Biomedical subjects

H Gutman

Publications and source records attributed to H Gutman.

60 records · Page 4Linked to original sources

PubMedDate not supplied

Topical Biafine and Lipiderm for the prevention of radiation dermatitis: a randomized prospective trial.

We evaluated the effects of Biafine and Lipiderm ointments in preventing radiation dermatitis. The study population included 74 patients after conservative surgery for early breast carcinoma who were referred for adjuvant external beam irradiation. Patients were randomized to receive Biafine or Lipiderm or no treatment. Both study preparations were applied twice daily, starting 10 days before onset of radiotherapy and continuing until 10 days after its completion. The skin treatment was upgraded, if clinically necessary, to steroids (grade 3), antibiotics (grade 4), or pause in therapy (grade 5). Success of treatment was evaluated according to the maximal level of skin treatment, the number of gaps in radiation therapy, the impression of the patients and the subjective skin reaction, and scores of the study nurse and radiotherapist. The three groups were comparable for all clinical features, except for a lower mean age of the Biafine group. Comparative analysis of the results showed no advantage for either preparation compared to the control arm other than maximal treatment level required for a skin reaction (mean 1.7 and 1.6 vs. 2.2), which did not reach statistical significance (p=0.145). Nevertheless, 86% of the patients in both the Biafine and Lipiderm arms expressed satisfaction with the respective ointments. In conclusion, neither Biafine nor Lipiderm seems to have a radioprotective effect.

Administration, Topical↗

PubMedDate not supplied

Multifactorial analysis of prognostic factors in emergency abdominal surgery in patients above 80 years. Analysis of 154 consecutive cases.

Patients above 80 have been the most rapidly growing group in the surgical department. The number of major laparotomies in this segment of the population has grown by 15% in the last two decades and is expected to grow by another 100% by the end of the century. The principal aim of the study was to identify by multifactorial analysis the combination of factors predictive of mortality in abdominal emergencies in this age group. A computer-held data base established by the Authors in 1978 was used to register all relevant information in 1327 major laparotomies performed in patients above 70. Of the base of 1327 patients, 219 (16.5%) were above 80. Of this group, 154 cases (70.3%) underwent emergency procedures and are the focus of this study. The principal conclusions of the Authors are as follows: A. The main differences between the two age groups 70-79 (Group A) and above 80 (Group B) are as follows: 1. Emergency laparotomies are much more frequent in Group B (70% versus 33%). 2. The overall mortality is over two and a half times as high (21.4% versus 8%). 3. The diagnostic profile and the mix of cases is different with an increased number of intestinal obstructions and malignancies in Group B. B. Unifactorial analysis of postoperative mortality disclosed the following factors associated with increased mortality: 1. Vital System Category III (Table 6-A). 2. Presence of generalized peritonitis or gangrenous bowel. 3. Presence of widespread malignant disease. 4. Belonging to the following diagnostic groups: carcinoma of pancreas, mesenteric thrombosis. 5. Age 85 or above.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗

PubMedDate not supplied

[Acute mesenteric thrombosis. Successful resection and revascularization. Report of a case].

Acute mesenteric thrombosis; resection and successful revascularization. A case report. A patient with acute mesenteric thrombosis was surgically treated with extensive bowel resection and revascularization interposing a synthetic vascular graft. A few months later on aortoduodenal fistula ensued. Critical discussion by the authors of their therapeutic approach with special emphasis on the value of dynamic CT scanning in the evaluation of a functioning synthetic vascular graft.

Aged↗

PubMedDate not supplied

Assessment of surgical residents' competence based on postoperative complications.

The aim of this prospective study was to evaluate surgical residents' operative skills on the assumption that differences in training might have a significant effect on postoperative complications, their type and incidence. This was accomplished using a departmental microcomputer and special non-commercial personally-developed software. There was no significant clinical difference found in the postoperative complication rate in matched groups of patients treated by senior staff and resident staff of the Department. It is suggested that the close supervision by the senior staff might play a role in this outcome. Although analysis of subgroups of patients sustaining moderate to severe postoperative complications showed a statistically significant difference between these surgeon categories, we may consider this difference attributable to the more complex operative problems handled by the senior staff in the same circumstances.

Female↗

PubMedDate not supplied

Sciatic pain: a diagnostic pitfall.

Neurological signs such as lower spinal cord lesions and/or femoral neuritis may be the presenting symptoms of a dissecting abdominal aortic aneurysm (AAA). We describe a patient in whom a severe sciatic pain was the presenting symptom of a non-dissecting AAA. The resection of the vascular mass resulted in dramatic relief of sciatic pain, thus indicating that the neurological impairment was caused by the non-dissecting aneurysm.

Aorta, Abdominal↗

PubMedDate not supplied

Age profiles of benign gallbladder disease in 2,000 patients.

Hospital charts and operative notes on 2,000 consecutive cholecystectomies performed between 1965-1984 for benign gallbladder disease were reviewed and computer analyzed. Patients were divided into five age categories (1-29, 30-49, 50-69, 70-79, 80 years and above). Fifteen variables were examined for each age category, including total number, sex, presenting symptoms (jaundice, acute cholecystitis, pancreatitis), intraoperative findings (presence of stones, common bile duct width and stones), operative procedures, bile cultures, histology, postoperative course and mortality. In addition to critically assessing performance and permitting comparison with other series, this age-related analysis suggests the following conclusions: The female predominance in age category 1 diminishes in categories 4 and 5. Acute cholecystitis and suppurative cholangitis occur in 44% of age category 5, compared to 14-24% in other age categories. Intraoperative fluorocholangiography is mandatory; common bile duct stones were found in 14% of age category 1. Age category 2 seems to be the group least susceptible to choledochal pathology. Acalculous cholecystitis is closely related to gangrenous changes, especially (almost selectively) in age categories 4 and 5. The frequency of infected bile rises with age, and is found in 90% of patients in age category 5. Mortality from operations for benign gallbladder disease is ten times higher in patients over 70 years of age compared to younger patients. An ultrasonographic study should be performed before any major laparotomy, especially in the aged, in order to diagnose silent stones, and prepare the patient for concomitant cholecystectomy. Elective cholecystectomy in age categories 4 and 5 is still accompanied by high mortality rates.

Adolescent↗