal wall defects can be repaired by primary closure. However, when the defect is so large that there is tension on closure, use of prosthetic material is indicated. Expanded polytetrafluoroethylene has the advantages of low rates of infection, foreign body reaction and adhesion formation, making it the material of choice for repair of large abdominal wall defects.

Abdominal Muscles↗
PubMed1986

Complement-dependent lysis of Erhlich ascites tumor cells by human serum (ascitolysin) is lowered in cancer patients and raised in pregnant women.

Normal human serum has been shown to contain IgM antibodies that are lytic to Ehrlich ascites tumor cells in the presence of complement. We call this activity ascitolysin (AL). Using a 51Cr release assay, the AL titers of 164 normal sera, 211 sera from patients with non-malignant disease, 62 sera from 25 pregnant women and 170 sera from cancer patients were estimated. The patient sera were taken preoperatively, and were assigned to the cancer or non-cancer group after histological diagnosis. In normals, higher titers were found in sera of A and O blood groups but not B and AB. The difference was due to a fraction absorbed by B red blood cells. Sera from untreated cancer patients showed significantly reduced titers when compared to normal, benign tumor, chronic and other non-malignant disease groups. In pregnancy, titers were positively correlated with duration and remained elevated for at least 6 weeks post partum. About 30% of AL activity was absorbed by the free galactose groups of agarose. This fraction was significantly lower in untreated cancer patients. Anti-T antigen antibodies do not contribute to AL levels. Galactophilic blocking factors were also found; eight times more frequently in cancer sera than in normals. The non-absorbed fraction was also lower in cancer sera. The data suggest that AL antibodies may be directed against human oncofetal antigens.

ABO Blood-Group System↗
PubMed1984

Determinants of wound infection after colon surgery.

Over a period of 54 months, every patient undergoing colon surgery at the Hadassah University Hospital in Jerusalem was followed up prospectively by the same nurse epidemiologist. A total of 403 patients completed the analysis. Risk factors for postoperative wound infection were explored in an epidemiological study, using both single and multivariate analysis. Of the 13 potential risk factors investigated, the four showing the highest association with wound infection were: the performance of more than one operation during a single admission; Arab ethnicity; the use of open drains; and the performance of a colostomy. In patients undergoing more than one operation, the risk for infection was greater if the second operation followed a surgical complication than if it was performed as an elective second procedure; whether the first operation was elective or not did not affect the infection rate. Second operations performed within 7 days of the first carried a higher risk for infection than those performed later. The different prophylactic protocols used during the period of investigation did not have an independently significant contribution to the risk of infection.

Aged↗