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Biomedical subjects

M Burnstein

Publications and source records attributed to M Burnstein.

14 recordsLinked to original sources
PubMed2001

Subcutaneous heparin versus low-molecular-weight heparin as thromboprophylaxis in patients undergoing colorectal surgery: results of the canadian colorectal DVT prophylaxis trial: a randomized, double-blind trial.

OBJECTIVE: To compare the effectiveness and safety of low-dose unfractionated heparin and a low-molecular-weight heparin as prophylaxis against venous thromboembolism after colorectal surgery. METHODS: In a multicenter, double-blind trial, patients undergoing resection of part or all of the colon or rectum were randomized to receive, by subcutaneous injection, either calcium heparin 5,000 units every 8 hours or enoxaparin 40 mg once daily (plus two additional saline injections). Deep vein thrombosis was assessed by routine bilateral contrast venography performed between postoperative day 5 and 9, or earlier if clinically suspected. RESULTS: Nine hundred thirty-six randomized patients completed the protocol and had an adequate outcome assessment. The venous thromboembolism rates were the same in both groups. There were no deaths from pulmonary embolism or bleeding complications. Although the proportion of all bleeding events in the enoxaparin group was significantly greater than in the low-dose heparin group, the rates of major bleeding and reoperation for bleeding were not significantly different. CONCLUSIONS: Both heparin 5,000 units subcutaneously every 8 hours and enoxaparin 40 mg subcutaneously once daily provide highly effective and safe prophylaxis for patients undergoing colorectal surgery. However, given the current differences in cost, prophylaxis with low-dose heparin remains the preferred method at present.

Anticoagulants↗
PubMed2000

Internal sphincterotomy is superior to topical nitroglycerin in the treatment of chronic anal fissure: results of a randomized, controlled trial by the Canadian Colorectal Surgical Trials Group.

PURPOSE: This was a multicenter, randomized, controlled trial to compare the effectiveness of topical nitroglycerin with internal sphincterotomy in the treatment of chronic anal fissure. METHODS: Patients with symptomatic chronic anal fissures were randomly assigned to 0.25 percent nitroglycerin tid or internal sphincterotomy. Both groups received stool softeners and fiber supplements and were assessed at six weeks and six months. RESULTS: Ninety patients were accrued, but 8 were excluded from the analysis because they refused internal sphincterotomy after randomization (6), the fissure healed before surgery (1), or a fissure was not observed at surgery (1). There were 38 patients in the internal sphincterotomy group (22 males; mean age, 40.3 years) and 44 patients in the nitroglycerin group (15 males; mean age, 38.7 years). At six weeks 34 patients (89.5 percent) in the internal sphincterotomy group compared with 13 patients (29.5 percent) in the nitroglycerin group had complete healing of the fissure (P = 5x10(-8)). Five of the 13 patients in the nitroglycerin group relapsed, whereas none in the internal sphincterotomy group did. At six months fissures in 35 (92.1 percent) patients in the internal sphincterotomy group compared with 12 (27.2 percent) patients in the nitroglycerin group had healed (P = 3x10(-9)). One (2.6 percent) patient in the internal sphincterotomy group required further surgery for a superficial fistula compared with 20 (45.4 percent) patients in the nitroglycerin group who required an internal sphincterotomy (P = 9x10(-6)). Eleven (28.9 percent) patients in the internal sphincterotomy group developed side effects compared with 37 (84 percent) patients in the nitroglycerin group (P<0.0001). Nine (20.5 percent) patients discontinued the nitroglycerin because of headaches (8) or a severe syncopal attack (1). CONCLUSIONS: Internal sphincterotomy is superior to topical nitroglycerin 0.25 percent in the treatment of chronic anal fissure, with a high rate of healing, few side effects, and low risk of early incontinence. Thus, internal sphincterotomy remains the treatment of choice for chronic anal fissure.

Administration, Topical↗
PubMed2000

Practice parameters for the treatment of sigmoid diverticulitis--supporting documentation. The Standards Task Force. The American Society of Colon and Rectal Surgeons.

It should be recognized that these guidelines should not be deemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all of the circumstances presented by the individual patient.

Diverticulitis, Colonic↗
PubMed1997

A new assessment tool: the patient assessment and management examination.

BACKGROUND: The major goal of certification is to assure the public that the candidate is competent in all facets required of the position. The patient assessment and management examination (PAME) was developed to enable a more comprehensive assessment of competence in the practice of surgery. METHODS: A six-station, 3-hour, standardized-patient-based evaluation was developed. Each station was scored using a set of five-point global rating scales. PAME results were compared to the last two in training evaluation reports (ITER), the clinical knowledge component of the ITER (ITER-CK), an in-house oral examination (OE), and the Canadian Association of General Surgeons' multiple-choice examination (CAGS). RESULTS: Eighteen senior general surgery residents were evaluated. Overall reliability was 0.70 (Cronbach's alpha). Fifth-year residents scored significantly better than fourth-year residents (t = 3.062; p = 0.0074), with 1 year of training accounting for 37% of the variance in scores. Correlations between the PAME and each of the other measures were ITER, 0.24; ITER-CK, 0.38; OE, -0.13; and CAGS, 0.061, with the PAME demonstrating better reliability and stronger evidence of validity than any other. CONCLUSIONS: The PAME had better psychometric properties than other measures and assessed areas often not evaluated. This type of evaluation may be useful for feedback, remediation, or certification decisions.

Adult↗
PubMed1997

Enteric duplication in the adult, derived from the foregut, midgut and hindgut: presentation, patterns and literature review.

Duplication of the alimentary tract may affect patients of all ages. Although they are relatively rare, the importance of these congenital lesions lies in the fact that they readily mimic other surgical disease processes and may result in significant morbidity if left untreated. Prompt recognition and treatment using combined radiologic and surgical management are generally associated with an excellent outcome. Three patients who presented with intestinal duplication arising from each of the major embryologic origins are reported. Their clinical histories reveal the spectrum of presentation associated with these lesions and provide a framework for a discussion of current management strategies.

Adult↗
PubMed1993

Managing anorectal emergencies.

Patients with anorectal emergencies frequently present to their family physicians or to their local emergency department. In most cases, they can be successfully treated as outpatients. The principles of diagnosis and management of common anorectal emergencies are reviewed.

Abscess↗
PubMed1986

Small intestinal transplantation using cyclosporine. Report of a case.

A case of small intestinal allotransplantation is described. Cyclosporine and Solumedrol were used for immunosuppression. A hemolytic episode occurred, caused by anti-A antibodies derived from graft lymphocytes. Sudden severe encephalopathy developed on the ninth postoperative day, followed by intractable hypotension and death. Hepatic and splenic microinfarcts were identified on postmortem examination. Allograft rejection was identified by serial stomal biopsies and correlated with a rise in monocyte procoagulant activity, a potentially useful serologic marker of rejection. The absence of an anatomic circuit for recycling of cyclosporine did not alter serum radioimmunoassay/high-performance liquid chromatography ratios.

Adult↗
PubMed1982

Necrotizing pancreatitis in renal transplant patients.

Acute necrotizing pancreatitis developed in 5 of 405 patients who underwent renal transplantation. All five patients were taking immunosuppressive medication (azathioprine and steroids). Three patients also received rabbit antithymus serum. Alcohol ingestion or cholelithiasis did not play any causative role in the pancreatitis, which began between 7 days and 13 months after renal transplantation. The delay from the time of admission for pancreatitis to surgical exploration was a mean of 17 days. Operative findings included pancreatic necrosis, hemorrhage and abscess formation. All five patients died of the complications of necrotizing pancreatitis--persistent sepsis, respiratory and renal failure, upper gastrointestinal bleeding and disseminated intravascular coagulation. This review demonstrates that prolonged conservative therapy in renal transplant patients with necrotizing pancreatitis is associated with high mortality. The authors believe that earlier surgical intervention will lead to increased survival.

Acute Disease↗