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Biomedical subjects

I S Benjamin

Publications and source records attributed to I S Benjamin.

At least 73 records · Page 4Linked to original sources
PubMed1990

Biliary endoprosthesis dysfunction in patients with malignant hilar tumors: successful treatment by percutaneous replacement of the stent.

Symptoms caused by malignant hilar bile duct tumors are often palliated by the insertion of a percutaneous biliary endoprosthesis. However, these often occlude early and may be difficult to replace. We have reviewed our experience with percutaneous replacement of endoprostheses in 17 patients with 31 episodes of stent dysfunction. The stent was changed successfully in 30 of the 31 attempts. The average durations of initial and subsequent stent patencies were 28 and 20 weeks, respectively. Significant acute complications occurred in three patients, one of whom had a perihepatic abscess and two of whom had septicemia. Two patients died within 30 days of their last stent change. The one patient in whom attempted insertion of a new stent was unsuccessful had to remain on continuous external catheter drainage. The occluded or migrated endoprosthesis was successfully removed either percutaneously (55%) or endoscopically (26%) in 25 of the 31 cases. Successful removal of the stent and reinsertion after blockage or migration is possible in most patients. Our experience suggests that patients with malignant obstruction of the bile duct should not be refused an indwelling endoprosthesis just because of the frequent occurrence of early occlusion of the stent.

Adenoma, Bile Duct↗
PubMed1990

Outcome of radical surgery in hilar cholangiocarcinoma.

In a prospective study performed between 1977 and 1985, 27 patients with cholangiocarcinoma at the confluence of the hepatic ducts underwent resection aiming at cure. Eleven patients underwent local excision and 16 underwent partial liver resection (extended right hepatic lobectomy in 12, left hepatic lobectomy in 3, and extended left hepatic lobectomy in 1). The 60-day hospital mortality rate was 7.4% (2 patients). None of 11 patients who underwent local excision and only 1 (5.5%) of 18 patients who had not undergone previous surgery, or preoperative biliary drainage, died in the hospital. The overall median and mean survival times for the 24 patients who left the hospital were 25 and 29 months, respectively (range, 5 to 80 months). Twenty patients died after a median survival of 22 months (mean, 25 months; range, 5 to 80 months). Four patients are alive and well at 45, 48, 51, and 54 months. Estimated (Kaplan-Meier) survival rates for all 27 patients at 1, 3, and 5 years were 70%, 26%, and 22%, respectively, with almost all patients dying of persistent or recurrent local disease. Survival time after hepatic resection was not statistically different from that after local excision of the lesion (p greater than 0.1). The difference in survival times between patients with histologic clearance and those with microscopically positive or close (less than 1 mm) resection margins was marginally significant statistically (p = 0.037). The quality of life was good. These results are in agreement with those of other studies employing treatment by excision and emphasize the need to assess all patients with hilar cholangiocarcinoma with a view to resection before the adoption of surgical bypass or palliative intubational procedures. However, further progress is unlikely to be made without significant advances in adjuvant therapy.

Adenoma, Bile Duct↗
PubMed1990

Complications of choledochal cysts in adulthood.

Choledochal cyst is a well-recognised entity, presenting primarily in infants and young children. Where symptoms are delayed until adulthood, associated hepatobiliary pathology may complicate the presentation. These problems may be aggravated by previous treatment with bypass surgery rather than resection. We report seven cases from our recent experience presenting with complications in adulthood. These included cholangitis, hepatic abscess, pancreatitis and malignancy within the cyst. Two patients presented during pregnancy. These complications and their implications for management are discussed.

Adenoma, Bile Duct↗
PubMed1990

Complications of cholecystectomy in district general hospitals.

The aim of this retrospective study was to determine the incidence of the complications in one thousand consecutive cholecystectomies performed in three district general hospitals. Major post-operative complications occurred in 63 patients (6.3 per cent) and were responsible for 12 deaths (1.2 per cent operative mortality) and 31 reoperations. The incidence of retained stones was 5.8 per cent (10 patients) for those who underwent exploratory choledochotomy, and 10.9 per cent in those who were managed by common bile duct exploration and stone extraction. There were four cases of iatrogenic biliary trauma (0.4 per cent), all in cases operated by junior registrars. All (except one) occurred during elective 'non-complicated' cholecystectomy.

Adult↗
PubMed1989

Primary sclerosing cholangitis associated with liver atrophy.

Of 27 patients with primary sclerosing cholangitis, 4 were found on investigation and subsequently at operation to have gross lobar atrophy. The disease was particularly severe in the hilar region. Three of the four patients were asymptomatic prior to the onset of jaundice. The presence of atrophy precipitated laparotomy to exclude cancer in two cases. Marked disparity in size between liver lobes precluded a hilar approach to relieve extrahepatic obstruction in two patients. Prolonged follow-up excluded coincident malignant disease. Selective liver atrophy should be considered part of the disease spectrum in primary sclerosing cholangitis.

Adolescent↗
PubMed1989

Nonoperative approach to hilar cancer determined by the atrophy-hypertrophy complex.

Twenty-seven of 135 patients with malignant hilar stricture who had associated liver atrophy or hypertrophy or both were treated by the percutaneous insertion of an endoprosthesis in the hypertrophied lobe only. The procedure was successful in 25 patients. Three patients died within 30 days of drainage. Procedure-related nonfatal complications occurred in seven patients. Effective decompression was accomplished in 21 patients, with complete relief of jaundice in 15. Late complications were experienced by 10 patients. The median total hospital stay was 22 days. Thirteen patients survived from 6 weeks to 12 months (median 5 months), 8 were alive from 3 to 18 months (median 8 months), and 1 patient was lost to follow-up. On the available evidence, we suggest that the preoperative demonstration of the atrophy-hypertrophy complex in jaundiced patients with irresectable hilar cancer is an indication for nonoperative therapy. Patients without the atrophy-hypertrophy complex and those with the complex but associated nonneoplastic disease are likely to fare better with surgical decompression and direct mucosa-to-mucosa anastomosis.

Adenoma, Bile Duct↗
PubMed1989

Liver resection for bile duct cancer.

Hilar cholangiocarcinoma is now diagnosed more frequently, and modern diagnostic methods allow a much more precise definition of the extent of disease, which assists in planning the therapeutic approach. Resection of tumors at the confluence of the bile ducts is possible in 20 per cent of patients. When the tumor extends along the hepatic ducts into the right or the left side of the liver, excision may be combined with partial hepatectomy. Involvement of the portal vein and hepatic artery do not necessarily preclude resection. The operative mortality rate of partial hepatectomy for hilar cholangiocarcinoma is about 10 per cent, and median survival after operation is approximately 22 months, with a few long-term cures reported. The quality of survival after the excision of tumor and biliary-enteric reconstruction is very good and indeed appears to be better than that after palliation by biliary decompression alone.

Adenoma, Bile Duct↗
PubMed1989

Intra-abdominal sepsis after hepatic resection.

One hundred and thirty hepatic resections performed over an 8-year period were reviewed for evidence of postoperative intra-abdominal sepsis. Of 126 patients who survived for more than 24 hours after operation, 36 developed culture positive intra-abdominal collections (28.6%). Significant independent variables associated with the development of intra-abdominal sepsis were diagnoses of trauma or cholangiocarcinoma, and the need for reoperation to control hemorrhage during the postoperative period. Before 1984, infected fluid collections were treated predominantly by operative drainage, but this has largely been replaced by percutaneous methods, which have proven effective in most cases. Eighteen (50%) of the infections were caused by a mixed bacterial culture, with Streptococcus faecalis, Staphylococcus epidermidis, Staphylococcus aureus and Escherichia coli being the most common isolates. Six patients with clinical signs of sepsis had a sterile fluid collection drained with complete relief of symptoms. This review suggests that intra-abdominal sepsis is a frequent complication after hepatic resection, and can often be managed successfully by nonoperative percutaneous drainage.

Abdomen↗
PubMed1989

Hepatic resection for secondary tumours.

The role of liver resection for secondary tumours is reviewed, with particular reference to secondary disease from primary colorectal cancer. While there are no controlled trials producing direct evidence of improved survival following resection, figures on five year survivors without resection are anecdotal. Numerous series now report five year survival of up to 50% following resection, instances of five year survival without resection are now fallen to around 5% in most major series. Factors which adversely affect survival after resection seem to be poor tumour clearance, number of metastases and possibly Dukes' C primary tumours. Other factors, including the extent of resection and size of the tumour, may affect perioperative morbidity and mortality but should not influence long-term survival. Resectional treatment is rapidly gaining an established position in the treatment of colorectal secondaries, and may be considered also for some non-colorectal lesions, particularly endocrine tumours.

Colorectal Neoplasms↗
PubMed1988

Hemobilia. A disease in evolution.

Ten patients with hemobilia were treated over a six-year period. Six cases resulted from iatrogenic injury (percutaneous invasive procedures, four; surgical trauma, two); the others were caused by gallstone disease (two), liver trauma (one), and vasculitis (one). Five patients were treated successfully by selective arterial embolization. In the other five patients, embolization was not possible due to previous surgical and/or radiologic procedures, or it was contraindicated, and thus, surgical treatment was undertaken. One of these patients died. There were no long-term sequelae in the remaining nine patients followed up for 12 to 66 months. Selective hepatic arterial embolization is the treatment of choice for hemobilia. Inappropriate embolization or surgery frequently fails to control the bleeding and may also prevent later successful embolization.

Adult↗
PubMed1988

Combined endoscopic and percutaneous stent insertion to overcome a problem of percutaneous stent insertion.

Non-operative stent insertion is a well-accepted means of palliating malignant biliary obstruction. The endoscopic approach is often considered the procedure of choice, with the percutaneous technique reserved for endoscopy failures. We recently encountered a patient in whom both techniques proved unsuccessful initially, and in whom palliation was finally achieved by means of a combined endoscopic and percutaneous transhepatic procedure.

Aged↗
PubMed1988

Percutaneous transhepatic endoprostheses for hilar cholangiocarcinoma.

In patients with unresectable hilar cholangiocarcinoma, percutaneous transhepatic endoprosthesis insertion is one of the available methods of palliation. We reviewed our experience with it in 35 consecutive patients with hilar cholangiocarcinoma who were judged on clinical or radiologic evidence to be unsuitable for resective or palliative surgery. The 30-day mortality rate was 14 percent (5 of 35 patients). Of the remaining 30 patients, endoprosthesis placement was successful in 28, with 2 patients discharged with a permanent external drainage catheter. Twenty-four patients survived a median of 3 months (range 1 to 17 months), and 2 were lost to follow-up. Good or fair palliation of symptoms was achieved in 50 percent of the discharged patients and in 66 percent of those living longer than 3 months. We believe that percutaneous transhepatic endoprostheses can provide useful palliation in patients with hilar cholangiocarcinoma, even in the presence of advanced disease.

Adenoma, Bile Duct↗
PubMed1988

Amino acid imbalance following portal diversion in the rat. The relevance of nutrition and of hepatic function.

End-to-end portacaval transposition has previously been shown to produce less hepatocellular dysfunction than end-to-side portacaval shunt in the rat. Liver weight is also significantly reduced after portacaval shunt compared to portacaval transposition and these differences are not abolished by pair-feeding. Histological evidence of CNS damage is also reduced in transposed rats compared to shunted animals. This study examines the amino acid and hormone changes in these models. The characteristic amino acid changes of chronic liver disease (decreased branched-chain and elevated aromatic amino acids) are reproduced in portacaval shunt rats, but not in portacaval transposition. The differences between these groups in the branched-chain amino acids, but not those in the aromatic amino acids, are reduced by pair-feeding. Insulin and glucagon are elevated to a similar extent in both groups. These findings add further support to a role for peripheral amino acid imbalance in the pathogenesis of portal-systemic encephalopathy. Normal liver function, maintained by replacement of portal inflow with systemic blood, appears to minimize both CNS damage and amino acid changes.

Amino Acids↗
PubMed1988

Spiral-shaped biliary endoprosthesis: initial study.

A new flexible, spiral-shaped biliary endoprosthesis is described. This spiral endoprosthesis can negotiate acute angles, can be cut to any length, and has been specifically designed to deal with the problem of stent migration. The authors report their initial experience with this endoprosthesis in 14 patients.

Adult↗