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Biomedical subjects

M Stavorovsky

Publications and source records attributed to M Stavorovsky.

At least 19 recordsLinked to original sources

Unusual presentation of carcinoma of the vermiform appendix: a report of two cases.

Two unusual presentations of perforated mucoid adenocarcinoma of the appendix are described. One patient presented with a large periappendicular abscess that extended into the gluteal region, the other with a retroperitoneal abscess and abscesses in the right flank and groin. Recognition of the source of the abscess may be difficult but is essential for the prevention and elimination of the sepsis which may be life-threatening. The presence of mucin in the drained pus is highly suggestive for perforated bowel carcinoma. A high index of suspicion and the performance of prompt diagnostic procedures may bring early surgical treatment and better results.

Abscess↗

'Essential' hypertension with hypokalemia. Caused by aldosterone-secreting adrenal adenoma.

Primary aldosteronism is a potentially curable cause of hypertension; it occurs in about 1% of hypertensive patients. In the case reported here, persistent hypokalemia developed in a 72-year-old man who had been treated for 13 years for essential hypertension. Investigation revealed elevated aldosterone level and reduced plasma renin activity. Computed tomography and selective angiography showed a tumor in the right adrenal gland. Aldosterone-secreting adenoma of the adrenal gland was diagnosed, and right adrenalectomy was performed. At a six-month follow-up examination, the patient's blood pressure and potassium level were normal.

Adenoma↗

Smooth muscle tumors of the alimentary tract.

Smooth muscle tumors (SMT) of the alimentary tract are uncommon. A series of 32 cases (16 leiomyomas and 16 leiomyosarcomas) are presented. The most common presenting clinical signs are bleeding or obstruction. These are caused mainly by degenerative changes within the lesion or its enlargement. The endoluminal SMT cause symptoms early and are more easily detectable. However, the extraluminal SMT, producing an extrinsic mass, can remain asymptomatic for a long time. Thus, such SMT may be found incidentally during operation. The larger SMT are mostly malignant. Microscopically it is sometimes difficult to determine if the SMT is benign or malignant.

Adult↗

Granulomatous peritonitis caused by glove starch.

Corn starch particles are used as a surgical glove lubricant. At present there is no better alternative for this lubricant. Implantation of corn starch particles into the peritoneal cavity can induce foreign body reactions, starch peritonitis and starch granulomata, and may cause adhesions and intestinal obstruction. Starch peritonitis should be treated conservatively.

Gloves, Surgical↗

Endometriosis of the umbilicus.

Endometriosis is a common phenomenon. Most cases reported are pelvic endometriosis which cause typical symptoms. Cutaneous endometriosis is rare, usually appearing in surgical scars or following surgical procedures. Umbilical endometriosis can occur after surgery but is generally spontaneous. Six cases of spontaneous umbilical endometriosis are presented.

Adult↗

Thromboendarterectomy combined with femoropopliteal bypass.

Most complications that appear within 5-6 weeks after femoropopliteal bypass (FPB) are associated with the surgical procedure in the groin. Destruction of lymphatic structures in the presence of an open foot infection and crushing of the intima by clamping the common and deep femoral arteries are significant predisposing factors in producing early infection or occlusion of the graft. To avoid these predisposing factors, a combined procedure of a short thromboendarterectomy of the proximal superficial femoral artery and an autogenous or prosthetic bypass graft was used, without application of clamps to the common and deep femora arteris. In a series of 45 patients, this combined procedure was used and a significant reduction of complications was achieved. Indications, technique, and advantages of this combined method are discussed.

Bacterial Infections↗

Skin petechiae and ecchymoses (vasculitis) due to anticoagulant therapy.

The appearance of petechiae and ecchymoses following anticoagulant and fibrinolytic therapy is an unusual and rare complication. The mechanism of the vasculitis is obscure but may be related to a chemical vasotoxic reaction. During anticoagulant and fibrinolytic therapy, 6 patients developed petechiae and ecchymoses which was accompanied by pain and fever. There were no disturbances of blood clotting factors. In spite of the varied action of the different anticoagulants and fibrinolytic drugs, the clinical course and the histological examination demonstrated a similar identical vasculitis.

Aged↗

Acute myocardial infarction and arterial embolectomy.

Emboli of a main artery cause serious complications in patients suffering from acute myocardial infarction, in whom the surgical risk is high. In order to save the limb, embolectomy is indicated and should be considered. Early diagnosis and prompt surgical intervention with the use of the Fogarty catheter simplify the embolectomy procedure and enable restoration of circulation to the ischaemic limb. Thirty-two embolectomies were performed in twenty-eight patients suffering from acute myocardial infarction. Patients with cardiac compensation survived the surgery and recovered. However 50% of the patients in whom acute myocardial infarction was accompanied with congestive heart failure and arrhythmias died. The cause of death was the underlying disease. Considering the severity of the acute myocardial infarction this group of patients represents the expected mortality.

Aged↗

Midgut volvulus with secondary thrombosis of superior mesenteric vessels in a pregnant woman.

An anomaly of the position of the midgut in a pregnant woman predisposes to volvulus. Vascular repair, despite the abdominal catastrophe, sometimes allows parts of the intestine to be saved. A case of volvulus in a pregnant woman is described. At operation, 18 hours after onset, two anomalies were found: reverse rotation of the midgut and an anomaly of the collecting system of the superior mesenteric vein. Most of the midgut was infarcted. Thrombi were removed from the superior mesenteric vessels, and a portion of the anamalous superior mesenteric vein was reconstructed. All but 3 M. of the small bowel and the entire right colon were resected. Prolonged treatment with parenteral hyperalimentation enabled us to control the appearance of a moderate degree of malabsorption. To our knowledge, no similar case has been reported previously in the literature.

Adult↗

Candida sepsis successfully treated by parenteral administration of 5-fluorocytosine.

Candida sepsis has become one of the most common and dangerous forms of hospital acquired infection. The recommended drug for parenteral treatment of Candida sepsis is amphotericin B, however, its toxic effects preclude its usage in many patients, particularly in the presence of renal failure. A less toxic antifungal agent is 5-fluorocytosine. A patient with Candida albicans sepsis was treated successfully with 5-fluorocytosine by intravenous administration. The fungal infection developed during the course of acute renal failure, repeated surgical intervention, intravenous hyperalimentation, gastrointestinal bleeding and five months of antibiotic therapy. The clinical symptoms receded rapidly and cultures became sterile after one week of intravenous treatment. The predisposing factors, difficulties in prevention and diagnosis of fungal infection are discussed.

Adult↗

Membranous glomerulonephritis. An initial symptom of gastric carcinoma?

A 51-year-old man was hospitalized and operated on for gastric carcinoma with widespread metastases and died two months after the laparatomy and biopsy examination. Two years prior to the operation, he deveoped nephrotic syndrome. Anaplastic carcinoma, linitis plastica form, of the stomach was found in the tumor biopsy examination and at autopsy. Light and electron microscopical studies of the kidney biopsy specimen taken at laparatomy confirmed the presence of membranous glomerulopathy. An immunologic basis of the concomitant appearance of malignant neoplasms and nephrotic syndrome is possible, based on reported cases. There is also a possibility that renal damage occurs more commonly in malignant neoplasms, but is not recognized clinically.

Carcinoma↗