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Biomedical subjects

N Rotman

Publications and source records attributed to N Rotman.

At least 55 records · Page 3Linked to original sources
PubMed1991

[Diagnostic and therapeutic strategy in acute pancreatitis].

The diagnostic and therapeutic management of acute pancreatitis (AP) is directly related to the severity of the initial attack. Mild AP usually subsides spontaneously. On the other hand, severe AP requires admission to an intensive care unit and supportive care for multiple organ failure. During the second phase of the disease, repeated CT scans with the routine use of percutaneous fine needle aspiration and drainage allows both diagnosis and treatment of pancreatic abscesses. However, infected necrosis usually requires surgical drainage. The treatment of acute biliary pancreatitis must be performed during the same admission for mild AP. In contrast, it seems better to postpone any kind of surgical treatment in the severe forms of gallstone pancreatitis. The efficacy of endoscopic sphincterotomy has not yet been demonstrated.

Acute Disease↗
PubMed1990

[Antibiotic prophylaxis in abdominal surgery].

In order to compare the efficacy of antibiotic therapy using Cefalozin or Cefotaxime, 3,137 patients operated with an abdominal approach were included into a multidepartmental prospective study by lot. The patients were distributed into 4 levels according to the degree of intraoperative contamination and to the risk factors they presented. The patients in each level were distributed by lot into three treatment groups: 1) Cefalozin, 2) Cefotaxime, 3) no treatment. The antibiotics were delivered perioperatively in 3 doses of 1 g every eight hours. The patients having had colic surgery or operated for peritonitis were excluded from the study. The number of intestinal wall abscesses was significantly lower in the treated groups, except in level 3 (contaminated surgery). The percentage of postoperative peritonitis was twice lower in the treated groups than in the control group. There was no difference between the treated groups. The patients included in the treated groups were given significantly less antibiotics than the patients of the control group. As far as costs are concerned, antibiotic prophylaxis with Cefalozin is effective in all procedures of abdominal surgery in which the degree of contamination by anaerobes is low.

Abdomen↗
PubMed1990

A survey of the role of the dietitian in preparing patients for home enteral feeding.

Teaching home enteral feeding is a complex process involving many activities not traditionally performed by dietitians. This survey was undertaken to investigate (a) tasks performed by the dietitian in preparing patients to receive home enteral feeding, (b) the effect of various demographic factors on the dietitian's role, (c) the amount of dietitian time spent preparing a patient for discharge on home enteral feeding, and (d) the types of home enteral feedings currently in use. A questionnaire was tested for reliability and validity, then mailed to 1,168 nutrition support dietitians. Results of the survey indicated that, more often than nurses or physicians, dietitians were responsible for calculating nutrient and fluid needs, selecting formula, determining the home feeding schedule, teaching the patient to prepare blenderized formulas, and teaching the patient to recognize formula intolerance. Dietitians were less often responsible than nurses for psychomotor skills such as teaching the patient to administer the formula, operate the pump, and flush the feeding tube. Dietitians seemed to have a larger role in hospitals with more than 499 beds, in teaching hospitals, and in hospitals with a nutrition support team. Dietitians reported a smaller role when they reported to a contract foodservice company and when their job duties were divided so that more time was spent in clinical dietetics than in nutrition support. However, dietitians in all demographic groups performed all tasks. The average amount of dietitian time spent preparing patients for discharge on home enteral feeding was 168 minutes (2.8 hours) per patient. More patients received gastric feedings (76%) than intestinal feedings (22%).(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗
PubMed1990

[Gastric duplication. Apropos of 3 cases].

Duplication of the stomach is a rare congenital malformation. Most reported cases involve infants or young children. On the basis of 3 cases identified at a later age, we describe the CT appearance of this malformation. Those 3 cases were demonstrated by the histological study of the surgical specimen.

Adenocarcinoma↗
PubMed1989

Prophylactic antibiotherapy in abdominal surgery. First- vs third-generation cephalosporins.

To compare the efficiency of antibioprophylaxis by cefazolin sodium or cefotaxime sodium, 3137 consecutive patients undergoing abdominal surgery were included in a prospective, randomized, controlled, multicenter study. The patients were divided into four strata, according to the degree of contamination during the operation and the risk factors. Within each stratum, the patients were randomized into three groups of treatment: (1) cefazolin, (2) cefotaxime, and (3) nontreatment (control). Antibiotics were administered perioperatively in three intravenous doses of 1 g at eight-hour intervals. Patients undergoing colon surgery or with peritonitis at the time of the operation were excluded from the study. The wound abscess rate was significantly lower in the treated groups than in the control group, except in stratum 3 (contaminated surgery). The percentage of postoperative peritonitis was twice as low in the treated groups as in the control group. There was no difference between the groups receiving cefazolin or cefotaxime. The patients in the treated groups received significantly less postoperative antibiotics than the patients in the control group. In terms of cost, antibioprophylaxis by cefazolin seems to be warranted in all operations with a low anaerobic contamination.

Abdomen↗
PubMed1989

Direct retroperitoneal approach to necrosis in severe acute pancreatitis.

From 1981 to 1987, 40 patients with severe acute pancreatitis were operated on using a direct retroperitoneal approach, 22 primarily and 18 after a first operation performed through another incision. The severity of the disease was assessed by Ranson's bioclinical and computed tomography scan scoring systems. The retroperitoneal approach consisted of a left lateral incision, just anterior to the 12th rib, allowing direct access to the pancreas and a complete manual exploration of the gland and peripancreatic spaces. All patients but one were operated on for infected necrosis. The overall mortality rate was 33 per cent but was lower in the patients operated on primarily through a direct retroperitoneal approach (18.2 per cent). Twenty patients (50 per cent) developed a local complication (haemorrhage, colon fistula and/or necrosis). The direct retroperitoneal approach permits the removal of necrosis and several reoperations without the risk of large wound dehiscence and does not preclude the extension of the incision to a subcostal incision when necessary.

Acute Disease↗
PubMed1989

Percutaneous management of pyogenic liver abscesses.

Twenty-four pyogenic liver abscesses have been treated during a six-year period percutaneously. Percutaneous management included percutaneous drainage and fine needle aspiration under ultrasound or CT scan guidance. Percutaneous management was successful in 92% of cases, and no further treatment was required in 91% of these. One patient died, giving a mortality rate of 4.1%. There were no complications related to this method. The authors conclude that percutaneous management of pyogenic liver abscesses should be attempted in all cases, since results compare favourably with surgical procedures.

Adolescent↗
PubMed1989

[Experimental acute necrotico-hemorrhagic pancreatitis in dogs. Treatment by intraductal block].

The aim of this experimental study was to demonstrate that the mortality of calcium chlorine induced acute pancreatitis in the dog was decreased by the intraductal injection of solid substances. Seventy-two dogs were used. In the control group (n = 5) the mortality was 100%. Three different drugs were used for the intraductal injection: Ethibloc (n = 37), Tissucol (n = 10) and silicones (n = 10). The mortality rate has been respectively of 13.5, 10 and 10%. In order to define at which level of the pancreatic duct the obstruction had a maximum efficiency, 10 dogs underwent a distal ligation of the pancreatic duct after induction of the pancreatitis. The mortality rate in this group was 100%. It can be therefore concluded that only the complete obstruction of the pancreatic duct decreases the mortality rate in this experimental model.

Acute Disease↗
PubMed1989

[Abscess of the spleen: diagnosis and treatment. Apropos of 12 cases].

Twelve cases of splenic abscess, seen at our hospital between January 1980 and June 1987, were reviewed retrospectively. The most common causes of splenic abscesses were subacute endocarditis and intra abdominal sepsis. Diagnosis was suspected on clinical grounds and was always confirmed by sonography and/or computerized tomography. Two patients were drained unsuccessfully under CT scan guidance and underwent splenectomy. The other patients were operated primarily. One patient developed a subphrenic abscess postoperatively. One patient died from intractable cardiac failure due to subacute endocarditis. The authors stress the role of CT scan in the diagnosis of splenic abscess and recommend early splenectomy in cases of failure of percutaneous drainage.

Abscess↗
PubMed1988

[Digestive surgery in France. A national epidemiologic survey (1978-1982)].

An epidemiological survey, carried out from 1978 to 1982 in 460 public and private institutions randomly selected from all parts of France, provided an assessment of the activity performed in digestive surgery. The sample included 37,967 patients, yielding an annual estimation of 700,000 patients operated on in the entire country. Digestive surgery was the first surgical domain (20 p. 100 of the entire surgical activity); 51.5 p. 100 of the patients were males and 53 p. 100 were under 35 yr of age. The annual incidence of these operations was 1.3 per 100 population. The first reason for operation was appendicitis (43 p. 100), followed by hernia (17.2 p. 100), gallbladder and biliary tract (10 p. 100), and anal diseases (7.7 p. 100). Digestive cancers led to 32,000 operations each year, with a majority of colonic cancers (40 p. 100). Except for appendectomy and operations on the gallbladder and biliary tract, most procedures were more frequent in males, especially operations on the stomach and esophagus. Incidences of appendectomy, cholecystectomy, inguinal hernia repair and operations for digestive cancers were assessed by sex and age. Incidence of appendectomy was 3 to 4 times greater than in other countries. Intraoperative and immediate postoperative (less than 24 h) mortality was higher for digestive operations (4.7 p. 1000) than for surgery as a whole (2 p. 1000). It increased with age and was higher in males.

Adolescent↗
PubMed1986

Computerized tomography in the evaluation of the late complications of acute pancreatitis.

The role of computerized tomography in the diagnosis and treatment of late complications of acute pancreatitis was evaluated in 25 patients with acute pancreatitis. The clinical severity of the pancreatitis was assessed by Ranson's criteria. In each patient. the scan showed abnormalities of the pancreatic and at least one intraabdominal extrapancreatic extension of the disease. The scan precisely locates the intraabdominal extensions secondary to acute pancreatitis, and thus can guide surgical drainage, but it is less accurate in differentiating solid infiltration of fat planes from necrotic collections. However, in most of our patients, the association of general signs of sepsis with a collection shown on computerized tomographic scan indicated necrosis requiring surgical drainage.

Acute Disease↗