Human costs of economic sanctions.
Explore the source record for details and available documents.
Diagnostic Errors↗
Biomedical subjects
E Shemesh
Publications and source records attributed to E Shemesh.
Does the use of the ileocecal region in reconstructive urology cause persistent diarrhea?
The ileocecal region (ICR) is used extensively in reconstructive urological surgery. To evaluate whether resection of the ICR may cause protracted diarrhea, 50 patients undergoing ileocecal resection were studied. Fifty patients undergoing left colectomy for cancer were used as controls. No significant change in bowel habits was noted in the control group. Among patients undergoing ICR resection 42% had transient loosening of stools 2 weeks after surgery which improved within 3 months. Twelve months after surgery only 6 patients with solid stools preoperatively had loose stools, and none suffered diarrhea. In conclusion, in the patients studied after resection of the ICR diarrhea gradually resolved. More work is necessary to study other potential metabolic consequences of such resection.
Adult↗
An outbreak of foodborne streptococcal throat infection.
Streptococcal pharyngitis is a common disease of epidemic nature, usually transmitted by saliva droplets. We present an epidemiologic analysis of an outbreak of streptococcal pharyngitis in a military unit involving 75 soldiers. The causing organism was Streptococcus pyogenes (group A beta hemolytic Streptococcus, T28 M56), which was isolated from 53 affected individuals. The source of the epidemic was probably an army cook. The infection was transferred by a cabbage salad to individuals who became symptomatic within 24-48 h. This epidemic is a reminder of an exceptional route of streptococcal dissemination and one of the largest outbreaks of foodborne streptococcal pharyngitis documented.
Disease Outbreaks↗
Complications of rubber band ligation of symptomatic internal hemorrhoids.
In a prospective study, 512 patients undergoing hemorrhoidal band ligation over a seven-year period were followed up to focus on complications. Thirteen patients (2.5 percent) were hospitalized: six with delayed massive rectal bleeding, three with urinary retention, pain, and fever (one developed perianal abscess), and three others with severe pain due to prolapsed thrombotic hemorrhoids (one developed difficulty in urination). One patient developed perianal abscess and perianal fistula two months after ligation. Twenty-four patients (4.6 percent) suffered from minor complications: 11 patients had painful thrombosed hemorrhoids; five experienced slippage of bands; three had mild bleeding; two developed band-related mucosal ulcer; one experienced each time, after two subsequent ligations, priapism lasting several hours; and difficulty in urination and tender induration above the dentate line occurred in two other patients. Rubber band ligation is, in effect, a miniature hemorrhoidectomy and has been considered, until recent reports of fatalities associated with this procedure, as an effective, safe, and efficient method of treating symptomatic second-degree and third-degree hemorrhoids. We conclude that the ability to handle complications that occur secondary to the rubber band ligation and, thereby, prevent sepsis and the low rate of major complications in our study justify reliance on this method of treating symptomatic hemorrhoids.
Female↗
Are tiny polyps important when found on sigmoidoscopy in asymptomatic people?
To determine the occurrence of synchronous large bowel polyps located proximal to the sigmoid, in persons undergoing screening flexible sigmoidoscopy, we examined those who had diminutive polyps (less than or equal to 0.5 cm) as the only finding in the distal colon by further colonoscopy. One hundred one asymptomatic persons (mean age 61 +/- 13 years) had 143 diminutive polyps; a single polyp was found in 76%, and 64% of all polyps were located in the rectum. Thirty (21%) were hyperplastic and 86 (60%) were neoplastic, including 14 with moderate and one with severe dysplasia. The others were inflammatory (five) or unclassified (hot biopsy changes or normal mucosa, 14 polyps), and eight were lost before processing. Colonoscopy revealed that 16 (16%) of the 101 patients had 21 additional polyps proximally, mostly less than 1 cm in diameter. These included one hyperplastic and 18 neoplastic polyps, and two specimens showed hot biopsy changes. Age, histological type, number or location of the index diminutive polyps, were not associated with proximal lesions. We question whether immediate colonoscopy is justified in asymptomatic patients with only diminutive polyps at flexible sigmoidoscopy.
Adult↗
Colonoscopy in patients aged 80 years or older and its contribution to the evaluation of rectal bleeding.
Colonoscopies performed in patients aged 80 years or older at the Sheba Medical Center were analysed according to the primary indication for the procedure: 101 colonoscopies were performed because of rectal bleeding of at least 2 months duration, and 335 for all other indications. Carcinoma of the large bowel was found in 29 (28.7%) bleeders, with the rectum being the most frequently involved site (12 patients). Among the non-bleeders, the prevalence of cancer was significantly lower (33 cases, 9.8%; P less than 0.001), and rectal carcinoma was less common (five patients, P = 0.04), but proximal tumours were more frequent. Of patients with cancer who had operations, the majority (72%) had a tumour confined to the bowel wall (Dukes A or B). The rate of adenomas was similar for both groups (34% vs 29%). The non-bleeders complained more frequently of abdominal pain or a change in bowel habits as compared to the bleeders, but both groups had similar rates for anaemia and weight loss. In all, 47% of these octogenarians with cancer, and 26% with adenomas were referred for colonoscopy because of rectal bleeding. This procedure was found to be safe in old age, as we recorded only four (0.9%) non-fatal complications among our series, a similar figure to the overall incidence of complications at our Institute. In conclusion, our data indicate that rectal bleeding in octogenarians warrants a complete colonic investigation, preferably by total colonoscopy.
Aged↗
Screening for colorectal neoplasia: a multicenter study in Israel.
We report the design and results of the first Israeli multicenter screening program for colorectal neoplasia. The screening protocol comprised a risk questionnaire, fecal occult blood testing, flexible sigmoidoscopy and colonoscopy. A total of 5,601 individuals were screened in five medical centers, 55% being asymptomatic with low or average risk. Colorectal tumors were found in 12.3% of screenees, the majority being adenomas. The risk for large bowel neoplasia was greatest in persons with a personal history of colorectal neoplasia (neoplasia rate 473.2/10(3)) and was increased in those with inflammatory bowel disease, a family history of colorectal tumor, or past history of cured breast cancer. European-born Jews had a 50% greater risk than non-European-born Jews. Persons at high risk were more likely to return for repeat screening than those at low or average risk. However, approximately 15% of persons at high risk actually thought that they were of average risk. Fecal occult blood testing was markedly less reliable than flexible sigmoidoscopy and had a false-negative rate of 84.4%. The results demonstrate that existing medical facilities in Israel can be used to screen at least those individuals with increased risk for colorectal neoplasia.
Adenoma↗
[Influence of violence in television programs of viewers' violence--a critical review].
Explore the source record for details and available documents.
Aggression↗
Colonoscopy without prior preparation in mild to moderate active ulcerative colitis.
We evaluated the effect of different types of preparations on the diagnostic yield of colonoscopy (total or limited) in mild to moderate active ulcerative colitis. Our ability to determine the extent of disease and see the mucosa beyond the inflamed areas was assessed in patients receiving no preparation (group A, 72 examinations) and those receiving diphosphosoda enemas (group B, 181 examinations). There were three failures in group A and 11 in group B. In the majority of patients (71% of group A, 83% of group B) the scope could be passed under optimal viewing conditions at least one segment beyond the involved area. In group A the cecum was reached in 16% of the procedures and in group B in 18%. We conclude that in mild to moderate active ulcerative colitis, colonoscopy can be performed without preparation, and still achieve the same results as with preparatory enemas.
Cecum↗
Clustering of colorectal neoplasia: characteristics of coexisting adenomas in patients with severely dysplastic polyps or invasive (malignant) polyps as compared to patients with benign adenomas or carcinomas.
This study compared the size, histology and morphology of coexisting neoplastic polyps found in colonoscopy, and evaluated the clustering of these polyps in patients with either colorectal carcinoma, cancerous polyps or benign adenomas. Patients were divided by their most malignant form of neoplasia: Group A included 58 patients with early invasive cancerous polyps, and Group B included 73 patients with in situ carcinoma within an adenoma. Group C consisted of 335 patients with benign adenomas, and Group D had 289 patients with colorectal carcinoma. There were no significant differences between the four groups regarding sex, age and ethnicity. The cancerous polyps were significantly larger than the benign polyps. There were significantly (P less than 0.01) more patients with multiple (greater than or equal to 5) colonic lesions in Groups A or B than in Groups C or D. Coexisting polyps were much closer to the index growth, and demonstrated more severe dysplastic changes in the case of cancerous polyps than those associated with benign polyps or cancer. Based on our data we speculate that cancerous polyps are not merely a middle link in adenoma-carcinoma sequence, but rather mark a subset of patients who are especially prone to develop neoplastic changes in their colonic mucosa. These patients should be included in a more strict colonoscopic surveillance programme.
Adenocarcinoma↗
Role of endoscopic retrograde cholangiopancreatography in differentiating pancreatic cancer coexisting with chronic pancreatitis.
The pancreatographic appearance and the clinical presentation of ten patients presenting with adenocarcinoma of the head of the pancreas coexisting with chronic pancreatitis were compared with those of 45 patients with chronic pancreatitis (CP), without malignancy, investigated at the same time period. All ten patients, had typical pancreatographic findings of CP, combined with an elongated narrowing of the duct of Wirsung. Marked localized irregularity of the adjacent main duct and of side branches were found in all ten patients. Such findings were not detected in the other 45 patients with CP only. Ultrasonography or computed tomography have detected a definite pancreatic mass in only five of these patients, and in six patients with CP without malignancy. It is concluded that endoscopic retrograde cholangiopancreatography is highly accurate in detecting pancreatic cancer coexisting with CP. It is primarily helpful in elderly patients having severe degrees of CP to rule out cancer.
Aged↗
Invasive colorectal adenomas: surgery versus colonoscopic polypectomy.
Of 6,426 colonoscopies performed in 1978-1987, 66 invasive colorectal adenomatous polyps were removed in 58 examinations. The study group included 36 (62%) men and 22 (38%) women with an age range of 42-96 years. Forty-three patients had invasive pedunculated polyps and 15 had invasive sessile polyps. Following the colonoscopic polypectomy, secondary surgical resection was done in 19 patients with pedunculated polyps and in 13 patients with sessile polyps. The operative specimens showed that the colonoscopic polypectomy removed the entire cancerous focus in all patients with pedunculated polyps, including those with stalk invasion. In contrast, most cases with sessile polyps turned out on operation to be Dukes' B or C carcinoma. Follow-up (mean 4.4 years) was available for 53 (93%) patients: none of 24 unoperated patients with pedunculated polyps suffered from local recurrence. We conclude that colonoscopic polypectomy is sufficient for invasive pedunculated polyps, provided that histology shows that the resection margins are free of tumoral cells. Surgery is recommended for all invasive sessile polyps.
Adult↗
Colorectal cancerous polyps compared with benign adenomas.
Explore the source record for details and available documents.
Adenoma↗
A comparison between emergency and delayed endoscopic injection sclerotherapy of bleeding esophageal varices in nonalcoholic portal hypertension.
To study whether or not emergency sclerotherapy was more effective than a program of stabilization and elective sclerosis, we studied 84 patients with bleeding esophageal varices. They underwent 332 sessions of endoscopic injection sclerotherapy, 134 of which were performed for acute variceal bleeding. Most patients (90.5%) had nonalcoholic portal hypertension. Emergency sclerotherapy (1-6 h after presentation) was performed in 65 bleeding episodes in 43 patients, and delayed sclerotherapy (more than 24 h from presentation) was performed in 69 episodes in 41 patients. The selection of patients was randomized. Emergency sclerotherapy arrested active variceal bleeding in all patients and resulted in an earlier eradication of varices and for a longer period than delayed sclerotherapy. Larger volumes of sclerosant (a mean of 26 ml compared to 13 ml) were more effective in arrest of bleeding and in an early eradication of varices. We conclude that emergency sclerotherapy, mainly with a large sclerosant volume, is highly effective in arresting active variceal bleeding. Such earlier arrest of bleeding was associated with reduced morbidity and mortality.
Adolescent↗
Early endoscopic sphincterotomy in the management of acute gallstone pancreatitis in elderly patients.
Eighteen elderly patients with acute attacks of gallstone pancreatitis underwent early endoscopic sphincterotomy of the papilla of Vater. Eleven patients were considered to be at high risk for surgery due to chronic cardiorespiratory or renal problems. The outcome of these patients was compared with that of 20 consecutive elderly patients with gallstone pancreatitis treated at the same time by means other than endoscopic sphincterotomy. Endoscopic sphincterotomy resulted in an immediate clinical improvement in all patients, except in one patient who developed transient cholangitis; there was no mortality. In contrast, there was one death (5%) and 20% morbidity in the controls. Mean hospitalization period was shorter in patients undergoing sphincterotomy (6 compared with 9.5 days), although the patients managed by sphincterotomy were initially more seriously ill than controls. Only two of the 11 high-risk patients underwent elective cholecystectomy; all others were well during a mean follow-up of 22 months. It is concluded that early endoscopic sphincterotomy is highly effective and safe in acute attacks of gallstone pancreatitis in elderly high-risk patients.
Acute Disease↗
Endoscopic sphincterotomy in patients with gallbladder in situ: the influence of periampullary duodenal diverticula.
Forty-four elderly patients (mean age, 77.2 years; range, 65 to 95) with acute bile duct obstruction, with gallbladder in situ, underwent endoscopic sphincterotomy without subsequent cholecystectomy during the same hospitalization. Thirty patients had periampullary duodenal diverticula, and 14 had no diverticula. Because periampullary diverticula were associated with biliary and pancreatic complications, possibly as a result of stasis in the diverticula, the clinical course in patients with and without diverticula was compared. Endoscopic sphincterotomy was well tolerated and resulted in a rapid clinical improvement in all patients. There were four complications related to the procedure (pancreatitis, two, and cholangitis, two), all were treated conservatively, and there were no deaths. The clinical outcome was similar in both groups of patients. During a mean follow-up of 25 months (range, 6 to 58), only two patients (one of each group) underwent elective cholecystectomy 2 and 3 months after initial presentation. It is concluded that endoscopic sphincterotomy is a safe and effective alternative to surgery as an initial treatment in elderly patients with choledocholithiasis and gallbladder in situ. Periampullary duodenal diverticulum does not interfere with the favorable results of endoscopic sphincterotomy in patients with gallbladder in situ.
Aged↗
[Methods for prevention of bleeding from esophageal varices].
Explore the source record for details and available documents.
Esophageal and Gastric Varices↗
The feasibility of in vivo resection of the left lobe of the liver and its use for transplantation.
The anatomical possibility of resecting the left lobe of the liver (segments II and III) in living subjects and using it for transplantation was evaluated. A group of 60 cadaveric livers were dissected at autopsy. The vascular and biliary elements of the left lobe were isolated and the lobe was resected and evaluated for possible grafting. The left lobe was 12-28% (mean 19.4%) of the liver mass. An extrahepatic segment of the left hepatic vein was isolated in 95% of specimens. Arterial blood supply to the left lobe consisted of a single artery (92%) or two arteries (8%). A single portal vein segment to the left lobe (type I) was found in 35% livers. Portal vein branches originated from a common orifice (type II, 35%) or separately (type III, 30%) from the left portal vein, and in these instances, preparation of a portal segment necessitated partial section of the left portal vein wall. Biliary drainage was extrahepatic in 56 livers and consisted of a single duct (type I, 78%), or two ducts (type II, 15%). The resected left lobe was evaluated as satisfactory (single hepatic vein and artery, types I or II portal vein, type I bile duct) in 48% of cases, while a less-satisfactory lobe (type III portal vein or type II bile duct) was obtained in 33%. It was found anatomically difficult or impossible to resect the left lobe for possible transplantation in 11 (19%) liver specimens.
Adolescent↗