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Biomedical subjects

I Wolfstein

Publications and source records attributed to I Wolfstein.

At least 19 recordsLinked to original sources
PubMed1990

High-resolution sonography of the undescended testis in childhood: an analysis of 45 cases.

A prospective study correlating the ultrasound and operative findings was carried out in 45 consecutive pediatric patients with undescended testes. Thirty-six of 37 (97%) palpable testes were located preoperatively by ultrasound. Six of eight impalpable testes (75%) were correctly localized by ultrasound. The three testes missed by the ultrasound examination were found to be atrophic at surgery. Three intra-abdominal (palpable) testes were found at surgery just proximal to the internal ring; all three had been identified by ultrasound preoperatively. The main contribution of ultrasound was the preoperative detection of impalpable testes (six of eight), which modified the consequent surgical approach. Ultrasound also helped in providing objective support to the clinical diagnosis in 36 of 37 children with palpable undescended testes. The ultrasound examination is noninvasive, nonionizing, readily available and of low cost. It is therefore suitable as the initial routine procedure for the evaluation of undescended testis.

Adolescent↗
PubMed1989

The feasibility of in vivo resection of the left lobe of the liver and its use for transplantation.

The anatomical possibility of resecting the left lobe of the liver (segments II and III) in living subjects and using it for transplantation was evaluated. A group of 60 cadaveric livers were dissected at autopsy. The vascular and biliary elements of the left lobe were isolated and the lobe was resected and evaluated for possible grafting. The left lobe was 12-28% (mean 19.4%) of the liver mass. An extrahepatic segment of the left hepatic vein was isolated in 95% of specimens. Arterial blood supply to the left lobe consisted of a single artery (92%) or two arteries (8%). A single portal vein segment to the left lobe (type I) was found in 35% livers. Portal vein branches originated from a common orifice (type II, 35%) or separately (type III, 30%) from the left portal vein, and in these instances, preparation of a portal segment necessitated partial section of the left portal vein wall. Biliary drainage was extrahepatic in 56 livers and consisted of a single duct (type I, 78%), or two ducts (type II, 15%). The resected left lobe was evaluated as satisfactory (single hepatic vein and artery, types I or II portal vein, type I bile duct) in 48% of cases, while a less-satisfactory lobe (type III portal vein or type II bile duct) was obtained in 33%. It was found anatomically difficult or impossible to resect the left lobe for possible transplantation in 11 (19%) liver specimens.

Adolescent↗
PubMed1989

Isolated gallbladder rupture due to blunt abdominal trauma.

Traumatic injury to the extrahepatic biliary system is rare and usually diagnosed at laparotomy when it is associated with other visceral injuries. Isolated gallbladder rupture due to blunt abdominal trauma is even rarer. The clinical presentation of gallbladder injury is variable, resulting in a delay in diagnosis and treatment. Awareness to the possibility of trauma to the extrahepatic biliary system enables early surgical intervention and eliminates the high morbidity associated with delated diagnosis. A 5 year old child with isolated gallbladder rupture caused by blunt abdominal trauma is presented.

Abdominal Injuries↗
PubMed1987

Jejunogastric intussusception. A new diagnostic test.

Jejunogastric intussusception is a rare complication of gastrojejunal reconstruction of unknown cause. There are two types of jejunogastric intussusception: the acute type, presenting as a surgical emergency, and the chronic intermittent type, which is difficult to diagnose and is usually of mild symptomatology but which may progress to the acute type with the incarceration of the intussusceptum. With two case reports and a literature review, an endoscopic diagnostic maneuver is proposed, hinting at disordered motility with reversed peristalsis as a possible causative factor. Corrective surgical treatment to prevent recurrence and incarceration in chronic cases is advocated. Treatment should include dismantling of the efferent loop, which is the most frequent intussusceptum.

Aged↗
PubMed1987

Parathyroid sonography: diagnostic accuracy related to shape, location, and texture of the gland.

The sonographic features of 51 pathological parathyroid glands detected pre-operatively were analysed. Atypical texture was found in 23.5% and variation in shape in 15.6% of the cases. Cystic parathyroid glands are difficult to differentiate from thyroid cysts, and may be the cause of false positive diagnosis, as in three cases in this series. Topographic assessment showed a relatively low sensitivity in detecting disease in the right upper gland (50%) and in the upper mediastinum (70%). The decreased accuracy in these regions is probably because of the particular anatomical location of the right upper gland and sonographic limitations in screening the mediastinal region. Awareness by the radiologist and surgeon of the variations in texture and location may influence both diagnosis and intraoperative detection of the abnormal parathyroid gland.

Humans↗
PubMed1987

Preoperative parathyroid localization by superimposed iodine-131 toluidine blue and technetium-99m pertechnetate imaging.

A new parathyroid scintigraphic localization study by a dual radioisotope technique using radioiodinated toluidine blue (RTB) for the parathyroids and 99mTc for thyroid imaging is presented. A simple RTB labeling procedure achieving 99% tagging of the 131I-TB was used. The RTB was found to be a highly specific parathyroid radiotracer, consequently enabling superimposition of the delineated thyroid gland over the RTB avid parathyroid foci without a need for subtraction of the thyroid or vascular background. Forty-six patients with primary hyperparathyroidism underwent scintigraphic study prior to cervical (41 patients) or mediastinal (5 patients) exploration and 67 pathological parathyroid glands (34 adenomas and 33 hyperplasias) were excised. On follow-up, serum calcium level returned to normal in all patients. Correlation of the scintigraphic results with the surgical findings disclosed a sensitivity of 93%, with a specificity of 80% and an overall accuracy of 87%. This new simplified and specific RTB scintigraphic method justifies its use as a routine procedure for preoperative parathyroid scintigraphic localization in primary hyperparathyroidism.

Adolescent↗
PubMed1986

Carcinoma of the large bowel after a single massive dose of radiation in healthy teenagers.

Three healthy teenagers were exposed to a single pelvic x-ray irradiation as part of sterilization experiments performed in the Auschwitz concentration camp in 1943. Single and multiple carcinomas of the colon and rectum developed 40 years later in the radiation field. Histologic examination of surgical specimens revealed severe radiation-induced changes in all layers of tumor-adjacent areas. In contrast to previous reports of radiation-induced large bowel cancers, these women had not undergone repeated courses of radiation, had no known co-existing disease that might raise the risk for colonic and rectal malignancies, and had an extremely long and remarkably similar latency period. These cases emphasize the need for long-term surveillance in previously radiated patients. Since thousands of teenagers were subjected to similar sterilization experiments, awareness of this association might help in the early diagnosis of additional cases.

Adenocarcinoma↗
PubMed1985

The simultaneous coexistence of adenocarcinoma and primary malignant lymphoma in the stomach.

A case of simultaneous adenocarcinoma and primary malignant lymphoma as two independent growths of the stomach is presented. Review of the literature documented two such cases along with nine cases of the collision-tumor type. The differential criteria between this entity and collision tumor and carcinosarcoma are emphasized. Diagnosis and treatment is discussed.

Adenocarcinoma↗
PubMed1985

Free pleuroperitoneal liquid movement indicating diaphragmatic tear.

An unusual radiological feature, not mentioned in the literature, is reported. It has been observed in a patient with traumatic rupture of the diaphragm associated with intra-abdominal bleeding. This injury produced a free pleuroperitoneal movement of liquid demonstrated in the supine and erect chest radiographs. Since there is an associated abdominal injury in most cases of rupture of the diaphragm, this radiological sign might be more common. The importance of supine and erect chest radiography is reinforced in cases of multiple injuries.

Child↗
PubMed1985

Unusual scintigraphic presentation of a shifting Meckel's diverticulum.

A Tc-99m red blood cell (RBC) study in a child with acute gastrointestinal bleeding of unknown origin suggested Meckel's diverticulum because of free pertechnetate uptake in the ectopic gastric mucosa. This finding has not been reported in the literature. A scan with Tc-99m pertechnetate then demonstrated a focal area of uptake with an unusual pattern of abdominal shifting consistent with a Meckel's diverticulum. A large Meckel's diverticulum containing gastric mucosa was found at surgery. A shifting pattern of focal uptake on a meckelogram study should be included among the diagnostic criteria for Meckel's diverticulum.

Child, Preschool↗
PubMed1985

Scintigraphic demonstration of acute gastrointestinal bleeding caused by gallbladder carcinoma eroding the colon.

Massive lower gastrointestinal (GI) bleeding caused by gallbladder carcinoma eroding into the colonic wall was demonstrated accurately by Tc-99m RBCs. In addition, retrograde bleeding into the gallbladder was also identified while arteriography did not show contrast extravasation. This case supports the use of Tc-99m RBCs over Tc-99m sulfur colloid for more accurate localization of lower GI bleeding.

Acute Disease↗
PubMed1985

Parathyroid localization. Sonographic-surgical correlation.

Sonographic localization of enlarged parathyroid gland was performed in 37 patients suspected of hyperparathyroidism who underwent surgical exploration of the neck. Nine of those patients were clinically asymptomatic. Most of the others presented with urolithiasis. The sonograms were obtained by conventional and high resolution realtime (10 mHz). Of the 37 patients, 31 patients had a single adenoma, three patients had two adenomas, and two patients had hyperplasia. Analysis of the results has shown accuracy of 84 per cent. The sensitivity of the procedure was 79.5 per cent and the specificity was 98 per cent. The exact side and location of the enlarged parathyroid in relation to the thyroid gland was predicted in 91 per cent. The false-negative cases were due to abnormal location (gland in mediastinum or incorporated within the thyroid). The false-positive findings were all colloid cysts located at the periphery of the thyroid parenchyma. Preoperative confirmation and localization of enlarged parathyroid glands facilitated the decision for surgical intervention, especially in hypercalcemic asymptomatic patients and in high operative risk patients. The duration of operation and postoperative complications were significantly reduced.

Adolescent↗
PubMed1979

Esophageal replacement in children: 10 years' experience.

Esophageal replacement continues to be a challenging surgical problem. Currently advocated methods entail using reversed gastric tube or colon for the interposition. Between 1969 and 1978, 11 children underwent esophageal reconstruction. Their ages at operation ranged from 1 to 16 years. All the operations were performed in one stage. The right colon was used in seven children and reversed gastric tube in four. There were no postoperative deaths. Temporary salivary fistula and cervical anastomotic stricture were the most common operation-related complications. On the follow-up visit, at least six months after surgery, all the children were able to eat a normal diet. The use of reversed gastric tube avoids intestinal resection, preserves the ileocecal valve, shortens the operative period and preserves the possibility of an alternative procedure (colon interposition) if technical failure occurs. On the basis of our limited experience we advocate the use of reversed gastric tube for esophageal replacement.

Adolescent↗