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A Szold

Publications and source records attributed to A Szold.

At least 19 recordsLinked to original sources
PubMed2001

Chronic idiopathic thrombocytopenic purpura (ITP) is a surgical disease.

BACKGROUND: We designed a study to assess the safety and long-term efficacy of laparoscopic splenectomy (LS) for the treatment of chronic idiopathic thrombocytopenic purpura (ITP). METHODS: Over a period of 55 months, 104 patients underwent LS for chronic ITP. The perioperative course was documented and the long-term follow-up data were recorded. RESULTS: The mean age was 36.9 years (range, 8-83) and 72 patients were female. Patients were operated on with a mean platelet count of 110,000/ml. Fifty-one patients were operated on with a platelet count of < 100,000; 18 of them had a count of < 50,000/ml and 11 had a count of < 10,000/ml. There were no conversions to laparotomy. Bleeding occurred in 14 patients, and five of them received a blood transfusion. The mean operating time was 56.5 min (range, 25-240). There were minor complications in five patients and major complications in three. The mean hospital stay was 2.1 days (range, 0-13). Over a mean follow-up period of 36 months (range, 4-62), all but four patients were available for follow-up. Eighty-four patients are in complete remission. Seven patients are in partial remission, with a platelet count of 50,000-100,000 \ml without medical treatment. Eleven patients did not respond or relapsed following a short initial response; three of them underwent later removal of an accessory spleen, two with partial response. All but two relapses occurred within 70 days of the operation. CONCLUSION: LS is safe and effective for the treatment of chronic ITP and yields excellent long-term results. Until another form of treatment emerges, LS should be considered the treatment of choice for this disease and recommended to the patient at an early stage of the disease.

Adolescent↗
PubMed2001

Laparoscopic adjustable silicone gastric banding for morbid obesity: results and complications in 715 patients.

BACKGROUND: Laparoscopic adjustable silicone gastric banding (LASGB) was used as the initial bariatric procedure for more than 36 months. The efficacy and safety of LASGB were studied. METHODS: Patients were followed up prospectively in a multidisciplinary center for the perioperative and long-term courses, and for complications. RESULTS: Between November 1996 and May 1999, 715 patients underwent surgery. The mean age was 34.6 years (range, 16-72) years, and the mean body mass index (BMI) was 43.1 kg/m2 (range, 35-66 kg/m2). The mean operative time was 78 min (range, 36-165 min), and the postoperative hospitalization time was 1.2 days (range, 1-8 days). There were six intraoperative complications (0.8%), eight early postoperative complications (1.1%), and no deaths. For follow-up evaluation, 614 patients (86%) were available. Late complications included band slippage or pouch dilation in 53 patients (7.4%), band erosion in 3 patients, and port complications in 18 patients. In 57(7.9%) patients, 69 major reoperations were performed. In patients with a follow-up period longer than 24 months, the average BMI dropped from 43.3 kg/m2 (range, 35-66 kg/m2) to 32.1 kg/m2 (range, 21-45 kg/m2). CONCLUSION: Laparoscopic adjustable silicone gastric banding is safe, with a lower complication rate than any other bariatric procedure. Most reoperations can be performed laparoscopically with low morbidity and short hospitalizations. On the basis of intermediate-term follow-up evaluation, it is an effective procedure for weight-reducing purposes.

Adolescent↗
PubMed2001

Laparoscopic splenectomy in patients with refractory or relapsing thrombotic thrombocytopenic purpura.

HYPOTHESIS: Thrombotic thrombocytopenic purpura (TTP) is a rare and serious hematological disease. First-line therapy is plasma exchange, often used in combination with corticosteroids, vincristine, aspirin, and dipyridamole. The role of splenectomy for patients resistant to or dependent on plasma therapy and for the prevention of TTP relapses is not yet determined. Laparoscopic splenectomy (LS) is effective and safe for the treatment of the chronic relapsing form of TTP. INTERVENTION: We performed LS in 8 patients with refractory or relapsing TTP. The operative as well as the early and late postoperative course and complications were recorded. RESULTS: The mean duration of LS was 70 minutes (range, 35-180 minutes). There were no serious bleeding complications during or after surgery. Convalescence was rapid, and the mean hospital stay was 2.5 days (range, 1-9 days). Patients were followed up for a mean of 32 months (range, 19-54 months). Seven patients are in remission with no relapse of TTP. One patient with familial TTP had multiple relapses before and after surgery. CONCLUSIONS: Laparoscopic splenectomy for refractory or relapsing TTP is safe and associated with low morbidity and fast recovery. It is effective in the long-term prevention of TTP relapses in most patients, and it should probably be considered early in the course of chronic, relapsing TTP.

Adolescent↗
PubMed2001

Dextromethorphan attenuation of postoperative pain and primary and secondary thermal hyperalgesia.

PURPOSE: To determine the effect of 90 mg dextromethorphan (DM) p.o. vs placebo 90 min preoperatively, on the immediate and delayed postoperative course. METHODS: Thirty patients undergoing laparoscopic cholecystectomy or inguinal hernioplasty under general anesthesia were studied. Half (DM) received 90 mg dextromethorphan and half received placebo 90 min before anesthesia. Intravenous Patient Controlled Aanalgesia with morphine was available for two hours within a six-hour observation period; 75 mg diclofenac i.m. prn was given later in PACU and on-ward (24 hr). Pain was assessed using the visual analogue scales. Thermal thresholds for cold and hot sensation and for pain (by limit method) were evaluated at the site of skin incision (primary-) and distantly (secondary hyperalgesia). Von Frey filaments were applied testing touch sensation. Sedation level and morphine consumption were also assessed in PACU. RESULTS: Demographic, surgical and perioperative parameters were similar; no untoward effects were encountered. Pain intensity and sedation were lower, and the feeling of well-being was greater, in the DM patients: one vs five (median), two vs five, five vs two, respectively, P <0.01 (90 min time-point). Thermal application revealed absence of primary and secondary hyperalgesia only in the DM patients; von Frey filaments induced similar pain sensation in both groups. Mean morphine/group, morphine/weight and diclofenac injection rates were approximately 55% lower in the DM group: 2.1 +/- 1.2 (SD) vs 4.7 +/- 2.3, 0.03 +/- 0.02 vs 0.07 +/- 0.03, 1.0 +/- 0.3 vs 2.4 +/- 0.2, respectively, P <0.01. CONCLUSIONS: Compared with placebo, DM enabled reduction of postoperative analgesics consumption, improved well-being, and reduced sedation, pain intensity and primary and secondary thermal hyperalgesia.

Adult↗
PubMed2001

Resolution of chronic medical conditions after laparoscopic adjustable silicone gastric banding for the treatment of morbid obesity in the elderly.

BACKGROUND: The routine cutoff age of surgery for morbid obesity is 55 years. A minimally invasive surgical approach, however, may enable its safe use in older individuals. METHODS: Laparoscopic adjustable silicon gastric banding (LASGB) was performed in 18 patients 60 years or older. The perioperative course, early and late complications, and long-term follow-up all were recorded. RESULTS: Of 398 patients who underwent LASBG until November 1998 (mean age, 38.1 years), 18 were 60 years or older (mean, 63.6 years). The mean body mass index (BMI) was 44.4 (range, 35-64.7). There were no intraoperative complications. However, four patients had late complications requiring reoperation. The mean operative time was 65 min; the mean hospital stay was 1.3 days; and the mean follow-up period was 21.9 months. The BMI dropped from 44.2 to 30.5, and all comorbid conditions improved markedly: Diabetes mellitus resolved in 71% of the patients, hypertension in 33%, and sleep apnea in 100%. CONCLUSION: According to the findings from this study, LASGB is feasible, safe, and effective in the elderly, and most benefit from resolution or marked improvement of comorbid conditions.

Age Factors↗
PubMed2001

Tai Chi Chuan practice as a tool for rehabilitation of severe head trauma: 3 case reports.

Rehabilitation after severe head trauma is a complex process that can be long and frustrating. New, more holistic methods for rehabilitation are constantly sought. We present the cases of 3 patients who had severe head injury and whose rehabilitation was facilitated by Tai Chi Chuan (TCC) therapy. TCC therapy should be taught only by a qualified TCC therapist and under close medical supervision.

Accidental Falls↗
PubMed2001

Laparoscopic management of Lap-Band erosion.

BACKGROUND: Laparoscopic adjustable silicone gastric banding (LASGB) is the bariatric operation of choice in our institution for most morbidly obese patients. The advantage of LASGB is a minimally invasive procedure, with low systemic and operative complication rates. However this procedure is not free from significant postoperative problems that may arise at a later stage. PATIENTS AND METHODS: 950 patients underwent LASGB between November 1996 and May 2000, with a median follow-up of 21 months. 3 patients (0.31%), developed band erosion 6 to 8 months following the original procedure. Laparoscopic band removal was attempted in all 3 patients. The charts of all patients were reviewed for the postoperative course of the original operation as well as the removal of the band. RESULTS: 2 patients presented with abscess formation at the port site, and 1 patient suffered from a gastric fistula at the port site 6 months following surgery. In all patients the immediate postoperative course was not smooth; 2 patients developed a subphrenic collection drained percutaneously, and one patient had fever, treated empirically with intravenous antibiotics. In all 3 patients, no leak was demonstrated by CT and barium meal. The diagnosis of band erosion was confirmed by gastroscopy, which demonstrated part of the band eroding through the gastric wall. All patients were operated laparoscopically. The band was removed and the gastric wall was sutured. The postoperative course was uneventful and patients left the hospital within 3 days. CONCLUSION: LapBand erosion following LASGB is very rare and may occur months following the operation. The postoperative course suggests that the erosion is the consequence of a minute stomach wall injury during the primary operation. Diagnosis is essential and the treatment of choice is laparoscopic band removal with suturing of the stomach wall. It is possible that a minute injury to the gastric wall during the initial procedure is the underlying cause of this complication.

Adult↗
PubMed2001

[Diagnostic laparoscopy--a useful tool in abdominal lymphoma].

Imaging-guided (CT/US) percutaneous biopsy has significantly improved diagnosis of intra-abdominal lymphoma. However, in many cases the tissue retrieved may be inadequate for specialized studies such as immunophenotyping or cytogenetic analysis that may be required for a complete analysis of lymphoma or determination of therapy. The success of diagnostic laparoscopy in the diagnosis and staging of gastrointestinal malignancies suggests that it could be used for intra-abdominal lymphomas as well. We describe our experience in 15 patients with suspected lymphoma who underwent diagnostic laparoscopy during 1995-98. Preoperative investigation performed in all included percutaneous FNA in 9 without conclusive diagnosis. Laparoscopy was diagnostic for lymphoma in 14 (93%) while in 1 there was a false negative result due to sampling error and the lymphoma was only diagnosed at a second laparoscopy. There was no mortality nor any major complication. Average hospital stay was 2 days and patients were then referred for further oncological treatment. Our experience shows that diagnostic laparoscopy is a safe and efficient tool and without major complications in diagnosing abdominal lymphoma.

Abdominal Neoplasms↗
PubMed2000

Laparoscopic splenectomies for idiopathic thrombocytopenic purpura: experience of sixty cases.

We performed a laparoscopic splenectomy (LS) in 60 patients (age 9-83, 45 females) with idiopathic thrombocytopenic purpura (ITP) who did not achieve sustained remission on steroid therapy. Using a modified procedure, the mean duration of LS was 78 min (range 25-240 min) and surgery was associated with only 5% major and 5% minor complications. Ten patients had a platelet count less than 50 x 10(9)/l during surgery despite the administration of immune globulin (0.4 g/kg x 3-5 days) or pulsed oral dexamethasone (40 mg/day x 4 days). Three patients were refractory to these therapies and underwent LS with a platelet count less than 5 x 10(9)/l. Bleeding complications during or after surgery were rare (5%). Accessory spleens were removed in eight patients. Convalescence was rapid and the mean hospital stay was 2.3 days (range 1-7 days). The patients were followed for a mean of 16 months (range 1-36 months), and 49 patients (84%) are in complete remission. Seven patients (12.5%) relapsed despite an initial good response in 6 of them. Two patients underwent laparoscopic removal of accessory spleens with excellent response. We conclude that LS for ITP is safe and effective and associated with low morbidity and fast recovery. Thus, LS may be considered earlier in the course of ITP.

Adolescent↗
PubMed2000

Laparoscopic accessory splenectomy for recurrent idiopathic thrombocytopenic purpura and hemolytic anemia.

BACKGROUND: Laparoscopic splenectomy is an effective treatment for idiopathic thrombocytopenic purpura (ITP) and hemolytic anemia that has a remission rate of 80-90%. In some patients in whom the disease persists or recurs, a diagnosis of accessory spleen is made. The long-term efficacy of laparoscopic accessory splenectomy is unknown. METHODS: Patients who underwent laparoscopic accessory splenectomy were followed in the outpatient clinic. The perioperative course, blood counts, and need for medical therapy to maintain a normal count were recorded. RESULTS: Eight patients underwent laparoscopic accessory splenectomy. All procedures were completed laparoscopically, and all patients were discharged on the 1st postoperative day. Patients were available for a follow-up period of 15 months range, (3-27). None of the ITP patients achieved a complete remission. Two of them had a partial remission, and five ITP patients are now being treated with chronic corticosteroids to maintain a platelet count of >100,000/ml. CONCLUSION: Laparoscopic accessory splenectomy is associated with a low rate of morbidity and a short hospital stay. Despite its success in removing all residual splenic tissue, most patients will probably not enjoy a complete remission.

Adrenal Cortex Hormones↗
PubMed2000

The effect of pneumoperitoneum on dissemination and scar implantation of intra-abdominal tumor cells.

PURPOSE: The role of laparoscopy for the treatment of cancer remains controversial, and a particular concern is port site metastases after laparoscopic surgery. Since laparoscopy is being performed with increasing frequency, the question arises as to whether it is a safe oncological procedure. After intraperitoneal inoculation of renal cell carcinoma cells in a mouse model, we compare abdominal wall scar implantation following laparoscopic trocar insertion and pneumoperitoneum with standard laparotomy, and examine the effects on tumor dissemination in the peritoneal cavity. MATERIALS AND METHODS: Following intra-abdominal RENCA cell inoculation, Balb/c mice were randomized into group 1-20 mice that underwent carbon dioxide pneumoperitoneum and telescope trocar insertion, group 2-20 subjected to laparotomy and group 3-10 anesthetized only. All animals were sacrificed 2 weeks after inoculation, and abdominal wall metastases and intraperitoneal tumor distribution were evaluated. RESULTS: Overall, intra-abdominal implantation of inoculated RENCA tumor cells was detected in 15 of 20 animals (75%) in group 1, 14 of 20 (70%) in group 2 and 10 of 10 (100%) in group 3. Wound metastases developed in 46.7% of the mice in group 1 and 50% in group 2. CONCLUSIONS: There was no difference among the groups in the pattern of intraperitoneal tumor implants and scar seeding incidence. Pneumoperitoneum does not facilitate port site metastases.

Abdominal Muscles↗
PubMed1999

[Laparoscopic donor nephrectomy: initial experience in Israel].

We present our initial experience in laparoscopic nephrectomy. 6 patients were operated for a kidney donation and 2 for treatment of a benign disease. All procedures were completed successfully, with no conversion to laparotomy or intraoperative complications. Mean operating time was 210 minutes, and in the donor kidneys the mean warm-ischemic time was 165 seconds. There were 3 postoperative complications, and mean hospitalization was 3.5 days. The transplanted kidneys are all functioning. From our initial experience, laparoscopic nephrectomy appears to be both feasible and safe. Its implementation requires a combined team with experience in donor surgery and advanced laparoscopic skills. The procedure may increase the availability of living donor kidneys, due to the smaller impact on the donor compared to conventional donor nephrectomy.

Adolescent↗
PubMed1999

Results and complications of laparoscopic adjustable gastric banding: an early and intermediate experience.

BACKGROUND: Laparoscopic adjustable silicone gastric banding (LASGB) has been performed as the initial procedure for weight reduction in the authors' institution for the past 22 months. The efficacy and safety of the procedure were studied. METHODS: Patients were followed up prospectively during the perioperative and long-term course and for complications. RESULTS: 391 patients, aged 16-72 years, with a mean body mass index (BMI) of 43.1 (range 33-66) were operated on. The laparoscopic procedure was completed in all but four. The mean operative time was 78 min (range 36-165), and the mean postoperative hospital stay was 1.2 days (range 1-8). There were four (1%) intraoperative complications: pneumothorax in one patient, bleeding in two patients, and injury to the stomach in one. Early postoperative complications were subphrenic abscess in two patients and band malposition in five. Of the patients operated on, 356 (91%) were available for follow-up. Over an average follow-up period of 13 months (range 1-22), band slippage occurred in 16 patients (4.1%), resistant port infection in 1, and longstanding pain in the port area in 9. There were 2 cases of port migration. A total of 26 (6.4%) reoperations were performed: early band repositioning (5), bleeding port site (1), late band repositioning (13), band removal (5), and local relocation of the port (2). All abdominal operations were performed laparoscopically. During the 18-month follow-up, the average BMI dropped from 43.1 to 29.8. CONCLUSION: LASGB is a safe procedure, with low early complication rates. Most reoperations may be performed laparoscopically, with subsequent low morbidity and short hospitalizations. On intermediate-term follow-up itseems to be an effective bariatric procedure.

Adolescent↗
PubMed1998

Optimizing laparoscopic splenectomy. Technical details and experience in 59 patients.

BACKGROUND: Laparoscopic splenectomy (LS), like other advanced laparoscopic procedures, is still an evolving procedure. The indications for surgery, criteria for patient selection, and operative technique are not yet well defined. We have therefore modified the standard technique for performing LS in an attempt to optimize the procedure. METHODS: Over the past 2 years, we have performed LS in 59 patients. The last 43 patients were operated using a standardized technique that we believe to be optimal. It includes the routine use of the right lateral position, operating through three trocars, the mass transection of the splenic vasculature with a vascular endoscopic stapler, and the use of a self-retaining retrieval bag. RESULTS: The average operating time was 79 min. Average blood loss was 95 cc, and average postoperative hospitalization was 2.3 days. There was one intraoperative complication and one postoperative complication. These results are superior to those we achieved earlier in our own experience, as well as to similar series that have been published recently. CONCLUSIONS: In our experience, the use of this new technique resulted in relatively short procedures with low morbidity. We believe that these results justify the use of LS as the procedure of choice for elective splenectomy in patients with normal or moderately enlarged spleens.

Disease-Free Survival↗
PubMed1996

Water-soluble contrast material has no therapeutic effect on postoperative small-bowel obstruction: results of a prospective, randomized clinical trial.

BACKGROUND: Hyperosmotic water-soluble contrast materials have been fo und to be helpful diagnostic tools in postoperative small-bowel obstruction (POSBO); however, their therapeutic value remains controversial. PATIENTS AND METHODS: A prospective, randomized clinical study was conducted to examine the use of meglumine ioxitalamate as a supplement to the standard conservative treatment of POSBO. Patients with POSBO (n = 50) suitable for a conservative approach were randomized to receive standard conservative treatment with (n = 25) or without (n = 25) the addition of 100 mL of meglumine ioxitalamate via the nasogastric tube (patients with diffuse carcinomatosis and early POSBO were excluded). Both groups were compared for resolution of obstruction, need for surgical relief of obstruction, and complications. RESULTS: Seven (14%) patients required surgery: 3 in the contrast material group and 4 in the control group (P = not significant [NA]. Resolution of symptoms was achieved in nonsurgical patients within an average of 25.7 hours in the contrast material group and 28.7 hours in the control group (P = NS). There was no mortality in this study. In 2 (4%) patients (1 in each group), strangulated bowel was found during surgery, but only the 1 (2%) patient in the contrast material group required bowel resection. No difference was found in the length of hospital stay or rate of complications. There were no complications that could be attributed to the use of the contrast material itself. CONCLUSIONS: Although water-soluble contrast material is a safe and useful diagnostic tool, it offers no advantage as a supplement to the usual conservative treatment of POSBO.

Adolescent↗
PubMed1996

Laparoscopic-modified Nissen fundoplication in children with familial dysautonomia.

Children with familial dysautonomia (FD) often require an antireflux operation and gastrostomy to prevent the detrimental effects of aspirated gastric juice on the lungs and to facilitate liquid feeding. The aim of this study was to examine whether a laparoscopic procedure in such patients is as safe and effective as the traditional open technique. The data for all pediatric patients who underwent a laparoscopic antireflux procedure for familial dysautonomia were reviewed and compared with those the last pediatric patients with FD who were operated upon using the open technique, before the introduction of the laparoscopic procedure. Of the 61 children who underwent an antireflux procedure for FD (1978-1996), 13 were operated on laparoscopically. The authors found that the postoperative course of these patients was less complicated than that of patients who had the traditional laparotomy procedure. There was no need for mechanical ventilation during the postoperative course, and there were no respiratory complications. The mean hospitalization period was significantly shorter (7.9 days v 13.2 days). There were no complications attributable to laparoscopy, and the antireflux procedure has been effective in all patients (short-term follow-up). The authors conclude that laparoscopic procedures that include a modified Nissen fundoplication, gastrostomy, and appendectomy are feasible and as safe as conventional surgery for the treatment of FD in children. It appears that this approach has fewer complications than laparotomy, might reduce the need for postoperative mechanical ventilation, and is associated with a shorter postoperative stay.

Adolescent↗