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Biomedical subjects

H Merhav

Publications and source records attributed to H Merhav.

32 records · Page 2Linked to original sources

Survival following organ transplantation in an Oklahoma institution, 1985-1993.

Since 1985, a total of 413 patients have undergone 439 solid organ transplants at the authors' institution. The current actuarial one-year survival rate of patients undergoing heart, kidney, lung, or liver transplantation at our center is 94%, 90%, 87%, and 91%, respectively. Five-year survival of heart and kidney recipients is 80% and 75%, respectively. In view of these excellent results and the excellent quality of life that successful organ transplants provide patients with end-stage organ failure, every possible effort should be made to increase organ donation.

Actuarial Analysis↗

Percutaneous transhepatic embolization of an intrahepatic pseudoaneurysm following liver biopsy in a liver transplant patient.

A 41-year-old liver transplant patient had severe hemobilia from an intrahepatic pseudoaneurysm secondary to a liver biopsy. Selective intra-arterial embolization was not technically possible due to marked redundancy and tortuosity of the allograft hepatic artery. The pseudoaneurysm was localized by ultrasound and embolized using a direct percutaneous transhepatic approach. This is a novel way of approaching hemobilia in liver transplant patients after liver biopsy and may avoid the risks of arterial embolization.

Adult↗

Delayed operation for acute pancreatitis.

A retrospective study of 72 patients with acute biliary pancreatitis admitted to our department between 1982 and 1988 was carried out to evaluate our policy of delaying surgery in such cases. Of the 57 patients who underwent surgery, 17 were operated upon within 1 to 14 days of admission ("early operation"), and 40 patients were managed conservatively and readmitted for elective surgery about 6 weeks after resolution of the acute attack. Higher mortality and morbidity rates were observed in the "early operation" group (18% and 18% compared to 0% and 10%, respectively, P < 0.05). However, all deaths occurred in septic patients over the age of 70 who were operated on due to failure of maximal intensive medical therapy. Advanced age and early operation were found to be significant predictors of hospital mortality (P < 0.01). The two groups had similar mean hospital stay; 12 patients (30%) suffered an attack while waiting for elective surgery, however in only 3 (8%) the second attack occurred within 4 weeks of discharge from hospital. We conclude that a "delayed" operation for biliary pancreatitis is an acceptable option, and that recurrent attacks of acute pancreatitis in the time interval before the operation are avoidable if the operation is performed within 6 weeks of the initial acute attack.

Acute Disease↗

Th polyagglutination with fatal outcome in a patient with massive intravascular hemolysis and perforated tumor of colon.

Polyagglutination is a rare disorder which has been associated with intravascular hemolysis (Levene et al.: Transfus Med Rev 2:176-185, 1988). In this condition cryptantigens exposed on the red blood cell membrane agglutinate with compatible sera and with lectins. A 76 year-old man with an acute abdomen due to a perforated tumor of the colon and severe fatal intravascular hemolysis is described. Th polyagglutination of the red blood cells was found.

Aged↗

The use of laser in rectal surgery.

Ten patients with rectal tumors were treated by surgical excision of the tumor using a CO2 laser Sharplan 733 CO2 laser, Laser Industries Ltd., Israel. The laser permitted sharp excision, evaporization, or fulguration of tissue. Good hemostasis was achieved. Anesthesia was unnecessary in cooperative, calm patients. There was no mortality or morbidity related to the procedure. In five patients with villous adenoma the tumor was resected with one recurrence as yet (followup 4-16 months). Five patients with inoperable carcinoma were treated for palliation with good results. Our preliminary results indicate that the CO2 laser can be a useful asset in rectal tumor surgery, especially in elderly, moribund patients and in the definite treatment of benign tumors of the rectum.

Adenocarcinoma↗

Tea drinking and microcytic anemia in infants.

To evaluate the effect of tea drinking on the occurrence of microcytic anemia in infants, we studied 122 healthy infants who underwent routine blood counts at the age of 6-12 months. An overall high frequency of anemia (Hb less than 11 gm/dl-48.4%), microcytosis (MCV less than 70 Mm3-21.3%) and microcytic anemia (19%) was found in the whole group. The percentage of tea drinking infants with microcytic anemia (32.6%) was significantly higher than that of the non-tea drinkers (3.5%). The daily amount of tea drinking was 50-750 ml (median 250 ml). The tea drinkers had significantly lower mean levels of hemoglobin than that of the non-tea drinkers (10.5 +/- 1.2 gm/dl vs 11.2 +/- 0.8 gm/dl, respectively) and significantly lower mean levels of mean corpuscular volume than that of the non-tea drinkers (71.5 +/- 7.1 micron 3 vs 76.1 +/- 4.6 micron 3). There were no significant differences between the two groups in their sex distribution and in the duration of breast feeding. The two groups differed with regard to their ages and social class but a multivariate analysis had excluded the possible confounding effect of these differences on the hematological results. Based on our finding we do not recommend giving tea to infants whose main source of iron is from milk, grains, vegetables or medicinal sources.

Anemia↗

Femoro-femoral crossover bypass for ruptured iliac artery aneurysm.

Atherosclerotic aneurysms of the iliac artery shows a marked tendency to rupture, usually with fatal outcome. A ruptured aneurysm of the left iliac artery in a 76-year-old man was successfully treated by removing the aneurysm and implanting an 8 mm dacron tubular prosthesis as a subcutaneous femoro-femoral crossover graft. The operative technique is described. The advantages of this bypass techniques as the treatment of choice in such cases are discussed.

Aged↗

Duodenostomy revisited.

Four patients were admitted to the Surgical Ward because of massive bleeding from a duodenal ulcer. In three the ulcer was induced by non-steroid anti-inflammatory drugs. On operation, following pylorotomy and suture of the bleeding artery, neither drainage nor stump closure could be affected safely. Partial gastrectomy with vagotomy, or high subtotal gastrectomy with gastroenterostomy were performed. The duodenum was dealt with by means of a tube duodenostomy. There was no mortality among these patients. Morbidity was related mainly to the extent of preoperative bleeding and associated pathology (e.g. perforation). Patient data is presented in Table I.

Aged↗

A comparison of pulmonary functions and oxygenation following local, spinal or general anaesthesia in patients undergoing inguinal hernia repair.

In order to compare the pulmonary effects of various anaesthetic techniques, 49 otherwise healthy patients needing inguinal hernia repair were randomized to general, spinal or local anaesthesia. Blood gases were drawn and spirometry performed pre- and postoperatively at fixed intervals. Results showed a superior ventilation and oxygenation pattern for local anaesthesia (p < 0.05). No statistically significant differences were found between the groups with respect to forced vital capacity (FVC) or forced expiratory volume per second (FEV1) but patients who had spinal anaesthesia performed worse, and for the group as a whole there was a significant reduction compared to preoperative values. We conclude that local anaesthesia is less detrimental to pulmonary function in inguinal hernia operations than spinal or general anaesthesia.

Adult↗