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E M Bass

Publications and source records attributed to E M Bass.

17 recordsLinked to original sources
PubMed1997

Does preoperative stoma marking and education by the enterostomal therapist affect outcome?

INTRODUCTION: It is generally accepted that preoperative patient education and skin marking for a stoma location are important in avoiding stoma complications. At our institution, enterostomal therapists are available to educate and mark patients before their surgery. However, for various reasons, not all patients who had an elective stoma created, had preoperative skin marking or instructions on stoma care. Our registry of patients provided us with a means of comparing patients who have undergone an elective stoma with (Group I) and without (Group II) preoperative marking and education. METHODS: Our stoma registry consisting of 1,790 patients was retrospectively reviewed from 1978 to 1996 to assess all patients who underwent elective stoma construction. Patients included for review had a total of 593 elective stomas. All patients with stomas are followed by the enterostomal therapists postoperatively and, therefore, were evaluated for both early and late complications. Early complications were defined as any adverse event occurring within 30 days of surgery and late complications as those occurring 30 days after surgery. RESULTS: Our enterostomal therapists preoperatively evaluated 292 of the 593 patients planned for possible stoma creation. This included careful marking of the stoma site by having the patients lie down, sit, and stand and locating a stable flat area on the abdomen, taking into account the belt line and any abnormal skin creases or deformities. Patients were instructed on stoma appearance with a model and given basic stoma care instructions. In Group I, there were 95 (32.5 percent) complications (68 (23.3 percent) occurred early and 27 (9.25 percent) occurred late). There were 301 patients who did not receive preoperative evaluation (Group II). In this second group, 131 (43.5 percent) complications were found, (95 (31.6 percent) occurred early and 36 (12 percent) occurred late). The difference in total number of complications between groups was determined to be statistically significant, with a P value of <0.0075, as was the difference in early complications, with a P value of <0.03. The difference in late complications is not significant, with a P value of <0.34. CONCLUSIONS: These results confirm that preoperative evaluation by an enterostomal therapist, marking of the skin site, and providing patient education reduce adverse outcomes. All elective procedures that may result in stoma formation should, therefore, be assessed and marked preoperatively. Patients, likewise, should be informed and taught to care for their forthcoming stomas preoperatively and postoperatively.

Enterostomy↗
PubMed1995

Blood flow in colon anastomotic stricture formation.

PURPOSE: The influence of both blood flow and anastomotic technique on the development of anastomotic stricture formation was studied using a dog model. METHODS: Fifty-three dogs underwent distal colocolonic anastomosis with either an EEA (U.S. Surgical Corp., Norwalk, CT) circular stapler or a Czerny-Lembert two-layered, handsewn anastomosis. Blood flow was measured by Laser Doppler Velocimetry using the Laserflo BPM2 (Vasamedics Inc., St. Paul, MN). The animals were separated into three blood flow groups: greater than or equal to 62.5 percent of normal blood flow, between 37.5 percent and 62.5 percent of normal blood flow, and less than or equal to 37.5 percent of normal blood flow. Each blood flow group had an anastomosis performed by either stapling or by hand sewing techniques. At six weeks, the anastomoses were opened longitudinally and fixed to determine the anastomotic index (AI). AI is defined as two times the anastomotic circumference over the proximal circumference plus the distal circumference. Blood flow groups and anastomotic technique groups were compared with an interaction variable for the outcome, AI using a two-way analysis of variance. RESULTS: The AI of the stapled anastomoses was found to be significantly higher than handsewn anastomoses (P < 0.006). There was no difference in AI between different blood flow groups and no correlation of observed histologic findings with AI. CONCLUSION: Clinically relevant ischemia does not directly influence stricture formation in either handsewn or stapled distal colonic anastomoses.

Analysis of Variance↗
PubMed1978

Duplication of the colon.

Colonic duplication is a rare congenital abnormality that can present diagnostic difficulties to the radiologist. Three new cases are reported to illustrate the different types of this anomaly. A classification is presented in which the condition is divided into two types: in type I lesions the duplication is limited to the colon and in type II lesions there are associated duplications of the genito-urinary tract. The wide spectrum of possible pathological, clinical and radiological features are reviewed.

Barium Sulfate↗
PubMed1977

Narrow-needle cholangiography.

Recent modification of percutaneous transhepatic cholangiography has resulted in success rates of 100% in opacifying obstructed biliary systems and of 50% in unobstructed systems. The authors use a 23-gauge needle with a 2- or 5-ml syringe for injecting contrast medium at high pressure. Only one puncture of the liver surface is usually required. Complications have not occurred in unobstructed cases, but early operation is still recommended in obstructed cases.

Cholangiography↗
PubMed1977

Percutaneous control of post-traumatic hepatic hemorrhage by gelfoam embolization.

A case is reported in which a male laborer sustained severe hepatic lacerations after a tree fell across his abdomen. Despite intensive resuscitation and a laparotomy, bleeding continued from the liver and a second laparotomy was performed. When this also failed to control the hemorrhage a selective hepatic angiogram showed a false aneurysm in the right lobe of the liver with surrounding hematoma. This was successfully embolized with Gelfoam emboli. Bleeding ceased immediately with an uneventful recovery. The role of embolization in the management of hepatic trauma is discussed, especially in relation to surgical hepatic artery ligation.

Adult↗
PubMed1976

Choledochal cysts: a clinical and radiological evaluation of 21 cases.

Choledochal cysts are predominantly a disease of children, the majority of which are female. The classical symptoms usually form part of a triad of jaundice, abdominal pain and a mass. The radiological features may be non specific and specific. Our experience of 21 cases with particular emphasis on the specific features which outline the cyst are presented.

Adolescent↗
PubMed1976

An accelerated diagnostic approach to surgical jaundice.

A clear distinction between obstructive and hepatocellular jaundice is difficult in many patients. Biochemical and clinical findings may cause confusion and result in long delays in diagnosis and treatment. Ultrasonography is a major advance in the positive identification of patients with dilated intrahepatic ducts, whether or not the gall bladder is dilated. Isotopic imaging also may be useful in identifying obstructive jaundice. If percutaneous transhepatic cholangiography (PTC) is performed soon after, the site and nature of the obstruction will become evident. Another advance is the introduction of a sheathless narrow needle for PTC. This reduces the possibility of complications and has the advantage of being able to puncture a normal, undilated biliary tree in as many as 60% of cases, ruling out an obstructive cause. The use of these newer radiological investigations will appreciably shorten the period between the onset of jaundice and the ascertainment of its cause.

Cholangiography↗
PubMed1975

Retrosternal density: a sign of pulmonary hypoplasia.

An anterior increased density, that parallels the posterior border of the sternum, was noted on the lateral radiograph of two children who were at first thought to have an accessory diaphragm. After a long follow-up and further investigations, it is now felt that this sign is solely due to upper lobe hypoplasia.

Child, Preschool↗
PubMed1975

The radiological diagnosis of hepatoma with special emphasis on angiography.

The radiological findings of 69 out of a total of 81 cases of proven primary hepatocellular carcinoma are reviewed retrospectively. Selective angiography was performed on 42 patients and the results are analysed according to specific angiographic findings and distribution of the neoplasm, Because of the more aggressive approach to surgical treatment of hepatomas, angiography is of utmost importance in the pre-operative evaluation of the extent of the lesion and the vascular supply to the liver. Apart from the conventional angiogram, the technique of slow-infusion hepatic angiography is discussed as well as the value of enhancement techniques such as photographic subtraction and the use of vasoconstrictor drugs. Response to chemotherapy can be assessed by an infusion hepatic angiogram if a catheter has been surgically placed in the hepatic artery. The majority of tumours were easily disgnosed on the angiogram but special problems were encountered in distinguishing multicentric forms of hepatoma from hepatic metastases and avascular lesions from primary cholangiocarcinoma. The wide variety of clinical and angiographic findings that may be found, are emphasised in 4 brief case repots.

Adenoma, Bile Duct↗
PubMed1973

Local immunoglobulin production in breast cancer.

Immunoglobulin levels (IgA, IgG, IgM) have been estimated in protein extracts of 55 malignant and 20 benign tumours of the breast, and in 17 normal tissues from a cancer bearing breast. IgA and IgG were significantly reduced in cancer compared with both benign and normal tissues but IgM, detected in only a third of tumours, was significantly increased. Total immunoglobulin levels and IgG in the malignant tumours correlated with plasma cell infiltration.The menstrual status of the patient had no influence on these findings.

Adenofibroma↗