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Biomedical subjects

O Shapira

Publications and source records attributed to O Shapira.

8 recordsLinked to original sources
PubMed1992

[Rupture of hepatic echinococcal cyst by minimal blunt abdominal trauma].

Hepatic echinococcosis is endemic in Israel, with about 90 new cases diagnosed each year. Although many are asymptomatic for years, 40% develop complications. We describe a man of 37 and women aged 22 and 35, respectively, in whom rupture of an echinococcal cyst followed minimal, blunt abdominal trauma. In each patient the rupture led to complications consisting of massive intra-abdominal bleeding in 1, diffuse peritonitis in another and cystocutaneous fistula with ureteral obstruction due to reactive retroperitoneal fibrosis in the third. All 3 underwent surgery to resolve the immediate complication, with no mortality. A striking feature was the disproportion between the stormy clinical presentation and the relatively innocent nature of the trauma. In only 1 of our cases was the correct preoperative diagnosis made, which in this condition depends primarily on a high index of suspicion.

Abdominal Injuries↗
PubMed1992

Delayed operation for acute pancreatitis.

A retrospective study of 72 patients with acute biliary pancreatitis admitted to our department between 1982 and 1988 was carried out to evaluate our policy of delaying surgery in such cases. Of the 57 patients who underwent surgery, 17 were operated upon within 1 to 14 days of admission ("early operation"), and 40 patients were managed conservatively and readmitted for elective surgery about 6 weeks after resolution of the acute attack. Higher mortality and morbidity rates were observed in the "early operation" group (18% and 18% compared to 0% and 10%, respectively, P < 0.05). However, all deaths occurred in septic patients over the age of 70 who were operated on due to failure of maximal intensive medical therapy. Advanced age and early operation were found to be significant predictors of hospital mortality (P < 0.01). The two groups had similar mean hospital stay; 12 patients (30%) suffered an attack while waiting for elective surgery, however in only 3 (8%) the second attack occurred within 4 weeks of discharge from hospital. We conclude that a "delayed" operation for biliary pancreatitis is an acceptable option, and that recurrent attacks of acute pancreatitis in the time interval before the operation are avoidable if the operation is performed within 6 weeks of the initial acute attack.

Acute Disease↗
PubMed1992

Acute symptomatic hernia.

Acute symptomatic hernia is a clinical entity characterized by the coexistence of acute incarceration of an abdominal wall hernia together with an acute abdominal disease. Thirteen such cases are described. Increased awareness of this entity, both pre- and intraoperatively, is probably the basis for the improved rate of correct diagnosis (60%) and the decreased mortality (7%).

Adolescent↗
PubMed1991

[Management of radiation-induced injuries of the intestine].

Radiation-induced injury of the intestine (RII) is a chronic iatrogenic disorder which often necessitates complex surgical intervention. We describe our experience with the surgical management of 9 patients with RII, 8 of whom suffered injuries of the small bowel and 1 of the rectosigmoid. There were 3 deaths, 2 from postoperative complications of ongoing RII and 1 from recurrence of the original tumor. 3 of the survivors continued to suffer from complications attributed to active RII, while only 3 remained symptom-free during follow-up. Our study emphasizes the fundamental role of good nutritional support during the perioperative period in these patients. It also indicates the desirability of using nonirradiated bowel for the anastomosis, and of a bypass procedure instead of resection and primary anastomosis in cases of radiation-induced frozen pelvis. Creating a barrier between the peritoneal cavity and the lower pelvis by an omental flap or other means, should be considered in patients operated on for pelvic cancer who might need adjuvant radiotherapy. This procedure shields the bowel from the radiation field, thus hopefully reducing the incidence of RII.

Humans↗
PubMed1990

[Nissen fundoplication for reflux esophagitis].

Nissen fundoplication was performed in 20 patients suffering from esophageal reflux. Failure of medical therapy was the indication in 60% of the patients, and complications of reflux (bleeding, stricture, Barrett's esophagus) in the others. There was no operative mortality; wound infection was the most common postoperative complication (4 patients). Follow-up after 1-8 years showed good results in 85%. The results of Nissen fundoplication in the world literature, as well as in this series, prove it to be effective for esophageal reflux. Those not responding to appropriate medical therapy should be referred earlier for surgery, prior to development of the complications of reflux.

Esophagitis, Peptic↗
PubMed1990

[Gastrointestinal bleeding and ascending biliary infection secondary to duodenal diverticulum].

We describe a 77-year-old man with recurrent upper gastrointestinal tract bleeding and ascending biliary infection secondary to a duodenal diverticulum. Although such diverticula are relatively common, the great majority are asymptomatic and are only discovered incidentally. Only 1% manifest clinically, usually secondary to a variety of complications such as bleeding, perforation, ascending biliary infection or pancreatitis. Most often the diagnosis is made by exclusion, which accounts for the usual delay in starting treatment. When present, one must consider the possibility that the duodenal diverticulum may be responsible for the patient's symptoms. The preferred approach to a bleeding diverticulum is complete excision, while bypassing the diverticulum by Roux-en-Y duodenojejunostomy is the operation of choice for pancreaticobiliary complications.

Aged↗
PubMed1989

[Retroperitoneal desmoid tumor and familial polyposis coli].

A 43-year-old woman with familial polyposis coli (FPC) and adenocarcinoma of the rectosigmoid was treated by total colectomy, mucosal proctectomy and construction of an ileal pouch with ileoanal anastomosis. A year after operation she developed a huge retroperitoneal desmoid tumor which on exploratory laparotomy was found to be nonresectable. A 21-month course of indomethacin followed by tamoxifen failed to induce regression of the tumor. Desmoid tumors appear in 3.5-29.0% of patients with FPC, mostly after colectomy. This possibility must be considered in the differential diagnosis of recurrent carcinoma of the colon. The preferred treatment of abdominal and retroperitoneal desmoid tumors is conservative, and includes the use of non-steroidal antiinflammatory drugs, ascorbic acid and tamoxifen.

Adenomatous Polyposis Coli↗