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Biomedical subjects

A Akovbiantz

Publications and source records attributed to A Akovbiantz.

At least 55 records · Page 3Linked to original sources
PubMed1982

[The continent ileostomy--indication and results].

Proctocolectomy with conventional ileostomy cures patients with severe ulcerative colitis, however ileostomy appliances had to be worn for the rest of their lives. The continent ileostomy as devised by Kock provides the patient with an intraabdominal ileal reservoir and a valve constructed by invaginating the efferent ileal segment into the reservoir. The patient empties his reservoir 2 to 3 times a day by inserting a catheter through the valve. Our experience with 45 patients is reported. In most cases the continent ileostomy was constructed as a second procedure after proctocolectomy. The construction of a continent ileostomy as a secondary procedure can be recommended in patients with proctocolectomy. It offers patients a life situation differing only insignificantly from that of normal persons.

Adolescent↗
PubMed1981

[Continent ileostomy - improvement of life quality].

Fifteen patients who had undergone proctocolectomy and conversion of conventional ileostomy into continent ileostomy as devised by KOCK were investigated an average of 4 1/2 years after continent ileostomy. The aspects investigated were skin problems, frequency of ileal pouch emptying, continence, and quality of life. It is concluded that successful conversion to continent ileostomy has eliminated most of the drawbacks of conventional ileostomy. The technically complex method of continent ileostomy should be employed only by surgeons experienced in this type of surgery and at centers where more experience with the method can be accumulated.

Adult↗
PubMed1981

Diagnostic value of the fecal chymotrypsin test in pancreatic insufficiency, particularly chronic pancreatitis: correlation with the pancreozymin-secretin test, fecal fat excretion and final clinical diagnosis.

The diagnostic value of the fecal chymotrypsin test (FCT) was reevaluated with regard to (a) proved pancreatic hypofunction of different severity (183 pancreozymin-secretin tests); (b) the final clinical diagnosis, and (c) fecal fat excretion (208 patients with chronic pancreatitis; CP). Progressive pancreatic disease (cancer, CP) was mainly associated with moderate or severe pancreatic hypofunction (119/138; 86.2%) and a low incidence of false-normal FCT values (14/138; 10.1%). Miscellaneous disorders (mainly reversible pancreatic hypofunction) were mainly associated with slight pancreatic hypofunction and a high incidence of false-normal FCT values (17/45; 37.8%). Pancreatic steatorrhea (greater than 10 g/day) was found only in patients with markedly depressed FCT values. Progressive deterioration of pancreatic function was demonstrated by repeated FCT in CP (n = 220).

Celiac Disease↗
PubMed1980

High incidence of extrapancreatic carcinoma in chronic pancreatitis.

In the prospective clinical long-term study of 246 patients with chronic pancreatitis, 26 patients (24 men) developed 27 histologically proved malignant tumors (11%). Four additional patients with neoplasia were excluded (papilloma, two; Bowen's disease of the tonsils, one; and seminoma, one, occurring 8 years before onset of pancreatitis). In six patients pancreatic cancer was diagnosed (2.4%), which indicates a slightly increased risk over the general population. Interestingly, 21 patients developed extrapancreatic cancer (8.5%), including a very high incidence that has not been noted previously. The cancers were located in the oral cavity (in six), larynx (three), bronchus (eight), and gastrointestinal tract (four). The data suggest a causal relationship between chronic pancreatitis and cancer. As possible factors, smoking, alcohol abuse, diabetes, malnutrition, immune deficiency, and high dietary fat intake are discussed. There is, however, no definite evidence for any single known factor.

Adult↗
PubMed1980

[Management of liver cell adenoma and focal nodular hyperplasia].

Since 1975 six cases with hepatic adenoma (5 females, 1 male) and five cases with focal nodular hyperplasia (3 females, 2 males) have been treated at our hospital. Four of the five women with hepatic adenoma took oral contraceptive pills before the diagnosis was made, only one patient took the pills in the group with focal nodular hyperplasia. Hepatic adenomas were resected electively in three patients; one patient underwent operation because of ruptureed adenoma with intraabdominal hemorrhage. In the other two cases with hepatic adenoma resections were not possible, but both tumors have regressed after the cessation of oral contraceptives. One patient in the group with focal nodular hyperplasia underwent liver resection because of intratumoral hemorrhage with recurrent pain; in the other four cases no treatment was done as symptoms were absent. We recommend elective resection for hepatic adenoma because of the high risk of spontaneous ruptur. Embolization or ligation of the hepatic artery are alternative procedures when resection is not possible and tumors do not regress after the cessation of oral contraceptives. On the other hand a more conservative attitude is suggested for focal nodular hyperplasia because those patients do not frequently bleed; resection is indicated in case of symptoms or growth of tumor.

Adult↗
PubMed1980

[Clinical use of lyophilized dura in diaphragmatic defects].

A short survey about pathology and clinic of diaphragmatic defects and injuries is given. The different operative possibilities of plastic diaphragmatic defect surgery are discussed. Direct, autoplastic, alloplastic and homoioplastic closure of diaphragmatic defects are used today. We report about two patients. In both cases we used lyophilized human dura for closing the diaphragmatic defect with success.

Aged↗
PubMed1979

[Use of antibiotics in a surgical clinic. A prospective study of the Waid Community Hospital, Zurich].

A study was performed to analyse antibiotic usage in a surgical department, with the object of providing a basis for improving antibiotic policies. Patients admitted to the Department of Surgery (134 beds) of the Waid Community Hospital in Zürich (400 beds) after 1st Jan. 1979, and who received antibiotics during the period between 22 Jan. and 31 March were included in the study (n = 154). Daily chartreview provided all necessary information on clinical, diagnostic and therapeutic data of the patients included. 154 patients had 178 treatment courses which were reviewed according to guidelines proposed by the "audits of Antimicrobial Usage" (1977) and categorized as follows: I. agree with indication, appropriate choice and use of antibiotics; II. same, inappropriate choice and/or use of antibiotics; III. administration not justified. 83 of 178 treatment courses were prophylactic and 95 therapeutic. 58% of the prophylactic treatment courses were not justified (cat. III), and the remaining 42% were inappropriate in choice and/or use of antibiotics (cat. II). 41% of therapeutic treatment courses were adequate (cat. I), 43% were indicated, but these patients would have benefited from a more appropriate choice and/or use of antibiotics (cat. II), and in 16% the use of an antibiotic was not justified (cat. III). These results are compared with similar studies. On the basis of our findings, appropriate propositions for improvement of antibiotic policies are discussed.

Anti-Bacterial Agents↗
PubMed1979

[Congenital cystic dilatation of the intrahepatic bile ducts. Caroli's disease and its complications].

Two cases with congenital dilatations of the intrahepatic bile ducts are reported. The clinical, diagnostic and therapeutic aspects and possible complications of this rare disease are discussed. The well-known frequent occurrence of cholangiocarcinoma in Caroli's disease is illustrated by one of our patients. Because of the limited therapeutic possibilities, the prognosis of this illness remains unfavourable.

Adult↗
PubMed1979

[Chemotherapy of human echinococcosis with mebendazole (Vermox): preliminary clinical results].

Two patients with inoperable multiple Echinococcus granulosus infections involving the lungs and the liver (one patient) were treated with the following daily doses of mebendazole (Vermox): 3 days 1000 mg, 3 days 1500 mg, the following 3 months 30-40 mg/kg body weight. One of the patients had been treated before with mebendazole in similar doses for 3 periods of 5-6 weeks each. The patients received the drug as 500 mg tablets divided into 3 daily doses after meals. After termination of treatment a distinct regression of lung cysts was demonstrable in both patients, with the exception of one cyst. The liver cyst in one of the patients had also decreased in size. About 8 months after therapy signs of reactivation of lung cysts were observed in one patient, and a new course of mebendazole treatment was therefore started.

Adult↗
PubMed1979

Pain relief by surgery in chronic pancreatitis? Relationship between pain relief, pancreatic dysfunction, and alcohol withdrawal.

Since 1963, 57 consecutive patients with chronic pancreatitis, 44 of them alcoholics who had been operated upon for recurrent severe pain, have been controlled regularly for an average of 6 years. Thirty-two of them had a cyst drainage procedure (group A), and 25 had a ductal drainage procedure and/or distal pancreatectomy (group B). Ten patients died within 2 years (group A, n = 5). Lasting pain relief by surgery occurred in 19 patients only. Of 28 patients with pain relapses after surgery (group A, n = 15), however, 22 (78.6%) obtained late pain relief 1-8 years after surgery in association with marked increase of pancreatic dysfunction (group A, n = 12). Pain relief was associated with pancreatic calcifications in 71-86% of the alcoholics. Cyst drainage procedures were successful in preventing pain relapses mainly in patients with either advanced pancreatic dysfunction or in non-alcoholic pancreatitis. The data suggest that in chronic pancreatitis lasting pain relief is more often due to marked pancreatic dysfunction than to surgery. Alcohol abstinence after surgery was probably an additional factor for lasting pain relief in some patients.

Adolescent↗
PubMed1979

A double-blind trial of synthetic salmon calcitonin in the treatment of acute pancreatitis.

A multicenter randomized double-blind trial on the use of synthetic salmon calcitonin (SCT) was carried out in 94 patients with acute pancreatitis. In addition to strict standard treatment--without aprotinin, atropine, or antacids--50 patients received daily 3 x 20 micrograms = 300 MRCU SCT intravenously and 44 patients received placebo for 6 days. Mortality rate was not influenced, overall mortality being 5.3%. The number of patients without pain and with normalized serum amylase on a given day was significantly higher in the group treated with SCT. Other parameters such as doses of analgesics, leukocyte count, and normalization of seven defined clinical and laboratory criteria within 6 days showed a positive trend without reaching significance.

Acute Disease↗
PubMed1979

[Turning-point of the bowel preparation?].

The whole-gut irrigation more and more carries through to be a favourite method for preoperative large bowel preparation. In 1975 it was used only by 3 hospitals in Switzerland, which resulted from our investigations about large bowel preparation. This new procedure brings advantages such as complete cleaning of the gastrointestinal tract, shortening of the preoperative hospitalisation time, retarded beginning of postoperative bowel function, no catabolic situation of patients' metabolism at operation-day, good compatibility and simple handling, according to our experience with 75 cases. There are not any disorders of the fluid and electrolyte balance except a small intake of water without clinical importance. The indication for whole-gut irrigation is given in all patients, who are subjected to an operation on the colon and rectum except the emergencies. Ileus, toxic megacolon and perforation of the large bowel are considered absolute contraindications. Severe large bowel stenosis, cardiac and renal insufficiency are relative contraindications only.

Humans↗