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Biomedical subjects

M Witz

Publications and source records attributed to M Witz.

At least 37 records · Page 2Linked to original sources
PubMed1997

Aneurysmal arterial disease in a patient with Ehlers-Danlos syndrome. Case report and literature review.

Multiple aneurysmal lesions and dissections of the right femoral artery in a young man with type IV Ehlers-Danlos syndrome are presented. Type IV results in a high incidence of vascular lesions-extreme fragility of arteries is associated with multiple aneurysm formation and spontaneous rupture and dissection of arteries. Surgical management of patients with this disorder is hazardous and often unrewarding. The successful surgical treatment of an acutely thrombosed aneurysmal femoral artery by means of an interposition graft, is presented and brief guidelines for the treatment and prevention of vascular complications are discussed.

Adult↗
PubMed1996

Renal vein occlusion: a review.

PURPOSE: The different etiologies of renal occlusion are reviewed. A special category, division of the left renal vein in abdominal aortic surgery, is also discussed in the review. MATERIALS AND METHODS: The various diagnostic modalities used in cases of renal vein occlusion include excretory urography, ultrasound, nuclear scan, angiography, venography, computerized tomography and magnetic resonance imaging. The main goals of therapy in this condition should be conserve renal parenchyma and to protect renal function. RESULTS: The principal mode of treatment is medical and includes correction fluid and eletrocyte imbalance, dialysis, antihypertensive drugs, anticoagulation and in certain cases thrombolysis. CONCLUSIONS: Renal vein occlusion in adults is usually a result of the vein thrombosis which is frequently associated with the nephrotic syndrome. The anatomy of renal vascularization is of primary importance in understanding its pathophysiological responses and the clinical and diagnostic presentation of patients with this condition. The reaction of the kidney to its vein occlusion is determined by the balance between the acuteness of the disease, extent of the development of collateral circulation, involvement of 1 or both kidneys and the origin of the underlying disease. Renal vein occlusion is generally a complication of some other condition but may also be a primary disease.

Adult↗
PubMed1996

Isolated true atherosclerotic aneurysms of the deep femoral artery. Case report and literature review.

Isolated true atherosclerotic aneurysms of deep femoral artery are rare. We report on a case of an isolated (DFA) aneurysm of a large size. In reviewing the literature, the great latency of the disease, the high complication rate at presentation and the significant incidence concomitant aneurysms elsewhere are emphasized. Duplex scanning followed by angiography should be performed in order to establish the diagnosis, and to plan the operation. Twenty four cases have been reported so far. Elective surgical treatment is associated with little risk to the patient and avoids the need for emergent operations.

Adult↗
PubMed1992

[Adenocarcinoma of the appendix].

Adenocarcinoma of the vermiform appendix is rare. It usually produces signs of acute appendicitis and is discovered only on pathological examination. The treatment of choice is right hemicolectomy, usually performed as a secondary operation. 2 cases of appendiceal carcinoma, in a 59-year-old man and in a 70-year-old woman, are described.

Adenocarcinoma↗
PubMed1991

[Splenic subcapsular hematoma and long-term hemodialysis].

Uremic patients, or those on maintenance hemodialysis, are at increased risk for spontaneous bleeding. Manifestations include retroperitoneal, costal, hepatic, renal, pericardial, mediastinal and subdural hemorrhages. We describe 2 patients on chronic hemodialysis, a 45-year-old man and a 50-year-old woman. Each developed a subcapsular hematoma of the spleen, diagnosed by sonography and CT scan. They were conservatively managed by low-dose heparin, bed rest and careful monitoring. Frequently repeated ultrasound and CT scans demonstrated complete resolution of the hematomas after 2 and 4 months, respectively.

Bed Rest↗
PubMed1991

[Ultrasonic examination of the abdominal wall in surgery].

Ultrasonic (US) examination is a simple, effective and quick method of investigating the abdominal wall. We evaluated various cystic and solid lesions in 26 patients by US. In 24 the US diagnosis was correct and revealed pathologic conditions of the abdominal wall such as abscesses, cellulitis, metastatic tumors and hematomas. In 2 patients lesions of the abdominal wall were missed. All but 3 patients were treated surgically.

Abdominal Muscles↗
PubMed1991

[Simultaneous aortic and renal revascularization in chronic renal artery occlusion].

The decision to revascularize an occluded main renal artery is often extremely difficult, especially when aortic and renal occlusive disease co-exist. The main objectives of surgery are preservation of renal parenchyma and possible amelioration of renovascular hypertension, provided the patient's condition permits. In a 52-year-old man with renovascular hypertension and intermittent claudication transfemoral aortography revealed severe atheromatosis of the aorta and iliac arteries. There was total occlusion of the left main renal artery, but the right renal artery was patent. Aorto-femoral bypass was performed using a bifurcated graft. The left kidney was revascularized using an 8-mm straight graft anastomosed end-to-end with the renal artery and the other end was inserted into the distal part of the bifurcated graft, constituting a triple bypass. The postoperative course was uneventful, blood pressure decreased and renal scan showed good left renal function. 6 months later aorto-bifemoral and renal bypass grafts were fully patent.

Adult↗
PubMed1991

[Vascular injuries in children].

Vascular trauma in children differs in some respects from that in adults. In infants and children the total blood volume is smaller, and despite effective compensatory mechanisms, critical blood loss is also smaller. Gentle and meticulous technical skill is needed to correct injuries of minute vessels and allow adequate blood flow. The use of synthetic tubes and materials is not recommended, as they do not lengthen as the child grows. Ischemia is a major factor influencing limb growth and function. 3 different types of vascular injuries operated on in the past year are presented.

Blood Vessels↗
PubMed1991

Diagnosis and treatment of primary and recurrent retroperitoneal liposarcoma.

We retrospectively reviewed 16 patients in whom primary retroperitoneal liposarcoma was diagnosed and treated. These patients were classified according to the first definitive surgical procedure employed: complete excision with or without radiotherapy; partial excision followed by radiotherapy; only biopsy of tumor followed by radiotherapy. Distribution of tumors according to histologic type was: well differentiated myxoid type, 10; poorly differentiated myxoid type, 4; and mixed type, 2. The main factor in determining resectability was extent and fixation of tumor to vital structures. Recurrent retroperitoneal disease developed in four patients all of whom underwent secondary intervention. We concluded from our experience that complete surgical excision is the most effective primary therapeutic approach for patients with primary and recurrent retroperitoneal liposarcoma.

Adult↗
PubMed1991

Gastrointestinal lipoma and malignancies.

Twenty gastrointestinal lipomata in 18 patients are reviewed: 15 located in the colon, 3 in the distal ileum, one in the duodenum, and one in the stomach. They were found most frequently in European-born, elderly women and presented with variable abdominal symptomatology. Four lipomata were removed during endoscopy, the remainder at laparotomy, partial colectomy being performed in 10 cases. All, except 2 subserosal types, were located in the submucosa, and their average size was 2.7 cm diameter. Microscopically, none showed true encapsulation, and all were composed of mature fat cells without cellular atypia. In spite of nonspecific changes at endoscopy, one-half of the cases showed, on microscopic examination, atrophy of the overlying glands and a prominent eosinophilic and/or lymphoplasmocytic infiltration of the lamina propria. Two large subserosal lipomata were associated with Crohn's disease. In addition, in 39% of cases, malignant tumours, either single or double, were present in the gastrointestinal tract or elsewhere. Gastrointestinal "lipomata" are located in the sites of normal fatty infiltration in the elderly; these growths could be a local aging or reactive process of the intestinal wall rather than true neoplasms without any potential malignancy. However, coexistent malignancies should be carefully searched for in elderly patients with colonic lipoma.

Adenocarcinoma↗
PubMed1991

Revascularisation for a poorly functioning solitary kidney.

Renovascular disease in a solitary kidney is a difficult and challenging problem. In six patients, with a mean age of 62 years, revascularisation was undertaken. In four of them, one to three attempts at PTA were made before the operation but all were unsuccessful. The preoperative mean serum creatine (Cr) was 3.52 mg% (range 2.5-5.5). The stenoses were caused by atherosclerosis in five cases and fibromuscular dysplasia (FMD) in one. Two methods of revascularisation were used: aortorenal bypass with saphenous vein (three patients) or PTFE (two patients), and transaortic renal endarterectomy with a venous patch (one patient). One patient with an aortic aneurysm underwent simultaneous aortic repair with a PTFE graft. There was no mortality or major complications in our series and no patient suffered acute tubular necrosis (ATN) after surgery. The mean follow-up period was 51 months (15-84 months). Postoperative Cr and blood pressure improved in all patients. Four patients no longer required any medication and the other two only needed reduced doses of antihypertensive drugs. Based on our experience of patients with poor single kidney function, we do not recommend PTA in this specific group of patients and suggest an aggressive surgical approach, which can effectively improve solitary kidney function, thus eliminating further haemodialysis.

Anastomosis, Surgical↗
PubMed1991

Hypnosis and the treatment of Huntington's disease.

Huntington's Disease is an inherited fatal disorder of the central nervous system. Literature on the hypnotic treatment of this disease is extremely sparse. We treated two patients with Huntington's Disease using a wide variety of hypnotic interventions. One patient was treated for a number of years and the other for 10 consecutive sessions. We discuss the continuously interacting cycle between the primary physical symptoms caused by the disease and the secondary psychological symptoms. Hypnotic techniques and daily self-hypnosis appeared to ameliorate both physical and psychological difficulties, thereby enhancing the quality of life that remained for the patients. Systematic research into the effectiveness of hypnosis with symptoms of Huntington's Disease needs to be undertaken in the future.

Adult↗
PubMed1991

[Chylous ascites imitating acute appendicitis].

Acute accumulation of chyle in the peritoneal cavity is rare. It is usually idiopathic and the diagnosis is made at laparotomy, when indicated because of signs of acute peritonitis. Drainage is the only treatment required and the prognosis is excellent. A 33 year-old man who was operated on for signs of acute peritonitis is described. There was more than a liter of chyle, but no underlying pathological condition was found. 3 months after discharge, physical and laboratory examinations were normal, with no evidence of chylomicron retention disease.

Adult↗
PubMed1989

Intraoperative pancreatic biopsy--a diagnostic dilemma.

The intraoperative diagnostic dilemma of pancreatic cancer vs. chronic pancreatitis often remains unresolved. In the literature, diagnosis based on intraoperative pancreatic biopsy is a matter of controversy. Our study comprised 70 patients with a suspected space occupying pancreatic process who were operated on with the primary goal of arriving at a speedy and precise diagnosis, according to which the appropriate surgery for the specific patient would be performed. Frozen section showed that 44 patients had malignancy of the pancreas; in three patients, there was a false-negative result. In four patients, the histological picture was consistent with chronic pancreatitis. In the remaining 19 patients, biopsy was not performed and the diagnosis was made on the basis of intraoperative inspection and palpation of pancreas. On reviewing the patients, we found that the surgical risk involved in biopsy is quite low and that a high price was paid for diagnosis by inspection and palpation alone. The risk vs. benefit aspect of intraoperative pancreatic biopsy is discussed.

Adenocarcinoma↗