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Biomedical subjects

J Melissas

Publications and source records attributed to J Melissas.

At least 37 records · Page 2Linked to original sources
PubMed1989

Carotid artery injuries: experience with 124 cases.

This is a retrospective study of 124 patients with carotid injuries. The common carotid artery was injured in 84% of the patients. Associated trauma to the internal jugular vein was present in 26%. Most patients (56%) were dead on arrival to the hospital and of those who were operated on, the mortality was 22% (overall mortality, 66%). All operative mortalities had severe shock or neurologic deficits on admission. We performed repair on all patients with preoperative neurologic deficits and the mortality was 64%. The use of a shunt did not influence the prognosis. We believe that there is no place for an emergency angiogram in order to diagnose a carotid injury or to plan the operation.

Adult↗
PubMed1988

Surgical approaches to vertebral artery injuries.

Twenty patients with penetrating injuries of the vertebral artery who were treated as emergencies were subjected to the following operative approaches: five cases, Henry's approach (posterior) and modified Henry's approach (anterior); five cases, limited exposure and application of metal clips; four cases, plugging of the arterial defect with Oxycell or crushed muscle; three cases, control with ligatures and non-conventional exposure of the artery; one case, inflation of a balloon catheter within the vertebral canal; one case, repair of the lacerated first extraosseous part of the vertebral artery. One patient died from exsanguination on the operating table, before any repair was possible. The overall mortality was 20 per cent and the mean hospital stay 6.1 days. Thirty-five per cent of the patients presented with neurological complications, and 55 per cent left the hospital well. No advantage of Henry's classical approach over limited exposure and control with metal clips was shown, when mortality, hospital stay and long-term problems were compared. Because of its relative simplicity we suggest that the metal clipping of the vertebral artery, above and below the site of injury, is an effective technique that can be used to stop the bleeding. One case presented as a false aneurysm of the vertebral artery, following a stab wound. This was successfully treated with excision of the aneurysm and vertebrovertebral artery bypass, using a saphenous vein graft.

Adult↗
PubMed1988

Factors influencing the morbidity of colostomy closure.

A series consisting of 110 patients who had colostomy closure was studied in an attempt to define the role of various factors in causing colon-related morbidity. The overall complication rate was 14.5 percent (wound sepsis 11.8 percent and anastomotic leak 2.7 percent). Patient age, the underlying pathologic abnormality (trauma versus nontrauma), the type of colostomy (loop versus end colostomy), the site of the stoma (right side, left side, or transverse), whether a drain was inserted or not, and the timing of the operation did not influence morbidity. Oral preoperative antibiotics appeared to be associated with less morbidity than parenteral antibiotics (p less than 0.01), and experienced surgeons had less complications than junior surgeons (p less than 0.05).

Adolescent↗
PubMed1988

The management of penetrating injuries of the back. A prospective study of 230 patients.

This is a prospective study of 230 patients with penetrating injuries of the back. The decision to operate or observe was taken exclusively on the abdominal physical findings. One hundred ninety-five patients (85%) did not require operation, 30 (13%) underwent a therapeutic laparotomy, four (1.7%) an unnecessary operation, and one patient (0.4%) had a completely negative laparotomy. The diagnosis and management was delayed in five (2.2%) patients with no serious consequences. Mortality rates were not recorded in this series. The initial physical examination was accurate in 95.2% of the patients. We suggest that penetrating injuries of the back should be assessed in the same way as anterior abdominal injuries. Physical abdominal examination is reliable in detecting significant intra-abdominal injuries.

Abdomen, Acute↗
PubMed1987

Primary lymphoma of the small bowel with obstructive jaundice and pancreatitis. A case report.

Primary lymphoma of the small bowel resulting in pancreatic duct or biliary obstruction is rare. Only 1 case of pancreatic obstruction causing pancreatitis has previously been reported. A patient with primary small-bowel lymphoma of the 'Western' variety is described. This was associated with extensive duodenal involvement and obstruction of the pancreatic and biliary system accompanied by obstructive jaundice and pancreatitis.

Cholestasis, Extrahepatic↗
PubMed1987

Pancreaticoduodenectomy for pancreatic trauma. A case report.

Pancreatic trauma is uncommon and severe, combined pancreaticoduodenal injuries are rare. Different surgical techniques for the management of these injuries have been used. In this article a case of severe pancreaticoduodenal injury which required pancreaticoduodenectomy is reported. This case is unusual because there was no history of trauma, the serum amylase level and abdominal radiograph were normal and the abdominal findings on admission to hospital were minimal. A system of grading pancreatic trauma in terms of severity is advocated and the management of pancreaticoduodenal injuries is discussed.

Adult↗
PubMed1986

Axillary intercostal drain in traumatic haemopneumothorax.

During an 8-month period, 242 patients with thoracic injuries were admitted to one of the general surgical units at Baragwanath Hospital. Of these, 7.4% required surgical exploration, while 92.6% had pneumothorax treated conservatively by insertion of a single drain at the mid-axillary line in the 5th intercostal space. Of patients managed conservatively 76 had pneumothorax and 148 haemopneumothorax. There were no deaths in this series. All patients explored recovered well from the operation and were discharged after a mean period of 6 days. Of those with a pneumothorax managed conservatively full expansion of the lung was obtained in 98.7%. In 80% of the patients with haemopneumothorax, axillary intercostal drainage proved adequate treatment and resulted in prompt re-expansion of the lung. However, 6.8% of the patients in this group required further needle aspiration of the pleural cavity and in 2.7% a second drain was inserted for evacuation of residual blood. Eight (5.4%) patients were discharged with a small and insignificant residual haemothorax.

Adult↗
PubMed1984

Dermatofibrosarcoma protuberans in black patients.

Twelve cases of dermatofibrosarcoma protuberans in Black patients admitted to Baragwanath Hospital, Johannesburg, between 1979 and 1983 are reviewed. The cause of this slow-growing, low-grade malignant fibrous histiocytoma is unknown, but there is some evidence that trauma may be a predisposing factor. The clinical and histological features of dermatofibrosarcoma protuberans are described, and treatment by wide tridimensional excision with local reconstruction is recommended.

Adolescent↗
PubMed1978

Spontaneous (nontraumatic) perforation of the common bile duct: report of three cases.

Three cases of non-traumatic perforation of the common bile duct are reported. Severe inflammatory reaction of the perforated site was a common and only histologic finding in those three patients. Timely diagnosis of the resulting choloperitoneum and prompt surgical treatment of the primary cause of biliary inflammation afforded long-term uncomplicated cure; the site of perforation healed spontaneously after simple external drainage of the newly formed bile cavity.

Cholangiography↗
PubMed1977

The incidence of urolithiasis in peptic ulcer patients.

Two hundred patients suffering from peptic ulcer have been examined for urinary stones. Two hundred healthy controls have been similary studied. In 14 patients from the first group (7%) urinary calculi were found, whereas the percentage in the second group was only 1%. This difference is statistically significant (P less than 0.01) (x2 distribution test). The increased incidence of peptic ulcer was attributed to the consumption of calcium in combination with easily absorbable alkalis (sodium bicarbonate). These findings must be considered in therapy for peptic ulcer diathesis.

Acid-Base Imbalance↗
PubMed1976

Liver actinomycosis: a case report.

A case of liver actinomycosis successfully treated with high doses of penicillin for a long period after surgery is reported. The unusual location of the disease and early detection difficulties delayed the diagnosis and establishment of proper treatment, causing additional liver damage. Serum globulin levels, alkaline phosphatase and turbidity tests were of diagnostic significance. Adequate drainage of the lesion and long-term antibiotic treatment with penicillin proved therapeutically satisfactory.

Actinomycosis↗
PubMedDate not supplied

Pylorus-preserving pancreaticoduodenectomy with external pancreatic remnant drainage.

BACKGROUND: Pancreaticoduodenectomy is the mainstay of surgical treatment for various benign and malignant diseases of the head of the pancreas and the periampullar region. The incidence of postoperative morbidity remains significantly high. Various modifications have been advocated for the restoration of the digestive continuity and drainage of bile and pancreatic ducts in order to diminish this high morbidity rate. METHODS: A new modification with the combination of an end-to-end duodenojejunal anastomosis and creation of an external pancreatic fistula following pylorus-preserving pancreaticoduodenectomy is described. Our initial experience with this modification in seven patients is reported and its advantages are discussed. RESULTS: There was no mortality, while morbidity was 29%, including postoperative pneumonia and psychosis in one patient, and intra-abdominal abscess in another patient. No significantly delayed gastric emptying was observed and no patient developed diabetes, anastomotic ulcer or reflux cholangitis postoperatively. CONCLUSIONS: The reported technique seems to be a safe modification of restoration after pancreaticoduodenectomy, with maintenance of anatomical gastrointestinal continuity, avoidance of complications from anastomosis with the pancreatic remnant, as well as maintenance of endocrine pancreatic function. However, long-term follow-up and larger comparative studies are needed to evaluate the impact of this modification on morbidity and mortality, including long-term nutritional complications.

Adenocarcinoma↗
PubMedDate not supplied

Management of blunt hepatic and splenic trauma in a Greek level I trauma centre.

BACKGROUND AND PURPOSES: Non-operative management (NOM) has revolutionized the care of blunt hepatic and splenic trauma patients. The objective of this study is to evaluate treatment of such patients in a Greek level I trauma centre, to identify factors that are important for selecting them for NOM and to investigate for predictors of NOM failure. MATERIAL AND METHODS: We reviewed the Trauma Registry data of 96 consecutive adult patients admitted with blunt liver and/or splenic injuries over a 4-year period. RESULTS: Immediately operated patients (32.3%) had lower diastolic arterial pressure (p = 0.02), lower International Classification of Diseases -9th revision Injury Severity Score (ICISS) (p = 0.01), and a higher grade of splenic injury (p = 0.002) than NOM patients. NOM success rate was 80%. No predictors of NOM failure were found ; however, isolated splenic trauma patients failed NOM more frequently than hepatic patients (p = 0.02). CONCLUSIONS: NOM of adult blunt hepatic and splenic trauma patients is safe and efficient. Haemodynamic stability, ICISS and the grade of splenic injury are important for selecting these patients for NOM while splenic trauma patients need more intense observation.

Abdominal Injuries↗