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Biomedical subjects

L Ungar

Publications and source records attributed to L Ungar.

11 recordsLinked to original sources
PubMed2000

[A structured course for primary care physicians on breaking bad news].

Physicians are frequently required to break bad news to their patients. Previous research has shown that inconvenience, incompetence, and difficulty in dealing with patients' feelings are the main complaints expressed by physicians after such an encounter. Current educational programs dealing with breaking bad news are usually short, given in lecture format, and are inadequate in addressing essential issues such as knowledge, personal beliefs and attitudes, and previous personal experiences of physicians in such situations. In the past 8 years our Dept. of Family Medicine has implemented a course in breaking bad news that addresses these issues. A senior family practitioner and a medical social worker conduct 14 sessions of discussions and role-playing for small groups of residents and primary care physicians. The program is based on: theory dealing with methods of managing stress and crisis intervention, clarifying personal attitudes, discussions of previous personal encounters of the participants, various modalities of communication, methods of addressing patients' feelings and emotions, and coping with the emotions of the one breaking the bad news. On a 1-5 Likert scale questionnaire the course received an overall score of 4.47 (SD 0.51). Participants noted that they gained relevant communication skills for future patient encounters. A reliable examination of practitioners' competence in breaking bad news is mandatory in order to assess the efficiency of such courses.

Communication↗
PubMed1999

Treating morbid obesity with laparoscopically placed, adjustable gastric band.

The authors present their first experiences on the laparoscopically placed, adjustable gastric band treatment of morbid obesity. Treating of the morbid obesity in a surgical way, this particular method is widely accepted as the less invasive and most modern procedure, with the benefit of adjustability of the gastric band. During the spring of 1999, 4 patients were treated with the method described above, 3 male and 1 female, the average BMI was 47.5 kg/m2. The mean operating time was 150 minutes (90-270), the patients left hospital the third day after the operations. We noticed no early complications, except for 1 band being displaced, it was replaced immediately by laparoscopic technique. The method, widely used all over the world is opening new aspects on treating morbid obese patients in our country, if properly indicated and operated, giving long lasting effective results.

Adult↗
PubMed1997

Living with mastectomy and breast conservation treatment: who suffers more?

Sixty-five patients who underwent modified radical mastectomy were compared with 55 breast conservation patients, all of whom were in stage I, II or III of breast cancer and were under treatment at an oncology clinic in northern Israel. The main findings indicate no differences between the groups in physical, psychosocial, marital or medical interaction, according to the CARE scale. These findings reflect the results of similar comparative studies conducted during the 1980s and 1990s as documented in the literature. Sexual interaction showed statistical differences favoring the women who had undergone mastectomies.

Adult↗
PubMed1997

Abdominal radical trachelectomy: a new surgical technique for the conservative management of cervical carcinoma.

Traditionally radical hysterectomy has formed the mainstay of treatment for early stage cervical carcinoma. More recently radical trachelectomy and laparoscopic lymphadenectomy have been introduced to allow preservation of fertility. We present a new approach to fertility-sparing surgery, namely abdominal radical trachelectomy. The technique is similar to a standard radical hysterectomy and lymphadenectomy. In our technique the ovarian vessels are not ligated and, following lymphadenectomy and skeletonisation of the uterine arteries, the cervix, parametrium and vaginal cuff are excised. The residuum of the cervix is then sutured to the vagina and the uterine ateries re-anastomosed.

Anastomosis, Surgical↗
PubMed1988

Unconjugated 17 beta-oestradiol and oestriol in maternal serum and in cord vein and artery blood at term and preterm delivery.

The serum level of unconjugated 17 beta-oestradiol (E2) and oestriol (E3) in the maternal vein (MV), the umbilical vein (UV) and artery (UA) immediately after term (n = 34) and preterm (n = 74) labour was measured to clarify the hormonal changes that occur between the maternal and fetal compartments. The following results were found. (1) The level of E2 and E3 increased equally in the MV, UV and UA serum from the 28th-32nd week to the 33rd-36th week of pregnancy. From the 33rd-36th week to the 40th week there was no change in the MV, but the value of E2 and E3 decreased significantly in the UV and UA serum. (2) The serum level of E2 in the MV was significantly higher than that in the UV and UA during every gestational period. In contrast, the serum concentration of E3 in the MV was significantly lower than that in the UV and UA. (3) The value of 'UA/UV X 100' of E2 and E3 was about 30% during the 28th-40th week. (4) A weak correlation was found between the MV serum level of E2 and E3 and UA serum concentrations. A strong correlation was found between the UV and UA serum levels of E2 and E3. The authors suggest that though there is a close connection between the fetal and the maternal organism, the fetus is still capable of maintaining its hormonal environment independently.

Adult↗
PubMedDate not supplied

Surgical treatment of lymph node metastases in stage IB cervical cancer: the laterally extended parametrectomy (LEP) procedure.

A surgical method has been introduced for the treatment of early stage cervical cancer patients with pelvic lymph node metastases. The procedure was used without any adjuvant treatment in 31 stage IB cervical cancer patients, where pelvic lymph node metastases were proven by intraoperative histology. Two patients were lost for follow-up. Twenty-nine patients were followed up for 24-105 months (mean 60 months). Twenty-five of 29 patients were alive and disease-free at the end of the study period. Kaplan-Meier 5 years cumulative proportion survival was 85% (SE 7%). Complications in four cases (16%) necessitated a second operation. One patient developed treatment-refractory grade II incontinence. All but the one incontinent patient are alive without significant treatment related symptoms. The results suggest that pelvic lymph node metastases can be cured by surgery alone. The LEP procedure seems to be a treatment alternative to chemoradiotherapy for early stage cervical cancer patients with pelvic lymph node metastases.

Adult↗
PubMedDate not supplied

Selective vessel ligation in the pelvis: an invaluable tool in certain surgical procedures.

While developing the technique of abdominal radical trachelectomy for conservative cervical cancer management, the vascular supply of the uterus was thoroughly examined. The question of how many vessels the uterus requires to ensure its viability arose. Following an abdominal radical trachelectomy for stage IB cervical carcinoma, blood supply of the body of the uterus is successfully maintained by only the two infundibulopelvic vessels (n= 34). Pregnancy has resulted following this technique (n= 2). Selective ligation of the pelvic vasculature has been utilized in the abdominal radical trachelectomy procedure. The objectives of this study were to investigate the vasculature of the infundibulopelvic and broad ligaments, to assess the contribution of the ovarian and uterine vessels to overall uterine perfusion, and to consider the clinical applications of selective pelvic vessel ligation. Ten fresh dissections of the infundibulopelvic vessels, broad ligaments of benign total abdominal hysterectomy, and bilateral salpingo-oophorectomy specimens were performed. Perfusion index (PI) and oxygen saturation (O(2)Sat) measurements using a modified probe were taken at specified intervals at the uterine cornu during ten routine benign abdominal hysterectomies to assess the contribution of the ovarian and uterine vessels to overall uterine perfusion and the concepts studied were utilized in certain gynecological procedures. The ovarian/infundibulopelvic vessels course medially through the broad ligament toward the uterine cornu and consistently give off a branch to the ovary on its lateral border. In addition, further vessels were noted to run laterally from the uterine cornu along the ovarian ligament to the medial aspect of the ovary. PI and O(2)Sat measurements imply that the uterine and ovarian vessels contribute almost equally to uterine perfusion. Clinical application by selective ligation of the pelvic vasculature has been utilized in certain gynecological procedures often prone to torrential life-threatening uterine hemorrhage. Selective temporary ligation of the uterine and ovarian vessels has proven useful in the surgical management of chemoresistant gestational trophoblastic disease, in the Strassman procedure, fertility-sparing surgery in ruptured cornual ectopic pregnancies, and unrelenting postpartum hemorrhage. Of the six supplying vessels (ovarian, uterine, and vaginal) to the uterus only two (ovarian or uterine or a combination thereof) are required for uterine viability.

Female↗
PubMedDate not supplied

Pelvic exenteration without external urinary or fecal diversion in gynecological cancer patients.

In 1993, the authors introduced an orthotopic bladder replacement technique in the treatment of gynecological cancer patients. In this series, they report their long-term experience with orthotopic urinary reconstruction in case of primary- and radiotherapy-treated recurrent gynecological malignancies. Between 1993 and 2003, in 29 patients orthotopic ileocecal ascending colon reservoirs (Budapest pouch) were created. Twenty-one of the 29 patients received radiotherapy prior to their operation. In 12 out of these 29 cases, the fecal stream was reconstructed with the use of low rectal anastomosis. Two patients (6.9%) died in the perioperative period. Orthotopic reconstruction of the lower urinary system was successful in 77% of the cases. Success rate was 68% in the irradiated cohort of patients. All orthotopic bladder replacement patients voided voluntarily at the time of their follow-up, without the need of self-catheterization, and 23.5% of them complained of some degree of daytime incontinence and 47% of nighttime incontinence. Low rectal anastomosis reconstruction of the fecal stream was successful in all but one case. Our present experience demonstrated that anterior and total supralevator pelvic exenteration in patients with gynecological malignancies is feasible with orthotopic reconstruction of the lower urinary tract.

Adult↗