Biomedical subjects
E Powsner
Publications and source records attributed to E Powsner.
Adenocarcinoma of the appendix: an unusual disease.
OBJECTIVE: To describe our experience with primary appendiceal tumours. DESIGN: Retrospective study. SETTING: University hospital, Israel. SUBJECTS: 2520 patients who had appendectomies during the 14 years, January 1982-December 1996. RESULTS: 22 patients 5 male and 17 female, mean age 56.2 years, had primary neoplasms; 14 were carcinoid tumours and villous adenomas and were treated by appendicectomy only. Adenocarcinoma was diagnosed in 8 patients (0.3%), 5 after appendicectomy (0.2%) which is twice the reported incidence. They were all treated by right hemicolectomy. Seven of the patients were classified as Dukes' B and one as Dukes' C. All patients were alive and disease-free after a mean follow-up period of 57.4 months. CONCLUSION: Right hemicolectomy is the treatment of choice for adenocarcinoma of the appendix.
Heterotopic abdominal pregnancy following in-vitro fertilization/embryo transfer presenting as massive lower gastrointestinal bleeding.
We present a case that, as far as we know, is the first report of lower gastrointestinal haemorrhage as a complication of heterotopic pregnancy induced by artificial reproductive technology. The heterotopic abdominal pregnancy caused erosion of the intestinal wall and massive rectal bleeding, 8 weeks after in-vitro fertilization/embryo transfer. The source of the bleeding could not be identified despite comprehensive investigation including gastroscopy, ultrasonography, sigmoidoscopy, 99Tc (technetium) scanning and angiography. Tagged-erythrocyte isotope scanning revealed an abnormal concentration in the left lower quadrant, compatible with active bleeding in the area of the terminal ileum. Laparotomy disclosed a heterotopic abdominal pregnancy, causing erosion of the intestinal wall at this site. As assisted reproductive technologies become more and more common this rare complication of intestinal erosion should be kept in mind in case of lower gastrointestinal bleeding.
Laparoscopic removal of an abdominal pregnancy adherent to the appendix after ovulation induction with human menopausal gonadotrophin.
The laparoscopic management of tubal pregnancies has become a standard form of treatment. We present, for the first time, a successful laparoscopic approach in the management of early abdominal pregnancy. Although it is difficult to reach conclusions from such limited published experience, it nevertheless appears that early abdominal pregnancies can be treated via operative laparoscopy. The possible advantages of such a therapeutic approach include lower morbidity and mortality, and a better fertility prognosis.
Surgery in chronic dialysis patients.
During recent years there has been a continuous increase in the number of patients with end-stage renal failure who require long-term dialysis. The purpose of this retrospective work was to look at the number and type of operations performed and the postoperative outcome and complications that may be typical for these patients. This report details our experience with surgery in chronic dialysis patients, focusing mainly on major surgical procedures. During 21 years (1972-93) 22 patients on long-term hemodialysis or peritoneal dialysis underwent 44 operations. All access operations and parathyroidectomies were excluded. Each patient underwent between 1 and 6 operations; 27 (61.4%) operations were elective and 17 (38.6%) were emergencies. The most common type of operation performed was abdominal surgery and hernia repair; the others, in decreasing order, were urological operations, amputations, and vascular surgery. Postoperative complications occurred in 54% of the operations, the most common being hyperkalemia in 32%, infectious complications in 16%, and bleeding in 11%. One patient (2%) died postoperatively; the cause was most probably secondary to hyperkalemia and a fatal arrhythmia. From a review of the literature and from the results of our study it appears that surgery in uremic patients can be performed with acceptable results in terms of morbidity and mortality rates. Complications, such as hyperkalemia, a fall in blood pressure, and bleeding, are expected and preventive measures should therefore be taken. Perioperative measures are recommended to minimize complications.
Primary appendiceal neoplasms.
A retrospective review of the files of 1,740 appendectomies performed during a 10-year period disclosed 13 patients (0.7%) with primary appendiceal tumors. Adenocarcinoma of the appendix was diagnosed in 6 patients (0.3%), which is a two- to four-fold higher incidence than reported in the literature. The other seven patients had benign tumors and only appendectomy was performed. The female to male ratio of adenocarcinoma was 5:1. All six adenocarcinoma patients, classified histologically as Dukes' B stage, underwent right hemicolectomy, and were disease free following a mean follow-up of 35 months. The results of our policy, also recommended by others, confirmed the benefit of right hemicolectomy in all patients with confirmed primary appendiceal carcinomas.
[Rectosigmoid carcinoma in an adolescent girl].
Carcinoma of the colon and rectum is very rare in childhood and adolescence. We describe a 16.5-year-old girl with rectal bleeding and constipation. She had been treated symptomatically for 6 months without being properly examined. Only with onset of weight loss was rectal examination performed. After workup a diagnosis of locally advanced carcinoma of the rectosigmoid with multiple lung metastases was reached. From review of the literature and our own case, it seems that the unfavorable prognosis in young patients is mainly due to lack of awareness of such a possibility, resulting in delayed diagnosis and treatment. An additional factor is the invasive nature of most colon cancers in this age group.
Prospective comparative study of magnetic resonance imaging versus transrectal ultrasound for preoperative staging and follow-up of rectal cancer. Preliminary report.
The efficiency of magnetic resonance imaging (MRI) and that of transrectal ultrasound (TRUS) were compared in preoperative staging of 15 patients with rectal cancer and in postoperative follow-up of 12 patients. Thirteen of the 15 patients evaluated for preoperative staging were operated on. Preoperative staging and pathologic finding were identical in 11 patients (84.6 percent) examined by TRUS and in 10 patients (76.9 percent) examined by MRI. Recurrent cancer was detected in 3 of 12 patients in the follow-up group. MRI was able to diagnose correctly 10 of 12 patients (83.2 percent), one patient was misdiagnosed, and in one patient the MRI could not distinguish between fibrous tissue and recurrent cancer. TRUS diagnosed correctly only 5 of 12 patients (41.6 percent). One was falsely diagnosed, and, in 6 patients (50 percent), this examination could not differentiate between fibrous tissue and recurrent tumor. According to our results, both MRI and TRUS have a place in the preoperative staging of patients with rectal cancer. The main differences between the two methods were in the differential diagnoses of fibrous tissue and recurrent cancer. MRI being more specific in detection of recurrence.
Spontaneous rupture of rectosigmoid with evisceration of small intestinal loops through anus.
Explore the source record for details and available documents.
Intramural hematoma of duodenum following endoscopic intestinal biopsy.
We present the fourth case to be reported in the literature of intramural hematoma of the duodenum following endoscopic small bowel biopsy. It is the first reported to have been diagnosed by ultrasonography and confirmed by contrast roentgenograms. Conservative treatment was effective in achieving satisfactory resolution of the obstruction within seven days, as evidenced by barium meal examination. The mechanism of trauma, in light of the other cases reported in the literature, is discussed.
Erythropoietin-induced DNA synthesis in normoblasts in vitro: effect of Actinomycin-D.
Explore the source record for details and available documents.
On the use of thymidine H-3 in tissue culture.
Explore the source record for details and available documents.
Free perforation of small intestine in adults.
In a 14-year period 15 cases of free perforation of the small bowel in adults were treated in our department. In two patients perforation was caused by a foreign body and in six by each of the following: duplication of the small bowel, Hodgkin's lymphoma, vasculitis and steroid treatment, intussusception, adhesions, diverticulum. All patients presented with the signs of diffuse peritonitis. One patient died before surgery. Of the 14 patients operated upon, 10 underwent resection and primary anastomosis and four suturing of the perforation. In six cases the etiology remains unknown even after surgical intervention and pathological examination. The mortality rate of the 14 operated patients was 7.1%. 78.5% of the patients were operated on within 24 hours of onset of symptoms, and early surgery is considered to be the most important factor in the low mortality rate achieved in this series.
Therapeutic considerations in Barrett's esophagus. Report of a case and review of the literature.
Explore the source record for details and available documents.