Biomedical subjects
M S Litwin
Publications and source records attributed to M S Litwin.
Extracorporeal shock-wave lithotripsy and ursodiol versus ursodiol alone in the treatment of gallstones.
The efficacy and occurrence of adverse effects after two forms of treatment were compared in 111 patients with biliary colic and radiolucent gallstones in this prospective, nonrandomized study. Fifty-four patients received extracorporeal shock-wave lithotripsy (ESL) plus ursodiol, and 57 patients received ursodiol alone. Among patients with a single stone (5-20 mm in size), no patient treated with ursodiol alone had a stone-free gallbladder at 6 or 12 months after treatment; of those treated with ESL plus ursodiol, 15 of 24 patients (63%) had a stone-free gallbladder at 6 months and 17 of 20 patients (85%) at 12 months. For patients with multiple stones (with an aggregate diameter of less than or equal to 30 mm), the incidence of a stone-free gallbladder was 2 of 43 patients (5%) at 6 months and 8 of 35 patients (23%) at 12 months in the ursodiol treatment group. In the ESL plus ursodiol group, the incidence of a stone-free gallbladder was 7 of 22 patients (32%) at 6 months and 9 of 20 patients (45%) at 12 months. Two patients in the ESL plus ursodiol group (4%) and 13 patients in the ursodiol group (24%) underwent cholecystectomy. Both patients in the ESL plus ursodiol therapy and 4 patients in the ursodiol group had emergency cholecystectomies because of acute cholecystitis. The remaining 9 patients in the ursodiol group had elective cholecystectomies. In this nonrandomized, prospective study, ESL plus ursodiol treatment produced stone-free gallbladders at a faster rate than ursodiol alone in patients with either single or multiple gallstones.
Normal sedimentation rates and giant cell arteritis.
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Congressional blow against residents.
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Resident physicians' involvement in organized medicine.
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100,000 and counting.
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Introducing the 'Resident Forum'.
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Placenta percreta invading the urinary bladder.
The placenta, normally confined to the decidual lining of the uterine cavity, can in some circumstances invade the muscular wall of the uterus, a condition known as placenta accreta. Less common is placenta increta, in which placental cotyledons become intertwined with the muscular stroma of the uterus. Placenta percreta, in which the trophoblastic tissues penetrate the serosa of the uterus and may extend directly to adjacent structures, is even more rare and is potentially life-threatening. There have been only 10 reports of direct invasion of placenta percreta into the urinary bladder. We review these cases and report 3 recent patients, one of whom was diagnosed pre-operatively by ultrasonography.
A role for topical 5-fluorouracil therapy in melanoma.
Topical 5-fluorouracil (Efudex) has been shown to be of great value in the treatment of skin cancers, Marjolin ulcers, and advanced squamous cell carcinoma of the mouth and esophagus. It has been advocated for use on patients with melanocytic dysplasia and lentigo maligna melanoma. This report confirms the use of topical 5-FU for lentigo maligna melanoma and melanocytic dysplasia. In melanomas with poor prognosis, preoperative treatment with topical 5-FU converts the cellular infiltrate from acute inflammatory cells to round cells which have been shown to be T-cells. We believe this preoperative stimulation of the patients' own immune reaction to the tumor may be of great significance in improving the surgical results for melanomas with a poor prognosis.
Early management of operative injuries of the extrahepatic biliary tract.
Since 1980, the authors have managed 19 patients with operative injuries to their biliary tracts. Eleven patients (58%) incurred their injuries during cholecystectomies for acute cholecystitis (average age--56 years); seven patients (37%) received their injuries during elective cholecystectomies (average age--24 years); and in one patient (5%) the injury occurred during gastrectomy. In group I were eight patients in whom injuries were recognized and repaired intraoperatively during their initial operations. Seven of these patients (88%) had primary duct reanastomoses, and one patient had a choledochoduodenostomy. All healed without further surgery, and none later had cholangitis develop. In group II were 11 patients diagnosed and reoperated later after surgery (mean time until diagnosis, 12 days). Seven of these patients (64%) were managed with Roux-en-Y hepaticojejunostomies or choledochojejunostomies. Four patients had cholangitis develop after surgery: two had demonstrable anastomic stenosis and two had no stenosis. Three of these four patients (75%) who had cholangitis develop did not have stents used in their repairs. The overall mortality rate in this series of 19 patients was 11%. The major risk factors for biliary tract injury were the presence of acute cholecystitis and of anatomically small biliary ducts. For this latter reason, younger patients who had elective cholecystectomies were particularly at risk. In delayed repair, the use of internal stents appeared to be useful in preventing the later development of stenosis and/or cholangitis; however, recurrent cholangitis developed in two patients who did not have demonstrable anastomotic stenoses.
Squamous cell carcinoma of the parotid gland.
Squamous cell carcinoma involving the parotid gland is an aggressive and rapidly advancing lesion which if not recognized and treated early will result in a high morbidity and mortality. We reviewed 30 patients with squamous cell carcinoma involving the parotid gland. Twenty-four patients had had previous epidermoid skin lesions in an area known to drain to the parotid gland and three resulted from direct extension into the gland from an overlying skin carcinoma, whereas only three were primary lesions of the gland. Patients who presented with involvement of the gland more than 4 months after excision of the skin lesion had a poor prognosis. Patients with epidermoid skin cancer in areas with a propensity to secondarily involve the parotid gland must be closely followed after treatment of the primary skin lesion.
Impact of emergency angiography in massive lower gastrointestinal bleeding.
Fifty patients with massive lower gastrointestinal bleeding were initially managed with emergency angiography. The average age was 67.2; mean hematocrit, 23.7; and average transfusion, 7.6 units. Thirty-six patients (72%) had bleeding site located; bleeding sites were distributed throughout the colon. Etiologies of bleeding included diverticular disease (19 patients) and arteriovenous malformations (15 patients). Twenty of 22 (91%) patients receiving selective intra-arterial vasopressin stopped bleeding; however, 50% rebled on cessation of vasopressin. Thirty-five of 50 (70%) patients underwent surgery, with 57% operated on electively after vasopressin therapy. Seventeen patients had segmental colectomy, with no rebleeding. Nine of the 17 patients had diverticular disease in the remaining colon. Operative morbidity in these 35 patients was significantly improved when compared to previously reported patients undergoing emergency subtotal colectomy without angiography (8.6% vs. 37%) (p less than 0.02). Emergency angiography successfully locates the bleeding site, allowing for segmental colectomy. Vasopressin infusion transiently halts bleeding, permitting elective surgery in many instances.
Use of absorbable collagen for hemostasis in general surgical patients.
Absorbable collagen sheet hemostat was used to obtain hemostasis in 62 general surgical patients. It was unusually effective in controlling profuse capillary, venular, and arteriolar bleeding in 61 of the 62 patients, with a mean time to hemostasis of 2.2 minutes. Collagen hemostat was particularly effective in the gallbladder bed after cholecystectomy, at liver and pancreatic biopsy sites, and on the cut surface of the thyroid gland. Collagen hemostat was also effective in inducing hemostasis in three patients with altered coagulation parameters associated with liver disease and in another patient with von Willebrand's disease. The material was easy to handle when wet with blood and did not stick to gloves, surgical instruments, or sponges. The collagen sheet hemostat also conformed well to tissues. None of our 62 patients experienced foreign body reaction, infection, or allergic manifestations.
False-positive hematuria.
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Physicians' group seeks nuclear arms ban.
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Pancreas divisum may be only coincidental.
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Respiratory distress syndrome.
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