Biomedical subjects

G J Kourtesis

Publications and source records attributed to G J Kourtesis.

7 recordsLinked to original sources

PubMed1990

Safety of operation in biliary pancreatitis during the same hospitalization.

Over the past 4 years, 61 patients with biliary pancreatitis were managed, 48 of whom had operation on the biliary tree within the same hospital admission. Initial therapy was medical and operation was performed at a median of 6 days from admission (range: 3-14 days). Two patients required surgery for non-resolution of the pancreatitis, but the other 44 patients had clinical and biochemical resolution prior to surgery. At operation, oedematous-interstitial pancreatitis was found in 18 patients, necrotizing pancreatitis in two and a normal pancreas in 28 patients. Common duct exploration in 15 patients resulted in 10 positive explorations. One death occurred in a patient with necrotizing pancreatitis and an impacted stone, but overall morbidity was low and total hospitalization in the operated group averaged 12 days. There was a statistically significant difference in the incidence of bile duct stones (five of 10 versus seven of 38, P = 0.019) and operative findings of pancreatitis (seven of 10 versus 11 of 38, P = 0.038) in patients having surgery before or after 4 days of hospitalization. Initial conservative management for 4 days allows resolution of pancreatitis in most patients, minimizing the need for and potential risk from common duct exploration.

Acute Disease↗

PubMed1988

Surgical options in acute diverticulitis: value of sigmoid resection in dealing with the septic focus.

The outcome of 78 patients hospitalized with acute diverticulitis was analysed to determine the indications for emergency operation and to examine the safety of sigmoid resection. Forty patients improved on medical therapy, but four relapsed soon after discharge. Forty-two (55%) patients had emergency operations for non-resolution of clinical sepsis (25), persistent symptoms or mass (14) and fistula (three). Operations performed were: sigmoid resection and primary anastomosis (23) with covering colostomy (six). Hartmann's operation (10), drainage with/without colostomy (seven) and right hemicolectomy (two). Findings at operation were: abscess (19), phlegmon (14), generalized peritonitis (six), colovesical fistula (three) and chronic diverticulitis (three). Complications included wound infections (six), respiratory complications (five) and one death. Six patients having drainage of the sigmoid inflammation alone as the first operation required subsequent resection, with prolonged and often complicated hospitalization. Minimal morbidity and shorter hospitalization were achieved when sigmoid resection was performed at the initial procedure.

Abscess↗

PubMed1988

Primary anastomosis in emergency distal colonic surgery after on-table colonic lavage.

The traditional operative management of emergency distal colon pathology has involved staged procedures, but recently Hartmann's operation has gained popularity. The indications for primary anastomosis without covering colostomy have remained controversial, but the technique of on-table lavage has extended the use of this approach in the acute setting. A series of seven patients having this procedure for diverticular abscess (three), obstructing colonic carcinoma (one), perforating colonic carcinoma (one) and sigmoid volvulus (two) is presented. The saline irrigation is introduced by a Foley catheter inserted via the appendix stump and the effluent is diverted from the proximal colon by anaesthetic scavenger tubing. The lavage is continued until the effluent is clear and anastomosis performed with one-layer interrupted absorbable sutures. There were no deaths in the series; one patient developed a wound infection and average hospitalization was 16 days (range: 6-31 days). Immediate anastomosis in selected cases of emergency distal colonic pathology is thus feasible and safe following on-table colonic lavage.

Acute Disease↗

PubMed1988

Acute diverticulitis: safety and value of contrast studies in predicting need for operation.

Results of treatment of 70 patients hospitalized with acute diverticulitis were analysed to determine the value of early contrast enema in management. A water-soluble enema done during the first week of hospitalization in 48 patients showed diverticulosis with spasm (30), a leak or peridiverticulitis (16) and a normal study (two). No complications were caused by the study. Forty patients improved on medical therapy, but four relapsed after discharge. Thirty-four (49%) patients had urgent operation during hospitalization for the acute episode of diverticulitis. Findings on contrast enema correlated with the need for surgery during the acute phase: 13 of 16 with peridiverticulitis or a leak compared with three of 30 with diverticulosis/spasm (P less than 0.001). Operations performed were: sigmoid resection and primary anastomosis (17) with covering colostomy (five). Hartmann's operation (eight), colostomy and/or drainage (seven), right hemicolectomy (two). Findings at surgery were: abscess (15), phlegmon (12), peritonitis (five) and colovesical fistula (two). It is concluded that early contrast enemas of the distal colon done with appropriate precautions are useful in confirming the diagnosis of diverticular disease: only two of 48 studies were falsely negative. A pericolic extravasation (as opposed to a small sinus tract) or abscess usually indicates need for operation, whereas the finding of diverticulosis/spasm suggests a favourable outcome of conservative management.

Acute Disease↗

PubMed1983

Biliary atresia: review of experience with twenty-three patients.

Prior to the Kasai procedure of hepatic porto-enterostomy in 1959, biliary atresia was a bleak chapter in paediatric surgery. It was only after many years, however, that the procedure became widely accepted. During the past 8 years 23 cases of biliary atresia have been treated at the Royal Alexandra Hospital for Children (RAHC). Twenty-one had the noncorrectable type of atresia. Sustained drainage was obtained in ten patients, all of whom had the noncorrectable type anomaly. Nine are still alive, eight having survived more than one year after operation and all are free from jaundice. Cholangitis has been a problem in six of these patients and six have evidence of fibrosis or cirrhosis on subsequent liver biopsy. Two patients have shown improvement in liver histology since operation. Sustained biliary drainage is related to age at operation, the size of biliary ductules at the porta and the subsequent development of cholangitis. Long term prognosis still remains uncertain.

Bile Ducts↗

PubMed1983

Major amputations for melanoma.

Major amputation is an infrequently performed procedure for melanoma. Less than one per cent of patients seen at our unit have had a major amputation for melanoma. Thirty-two patients who had a total of thirty-four amputations have been reviewed in this article. The most frequent indication for amputation has been intractable local recurrences not responding to other forms of treatment. Amputation is only considered in patients with no evidence of systemic disease. Our conclusion, based on survival figures after amputation, is that the procedure has a palliative role in some cases of advanced localized melanoma, with a few long term cures.

Adult↗

PubMed1982

Aortointestinal fistulae following aortic reconstruction.

Six patients with aortointestinal fistula have been treated at Royal Prince Alfred Hospital (RPAH) over the last decade. Four had their initial vascular reconstruction at RPAH and two were referred. This represents an incidence of 0.8% following aortic reconstruction at this hospital. All presented with gastrointestinal bleeding (GIT) and two also had infective complications. Preoperative investigations were helpful in only half the patients. Three died as a direct result of the aortointestinal fistula. Later complications occurred in two of three patients where the graft was not removed. The most important aspect of management is suspicion of aortointestinal fistula as a cause for GIT bleeding in a patient with previous aortic surgery. Effective surgical management requires removal of the graft and early revascularization.

Aorta↗