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Biomedical subjects

A Dinbar

Publications and source records attributed to A Dinbar.

At least 37 records · Page 2Linked to original sources
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

[Hospitalization policy following minor head injuries].

Of 44 patients admitted with head injuries during 1980-84, 316 (72%) arrived fully conscious with normal neurological status and no X-ray evidence of skull fracture. These cases were admitted for observation, but in none was there any untoward development. On analysis of the cases that developed complications and in the light of the literature, we conclude that it is possible to define a group at low risk for developing complications following head injury. These patients could safely be discharged from the emergency room without admission for observation. This group included 176 (40%) of those admitted and fulfilled the following criteria. They arrived fully conscious, there was no recurrent vomiting, neurological examination was normal, there was no X-ray evidence of skull fracture, and they were between 16-70 years of age. However, these cases should only be discharged from the emergency room after a physician gives oral and written instructions to a responsible adult who accompanies the patient. Such a policy would result in considerable saving of resources by reducing admissions for observation of those at low risk for developing complications.

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↗
PubMed1989

Intraoperative pancreatic biopsy--a diagnostic dilemma.

The intraoperative diagnostic dilemma of pancreatic cancer vs. chronic pancreatitis often remains unresolved. In the literature, diagnosis based on intraoperative pancreatic biopsy is a matter of controversy. Our study comprised 70 patients with a suspected space occupying pancreatic process who were operated on with the primary goal of arriving at a speedy and precise diagnosis, according to which the appropriate surgery for the specific patient would be performed. Frozen section showed that 44 patients had malignancy of the pancreas; in three patients, there was a false-negative result. In four patients, the histological picture was consistent with chronic pancreatitis. In the remaining 19 patients, biopsy was not performed and the diagnosis was made on the basis of intraoperative inspection and palpation of pancreas. On reviewing the patients, we found that the surgical risk involved in biopsy is quite low and that a high price was paid for diagnosis by inspection and palpation alone. The risk vs. benefit aspect of intraoperative pancreatic biopsy is discussed.

Adenocarcinoma↗
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

Metachronous leiomyosarcoma in colostomy after abdominoperineal resection for rectal carcinoma.

Leiomyosarcoma of the colon is a rare neoplasm. It is widely known that primary malignant lesions may present either simultaneously (synchronous tumor) or at different times (metachronous tumor). The incidence of metachronous colonic mucosal carcinoma is generally considered to range from 3 to 5%. Metachronous leiomyosarcoma in colostomy 4 years after abdominoperineal resection for rectal carcinoma is unusual and we have found no reports on this in the literature. The clinical symptoms, diagnostic features, and mode of treatment are discussed.

Adenocarcinoma↗
PubMed1986

Leiomyoma of the anal canal: report of two cases.

Leiomyoma of the rectum and anal canal is an unusual clinical entity. Generally, it does not produce any clinical signs and in most cases it is discovered incidentally in the course of routine rectal examination. The clinical presentation, diagnosis, and surgical treatment are described in two presented cases of anal canal leiomyoma.

Aged↗
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↗
PubMed1985

Bile composition and bile acid pool size. Comparison after truncal, selective, and highly selective vagotomy.

We studied biliary lipid composition and bile acid pool size in 29 patients surgically treated for duodenal ulcer. Fourteen were examined both before and after surgery, the rest postsurgically only. They were divided into three groups according to type of vagotomy. With duodenal fluid obtained via nasogastric tube, we determined bile acid pool size, bile concentrations, and lithogenic index. We found no significant differences in bile composition and bile acid pool size among the three types of vagotomy, postsurgically. However, patients studied before surgery, compared with the entire post-vagotomy group, had a significant increase in relative cholesterol content and lithogenic index, most pronounced in the truncal vagotomy group. Bile acid pool size was also increased postsurgically. Vagotomy may predispose to gallstone development by increasing the bile's relative cholesterol concentration and thus the lithogenic index. However, the slightly expanded bile acid pool size may improve cholesterol solubility in certain patients.

Bile↗
PubMed1985

Desmoid tumor--review and follow-up of ten cases.

Ten cases of desmoid tumor, diagnosed, treated, and followed during the past 11 years, were reviewed and the patients reexamined. Two were up to 3 years, two up to 5 years, and four up to 11 years after excision. The remaining two patients were lost to follow-up. The 10 patients included one male and nine females; six females were of childbearing age and three were postmenopausal. In four females the desmoid tumor was located near various surgical scars. In the one recurrent desmoid it was most probably related to both repeated traumatization of the abdominal wall due to pregnancies and hyperestrogenism. All the surgical margins of resection were microscopically involved by the process. An open liver biopsy, performed simultaneously with the excision of the recurrent desmoid, showed benign nodular hyperplasia compatible with hyperestrogenism. Estrogen and progesterone receptors of this desmoid were negative. In the present series follow-up revealed, in contrast to general agreement, that in spite of incomplete excision, the recurrence rate was low. We suggest that the surgical approach to desmoid tumors could be less radical, except possibly for lesions in patients with multiple causative factors.

Abdominal Neoplasms↗
PubMed1985

Portal hypertension as an early manifestation of carcinoma of the pancreas.

Massive hematemesis followed by 48 hours the onset of obstructive jaundice in a previously asymptomatic 38-year-old male patient. Splenomegaly was the only abnormal physical finding. Esophagoscopy visualized bleeding varices. The liver scan was normal. Dilated intra- and extrahepatic bile ducts and a possible retroperitoneal mass were demonstrated by ultrasonography. Laparotomy disclosed the presence of a carcinoma of the head and body of the pancreas that obstructed the common bile duct and the portal vein. This case report should draw attention to the vast spectrum of rare presentations of pancreas carcinoma.

Adult↗
PubMed1985

Torsion of a wandering spleen.

We present an unusual case of torsion of a wandering spleen in a 14 year old boy. Wandering spleen is an entity which has rarely been reported in infants and children. Although patients may be asymptomatic, some may present as an acute surgical emergency if trauma or torsion of the vascular pedicle occurs, as in our case. The treatment of this condition is splenectomy.

Adolescent↗
PubMed1985

Bilateral primary malignant lymphoma of the breast.

A rare case of bilateral primary malignant lymphoma of breast in a 76 year old woman is presented. The lesion was examined by electron microscopy and immunochemistry. The diagnosis of primary malignant lymphoma remains a diagnosis by exclusion and requires extensive work-up to exclude widespread malignant process. The behaviour of this malignancy tends to be an aggressive one and the prognosis is generally poor.

Aged↗