Biomedical subjects
Publications and source records attributed to M Schein.
This review discusses postoperative gastric ischaemia after detailed consideration of the gastric blood supply and the effects of devascularization. Special consideration is given to gastric remnant necrosis, lesser curve ischaemia after highly selective vagotomy, and gastric ischaemia after other operations.
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The healing of colonic or colorectal anastomoses depends, at least partially, on the volume of fecal residue. Intraoperative antegrade colonic irrigation enables the surgeon to prepare the colon adequately at the time of surgery and to perform safely an immediate resection and primary anastomosis in obstructive lesions of the left colon. Its indications have been extended to other left-sided colonic emergencies, especially perforation and hemorrhage. The technique is described in this study and its value is assessed in the light of available experimental and clinical evidence.
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The unique association between carcinoma of the breast and meningioma was previously described. We report herein an additional series of ten instances representing such an association and review the relevant literature. Surgeons should be aware of the possible relationship between these two conditions. Lesions of the central nervous system in patients with carcinoma of the breast should not be labeled as metastases unless benign, resectable, intracranial lesions have been ruled out by proper investigations.
A rare case of true necrotizing fasciitis arising from a spontaneously drained Bartholin's abscess is described. The presentation, diagnosis and treatment of this condition are discussed, and the literature on similar cases arising from the female genital tract is reviewed, emphasizing the importance of early and aggressive surgical excision of all involved tissues.
The introduction in the late 1970s of potent and effective anti-ulcer drugs revolutionised the medical treatment of peptic ulcer disease and modified the indications for surgical management. Since, as far as we were aware, there had been no previous detailed evaluation of the pattern of surgery for peptic ulcers in this country during the modern era of ulcer therapy, we decided to look at our experience since 1980.
Emergency surgery for a bleeding post-bulbar duodenal ulcer may entail a risk of injury to the common bile duct. In an experimental study on 20 fresh cadavers, the distance between the common bile duct and the duodenum was measured, and sutures and metal clips were placed in the duodenal wall. Sutures presented a greater risk of injury to the common bile duct than metal clips. Recent clinical experience with the application of metal clips in a bleeding post-bulbar ulcer is presented and relevant reports summarised.
The first surgical audit from a South African teaching hospital is presented. During a 1-year period (1987) 1,725 patients were treated in a 60-bed unit (29 patients/bed/yr). Eighty per cent of admissions were emergencies; 1036 operative procedures were performed (45% emergency operations). Aspects of workload, utilisation of beds, pattern of admission and operations are discussed. The audit indicated that a surgical unit in an urban teaching hospital for white patients serves mainly as an acute surgical facility.
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Four cases of suture-line dehiscence occurring during acute postoperative pancreatitis are presented. The possible causative role of the pancreatitis in the pathogenesis of these leaks is discussed.
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A case of small-bowel volvulus occurring during pregnancy after pancreaticobiliary bypass for morbid obesity is presented. The association between pregnancy, previous small-bowel bypass surgery and intestinal volvulus is discussed.
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In a prospective study of 22 patients with diffuse peritonitis managed by the method of electively staged multiple laparotomies, the abdomen was left open in 9 patients. The patients were selected on the basis of the severity of their intra-abdominal infection: only massive faecal peritonitis, postoperative peritonitis and pancreatic abscesses were included. These amounted to only 9 per cent of all patients with intra-abdominal infection treated over a 2-year period. Up to seven re-operations were required per patient. In view of a high mortality rate of 32 per cent, the superiority of this aggressive management strategy over conventional methods is not fully established.
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During a three-year period, 30 patients had emergency Hartmann procedures for diverticular disease (N = 12), carcinoma (N = 6), trauma (N = 3), and miscellaneous causes (N = 9). Two patients died postoperatively (6.7 percent) and wound infection developed in 60 percent of the patients. Planned relaparotomies for severe intra-abdominal infection were performed in ten patients (an average of 2.5 procedures per patient) with no mortality. In five cases a mucous fistula was converted into a Hartmann pouch; a preference for the Hartmann pouch in patients undergoing repeated explorations is discussed. Colorectal continuity was subsequently restored in 23 patients (76.6 percent).