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Biomedical subjects

M Schein

Publications and source records attributed to M Schein.

At least 55 records · Page 3Linked to original sources
PubMed1990

Gastrointestinal fistulas associated with large abdominal wall defects: experience with 43 patients.

Experience with 43 patients with gastrointestinal fistulas associated with a large abdominal wall defect is presented. The overall mortality rate was 60 per cent; 37 per cent in patients who underwent the primary procedure in the home unit and 74 per cent in those from elsewhere. An average of five operations per patient was performed. The abdominal wall defect developed spontaneously as a consequence of postoperative peritonitis in 24 patients (mortality rate, 71 per cent) and was created intentionally as a part of the 'open management' in 19 cases (mortality rate, 47 per cent). Errors in management were identified in 63 per cent of the patients and this adversely influenced the outcome. Patients with this condition should be referred early to tertiary care facilities where diversion of the intestinal leak away from the defect, prompt control of the associated intra-abdominal infection and adequate handling of the defect itself can be performed.

Abdominal Muscles↗
PubMed1990

Gut barrier function and the surgeon.

There is accumulating evidence that multiple organ failure is not always the result of an established septic focus. Increasing attention has centred on the gut as a reservoir of bacteria (and bacterial endotoxins) that can traverse the intestinal mucosal barrier (a process called 'bacterial translocation') and initiate the septic state. Although the link between haemorrhagic shock and sepsis was recognized decades ago, the full experimental demonstration of this phenomenon is more recent. It was shown to occur in three main settings: physical disruption of the gut mucosa, impaired defence mechanisms and altered gut microbial ecology. Conditions such as haemorrhagic shock, burns, protein malnutrition and sepsis are seen in the severely ill surgical patient or the multiply injured, and are known to cause various combinations of circumstances favourable to bacterial translocation and endotoxin absorption. These may play an important role in the mortality of the critically ill.

Animals↗
PubMed1990

Surgical management of the redundant transposed colon.

Redundancy of the transposed thoracic colon is not uncommon. Rarely, however, when accompanied by severe symptoms, it may necessitate surgical correction. We describe herein a surgical technique that allows the stretching and straightening of the redundant transposed organ.

Anastomosis, Surgical↗
PubMed1990

APACHE II in emergency operations for perforated ulcers.

Most reports concerning the management of patients with perforated peptic ulcers suffer from inadequate documentation of the severity of illness and the operative risk of these patients. This study attempts to evaluate the prognostic value of the APACHE II scoring system in a homogeneous group of patients with perforated peptide ulcers, to assess it as a potential clinical and research tool for future studies, and to examine its usefulness in stratifying these patients according to their surgical risk. Our results confirm the prognostic value of the APACHE II scoring system, measured either retrospectively or prospectively, in patients who undergo emergency operations for perforated ulcers. When measured preoperatively, it accurately stratifies these patients to various risk groups and should therefore be used in future trials examining various treatment aspects of this condition. Our data, evaluating the results of various procedures in subgroups of patients stratified by the APACHE II, failed to support the superiority of one approach over another.

Duodenal Ulcer↗
PubMed1990

Serum amylase levels after obstetric and gynecologic operations.

The incidence of postoperative hyperamylasemia was evaluated in 131 patients who underwent obstetric and gynecologic procedures. Preoperative and postoperative serum amylase levels were determined in 178 patients who underwent routine surgical procedures. In our sample, we could not document any elevations in serum amylase levels after operations. These findings contradict those of previous reports of a high incidence of postoperative hyperamylasemia after surgical procedures except those performed upon the gastrointestinal tract. Furthermore, in spite of the fact that the female internal genitalia is rich in amylase and that pregnancy is considered a predisposing condition for the development of postoperative pancreatitis, the preoperative and postoperative serum amylase levels were consistently within normal range. We would like to conclude that the manipulation of female internal genitalia, pregnant or not, does not induce hyperamylasemia. Therefore, hyperamylasemia in postoperative gynecologic and obstetric patients should alert the clinician to the possibility of postoperative pancreatitis. We believe that our findings should be confirmed on large samples of patients.

Amylases↗
PubMed1990

Abdominal wall reconstruction after open management of the septic abdomen.

The increasing popularity of open management of the septic abdomen has generated a challenge that the surgeon is forced to face more frequently. The typical presentation is that of a patient with a full-thickness abdominal wall defect occurring after a protracted, severe illness. The various methods of reconstruction of the abdominal wall are reviewed and evaluated. The reconstruction should only be attempted once intra-abdominal sepsis is controlled, re-exploration of the peritoneal cavity is no longer necessary and organ support is discontinued. Although various methods of reconstruction are described, the recommended technique consists of either medial advancement of the rectus abdominis muscle or direct application of split-thickness skin grafts. Mid-line abdominal defects may also be repaired with tensor fasciae latae or rectus femoris flaps.

Abdominal Muscles↗
PubMed1990

Thoracic empyema--a delayed complication of excluded benign thoracic oesophagus. Case report.

Delayed 'blow-out' of retained thoracic oesophagus, 2 years after its exclusion for iatrogenic oesophageal perforation, gave rise to thoracic empyema. Oesophageal exclusion performed for benign, non-caustic conditions tends particularly to cause complications. Excision of the oesophageal remnant should therefore be considered in restoration of alimentary-tract continuity.

Aged↗
PubMed1990

Technical aids in surgery. Gastroduodenostomy for the "difficult" duodenum.

Many techniques have been devised for the safe closure of the 'difficult' duodenal stump after Billroth II gastrectomy. It is suggested that, in the presence of a 'difficult' duodenum and when gastrectomy is unavoidable, gastroduodenal anastomosis obviates the potential hazards of the high-risk duodenal stump.

Duodenostomy↗
PubMed1989

APACHE II score in massive upper gastrointestinal haemorrhage from peptic ulcer: prognostic value and potential clinical applications.

This study examined the prognostic value of the APACHE II scoring system in patients undergoing emergency operations for bleeding peptic ulcer. There were 96 operations for gastric ulcers and 58 for duodenal ulcers. The mean scores in survivors and in patients who died were 10.8 and 17.5 respectively. None of the 66 patients with an APACHE II score less than 11 died, while the mortality rate in those scored greater than 10 was 22 per cent. In patients scored greater than 10 non-resective procedures carried less risk of mortality than gastrectomy. The APACHE II score is useful when measuring the severity of the acute disease and predicting the outcome in these patients. If used in daily practice it may assist the surgeon in stratifying patients into a low-risk group (score less than 11) in which major operations are well tolerated and outcome is favourable and a high-risk group (score greater than 10) in which the risk of mortality is high and the performance of procedures of lesser magnitude is probably more likely to improve survival.

Duodenal Ulcer↗
PubMed1989

Postoperative gastric ischaemia.

This review discusses postoperative gastric ischaemia after detailed consideration of the gastric blood supply and the effects of devascularization. Special consideration is given to gastric remnant necrosis, lesser curve ischaemia after highly selective vagotomy, and gastric ischaemia after other operations.

Animals↗
PubMed1989

The place of intraoperative antegrade colonic irrigation in emergency left-sided colonic surgery.

The healing of colonic or colorectal anastomoses depends, at least partially, on the volume of fecal residue. Intraoperative antegrade colonic irrigation enables the surgeon to prepare the colon adequately at the time of surgery and to perform safely an immediate resection and primary anastomosis in obstructive lesions of the left colon. Its indications have been extended to other left-sided colonic emergencies, especially perforation and hemorrhage. The technique is described in this study and its value is assessed in the light of available experimental and clinical evidence.

Anastomosis, Surgical↗