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Biomedical subjects

M Bronstein

Publications and source records attributed to M Bronstein.

48 records · Page 3Linked to original sources
PubMedDate not supplied

[Ambulatory laparoscopy].

We present our experience with laparoscopy in 600 outpatients with several diseases in seven years (1982-1988). We performed 707 studies in 594 patients (99%), in six cases (1%) the examination was not feasible because of intra-abdominal adhesions. In 235 patients (39.16%) previous abdominal surgery was not considered a contraindication for the examination. We performed 295 hepatic biopsies, 69 adhesions cuts, 9 laparoscopic placement of Tenckhoff catheter and other procedures. The incidence of complications was 5.23%, related to laparoscopy 3.67% and to procedures 1.55%. Major complications occurred in four patients (0.56%), surgical intervention was required in one patient (0.14%). We neither had infectious complications, nor mortality. We conclude that laparoscopy can be an ambulatory procedure, because it has a low incidence of complications in skilled hands and is well tolerated.

Adolescent↗
PubMedDate not supplied

[Ultrasound, computed tomography and laparoscopy. Efficacy in the detection of primary and metastatic hepatic tumors. Comparative study].

OBJECT: To compare ultrasound, computed tomography and peritoneoscopy in the diagnosis of primary and metastatic hepatic tumors. DESIGN: Prospective trial of a cohort patients during a year. PLACE: Digestive Disease Department in a National referral Cancer Center. PATIENTS: Forty five patients with intraabdominal tumors for pretreatment evaluation. Intervention; Ultrasonography, computed tomography and peritoneoscopy performed in a period of ten days. MEASUREMENTS: sensibility, specificity and efficiency comparison of results by Chi square test, with Yates correction (X2 Yates), measure of pre test and post test probabilities using Bayes theorem. RESULTS: In hepatic humors, peritoneoscopy was the most sensitive, specificity was similar for the three procedures (p greater than 0.1), in the detection of hepatic metastases peritoneoscopy was the most sensitive 91.6% vs 50% (p less than 0.05) similar specificity and high positive predictive value for the three procedures, comparable with the post test probabilities. CONCLUSIONS: In the detection of focal hepatic lesions, peritoneoscopy was the best method; in case of doubt, failure of non invasive procedures or the need of biopsy samples must be considered the procedure of choice.

Adolescent↗
PubMedDate not supplied

[Results of radical surgery for renal cancer in adults].

For thirteen years, between 1963 and 1976, 120/139 patients with renal cancer were operated. 45 were stage I, 20 were stage II, 45 were stage III and 12 were stage IV (Robson's classification). Of the 45 stage III cancers, 13 had lymphatic invasion and 37 had venous invasion ranging from microscopic stages to invasion of the inferior vena cava. Treatment included: preoperative teleirradiation with cobalt most often a single dose of 500 rads on the day before the operation. Wide excision with primary ligation of the vascular pedicle and node dissection via a lumbar abdominal transperitoneal route remaining the minimum strictly necessary. Sequential monthly chemotherapy over two years of Vincristine and CCNU (chloroethyl cyclo hexylnitroso urea). Postoperative mortality was considerable (14%) but involved patients with advanced cancers, poor general condition (o% stage I, 10% stage II, 22% stage III and 40% stage IV). The long range survival remains excellent in spite of the postoperative losses: 65 p. cent 5 years all stages. However, stage determines the prognosis: 85 p. cent 5 year survival stage I and II and 53 p. cent 5 year survival stage III. Severe affection of the general state of the patient carries a very poor prognosis. Fever does not indicate a worse value except in stage III tumors. In stages I and II it can have value in the paraneoplastic syndrome (terme non familier). The authors, uncertain of the efficacity of preoperative radiotherapy and postoperative chemotherapy, concluded that wide excision with node dissection is the proper fundamental treatment of renal cancer in the adult.

Aged↗
PubMedDate not supplied

[Endoscopic management of biliary fistula].

From January 1991 to July 1993 we diagnosed 16 patients with biliary fistulas. Nine patients showed a fistula of the stump after cholecystectomy (two laparoscopic and the rest in a conventional form). In none was there any evidence of residual stones. Three patients that showed biliary fistula who had residual stones which was no diagnosed during surgery. Four patients had biliary fistulas at different levels after abdominal traumas due to bullet wounds. All the patients were treated endoscopically by means of endoscopic sphincterotomy and in one of them it was necessary to place a biliary stent due to the fact that there was a stricture under the level of the fistula. One patient who, in addition to the fistula had an abscess was drained guided by ultrasound after the sphincterotomy. The evolution of the patients was satisfactory. There were no complications because of the procedure.

Adolescent↗
PubMedDate not supplied

[Colitis due to radiation: endoscopic management with heat probe].

Rectal bleeding is a frequent symptom in radiation colitis, and is due to vascular lesions usually confined to the rectum. We present our preliminary experience with the use of the heater probe, in eight patients with radiation proctitis, whose main symptom was rectal bleeding. Six patients had radiation for carcinoma of the cervix and 2 had endometrial cancer. One to four sessions of coagulation were performed with an intensity of 200 to 400 Joules per session. In all patients a good response was obtained, bleeding diminished or stopped completely, with improvement of blood counts and the need for transfusions. We think that heater probe is a good therapeutic alternative, for the management of these difficult complication.

Cautery↗
PubMedDate not supplied

[Trial of a synthetic absorbable suture, Polyglactin 910, in 100 urologic patients].

The authors studied the clinical tolerance of Polyglactine 910 (Vicryl) in 100 patients operated upon for urological disorders. The operations were mostly for ureterovesical reimplantations to treat reflux, pyelocaliceal kidney stones and ureteral calculi, and prostatic adenomectomy. The suture appears to be solid, and the knots do not loosen. It slides badly however and is not easy to manipulate. When used to close cavity walls this solid suture did not cause a higher percentage of abscess than catgut, when used to suture the urinary excretory tract the authors observed, in one case only, multiple calcification around the ureterovesical suture points and those used to close the bladder. The suture is not suitable for vaginal repair operations during the surgical treatment of incontinence. The authors conclude by defining the properties of a suture they would like to see become available: one which has the same solidity, is easier to manipulate, slides more easily, and, above all, has a different texture: a monofilament rather than a braided suture.

Catgut↗
PubMedDate not supplied

[Percutaneous endoscopic gastrostomy in patients with head and neck neoplasms. Evaluation of a new gastrostomy].

Since their aparition in 1980, percutaneus endoscopic gastrostomy (PEG), represented a dramatic impact in the enteral nutrition thecnics and their indication have expanded. The PEG have many advantages over the surgical gastrostomy. In this paper, we present our experience with the use of PEG in patients with head and neck cancer using a new home made gastrostome. Included were 61 patients 37 males (64.8%), 21 females (36.2%) with ages betwen 11 and 72 years. In 3 patients the PEG was not intended because tight esophageal stenoses. The PEG was completed in 56 cases (91.8%). In 5 patients (8.6%) there were minor complications (4 infections and 1 patient with pain). We have only one case of major complication which consisted in migration of gastrotome to the abdominal wall (Buried Bumper Syndrome). The gastrostome was patent between 15 and 312 days with a median of 125 days. The gastrostomies was made with siliconed 22Fr Foley catheter, crazy glue, and plastic tops. The Foley catheter is acid resistant and not deteriorate like other materials like latex. There was not adverse reaction at the ostomy site. The cost of the kit is about 11 US$ and the commercial kit is 125 US$, on the other hand the internal diameter is 15% wider than the commercial one.

Adolescent↗