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Biomedical subjects

M Schein

Publications and source records attributed to M Schein.

At least 37 records · Page 2Linked to original sources
PubMed1991

Surgical strategies in the treatment of pancreatic necrosis and infection.

Controversy still surrounds the management of necrotic and septic complications of acute pancreatitis. A review of the literature of the past decade dealing with the surgical treatment of pancreatic necrosis, pancreatic abscess and infected pancreatic necrosis has been undertaken. Three main patterns of management could be identified: (1) 'conventional treatment', consisting of pancreatic resection or necrosectomy with drainage; (2) 'local lavage', consisting of necrosectomy followed by regional lavage; and (3) 'open management', with resection or necrosectomy followed by planned multiple re-explorations. From this review it appears that local lavage and open management offer better survival prospects than conventional treatment. Open abdomen techniques, however, are associated with an increased risk of complications, such as colonic necrosis, intestinal fistula, and intra-abdominal bleeding. Excellent results can be achieved in specialized centres with any of the three methods, provided adequate debridement and prompt reoperations are undertaken if the septic state persists.

Abscess↗
PubMed1991

Pancreatic pseudocysts: a proposed classification and its management implications.

Pancreatic pseudocysts in 83 patients were classified according to clinical and radiographic criteria. Group I (45 patients) had acute, 'post-necrotic' pseudocysts with normal pancreatic duct anatomy and rarely duct-pseudocyst communication. Percutaneous drainage was curative in all patients in whom it was used. Group II (26 patients) included 'post-necrotic' pseudocysts developing in patients already suffering from chronic pancreatitis. The pancreatic duct was diseased but not strictured, and duct-pseudocyst communication was often present. Percutaneous drainage is possible for such patients but it may have to be prolonged; surgical internal drainage was usually successful. Group III (12 patients) had chronic 'retention' pseudocysts. The pancreatic duct was grossly diseased and strictured and duct-pseudocyst communication was present in all cases. Percutaneous drainage is contraindicated and surgical internal drainage has a high recurrence rate. Operative procedures in this group should address the specific ductal pathology. An improved classification of pseudocysts could help the surgeon to choose the most appropriate form of treatment.

Acute Disease↗
PubMed1991

Ureteral obstruction after abdominal aortic surgery.

Obstructive uropathy following abdominal aortic surgery can no longer be considered a rarity. Early hydronephrosis, developing in the first postoperative year, occurs in 10% to 20% of patients; it usually runs a benign, self-limiting course. The incidence of delayed ureteral obstruction, which develops or persists after the first postoperative year, is unknown because it is asymptomatic in most cases. Although spontaneous resolution is possible, it seems that this late form is more likely to persist. The diagnosis of postoperative hydronephrosis is not an indication for urologic intervention. This should seldom be necessary; it should be reserved only for patients with evidence of worsening obstruction or deteriorating renal function. Early and particularly, delayed hydronephrosis seems to be a marker for present or impending graft complications, such as infection or false aneurysms. A prolonged follow-up is therefore mandatory whenever the diagnosis is established as it may improve long-term survival and limb salvage. The need for routine screening for this condition remains to be established. With the availability of noninvasive methods, such a task could be easily accomplished.

Aorta, Abdominal↗
PubMed1991

Postoperative external alimentary tract fistulas.

Most series dealing with external gastrointestinal fistulas cover experience of many years and include a heterogeneous sample of fistulas. We present our experience with 117 cases of postoperative external alimentary tract fistulas treated since 1980. Only fistulas caused by anastomotic leaks and operative injury to bowel are included. The overall mortality rate was 37%. The fistulas are classified into four types: type I-abdominal, esophagus, gastroduodenal (mortality rate, 17%); type II-small bowel (mortality rate, 33%); type III-large bowel (mortality rate, 20%), and type IV-all sites associated with a large abdominal wall defect (mortality rate, 60%). The main cause of death was intra-abdominal infection. Seventy-six percent of the patients required further operations. We conclude that despite the availability of all modern diagnostic and management facilities, postoperative external gastrointestinal fistulas treated during the 1980s continue to represent a surgical "disaster." Only prevention and improved methods in the management of the associated intra-abdominal infections could improve the results.

Abdominal Muscles↗
PubMed1991

Partial cholecystectomy in the emergency treatment of acute cholecystitis in the compromised patient.

Emergency cholecystectomy in the high-risk patient still results in a substantial mortality and morbidity rate. A prospective experience is presented with partial cholecystectomy in 16 high-risk patients (APACHE II greater than 10) undergoing emergency surgery for perforation, empyema or failure to respond to conservative treatment. Excessive bleeding tendency was present in three patients. One patient died (6%). Mean operative time was 40 min. One patient developed an intra-abdominal bile leak due to a retained common bile stone 8 months after operation. Partial cholecystectomy has the advantages of both cholecystectomy and cholecystostomy. It is a fast and safe procedure and should be considered as an option in the emergency situation in the high-risk patient.

Acute Disease↗
PubMed1991

Anal canal adenocarcinoma. A report of 4 cases.

Although rare, adenocarcinoma of the anal canal may be more common than previously thought in populations with a high incidence of peri-anal sepsis. Four such cases are presented and published reports reviewed. To avoid unnecessary delays in diagnosis, the clinician must adopt a high index of suspicion when dealing with chronic peri-anal disease. More regular follow-up examinations and biopsies of suspicious lesions are necessary. Since the origin and histological appearance of these tumours are often not clear cut, both clinician and pathologist must work closely together when correlating their findings. Until recently, the vast majority of cases have been managed surgically, and a concerted effort needs to be made to evaluate the role of chemoradiotherapy and preoperative radiotherapy as therapeutic modalities.

Adenocarcinoma↗
PubMed1991

Intestinal presentation of phaeochromocytoma. A case report.

An unusual case of a patient with a phaeochromocytoma presenting with colitis is reported. A review of published reports showed a high mortality rate in patients with phaeochromocytoma complicated by intestinal disease. The importance of pre-operative preparation with alpha-adrenergic blockers and removal of the tumour for the disappearance of intestinal symptoms is emphasised.

Adrenal Gland Neoplasms↗
PubMed1990

The bad blood.

Explore the source record for details and available documents.

Health Services Misuse↗
PubMed1990

Peritoneal lavage in abdominal sepsis. A controlled clinical study.

The value of intraoperative peritoneal lavage (IOPL) with saline solution, with or without antibiotics, in the treatment of peritoneal contamination, continues to be controversial. A prospective trial was carried out in 87 patients who underwent emergency laparotomies for peritonitis. They were randomized to be treated in one of three ways: group 1 (mean acute physiologic and chronic health evaluation [APACHE] II score, 8) received no IOPL; group 2 (mean APACHE II score, 10) received IOPL with saline solution; and group 3 (mean APACHE II score, 8) received IOPL with saline solution and 2 g of chloramphenicol succinate. In groups 1, 2, and 3, the mortality was 21%, 21%, and 10%, respectively (not significant), and correlated well with the preoperative APACHE II scores. In groups 1, 2, and 3, the mean hospital stay was 13, 13, and 10 days, respectively (not significant), and the incidence of wound infections was 20%, 17%, and 17%, respectively; the incidence of surgical complications was 10%, 24% and 7%, respectively (not significant), and of medical complications, 24%, 31%, and 17%, respectively. We concluded that IOPL with saline solution or antibiotics did not influence the outcome following laparotomies for peritonitis.

Adolescent↗