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Biomedical subjects

W P Schecter

Publications and source records attributed to W P Schecter.

10 recordsLinked to original sources
PubMed1992

Appendicitis in acquired immunodeficiency syndrome.

Reports in the surgical literature are few regarding common intra-abdominal disease processes, such as gallstone disease or appendicitis, in patients with AIDS and instead have focused on AIDS-related intra-abdominal diseases that infrequently require surgical intervention unless complicated by bleeding, obstruction, or perforation. A literature review for appendicitis in AIDS patients revealed only 30 well-documented cases drawn from 13 studies, with a 40% perforation rate and frequent delays and errors in diagnosis. A 7-year experience with 28 patients with appendicitis and AIDS from 4 urban San Francisco hospitals is reviewed. There were no perioperative deaths and an 18% postoperative complication rate. Five patients (18%) were found to have normal appendices with other intra-abdominal pathology, and an AIDS-related etiology for appendicitis was discovered in 7 of 23 patients with appendicitis (30%). With the exception of diffuse versus localized abdominal pain, no preoperative symptom or sign was useful in differentiating AIDS-related and non-AIDS-related disease. Aggressive use of ultrasound and abdominal computed tomographic scanning, along with early surgical intervention, is recommended.

AIDS-Related Opportunistic Infections↗
PubMed1992

Surgical care of HIV-infected patients.

An increasing number of HIV-infected patients will require surgical therapy. The methods of diagnosis and therapeutic planning for HIV-infected patients are the same as for all other patients. Surgery should be advised if an operation is likely to have a positive effect on the patient's life. Most patients with AIDS with diseases for which surgical therapy is advantageous benefit from carefully chosen operations designed to solve specific problems.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Wound healing after anorectal surgery in human immunodeficiency virus-infected patients.

Medical records of 52 human immunodeficiency virus (HIV)-infected patients who underwent a total of 80 anorectal operations from January 1985 to January 1990 were retrospectively reviewed to determined whether anorectal surgical wounds healed in HIV-infected patients and the mean survival time of these patients after surgery. Twenty-four operations were performed in asymptomatic HIV-infected patients, 19 in HIV-infected patients with persistent lymphadenopathy, and 37 in patients with acquired immunodeficiency syndrome. Wounds healed in 49 patients (94%). The mortality rate 30 days after surgery was 2%. There were no major complications. The mean survival time of HIV-infected patients after surgery was 15 months. We conclude that anorectal surgical wounds heal in most HIV-infected patients and that the survival time after surgery of HIV-infected patients with anorectal disease justifies appropriate surgical treatment.

Abscess↗
PubMed1990

Risk of exposure of surgical personnel to patients' blood during surgery at San Francisco General Hospital.

We undertook an observational study of 1307 consecutive surgical procedures at San Francisco General Hospital to record descriptions of intraoperative exposures to blood and other body fluids, determine the factors predictive of these exposures, and identify interventions that might reduce their frequency. During a two-month period, circulating nurses took note of parenteral and cutaneous exposures to blood and recorded information about all procedures. In a follow-up validation study, 50 additional procedures were observed by the study investigators to determine the accuracy of the data collected by the nurses. A total of 960 gloves used by surgical personnel during the validation study were examined to determine the perforation rate. Accidental exposure to blood (parenteral or cutaneous) occurred during 84 procedures (6.4 percent; 95 percent confidence interval, 5.1 to 7.8 percent). Parenteral exposure occurred in 1.7 percent. The risk of exposure was highest when the procedures lasted more than three hours, when blood loss exceeded 300 ml, and when major vascular and intraabdominal gynecologic surgery was involved. Neither knowledge of diagnosed human immunodeficiency virus (HIV) infection nor awareness of a patient's high-risk status for such infection influenced the rate of exposure. Double gloving prevented perforations of the inner glove and cutaneous exposures of the hand. We conclude that all surgical personnel are at risk for intraoperative exposure to blood. Our data support the practice of double gloving and the increased use of water-proof garments and face shields to prevent mucocutaneous exposures to blood. No evidence was found to suggest that preoperative testing for HIV infection would reduce the frequency of accidental exposures to blood.

Accidents, Occupational↗
PubMed1990

Withholding and withdrawal of life support from the critically ill.

We investigated decisions to withhold or withdraw life support from patients in the medical-surgical intensive care units at the Moffitt-Long Hospital of the University of California and San Francisco General Hospital, from July 1987 through June 1988. Among 1719 patients admitted to the two intensive care units, life support was withheld from 22 (1 percent) and withdrawn from 93 (5 percent). The reason for limiting care was poor prognosis. Of these 115 patients (18 of whom were considered brain-dead), 89 died in the intensive care unit (accounting for 45 percent of all deaths there), and all but 1 of the remaining patients died after transfer from the intensive care unit. Thirteen (11 percent) had earlier expressed the wish that their terminal care be limited, but this affected care in only four cases. Only 5 of the 115 patients made the actual decision to limit care; the others were incompetent at the time. Of the latter, 102 had families who participated in the decision; family members of the other 8 incompetent patients could not be found, and the decisions were made by physicians. Only 10 families initially disagreed with the recommendations to limit care, and they later agreed. The median duration of intensive care among the patients from whom life support was withheld or withdrawn was eight days at Moffitt-Long Hospital and four days at San Francisco General, as compared with medians of three and one days, respectively, for other patients who died in the intensive care units. We conclude that although life-sustaining care is withheld or withdrawn relatively infrequently from patients in the intensive care unit, such decisions precipitate about half of all deaths in the intensive care units of the hospitals we studied. In most of these cases the patients are incompetent, but physicians and families usually agree to limit care.

Adult↗
PubMed1990

Giant malignant tumors of the anus. A strategy for management.

Four homosexual male patients with giant anal carcinomas, ranging from 10 to 17 cm in diameter, are presented. These patients were not candidates for abdominoperineal resection because of fixation to adjacent structures. Common symptoms included pain, sepsis, anemia, incontinence, and weight loss. Diverting colostomy was performed in all patients. Two of the four patients were treated by wide local excision of the tumors for palliation. Two patients were treated with chemotherapy and radiation therapy. Three of the four patients died within 12 months. The authors conclude that diverting colostomy and wide local excision of giant anal cancers offer effective palliation of local wound problems in selected cases.

Adult↗
PubMed1990

Kaposi's sarcoma of the rectum in patients with the acquired immunodeficiency syndrome.

We retrospectively reviewed eight patients with biopsy-proven anorectal Kaposi's sarcoma (KS) treated between 1984 and 1989 at San Francisco General Hospital. All patients were homosexual men with the acquired immunodeficiency syndrome (AIDS). The average age was 34 years. Three patients had primary rectal KS without metastases. Five patients had disseminated KS with lesions throughout the alimentary tract, viscera, skin, or local lymph nodes. Three patients were treated with radiation or chemotherapy. Five patients had disseminated KS with lesions throughout the alimentary tract, viscera, skin, or local lymph nodes. Three patients were treated with radiation or chemotherapy. Five patients with advanced AIDS received no specific treatment for anorectal KS. Follow-up ranged from 1 month to 5 years. Three of the untreated patients and the three patients treated with chemotherapy or radiotherapy were alive 1 month to 5 years after diagnosis. Aggressive surgical treatment of anorectal KS is not indicated.

Acquired Immunodeficiency Syndrome↗
PubMed1977

Transmetatarsal amputation.

We have reviewed the records of 25 patients who underwent a transmetatarsal amputation at San Francisco General Hospital. The average patient age was 63 years old. Twelve of the patients were diabetic, while transmetatarsal amputations were performed in eleven with simple arteriosclerosis. Two patients underwent amputations for either trauma or nonhealing ulcer. Thirteen of the patients healed their amputation, and twelve of these became ambulatory. Eleven required higher amputation, because of nonhealing due to infection in seven and progressive ischemia in four. One patient died on the first postoperative day of pneumonia. The failure group was younger, contained more diabetics, and had a higher incidence of infection. The operative procedure of transmetatarsal amputation is described. We believe that patients with distal gangrene without spreading infection should be considered for transmetatarsal amputation, reserving initial below-knee amputation for those with greater involvement of the foot.

Adult↗