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Biomedical subjects

L Morgenstern

Publications and source records attributed to L Morgenstern.

At least 19 recordsLinked to original sources
PubMed1992

Twelve hundred open cholecystectomies before the laparoscopic era. A standard for comparison.

Records of 1200 consecutive open cholecystectomies, performed by a teaching service of a large, urban hospital in the years immediately preceding the laparoscopic era, were reviewed for morbidity and mortality rates. The mortality rate in this series was 1.8%, chiefly in the older age groups. Only two ductal injuries were incurred. A review of published series from 1952 through 1990 revealed a mean mortality rate of 1.53%. These recent observations on the morbidity and mortality after open operation should provide a useful standard of comparison with ongoing similar studies of laparoscopic cholecystectomy.

Adolescent↗
PubMed1992

The clinical spectrum of lymphangiomas and lymphangiomatosis of the spleen.

Lymphangiomas of the spleen are infrequent neoplasms of the spleen with clinical manifestations ranging from insignificant incidental findings to large, symptomatic cystic masses requiring surgical intervention. An associated syndrome may be lymphangiomatosis, in which the lymphangiomatous process involves other sites or organs, such as the liver, spleen, axilla, and mediastinum. Vasoformative neoplasms (hemangioma, lymphangioma) are relatively uncommon tumors or hamartomas of the spleen. Although well reported in the literature, their surgical significance is not well recognized. These lesions present a broad spectrum of pathologic findings of varied surgical importance. As incidental findings, they may be mistakenly considered as a valid indication for splenectomy. On the contrary, more extensive involvement of the spleen may cause symptomatic splenomegaly, which is a valid indication for splenectomy. When the spleen is diffusely involved (lymphangiomatosis), it may be part of a syndrome of generalized lymphangiomatosis involving structures and organs other than the spleen. This syndrome should be considered in obscure cases of splenomegaly in which the usual hematologic causes have been ruled out.

Adult↗
PubMed1990

The current spectrum of peptic ulcer disease in the older age groups.

Not only has there been a relative increase in the prevalence of peptic ulcer disease (PUD) among America's older age groups, but the characteristics of PUD in these patients differ significantly from those of the general population. Seventy-two consecutive patients 60 years of age or older who underwent operation for PUD between 1984 and 1989 were studied. The unusual features in these patients were 1) 92 per cent required emergency operation, 2) 57 per cent with perforated PUD were female, 3) 85 per cent had duodenal pathology, 4) 28 per cent were currently taking nonsteroidal anti-inflammatory agents, and 5) over one half of all patients had serious postoperative complications. The increasing incidence and associated serious complications of PUD in the elderly population present new challenges to physicians in the diagnosis and treatment of this disease.

Age Factors↗
PubMed1990

The intracolonic bypass tube for left colon and rectal trauma. The avoidance of a colostomy.

Traumatic perforations of the left colon and rectum are most frequently managed by procedures that include the formation of a colostomy. Primary repair without colostomy is much less commonly employed. We report nine patients with traumatic perforations of the left colon and rectum treated with the intracolonic bypass tube (ICBT) without concomitant colostomy. In all these patients we believe the standard treatment would have included fecal diversion. Four patients sustained blunt trauma and five sustained penetrating trauma. Healing of the colonic anastomosis occurred in all cases, and the ICBTs were passed per rectum between the tenth and nineteenth days postoperatively. On the basis of this study, we conclude that the ICBT has a role in the treatment of selected injuries of the left colon and rectum as a safe means of avoiding a colostomy.

Adult↗
PubMed1990

Cystic neoplasms of the pancreas.

Cystic neoplasms of the pancreas can be easily misdiagnosed and mistreated by the surgeon unfamiliar with the pathology, natural history, and operative strategy specific to these uncommon tumors. The authors have treated nine patients over a seven-year period involving four cystadenocarcinomas, two mucinous cystadenomas, two serous cystadenomas, and one solid and papillary epithelial tumor. Our experience illustrates the inaccuracies in both clinical and pathologic diagnosis. Suspected cystic neoplasms are optimally managed by resection. Their slow growth and late metastasis permits curative surgery after a previous drainage or bypass procedure. An aggressive surgical approach is therefore warranted, and multimodal treatment with radiation and chemotherapy may be clinically applicable to large, invasive cystadenocarcinomas.

Adult↗
PubMed1989

Intra-operative and postoperative biliary endoscopy (choledochoscopy). The role of the surgeons.

Intra-operative and postoperative choledochoscopy is an important adjunct to biliary surgery. In the last two decades, the necessity of this examination became obvious but two surveys clearly indicated that despite the availability of instruments surgeons do not use it routinely. One of the reasons is the long learning curve and the limited experience. The introduction of the video choledochoscope opened a new chapter because the surgeon could learn it faster and the technique is easier to use. Choledochoscopy is a "two man" job, requiring four hands. Using video choledochoscopy, the assistant and the operator can observe the situation together, therefore coordination of movement is easier. The actual endoscopic procedure is faster and the location of the stone, its removal, and the sphincter function are recorded on tape. This is a great step forward in analyzing sphincter function. It became the method of choice in teaching. It is assumed that, with the introduction of video choledochoscopy, the incidence of missed stones will be decreased significantly.

Animals↗
PubMed1989

Liposarcoma of the ileocecal valve: a case report.

Liposarcomas are common soft-tissue neoplasms but are rarely present in the gastrointestinal tract. We report a patient with a primary liposarcoma at the ileocecal valve, a previously unreported location. Wide local excision remains the treatment of choice, but local recurrences are common.

Female↗
PubMed1979

Techniques of splenic conservation.

The scope of surgical procedures on the spleen has undergone a dramatic change in the past few years. Efforts directed toward splenic preservation have intensified with the emerging realization that sepsis is a sequela not to be ignored in asplenic subjects. Successful operations on splenic parenchyma require modified techniques of exposure and mobilization of the spleen. The segmental vasculature of the spleen makes possible controlled resection of traumatized or diseased segments of parenchyma. Hemostatic measures include the use of metal clips, ligation of small intrasplenic vessels, and application of topical agents for residual surface bleeding. With the use of such techniques, conservative splenic surgery is possible in minor and major splenic trauma, splenic cysts, and selected pathologic states in the spleen.

Adolescent↗
PubMed1979

'Malignant' diverticulitis: a clinical entity.

A form of severe diverticulitis exists that is characterized by (1) phlegmonous inflammation of the sigmoid and rectosigmoid colon, often extending below the peritoneal reflection, (2) frequent fistulization to skin, urinary bladder, and small intestine, (3) frequent colonic obstruction, and (4) high postoperative morbidity and mortality. The clinical similarity to granulomatous colitis is very apparent, but pathologic findings are consistent with severe diverticulitis rather than granulomatous colitis. The term "malignant" diverticulitis is suggested because of the progressive nature of the disease process and the frequency of severe morbidity associated with it. Seventeen patients have been studied since 1965, comprising approximately 7% of patients operated on for diverticular disease at Cedars-Sinai Medical Center.

Aged↗
PubMed1978

Modern operative fluorocholangiography: utopia or overlooked entity?

A system of image amplification with television fluoroscopy and 100 X 100 mm cut film technique is presented for use in the operating room. Biliary surgery has benefited from this equipment as operative cholangiography has been improved and unnecessary extension of operating time avoided. Applications of the equipment for other procedures are discussed.

Biliary Tract Surgical Procedures↗
PubMed1978

Spatial distribution of colonic carcinoma.

During the past several decades, there has been a shift in the distribution of colorectal cancer toward the right side, with an increase in colon lesions on the right side and a marked decrease in rectal lesions. In 1,009 cases studied between 1966 and 1977, this change in distribution pattern is illustrated. A revision of widespread current concepts of colonic cancer detection is indicated.

Animals↗