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Biomedical subjects

I Kreel

Publications and source records attributed to I Kreel.

At least 19 recordsLinked to original sources
PubMed1992

Elevated CA19-9 in a case of Mirizzi's syndrome.

At levels greater than 1000 U/ml, the tumor-associated antigen CA19-9 has a specificity approaching 100% for malignant disease. A 67-yr-old woman with known cholelithiasis presented with painless jaundice and a CA19-9 of 1320 U/ml. The diagnosis of Mirizzi's syndrome was made at laparotomy, and the postoperative level fell rapidly to normal. Mirizzi's syndrome should be included among the few benign disorders which can yield such elevations in the CA19-9.

Aged↗
PubMed1987

Repair of large abdominal wall defects with expanded polytetrafluoroethylene (PTFE).

Most abdominal wall incisional hernias can be repaired by primary closure. However, where the defect is large or there is tension on the closure, the use of a prosthetic material is indicated. Expanded polytetrafluoroethylene (PTFE) patches were used to repair incisional hernias in 28 patients between November 1983 and December 1986. Twelve of these patients (43%) had a prior failure of a primary repair. Reherniation occurred in three patients (10.7%). Wound infections developed in two patients (7.1%), both of whom had existing intestinal stomas, one with an intercurrent pelvic abscess. The prosthetic patch was removed in the patient with the abscess, but the infection was resolved in the other without sequelae. Septic complications did not occur after any operations performed in uncontaminated fields. None of the patients exhibited any undue discomfort, wound pain, erythema, or induration. Complications related to adhesions, erosion of the patch material into the viscera, bowel obstruction, or fistula formation did not occur. Based on this clinical experience, the authors believe that the PTFE patch appears to represent an advance in synthetic abdominal wall substitutes.

Adult↗
PubMed1986

Proctectomy for inflammatory bowel disease.

Between July 1973 and October 1984, we performed proctectomy either as part of a primary proctocolectomy or as a secondary staged procedure in 388 patients with ulcerative colitis and in 39 patients with Crohn's disease. The proctectomies were performed using a two-team synchronous approach. An intersphincteric or perimuscular technique was employed. All perineal wounds were closed and drained by suction drainage and the pelvic peritoneum was closed in all cases. Two patients died in the early postoperative period, one from a pulmonary embolus and one from sepsis. Three patients had to be reexplored for postoperative hemorrhage, in all cases from a branch of the superior hemorrhoidal artery. Postoperative perineal hematoma developed in two patients and perineal abscess developed in four patients which necessitated opening of the perineal skin wound. Nonhealing of the perineal wound occurred in 3 of 388 patients with ulcerative colitis and in 5 of 39 patients with Crohn's disease. No perineal dehiscence or hernias were seen. Postoperatively, one man was permanently impotent and two had prolonged but temporary impotence. Three patients had retrograde ejaculation at last follow-up.

Abscess↗
PubMed1985

Use of the long tube in the management of patients with small-intestinal obstruction due to adhesions.

A retrospective analysis was performed of all patients admitted to our hospital over a six-year period with a diagnosis of small-intestinal obstruction due to adhesions, to assess the efficacy of treatment with long-tube decompression. Of 127 episodes of obstruction, two thirds responded to nonoperative treatment. Factors that were associated with a greater likelihood of success with long-tube decompression included incomplete obstruction, recurrent obstruction, and passage of the tube beyond the pylorus. Clinical findings were relatively reliable as diagnostic indicators of strangulation. The overall mortality was 1.5%, with no deaths due to a delay in operative intervention. A trial of long-tube decompression is recommended in patients presenting with a diagnosis of small-intestinal obstruction due to adhesions in the absence of clinical evidence of strangulation.

Adolescent↗
PubMed1985

Distribution of colorectal cancer in patients with and without ulcerative colitis.

A comparison of the anatomic distribution of colorectal cancer in patients with and without CUC is difficult because of the unequal number of patients in each group and the changing epidemiologic parameters of colorectal cancer in general. In the present study, the distribution of colorectal tumors in patients with and without CUC was compared over two different time periods at a single hospital. In the early time period (1960 to 1975), there was a significantly higher percentage of proximal tumors in the group with cancer and CUC compared to the group with cancer alone. In the most recent time period (1975 to 1981), there was no difference in distribution of colorectal cancer regardless of whether the patient had CUC or not. We believe that the increased percentage of proximal tumors in patients with colorectal cancers and no CUC that has occurred in recent years has led to the present findings of a similar distribution of tumors in patients with and without CUC.

Adenocarcinoma↗
PubMed1985

Is routine postoperative nasogastric decompression really necessary?

Controversy exists regarding the need for nasogastric tube decompression and the incidence of complications resulting from its use following major intra-abdominal surgery. To determine the value of such tubes, 100 patients were managed after surgery with a nasogastric tube in situ until the passage of flatus per rectum (Group I). In a second group of 100 patients, no nasogastric tube was placed after surgery unless vomiting, gross distention, or overt obstruction occurred (Group II). In Group I, the nasogastric tube remained in place an average of 6 days and five patients required replacement of the tube after its initial removal. In Group II, nasogastric intubation was required at some point after surgery in six patients. No aspiration pneumonia, nasal septum necrosis, anastomotic leak, or wound dehiscence was seen in either group. There were three wound infections in Group I and two in Group II. The most obvious difference was the increased comfort and mobility of the group of patients treated without routine nasogastric decompression (Group II). Routine use of the nasogastric tube adjunct to patient care following gastrointestinal tract surgery may be safely eliminated.

Cholecystectomy↗
PubMed1983

Mucosal proctectomy without reservoir.

Mucosal proctectomy with endorectal pull-through allows the removal of all colonic mucosa with preservation of continence. This operation was performed in 19 patients with familial polyposis coli and ulcerative colitis. A temporary loop ileostomy was used to defunctionalize the anastomosis. Intestinal continuity was restored in 17 of the 19 patients. Mean duration of follow-up was 29 months. All patients are continent, and the mean number of bowel movements per 24 hours is 6. Follow-up barium studies revealed a gradual dilatation of the terminal ileum within the rectal cuff which accounts for the decrease in the number of bowel movements. This operation eliminates the risk of carcinoma without compromising sphincter function.

Adolescent↗
PubMed1983

Sexual dysfunction following proctocolectomy for benign disease of the colon and rectum.

Standard surgical therapy for the treatment of chronic ulcerative colitis is total extirpation of the colon and rectum. Since ulcerative colitis is primarily a disease of young adults affecting many people at the inception or height of their sexually active years, postoperative sexual dysfunction is an extremely disconcerting complication. Between July 1973 and May 1981, 291 proctectomies for benign disease of the colon and rectum were performed by the authors. This included 135 men and 156 women. Resection of the rectum was performed using an intrasphincteric technique with dissection kept extremely close to the wall of the rectosigmoid, rectum, and anus. Proctectomy was performed in this manner to prevent significant disruption of the nerves carrying stimuli to the genital organs. Of the 135 males undergoing a proctectomy, four (3%) had a permanent deficit in sexual function. Two men, aged 32 and 30, could sustain an erection but had retrograde ejaculation. Two patients, age 19 and 44, have remained impotent for 1 1/2 and two years, respectively. One hundred fifty-two of the 156 females are sexually active and only two (1.3%) have complained of any physical sexual dysfunction. Each had temporary dyspareunia lasting between nine months and one year after operation.

Adult↗
PubMed1982

Nonoperative conversion of tube gastrostomy to feeding jejunostomy.

Although esophageal reflux of gastrostomy feeds is an uncommon problem, severe pulmonary complications can arise. If implementation in an upright position and use of continuous infusion does not prevent reflux, an alternative method of providing adequate nutrition must be used. This nonoperative technique of converting a tube gastrostomy to a feeding jejunostomy is simple to perform, atraumatic and extremely useful.

Enteral Nutrition↗
PubMed1982

Ruptured hepatic abscess: a rare cause of spontaneous pneumoperitoneum.

A 68-yr-old woman who developed an acute abdomen with clinical and radiological evidence of pneumoperitoneum is is described. At surgery, multiple left lobe hepatic abscesses were identified. Perforation of one abscess was apparent. Bacteriological studies revealed Streptococcus faecalis and gas-producing Klebsiella pneumoniae from the abscess cavities. Spontaneous pneumoperitoneum secondary to a ruptured hepatic abscess has to our knowledge never been reported.

Aged↗
PubMed1981

Experience with the flexible fiberoptic choledochoscope.

Despite significant effort on the part of surgeons, the incidence of retained calculi after common duct exploration still remains unacceptably high. It seems likely that the best way to reduce the incidence of retained calculi would be a more complete exploration of the common duct at the time of the initial operation. We report our experience with a flexible fiber optic endoscope used intraoperatively in 52 patients and postoperatively in one case to visualize the intrahepatic and extrahepatic bile ducts. In addition to visualization of stones, the choledochoscope has a channel through which various instruments can be passed to facilitate stone removal. Flexible choledochoscopy has been performed 53 times in 52 patients between July 1978 and November 1980. In one patient, the choledochoscope was used to explore the bile ducts via the T-tube tract after operation. In 52 patients, the scope was used intraoperatively: a) two patients demonstrated bile duct tumors, b) in 14, stones were not found on exploration. Of these, one had stenosis at the papilla of Vater and one had external compression of the duct by a pancreatic pseudocyst. All of these findings were confirmed by choledochoscopy, c) in 26 patients choledochoscopy confirmed complete surgical removal of all stones, d) in six patients, multiple stones were removed using routine common duct exploration but additional stones were seen with the choledochoscope, e) in three patients no stones were retrieved on routine duct exploration but were seen using the choledochoscope. In groups (d) and (e) the scope facilitated removal of the remaining stones. In eight cases stones were either grasped or crushed using the accessories of the choledochoscope. In one patient calculi were missed both by routine surgical exploration and choledochoscopy. No septic complications were seen in any of these patients.

Endoscopes↗
PubMed1979

Splenectomy for Gaucher's disease.

The records of ten patients who underwent splenectomy for Gaucher's disease were reviewed. All patients had the adult type of the disease. The indications for splenectomy were hypersplenism and mechanical problems. The hematological picture returned to normal in all cases and has remained so throughout the follow-up period. The different forms Gaucher's disease and specific diagnostic tests are discussed. Even though splenectomy is indicated when hematological and mechanical problems exist, selective enzymatic replacement therapy seems to be the preferred future mode of treatment.

Adolescent↗
PubMed1979

Cancer in universal and left-sided ulcerative colitis: factors determining risk.

A retrospective study of 267 patients with ulcerative colitis admitted to The Mount Sinai Hospital during the period 1960--1976 revealed 26 (9.7%) with adenocarcinoma of the colon. Twenty-one cases of colorectal cancer were observed among 158 patients with universal colitis (13%), and 5 occurred among 109 patients with left-sided disease (5%). Patients with left-sided disease tended to develop cancer at least a decade later than patients with universal disease. The median duration from onset of colitis to diagnosis of cancer was 20 yr for those with universal colitis, and 32 yr for those with left-sided colitis. The decade incidence of colorectal carcinoma increased from 0.4% in the first decade to 7.4% in the second, 15.9% in the third, and 52.6% in the fourth decade of follow-up. The estimated cumulative probability of developing cancer reached 34% at 30 yr and 64% at 40 yr. Cancer risk was positively correlated with duration and anatomic extent of colitis, but did not appear to be increased by early age at onset of disease.

Adenocarcinoma↗
PubMed1978

Temporary loop ileostomy in the treatment of Crohn's disease.

The use of a temporary loop ileostomy for fecal diversion in 15 patients with Crohn's disease is discussed. The indications for the use of ileostomy included both emergency and nonemergency situations. Emergency indications included cases of acute peritonitis secondary to perforated bowel or abscesses, and intestinal obstruction. In nonemergency settings ileostomy was used either in conjunction with other surgery that was thought to have a significant risk of anastomotic leakage or to prepare a patient for major resectional surgery. It was the impression of the author's that temporary loop ileostomy was a helpful adjunct in the management of certain difficult cases of Crohn's ileocolitis.

Adolescent↗