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Biomedical subjects

B Klin

Publications and source records attributed to B Klin.

At least 55 records · Page 3Linked to original sources
PubMed1990

The use of the CO2 laser in pilonidal sinus disease: preliminary results of an ambulatory prospective study.

During a period of 18 months, from January 1988 to June 1989, 70 patients were treated for pilonidal sinus disease in a Multi-Specialty Military Clinic. There were 62 men and 8 women, with a median age of 19 years (range 18 to 35). All were managed as outpatients under local anesthesia. When an abscess was involved, the surgical procedure included incision, drainage, curettage, peroxide irrigation, and CO2 laser therapy. For the other processes, the surgical procedure included excision of sinus tissue and lateral fistulas, curettage, peroxide irrigation, and CO2 laser therapy with secondary healing. Morbidity was minimal. Healing time ranged from 14 days to 8 weeks, yet most sinuses healed in 4 weeks. The complications observed--pain, bleeding, and skin bridging--were minor. All recurrences but three were minor and healed completely after additional local treatment (4.3 percent major recurrences). Preliminary satisfactory results are reported, supporting a more conservative approach in the treatment of this often overtreated disease.

Adolescent↗
PubMed1990

Treatment of uncontrolled hemorrhagic shock with hypertonic saline solution.

Hypertonic saline solution (HTS) treatment of uncontrolled hemorrhagic shock (UCHS) induced by incision of three major branches of the ileocolic artery, leading to free intra-abdominal bleeding, was studied in rats. The rats were divided into two groups. In group 1, the abdominal wall was closed immediately after induction of hemorrhage and the rats were divided into six subgroups--1a, five untreated; 1b, 14 treated with 5 milliliters per kilogram of sodium chloride 7.5 per cent (HTS) after five minutes; 1c, eight had HTS infused after 15 minutes; 1d, nine had HTS infused after 30 minutes; 1e, nine had HTS infused after 60 minutes, and 1f, nine had HTS infused after 120 minutes. In rats in group 2, the abdominal wall was kept open during HTS therapy and bleeding was estimated by the amount of sponges used to absorb shed blood. These rats were also divided into six subgroups--2a, five untreated; 2b, nine had HTS infused after five minutes; 2c, six had HTS infused after 15 minutes; 2d, six had HTS infused after 30 minutes; 2e, eight had HTS infused after 60 minutes, and 2f, six had HTS infused after 120 minutes. UCHS in group 1 was followed by a fall in the mean arterial pressure (MAP) from 99 to 46 torr (p less than 0.001) in five minutes and a gradual rise to 63 torr (p less than 0.01) after 30 minutes, with a survival rate of 80 per cent. HTS infusion five minutes after hemorrhage was followed by a further fall in MAP to 37 torr (p less than 0.01) after 30 minutes and a mortality rate of 85.7 per cent (p less than 0.01). HTS treatment after 15, 30, 60 and 120 minutes also led to a further fall in MAP and increased mortality. In group 2, the hemodynamic response to intra-abdominal vessel injury in untreated rats was similar to that of those in group 1 and the amount of sponges used to absorb shed blood was 2.4. After five, 60 and 120 minutes of HTS treatment, the hemodynamic response was similar to that in group 1. Five and one-half (p less than 0.01), 3.5 and 3.0 sponges, respectively, were used to absorb shed blood.(ABSTRACT TRUNCATED AT 400 WORDS)

Abdominal Muscles↗
PubMed1990

Sebaceous cyst excision with minimal surgery.

Sebaceous cysts are common benign tumors found on the scalp, ears, retroauricular areas, scrotum, face and thorax. A technique involving minimal surgical trauma and good cosmetic results is described. In a series of 302 patients, the recurrence rate was extremely low (0.66 percent) during 18 months of follow-up. Experience with a minimal-incision technique suggests that this method is a satisfactory alternative to conventional, more invasive surgery.

Epidermal Cyst↗
PubMed1989

The ultrasound spectrum of emphysematous cholecystitis.

This report presents a gamut of ultrasound signs that may be seen in emphysematous cholecystitis. These can be summarized as follows: Intraluminal gas: (a) A dense band of hyper-reflective echoes with distal reverberations when gallbladder is full of gas. (b) A band of reverberations in the gas-filled portion of the gallbladder with the usual signs of cholecystitis in the bile-filled portion when the gallbladder is partially full of gas. Intramural gas: (c) An area of high reflectivity in the gallbladder wall with reverberations that may change position with change in position of patient. (d) A bright hyper-reflective ring emanating from the whole circumference of the gallbladder.

Acute Disease↗
PubMed1989

Quantitative measurement of bleeding following hypertonic saline therapy in 'uncontrolled' hemorrhagic shock.

The effect of small volume hypertonic saline in "uncontrolled" hemorrhagic shock (UCHS) induced by partial resection of the tail was studied in rats. The rats were divided into three groups: in group 1 (n = 15) 10% of the terminal portion of the animal's tail was resected to induce UCHS. In group 2 (n = 14) UCHS was induced as in group 1 and after 5 min 5 ml/kg NaCl 0.9% (NS) was infused intravenously. In group 3 (n = 22) UCHS was induced as in group 1 and after 5 min, 5 ml/kg NaCl 7.5% (HTS) was infused intravenously. Resection of the animal's tail was followed by bleeding of 3.5 +/- 0.3 ml within 5 min, fall in MAP to 63 +/- 4 torr (p less than 0.001) and pulse to 300 +/- 18 per min (p less than 0.05). The amount of bleeding, fall in MAP, and pulse after 5 min were similar in the three groups. Further blood loss after 60 min in group 1 was 3.7 +/- 0.8 ml, in group 2, 2.9 +/- 0.5 ml, and in group 3, 6.5 +/- 0.8 (p less than 0.01). Increased bleeding in group 3 showed two peaks: an early peak of 1.3 +/- 0.2 ml after 15 min (p less than 0.05) and a late peak of 1.2 +/- 0.4 ml at 45 min (p less than 0.05) and 1.7 +/- 0.5 ml at 60 min (p less than 0.01). MAP fell after 60 min to 54 +/- 7 torr in group 1 (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

Epidural methadone for analgesic management of patients with conservatively treated proximal femoral fractures.

Epidural methadone analgesia was initiated soon after admission to emergency room in elderly patients who sustained osteoporotic proximal femoral fracture and who were considered to be high surgical risks. The severe pain was significantly reduced, enabling early mobilization of the patients. The analgesia was discontinued only when nonnarcotic analgesia sufficed. The treatment lasted for about 3.5 weeks. One minor complication was observed during the treatment period. We concluded that patients who have femoral neck fracture who are at high risk for operation and have to be observed and stabilized before operation can be managed by continuous epidural methadone analgesia.

Aged↗
PubMed1989

Small bowel phytobezoars: detection with radiography.

The authors reviewed the radiographic findings in 19 patients with phytobezoars of the small bowel. The most common predisposing causes were previous gastric outlet surgery and persimmon ingestion. Twelve patients underwent contrast material-enhanced studies of the upper gastrointestinal tract, and one patient underwent a barium enema study. These examinations revealed four gastric, two duodenal, and eight small bowel phytobezoars in 10 patients. The obstruction caused by small bowel phytobezoars frequently occurred in the jejunum or proximal ileum, more proximally than has been reported in previous series. Barium studies are useful in differentiating obstruction due to postoperative adhesions from obstruction caused by bezoars. In addition, barium studies enable the detection of residual gastric bezoars. This information has important implications in patient treatment because bezoar obstruction is unlikely to respond to conservative treatment, and concurrent gastric bezoars must be removed to prevent recurrent bowel obstruction.

Barium Sulfate↗
PubMed1988

Effect of prostaglandin and leukotriene antagonists in acute mesenteric artery occlusion.

Superior mesenteric artery occlusion leads to mesenteric ischemia, activation of arachidonic acid metabolism and release of endotoxins into the systemic circulation. The effect of leukotriene and prostaglandin antagonists on hemodynamic response and survival of rats after superior mesenteric artery (SMA) occlusion was investigated. The animals were divided into five groups: in group 1 (n = 105) the SMA was clamped for 2 h and mortality assessed after 24 h. Group 2 animals (n = 20) were pretreated with 5 mg/kg indomethacin and the SMA clamped similarly to group 1, group 3 animals (n = 15) were pretreated with 5 mg/kg Voltaren, group 4 animals (n = 20) received 20 mg/kg BW 755C before mesenteric artery occlusion, and group 5 animals (n = 50) were pretreated with 100 mg diethylcarbamazine. The blood pressure and pulse response as well as histologic appearance of the bowel 1 h after declamping was similar in all five groups. The mortality rate after 24 h was 34% in the control group, 36% with indomethacin treatment, 36% with voltaren, 47% with BW 755C and 40% with diethylcarbamazine. The mortality rate in all the treated groups was not significantly different from the control group. Plasma thromboxane B2 levels were inhibited significantly by indomethacin and Voltaren and to a lesser extent by BW 755C. There was a paradoxical rise in thromboxane B2 following diethylcarbamazine treatment. It is concluded that inhibition of the cyclooxygenase and/or the lipoxygenase pathways of arachidonic acid did not alter the hemodynamic response and mortality following 2 h of acute superior mesenteric artery occlusion.

Acute Disease↗
PubMed1987

Disseminated intravascular coagulopathy in patients with cancer undergoing operation for pathological fractures of the hip.

Disseminated intravascular coagulopathy is a serious complication of numerous pathological conditions, particularly metastatic cancer. It is rarely encountered in orthopaedic surgery. Prompt recognition and treatment is required to prevent death. We describe two patients with pathological fractures of the proximal femur due to metastatic disease who died from disseminated intravascular coagulation after operation. A high index of suspicion, careful monitoring of the clotting mechanism and prompt treatment are required.

Aged↗
PubMed1985

Continuous epidural narcotic analgesia for intractable pain due to malignancy.

Eighty consecutive cancer patients with severe pain, uncontrolled by conventional narcotic analgesics, received a 2-mg test dose of morphine epidurally. Thirty-four of them had significant pain relief and were thus selected to receive continuous treatment. This consisted of 2-6 mg of morphine administered every 8-24 hours through an indwelling epidural catheter. The duration of treatment was from 1 to 28 weeks with a median of 4 weeks. Twenty-five (76%) of the patients experienced complete relief of pain, while nine had only a partial analgesic response. Complications were minimal. No sepsis, hypotension, or respiratory depression occurred. It is recommended that cancer patients with intractable pain will be selected for continuous epidural analgesia by evaluating their response to a test dose of epidural morphine.

Adult↗
PubMed1984

Amputation neuroma of common bile duct with obstructive jaundice: a case report.

A 67-year-old woman was hospitalized because of recurrent attacks of epigastric pain, chills, fever, jaundice and pruritus of 6 months' duration. Six years earlier, the patient had undergone cholecystectomy. The present endoscopic retrograde cholangiopancreatography demonstrated a proximal irregular choledochal stricture. Resection of the stricture with end-to-end anastomosis was performed. Histological examination of the surgical specimen revealed an amputation neuroma.

Aged↗
PubMedDate not supplied

Laparoscopic cholecystectomy: treatment of choice for cholelithiasis in children.

Laparoscopic cholecystectomy is rapidly replacing traditional cholecystectomy as the standard treatment for cholelithiasis and cholecystitis in adults. Over a period of 16 months, 14 children with a clinical diagnosis of cholelithiasis, ranging in age from 4 to 15 years (mean 12.2), were treated. All had symptoms of abdominal pain or vomiting; one had jaundice and recurrent cholecystitis. Five children (35%) had associated metabolic or hemolytic diseases. The 14 children were operated on using the laparoscopic cholecystectomy technique. No operation was converted to open cholecystectomy, but two patients required laparotomy: one because of suspected injury to the common duct, and the other because of nonvisualization of the gallbladder during laparoscopy. The mean post-operative hospital stay for the 11 children who underwent only laparoscopic cholecystectomy (one patient also had a simple mastectomy) was 50 hours (range 48-72 hours). All children resumed their normal activities almost immediately after discharge from hospital. No long-term biliary or other complications were seen in any patient throughout an average follow-up period of 6.2 months (range 3-16 months). The benefits of this operation in children are obvious: It is safe, effective, and well tolerated.

Adolescent↗
PubMedDate not supplied

Balloon catheter dilatation of focal colonic strictures following necrotizing enterocolitis.

Two infants with severe colonic strictures secondary to necrotizing enterocolitis (NEC) were successfully dilated with balloon catheters. The procedures were performed under mild sedation, with fluoroscopic guidance. Results were sustained for more than 4 years follow-up. This procedure proved to be a safe and effective alternative to operative repair.

Catheterization↗
PubMedDate not supplied

Nonoperative management of blunt splenic trauma in adults.

Forty-five adult patients with traumatic splenic injuries were treated during a 6-year period between 1980-1986 at Hadassah Hospital. The diagnosis was confirmed by splenic scintigraphy with 99mTc Tin-colloid. Fifteen patients (33%) who were stable on admission or after initial resuscitation were treated non-operatively and selected for this study. Treatment consisted of careful hemodynamic monitoring, strict bed rest, nasogastric suction, and i.v. fluids. In no case was emergency laparotomy necessary for deterioration of clinical condition or late complications. Splenic scans were repeated in 11 of the patients to assess resolution. In six of the patients, minimal residual defects were detected with no further complications. It is concluded that nonoperative treatment of splenic injuries in carefully selected patients is both safe and effective.

Adolescent↗