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Biomedical subjects

C R Deutsch

Publications and source records attributed to C R Deutsch.

14 recordsLinked to original sources
PubMedDate not supplied

[Esophagoplasty with bypass using an isoperistaltic gastric tube in the treatment of cancer of the thoracic esophagus: study of 13 cases].

In order to relieve complete obstruction of the thoracic esophagus due to spinocellular carcinoma, thirteen patients, all of them in good or at least regular general conditions were submitted to a bypass using a isoperistaltic gastric tube. The disease itself was treated by radiotherapy after surgery. Only one patient died at the hospital due to an error in the radiotherapy schedule. Cervical fistula was observed in six patients seven days after surgery; local treatment was enough for complete healing in five out of six. In one patient surgery was performed in order to repair the anastomotic area. Stenosis was observed in three patients but in all cases it was possible to overcome it by endoscopy. With the progress of the disease other complications were observed such as hemoptysis and respiratory distress. The survival rate was nine months (running between five and sixteen) but it should be noted that swallow capacity was maintained until death. The employed of a bypass of isoperistaltic gastric tube seems to be a desirable alternative in the treatment of esophageal cancer because it allows the reestablishment of deglutition before any treatment such as radiotherapy alone or combined with surgery.

Adult↗
PubMedDate not supplied

[Recurrent inguinal hernia: study of 87 cases].

A retrospective analysis is made of the data of 87 patients with recurrent inguinal hernias operated at the Hospital das Clínicas of the University of São Paulo in a period of six years. As it happened with other authors, frequency of recurrence was: direct hernia (43.5%), indirect hernia (50%), the less often seen mixed form (3.9%), and crural hernia (2.6%). They discuss local and systemic etiopathogenic factors, strain in the early postoperative period being indicated as a major factor, responsible for 43.1% of the cases. More than half of recurrences (48/85) occurred in the first year, some occurring after a longer period of time (30.6% after three years). The mostly used repair techniques were modified Bassani's technique (suture of the transverse arch to the inguinal ligament) and the Lotheissen-McVay technique, in 46.1% and 42.5% of the cases, respectively. In 9 of the 85 cases, tightening the deep inguinal orifice was enough. Analysis of the rate of surgical failure was difficult, as patients did not routinely return for follow-up visits.

Female↗
PubMedDate not supplied

[Prevention of infection in closure surgery in colostomies. Double-blind study with tinidazole].

A comparative double-blind study of tinidazole vs placebo was conducted in order to assess the prophylaxis of post-surgical abdominal infections in 40 patients undergoing closure colostomy surgery. During three days the patients were kept on a low residue diet, and underwent a colon mechanical cleansing. About 10 to 12 hours prior to surgery the patients were given placebo or tinidazole in tablets of identical appearance; the dose of tinidazole was of 2 g (4 tablets) in a single oral dose. Evaluation performed after surgery showed that in the tinidazole group occurred two surgical mild infections (10%), while in placebo group occurred nine infections (45%)--four of them severe and one very severe, showing a significative difference between the two groups (p less than 0.05). In placebo group 21 bacteria were isolated, 3 of them were anaerobic; only two aerobic species were identified in the tinidazole group (p less than 0.001). No adverse reactions were reported in both groups. The authors concluded that in this study, tinidazole showed a prophylactic effect on post-surgical abdominal infections in patients who underwent closure colostomy surgery.

Adolescent↗
PubMedDate not supplied

[Cystic dilatation of the intrahepatic bile ducts (Caroli's disease)].

Congenital cystic dilatation of the intrahepatic biliary ducts, known as Caroli's disease, is rarely recognized in general surgical practice and often overlooked. Until now little more than a hundred cases have been described although modern diagnostic procedures disclose more frequently new ones. Three patients with this anomaly have been treated by the authors during the past years and the different aspects concerning diagnosis and treatment are discussed and compared with existing information. In all three patients colic pain in the upper abdomen was the first symptom reported in the first years of life. In one patient jaundice and fever were associated with the abdominal pain and cholangitis developed a secondary biliary cirrhosis. Somatic underdevelopment, consequence of the cirrhosis in this child was observed. In two patients an intrahepatic hepaticojejunostomy was performed and a left hepatectomy in the third. In the two older children intrahepatic gallstones were found; in the younger one no stones were found inside the dilated ducts.

Adolescent↗
PubMedDate not supplied

[Cystic dilatation of the common bile duct in adults. Report of 4 cases].

The authors report four cases of patients who presented congenital choledochal cysts. They discuss the incidence, classification, pathophysiology, diagnosis, clinical presentation and current treatment based in their own experiences and in a review of the literature on the subject.

Adult↗
PubMedDate not supplied

[New tactical maneuver for hemostasis of parenchymal organs].

The authors report a new surgical procedure destined to realize the hemostasis suture of parenchymatous organs, mainly spleen and liver. The suture is done with needle and absorbable suture material appropriate for the lesion and small hemostatic gere plates. The main qualities of these procedure are the passage of the suture wire in the easiest direction for the surgeon and the confection of these manoeuvre out of abdominal cavity. This procedure was applicated, until now, in nine cases with fully success.

Hemostasis, Surgical↗
PubMedDate not supplied

[Bilio-digestive fistulas].

The authors report upon 5 cases of biliary-enteric fistulas, all of them detected preoperatively in a General Surgery Service during a relatively short period of time (6 months). Two cholecysto-duodenal and one cholecysto-ileal fistula were complications of a pre-existent cholelithiasis. A choledocho-duodenal fistula was caused by a penetrating peptic ulcer and a choledocho-colonic fistula was a iatrogenic traumatic one. The review of the literature demonstrates generally a lower incidence of this pathology in different surgical centers, one or two cases a year. More than 50 per cent of the biliary-enteric fistulas were unexpectedly found during operations on the biliary tract or stomach. This forces the surgeon to change his programmed surgical procedure without adequate preoperative preparation. The consequence is a higher morbidity rate in such operations. The continuing refinement of diagnostical procedures have led to a progressive and more frequent preoperative assessment of these fistulas. Adequate diagnostic methods and surgical procedures adopted in different cases of biliary enteric fistulas are discussed, emphasizing the good results obtained and the lower morbidity.

Adult↗