PubMed Health⌕ Search

Biomedical subjects

I L Rosenberg

Publications and source records attributed to I L Rosenberg.

At least 19 recordsLinked to original sources
PubMed1999

Evaluation of a protocol for the non-operative management of perforated peptic ulcer.

BACKGROUND: The non-operative management of perforated peptic ulcer has previously been shown to be both safe and effective although it remains controversial. A protocol for non-operative management was set up in this hospital in 1989. Adherence to the guidelines in the protocol has been audited over a 6-year period with a review of outcome. METHODS: The case-notes of patients with a diagnosis of perforated peptic ulcer were reviewed. Twelve guidelines from the protocol were selected for evaluation of compliance to the protocol. RESULTS: Forty-nine patients underwent non-operative treatment initially. Eight patients failed to respond and underwent operation. Complications included abscess formation (seven patients), renal failure (one), gastric ileus (one), chest infection (two), and cardiac failure and stroke (one). Four deaths occurred in this group. Adherence to certain protocol guidelines was poor, notably those concerning prevention of thromboembolism, use of antibiotics, use of contrast examination to confirm the diagnosis and referral for follow-up endoscopy. Two gastric cancers were detected on subsequent endoscopy. CONCLUSION: This experience demonstrates that non-operative treatment can be used successfully in a general hospital. Adherence to protocol guidelines was found to be variable and the protocol has therefore been simplified. This study highlights the need for an accurate diagnosis and the importance of follow-up endoscopy.

Adolescent↗
PubMed1994

Case report: rectal infarction after abdominal aortic surgery.

Full thickness ischaemic colitis complicates approximately 1-2% of abdominal aortic procedures. Ligation of the inferior mesenteric artery and hypotension are recognized as causative factors. It is not, however, widely appreciated that ischaemic proctitis may also rarely complicate aortic surgery, especially after complex procedures or if there has been additional interruption to the internal iliac circulation. We report a case of rectal necrosis following repair of a thrombosed aortic aneurysm in which plain X-ray appearances aided the diagnosis.

Aged↗
PubMed1993

Gastric cancer: the case for a more selective policy in surgical management.

Over a 5-year period 114 patients with gastric cancer were evaluated. Seventy-seven (68%) of these underwent laparotomy, of which 5A (47%) had a resection performed though only 22 (19%) of these were considered curative. Thirty-seven patients (32%) were not offered surgery because they were aged, had poor cardiorespiratory function, or were thought to have advanced disease based on a combination of clinical (fixed epigastric mass, hepatomegaly, jaundice or ascites), radiological and endoscopic features. Overall 5-year survival was 10.9%, with the patients who had curative and palliative resections having 5-year survivals of 24.4% and 18.2% respectively. Eight of the 12 patients who had palliative gastroenterostomy were not satisfactorily palliated, and 9 patients who had 'open and close' laparotomy fared badly with an operative mortality of 44%; mean survival in these two groups was 3.8 and 3 months respectively. Mean survival in patients treated without operation was 5 months. Unit policy in the management of patients with carcinoma of the stomach has been to resect for cure and palliation whenever possible. However, because so many patients present with advanced disease, the avoidance of inappropriate surgery has been an equal priority. In this context, the wider use of ultrasonography, laparoscopy and perhaps computed tomography (CT) may be of help. In this paper, the experience of these 114 patients is reviewed.

Adenocarcinoma↗
PubMed1991

Experience with early anastomosis after the Hartmann procedure.

From January 1980 to December 1989, 108 Hartmann procedures were performed and 55 of these patients subsequently had colorectal continuity re-established. Thirty-eight patients had colorectal anastomosis after an average interval of 6.5 months and 17 had early anastomosis performed within 1 month of the primary procedure. On the basis of the experience reported here, it would seem that early colorectal anastomosis does not increase the risk to the patient and may be an easier procedure to perform than the delayed operation. For selected patients, we recommend early colorectal anastomosis after a Hartmann procedure, thus sparing them the problems of life with a temporary colostomy.

Aged↗
PubMed1988

A district general hospital experience of surgical treatment of gastric and duodenal ulcer from 1970 to 1982.

Seven hundred and thirteen patients who had undergone 793 operations for peptic ulcer disease during the years 1970 to 1982 were subsequently referred to a gastric follow-up clinic. The indications for initial elective surgical treatment (514) were failed medical management (448), recent hemorrhage (32) and obstruction of gastric outflow (34); for initial emergency surgical treatment (199), the indications were hemorrhage (97) and perforation (102). Reoperation was required in 80 patients-previous perforation (40), recurrent ulcer (32), reperforation (three), hemorrhage (three) and obstruction of gastric outflow (two). The over-all postoperative mortality rate was 4.2 per cent (33 of 713); 15 deaths occurred after elective surgical treatment (2.5 per cent) and 18 after emergency surgical treatment (8.6 per cent). The postoperative morbidity expressed in terms of duration of postoperative stay was unaltered for each procedure throughout the study period. Follow-up attendance rates at one, three, five and ten years were 86, 85, 74 and 28 per cent, respectively. Iron deficiency anemia was detected in 13.6 per cent of gastric resection procedures and 1.6 per cent of vagotomy and drainage procedures. No instances of macrocytic anemia and only two instances of asymptomatic metabolic bone disease were recorded. By providing accurate data for surgical audit, which suggested that screening for metabolic sequelae in the first decade after surgical treatment is not indicated and which resulted in alteration of policy toward peptic ulcer perforation, a specific follow-up clinic has proved valuable in formulating the over-all management policy regarding surgical treatment for peptic ulcer.

Adult↗
PubMed1987

Effect of 1-oleoyl-2-acetylglycerol and other lipids on phosphatidylcholine synthesis and cholinephosphate cytidylyltransferase activity in cultured type II pneumocytes.

We previously reported that addition of phosphatidylglycerol to the culture medium stimulates phosphatidylcholine synthesis and cholinephosphate cytidylyltransferase activity in type II pneumocytes. In view of the known biological effects of diacylglycerols and since phosphatidylglycerol could be metabolized to diacylglycerol, we now examined the effects of diacylglycerols on the same parameters. The rate of choline incorporation into phosphatidylcholine was increased 30-60% by 10 microM phosphatidylglycerol, diolein, mixed diacylglycerols and 1-oleoyl-2-acetylglycerol (OAG). The effects of phosphatidylglycerol and OAG were not additive, suggesting a similar mechanism of action. The diacylglycerols and phosphatidylglycerol increased the activity of cholinephosphate cytidylyltransferase in type II cell sonicates by 35-50%, but had no effect on the activities of choline kinase, cholinephosphotransferase or 1-acylglycerophosphocholine acyltransferase. Again, the effects of OAG and phosphatidylglycerol on cytidylyltransferase were not additive. It is known that addition of lipids to the assay mixture increases the activity of cholinephosphate cytidylyltransferase in vitro and inclusion of the above lipids (1.1 mM) in the in vitro assay mixture increased cytidylyltransferase activity in type II cell sonicates. In addition, the stimulatory effects of OAG and of diolein, as well as of phosphatidylglycerol as reported previously, in the culture medium on cytidylyltransferase activity in type II cells were diminished or abolished when the assay was carried out in the presence of sufficient amounts of the same lipids to stimulate maximally the activity in vitro. These data show that lipids in the culture medium stimulate phosphatidylcholine biosynthesis in type II cells by direct activation of cholinephosphate cytidylyltransferase.

Animals↗
PubMed1985

The value of HIDA scanning in intestinal fistulae.

Intestinal fistulae have been outlined using the delayed phase of Tc-99m labelled HIDA. The technique involved is simple, safe and easily reproducible. This method has advantages over conventional radiography particularly for the leaking duodenal stump and involves minimal disturbance to the patient.

Humans↗
PubMed1984

Allergic bronchopulmonary aspergillosis and aspergilloma. Long-term follow-up without enlargement of a large multiloculated cavity.

A 47-year-old man with a history of mild asthma presented with hemoptysis attributed to a large multiloculated cavitary mycetoma. Peripheral blood eosinophilia of 43 percent led to the diagnosis of allergic bronchopulmonary aspergillosis (ABPA). Treatment of ABPA with prednisone led to resolution of an upper lobe infiltrate and a dramatic reduction in the total serum IgE level. Evaluation over a two-year period did not demonstrate enlargement of the cavity or disseminated aspergillosis.

Aspergillosis, Allergic Bronchopulmonary↗
PubMed1979

The aetiology of colonic suture-line recurrence.

Cell viability studies have been performed on human desquamated colonic cancer cells obtained by both in-vivo and ex-vivo techniques, and on desquamated colonic cancer cells from an experimental animal model. There was no evidence of cell viability and I conclude that the hypothesis that suture-line recurrence occurs as a result of the implantation of desquamated tumour cells is of questionable validity. Field change in the colonic mucosa has been studied by examining the reactions of the mucosubstances in the goblet cells. A potential correlation between transitional mucosa at the anastomosis and the development of suture-line recurrence was found and warrants further study. The clinical problem has been investigated by the clinicopathological study of 16 patients developing suture-line recurrence in an attempt to discern the aetiology of each. In all but one the recurrence was due to incomplete excision of cancer or, in one instance, a second primary growth.

Adenocarcinoma↗
PubMed1978

Cell viability studies on the exfoliated colonic cancer cell.

Suspensions of desquamated colonic cancer cells were obtained from patients with cancer of the large bowel by colonic exfoliative cytology and from resected specimens of colonic cancer by an exfoliative technique. In addition, a tumor suspension was obtained from the resected specimens. Cell viability studies were performed on these cell suspensions. Whereas 23 of the 25 tumour homogenate cell suspensions were shown to exclude trypan blue, none of the exfoliated colonic cancer cell suspensions had viable cells. This finding would cast some doubt on the hypothesis that suture line recurrence following large bowel cancer surgery is due to the implantation of cells desquamated from the surface of the growth.

Cell Separation↗
PubMed1977

An evaluation of viability tests of human cadaveric kidneys.

Cadaveric kidneys are sometimes unsuitable for transplantation because of possible ischaemic damage. The advent of perfusion preservation machines has enabled evaluation of perfusion characteristics and perfusate changes of organs prior to transplantation. This study has evaluated the changes in perfusate pH, lacate dehydrogenase, lactate and free fatty acid utilization in an attempt to identify those kidneys with ischaemic damage. In this investigation no single factor was discriminatory and it was not possible to predict with any degree of certainty those kidneys liable to delayed function or to non-function.

Cadaver↗