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Biomedical subjects

Z Kaufman

Publications and source records attributed to Z Kaufman.

At least 19 recordsLinked to original sources
PubMed1992

Breast masses in adolescent females.

In a retrospective study of 38 adolescent females operated on for mammary masses, 42 fibroadenomata (FA), 2 fibrous scars around abscesses, and one papilloma were found. All were postmenarchal. Clinical and pathological features were reviewed and the patients reexamined or interviewed. FA were mostly asymptomatic and removed a few weeks after incidental discovery. They were often seen in Jewish girls of parents born in North Africa and the Middle East, and were more frequently located in the outer superior quadrant of the left breast. New FA appeared in almost half of the cases later on in the same breast, as well as in the other breast, or bilaterally. Necrosis occurred in three FA and was unrelated to the size of the tumor. There was no correlation between the size of FA, multiplicity, or necrosis, nor between increased stromal or epithelial atypia, cellularity, or mitotic activity. One explanation for the high rate of multiplicity might be related to this neoplasm occurring in an actively developing organ under hormonal control. There was no increased breast carcinoma apparent in the family history. Therefore, except in cases of fast-growing tumors, a conservative approach is recommended because of the frequency of multiple FA as well as aesthetical postoperative complications.

Adenofibroma↗
PubMed1991

Fibrous mastopathy in insulin dependent diabetics.

The cases of two poorly controlled insulin dependent diabetic women, presenting with hard discrete breast lumps clinically suspicious of carcinoma are presented. Mammography revealed dense dysplastic parenchymal changes with no specific features of carcinoma and ultrasound showed acoustic shadowing but no discrete mass. Excision biopsy of these lumps was performed. Histologically they were benign, and were composed of fibrous tissue with a chronic inflammatory cell infiltrate. With better awareness of fibrous mastopathy which can occur in this group of diabetic patients, and with the absence of specific radiological features of malignancy, some of these women may be observed and spared excision biopsy.

Adult↗
PubMed1991

The mammographic parenchymal patterns of nulliparous women and women with a family history of breast cancer.

One-hundred-and-thirteen mammograms of nulliparous women and 44 mammograms of women with a family history of breast cancer were graded according to Wolfe's parenchymal pattern classification. These were compared to 437 mammograms of women without these risk factors. Mammograms were read by two independent observers in order to evaluate inter- and intra-observer variation. The interobserver variation was reduced from 17% to 5% by combining high risk patterns (P2 and DY) and low risk patterns (N1 and P1). A significantly higher proportion of high risk patterns was found in nulliparous women compared to parous women (P less than 0.01). The proportion of high risk patterns decreased significantly with the number of children (P less than 0.01). Women with a family history of breast cancer had almost the same parenchymal patterns as women without a family history. In conclusion, while nulliparity and family history are recognized risk factors for developing breast cancer, only nulliparity would appear to influence the mammographic parenchymal pattern. This probably reflects the different mechanism by which the two factors affect breast tissue.

Breast Neoplasms↗
PubMed1991

The mammographic parenchymal patterns of women on hormonal replacement therapy.

In this study 383 mammograms of women on hormone replacement therapy (HRT) for more than one year and 216 mammograms of women performed before HRT was started were examined to identify any mammographic features which are associated with a higher incidence of developing breast cancer according to Wolfe's criteria. There was no significant difference in the proportion of high and low risk parenchymal patterns as the duration of HRT increased. A significantly higher proportion of low risk patterns with ageing was observed in 216 women who had never been on HRT when compared to 194 mammograms of women who had been on HRT for more than 5 years. This difference becomes more obvious in women on HRT with less than three children compared to a similar group not taking HRT. Women who had not taken HRT appeared to undergo normal involutional changes which were reflected by an increase in the proportion of low risk patterns with increasing age. We may conclude from these findings that HRT appears to inhibit involutional processes within the breast and therefore this group have higher risk parenchymal patterns for a longer period of time and subsequently may have a higher risk of developing breast cancer.

Age Factors↗
PubMed1990

[Metastatic malignant melanoma of the small bowel as a surgical emergency].

2 cases of metastasis of malignant melanoma to the small bowel presenting as surgical emergencies due to obstruction, are reported. In both cases there was no other evidence of metastatic spread at the time of surgery. Segmental resection of involved bowel was performed, providing satisfactory palliation. This reinforces the opinion that surgical resection of symptomatic metastases of malignant melanoma to the small bowel is justified, despite the poor prognosis of the disease itself.

Female↗
PubMed1990

Definitive management of acute pilonidal abscess by loop diathermy excision.

A simple technique of definitive management of acute pilonidal abscess is described. The procedure consists of incision with drainage of pus followed by controlled excision of diseased tissue and lateral sinuses, using a loop diathermy. It allows one-stage definitive management of both acute pilonidal abscess and chronic pilonidal sinuses.

Acute Disease↗
PubMed1990

Cecal diverticulitis presented as a cecal tumor.

Seven patients diagnosed as having acute appendicitis were operated on and a cecal wall mass due to cecal diverticulitis was found. In two patients the mass could not be separated from the cecal wall and right colectomy was performed. In five patients, in whom the mass could be separated from the cecum, conservative operations (three diverticulectomies and two wedge resections) were performed, thus avoiding needless, more extensive surgery.

Acute Disease↗
PubMed1990

Pyogenic liver abscess.

A retrospective study of 18 adults admitted to Meir General Hospital with pyogenic liver abscess during the years 1982-88 was conducted. Our most useful diagnostic tool was ultrasound, which was accurate in all 15 patients in whom it was performed. Only two patients presented with multiple abscesses. Increased alkaline phosphatase was the most predictive laboratory finding, seen in all but one patient. One person was treated conservatively by antibiotics only. In one patient the abscess drained spontaneously into the right thoracic cavity. Initial surgical drainage was done in nine patients and percutaneous catheter drainage in seven. Only one patient died, of septic shock, yielding a mortality rate of 5.5%. The treatment-related complication rate, observed in almost half of the patients, was high. All patients with such complications required repeated drainage, which was achieved surgically in all cases.

Adolescent↗
PubMed1989

Completely obstructive colorectal cancer.

Forty-five patients with obstructing carcinoma of the colon and rectum were compared with 176 patients with nonobstructing tumor diagnosed over a 10-year period. The age and sex distribution did not differ between the two groups. The site of greatest risk for obstruction was the splenic flexure and descending colon (50%); median survival in these patients was one-half that for other sites. In the obstructed group no patient had Dukes' stage A vs. 9.6% in the nonobstructed patients, and 22% of the obstructed patients had Dukes' D vs. 14% of the nonobstructed patients. The 5-year survival in Dukes' A was 82%, while no survivors were found for Dukes' D. The crude 5-year survival rate was 22.4% in the obstructed patients and 49.1% in the nonobstructed patients; in-hospital mortality was 22.4% and 6.8%, respectively, and the adjusted actuarial survival was 39% vs. 64%, respectively. Curative resection was performed in 68% of the obstructed and 83% of the nonobstructed patients. The adjusted actuarial 5-year survival rates for these patients were 53% and 76%, respectively. The criteria for the tumor grade tested in this study, which included differentiation of the tumor cells, size, and the presence of perforation, did not influence the survival. Twenty-one patients underwent primary resection, 15 had stage resection, and 9 had diversion procedures. The in-hospital mortality rates were 35% for primary resection and diversion procedures and 7% for stage resection. The crude 5-year survival was 32% for primary resection, 42% for stage resection (not statistically significant), and 0 for diversion procedures. The poor prognosis for the obstructed patients in our study was mainly related to 1) high in-hospital mortality, 2) the lower rate of curative resection, 3) unequal distribution of the tumor site, and 4) to a small extent, the difference in Dukes' stage.

Actuarial Analysis↗
PubMed1988

Anorectal region malignant melanoma.

A retrospective study of eight patients who had suffered from malignant melanoma in the anorectal region was carried out. The initial presentation, histological findings, treatment, and survival are described. Mean survival was 18 months; however, one patient survived 147 months after initial diagnosis. An inverse correlation was noted between depth of tumor penetration and the number of giant multinucleated cells. No correlation was found between survival and histological findings or therapy regimen.

Adult↗
PubMed1986

Frozen-section diagnosis in surgical pathology. A prospective analysis of 526 frozen sections.

Five hundred eighty-six consecutive frozen-section consultations performed during a 1-year period were studied prospectively in order to assess the accuracy of the method and develop a quality control mechanism. The overall accuracy was 97.1%. The accuracy of the method with breast lesions was 97.9%. Specimens from the gastrointestinal tract and thyroid were incorrectly interpreted in 5% of the cases. The accuracy for lymph node specimens was 96.2%, with more than 50% consulted out of curiosity. The authors conclude that frozen section of lymph node is not recommended. Most of the errors were sampling errors made by the pathologist. The authors therefore conclude that in clinically suspected malignancy, more than one sample must be examined in order to decrease the false-negative diagnosis in frozen section.

Breast Neoplasms↗
PubMed1986

Single dose prophylaxis in elective cholecystectomy. A prospective, double-blind randomized study.

We tested the effectiveness of a single dose of prophylactic antibiotic (gentamicin) in elective cholecystectomy in a double-blind, controlled randomized study. All patients recognized preoperatively as being at risk were excluded. The treatment group comprised of 102 patients received a single dose of gentamicin and the 74 patients in the control group received a placebo. Of the patients who received gentamicin, wound infection developed in 4.9 percent versus 13.5 percent in the control group. Among 45 patients who had positive bile cultures, the wound infection rate for those in the treatment group was 14 percent versus 44 percent for those in the control group. Of 17 patients who underwent unexpected exploration of the choledochus, none of those in the treatment group had development of wound infection. The rate of wound infection in the control group was 50 percent. As 30 percent of the patients undergoing elective cholecystectomy were found to have risk factors for the development of wound infection which could not be identified preoperatively, we recommend single dose prophylaxis for all patients undergoing cholecystectomy.

Adult↗