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Biomedical subjects

H Paran

Publications and source records attributed to H Paran.

27 records · Page 2Linked to original sources
PubMed1995

Outpatient surgical treatment of anal fissure.

OBJECTIVES: To review our experience of treating anal fissures by lateral subcutaneous anal sphincterotomy in the outpatient clinic. DESIGN: Retrospective study. SETTING: University hospital, Israel. SUBJECTS: 108 of 112 Consecutive patients with anal fissures. INTERVENTIONS: All patients had failed to respond to a two week course of conservative treatment. They all underwent lateral subcutaneous anal sphincterotomy under local anaesthesia in either the outpatient clinic or the day-case operating theatre. MAIN OUTCOME MEASURES: Early and late morbidity, patient satisfaction, admission to hospital, and recurrence. RESULTS: 108 of the 112 were followed up for a mean of 20 months (range 2-56). 100 (93%) reported that the late results were good to excellent. Four patients bled immediately after the operation and required admission to hospital and four developed abscesses of which only one responded to conservative treatment; 14 patients complained of initial mild incontinence but in most this resolved over time; 92 patients (85%) had no complaints at late follow up, and only 3 reported either no improvement or recurrence; 10 reported slight soiling, and only one patient remained incontinent. CONCLUSION: Sphincterotomy is the operation of choice for patients with anal fissures that have not responded to conservative treatment, particularly as it can be done effectively and safely in the outpatient clinic under local anesthesia.

Abscess↗
PubMed1995

Preliminary report of a prospective randomized study of octreotide in the treatment of severe acute pancreatitis.

BACKGROUND: Experimental and clinical studies on the effect of octreotide in the treatment of patients with acute pancreatitis have presented controversial results. Since January 1992, we have been conducting a prospective randomized study on the clinical effect of octreotide in severe acute pancreatitis, at three hospitals in Israel. STUDY DESIGN: The entering criteria included three or more of the Ranson's prognostic signs and computed tomographic findings of severe pancreatitis. Patients were randomly assigned to conservative treatment either with or without octreotide (0.1 mg injected subcutaneously three times a day). The end points of the study included: complication rate (adult respiratory distress syndrome [ARDS], sepsis, renal failure, pseudocyst, fistula, and abscess), length of hospital stay, and mortality. RESULTS: During the first two years (from January 1992 to December 1993), 51 patients entered the study. After evaluation, 13 patients were excluded due to failure to meet the entering criteria, incomplete data, or incorrect diagnosis. Of the remaining 38 patients, 19 were assigned to octreotide (treatment group) and 19 to conservative treatment alone (control group). The two groups were matched with regard to age, sex, etiology, and severity of disease. The complication rate was lower in the treatment group compared with the control group with regard to sepsis (26 compared with 74 percent, p = 0.004) and ARDS (37 compared with 63 percent, p = 0.1). The hospital stay was shorter in the treatment group compared with the control group (17.9 compared with 34.1 days, p = 0.02). Death occurred in two patients in the treatment group and six patients in the control group. CONCLUSIONS: Although some of the parameters did not reach statistical significance, these preliminary results suggest that octreotide may have a beneficial effect in the treatment of patients with severe acute pancreatitis. This study is scheduled to continue for two more years.

Abscess↗
PubMed1992

The possible role of Chlamydia trachomatis in perineal suppurative hidradenitis.

OBJECTIVE: To find out if there is an association between perineal suppurative hidradenitis and Chlamydia trachomatis infection. DESIGN: Open study. SUBJECTS: Seven consecutive patients treated for perineal suppurative hidradenitis during the past three years, and 10 control subjects who were being treated for acute cryptogenic perianal abscesses. MAIN OUTCOME MEASURE: Presence of C. trachomatis detected by direct immunofluorescent staining. RESULTS: All but one patient had serological evidence of C. trachomatis infection. All 10 control subjects failed to react to IgA antibodies to C. trachomatis, and two reacted to IgG antibodies. CONCLUSION: There may be a link between C. trachomatis infection and suppurative hidradenitis, but it is uncertain whether it is a direct cause or a predisposing factor.

Abscess↗
PubMed1992

Seasonal pattern in the incidence of bleeding caused by peptic ulcer in Israel.

We have reviewed all endoscopies performed in our hospital between 1977 and 1986. During that period, 1337 endoscopies were performed to identify bleeding from peptic ulcers. Excluded were cases in which a predisposing factor was found, such as the use of ulcerogenic drugs. Also excluded were chronic or critically ill patients. The remaining 540 cases were reviewed. In 447 of those cases, the bleeding lesion was a duodenal ulcer, whereas, in 93 cases, a gastric ulcer was found (a ratio of 5:1). The seasonal variation in the incidence of bleeding from peptic ulcers was evaluated. We found a significant difference in bleeding in the cold and hot seasons, the incidence being significantly greater during the cold season (November until February). A similar pattern was found for bleeding from both duodenal and gastric ulcers.

Duodenal Ulcer↗
PubMed1991

[Use of somatostatin analogue for intestinal and pancreatic fistulas].

The hormone somatostatin, a tetra-deca-peptide, was discovered in 1972. It inhibits the central nervous system and the endocrine and exocrine secretions of the gastrointestinal tract. The first clinical use of the hormone was to inhibit hormone-secreting tumors of the CNS. It has also been used to treat hormone-secreting tumors of the pancreas and GI tract. Treatment of small bowel and pancreatic fistulas has also been attempted. A new synthetic analogue of the hormone, SMS 210-995, (Sandostatin) has a long half-life and is highly effective after subcutaneous injection. It was used in the treatment of 3 patients with fistulas of the small bowel and pancreas. In all impressive reduction of fistula secretion was achieved within 24 hours. In 2 there was complete, spontaneous closure of the fistula: in 1 after 10 days and in the other after 15 days of treatment. In the 3rd, there was significant reduction of fistula output. There were no side-effects except for mild pain at the injection site in 1 patient. Previous reports and our own results indicate that this somatostatin analogue may be very useful in the nonsurgical treatment of GI tract fistulas.

Aged↗
PubMed1986

Serological, clinical and radiological findings in adults with bronchopulmonary infections caused by Chlamydia trachomatis.

We report here four cases of lower respiratory tract infection caused by Chlamydia trachomatis. Three of them had clinical and radiological findings of atypical pneumonia, while one presented with an acute exacerbation of chronic obstructive pulmonary disease (COPD). None of the patients had signs of ocular or genitourinary infections. All patients had specific IgM, IgA and IgG antibodies for C. trachomatis during the acute infection, and were seronegative for C. psittaci. No specific clinical or radiological patterns were found. Two of the patients with pneumonia were laboratory workers who were exposed to the L2 (434 bu) serovar of C. trachomatis. They had a striking seroconversion and were followed up serologically for up to 30 weeks after onset of illness.

Adult↗
PubMedDate not supplied

Octreotide for treatment of postoperative alimentary tract fistulas.

Eighteen patients with postoperative fistulas of the gastrointestinal tract were treated with the somatostatin analog octreotide between November 1989 and November 1992. Fourteen patients had enterocutaneous fistulas: seven from the duodenum and seven from the ileum. Another three patients had pancreatic fistulas, and one patient had a biliary fistula. Within 24 hours of octreotide treatment, a mean reduction of 52% in the intestinal fistulas' output, 40% in the pancreatic fistulas, and 30% in the biliary fistula was noted. In the intestinal fistulas group the closure rate was 72% after a mean of 11 days. Early closure (mean 6 days) was achieved in all three pancreatic fistulas. In the patient with the biliary fistula a 30% reduction was observed twice following the administration of octreotide, and an increase occurred when it was withheld. The reduction rate of the secretions in high-output intestinal fistulas (> 500 ml/day) was higher than in the low-output fistulas (63 +/- 8% versus 39 +/- 4%, p < 0.05). Fistula output and the initial response to octreotide treatment had no value in predicting spontaneous healing. In conclusion, octreotide is a valuable tool for the conservative treatment of fistulas of the digestive tract. It is especially valuable for management of high-output enteric fistulas and pancreatic fistulas.

Anti-Bacterial Agents↗
PubMedDate not supplied

Small bowel obstruction secondary to Crohn disease: CT findings.

We investigated the computed tomographic (CT) findings in patients with small bowel obstruction (SBO) and Crohn disease (CD). Fourteen patients, seven men and seven women (mean age, 41.3 years), were retrospectively reviewed. All presented with clinical symptoms and signs of SBO. Eleven had a history of CD, whereas three experienced the bowel obstruction as the first manifestation of the disease. On CT, features of complete SBO were seen in nine patients, whereas incomplete obstruction was found in the other five. One patient had CT findings of an adhesive obstruction. The other 13 were diagnosed as having CD-related SBO; a markedly stenotic bowel segment caused the obstruction in one patient, and a thickened-wall small bowel segment with luminal narrowing was evident at the transition zone in the other 12. The mural thickening had a target appearance in seven and homogeneous thickening in the other five. Additional thickened bowel segments were found in five patients and mesenteric involvement was found in 10. Five patients were treated conservatively, and the other nine underwent surgery (one with adhesiolysis only). Resection of the stenotic bowel was performed in six patients and stricturoplasty was done in the other two, with associated intestinal biopsy in one of these two patients. Histopathology revealed findings of active on chronic disease in all. CT is frequently performed for suspected SBO, so radiologists should be aware of the diagnosis of CD, because SBO may be its first manifestation. Alternatively, radiologists can accurately diagnose a CD-related obstruction in a patient with known CD and differentiate it from an obstruction due to adhesions. Patient management in these cases, however, is based most often on the clinical condition.

Adult↗