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Biomedical subjects

J H Bloch

Publications and source records attributed to J H Bloch.

At least 19 recordsLinked to original sources
PubMed1995

Diagnostic laparoscopy in women with acute abdominal pain.

Nineteen women with acute lower abdominal pain of uncertain etiology underwent diagnostic laparoscopy during a 2-year period from August 1991 to August 1993 and were retrospectively reviewed. All patients, aged 12 to 44 years, were premenopausal. Laparoscopy provided definitive diagnosis in all 19 patients. Laparoscopic findings included appendicitis (11 cases), pelvic inflammatory disease (five cases), significant ovarian cysts (two cases), and ectopic pregnancy (one case). Successful laparoscopic procedures included appendectomy (five cases), and salpingo-oophorectomy (one case). Five patients required only diagnostic laparoscopy. Eight patients required conversion to an open procedure because of anatomical considerations (six cases) or equipment failure (two cases). Median operative time was 71 min, and median postoperative hospital stay was 2 days. Most diagnostic procedures were performed on the same day as admission, resulting in a median hospital stay of 3 days. Diagnostic laparoscopy performed in premenopausal female patients with acute lower abdominal pain of unknown etiology provides diagnostic accuracy as well as therapeutic capabilities and prevents unnecessary laparotomy.

Abdomen, Acute↗
PubMed1994

Laparoscopic management of gallstone pancreatitis.

Thirty-seven patients with gallstone pancreatitis were encountered over a 28-month period from June 1990 to October 1992. The use of laparoscopic cholecystectomy with intraoperative cholangiography in the management of gallstone pancreatitis was retrospectively studied. Thirty-two women and 5 men ranged in age from 16 to 74 years. Admitting amylase levels ranged from 241 to 5547 IU/L. No patient had a clinical history consistent with other causes of pancreatitis. Initial treatment consisted of bowel rest until amylase levels had normalized and abdominal tenderness had resolved. Twenty-nine of 37 patients were initially treated laparoscopically, but 7 required conversion to open cholecystectomy. Choledocholithiasis was identified intraoperatively in 4 patients. These stones were cleared either laparoscopically (2), by open common bile duct exploration (1), or by postoperative endoscopic retrograde cholangiopancreatography (1). Patients treated laparoscopically had a median postoperative discharge time of 1.0 day vs 3.5 days for those treated by open technique. Not all patients with gallstone pancreatitis can be treated successfully using laparoscopic techniques. As the experience and confidence of surgeons increases, laparoscopic management of gallstone pancreatitis is appropriate, with open conversion as necessary.

Adult↗
PubMed1991

Thymic carcinoid.

Carcinoid of the thymus is a rare neoplasm. Differentiation from thymoma is important because they have entirely different prognosis. A patient in whom a 19 x 18 x 12 cm carcinoid tumor of the thymus was surgically removed is presented. The tumor metastasized to peritracheal and internal mammary nodes, and invaded the SVC, pleura, lung, and pericardium. This is apparently the largest reported tumor of its kind. Prior to induction of anesthesia cardiopulmonary bypass and rigid bronchoscopy were readily available. Awake intubation was utilized. Even though long-term prognosis is poor, an aggressive surgical approach and adjuvant radiotherapy may achieve extended survival with excellent quality of life. Central aspects of the disease as well as pivotal therapeutic points are discussed.

Adult↗
PubMed1990

Intra-abdominal seatbelt injury.

The use of seatbelts has significantly decreased the mortality and morbidity of injuries caused by motor vehicle accidents. We present eight patients who sustained severe intra-abdominal injuries peculiar to the use of the seatbelt. Serious injuries to the bowel and mesentery may be present without early symptoms or physical signs and neither CT scanning nor diagnostic peritoneal lavage is fully reliable or accurate in finding the injury. Prompt diagnosis may be difficult and requires a high index of suspicion as well as a determined approach that may include exploratory celiotomy. The presence of a seatbelt sign across the abdomen is not incontrovertible evidence that a laparotomy must be done, but its presence should create a high index of suspicion for serious visceral injury. Delay in diagnosis significantly increases morbidity and is associated with high mortality rates.

Abdominal Injuries↗
PubMed1979

Central vessel trauma.

During a 24 month period, 30 patients were treated for central vessel trauma (CVT). Injured vessels included all of the major arteries and veins in the chesk, neck and abdomen except the infrarenal aorta. Overall survival was 70 per cent. Experience with specific injuries is reviewed with commentary on surgical access to difficult areas including the thoracic outlet, suprarenal aorta and inferior vena cava. Common factors in the nine deaths are reviewed with the findings that cardiac arrest at any time during pre- or intraoperative management is uniformly lethal; emergency thoracotomy for control of bleeding carries an expectedly high mortality; cross-clamping of the descending thoracic aorta to control hemoperitoneum has a limit of tolerance of about one hour, and prolonged shock, whether compensated or profound is poorly tolerated and is associated with a high mortality.

Abdominal Injuries↗