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Biomedical subjects

L Morgenstern

Publications and source records attributed to L Morgenstern.

At least 73 records · Page 4Linked to original sources
PubMed1984

Surgical procedures in nonagenarians.

During the hospital course of 225 nonagenarian patients who underwent 285 major operations-80% on the general, vascular, orthopedic and urologic services-overall morbidity was 37% and mortality 7.5%. The 100 emergency operations were associated with a higher morbidity and mortality rate. Nonsurvivors were more likely to have associated cardiac or cerebral medical conditions, higher utilization of intraoperative invasive hemodynamic monitoring and greater use of surgical intensive care units. Compared with all surgical patients, the nonagenarians were admitted twice as often to the surgical intensive care unit, required twice the number of hospital days, underwent intraoperative hemodynamic monitoring twice as frequently and incurred 200% greater hospital charges. We conclude that with careful evaluation and management, a nonagenarian patient presenting with a surgical condition can safely undergo necessary operative procedures.

Aged↗
PubMed1983

Melanosis coli. Changes in appearance when associated with colonic neoplasia.

In 30 cases of colonic neoplasia associated with melanosis coli, proliferating or neoplastic colonic epithelium was notable within the melanotic colons by virtue of a striking absence of pigmentation. Microscopically this characteristic was found to be due to an absence or diminution of pigment-laden macrophages in the lamina propria underlying such lesions. Therefore, the absence of pigment-laden macrophages can be considered a marker for abnormally proliferating epithelium. This characteristic may denote a cellular or humoral change mediated by macrophages in association with neoplastic epithelium.

Colonic Diseases↗
PubMed1983

Comparative tissue reactivity to topical hemostatic agents in the periureteral area.

Application of the topical hemostatic agents microfibrillar collagen hemostat (Avitene), oxidized cellulose (Surgicel), and absorbable gelatin sponge (Gelfoam) to the periureteral regions in dogs did not incite an adverse inflammatory or fibrotic reaction when used in standard, recommended fashion. No instances of ureteral obstruction resulted from such application. The addition of a small amount of sterile urine in the same area with the topical agent did not influence the degree of reaction. We concluded that these useful hemostatic agents, when used properly, are absorbed with only slight or no residual tissue reaction. The adverse tissue reaction occasionally reported probably can be ascribed to either improper use of the hemostatic agent, other concomitant noxious influences such as infection, or admixture with abnormal collections of body fluids.

Administration, Topical↗
PubMed1983

The left transverse colostomy.

The right transverse colostomy is the one traditionally performed for distal colonic obstructive tumors, perforated sigmoid diverticulitis, distal colonic injuries, or for the protection of precarious low colonic anastomoses. However, the right transverse colostomy has a tendency to prolapse; its effluent is frequently liquid; it cannot be performed without producing adhesions in the right upper quadrant; and it obligates the surgeon generally to three operations when done as the first part of a staged colonic resection. The left transverse colostomy has the advantages of a reduced incidence of prolapse, an increased length of absorptive surface, absence of adhesions in the right upper quadrant, and the possibility of a two-stage resection. Fifteen instances in which left transverse colostomies were performed with diverse indications formed the basis for this report.

Colonic Diseases↗
PubMed1983

Emergency minilaparoscopy in abdominal trauma. An update.

In 106 cases of blunt abdominal trauma, the emergency minilaparoscope was used as a diagnostic tool. In 57 patients (53.5 percent), the findings proved to be negative. In 22 patients (20.8 percent), the laparoscopic findings were corroborated by exploration. But, in 27 instances (25.4 percent), minimal to moderate hemoperitoneum was found and the laparoscopic view indicated that these patients could be treated nonoperatively with close observation. None of these patients required subsequent exploration. There were no complications of laparoscopy which required surgical intervention. In our opinion, minilaparoscopy is more diagnostically accurate than lavage. It is a fast and safe examination which can be performed at the bedside with the patient under local anesthesia. The number of unnecessary abdominal explorations in severely injured patients can be reduced to a negligible figure, thus decreasing morbidity, hospitalization time, and costs.

Abdominal Injuries↗
PubMed1983

Nonoperative management of injuries of the spleen in adults.

Seventeen adult patients with proved splenic injuries were managed nonoperatively without a single instance of morbidity or mortality. All patients had a clinical history and physical findings suggestive of splenic trauma; the diagnosis was confirmed by splenic scintigraphy and, in some patients, additionally by angiography. The selection of patients for nonoperative management was made on the basis of a stable clinical status and laboratory evidence of cessation of bleeding. Patients who had progressive hypovolemia, worsening abdominal signs and laboratory evidence of continued bleeding were subjected to laparotomy for the performance of total splenectomy, partial splenectomy or splenorrhaphy. An arbitrary limit of three transfusions was set beyond which laparotomy was mandated. Nonoperative management is clearly not indicated for all patients with splenic injuries. In selected patients, however, nonoperative management is feasible and safe, providing careful clinical and laboratory observations are available. The theoretical long term sequelae of splenosis and splenic cyst formation have not yet been observed.

Adolescent↗
PubMed1982

Surgical shrapnel.

Explore the source record for details and available documents.

Foreign Bodies↗
PubMed1980

Minilaparoscopy for blunt abdominal trauma.

A new technique of minilaparoscopy has been developed for use in patients with blunt abdominal trauma. Fifteen injured patients underwent laparoscopy using this new method. Six patients had normal findings, seven patients had evidence of minor injury, and two patients had what seemed to be major injuries. The patients with normal findings or minor injuries were treated nonoperatively and all did well. The two remaining patients underwent laparotomy where serious injuries were found and repaired accordingly. With this modified instrumentation, emergency laparoscopy is simple and rapid enough to become a practical tool in the management of blunt abdominal trauma.

Abdominal Injuries↗
PubMed1980

Partial splenectomy for nonparasitic splenic cysts.

Four cases of partial splenectomy for large, nonparasitic splenic cysts are described. In all four patients it was possible to successfully preserve most of the splenic parenchyma. With the increasing realization of the importance of splenic function, the feasibility of this operative approach to splenic cysts is proposed.

Adult↗
PubMed1980

Identification of anastomotic sites with radiopaque markers.

Routine marking of the anastomotic site in gastrointestinal and biliary tract operations by hemoclips is a useful adjunct in the study and interpretation of postoperative roentgenologic studies. The addition of this simple maneuver has been greeted with enthusiasm by our radiologists. We suggest that the use of hemoclips be made routine in gastrointestinal and biliary tract operations.

Biliary Tract Surgical Procedures↗
PubMed1979

Techniques of splenic conservation.

The scope of surgical procedures on the spleen has undergone a dramatic change in the past few years. Efforts directed toward splenic preservation have intensified with the emerging realization that sepsis is a sequela not to be ignored in asplenic subjects. Successful operations on splenic parenchyma require modified techniques of exposure and mobilization of the spleen. The segmental vasculature of the spleen makes possible controlled resection of traumatized or diseased segments of parenchyma. Hemostatic measures include the use of metal clips, ligation of small intrasplenic vessels, and application of topical agents for residual surface bleeding. With the use of such techniques, conservative splenic surgery is possible in minor and major splenic trauma, splenic cysts, and selected pathologic states in the spleen.

Adolescent↗
PubMed1979

'Malignant' diverticulitis: a clinical entity.

A form of severe diverticulitis exists that is characterized by (1) phlegmonous inflammation of the sigmoid and rectosigmoid colon, often extending below the peritoneal reflection, (2) frequent fistulization to skin, urinary bladder, and small intestine, (3) frequent colonic obstruction, and (4) high postoperative morbidity and mortality. The clinical similarity to granulomatous colitis is very apparent, but pathologic findings are consistent with severe diverticulitis rather than granulomatous colitis. The term "malignant" diverticulitis is suggested because of the progressive nature of the disease process and the frequency of severe morbidity associated with it. Seventeen patients have been studied since 1965, comprising approximately 7% of patients operated on for diverticular disease at Cedars-Sinai Medical Center.

Aged↗