Abandonment of rotating internships.
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Curriculum↗
Biomedical subjects
L S Bizer
Publications and source records attributed to L S Bizer.
Emergency abdominal operations in the patient with acquired immunodeficiency syndrome.
BACKGROUND: We have previously shown high morbidity and mortality rates in patients with acquired immunodeficiency syndrome (AIDS) who require emergency abdominal operations. In a larger series of patients, we have investigated the reasons for these findings and have hypothesized that they are primarily the result of starvation and decreased resistance to infection. STUDY DESIGN: A retrospective review of the clinical records of patients at Montefiore Medical Center and its two associated municipal hospitals was done during a six year period. RESULTS: Postoperative morbidity and mortality rates of 50 and 38 percent, respectively, were documented and seem to be related to immunosuppression and the malnourished condition of these patients. CONCLUSIONS: Patients who meet the criteria for the diagnosis of AIDS have increased morbidity and mortality rates after emergency abdominal operations. This, however, should not exclude these patients from operation when it is indicated because many will survive and benefit from the operative procedure. Attention to nutritional support and the early diagnosis and treatment of associated infectious complications may result in decreased morbidity and mortality rates subsequent to the emergency abdominal operations.
Abdomen, Acute↗
Intestinal perforation from gastrointestinal histoplasmosis in acquired immunodeficiency syndrome. Case report and review of the literature.
Gastrointestinal involvement with histoplasmosis in patients with the acquired immunodeficiency syndrome is a rare but documented phenomenon. Most patients present with diarrhea, fever, and abdominal pain. We present a case of a woman who tested positive for the human immunodeficiency virus antibody who developed an intestinal perforation due to Histoplasma capsulatum of the ileum. The patient, whose only risk factor was a blood transfusion 8 years earlier, had been previously diagnosed as having disseminated histoplasmosis with gastrointestinal involvement. While receiving oral antifungal treatment (itraconazole), she developed two separate areas of ileal perforation due to H capsulatum. Complications from gastrointestinal involvement with histoplasmosis, such as perforation, should be considered in patients infected with the human immunodeficiency virus with signs and symptoms suggesting abdominal disease.
Acquired Immunodeficiency Syndrome↗
Acute appendicitis is rarely the initial presentation of cecal cancer in the elderly patient.
Acute appendicitis is rarely the initial presentation of carcinoma of the cecum in elderly patients. A 20-year retrospective review of all patients 65 years of age or older presenting with proven acute appendicitis at the Montefiore Medical Center confirms this opinion. In only 1.8% of patients was acute appendicitis the initial presentation of an underlying carcinoma of the cecum.
Acute Disease↗
A prospective randomized double blind study of perioperative antibiotic use in the grafting of ulcers of the lower extremity.
We conducted a prospective, randomized, double blind study of the use of a perioperative antibiotic in the skin grafting of arterial and venous ulcers of the lower extremity. Ninety-four patients were randomized and 90 were available for analysis. There was no statistically significant difference in graft "take" or incidence of recipient site infection in the antibiotic versus the no antibiotic group.
Cefazolin↗
An objective appraisal of the role of computed tomographic (CT) guided drainage of intra-abdominal abscesses.
Computed tomographic (CT) guided drainage is an important tool in the treatment of intra-abdominal abscess. Its most important role is in the treatment of small, unilocular, well-placed abscesses. Success rates in our experience diminish considerably in abscesses involving necrotic tumors or those infected with yeast. As is frequently characteristic of new technologic procedures, the initial evaluation of the success rate of the procedure is overly optimistic. The procedure carries a considerable complication rate (13%) and mortality rate (15%). Most importantly, success is usually evident early; within the first 24 to 48 hours. After this length of time, careful evaluation to consider further treatment should be contemplated.
Abdomen↗
Emergency abdominal operations in the patient with acquired immunodeficiency syndrome.
We have reviewed the medical records of ten patients with acquired immunodeficiency syndrome who required emergency celiotomy in a three-year period. These operations are characterized by a high morbidity and mortality. Careful attention to the support of these immunosuppressed, malnourished patients if emergency operation is necessary may improve the poor results reported herein.
Abdomen↗
Theoretical and practical considerations in the treatment of portal hypertension secondary to hepatic cirrhosis.
Portal hypertension related to hepatic cirrhosis produces significant alterations in portal blood flow, pressures, blood volume, and systemic hemodynamics. These alterations decrease portal blood flow to the hepatic parenchyma with measurable decreases in hepatic parenchymal function. The development of bleeding esophagogastric varices and the methods used to treat this complication are all unsatisfactory either in the short or long term. Portal systemic shunting, in particular, further decreases portal flow to the liver with deleterious effects on hepatic cellular function. Pharmacologic methods to decrease the risk of variceal bleeding are the most promising recent development in the care of these patients.
Animals↗
Adenocarcinoma of the stomach: current results of treatment.
One hundred-seventy-one patients with gastric adenocarcinoma seen at this medical center from 1972 through 1976 were reviewed. Proper TNM staging was possible in 154 patients. The overall 5-year survival (NED) was 10% and was 20.5% in those patients resected for cure. The operative mortality was 13.7% with most deaths occurring in patients with advanced stage disease. Although operating mortality has decreased in the past 50 years, long-term survival has not changed appreciably in spite of the additional use of radiotherapy or chemotherapy either as adjuvant therapy or for advanced residual neoplasm. Microscopic involvement of margins of resection must be avoided at operation as it is nearly synonymous with early recurrence and death.
Adenocarcinoma↗
Small bowel obstruction: the role of nonoperative treatment in simple intestinal obstruction and predictive criteria for strangulation obstruction.
The clinical presentation, treatment, and results of 405 patients with mechanical small intestinal obstruction admitted to the Montefiore Hospital and North Central Bronx Hospitals were reviewed. The etiology of obstruction was adhesions 74%, malignancy 8.6%, hernia 8.1%, inflammatory bowel disease 5.2%, and miscellaneous causes 4.1%. The overall mortality rate for the series was 6.7%, and the incidence of bowel strangulation was 10.1%. Strangulation occurred in 33.3% of the hernia group, 9.0% of the adhesions group, and 2.8% of the malignancy group. The largest single cause of death was related to malignant disease--12 cases (44.4%). Six deaths (22.2%) were caused by bowel strangulation. Of the patients who received more than 24 hours of nonoperative therapy, 46% had relief of obstruction. There was no statistically significant difference in successful results between patients managed with long tubes compared to patients managed with nasogastric tubes. Conservative therapy for malignant obstruction was not successful in 85% of cases. The presence of bowel strangulation shows a positive correlation with age (greater than 70 years), feculant vomiting, peristaltic sounds, and a white blood cell count higher than 18,000/mm3. It shows no correlation with onset, localization or type of pain, duration of symptoms, temperature, tachycardia, or x-ray findings. The results of the study indicate that accurate criteria for small bowel obstruction therapy have not been clearly defined except in patients with incarcerated hernias. Nonoperative management is successful in a significnt percentage of patients.
Adolescent↗
Rhabdomyosarcoma.
The care of patients with rhabdomyosarcoma has undergone significant change in the past decade. Careful staging and multidisciplinary treatment have improved the prognosis for patients with this neoplasm. A review of the medical literature of the past decade documents these changes in staging, therapy and prognosis.
Adolescent↗
Fibrosarcoma. Report of sixty-four cases.
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Adolescent↗
Peripheral vascular trauma.
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Angiography↗
Rhabdomyosarcoma: report of 20 cases.
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Humans↗
Percutaneous transhepatic biliary drainage. Results and complications in 81 patients.
Percutaneous transhepatic biliary drainage is usually used for preoperative decompression and for palliation in obstructive jaundice, but little attention has been focused on catheter complications. We retrospectively reviewed our experience with percutaneous transhepatic biliary drainage in 81 consecutive patients. There was a 10.0% failure rate and an 8.6% mortality rate. Four patients (4.9%) required emergency operations for complications and an additional ten patients (12.3%) required transfusions. The overall sepsis rate was 34.6%; prophylactic antibiotics decreased the sepsis rate. Thirty-eight patients (47.0%) required 68 manipulation procedures for catheter malfunctions. No distinguishing characteristics could be found to identify the subgroups having complications or mortalities. The efficacy of preoperative percutaneous transhepatic biliary drainage has not been proved, and the indications for palliation are not clearly defined. Further trials are needed to define the role of percutaneous transhepatic biliary drainage in patients with obstructive jaundice.
Aged↗