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Biomedical subjects

L Morgenstern

Publications and source records attributed to L Morgenstern.

At least 37 records · Page 2Linked to original sources
PubMed1994

Laparoscopic management of common bile duct stones. A multi-institutional SAGES study. Society of American Gastrointestinal Endoscopic Surgeons.

Laparoscopic common bile duct exploration (CBDE) was the subject of a multi-institutional study on 226 patients from 19 major hospital centers. Female patients predominated (2.3:1); the average age was 54; 75% of cases were chronic, and the remainder were acute. Although 97% had preoperative ultrasonograms, only 12% showed a stone in the dilated common bile duct. The alkaline phosphatase was elevated in 41% and the serum bilirubin in 28% of cases. Preoperative endoscopic retrograde cholangiography with sphincterotomy (ERC-ES) was performed in 8.5%; there was a successful stone extraction in less than half the cases. Cholangiography was performed in 99.5%, and in 94% of those cases, stones were found. In 83% of cases, stones were removed through the transcystic approach, and in 17% removal was throughout the CBD. In the majority of cases, the choledochoscope and wire basket (34%), irrigation (33%), or a combination of both was employed. In the transcystic group, 5% were converted to open procedures due to technical difficulty, as contrasted with the trans-CBD route, where the conversion rate was 19%. There were two ductal injuries. Minor complications occurred in 5.7% within 24 h; there was one death (0.4%). Within 30 days, the morbidity rate was 7% and there were no deaths. Retained stones were discovered in 2.6% of cases. Laparoscopic CBDE is a feasible approach for CBD stones which permits a definitive procedure in one stage, without pre- or postoperative ES. It is a skill which should be mastered by the biliary surgeon. Further improvement in instrumentation and technique should make the laparoscopic approach not only comparable but preferable to the standard open choledocholithotomy.

Cholangiography↗
PubMed1993

Subtotal splenectomy for Gaucher's disease: a follow-up study.

Three patients with Gaucher's disease who underwent partial splenectomy have been followed for 3, 7 3/4, and 8 1/2 years. All have had significant regrowth of the the splenic remnant and some recurrence of hypersplenism. A review of all previously reported cases also substantiates the recurrence of splenomegaly and hypersplenism. Among new options for the therapy of Gaucher's disease, enzyme replacement therapy (Ceredase) holds great promise for effective treatment.

Female↗
PubMed1993

The enigma of leiomyoblastoma: spectrum of a rare gastric tumor.

Leiomyoblastoma is a rare, smooth muscle tumor of the stomach occurring chiefly in the antrum in patients between the fifth and seventh decades. The clinical spectrum, as illustrated in eight patients described in this report, ranges from an incidental finding to a highly malignant, metastasizing neoplasm. Although the large majority of leiomyoblastomas are benign, malignancy has been reported to occur in up to 12% of cases. Resection of the tumor with an appropriate full thickness segment of gastric wall is mandatory.

Adult↗
PubMed1992

Twelve hundred open cholecystectomies before the laparoscopic era. A standard for comparison.

Records of 1200 consecutive open cholecystectomies, performed by a teaching service of a large, urban hospital in the years immediately preceding the laparoscopic era, were reviewed for morbidity and mortality rates. The mortality rate in this series was 1.8%, chiefly in the older age groups. Only two ductal injuries were incurred. A review of published series from 1952 through 1990 revealed a mean mortality rate of 1.53%. These recent observations on the morbidity and mortality after open operation should provide a useful standard of comparison with ongoing similar studies of laparoscopic cholecystectomy.

Adolescent↗
PubMed1992

The clinical spectrum of lymphangiomas and lymphangiomatosis of the spleen.

Lymphangiomas of the spleen are infrequent neoplasms of the spleen with clinical manifestations ranging from insignificant incidental findings to large, symptomatic cystic masses requiring surgical intervention. An associated syndrome may be lymphangiomatosis, in which the lymphangiomatous process involves other sites or organs, such as the liver, spleen, axilla, and mediastinum. Vasoformative neoplasms (hemangioma, lymphangioma) are relatively uncommon tumors or hamartomas of the spleen. Although well reported in the literature, their surgical significance is not well recognized. These lesions present a broad spectrum of pathologic findings of varied surgical importance. As incidental findings, they may be mistakenly considered as a valid indication for splenectomy. On the contrary, more extensive involvement of the spleen may cause symptomatic splenomegaly, which is a valid indication for splenectomy. When the spleen is diffusely involved (lymphangiomatosis), it may be part of a syndrome of generalized lymphangiomatosis involving structures and organs other than the spleen. This syndrome should be considered in obscure cases of splenomegaly in which the usual hematologic causes have been ruled out.

Adult↗
PubMed1990

The current spectrum of peptic ulcer disease in the older age groups.

Not only has there been a relative increase in the prevalence of peptic ulcer disease (PUD) among America's older age groups, but the characteristics of PUD in these patients differ significantly from those of the general population. Seventy-two consecutive patients 60 years of age or older who underwent operation for PUD between 1984 and 1989 were studied. The unusual features in these patients were 1) 92 per cent required emergency operation, 2) 57 per cent with perforated PUD were female, 3) 85 per cent had duodenal pathology, 4) 28 per cent were currently taking nonsteroidal anti-inflammatory agents, and 5) over one half of all patients had serious postoperative complications. The increasing incidence and associated serious complications of PUD in the elderly population present new challenges to physicians in the diagnosis and treatment of this disease.

Age Factors↗
PubMed1990

The intracolonic bypass tube for left colon and rectal trauma. The avoidance of a colostomy.

Traumatic perforations of the left colon and rectum are most frequently managed by procedures that include the formation of a colostomy. Primary repair without colostomy is much less commonly employed. We report nine patients with traumatic perforations of the left colon and rectum treated with the intracolonic bypass tube (ICBT) without concomitant colostomy. In all these patients we believe the standard treatment would have included fecal diversion. Four patients sustained blunt trauma and five sustained penetrating trauma. Healing of the colonic anastomosis occurred in all cases, and the ICBTs were passed per rectum between the tenth and nineteenth days postoperatively. On the basis of this study, we conclude that the ICBT has a role in the treatment of selected injuries of the left colon and rectum as a safe means of avoiding a colostomy.

Adult↗
PubMed1990

Cystic neoplasms of the pancreas.

Cystic neoplasms of the pancreas can be easily misdiagnosed and mistreated by the surgeon unfamiliar with the pathology, natural history, and operative strategy specific to these uncommon tumors. The authors have treated nine patients over a seven-year period involving four cystadenocarcinomas, two mucinous cystadenomas, two serous cystadenomas, and one solid and papillary epithelial tumor. Our experience illustrates the inaccuracies in both clinical and pathologic diagnosis. Suspected cystic neoplasms are optimally managed by resection. Their slow growth and late metastasis permits curative surgery after a previous drainage or bypass procedure. An aggressive surgical approach is therefore warranted, and multimodal treatment with radiation and chemotherapy may be clinically applicable to large, invasive cystadenocarcinomas.

Adult↗
PubMed1989

Intra-operative and postoperative biliary endoscopy (choledochoscopy). The role of the surgeons.

Intra-operative and postoperative choledochoscopy is an important adjunct to biliary surgery. In the last two decades, the necessity of this examination became obvious but two surveys clearly indicated that despite the availability of instruments surgeons do not use it routinely. One of the reasons is the long learning curve and the limited experience. The introduction of the video choledochoscope opened a new chapter because the surgeon could learn it faster and the technique is easier to use. Choledochoscopy is a "two man" job, requiring four hands. Using video choledochoscopy, the assistant and the operator can observe the situation together, therefore coordination of movement is easier. The actual endoscopic procedure is faster and the location of the stone, its removal, and the sphincter function are recorded on tape. This is a great step forward in analyzing sphincter function. It became the method of choice in teaching. It is assumed that, with the introduction of video choledochoscopy, the incidence of missed stones will be decreased significantly.

Animals↗
PubMed1989

Liposarcoma of the ileocecal valve: a case report.

Liposarcomas are common soft-tissue neoplasms but are rarely present in the gastrointestinal tract. We report a patient with a primary liposarcoma at the ileocecal valve, a previously unreported location. Wide local excision remains the treatment of choice, but local recurrences are common.

Female↗
PubMed1988

The impact of electronic imaging in intraoperative biliary endoscopy (choledochoscopy).

In the last decade, choledochoscopy has become an essential tool for biliary surgery. It is widely accepted, but it is not employed by every surgeon who performs choledocholithotomies. The reason is the limited experience of surgeons performing 30-40 cholecystectomies per year. A survey of 150 hospitals clearly showed that common bile duct exploration is performed in 10%-15% of these cases. General surgeons are not endoscopists. A new video choledochoscope that displays the image in a large format via the TV monitor was developed, which can be viewed with both eyes and an assistant's help; this expedites and coordinates the procedure. The entire process is videotaped and can be used for further analysis and during consultation. It has become the method of choice for teaching. Most importantly, the learning curve of general surgeons has become significantly shorter. The procedure is taught and the surgeon can learn it easily. Its use will contribute to a decrease in the incidence of retained stones and will improve patient care.

Animals↗
PubMed1988

Mini-laparoscopy in blunt abdominal trauma.

Blunt abdominal trauma in multiorgan injured or comatose patients always presents a problem. The aim is to assess, in the shortest period of time, which organ injury requires priority and whether intra-abdominal bleeding or perforation exists. Abdominal lavage proved to be too sensitive. Not every positive case needs exploration. Approximately 15%-20% of the cases explored because of positive lavage did not show a significant bleeding site that would require surgical treatment. The authors developed a mini-laparoscope that can be used at the bedside, in the emergency room, or in the intensive care unit. The procedure can be performed with intravenous sedation and local anesthesia. In 150 cases, no hemoperitoneum was found in 53% of these cases. Except for 1, none of these patients needed further exploration. In 21%, severe hemoperitoneum was discovered; these patients were transferred to the operating room, and this was confirmed by surgery. In 26%, a small amount of blood was found in the gutters. These patients were observed in the intensive care unit and an unnecessary exploration was avoided. Laparoscopy gives a wider range of decision making by observing the abdominal cavity. It can be completed in 10-20 min at the bedside. No serious complications were encountered. This procedure should be taught and practiced in trauma centers.

Abdominal Injuries↗