[Axillary lymph node dissection in breast cancer--is it always necessary?].
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Biomedical subjects
Publications and source records attributed to O Lernau.
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OBJECTIVE: To find out if preoperative prophylaxis would reduce infection rates after umbilical and incisional hernia repair. DESIGN: Randomised controlled trial. SETTING: Teaching hospital, Israel. SUBJECTS: 35 Patients who presented with umbilical (n = 19) or incisional (n = 16) hernias during a period of 8 months. INTERVENTIONS: Cefonicid 1 g was given by intravenous infusion to alternate patients 30 minutes before the operation. MAIN OUTCOME MEASURES: Wound infection. RESULTS: The groups were comparable for age, body mass index, grade of surgeon, operating time, and size of hernial ring. The wound infection rates were 0/8 compared with 4/8 for incisional hernia repairs (p = 0.08) and 1/9 compared with 4/10 for umbilical hernia repairs (p = 0.3). The overall rate was 1/17 compared with 8/18 (p = 0.02). CONCLUSIONS: Single dose antibiotic puphylaxis seems to exert a beneficial effect on the wound infection rate after umbilical and incisional hernia repair.
Perforation of the esophagus is life-threatening and requires prompt diagnosis. Immediate surgery with primary suture of the perforation is the treatment of choice. Any delay in diagnosis or treatment results in a sharp increase in mortality due to the combination of rapid development of necrotizing mediastinitis and inability to close the perforation surgically. To avoid leaks from the anastomosis the suture line can be buttressed with adjacent structures. The fundus of the stomach, parietal pleura and muscular flaps have been used to cover the perforation. We describe 2 patients with perforation of the lower esophagus. Both were operated on within 8 hours, the perforation was closed primarily and a diaphragmatic flap was formed to cover the suture line. There were no postoperative leaks and recovery was uneventful.
During 1980 to 1986, 89 children with Down syndrome and 42 with imperforate anus were diagnosed among 64,870 liveborn infants in the Jewish population of Jerusalem. Two of the children had both Down syndrome and imperforate anus. This indicates a high incidence of imperforate anus among children with Down syndrome (2.2%).
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Quadriplegia as a presenting syndrome in a case of primary hyperparathyroidism is reported. The clinical picture was misdiagnosed as a space-occupying lesion in the cervical spinal canal, for which an unnecessary laminectomy was performed. The neurologic deficits disappeared following the removal of a parathyroid adenoma. The neurologic presentations of hyperparathyroidism are reviewed and discussed.
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A girl with a rare congenital malformation consisting of duplication of the urinary and genital tracts as well as of the entire colon, terminating in double rectogenital fistulas, is presented. Because of a small-capacity urinary bladder on one side and an atonic neurogenic bladder on the other side, urinary diversion was necessary. A preliminary diverting colostomy of the duplicated transverse colon was followed by anoplasty of one anus. Later on, the duplicated proximal colostomy was anastomosed to the one distal colon leading to the rectum with anoplasty. The treatment of this complex anomaly is described.
The rectoanal reflex in the rat consists of relaxation followed by contraction of the internal anal sphincter (IAS). Beta-adrenergic drugs produce prolonged relaxation of the IAS, where alpha-agonists cause brief relaxation followed by contraction. Muscarinic cholinergic drugs contract the IAS. ATP and related purines produce relaxation which is blocked by theophylline. The reflex persists during adregeneric, cholinergic, and purinergic block. The potassium-blocker apamin prevents the relaxation induced by rectal distension. This suggests that the reflex is not mediated by adrenergic, cholinergic, or purinergic transmitters. Blocking potassium conductance was apparently the only way to eliminate this reflex.
A 13-year-old boy with Sandifer's syndrome whose only symptoms were abnormal posture and movements of the head and neck, underwent a repair of a hiatus hernia. The disappearance of all symptoms following the operation could be explained by the common innervation of the diaphragm and the neck.
A patient with nonfunctional paraganglioma situated adjacent to the pancreas is presented. The clinical picture, the laboratory studies, as well as the gross appearance of the tumor and a frozen section at operation were not diagnostic. Internal drainage of the cystic tumor, assumed to be a pseudocyst of the pancreas, was done. Excision was performed when the diagnosis was histologically and ultrastructurally established. The microscopic and the electron microscopic features of this rare neoplasm are discussed. Excision of the tumor is recommended as the treatment of choice because of the malignant potential that does not correlate well with the histological appearance.
Seventy-five percutaneous splenoportographies and splenic pulp pressure measurements were performed in 70 patients. This procedure was done routinely during the preoperative investigation of patients with bleeding esophageal varices. Splenoportagraphy was also performed for evaluation of patients with portal hypertension of an obscure etiology, and for follow-up study after portosystemic shunt procedures, where the spleen had been preserved. There were no complications related to the procedure. Splenoportography is a simple and safe diagnostic tool. The information obtained is important for planning an operation to relieve portal hypertension. It may also help in the postoperative evaluation of the patency of certain types of shunt procedures.
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From 1966 through 1980, 39 children were treated with anorectal myectomy for the mild form of Hirschsprung's disease. The mild form of Hirschsprung's disease is differentiated from the severe one mainly on clinical grounds. Of the entire group, only four patients needed a Duhamel procedure, one to three years after myectomy. One patient still uses occasional enema (11 years after operation). The remaining 34 patients are symptom-free (1--14 years after operation). Anorectal myectomy is the treatment of choice in the management of the mild form of Hirschsprung's disease.