Biomedical subjects

H Wasvary

Publications and source records attributed to H Wasvary.

5 recordsLinked to original sources

PubMed1999

Same hospitalization resection for acute diverticulitis.

We reviewed our experience with same hospitalization resection in the treatment of acute diverticulitis (AD) and compared outcomes with patients admitted for elective resection. From January 1987 through December 1996, 20 patients (Group 1) were admitted with AD and were operated on during the same hospital admission. During that same time period, 22 patients (Group 2) were admitted for elective resection and found to have an abscess intraoperatively. Thirty patients had elective resection with no abscess found (Group 3), and 10 patients were found to have a fistula to adjacent structures during elective resection (Group 4). Demographics and type of procedure done were similar in all groups. Fifteen patients (75%) in Group 1 had an abscess; eight were pericolic, and seven were pelvic. In contrast, all Group 2 abscesses were pericolic (P < 0.001). There was no mortality or major morbidity in any group. Patients in Groups 1 and 4 had higher fluid requirements (not significant), estimated blood loss (P < 0.01), and longer operative times (P < 0.05) when compared with the other groups. Postoperative and total hospital stay was significantly longer in Group 1. We conclude that hospitalized patients with AD who meet indications for surgery can be operated on during the same hospitalization without an increase in morbidity, compared with those patients discharged and later readmitted for elective resection.

Aged↗

PubMed1998

Unilateral lobectomy for Hurthle cell adenoma.

Considerable controversy exists regarding the ability to predict the biologic behavior of Hurthle cell tumors. Some have found the clinicopathologic criteria used to differentiate benign from malignant lesions to be unreliable and have advocated total thyroidectomy for all Hurthle cell neoplasms. From January 1980 to December 1995, 39 patients had surgery for Hurthle cell tumors of the thyroid. The surgical pathologic findings were reviewed by an experienced pathologist (JP). Eight patients had histologic findings of capsular or vascular invasion consistent with carcinoma and had total thyroidectomy. Four of these patients had postoperative evidence of residual disease and were treated by radiation ablation. No evidence of invasion was found in 31 patients diagnosed with Hurthle cell adenoma. Twenty-three of these patients had unilateral lobectomy; total thyroidectomy was done in the remaining 8 patients, 5 of whom were found to have an associated papillary carcinoma at the time of operation. There were no operative deaths or significant morbidity. Twenty-two adenomas (71%) were found in females, whereas males had malignant tumors in 6 of 8 cases (P = 0.025). The mean age of adenoma patients is 54.1 years, and that of the carcinoma patients is 55.8 years. Mean size of benign tumors was 2.8 cm and of malignant tumors 4.1 cm (P = 0.04). Four of seven (57%) carcinomas were larger than 4 cm as compared with 6 of 30 (20%) adenomas (P = 0.069). Follow-up has ranged from 1 month to 15 years, with a mean of 3.2 years. There have been no deaths, and no patients with Hurthle cell adenoma have had evidence of recurrence or metastases during follow-up. Our data suggest that carcinoma patients tend to be male and tumor size is larger. An association was found when trying to predict malignancy by using 4 cm as a threshold size. We conclude that pathologic evidence of capsular or angioinvasion can accurately differentiate benign from malignant tumors. Unilateral thyroid lobectomy is adequate therapy for the treatment of Hurthle cell adenoma, with total thyroidectomy reserved for those patients with histologically proven carcinoma.

Adenoma, Oxyphilic↗

PubMed1997

Gastro-aortic fistula: an uncommon complication of Nissen fundoplication.

We report a case of and review the literature concerning primary gastro-aortic fistula secondary to erosion of a gastric ulcer into the thoracic aorta in a patient with a previous Nissen fundoplication. Treatment consisted of excision of the fistula with closure of the gastric and aortic defects. This rare cause of upper gastrointestinal bleeding is life threatening, and a high level of suspicion is necessary to make the diagnosis and initiate early, aggressive surgical treatment.

Aortic Diseases↗

PubMed1997

Nonoperative management of adult blunt splenic trauma: a 15-year experience.

From January 1989 to December 1993, 40 consecutive adult patients with ruptured spleen from blunt trauma were examined. Fourteen patients (35%) were taken to the operating room initially because of hemodynamic instability and generalized peritoneal signs. Twenty-six patients (65%) were hemodynamically stabilized at admission and treated by nonoperative management, which included strict bed rest, intensive care unit monitoring, frequent physical examinations, and serial hematocrits. Four patients failed nonsurgical management and required a splenectomy, three because of clinical deterioration within 1 to 3 days of admission; the fourth patient had recurrent bleeding 7 days after injury. The patients in the operative group had a greater severity of injury with a mean injury severity score of 26.6, four deaths, and mean transfusion requirements of 3.7 to 4.0 units of blood, compared to a mean injury severity score of 14.6, one late death from cardiac causes, and average blood requirement of 0.4 to 0.7 units. Splenic injury grading averaged 3.2 in the surgical group (grade 1, one patient; grade 2, four patients; grade 3, eight patients; grade 4, no patients; and grade 5, one patient) and differed significantly from that of the nonoperative group (mean = 2.4; grade 1, 12 patients; grade 2, seven patients; grade 3, six patients; grade 4, two patients; and grade 5, no patients). Recent ultrasound analysis of select grades I to IV has shown excellent resolution or repair of these injuries. This report extends our series from 1978 to 1993 and includes 144 adult patients sustaining blunt splenic ruptures. Seventy-nine (55%) of these patients were treated nonsurgically. Seven patients (of 80) failed nonoperative management and required interval laparotomy, representing a 91 per cent success rate. Follow-up on more than 90 per cent of the patients has shown no sequelae from their splenic injuries. We conclude that adult patients with splenic injuries from blunt trauma who are hemodynamically stable and are without abdominal findings requiring celiotomy can be safely managed by a nonoperative approach.

Adolescent↗

PubMed1997

Timing of coronary artery bypass grafting after acute myocardial infarction.

Appropriate timing for coronary artery bypass grafting (CABG) after acute myocardial infarction (AMI) remains controversial. We retrospectively examined 423 patients who underwent CABG within 21 days of an AMI between 1992 and 1995, mainly for postinfarction angina and complex anatomy. The operative mortality rates associated with increasing time intervals between AMI and CABG were 17.4, 9.1, 4.0, and 5.8 per cent, for less than 6 hours, 6 to 24 hours, 1 to 7 days, and 7 to 21 days, respectively. There were 25 (5.9%) deaths overall. Statistical analysis was performed to evaluate the following preoperative parameters: age, sex, reoperation, previous myocardial infarction (MI), MI type and location, anatomy, cardiogenic shock, unstable angina, ventricular arrhythmias, extending MI, ejection fraction, indications for surgery, cardiac index, and interval from infarction to CABG. Interval between operation and AMI did not have a significant impact on patient outcome. Factors associated with an increased hospital mortality were ejection fraction < 30 per cent, age > 70 years, presence of cardiogenic shock, and cardiac index < 1.5. Only cardiac index proved to be a significant predictor of mortality (P < 0.001). We conclude that the timing of CABG, in and of itself, has no significant effect on hospital mortality of symptomatic patients within 3 weeks of AMI.

Age Factors↗