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Biomedical subjects

D Kopelman

Publications and source records attributed to D Kopelman.

At least 37 records · Page 2Linked to original sources
PubMed1998

Thoracoscopic sympathectomy for hyperhidrosis: is there a learning curve?

The aim of this study was to evaluate the learning curve of upper dorsal thoracoscopic sympathectomy. From June 1993 to December 1996, we performed 232 sympathectomies on 116 patients with primary palmar hyperhidrosis. The T2-T3 ganglia were resected by electrocuting and were removed for histologic examination. The series was divided into two groups of 58 patients each, and operations in each group occurred during a period of 21 months. Follow-up was obtained on 111 patients for a mean of 25.06+/-12.62 months. All limbs were dry after the operation, and hyperhidrosis did not recur. The anesthesia time was reduced, but the operating time, the difficulty in identifying and in resecting the ganglia, compensatory hyperhidrosis, postoperative neuralgia, and subjective satisfaction with the procedure were similar in both groups. The learning curve in the present study was mainly reflected by a reduction in the incidence of Horner's syndrome.

Adolescent↗
PubMed1997

[Gastrografin for mechanical partial, small bowel obstruction due to adhesions].

The therapeutic effect of gastrografin is occasionally mentioned in the literature. However, this effect has not been objectively evaluated. We studied prospectively the effect of Gastrografin in cases of adhesive, simple, partial, small bowel obstruction (SBO) compared to conventional management. During 3 years, a total of 137 episodes of simple, partial SBO in 127 patients (10 recurrent episodes) were treated. The episodes were randomized into a control group (80 episodes), treated conventionally, and a trial group (77 episodes), which received in addition 100 ml of Gastrografin administered through the nasogastric tube. The two groups were well-matched with regard to age, gender, weight, medical and surgical background and duration of complaints before admission. Time to first stool and resolution of obstruction, complications, need for surgery, and hospital stay were noted. Mean time to first stool was significantly shorter in the trial group: 6.2 +/- 3.9 hours vs 23.5 +/- 12.7 (p < .0001). Mean hospital stay for unoperated patients was also shorter in the trial group: 2.7 +/- 2 days vs 5.5 +/- 2 days, (p < .0001). In addition, significantly fewer episodes in the trial group required operation, 10.4 vs 26.7% (p < 0.013). 1 patient in each group dies following operation. There were no Gastrografin-related complications and it was effective and safe for adhesive, partial, simple SBO. It significantly speeds resolution of obstruction, reduces the need for operation, and shortens convalescence.

Contrast Media↗
PubMed1997

Emergency minilaparotomy cholecystectomy for acute cholecystitis: prospective randomized trial--implications for the laparoscopic era.

This prospective controlled trial evaluates the efficacy of minicholecystectomy (MC) in cases of acute cholecystitis compared to that of conventional cholecystectomy (CC) and discusses its implications in the laparoscopic era. Sixty consecutive patients with acute cholecystitis were prospectively randomized into two groups: MC group (30 cases) and CC group (30 cases). The two groups were well matched with regard to age, sex, weight/height index, previous upper abdominal surgery, and APACHE II scores. The mean length of incision was 5.5 cm (range 4.5-9.0 cm) in the MC group compared to 13.5 cm (range 12-16 cm) in the CC group. No significant differences were found between MC and CC with regard to operative time (69.1 +/- 17.0 and 68.1 +/- 15.4 minutes, respectively; p = 0.82), operative difficulty on a 1 to 10 scale (5.2 +/- 1.5 versus 4.6 +/- 1.6, respectively; p = 0.177), and complication rate (11% and 17%, respectively; p = 0.19). Significantly lower analgesia requirements were noted in the MC group: 27.5 +/- 14.6 mg of morphine sulfate compared to 44.5 +/- 13.2 mg in the CC group (p < 0.001). In addition, the duration of hospital stay was significantly shorter for MC patients (3.1 +/- 1.0 days) than in CC patients (4.7 +/- 1.2 days) (p < 0.001). Twenty-two patients (73.3%) in the MC group were reported to return to normal daily activities 2 weeks after the operation, compared to only 12 (40%) in the CC group (p = 0.0028). MC is safe and applicable as an emergency procedure for acute cholecystitis. It is superior to CC in terms of convalescence and cosmesis. The results of MC in the setting of acute cholecystitis compare favorably with the published results of laparoscopic cholecystectomy.

Acute Disease↗
PubMed1996

Upper dorsal thoracoscopic sympathectomy for palmar hyperhidrosis: improved intermediate-term results.

PURPOSE: The purpose of this study was to examine the immediate and mid-term results of thoracoscopic upper dorsal (T2-T3) sympathectomy for primary palmar hyperhidrosis. METHODS: From June 1993 to October 1994 we performed 106 sympathectomies on 53 patients with palmar hyperhidrosis. Thirty-four female patients and 19 male patients ranging in age from 15 to 44 years, (mean 23.1 years) were studied. Both sides were operated during the same surgical procedure. The T2-T3 ganglia were resected by electrocuting with a hook and were removed for histologic examination. Follow-up for a mean of 19.25 months was obtained on 52 patients (104 operated limbs). RESULTS: All limbs were completely dry at the end of the procedure, and hyperhidrosis did not recur during the whole follow-up period. Short-term postoperative complications (mainly atelectasis, pneumonia, pneumothorax, and hemothorax) occurred in six (11.3%) patients. Long-term sequelae were observed in 43 (81.1%) patients and included Horner's syndrome (9 patients, 17.3%, one side only in each patient), neuralgia (7 patients, 13.5%), and compensatory hyperhidrosis (35 patients, 67.3%). These sequelae were not permanent in all cases, and the degree of severity was variable. Six (11.5%) patients, three of whom regretted being operated, were dissatisfied with their results: one because of Horner's syndrome, one because of persisting neuralgia, and four because of compensatory sweating. CONCLUSIONS: Despite the large number of postoperative long-term sequelae, 88.5% of patients expressed subjective satisfaction from the procedure. Obtaining 100% of dry hands on mid-term follow-up makes this approach rewarding.

Adolescent↗
PubMed1996

Carcinoid tumor of the common bile duct.

A case of primary carcinoid tumor of the common bile duct is presented. Diagnostic and therapeutic uncertainties of this extremely rare cause of jaundice are discussed.

Adult↗
PubMed1995

An anomaly of the extrahepatic biliary system.

An anomaly of the extrahepatic biliary system is reported in which the common hepatic duct was found to enter the gallbladder, whereas the cystic duct drained the whole biliary system into the duodenum. Review of the literature revealed only eight previously reported similar cases. To ascertain such anatomy, a choledochal cyst and the Mirizzi syndrome must be excluded. In the past, the rarity of the configuration described herein led to transection of the common hepatic duct during cholecystectomy in most cases. The concomitant presence of other abdominal anomalies, as in our case, or severe inflammation in the porta hepatis should prompt suspicion of biliary anomalous anatomy. In that case, dissection of the gallbladder from the fundus downward will allow timely discovery of such an anomaly. Maintenance of continuity between the common hepatic duct and cystic-common biliary duct by preserving part of the gallbladder permits easy repair on a T tube.

Aged↗
PubMed1994

Thoracoscopic versus open supraclavicular upper dorsal sympathectomy: a prospective randomised trial.

The purpose of the present study was to compare the short term results of the "open" supraclavicular approach with the thoracoscopic access for T2-T4 sympathetic ganglionectomy in patients with palmar hyperhidrosis. Patients were randomly allocated into two groups of 12 each, and were operated on: one by the open supraclavicular access; the other by the transthoracoscopic approach. The effect on palmar perspiration, operative data, postoperative complications and patients's satisfaction on short term follow up were examined. All operations achieved dry hands. Only two significant differences were observed: longer anaesthesia and poorer patient satisfaction in the thoracoscopic group one week after surgery (probably because a higher proportion of cases developed prolonged postoperative chest pain). Both techniques similarly achieve dry hands. The open method is not longer or more difficult, is possibly associated with less morbidity, and gives a higher subjective satisfaction.

Adolescent↗
PubMed1994

Small bowel obstruction following laparoscopic cholecystectomy: diagnosis of incisional hernia by computed tomography.

As laparoscopic cholecystectomy has become the procedure of choice for symptomatic gallstones, specific complication related to this technique have been noted. We report a case of small bowel obstruction in the trocar puncture site following uneventful laparoscopic cholecystectomy in an extremely obese woman. Diagnosis was made by computed tomography, and reduction was possible by local approach, avoiding explorative laparotomy.

Cholecystectomy, Laparoscopic↗
PubMed1994

Therapeutic effect of oral Gastrografin in adhesive, partial small-bowel obstruction: a prospective randomized trial.

BACKGROUND: Previous published clinical observations claim that Gastrografin, a hyperosmolar gastrointestinal water-soluble contrast agent, speeds the resolution of postoperative ileus, barium impaction ileus, adhesive small-bowel obstruction, and intestinal obstruction caused by parasites and bezoars. However, no objective data exist that support the therapeutic effects of Gastrografin in these situations. METHODS: A total of 107 episodes of adhesive, partial small-bowel obstruction in 99 patients were randomized into a control group (48 episodes), who were treated with conventional methods, and a trial group (59 episodes), who were treated with 100 ml of Gastrografin administered through the nasogastric tube. The following variables were examined: time to resolution of partial small-bowel obstruction, the need for operation, complications, and hospital stay. RESULTS: Mean timing of the first stool was 23.3 hours in the control group and 6.2 hours in the patients receiving Gastrografin (p < 0.00001). Ten obstructive episodes (21%) in the control group required operative treatment compared with six (10%) in the trial group (p = 0.12). Mean hospital stay for the patients who responded to conservative treatment was 4.4 days and 2.2 days in the control and trial groups, respectively (p < 0.00001). One patient in each group died after operation. No Gastrografin-related complications were observed. CONCLUSIONS: Orally administered Gastrografin is safe and has a therapeutic role in adhesive, partial small-bowel obstruction. It significantly prompts the resolution of the obstructive episodes and shortens hospital stay. However, further studies are necessary to confirm the significance of our observation that it may reduce the need for operation.

Administration, Oral↗