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Biomedical subjects

M E Schwartz

Publications and source records attributed to M E Schwartz.

16 recordsLinked to original sources
PubMed1992

Simultaneous laparotomy and endoscopy for control of bleeding gastric ulcerations after liver transplantation without enterotomy.

Treatment of gastric peptic ulcerations, which requires both medical and surgical coordination in its management, is a complex subject. Despite advances in the medical therapy of ulcers, medications have little impact on the course of bleeding peptic ulceration. Newer endoscopic techniques of injection with adrenaline or alcohol, heater probes, and vicaps electrodes have controlled bleeding in many patients. Still, a subset of patients remains who will require surgical interventions with gastrotomy and oversewing of the ulcer crater. We describe a new technique for management of the acute gastric ulcer bleeding that avoids gastrotomy and potential contamination in the post-transplant patient.

Esophageal and Gastric Varices↗
PubMed1991

Combined hepatic and vena caval resection with autogenous caval graft replacement.

Right-sided and caudate hepatic lobectomy with resection of the retrohepatic vena cava were performed in a 34-year-old woman with recurrent adrenal carcinoma. The vena cava was replaced with a graft constructed from autogenous superficial femoral vein. Included herein is a review of the literature detailing the three previously reported cases of combined hepatic and caval resection; to our knowledge, there are no prior reports of the use of an autogenous vein graft in this setting. With surgical and anesthetic techniques, including total vascular exclusion of the liver and venovenous bypass, methods that were developed in large part through experience in liver transplantation, this type of surgery can be performed with a high rate of success.

Adrenal Gland Neoplasms↗
PubMed1990

Expanded indications for laser-assisted balloon angioplasty in peripheral arterial disease.

Successful recanalization of isolated femoropopliteal occlusions by laser-assisted balloon angioplasty has been widely reported. However, the utility of this approach in other sites remains undetermined. The potential of laser-assisted balloon angioplasty in the treatment of a broad spectrum of lower extremity atherosclerosis was explored. Seventy-seven limbs in 69 patients were treated with laser-assisted balloon angioplasty by means of a percutaneous approach. Technical success was achieved in 62/77 (81%), with 52/77 (68%) open at discharge. At a mean of 8.6 months' follow-up, cumulative patency was 50% at 6 months and 42% at 9 months. In 10 cases initial guide wire placement was not possible; primary laser probe passage was technically successful in six, with two open at latest follow-up. Eleven patients underwent laser therapy without balloon angioplasty of distal sites with technical success in eight; at most recent follow-up five were open at the site of sole laser therapy. Complications were frequent. Bleeding requiring transfusion occurred in six, with three patients requiring emergency surgery; worsened ischemia necessitating urgent arterial bypass grafting developed in five patients. In this series laser angioplasty carried significant complications and a high failure rate. Widespread application of this procedure should await further clinical investigation.

Aged↗
PubMed1990

Regional procurement and export of hepatic allografts for transplantation.

A team dedicated to hepatic procurement exclusively for export to distant centers was established at The Mount Sinai Hospital in New York. Between January 1987 and March 1988, 20 livers were retrieved and sent to five institutions in the U.S. and Canada for implantation. These procedures were carried out in concert with local cardiac and renal procurement teams; 12 hearts and 34 kidneys were used from these 20 donors. Functional results of both the livers and the other organs were in line with nationally reported standards. The multi-organ procurement procedure was streamlined as a result of the coordination which developed between the teams. Savings in time and travel expense by skilled personnel were realized; in five cases no alternative hepatic procurement team was available. With the ability to preserve livers for increasingly long periods, this type of program will assume greater importance in the future.

Humans↗
PubMed1988

Unusual venous thrombosis associated with protein C deficiency.

A patient in whom massive puerperal thrombophlebitis developed had protein C deficiency. In patients who initially have thrombosis that is unusual either in its nature or extent, investigation may, as in this case, reveal the presence of a hypercoagulable state.

Adult↗
PubMed1988

Wound complications after in situ bypass.

In situ saphenous vein bypass presents unique problems in wound management. A retrospective analysis of wound complications occurring after in situ bypass was undertaken in 93 patients who had 98 operations. For purposes of statistical analysis, only the first procedure was considered in patients having bilateral bypass. Fifty-nine percent of patients were male; the average age was 69 years. Medical risk factors surveyed included diabetes (64%), hypertension (52%), and smoking (53%). Ninety-one percent of the procedures were done for limb salvage; the mean ankle-brachial index was 0.43. Sixty percent of bypasses were infrapopliteal, and the mean duration of surgery was 4.6 hours. Continuous incision was used to expose the vein in 59% of cases. Skin closure was effected with staples in 44% and with sutures or both in the remainder. The mean postoperative hospital stay was 27 days. Wound problems developed in 31 cases, 11 of which were major. The thigh was the most common location. There was a significant association between continuous incision and anterior tibial bypass and wound complications. Anterior tibial bypass and staple closure were found to be independent predictors of wound problems with the use of stepwise logistic regression. Postoperative hospital stay was significantly prolonged; two bypasses failed and three lower extremities were amputated because of incisional complications. A discussion of the technical aspects of wound management is presented.

Aged↗
PubMed1986

Postoperative intussusception after vaginal vault suspension.

Postoperative intussusception in the adult is a rarely reported and poorly understood condition. Presented is the case of a patient developing incomplete small bowel obstruction after an uneventful vaginal vault suspension. Jejunojejunal intussusception, requiring resection, was found at celiotomy. Intussusception must be considered in treating patients developing postoperative intestinal obstruction.

Female↗