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Biomedical subjects

B Kleiner

Publications and source records attributed to B Kleiner.

17 recordsLinked to original sources
PubMed1998

[Simultaneous laparoscopic therapy of cholecysto- and choledocholithiasis. An analysis of results].

INTRODUCTION: With the advent of laparoscopic cholecystectomy, ERCP has gained importance in the treatment of choledocholithiasis. Laparoscopic cholecystectomy with intraoperative cholangiography and common bile duct surgery allows diagnosis and treatment of cholecystolithiasis and choledocholithiasis in a single procedure. PATIENTS AND METHODS: Laparoscopic treatment of choledocholithiasis was evaluated in 99 consecutive patients with choledocholithiasis. 28 patients underwent successful preoperative ERCP. Of the patients with intraoperative confirmation of choledocholithiasis, removal was attempted by a transcystic approach in 36 and 23 underwent choledochotomy. 24 patients with a high operative risk underwent postoperative ERCP. RESULTS: The transcystic approach was successful in 72.2%. Choledochotomy was successful in 91.3%, yielding a combined success rate of 80%, 3.4% had local complications and 8.4% had other complications (complication rate 11.8%), 20.3% of the patients underwent ERCP after failed laparoscopic procedures. One patient had a laparoscopic redo. There was no mortality and no conversion to open surgery. CONCLUSION: ERCP and laparoscopic common bile duct surgery are complementary, efficient and safe modalities of treatment for choledocholithiasis. Choice of procedure is influenced by the surgeon's experience and institutional infrastructure, and the individual patient.

Adolescent↗
PubMed1997

Self-expanding metal stents in malignant esophageal obstruction: a comparison between two stent types.

OBJECTIVES: Self-expanding metal stents are a promising alternative in the palliation of malignant esophageal obstruction, but the relative value of different stent types is not well established. METHODS: During a 3-year enrollment period in four different centers, 82 consecutive patients with malignant dysphagia without tumor recurrence after surgery or esophagorespiratory fistulas received either an uncovered Wallstent (44 patients) or a knitted nitinol stent (38 patients). RESULTS: Age (median: 79 yr), sex (F:M = 33:67), dysphagia score (median: 3), Karnofsky score (median: 53), body mass index (median: 19), type of pretreatment, tumor stage, stricture length (median: 5.4 cm), and stricture location were comparable in both stent groups. After stent placement, median dysphagia score improved markedly in both groups by two points. Procedure-related mortality (16 vs 0%; p < 0.01), early complication rate (32 vs 8%; p < 0.01), and severe persistent pain after stent placement (23 vs 0%; p < 0.002) were higher in the Wallstent compared with the knitted nitinol stent group. In contrast, stent dysfunction (7 vs 32%; p < 0.005), reintervention rate (9 vs 34%; p < 0.005), and costs were lower in the Wallstent compared with the nitinol stent group. CONCLUSIONS: In malignant esophageal obstruction, both stents markedly improved dysphagia. Uncovered Wallstents seem to cause more early severe complications than knitted nitinol stents. In contrast, stent dysfunction, reintervention rate, and costs appear to be higher in the nitinol stent group.

Adult↗
PubMed1996

[15 years of endoscopic therapy in choledocholithiasis].

INTRODUCTION: The relevance of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment of common bile duct stones has increased since the introduction of laparoscopic cholecystectomy in 1989-1990. METHODS: The number, indications, success and complication rate of ERCP were analyzed retrospectively in 1121 consecutive patients with bile duct stones treated at Berne University Hospital between 1980 and 1994. RESULTS: The number of patients undergoing endoscopic stone extraction increased slowly from 1980 to 1990, but has shown a 4-fold increase in the last 5 years parallel to the introduction of laparoscopic cholecystectomy. Failure to diagnose and remove bile duct stones decreased 5-fold from 23% (14 of 60 patients) in 1986 to 4.4% (10 of 225 patients) in 1994. Major complications occurred in 3.2% (30 of 617 patients) and consisted of acute pancreatitis (1.6%), hemorrhage of the papilla (1%), and cholangitis (0.6%). The severity but not the number of complications has decreased in the last 15 years. CONCLUSION: Gallbladder stones with common bile duct stones are usually treated by endoscopic stone extraction combined with laparoscopic cholecystectomy. Open operation with bile duct exploration is reserved for a small subgroup of patients with specific problems.

Adult↗
PubMed1993

[Monitoring fetal delivery by oxycardiotocography].

Oxycardiotocography is a combination of cardiotocography and continuous registration of the foetal arterial oxygen saturation (SaO2). In a few cases, the value of this additional information of foetal SaO2 is demonstrated. During uncomplicated deliveries with normal foetal heart rate patterns, the foetal SaO2 usually ranges between 50% and 70%. Uterine hyperactivity with impaired perfusion of the placenta shows besides a changed heart rate patterns, a significant decrease of the foetal oxygen saturation. Conversely, by supplying oxygen to the mother with a mask, the foetal oxygen saturation can be increased by approx. 10%. In case of a breech presentation and application of the sensor to the buttocks, the measured O2-saturation is approx. 10% to 15% below the values usually obtained from the scalp because the tissue there is supplied with mixed blood after the ductus.

Apgar Score↗
PubMed1987

Sonographic analysis of the fetus with ureteropelvic junction obstruction.

Twenty-five fetuses with ureteropelvic junction obstruction were evaluated to determine the likelihood of progression of hydronephrosis in utero, and the outcome for the neonate. Such information may alter prenatal as well as perinatal management. These observations showed that the degree of dilatation in utero is likely to be greater than that observed postnatally; the degree of dilatation does not necessarily correlate with renal functional impairment measured postnatally; significant progression of dilatation in utero is relatively uncommon, especially in unilateral cases; and uretero-pelvic junction obstruction, even when bilateral, is unlikely to be fatal. Of 21 live newborn infants with follow-up, 14 required surgery and seven were placed under observation.

Female↗
PubMed1986

Multicystic dysplastic kidney: observations of contralateral disease in the fetal population.

To evaluate multicystic dysplastic kidney (MDK) and associated contralateral renal abnormalities in the fetal population, 27 cases detected and followed in utero were reviewed retrospectively. The sonographic assessment included estimation of amniotic fluid volume and interval growth, evaluation for non-genitourinary anomalies, and postnatal follow-up study. Contralateral renal anomalies were detected in 41% of the fetuses and included obstruction of the ureteropelvic junction, renal agenesis, renal hypoplasia, and bilateral MDK. The incidences of these malformations were compared with results of earlier studies of MDK in the pediatric and adult populations. Lethal anomalies, such as bilateral MDK and MDK associated with contralateral agenesis, are common (19% and 11%, respectively) in the fetal population; obstruction of the contralateral ureteropelvic junction, a nonlethal anomaly, was seen less commonly (7%). Perinatal death from lethal abnormalities may spuriously raise the incidence of nonlethal contralateral abnormalities in the pediatric and adult populations. Contralateral mild fetal pyelectasis, found in 15% of fetuses with MDK, was not clinically significant.

Cysts↗
PubMed1977

Neurofibromatosis: a neoplastic birth defect with two age peaks of severe problems.

A survey involving more than 400,000 patient sources revealed a population of 129 NFT patients relatively unbiased by the specific character of the disease (eg neurologic vs orthopedic problems), though biased in terms of severity. Two age peaks of severe disease were demononstrated, one early in life (10 yr or less) and one late (apex in 36- to 50-yr group). Neural crest-derived malignancies were the critical component of the second peak (75% of severe cases). The high burden nature of the disorder is emphasized by the fact that moderate and severe cases amounted to 64% in the survey population (ie those brought to medical attention) and 26% in nonproband affected family members in 46 families. In addition, even correcting for 5% of ascertainment of minimal-mild cases and 61% ascertainment of moderate-sever cases, 7% of the presumed NFT population may be considereed at risk for severe problems.

Adolescent↗
PubMed1976

Photochemical air pollution: transport from the New York City area into Connecticut and Massachusetts.

Photochemical air pollution resulting from primary emissions in the New York City metropolitan area is transported by prevailing winds on a 300-kilometer northeast trajectory through Connecticut and as far as northeastern Massachusetts. As a result, southwestern Connecticut has the highest ozone concentrations in the region and there is a substantial increase in ozone concentrations in Massachusetts. The ozone concentrations of air entering the New York City metropolitan area are often already above the federal standard of 0.08 part per million, but the concentration distribution is well below concentration distributions at downwind sites in Connecticut.

Air Pollution↗