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Biomedical subjects

A Mishrick

Publications and source records attributed to A Mishrick.

8 recordsLinked to original sources
PubMed1990

Management of indirect inguinal hernias by laparoscopic closure of the neck of the sac.

Fifteen animals with indirect inguinal hernias were treated by closure of the abdominal opening of the patent processus vaginalis by the application of staples laparoscopically. The satisfactory results confirm those obtained in a previous study, where similar openings found during laparotomy for abdominal surgery were closed by the application of metal clips. Laparoscopic closure of the abdominal opening of a hernial sac may have advantages over the present operative management.

Animals↗
PubMed1987

The treatment of perforated diverticulitis by one-stage intracolonic bypass procedure.

The one-stage intracolonic bypass procedure prevents gastrointestinal secretions and fecal content from coming in contact with an anastomotic site without interrupting the intraluminal continuity of the fecal flow from proximal to distal colon. This can be achieved by the intraluminal implantation of a soft, pliable tube above the anastomotic site. Previous clinical and experimental data have indicated that the intracolonic bypass procedure can protect an anastomosis in the presence of maximal colonic loading, gross dehiscences, or fecal peritonitis. This report presents 28 patients with perforated diverticulitis, all of whom were treated by one-stage intracolonic bypass procedures. Ten of the 28 patients had peritonitis, and 18 had pericolic abscesses. Results indicate no deaths and no anastomotic leakages. Three patients (10.7%) had a complicated postoperative course. One patient with fecal peritonitis had prolonged ileus and a pulmonary effusion, and one had a myocardial infarction. Both of these patients responded to medical therapy. Another patient had a wound infection. The hospital stay ranged from 10 to 18 postoperative days. All patients passed the tubes spontaneously 2 to 3 weeks after operation. The one-stage intracolonic bypass procedure can be recommended as a viable alternative to the two- or three-stage procedures commonly used for perforated diverticulitis.

Abscess↗
PubMed1985

Unusual extraperitoneal presentations of diverticulitis.

Extraperitoneal presentations of complicated diverticular disease are unusual. The initial clinical presentations of these extraperitoneal manifestations have been described in the perineum, scrotum, buttock, hip, joints, thigh, lower extremities, mediastinum, and neck. These presentations render the diagnosis difficult and may lead to the delay of the proper therapy. The purpose of this report is to call attention to these unusual extraperitoneal presentations of complicated diverticular disease to describe the routes of spread and to present a case in point. Reviewing the literature, we have concluded that these unusual presentations occur more commonly in women and the elderly, that a delayed diagnosis significantly increases the mortality rate, and that the most common site of an extraperitoneal presentation is in the area of the hip.

Abscess↗
PubMedDate not supplied

Management of groin hernias by laparoscopy.

The surgical treatment of groin hernias continues to undergo technical modifications. The introduction of minimally invasive surgery had added a possible new dimension, replacing an inguinal approach by laparoscopy. Conceived some 15 years ago, the thesis was subjected to a clinical trial where coincidental abdominal hernial openings were closed at laparotomy. This study was followed by an experimental study at which time the openings were closed laparoscopically. The satisfactory results led to the development of a stapling instrument that could be passed through a cannula at laparoscopy and used to close the abdominal hernial opening. The clinical trial of treating hernias by laparoscopy was originally directed to the management of indirect inguinal hernias, but its use has since been expanded to include treatment of direct, femoral, obturator, incarcerated, recurrent, and bilateral hernias. The laparoscopic anatomy of the inguinal hernia, different from that seen by an inguinal approach, is briefly reviewed. The details of the operative technique are presented, as are the bases of other laparoscopic techniques that have evolved. Thirty-one hernial orifices have been closed and followed over 18 months. The results appear to be satisfactory in 27 instances. There were early technical failures in 2: One patient developed a recurrence after 5 months, later shown to be due to a sliding hernia; and symptoms of meralgia paresthetica of indeterminate origin appeared in one case. The advantages over the traditional approach are described; the disadvantages of the laparoscopic approach are those of laparoscopy itself and the absence of a long-term follow-up.

Adolescent↗
PubMedDate not supplied

Adrenal ablation.

Of 135 patients who had bilateral adrenalectomies for metastatic breast cancer, 110 could be evaluated and 63 patients (57.3%) responded (43 objective, 20 subjective responders). Patients aged 31 to 45 years had a 56% response rate; 58% of patients aged 46 to 70 responded. Oophorectomy responders benefited from adrenalectomy 62% of the time and oophorectomy failures reponded in 38% of the cases. Patients with a disease-free interval of zero to 2.5 years responded to adrenalectomy at a rate of 46%, whereas patients with a free interval greater than 2.5 years responded at a rate of 73%. The median survival rate of 63 adrenalectomy responders was 28 months; it was ten months for 47 nonresponders.

Adrenalectomy↗