Biomedical subjects
D Weissberg
Publications and source records attributed to D Weissberg.
Pneumothorax following induction chemotherapy in patients with lung metastases: a case report and literature review.
A 29-year-old patient presented with bilateral pulmonary lesions following surgery for recurrent placental site trophoblastic tumor (PSTT). On day seven after institution of the 'EMA' regimen (etoposide, medium dose methotrexate with folinic acid rescue and actinomycin-D), complete pneumothorax occurred. Closed-system air drainage brought only transient lung expansion and subsequent talc pleurodesis was needed. During follow-up, complete regression of lung metastases was observed. A literature survey of post-chemotherapy pneumothorax in patients with lung metastases disclosed fourteen hitherto reported cases. Including the present PSTT case, non-epithelial gynecologic malignancy (3 patients) ranks second to osteogenic sarcoma (6 cases) with regard to the primary tumor involved.
Foreign bodies in the tracheobronchial tree.
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Suture closure versus stapling of bronchial stump in 304 lung cancer operations.
Suture closure of the bronchial stump was compared with staple closure after 304 operations for bronchogenic carcinoma over an 8-year period. In 154 cases (112 lobectomies and 42 pneumonectomies) the bronchial stump was closed with interrupted sutures of 000 polyester, and in 150 cases (120 lobectomies and 30 pneumonectomies) an autosuture stapler was used. The time for suture closure ranged from 5-15 minutes, whereas stapling was accomplished uniformly in c. 90 seconds. Bronchopleural fistula developed after suture closure in seven cases (4.5%), but in none after stapling closure. Stapling of the bronchial stump after lobectomy or pneumonectomy for lung cancer is safer and quicker than suture closure, and is recommended as the method of choice.
Foreign bodies in the gastro-intestinal tract.
Between 1971 and 1990, 70 patients with foreign bodies in the gastro-intestinal tract were admitted to our service. There were 35 children and 35 adults. Foreign bodies were found in the pharynx and the oesophagus in 22 patients, with 1 perforation; and in the stomach and intestines in 27, with 14 perforations. Fifteen foreign bodies were swallowed and defecated, 6 were inserted into the rectum. Coins were found in 8 patients, toys in 3, pins and needles in 6, chicken bones and fish bones in 15, and toothpicks, shaving blades, cutlery, dentures, plastic bag containing cocaine, parts of a foam rubber mattress and other items in the remainder. Foreign bodies retained in the oesophagus must be removed promptly lest obstruction and perforation occur. Many foreign bodies that have passed the oesophagus progress uneventfully to defaecation. Others become retained and should be removed. If retained in the stomach, endoscopic removal may be attempted before resorting to a laparotomy. Perforation is an urgent indication for operation. Those patients inclined to swallow foreign bodies intentionally and those who insert items into the rectum should undergo psychiatric evaluation.
Compressed air injury to the esophagus: case report.
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Acute pseudo-obstruction of the colon.
Fourteen patients with acute pseudo-obstruction of the colon (Ogilvie's syndrome) were treated over a 16-year period. Ten patients (71.4%) had a recent history of mental illness and were treated with hypnotic and sedative drugs uninterruptedly for many months. The clinical picture and abdominal radiographs on admission to hospital were typical of acute mechanical obstruction of the colon; 1 patient had a perforation of the transverse colon. Obstruction was ruled out by barium enema in 9 patients, by colonoscopy in 3 and by immediate laparotomy in 2. Twelve patients were treated conservatively by nasogastric tube, correction of fluid and electrolyte imbalance, enemas, cessation of all hypnotic and sedative drugs, and decompression of the colon using a rigid rectoscope and rectal tube. There were no complications and no deaths. Ogilvie's syndrome should be suspected in patients with symptoms of large-bowel obstruction whose history discloses intake of hypnotic and sedative drugs. After mechanical obstruction is ruled out, conservative management is indicated. It should include cessation of all psychopharmacological agents and decompression of the colon by rectal intubation or colonoscopy. If conservative measures fail and the caecum increases in size, operative decompression by transverse colostomy rather than cecostomy is indicated.
Bleomycin and talc for control of pleural effusions.
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Technical aids in surgery. Two muscle-sparing thoracotomies--techniques and indications.
Two types of muscle-sparing thoracotomies are described. They have been used over the past 11 years in 396 patients. These incisions are ideal for wedge resections, biopsies, exploratory thoracotomies, excisions of emphysematous blebs, decortications, and a variety of other operations, including pulmonary resections in selected patients. They provide entirely adequate exposure, while minimising the trauma of thoracotomy.
Cholecystostomy as a definitive operation.
Cholecystostomy for decompression and drainage of the biliary tree is indicated when the elderly, poor risk patient with destructive inflammatory process in the gallbladder is unable to tolerate a more extensive operation. Cholecystostomy is often criticized as an inferior operation, because it provides some palliation but leaves the patient with most problems unattended. To re-evaluate the role of cholecystostomy in the management of acute disease of the gallbladder, we reviewed our experience with it. During the years 1974 to 1987, 37 patients underwent a cholecystostomy. Patients ranged in age from 58 to 90 years, with an average age of 69 years. Twenty-eight patients had acute destructive cholecystitis, usually complicated by perforation, peritonitis or ascending cholangitis. Five had severe pancreatitis; three, cholelithiasis, and one patient, carcinoma of the bladder. Twenty-seven of the 37 patients had severe systemic disease and were critically ill. At the operation, calculi were extracted and the gallbladder and abscess were drained. Two patients died, yielding a mortality rate of 5.4 per cent. Tube cholangiography was done in 33 patients. Although residual stones were demonstrated in seven patients, the stones were removed electively at a later date under much more favorable conditions. None of the 35 survivors had symptoms of disease of the gallbladder during the follow-up period, which ranged from one to 12 years. Cholecystostomy is a curative operation indicated in critically ill and elderly patients for whom extensive operation is a prohibitive risk.
Bronchoesophageal fistula in adults: congenital or acquired?
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Human immunodeficiency virus.
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[Penetrating injuries of the heart].
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Effects of upper dorsal sympathectomy on esophageal motility in humans.
To evaluate the role of the sympathetic nervous system in modulating esophageal motility, esophageal manometry was performed on two groups of patients who underwent upper dorsal sympathectomy for relief of palmar hyperhydrosis. In six patients sympathectomy was done by the supraclavicular approach, with removal of T2 and T3 ganglia. Manometry was performed before the operation and three weeks after it. In seven other patients sympathectomy was done by the axillary approach, with removal of T2-T4 ganglia. Manometry in this group was performed 28.4 +/- 22.4 months after the operation. Fifteen individuals with an intact sympathetic system served as controls. Manometric parameters evaluated were esophageal contraction amplitude and duration and lower esophageal sphincter pressure. The difference between the results obtained in the pre- and postoperative periods in the first group was not statistically significant. The differences between the two patient groups and between the patient groups and the control group were not statistically significant either. We conclude that upper dorsal sympathectomy does not affect esophageal motility in man.
Stapler closure of the bronchial stump.
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Traumatic perforations of the esophagus.
Over the past 15 years nine patients with traumatic mechanical perforations of the esophagus have been treated. Seven perforations were iatrogenic, two were accidental. One patient treated conservatively did well. Two patients were operated on without delay. Their hospitalization was short and they had no complications. Six patients were referred to surgery after a delay ranging from 5 days to 17 days from the time of perforation. Their hospitalization ranged from 9 to 113 days, averaging 62.7 days. Complications were common and two patients died. In order to assure survival of patients with esophageal perforation, early aggressive treatment is essential in nearly all instances. In an occasional patient with a small and clean perforation at the esophageal inlet, conservative treatment may be justified.