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Biomedical subjects

E Antebi

Publications and source records attributed to E Antebi.

At least 19 recordsLinked to original sources
PubMed1998

Technetium-99m-HIDA scintigraphy versus endoscopic retrograde cholangiopancreatography in demonstrating bile leaks after laparoscopic cholecystectomy.

In two patients who had laparoscopic cholecystectomy, the postoperative course was complicated by continuous bilious drainage from the surgical drain in one and by jaundice in the other. In both patients, the findings of 99mTc-N-substituted-2,6-dimethylphenyl carbamoylethyl iminodiacetic acid (HIDA) scanning were interpreted as clearly demonstrating a significant bile leak in one and the complete absence of bile passage from the liver to the intestines in the other. These findings could result from either spontaneous closure of the bile leak or false-positive HIDA scans. Subsequent endoscopic retrograde cholangiopancreatography (ERCP) showed the common bile duct and the cystic duct to be normal, without any evidence of bile leakage or any problem with drainage to the intestines. In all patients who have a positive 99mTc-HIDA scan, ERCP should be performed before deciding on further surgical intervention.

Adult↗
PubMed1997

Surgery in Israel.

The evolution and development of surgery in Israel reflects the influence of its dramatic historical events. The immigration of surgeons, particularly since the fourth decade of the 20th century, highly contributed to the framework of modern surgery. Medical education occurs at 4 medical schools, in Jerusalem, Tel Aviv, Haifa, and Beer Sheva, and postgraduate surgical training takes place in all public hospitals, most of which are university hospitals or have university-affiliated departments, and is controlled by the Scientific Council of the Israel Medical Association (Tel Aviv). Health care is provided by 4 health insurance funds and has been recently influenced by the National Health Insurance Bill and the Bill of Patient's Rights. Surgical standards are high and similar to the very best of Western countries. The geographical location of Israel in the Middle East, surrounded by hostile Arab countries, has dramatically influenced the development of Israeli surgery. The practice of surgery ranges from full-time service in state and insurance-funded mostly academic hospitals, to private part-time clinics for wealthy and insured patients. Surgical training occurs only in departments accredited by the Scientific Council, which are mostly affiliated with the 4 medical schools. A surgical residency in Israel usually requires 6 years, and its guidelines and regulations are elaborated and recommended by the Israel Surgical Society and controlled by the Scientific Council. Most Israeli surgeons were trained in Israeli hospitals, but a substantial number of surgeons immigrated to the country, especially from eastern Europe.

Curriculum↗
PubMed1997

Liver hemangioma. A perioperative Tc-99m RBC SPECT correlation.

Scintigraphic diagnosis of a liver hemangioma may be difficult when its size approaches the spatial resolution of a gamma camera, and it may not be visualized on a Tc-99m tin-colloid liver SPECT study. The contribution of Tc-99m labeled RBC scintigraphy is shown in a patient with a liver hemangioma discovered during laparoscopic cholecystectomy for chronic cholecystitis. Despite negative CT, US, and Tc-99m tin-colloid SPECT of the liver, Tc-99m labeled RBC SPECT disclosed a focus of increased activity consistent with the hemangioma.

Colloids↗
PubMed1996

The role of nuclear scintigraphy of suspected bile duct injury following laparoscopic cholecystectomy.

Nuclear scintigraphy is a rapid and non-invasive tool for the diagnosis of suspected bile duct injury following laparoscopic cholecystectomy. We describe our experience with this technique in 19 out of more than 1,000 cases of laparoscopic cholecystectomy in our department. Of the five patients in whom nuclear scintigraphy revealed abnormalities, three showed bile leak to the peritoneum and underwent immediate laparotomy. Only one of these required choledochojejunostomy; in the others the leak would have closed spontaneously without surgery. In the remaining two patients there was apparently no passage to the duodenum on nuclear scintigraphy. Endoscopic retrograde cholangiopancreatography (ERCP) performed in one showed a normal bile duct. In the other patient, repeated scintigraphy done 12 h later, prior to ERCP, showed normal passage to the duodenum. Our experience indicates that laparotomy could have been avoided had ERCP been performed first. Therefore, we suggest that if nuclear scintigraphy fails to demonstrate passage to the bowel or shows a bile leak, ERCP is indicated.

Aged↗
PubMed1993

[Malignant peritoneal mesothelioma].

Public attention has recently been devoted worldwide to malignant mesotheliomas and their relation to exposure to industrial materials, especially asbestos and its products. The more common form of the disease is the pleural type, while the peritoneal variant is rare, with an estimated incidence of less than 1:1,000,000 new cases per year. In contrast to the pleural type, the relationship of malignant peritoneal mesothelioma to exposure to asbestos is unclear. The differential diagnosis, based on clinical appearance and imaging techniques, is broad and the diagnosis is inconclusive, so that the diagnosis must be confirmed by histologic examination. Treatment is a combination of surgery, chemotherapy and irradiation. Contrary to occasional reports, the malignancy is fatal, death occurring within a few months of diagnosis. We present a 65-year-old man in whom malignant peritoneal mesothelioma was diagnosed. The presenting symptoms were a large abdominal mass involving the colon, and ascites. He died 5 months after the diagnosis was made.

Aged↗
PubMed1993

Management of gallstone ileus--a controversial issue.

Four cases of gallstone ileus were treated during a 3-year period. Three patients aged 74-81 years underwent a one-stage operation consisting of enterotomy, stone extraction, cholecystectomy, and suturing of the entero-biliary fistula. One 83-year-old patient was considered a poor risk and underwent only enterotomy with stone extraction, without cholecystectomy. In all four patients the postoperative course was uneventful. In one, carcinoma of the gallbladder was found. On the basis of this experience as well as that reported in the literature, it is concluded that the procedure to be preferred in stabilized patients is a one-stage operation, whereas in debilitated patients only relief of the obstruction should be sought.

Aged↗
PubMed1992

[Subcutaneous emphysema complicating laparoscopic cholecystectomy].

Laparoscopy using carbon dioxide has been a standard gynecological procedure for many years. During the past 3 years, it has become commonly used in general surgery as well. Laparoscopic cholecystectomy is rapidly spreading world-wide. Although minor and major complications have been attributed to this procedure, their frequency is low. We report a case of subcutaneous emphysema following laparoscopic cholecystectomy.

Adult↗
PubMed1992

The effect of short-term lipid infusion on liver function and biliary secretion in rats.

This study was undertaken to determine the effect of various lipid emulsions on the hepato-biliary system in rats. Rats were randomly divided into six groups and infused continuously for 48 hr with either long-chain triglycerides (LCT), medium-chain triglycerides (MCT) or a mixture of MCT and LCT. One group infused with physiological saline solution served as controls. Throughout this period the rats received a fat free diet ad libitum. During the last hour of lipid infusion bile was collected for determination of bile flow and composition. Subsequently, the rats were sacrificed and the morphology and lipid content of the liver determined. Only LCT lipid emulsions induced morphological changes and increased liver cholesterol content. In two rats infused with radiolabeled LCT, no labeled cholesterol was found in the liver, indicating that the excess hepatic cholesterol level may originate from enhanced cholesterol mobilization to the liver. Biliary cholesterol and phospholipid concentrations in LCT-treated rats were also elevated, as was the lithogenic index, whereas the other emulsions had no such effects. None of the emulsions affected the plasma liver function tests or bile flow. We therefore conclude that the lithogenicity of the bile in rats is directly related to the lipid components of the total parenteral nutrition and the type of triglyceride infused.

Animals↗
PubMed1992

Effect of lipid infusion on bile composition and lithogenicity in patients without cholesterol gall stones.

A prospective study was performed to investigate the effect of short term lipid infusion on bile composition and its lithogenicity in humans. Thirty five patients shown to be free of cholesterol gall stones participated in the study. Starting 48 hours before surgery they were infused randomly with a lipid emulsion of either long chain triglycerides (LCT) or a mixture of medium and long chain triglycerides (MCT/LCT) (50%/50%) for six hours each 24 hours. A group of patients infused with a solution of 5% glucose in NaCl 0.9% served as a control. Bile samples were obtained by puncture of the gall bladder during operation. Both lipids caused an increase in biliary cholesterol and phospholipids but this effect was more pronounced and significant (p < 0.001) only with the MCT/LCT emulsion. The fatty acid composition of biliary phospholipids was not affected by either lipid infusion. The cholesterol saturation index increased significantly (p < 0.005) with the MCT/LCT emulsion and there was shortening in the nucleation time but this was not significant. There was no effect on the distribution of cholesterol between micelles and vesicles. This study shows that infusion of MCT/LCT lipid emulsion can cause lithogenic changes in bile composition in humans and may thus contribute to sludge formation and cholelithiasis during long term parenteral nutrition.

Bile↗
PubMed1992

Auditory brainstem evoked response in patients undergoing carotid endarterectomy.

Auditory brainstem evoked response-(ABR) may be affected by changes in cerebral blood flow. Apart from its primary indications for prevention of stroke and transient ischemic attacks-(TIA's), internal carotid endarterectomy-(ICE) has been shown to improve cognitive function and cause diminution of tinnitus and vertigo. A one-week postoperative ABR previous study of patients undergoing ICE demonstrated no change in ABR recordings. In order to evaluate possible late changes, we have conducted a prospective study of the delayed effects of ICE on ABR in 13 patients. No initial pathology was noted and no significant change found in any of the absolute and interpeak latencies of ABR waves.

Acoustic Stimulation↗
PubMed1992

[Implanted subcutaneous venous catheter for prolonged intravenous treatment].

Subcutaneous venous catheter devices were implanted in 104 patients between January 1989 and June 1991. In 90% the implantation was performed under local anesthesia as an ambulatory procedure. In 85% the catheter was implanted for long-term chemotherapy and in 15% for intravenous feeding, antibiotic treatment or dialysis. There were postoperative complications in about 10%, the most frequent being infection of the surgical wound or of the catheter canal. Venous thrombosis, cutaneous necrosis and catheter occlusion were observed in only 5%. The main advantages of the method are its convenience for the patient, ease of installation and low rate of complications. From our experience we conclude that the implanted subcutaneous venous catheter is a simple and effective procedure for prolonged intravenous treatment.

Ambulatory Surgical Procedures↗
PubMed1991

Prospective comparative study of magnetic resonance imaging versus transrectal ultrasound for preoperative staging and follow-up of rectal cancer. Preliminary report.

The efficiency of magnetic resonance imaging (MRI) and that of transrectal ultrasound (TRUS) were compared in preoperative staging of 15 patients with rectal cancer and in postoperative follow-up of 12 patients. Thirteen of the 15 patients evaluated for preoperative staging were operated on. Preoperative staging and pathologic finding were identical in 11 patients (84.6 percent) examined by TRUS and in 10 patients (76.9 percent) examined by MRI. Recurrent cancer was detected in 3 of 12 patients in the follow-up group. MRI was able to diagnose correctly 10 of 12 patients (83.2 percent), one patient was misdiagnosed, and in one patient the MRI could not distinguish between fibrous tissue and recurrent cancer. TRUS diagnosed correctly only 5 of 12 patients (41.6 percent). One was falsely diagnosed, and, in 6 patients (50 percent), this examination could not differentiate between fibrous tissue and recurrent tumor. According to our results, both MRI and TRUS have a place in the preoperative staging of patients with rectal cancer. The main differences between the two methods were in the differential diagnoses of fibrous tissue and recurrent cancer. MRI being more specific in detection of recurrence.

Aged↗
PubMed1991

[Laparoscopic cholecystectomy].

The standard treatment for cholelithiasis is cholecystectomy at open operation, which requires relatively long hospitalization and long absence from work. These socio-economic factors and a desire to avoid operative trauma and its complications led to the development of noninvasive therapy. The methods used so far, stone dissolution and extracorporeal shock wave lithotripsy, have proven unsatisfactory. The first takes a long time and has a high recurrence rate, the second has relatively frequent complications. Furthermore, both methods leave the diseased gallbladder in place. During the past year laparoscopic cholecystectomy has been developed in various centers and has been adopted in our department. We describe our initial experience with the technique in 70 cases aged 18-79 years.

Adult↗
PubMed1990

[Duodenal duplication cyst].

Duodenal duplication cysts are rare and are usually found in neonates or young children who present with obstructive symptoms. It accounts for 4-12% of all duplications in the gastrointestinal tract. The rate of other developmental abnormalities has been reported as high as 38%. In few instances have duodenal duplication cysts been described in adults. A case of duodenal duplication cyst in a 46-year-old woman is presented. The diagnosis was established preoperatively by computerized tomography and ultrasound examination.

Cysts↗
PubMed1990

[False aneurysm: a complication of carotid endarterectomy].

False aneurysm of the carotid artery is a rare complication of carotid endarterectomy. We present a 65-year-old woman and a 68-year-old man with this condition. In 1 the artery had been closed with a Dacron patch graft, and in the other by direct suture. In the first case the aneurysm was successfully repaired with an expanded GoreTex (PTFE) patch graft sutured with monofilament nylon. In neither case was an organism grown from cultures taken at operation. The incidence of false carotid aneurysm as a complication of endarterectomy is only 0.3%. Usually infection is the main cause. It is therefore surprising that closure with a synthetic patch-graft is not a predisposing factor in the development of false carotid aneurysms, neither according to the literature nor in our own very limited experience with this complication.

Aged↗
PubMed1989

[Spontaneous external biliary fistula].

Spontaneous biliary cutaneous fistula is a rare complication of inflammatory perforation of the gallbladder. We describe a 70-year-old woman who developed a fistula between the gallbladder and the skin following drainage of an abdominal wall abscess. In such cases primary drainage of the abscess alone is advisable. Only after the active infection has subsided should definitive cholecystectomy and excision of the fistulous tract be carried out.

Abdominal Muscles↗