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Biomedical subjects

J M Klausner

Publications and source records attributed to J M Klausner.

At least 109 records · Page 6Linked to original sources
PubMed1986

The effects of perioperative fluorouracil administration on convalescence and wound healing.

Administration of chemotherapy is delayed by most clinicians until complete recovery from surgery because it is generally feared that cytotoxic drugs impair wound healing, reduce resistance against infection, and may hinder the recovery process. However, clinical experience is lacking. This clinical study examines the effect of perioperative administration of fluorouracil on the healing of wounds and intestinal anastomoses and the recovery process in general. Forty patients with advanced gastrointestinal tract cancers entered the study. Intravenous bolus administration of 0.5 g of fluorouracil was started during surgery. The patients underwent a variety of abdominal operations for palliation or cure. A total of 22 gastric and enteric anastomoses were performed. One half gram of fluorouracil diluted in 150 mL of 5% glucose solution was given intravenously over one hour daily for ten days postoperatively. The patients were carefully evaluated for any alteration in the postoperative recovery. Thirty-eight of the 40 patients received the full course of fluorouracil. Twenty-one patients had an uneventful postoperative course. Eighteen had mild to moderate respiratory and cardiovascular complications unrelated to fluorouracil administration. One patient died of pulmonary emboli 16 days after abdominoperineal resection. Surgical wounds healed without complications in 37 patients. One case of wound disruption occurred after sigmoidectomy. Two patients developed wound infections that healed secondarily. All 22 patients with anastomoses recovered without any evidence of leakage. Colostomies and gastrostomies functioned as anticipated. Side effects attributed to fluorouracil appeared in seven of the patients; in only two of the patients were complications life-threatening, involving bone marrow depression. All patients recovered after discontinuation of fluorouracil therapy and with supportive treatment. On the whole, the course of recovery of this group was no different than expected from patients with advanced malignant neoplasms who were undergoing extensive surgery. Based on this study, it seems that fluorouracil administration during and immediately after surgery has no deleterious effect on wound healing and recovery.

Abdominal Neoplasms↗
PubMed1986

"Spermatocele" following abdominoperineal resection and radiotherapy.

A 60-year-old man developed repeated spermatic fluid collection in the small pelvis following abdominoperineal resection and radiotherapy for carcinoma of the rectum. The "spermatocele" was due to a fistula originating in the vasoseminal vesicle junction. This complication has not been described previously.

Abdomen↗
PubMed1986

Intramural haematoma of the duodenum following blunt abdominal injury--the place for conservative treatment.

Two patients with intramural haematoma of the duodenum following blunt abdominal injury are presented. They responded well to conservative treatment. Complete resolution of the duodenal obstruction was demonstrated by consecutive radiological studies. Because haematomas usually resolve spontaneously, awareness and diagnosis of this rare condition are important in order to prevent unnecessary operation.

Abdominal Injuries↗
PubMed1986

Crohn's disease isolated to the appendix: truths and fallacies.

Twenty-five cases of Crohn's disease confined to the appendix were reported in eight hospitals in Israel during a 15-year period. Review of the histologic slides confirmed the diagnosis in 22 cases. Re-evaluation of these 22 patients included physical examination and radiologic studies of the small and large bowel. Rectosigmoidoscopy was performed in 16 patients. Signs and symptoms of Crohn's disease at other sites in the gastrointestinal tract did not occur during follow-up periods of two to 15 years (mean, 6.4 years) after appendectomy. This study and a review of the literature indicate that in most cases (93 per cent) Crohn's disease initially limited to the appendix is not a predictor of subsequent involvement of another portion of the bowel. It is concluded that the so-called Crohn's disease isolated to the appendix is a form of chronic granulomatous and follicular appendicitis of unknown etiology that is unrelated nosologically in the majority of the cases to Crohn's disease proper.

Adolescent↗
PubMed1986

Endoscopic decompression of acute colonic obstruction. Avoiding staged surgery.

Colostomy is the traditional treatment for acute obstruction of the sigmoid colon. This entails two or three surgical procedures in a high-risk group of patients. Presented is a nonsurgical approach used in three patients with acute colonic obstruction. Decompression of the bowel was achieved with a tube introduced proximal to the obstruction with the aid of a flexible sigmoidoscope. In a fourth patient, in whom the obstruction was next to the splenic flecture, the procedure failed. In all instances where decompression was successful, a one-stage procedure--primary resection and anastomosis--was performed.

Acute Disease↗
PubMed1986

Femoral vein occlusion following Mc-Vay repair.

Three cases of femoral vein occlusion following a Mc-Vay repair for femoral and inguinal hernias are presented. Phlebography demonstrated constriction of the femoral vein at the site of the repair. This complication is due to compression of the femoral vein by too tight a repair.

Aged↗
PubMed1986

The evacuation hospital in civilian disasters.

In a mass casualty situation the hospital nearest to the disaster scene is usually overwhelmed by the injured. We propose a solution whereby a civilian hospital in times of crisis can become an evacuation hospital (EH) to meet the immediate needs of the casualties. An EH is a hospital located as near as possible to the disaster area, whose function is to serve as a forward treating facility. All the wounded should be brought first to the EH, where they are sorted, resuscitated and stabilized for transportation, after which they are evacuated. Only the critically wounded undergo surgery at the EH; the lightly wounded remain in the EH, and all other wounded are distributed among the general hospitals for rapid definitive treatment. This principle was first applied in a civilian medical system. The Rokach (Hadassah) Hospital in Tel Aviv served as an EH in admitting 40 casualties following a nearby terrorist attack. Seventeen seriously and moderately wounded patients were resuscitated and evacuated to hospitals in the vicinity. All arrived in stable condition. Seventeen lightly wounded were detained in the EH and 4 underwent life-saving surgery there.

Disasters↗
PubMed1985

Acral (volar-subungual) melanoma.

Acral melanoma occurs in the volar surface of the hands, feet, fingers, toes and subungual sites. Recently it has been recognized as a distinct entity with characteristic clinical and pathological features. Of our 340 patients with malignant melanoma, 24 (7 per cent) had acral melanoma. Sixteen were in the plantar skin, two in the palms and six in the nailbed. The delay in diagnosis was 6 months to 5 years and most of the patients presented with large neglected tumours. Fourteen lesions had histological features consistent with acral lentiginous melanoma - a unique pattern to this area. Fourteen patients were in clinical stage I at diagnosis, seven in stage II and three had distant metastases (stage III). The treatment was mainly surgical. Palmar-plantar lesions were widely excised. One patient underwent below-knee amputation. Lesions of the digits were treated by amputation of the affected toe. Fourteen of the patients underwent either prophylactic or therapeutic lymph node dissection. In 9 of them, regional metastases were found. In patients with advanced disease chemotherapy was added. Three patients had isolated limb perfusion. Fourteen patients died of metastatic disease within 1-5 years. Four are alive but have metastatic spread. Six patients are disease-free, one to 4.5 years following diagnosis.

Adult↗
PubMed1983

Renal cell carcinoma presenting as acute pancreatitis and GI bleeding.

A 75-year-old woman was admitted for acute pancreatitis, jaundice, GI bleeding, and a tender mass in the right hypochondrium. Upper gastrointestinal series demonstrated a diverticulum-like structure on the lateral aspect of the second part of the duodenum. This structure was excised and turned out to be a renal cell carcinoma invading the duodenum by direct extension from the right kidney. Although renal cell carcinoma may present in numerous and often perplexing manifestations, this is a unique presentation.

Acute Disease↗
PubMed1983

Unknown primary melanoma.

Of 230 melanoma patients treated during the past 8 years, 12 (5.2%) were found to have unknown primary lesions. Nine of these "unknown primary melanoma' patients presented with metastases in regional lymph nodes, one inside the parotid gland, and two presented with disseminated melanoma and no detectable primary tumor. The patients with melanoma confined to a regional lymph node underwent block dissection followed by adjuvant chemotherapy and immunotherapy. Four patients with metastasis in only one lymph node are disease free 4-6 years after diagnosis. One patient with multiple metastases in the groin is alive 8 years after lymphadenectomy. The other five patients with metastases in multiple regional lymph node died 16 months to 3 years after surgery. Both patients with disseminated melanoma succumbed to their disease within a month of diagnosis. The prognosis of unknown primary melanoma seems to be no worse than the typical melanoma at the same stage. This justifies the aggressive surgical approach to this unusual entity of melanoma.

Adult↗
PubMed1983

Breast carcinoma originating in cystosarcoma phyllodes.

Only three cases of carcinoma infiltrating the stroma of cystosarcoma phyllodes have been reported. An additional case is presented. Unlike the treatment of cystosarcoma phyllodes which is limited to complete removal of the tumor, carcinosarcomas should be treated in the same manner as carcinoma by mastectomy and axillary dissection.

Adenocarcinoma↗
PubMed1983

Cholelithiasis in Dubin-Johnson syndrome.

Only one instance of Dubin-Johnson syndrome associated with cholelithiasis has been reported. We present one additional patient, a 30 year old man with Dubin-Johnson syndrome in whom pancreatitis and cholecystitis, secondary to cholesterol gallstones, developed. A possible cause for the lithogenicity of the bile in the Dubin-Johnson syndrome is considered.

Adult↗
PubMed1982

Acute complications of metastatic melanoma to the gastrointestinal tract.

The gastrointestinal tract is a favoured site for metastatic melanoma. Complications such as obstruction, bleeding or perforation should be alleviated by surgery in order to improve the patient's condition for further systemic therapy. Six patients with melanoma involving the gastrointestinal tract are presented: 3 were operated upon for metastatic lesions in the small bowel causing intussusception, 2 patients were treated for perforation of the small bowel and 1 patient with massive bleeding from metastatic melanoma in the stomach underwent gastrectomy. Two of the patients are alive 6 months and 4 years respectively after these operations. The other 4 survived between 6 months and 2 years.

Adult↗
PubMed1981

[Rectus sheath hematoma].

Rectus sheath hematoma is rarely diagnosed preoperatively. It can mimic acute intra-abdominal disease and other familiar disorders. It is more frequent during pregnancy and debilitating diseases. Blunt trauma to the abdomen, straining, coughing and anticoagulant therapy are also common contributing factors. The presenting symptom is onset of acute, localized, abdominal pain soon after the precipitating event. A tender abdominal mass is palpated in one of the rectus muscles. There are no specific diagnostic laboratory tests. Ultrasonography is the procedure of choice for correct diagnosis. Most of these patients can be successfully managed conservatively. During a period of two years, five cases were treated. Three of the patients suffered from acute cough associated with upper respiratory infections. Two had had multiple childbirths, one had had an abdominal operation and another had Cushing's disease and morbid obesity. Three were misdiagnosed and operated on. The hematoma was evacuated but the peritoneum was not opened. In two patients the correct diagnosis was made by ultrasonography and they were successfully treated conservatively.

Abdomen, Acute↗
PubMedDate not supplied

Failure of thalidomide to inhibit tumor growth and angiogenesis in vivo.

Thalidomide was recently suggested to be angiogenesis-inhibitor following the demonstration of its activity in a rabbit cornea micropocket model. The purpose of the present study was to test its efficacy in solid tumors in mice. B16-F10 melanoma and CT-26 colon carcinoma cells were injected subcutaneously, intravenously and intraperitoneally, and mice received daily gavage of 0.3-1.0 mg thalidomide starting either two or 10 days following tumor cell injection. The tumors were measured and compared with controls. There was no growth retardation in CT-26 bearing mice nor in mice with pulmonary or peritoneal metastases of B16-F10 melanoma. In 3/7 groups of mice with SC B16-F10 tumors, growth retardation was demonstrated, however the difference was not statistically significant. All tumors eventually reached maximal size, similar to controls. Morphological evaluation of the blood vessels oriented towards the tumor revealed that in both thalidomide and control groups, all mice had developed an intact network of new blood vessels. In our model for the oral administration of thalidomide inhibition of tumor growth and angiogenesis did not occur. We hypothesize that the lack of sustained antiangiogenic response was either due to immune modulation or to tumor heterogeneity and adaptation.

Animals↗