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J S Bender

Publications and source records attributed to J S Bender.

At least 37 records · Page 2Linked to original sources
PubMed1995

Acute abdomen in the hemodialysis patient population.

BACKGROUND: The cause and frequency of the acute abdomen in patients undergoing hemodialysis are not well reported. Previous studies associate bowel infarction with hemodialysis, but dialysis generally is not implicated as a risk factor for mesenteric ischemia. METHODS: The records of 567 patients undergoing long-term hemodialysis during the period from July 1988 to June 1993 were retrospectively reviewed. RESULTS: Twelve patients (2.1% of the hemodialysis population) were admitted with acute abdominal pain or sepsis. They were demographically no different than their counterparts who did not have an acute abdomen. The final diagnoses were bowel infarction in 11 patients and acute pancreatitis in one. Principal areas of involvement were equally divided between large and small intestine and were due to nonocclusive mesenteric ischemia in all cases. Six patients had an occluded hemodialysis fistula on admission, suggesting hypotension and/or hypovolemia as a possible etiologic factor. Overall, mortality and major morbidity rates were 50% and 25%, respectively. CONCLUSIONS: An acute abdomen is a relatively uncommon problem in the hemodialysis population but is associated with a high mortality. Mesenteric infarction is the most common cause and should be the presumptive diagnosis until proven otherwise.

Abdomen, Acute↗
PubMed1995

Pseudocysts and pseudoaneurysms: surgical strategy.

Eight patients over an 8-year period required operation for spontaneous hemorrhage as a complication of a pancreatic pseudocyst. Three patients presented with abdominal pain or jaundice and bled in hospital while undergoing work-up. Four patients were admitted with upper gastrointestinal bleeding and one with intraperitoneal bleeding. Five patients were managed by pancreatic resection (two of the head and three of the tail) and three were managed by arterial ligation and internal drainage. There was one death (mortality rate, 12.5%). The first four patients in the series had their operations delayed secondary to a perceived need for further work-up or an inability to make an exact diagnosis of the bleeding site. All rebled, necessitating an emergency operation. The last four patients underwent an expedited workup and operation. Successful treatment of bleeding pancreatic pseudocysts requires good surgical judgment, especially when nonoperative methods fail or aren't applicable. The risk of recurrent hemorrhage is high, suggesting the need for immediate intervention once the diagnosis is made. Resection provides definitive control, although selected patients with easily accessible vessels may be managed more conservatively with ligation and drainage.

Adult↗
PubMed1995

Malignancy is the most common cause of gastric outlet obstruction in the era of H2 blockers.

OBJECTIVES: To determine the relative incidence of malignant and nonmalignant pathology in patients presenting with gastric outlet obstruction in the era of H2 blockers and to determine whether clinical features can differentiate between the two causes. METHODS: The charts of 33 consecutive patients with gastric outlet obstruction admitted to one institution between July 1990 and November 1993 were reviewed to determine etiology, management, and outcome. The diagnosis of gastric outlet obstruction was based on clinical presentation, an upper gastrointestinal barium study, and/or an inability during upper endoscopy to intubate the second portion of the duodenum. Patients with gastroparesis or a previously known cancer were excluded. RESULTS: Sixty-one percent (20 patients) had malignancy as the cause of their gastric outlet obstruction. Thirty-nine percent (13 patients) had benign disease. The patients with cancer tended to be older, and fewer had a history of peptic ulcer disease, although these factors were not statistically significant. The use of nonsteroidal anti-inflammatory drugs was not associated with gastric outlet obstruction. Four patients had malignancy that had not been suspected before operation despite numerous endoscopic and radiological studies. CONCLUSION: The incidence of malignancy in patients presenting with gastric outlet obstruction is greater than 50%. The etiology of gastric outlet obstruction cannot be predicted by age, history of peptic ulcer disease, or nonsteroidal anti-inflammatory drug use. The endoscopic treatment of gastric outlet obstruction should be approached with caution because malignancy cannot be reliably excluded by endoscopic or radiological studies.

Aged↗
PubMed1994

Antrectomy. A safe and effective bypass for unresectable pancreatic cancer.

BACKGROUND: Pancreatic cancer is most often diagnosed too late for curative resection. Operative therapy, therefore, involves relief of biliary obstruction and relief or prevention of gastric outlet obstruction. Previous studies show that gastrojejunostomy done either therapeutically or prophylactically often causes delayed gastric emptying. OBJECTIVE: To describe the results of antrectomy with Billroth II reconstruction (A/BII) as the palliative operation for gastric outlet obstruction. SUBJECTS: Fifty patients with unresectable pancreatic cancer underwent A/BII without vagotomy from 1987 through 1993. Of these patients, 42 underwent simultaneous biliary bypass; six had undergone biliary bypass from 3 weeks to 34 months previously; and two with cancer originating in the uncinate process had no biliary bypass. RESULTS: One 87-year-old patient died on day 12 of azotemia and pulmonary insufficiency. The other 49 patients were discharged tolerating an oral diet an average of 11.3 days (range, 5 to 29 days) after A/BII. The length of stay following A/BII was not related to the extent of disease or to preoperative weight loss but was increased in older patients. CONCLUSION: The A/BII is a safe and effective bypass in patients with unresectable pancreatic cancer.

Aged↗
PubMed1994

Telerobotic assisted laparoscopic surgery: initial laboratory and clinical experience.

OBJECTIVES: To assess the feasibility of telerobotic assisted surgery. METHODS: In a laboratory model, a cholecystectomy, splenectomy, and nephrectomy were performed by an inexperienced surgeon who was being mentored by an experienced surgeon stationed at a remote site. The remote surgeon controlled the laparoscopic camera by utilizing a telerobotic system. In patients, laparoscopic cholecystectomy, varix ligation, and bladder suspension were performed by an experienced team utilizing a robotic system controlled by an experienced surgeon from a remote site. RESULTS: In both the laboratory and clinical setting, all procedures were successfully completed without complications. CONCLUSIONS: Current technology is available to successfully allow for telerobotic assisted surgery.

Animals↗
PubMed1994

Limited role of barium enema examination preceding colostomy closure in trauma patients.

Whether trauma patients should undergo barium enema (BE) examination of the colon prior to colostomy closure has recently been questioned. To ascertain the utility of BE and its impact on postoperative course in this patient population, we reviewed 86 trauma patients who underwent colostomy closure during a 12-year period at our institution. There were 82 males and four females with an average age of 28 years. Ninety-five percent of the injuries were the result of penetrating trauma. Sixteen patients had rectal injuries. Fifteen of these had BE greater than 6 weeks post-trauma and all showed healing of the injury. Of the 70 patients with colonic injuries, 43 (group 1) had BE prior to colostomy closure. Ninety-eight percent (n = 42) of these studies were negative. The only positive finding did not affect the planned surgical procedure. Group 2 (n = 27) did not have a BE prior to colostomy closure. Overall complication rates were not significantly different between group 1 (18.6%) and group 2 (29.6%). We conclude that BE prior to colostomy closure for colonic injuries yields little useful information and does not affect the morbidity rate prior to colostomy closure. Its routine usage should be abandoned. The role of barium enema in assessing rectal injury status is less clear because of the small number in our series, but probably offers no advantage over proctoscopy.

Adolescent↗
PubMed1994

The technique of visceral packing: recommended management of difficult fascial closure in trauma patients.

Since 1986, we have cared for 17 patients whose abdomen could not be closed because of bowel edema and loss of abdominal wall compliance. These patients were managed by a technique of visceral packing with the intestines kept in place by a combination of rayon cloth, gauze packs, and retention sutures. This packing was changed in the operating room under general anesthesia until the edema was sufficiently resolved to allow for closure. Two patients died within 24 hours of operation from irreversible shock. The remaining 15 patients had their fascia successfully closed with an average of two additional anesthetics. There was one case of fasciitis associated with the development of an intra-abdominal abscess and one patient died of late sepsis. There was no early postoperative ventilatory compromise or acute oliguric renal failure. Other direct complications have been minor with no enterocutaneous fistulae, dehiscence, or incisional hernia. Visceral packing of posttraumatic abdominal wounds circumvents expected complications of intraperitoneal hypertension and enhances the chance for survival. Its ease and low morbidity also lends itself to a wide variety of other uses.

Abdominal Injuries↗
PubMed1994

Total abdominal colectomy: conditions defining outcome.

Published conclusions that total abdominal colectomy is a safe procedure need to be qualified by analysis of specific risk groups. We reviewed the records of 87 consecutive patients undergoing total abdominal colectomy at our institution to determine the factors affecting morbidity and mortality. Underlying disease and urgency of operation were the primary determinants of outcome. Mortality was 5.9 per cent in the patient groups who had the procedure done non-emergently or for bleeding when transfusion requirements were less than 10 units. Mortality was 10-fold higher (55.6%) in the groups where the procedure was done either as an emergency for non-hemorrhagic reasons or when perioperative transfusion requirements reached 10 units (P < 0.001). Morbidity followed the same distribution. Death resulted primarily from shock, myocardial infarction, or sepsis from an anastomotic leak. Limiting transfusion needs to less than 10 units, by either more aggressive evaluation or earlier operation, and more liberal use of ileostomy were the only maneuvers identified that may decrease risk in the emergency setting. Elective operation before complications arise will likely result in improvement in morbidity and mortality rates.

Adolescent↗
PubMed1994

Bleeding gastroduodenal ulcers: improved outcome from a unified surgical approach.

We have adopted a uniform, aggressive approach to the management of upper gastrointestinal hemorrhage. Our protocol consists of admission to a surgical service, endoscopy within 24 hours, and liberal use of intensive care monitoring. Urgent or emergency surgery is recommended for the following criteria: 1) presence of shock upon admission; 2) resuscitation requirements of greater than 4 units of blood; 3) age 65 years or older; 4) ulcer size greater than 2 cm or with stigmata of recent hemorrhage; or 5) history of a previous admission for an ulcer complication. During the period 1986-1990, 66 patients met the criteria for operation. There were 45 males and 21 females with an average age of 53.5 years (range, 29-84). Thirty-seven bled from a gastric ulcer and 29 from a duodenal ulcer. They were transfused an average of 5.0 units of blood (range, 0-13). There were no hospital deaths, but 11 patients (16.7%) had 12 postoperative complications. We conclude that a unified, single team approach to gastroduodenal hemorrhage with expedited work-up and early operation prevents death from this treatable condition.

Adult↗
PubMed1993

Morbidity and timing of colostomy closure in trauma patients.

The reported morbidity of colostomy closure in trauma patients varies from 5 to 27 per cent. Low morbidity rates are cited as a factor favouring colostomy creation and against expanded indications for primary repair in the treatment of colonic injuries. In order to assess the morbidity of colostomy closure, we reviewed all colonic injuries from 1979 to 1991 at our institutions. In all, 86 trauma patients who underwent colostomy creation and closure were identified. There were 82 men and four women with an age range of 16 to 74 years (mean 28.1 years). Of these, 95 per cent (N = 82) resulted from penetrating trauma. Of the patients, 63 per cent (N = 54) received end colostomies and 81 per cent (N = 70) of the patients had associated injuries. Of the patients, 38 per cent (N = 33) had a complication with their initial operation. There were no deaths after colostomy closure, but a total morbidity of 24.4 per cent (N = 21) was noted. There were 11 anastomotic complications (two of which required repeat laparotomy) and nine wound infections. The average length of stay was 10.4 days. Morbidity was concentrated in the group who had complications at their initial hospitalization. This was especially true if these patients underwent closure earlier than 3 months after injury. Conversely, if the first operation was uncomplicated, waiting longer than 3 months to perform colostomy closure did not improve results further.

Adolescent↗
PubMed1993

Use of the pulmonary artery catheter to reduce operative complications.

Despite several prospective, randomized trials that demonstrated reductions in operative morbidity and mortality rates, routine use of invasive monitoring has not achieved widespread acceptance. This probably comes from skepticism about the validity of some of the studies along with known complications of the pulmonary artery catheter. The major studies are reviewed and a rational approach to monitoring is presented.

Age Factors↗
PubMed1993

Surgical issues in the management of the HIV-infected patient.

As of 1992, approximately 1,000,000 Americans are infected with HIV. The natural history of the illness includes a relatively long latent period (about 10 years) between infection and development of AIDS. Surgeons are called on to participate in the management of these patients, usually for diagnostic biopsies, supportive measures, or intraabdominal events. Precautions and safe surgical practices will minimize the risk of HIV transmission from patient to surgeon (or surgeon to patient).

Cross Infection↗
PubMed1993

Improving outcome from extremity shotgun injury.

The charts of 124 consecutive patients with extremity shotgun injuries managed over an 8-year period were reviewed to assess the results of a uniform protocol. This consisted of liberal use of arteriography, prompt exploration, wide debridement or fasciotomy, and frequent operating room dressing changes for large wounds. Thirty-three patients had arterial injuries and 16 had major venous injuries. Twenty patients had major soft tissue wounds and there were 15 significant long bone injuries. Results overall were excellent with over 95 per cent of patients retaining an intact and functional limb. Of the six limb amputations, three were done primarily and three were performed for late septic complications. Two of these late amputations were done following inadequate initial revascularization at referring hospitals. Early wound closure, liberal use of arteriography and fasciotomy, early fracture stabilization, and repair of all significant vascular injuries contribute to a successful outcome in patients with extremity shotgun wounds.

Adolescent↗