Biomedical subjects
Publications and source records attributed to A Ovnat.
Lipomas of the esophagus are relatively rare, but are of clinical interest since they may produce significant clinical symptoms that must be differentiated from malignant conditions. A case of esophageal lipoma is reported. The pliable, pedunculated esophageal tumor, which changes shape radiologically and has minimal clinical symptomatology, are the hallmarks for a correct diagnosis.
This study was undertaken in order to evaluate the implications of substituting a failed jejunoileal bypass with a gastric bypass, another bariatric procedure. During the same operation, the jejunoileal bypass is taken down and a Roux-en-Y gastric bypass created. All 12 patients who underwent the procedure and who form the basis for this study survived. In comparison with patients who underwent gastric bypass alone during the same period, peri- and postoperative morbidity did not increase. Following this operation blood glucose levels and arterial blood pressure decreased as the patients with the failed jejunoileal bypass lost weight. Serum cholesterol and triglyceride levels, which are known to decrease significantly after jejunoileal bypass, slightly increased but always remained within normal range after substitution by the gastric bypass. All patients who underwent the combined operation showed a dramatic improvement in life quality. We conclude that the simultaneous performance of these two procedures is a preferable alternative to the take-down alone of the original unsuccessful procedure.
In four patients, acute cholangitis was found to result from a ruptured hydatid cyst. In three patients, the diagnosis was established before operation by ultrasonography, and the fourth case was diagnosed during operation. Once the diagnosis of cholangitis is reached, our working policy includes administration of antibiotics and fluids, accelerated diagnostic workup, and operation as soon as possible. Our suggested operative procedure is cholecystectomy, choledochotomy, choledochoduodenostomy, and removal of the echinococcal cyst. In all four cases treated by us, there were no deaths, and only one patient who did not undergo removal of the echinococcal cyst at the initial operation needed a second operation 2 months later.
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A leaking anastomosis between the proximal stomach and the jejunum is a serious postoperative complication of the gastric bypass operation. Associated intra-abdominal sepsis carries a high mortality rate. Early diagnosis, particularly at the time of operation, and remedial treatment reduce mortality. We have devised a method for the detection of leaks, using nasogastric infusion of methylene blue with an i.p. sump suction catheter. In our initial group of 150 patients, where this method was not used, 5 patients had an anastomotic leak and 2 died of fulminant sepsis. The presence of a leak in these cases was diagnosed on clinical grounds and confirmed in all five by Gastrografin swallow between the 3rd and 5th postoperative day. In a later group of 250 patients, methylene blue was routinely used intra-operatively and twice daily thereafter to verify the integrity of the anastomosis. Of this group, seven patients developed leaks, five of which were diagnosed intra-operatively while the other two were diagnosed on the 1st postoperative day. There was no mortality in this group. The use of methylene blue provides early detection of a leaking anastomosis and thus may significantly reduce the morbidity and mortality of the gastric bypass operation.