Biomedical subjects
Publications and source records attributed to A Halevy.
Although percutaneous endoscopic gastrostomy (PEG) for feeding purposes has been in use for the past 10-12 years, many practitioners are unaware of this option. We describe 10 patients who underwent PEG with only 1 major, but nonfatal, complication. We stress that PEG is indicated for those who cannot swallow, and is safe, easy to perform, and a relatively cheap procedure. It is therefore a useful substitute for surgical gastrostomy.
There is a relatively high incidence of asymptomatic gallbladder polyps in the general population (1.5-9.5%). We present a 61-year-old woman who had a 22 x 37 mm polyp of the gallbladder.
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Two patients with stricture of the extrahepatic biliary tree are described. Both patients presented with a clinical picture of obstructive jaundice one to two years following radiotherapy for a malignant condition. As no recurrent tumour was detected in either of the patients the strictures were considered to be the result of radiation therapy. Bilio-enteric decompression was performed in both patients who are well at follow up one and ten years after the procedure.
Laparoscopic cholecystectomy is increasingly being used in adults with gallbladder disease. Despite the exponential increase in the number of laparoscopic cholecystectomies performed in adults, there are very few reports of its use in children. It is thought that gallstone disease is rare in childhood. Since the introduction of ultrasonography, it is used almost routinely for evaluating children with abdominal pain, and cholelithiasis is being increasingly recognized in children. Since the beginning of 1991 we evaluated 7 children for biliary colic, and on sonography gallstones were demonstrated in all of them. 1 boy also had thalassemia and another hyperlipidemia; the other 5 developed symptoms of biliary colic without any history of hematological or other disease. 5 underwent laparoscopic cholecystectomy without complication. In the other 2 laparotomy was performed. In 1 suspected damage to the common bile duct during laparoscopy required direct visualization, but no damage was found. In the other, no gallbladder was identified on laparoscopy; laparotomy confirmed the diagnosis of congenital agenesis of the gallbladder with several technical modifications. We found laparoscopic cholecystectomy to be both safe and effective in children. Its advantages include shorter hospitalization, decreased postoperative discomfort and a much shorter interval between operation and return to normal activity.
Desmoid tumors in various anatomic sites were treated in 4 females and 3 males, ranging in age from 16-50 years, during a 6-year period. In 5 the tumor was completely excised with free margins. In the other 2 excision was incomplete and the tumor recurred within a few months. Desmoid tumors have a marked tendency to local recurrence, and therefore should be widely excised. There is no evidence that adjuvant therapy has a place in the management of these tumors.
In the past, ambulatory surgery has been considered unsuitable for military personnel. In this pilot study, 69 members of the Israel Defense Forces underwent a variety of surgical procedures on an ambulatory basis in a central, university-affiliated general hospital. The waiting time for surgery was considerably reduced. The patients, the army, and the hospital staff were satisfied with the service. Although further study is needed, ambulatory surgery appears to be a suitable and advantageous modality for military personnel.
Five patients with a side-to-side arteriovenous fistula complaining of pain, numbness, and cold sensation were evaluated by pulse oximetry. Low SaO2 was noticed in all five. Closure of a major proximal venous collateral vessel eliminated the steal and resulted in SaO2 correction and was followed by clinical amelioration. Pulse oximetry proved to be a helpful adjunct in the evaluation of the painful hand after creation of an arteriovenous fistula. By applying the pulse oximeter to the patient's affected limb, we were able to determine whether the pain was a result of ischemia and if the correction of the steal improved oxygenation.
Deep vein thrombosis of the upper limb is much rarer than that of the lower limb. Despite conventional treatment with systemic heparin, there are residual symptoms in many patients. An alternative method of local thrombolytic therapy was used with success in a 30-year-old-women with thrombosis in his arm. 1 year later s/he is well and symptom-free.
A 70-year-old woman developed fever accompanied by impairment of liver function and eosinophilia after 2 courses of halothane anaesthesia given within a few days. Serologic tests excluded viral hepatitis. Liver function and blood count returned to normal within 2 weeks. When a second operation is necessary shortly after a previous anesthesia with halothane, a different, non-hepatotoxic agent should be used.
During a 12-year period, 10 men and 5 women ranging in age from 22-76 (mean 53 years), were treated for liposarcoma. In 7 the tumor was located in the retroperitoneum, in 5 in the lower extremity and in 1 each, in the back, shoulder and groin. The best results were given by wide excision of the tumor followed by chemo or radiotherapy.
During a 5-year period, 22 patients with obstructing carcinoma of the left colon were operated on in our department. All patients underwent emergency subtotal colectomy with primary ileocolonic or ileorectal anastomosis. The quality of life for patients undergoing subtotal colectomy is excellent. All patients enjoy an almost normal diet and those with an ileorectal anastomosis stabilize on two to three bowel movements per day. During a followup period of 65 months, four patients died from spread of their primary disease while two other patients died of unrelated causes. Sixteen patients are alive and free of disease. We consider subtotal colectomy the procedure of choice for patients with obstructing carcinoma of the left colon.
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Magnetic resonance images (MRI) of the liver were obtained using a combination of short time inversion recovery (STIR) and spin echo (SE) sequences. These were correlated with comparable tissue slices generated from resected specimens obtained at partial hepatectomy. All 10 cases appeared to have solitary masses on contrast enhanced computed tomography (CT). Histological examination revealed five primary tumours (two hepatocellular carcinomas, two haemangiomas and one cholangiocarcinoma) and five metastatic tumours. The STIR images demonstrated a high signal intensity in all areas of viable tumour involvement and reduced signal intensity in regions of confluent necrosis with superimposed haemorrhage or calcification. This sequence also demonstrated additional areas of high signal intensity adjacent to several lesions which were not visible on CT. Microscopy of these regions in the specimens demonstrated no tumour involvement or steatosis and their precise cause remains obscure. All the lesions demonstrated on the CT images were visible on MRI and no additional lesions were discovered on detailed microscopical examination of the specimens. Delineation of the extent of the cholangiocarcinoma was a problem with both techniques. MRI showed no major advantage over CT except for a higher contrast of the lesion compared with normal liver and also a better delineation of the tumour mass.
In this prospective study, the abdominal wounds of 500 consecutive patients were closed with buried retention monofilament stainless steel wire. The strength of the suture material, the rapidity of the closure, the very low 0.4% dehiscence rate and the almost total lack of wound complications seems to override the relatively minor inconvenience of handling the wire. These results seem to justify the rountine use of this method of wound closure in abdominal surgery, especially in the elderly and high-risk patients.
A survey of 47 Israeli ileostomates known to the Israel Ostomy Association was performed. The outstanding features are 1) a low (5 per cent) referral rate of patients with inflammatory bowel disease for procto colectomy and ileostomy; 2) a high (64-85 per cent) incidence of cutaneous problems; 3) a low rate of rehabilitation, as measured by return to previous occupation, sexual life and social adjustment. However, our 47 ostomates were operated on 14 institutions in five countries and live in a subtropical climate-factors that may negatively affect the outcome. Since the study, the situation has improved.