Biomedical subjects

O Olsha

Publications and source records attributed to O Olsha.

11 recordsLinked to original sources

PubMed2005

Anal melanoma in the era of sentinel lymph node mapping: a diagnostic and therapeutic challenge.

Melanoma of the anal canal is a rare malignancy that often has an atypical presentation. Locoregional metastases, which are often present at the initial presentation, may occur in both groin and pelvic lymph nodes, but the utility of lymph node dissection remains unknown. We explored the possibility of applying the technique of sentinel lymph node (SLN) mapping to anal melanoma. SLN mapping was performed in 2 patients with anal melanoma. Radioactive tracer and blue dye were injected around the lesions. The SLN was identified pre-operatively by lymphoscintigraphy, and at surgery with a hand-held gamma detector and by visualization of the dye. The SLN was identified in both patients, only in the groin in one and only in the presacral region in the other. One patient had a wide local excision of the anal lesion with house flap anoplasty, while the other had abdominoperineal resection with total mesorectal excision. There were no SLN metastases in either patient. The technique of SLN mapping and biopsy is easily adapted to surgery for malignant melanoma of the anus. SLN mapping and biopsy could aid in planning surgical strategy, but definitive conclusions may only be reached after more experience has been acquired.

Anus Neoplasms↗

PubMed2003

Primary forearm arteriovenous fistula for hemodialysis access--an integrated approach to improve outcomes.

PURPOSE: Maximizing the ratio of primary arteriovenous fistula (PAVF) over bridge graft fistula (BGF) for hemodialysis access is a primary recommendation of the National Kidney Foundation published as Dialysis Outcomes Quality Initiative (DOQI). Imaging, anesthetic and surgical techniques were taken into account to achieve this and other goals, including extensive use of forearm vessels to lower immediate and early failure rates and prolong the useful life of PAVFs. DESIGN: Prospective non-randomized study. METHODS: High-resolution duplex ultrasonography (DUS) was added to careful clinical assessment in planning and follow-up of the dialysis access. Brachial plexus block, which allowed the use of an arterial tourniquet and gave a postoperative sympathectomy type effect, was used for anesthesia, and together with meticulous surgical technique, prevented spasm. Access puncture, post-operative follow-up and surgical revisions were planned in close cooperation with the nephrology team. FINDINGS: Ninety (57.3%) of the 157 fistulas constructed for new hemodialysis access between August 1998 and March 2000 were PAVFs. Seventy-three (81.1%) of these were confined to the forearm and comprise the study population, with a mean follow-up of 8.4+/-4.4 months. There were no immediate failures in the study group. The early failure rate (1 month) was 6.8% and revisions based on DUS were easily accomplished in all cases. The one year assisted primary patency rate was 81.8% and the secondary patency rate at 18 months was 98.6%. CONCLUSIONS: DUS for planning and follow-up of PAVF along with careful surgical technique under a brachial plexus blockade can achieve a PAVF/BGF ratio well above 50% with a low early failure rate and a high secondary patency rate. Algorithms are presented to achieve these goals.

Adolescent↗

PubMed2001

Dialysis access induced limb ischemia corrected using quantitative duplex ultrasound.

Dialysis access induced limb ischemia (DAILI) is a rare complication after the creation of an arteriovenous fistula in infancy but can cause irreversible ischemic limb damage in severe cases. The incidence of DAILI is higher in bridge graft fistulas than in native fistulas. DAILI patients may be managed by surgically reducing the volume flow in the fistula. However, in the pediatric age group, such a reduction of volume flow may result in thrombosis or an inadequate flow for effective dialysis. Several methods have been described to achieve the delicate balance between essential flow in the fistula and adequate limb perfusion pressure. We have developed a new method employing preoperative duplex ultrasonography to predict quantitatively the reduction in volume flow in the fistula that will allow effective dialysis while providing adequate limb perfusion. The preoperative assessment was reproduced on the operating table using intraoperative duplex. A 3-year-old girl thus treated has had resolution of her ischemic symptoms and maintains long-term patency of her dialysis access.

Catheters, Indwelling↗

PubMed1995

Metastatic pleomorphic adenoma.

We report a case of pleomorphic adenoma of the parotid with metastasis to the liver, following resection for local recurrence, which has only been described once before. The diagnosis was made by fine needle aspiration and the lesion was resected without complications. The patient is free of disease 4 years later. Histological features of malignancy were not present in any specimens from the original resection, the local recurrence and the metastatic lesion. It is difficult to say which patients with pleomorphic adenoma should be observed for the development of treatable metastases, but metastases have been reported to occur mainly after repeated resections for local recurrences.

Adenoma, Pleomorphic↗

PubMed1991

Over-transfusion ascites.

A 12-year-old girl was injured in a traffic accident and suffered fractures of all the long bones of both legs. During the operation she received 10 l of lactated Ringer's solution, 3 l of 0.9% NaCl, and 2 l of 5% glucose, until blood was available, because of difficulty in its cross-matching. Her hemoglobin dropped to 4.9 g%. After the operation a distension of the abdomen was noted. An abdominal tap confirmed ascites. A simultaneous intravenous pyelogram and retrograde cystogram revealed no leakage from the urinary tract. An over-transfusion ascites was diagnosed combined with pulmonary edema. The patient was treated for 2 days in the ICU, until she was transferred to the orthopedic department with no signs of ascites.

Ascites↗

PubMed1990

Spreading sepsis by cystoscopy.

A healthy 54 year old man was investigated for haematuria. In spite of a proven urinary tract infection a cystoscopy was carried out with no antibiotic therapy. As a result he developed systemic infection leading to two independent, and potentially fatal, complications: vertebral osteomyelitis and a mycotic false aneurysm.

Aneurysm, Infected↗

PubMed1987

Congenital absence of the anatomic common bile duct. Case report.

In congenital absence of the anatomic common bile duct, all bile from the liver drains into the gallbladder and thence to the duodenum via the cystic duct. A likely consequence of cholecystectomy then is discontinuity of hepatic drainage, since the gallbladder and cystic duct appear normal, and the anomaly is so rare that it is not considered.

Cholangiography↗

PubMed1986

Crohn's disease isolated to the appendix: truths and fallacies.

Twenty-five cases of Crohn's disease confined to the appendix were reported in eight hospitals in Israel during a 15-year period. Review of the histologic slides confirmed the diagnosis in 22 cases. Re-evaluation of these 22 patients included physical examination and radiologic studies of the small and large bowel. Rectosigmoidoscopy was performed in 16 patients. Signs and symptoms of Crohn's disease at other sites in the gastrointestinal tract did not occur during follow-up periods of two to 15 years (mean, 6.4 years) after appendectomy. This study and a review of the literature indicate that in most cases (93 per cent) Crohn's disease initially limited to the appendix is not a predictor of subsequent involvement of another portion of the bowel. It is concluded that the so-called Crohn's disease isolated to the appendix is a form of chronic granulomatous and follicular appendicitis of unknown etiology that is unrelated nosologically in the majority of the cases to Crohn's disease proper.

Adolescent↗

PubMed1982

Prepyloric diaphragm, an unusual case of gastric outlet syndrome.

The prepyloric diaphragm is a rare entity, with well-established anatomicopathological features but of unknown etiology. Approximately half of the 180 cases described occurred in children. The clinical presentation may be a chronic partial obstruction as in pyloric stenosis, or a complete gastric outlet obstruction when the orifice of the diaphragm is very small or nonexistent. Despite the variable clinical picture, radiological and endoscopic examinations may reveal typical pathognomonic features. With cases being reported more frequently, the treatment had changed from a wholly surgical approach to the introduction of endoscopic web incision and conservative treatment. We report a case diagnosis during surgery, and review the pertinent literature.

Adult↗

PubMedDate not supplied

Kingella kingae endocarditis in a child with hair-cartilage hypoplasia.

Abstract. Kingella kingae is a fastidious Gram-negative rod that since the 1980s has been appreciated as a cause of a variety of human infections, including bone and joint infections, bacteremia, and rarely endocarditis [2, 6, 7, 9]. K. kingae endocarditis is rare, and only a few cases occur in normal, native valves. We report a case of K. kingae endocarditis in a patient with hair-cartilage hypoplasia who had previously undergone bone marrow transplantation. The combination of these rare conditions is discussed.

Adolescent↗

PubMedDate not supplied

Intra-operative central vein angioplasty during arteriovenous access creation.

Central vein stenosis or occlusion due to prior use of central vein hemodialysis catheters may lead to disabling extremity edema or cause early failure after arteriovenous access construction. Our integrated program for arteriovenous access management enables us to identify these stenoses pre-operatively. We carried out intra-operative angiography and angioplasty during arteriovenous access creation in 3 patients with good immediate and long-term results. Intra-operative endovascular therapy is a new application of peripheral vascular surgery techniques for patients with significant central vein stenosis undergoing access surgery, which exploits the high postoperative flow state to maintain patency after angioplasty. It may also be applicable in situations such as proximal arterial stenosis with anticipated steal syndrome and other conditions that may compromise access patency.

Journal Article↗