Biomedical subjects
Publications and source records attributed to D Seror.
Enteral feeding by a jejunostomy tube is a reliable and cost-effective method for both long- and short-term nutritional support in selected patients, although a high complication rate has been reported in some series. The authors report on jejunal perforation in an infant, caused by a kinked jejunostomy tube, and emphasize this possible pitfall as a warning to others.
Spontaneous rupture of the urinary bladder is a rare entity. This is, in part, the cause for the low rate of correct preoperative diagnosis, the high rate of delayed diagnosis, morbidity and mortality. We report a case of spontaneous rupture of the urinary bladder in an adult patient, complicated by extensive fascitis of the abdominal wall. The stormy course and long hospitalization in the case described are characteristic of patients with spontaneous bladder rupture and warrant a high index of suspicion in order to achieve an early diagnosis.
Spontaneous rupture of the spleen is rare Although over 100 cases have been reported, only a few were of true spontaneous rupture. Most cases were associated with diseases which directly involved the spleen. We report a 53-year-old woman with facial erysipelas and true spontaneous rupture of the spleen.
Explore the source record for details and available documents.
Although postoperative adhesion ileus is the most common cause of small bowel obstruction in adults, its management remains controversial. We retrospectively studied 297 admissions of 227 patients over a period of 14 years to evaluate our conservative approach in managing adhesion ileus. We found that nonoperative therapy of up to 5 days' duration can be used safely for the majority of patients who present with postoperative intestinal obstruction, including those with complete obstruction. In those patients, who responded to conservative treatment, the obstruction resolved within a mean of 22 hours and a maximum of 5 days. A trial of more than 5 days' duration proved ineffective. The conservative approach resulted in a 73% resolution of obstruction with no significant increase in mortality or in the rate of strangulated bowel.
Explore the source record for details and available documents.
Thirty-four children with familial dysautonomia (FD) underwent Nissen fundoplication and gastrostomy. The indications for operation were persistent cyclic vomiting that resulted in repeated aspiration pneumonia (94% of the patients), chronic dehydration (82%), failure to thrive (97%), and frequent hospitalizations (76%). There was no operative or early postoperative mortality. Long-term follow-up for up to 12 years was available. Eight patients died during this period from 7 months to 7.5 years postoperatively. In 5 patients (15% of the operated patients), the fundoplication ceased to function 16 months to 5 years postoperatively, which was attributed mainly to repeated severe dysautonomic crises with vigorous retching. Vomiting ceased in 85% of the symptomatic patients; pulmonary deterioration was halted, and the frequency of aspiration pneumonia was reduced in 68%; nutritional improvement was seen in 44%; the hydration status improved in 88%; and the frequency of hospital admissions decreased in 74%. These long-term findings resulted in a significant improvement in the quality of life for the majority of the patients. The absence of operative mortality and the low postoperative morbidity, together with the long-term beneficial results of this surgical procedure, should encourage early surgical intervention in selected FD patients.
Acquired tracheoesophageal fistula (TEF) is a rare entity in the pediatric age group. We report two pediatric patients with acquired TEF caused by shells of pistachio nuts. In both patients the primary operation did not resolve the problem and a second intervention for recurrent fistula was needed. The special nature of acquired TEF, particularly the one described herein, requires delayed surgical intervention and meticulous separation of the respiratory and alimentary tracts by an intercostal muscle flap.
Felix Wurtz, a surgeon in Basel and Zurich, wrote a book on pediatrics, The Childrens Book, which was first published (after his death) in 1612. It is the first known book in western Europe to deal with pediatrics and surgery. The book discusses issues dealing with the care of children, also addressing problems in pediatric surgery, primarily congenital and acquired orthopedic malformations. The book, and the contribution of its writer to pediatric surgery, are reviewed. The accuracy of the first English language translation is also evaluated.
Enteral feeding by tube jejunostomy, inserted during definitive surgery, was used in 19 adult patients operated upon in a 24 month period. Jejunostomy feeding was associated with a low rate of minor complications enabling delivery of adequate caloric and protein input shortly after major abdominal operations and up to 9 months later. We feel that the insertion of a regular size jejunostomy tube during surgery is a simple, brief and safe procedure which offers efficient and inexpensive nutritional support, and thus has an important role in the post-operative management of selected patients. It is also easily used in the home setting if needed.
We report the case of a patient with peptic ulcer disease who developed cimetidine-induced thrombocytopenia. The thrombocytopenia resolved spontaneously following discontinuation of cimetidine, and did not recur with ranitidine. We concluded that cimetidine and ranitidine do not necessarily cross-react to induce thrombocytopenia. Thus the exclusion of both H2-blockers in the event that one has caused thrombocytopenia may not be justified.
Explore the source record for details and available documents.
The effect of meperidine on the mechanical activity of isolated guinea pig common bile duct (CBD) and gallbladder was studied in vitro. The effect was found to consist of inhibitory and excitatory phases. The inhibitory phase, characterized by a decrease in the response of the CBD and gallbladder to carbachol and electrical stimulation, was seen with concentrations of 10(-6) M or higher. The excitatory phase, seen at high concentrations of meperidine (5 X 10(-5)-10(-4) M), involved an increase in spontaneous contractions of CBD and in the tone of the gallbladder. Neither effect of meperidine was affected by 0.5 X 10(-5) M naloxone. These data indicate that meperidine acts on the biliary tract by a mechanism different from that associated with the effect of morphine.
Percutaneous cannulation of the internal jugular vein is a widely used and accepted method for central venous cannulation, used for parenteral alimentation, fluid administration, and measurement of pressures. A multitude of complications associated with this procedure have been described. Horner syndrome as a rare complication of internal jugular vein cannulation is presented.
BACKGROUND: Morbid obesity is associated with over-secretion of leptin and insulin, and predisposes to development of carbohydrate intolerance. In the current study, we explored the impact of BMI after laparoscopic adjustable gastric banding (LAGB) on leptin, insulin and proinsulin levels. METHODS: 23 obese patients (8 males, 15 females) were included in the study. Their mean age was 36+/-6 yrs (range 21-56 yrs). Blood samples were collected for measurement of plasma leptin, insulin and proinsulin before and 6 and 14 months after LAGB. RESULTS: Mean BMI before surgery was 46.04 +/- 4.44 kg/m2, with significant and equal reduction of 18% in each of the follow-up periods, with total BMI reduction of 33% (P <.0001). The levels of circulating leptin, insulin and proinsulin before intervention were 119.3 +/- 53.1 ng/ml, 159 +/- 13 pmol/l, and 36.36 +/- 23.06 pmol/l respectively. Despite an equal BMI reduction in the 2 follow-up periods, the most significant decrease in hormone levels was observed in the immediate postoperative period (54, 53, and 45%, respectively), when compared to the second follow-up period (15, 30, 10%, respectively). The highest total decline in hormone level of 70% was obtained with insulin, compared to 52% in leptin, and 50% in proinsulin. Despite the significant decrease in proinsulin and insulin levels, their ratio increased from 0.22, to 0.28 and 0.36 after LAGB. Unlike insulin and proinsulin, leptin levels strongly and persistently correlated with BMI during the study. CONCLUSION: Following LAGB, weight loss was associated with decreased levels of circulating leptin, insulin and proinsulin, most prominent in the first follow-up period. Unlike insulin and proinsulin, leptin showed the most significant and persistent correlation with BMI, suggesting that morbid obesity acts through different feedback hormonal mechanisms which are probably not regulated only by absolute weight loss. Longer follow-up and larger numbers of patients are needed to clarify long-term hormonal profile, as well as the beneficial lasting effects of such interventions.
We report an 11-year-old boy with acute rheumatic fever who presented with gastric perforation while treated with corticosteroids (CS). He had been treated initially with acetylsalicylic acid for 11 days, CS replaced the treatment with acetylsalicylic acid due to deterioration of carditis. The possible pathogenesis is discussed.