Biomedical subjects
Publications and source records attributed to I Charuzi.
Lipomas of the esophagus are relatively rare, but are of clinical interest since they may produce significant clinical symptoms that must be differentiated from malignant conditions. A case of esophageal lipoma is reported. The pliable, pedunculated esophageal tumor, which changes shape radiologically and has minimal clinical symptomatology, are the hallmarks for a correct diagnosis.
This study was undertaken in order to evaluate the implications of substituting a failed jejunoileal bypass with a gastric bypass, another bariatric procedure. During the same operation, the jejunoileal bypass is taken down and a Roux-en-Y gastric bypass created. All 12 patients who underwent the procedure and who form the basis for this study survived. In comparison with patients who underwent gastric bypass alone during the same period, peri- and postoperative morbidity did not increase. Following this operation blood glucose levels and arterial blood pressure decreased as the patients with the failed jejunoileal bypass lost weight. Serum cholesterol and triglyceride levels, which are known to decrease significantly after jejunoileal bypass, slightly increased but always remained within normal range after substitution by the gastric bypass. All patients who underwent the combined operation showed a dramatic improvement in life quality. We conclude that the simultaneous performance of these two procedures is a preferable alternative to the take-down alone of the original unsuccessful procedure.
In four patients, acute cholangitis was found to result from a ruptured hydatid cyst. In three patients, the diagnosis was established before operation by ultrasonography, and the fourth case was diagnosed during operation. Once the diagnosis of cholangitis is reached, our working policy includes administration of antibiotics and fluids, accelerated diagnostic workup, and operation as soon as possible. Our suggested operative procedure is cholecystectomy, choledochotomy, choledochoduodenostomy, and removal of the echinococcal cyst. In all four cases treated by us, there were no deaths, and only one patient who did not undergo removal of the echinococcal cyst at the initial operation needed a second operation 2 months later.
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A granular cell myoblastoma of the upper sigmoid colon is reported in a 53-year-old male. The tumor was detected during investigation of abdominal pain and was removed by colonoscopic polypectomy. Colonoscopy provides a new method of treatment for these unusual colonic lesions and avoids the need for surgery. To our knowledge the tumor has not been reported previously in the sigmoid colon.
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An investigation of the behavior of the blood platelet population following splenectomy and autologous splenic tissue implantation has been done on the rabbit. A bimodal rise in platelet size and count is observed in the postoperative period. After splenectomy, a 722 per cent increase in the platelet count and a 21.9 percent rise in the platelet size are found. These increases are abolished by the implantation of splenic tissue. The existence of a splenic humoral factor that controls platelet production in the bone marrow is possible.
A patient with varicoid carcinoma of the esophagus is reported. These tumors differ from classical esophageal carcinoma and have some resemblance to esophageal varices in their radiological and endoscopic appearances. Dysphagia is generally not the presenting symptom. The histological picture in our patient was that of a poorly differentiated adenocarcinoma with areas of signet-cell carcinoma. This is an exceptional finding since all previously reported cases of varicoid carcinoma of the esophagus have been squamous cell carcinomas.
A 38-year-old man developed pyloric stenosis one year after parietal cell vagotomy with omentopexy had been performed for perforated duodenal ulcer. Gastric outlet obstruction frequently occurs after treatment of perforated ulcer by omentopexy alone, and may also occur after parietal cell vagotomy with omentopexy. The usefulness of this combined procedure as a definitive treatment for perforated duodenal ulcer remains in question.
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Glomerulonephritis was induced in rats by multiple injections of rabbit anti-rat kidney serum. Colchicine was administered daily for 4 months to nephrotoxic serum treated rats and untreated control animals. Nephritic rats receiving colchicine had significantly less proteinuria and less glomerular damage than unprotected nephritis animals. A possible role for colchicine in the early treatment of human glomerulonephritis is suggested.
Clinical signs of central vein thrombosis as a complication of internal jugular vein cannulation are rarely seen. Two infants who developed thrombosis of the superior vena cava and one adult who developed thrombosis of the left brachiocephalic vein are presented.
3 cases of adrenal cysts are reported. The incidence of cyst originating in the adrenal gland was found to be 0.02-0.06% in autopsies. Adrenal cysts are usually symptomless making the diagnosis difficult. The cases described here were diagnosed and removed at operation. One of them was associated with hypertension, and another with pregnancy, considered to be exceptional. Two of these cysts were calcified. All of them were benign. The definite preoperative diagnosis is difficult and the surgical procedure recommended is resection of the cyst with preservation of as much adrenal tissue as possible if malignancy is excluded by frozen section. Since the number of operated cases diagnosed preoperatively are too small, the possibility of treating adrenal cyst by percutaneous aspiration and injection of opaque material to eventually avoid surgery could not be established.
A rise in the blood platelet count and volume occurred in 11 patients following traumatic splenectomy. The pattern of the volume distribution, however, remained unchanged. This indicates an increased rate of platelet production, with the newly formed cells substantially larger than their preoperative counterparts, and can be interpreted in terms of a humoral factor of splenic origin that is able to exert its control over the bone marrow. The stable shape of the volume distribution, despite splenectomy, suggests the presence of an organ other than the spleen that is capable of maintaining the normal age distribution in the peripheral circulation, and the liver is proposed as a possible candidate for this role. The evidence, so far, has been circumstantial and further investigation will be required before definite conclusions can be drawn.