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Biomedical subjects

A Szold

Publications and source records attributed to A Szold.

At least 19 recordsLinked to original sources
PubMed1995

[Laparoscopic colonic resection].

We present our initial experience with laparoscopic colonic resection in 15 patients: adenocarcinoma of the colon, 10 cases, giant villous adenoma (2), arteriovenous malformation (2), and a case of benign stricture. Mean operating time was 190 minutes and there were no intraoperative complications. The margins of resection and number of resected lymph nodes in patients with malignancy were comparable to those in the conventionally operated. Mean postoperative hospital stay was 6.1 days. During a maximum follow-up of 15 months there were no wound or trocar-site recurrences. We conclude that laparoscopic colonic resection is technically feasible and safe. However, its use for treating malignant diseases of the colon needs further study.

Adenocarcinoma↗
PubMed1995

[Laparoscopic splenectomy for immune thrombocytopenic purpura].

Splenectomy is effective in treating immune thrombocytopenic purpura (ITP). Recent advances in laparoscopic technique and technology have made laparoscopic splenectomy feasible. We performed it in 8 cases of ITP (16-34 years old, and 2-24 months after the diagnosis was made and appropriate treatment started). Indications for splenectomy were no response to corticosteroid therapy (2 patients), decrease in platelet count when attempting to taper off therapy (3), or severe side-effects of the treatment (3). 4-5 ports were used. The splenic artery was first double-clipped through an opening in the gastrocolic ligament and then the lower splenic pole and the posterolateral attachments were dissected using endoclips and electrocautery. The hilum and short gastric vessels were separated using an endostapler. The spleen was placed in a plastic bag whose open end was pulled out through an umbilical incision and the spleen fragmented and aspirated out of the bag, while it was still inside the abdomen. Blood or platelet transfusions were not needed and the postoperative course was uneventful in all, with early return to full normal activity. Postoperatively, platelets increased to more than 150,000/mm3 in all patients, and there was no further need for corticosteroids during a follow-up of 2-12 months. We recommend laparoscopic splenectomy for ITP because of the reduced operative trauma, better recovery and rehabilitation, less postoperative pain, cosmetic advantage, and possibly fewer postoperative complications.

Adolescent↗
PubMed1995

[Laparoscopic cholecystectomy in high risk patients].

Of approximately 600 laparoscopic cholecystectomies performed between October 1991-April 1994, 21 were in patients categorized as "high operative risks." The indications for operation were: symptomatic gallstones, 9 patients, state after acute cholecystitis treated medically (8), state after acute cholecystitis treated by cholecystostomy (3), and 1 patient with acute cholecystitis unresponsive to medical treatment. Operative risk according to ASA grading was II-III in 7 patients, III in 10, III-IV in 2 and IV in 2 (group average ASA III). They were prepared for operation by optimizing their various medical conditions. 4 with severe cardiac disease (ASA III-IV and IV) underwent laparoscopic cholecystectomy with close monitoring of hemodynamic status via radial artery and pulmonary artery catheters. Following surgery, they were monitored in the surgical intensive care unit for 12-24 hours. There were no complications during or following operation. The mean postoperative stay in hospital was 1.9 days (range 1-3). All patients were able to return to their preoperative life styles and activities. High operative risk is not a contraindication to laparoscopic cholecystectomy.

Cholecystectomy, Laparoscopic↗
PubMed1995

Antley-Bixler syndrome and esophageal atresia in a patient with trisomy 21.

The Antley-Bixler syndrome (ABS) is characterized by craniofacial, skeletal and urogenital anomalies. While most patients with ABS die of severe respiratory complications in their first months, long-term survivors have been reported. We report an infant girl, born to a consanguineous couple, with craniofacial and skeletal anomalies, consistent with ABS, in addition to atresia of the esophagus and trisomy 21.

Abnormalities, Multiple↗
PubMed1995

[Laparoscopic surgery in children and adolescents].

Laparoscopic surgery is a rapidly developing field in general surgery. The advantages of laparoscopic procedures are short postoperative courses, fewer wound-related complications, possible reduction in rate of late postoperative adhesions and better cosmetic results. Laparoscopic procedures are indicated in well-defined clinical settings, after enough experience has been acquired and technical problems solved. Children and adolescents may also benefit from laparoscopic procedures. The technique is suitable for cholecystectomies, appendectomies in selected cases, splenectomies, anti-reflux procedures, bowel resections, and diagnostic procedures, among others. In the past 3 years we have performed 65 laparoscopic procedures in patients younger than 17 years, including 10 cholecystectomies, 31 appendectomies and 7 Nissen fundoplications.

Adolescent↗
PubMed1993

High-grade retroperitoneal sarcomas: role of an aggressive palliative approach.

Between 1968 and 1988 we treated 41 patients with high-grade soft tissue retroperitoneal sarcomas. Clinical, pathological, and treatment variables were analyzed retrospectively with regard to their influence on recurrence rate and mortality. The actuarial 5-year median survival for the whole group was 48 months, with 33% of the patients surviving 10 years. Gender, clinical presentation, tumor size, and histological types did not predict outcome by multivariate analysis. Complete tumor resection was performed in 56% of the patients, but at 10 years after surgery only 10% of those patients remained disease free. Patients were classified into four groups according to the most aggressive surgical procedure employed: (1) total gross tumor resection; (2) subtotal resection, in which the major tumor bulk was excised (often with adjacent organs), but in which obvious residual disease remained; (3) palliative resection, in which minimal tumor resection was performed in order to alleviate symptoms; and (4) exploration only. Patients who were either explored and had no tumor removed or who underwent a palliative resection had a similarly poor prognosis, with a median survival of 12 and 20 months, respectively. To our surprise, patients after total resection had no survival benefit over patients who had undergone subtotal resection. However, both groups together had a significantly longer median survival of 241 months compared to the median survival of the patients with either no resection or only palliative resection (P < 0.02). The addition of chemotherapy or radiation therapy failed to show any advantage in this series. We claim from our experience that the impossibility of performing a complete resection should not prevent attempts at aggressive subtotal tumor excision, including the removal of adjacent organs, since this aggressive surgical approach may prolong survival significantly.

Combined Modality Therapy↗
PubMed1993

How conservatively can postoperative small bowel obstruction be treated?

Although postoperative adhesion ileus is the most common cause of small bowel obstruction in adults, its management remains controversial. We retrospectively studied 297 admissions of 227 patients over a period of 14 years to evaluate our conservative approach in managing adhesion ileus. We found that nonoperative therapy of up to 5 days' duration can be used safely for the majority of patients who present with postoperative intestinal obstruction, including those with complete obstruction. In those patients, who responded to conservative treatment, the obstruction resolved within a mean of 22 hours and a maximum of 5 days. A trial of more than 5 days' duration proved ineffective. The conservative approach resulted in a 73% resolution of obstruction with no significant increase in mortality or in the rate of strangulated bowel.

Humans↗
PubMed1992

Surgical approach to occult gastrointestinal bleeding.

In 5% of patients with gastrointestinal bleeding, standard evaluation fails to reveal the source of the bleeding. We describe the management of 71 patients treated for obscure gastrointestinal bleeding at the Mount Sinai Medical Center, New York, New York, from 1985 to 1991. There were 38 men (54%) and 33 women (46%). The mean age was 60 years. The patients had bleeding episodes for a mean period of 26 months and required an average of 20 units of blood prior to surgical treatment. All had undergone an extensive diagnostic workup including barium contrast studies, endoscopies, and angiographies. Some had multiple bleeding scans, Meckel scans, and surgical explorations. Three patients were found to have "watermelon stomach" on endoscopy and had an antrectomy. Sixty-eight (96%) patients underwent a preoperative small bowel enteroscopy, which revealed the precise diagnosis in 50 (70%) of the patients. All patients underwent surgery. In 30 (42%) patients in whom the bleeding site was not apparent at exploration, intraoperative enteroscopy was performed. Two actively bleeding patients had intraoperative enteroscopy, which failed to localize the bleeding site, and intraoperative scintigraphy was utilized. The bleeding was found to originate in small bowel arteriovenous malformation (AVM) (28 patients), leiomyoma (8 patients), primary small bowel malignancies (11 patients), and other causes (24 patients). Fifty-six patients (80%) had no further bleeding; 9 with multiple small bowel AVM have experienced rebleeding and are alive. Six patients died of recurrent bleeding, and six died of metastatic cancer. An aggressive approach should be applied in patients in whom standard evaluation fails to localize the source of gastrointestinal bleeding. Enteroscopy, surgical exploration with additional intraoperative enteroscopy, and occasional intraoperative scintigraphy can achieve an excellent yield and allow resection and potential cure.

Algorithms↗
PubMed1992

Cardiac vagal tone predicts outcome in neurosurgical patients.

OBJECTIVE: To evaluate the relationship between presurgical levels of cardiac vagal tone and outcome in neurosurgical patients. DESIGN: Prospective series. SETTING: Respiratory ICU in a university hospital. PATIENTS: Fifty-one adults admitted to the respiratory ICU between 1982 and 1985. Forty-two patients were scheduled for elective neurosurgery, and nine patients suffered from head trauma. INTERVENTIONS: Ten minutes of electrocardiographic (EKG) data were recorded before medical intervention. Neurosurgical patients scheduled for surgery had EKG data recorded 24 hrs before their operation. Trauma patients had EKG data recorded immediately after arrival in the respiratory ICU. MEASUREMENTS AND MAIN RESULTS: Cardiac vagal tone was evaluated using a vagal tone index, quantified from the EKG. Cardiac vagal tone monitored before surgical intervention significantly distinguished between the outcome groups only for the elective neurosurgical patients. Age, gender, heart rate, Glasgow Coma Scale scores, and tumor location, size, and malignancy were not related to outcome in the elective neurosurgery group. However, within the trauma group, low Glasgow Coma Scale scores were significantly related to poor outcome. CONCLUSIONS: Cardiac vagal tone may offer important predictive value by alerting the physician to the functional consequence of head injury. Information relating to autonomic nervous system functioning, such as the vagal tone index used in this study, may provide additional information that will complement the computed tomography scan results. This study demonstrates that the vagal tone index is a predictive factor that may be efficiently extracted from the heart rate pattern routinely monitored in ICUs.

Adolescent↗
PubMed1991

Acquired tracheoesophageal fistula in infancy and childhood.

Acquired tracheoesophageal fistula (TEF) is a rare entity in the pediatric age group. We report two pediatric patients with acquired TEF caused by shells of pistachio nuts. In both patients the primary operation did not resolve the problem and a second intervention for recurrent fistula was needed. The special nature of acquired TEF, particularly the one described herein, requires delayed surgical intervention and meticulous separation of the respiratory and alimentary tracts by an intercostal muscle flap.

Child, Preschool↗
PubMed1991

Felix Wurtz: surgeon and pediatrician.

Felix Wurtz, a surgeon in Basel and Zurich, wrote a book on pediatrics, The Childrens Book, which was first published (after his death) in 1612. It is the first known book in western Europe to deal with pediatrics and surgery. The book discusses issues dealing with the care of children, also addressing problems in pediatric surgery, primarily congenital and acquired orthopedic malformations. The book, and the contribution of its writer to pediatric surgery, are reviewed. The accuracy of the first English language translation is also evaluated.

General Surgery↗
PubMed1990

[Congenital diaphragmatic hernia presenting after the neonatal period].

Congenital diaphragmatic hernia (Bochdalek) is a congenital malformation usually presenting early after birth with a mortality of 50-70%. It is rarely diagnosed after the neonatal period, when the prognosis is considered favorable. We operated on 11 children past the neonatal period, ranging from 6 months to 5.5 years of age. 9 had presented with respiratory symptoms and were operated on semi-electively with excellent results. 2, operated on for strangulation of bowel incarcerated in the hernia, eventually died (aged 7 months and 1 year, respectively). Early diagnosis is important, as early surgery is recommended, even in those without symptoms.

Child, Preschool↗
PubMed1989

The effect of tidal volume and intravascular volume state on systolic pressure variation in ventilated dogs.

Both tidal volume and effective blood volume may affect the variation in the arterial pressure waveform during mechanical ventilation. The systolic pressure variation (SPV), which is the difference between the maximal and minimal systolic pressure values following one positive pressure breath was analyzed in 10 anesthetized and ventilated dogs, during ventilation with tidal volumes of 15 and 25 ml/kg. The dogs were studied during normovolemia, hypovolemia (after bleeding of 30% of estimated blood volume) and hypervolemia (after retransfusion of shed blood with additional 50 ml/kg of plasma expander). The SPV reflected hemodynamic changes and was maximal during hypovolemia and minimal during hypervolemia. Unlike all other hemodynamic parameters it was also affected by the tidal volume and significantly increased at higher tidal volumes during each volume state. We conclude that the SPV and its components are useful parameters in evaluating the intravascular volume state. They also reflect the magnitude of the tidal volume employed.

Animals↗
PubMedDate not supplied

Elective laparoscopic appendectomy in patients with familial Mediterranean fever.

Familial Mediterranean fever (FMF) also known as hereditary polyserositis, is an inherited disorder commonly found in Armenians, Turks, Arabs, Balkans, and Jews originating from North African countries. The diagnosis of FMF is based on clinical findings and family history, as no specific diagnostic test is yet available. One of its main clinical features is recurrent acute episodes of peritonitis. During such an episode, physical examination and laboratory findings may be similar to those for acute appendicitis. Therefore up to two-thirds of FMF patients undergo emergency appendectomy, with the appendix being normal in most cases. As laparoscopic appendectomy has proved to be safe and advantageous, and to prevent misdiagnosis and unnecessary emergency surgery, we performed elective laparoscopic appendectomy in 13 FMF patients ranging in age from 8 to 32 years. They had been suffering from the disease for 1 to 12 years (mean 3.8) and had had an average of 3.5 yearly episodes of FMF peritonitis. All procedures were concluded by laparoscopy without conversion to open surgery. The average postoperative hospital stay was 3.07 days. The only complication was superficial wound infection in one patient (7.6%), and the mean time to regain full normal activity was 8.5 days. We conclude that elective laparoscopic appendectomy in FMF patients is safe. It helps to exclude appendicitis as a cause for peritonitis in these patients and may prevent unnecessary emergency surgery.

Adolescent↗