Search PubMed⌕ Search

Biomedical subjects

M Schein

Publications and source records attributed to M Schein.

At least 55 records · Page 3Linked to original sources
PubMed1994

Minimal antibiotic therapy after emergency abdominal surgery: a prospective study.

The optimal duration for courses of antibiotic therapy following emergency abdominal surgery was examined. The length of postoperative administration was based on the operative findings of contamination versus infection and the degree of the latter. A total of 163 patients (mean APACHE II score 7) were stratified into four groups: group 1 (60 patients), no postoperative antibiotics; group 2 (32), antibiotic therapy for 24 h; group 3 (48), administration for 48 h; and group 4 (23), antibiotic therapy for 72 h to 5 days. Three patients (2 per cent) died. Wound infection developed in 12 patients (7 per cent) and postoperative intra-abdominal infection in two (1 per cent). Antibiotics were stopped according to the protocol in 28 patients in spite of continued fever; one developed a subhepatic abscess and three had wound infections. Distinguishing contamination from infection and operative stratification of the latter allowed a successful 'minimal' postoperative antibiotic policy to be employed.

Abdomen↗
PubMed1994

Thoracoscopic versus open supraclavicular upper dorsal sympathectomy: a prospective randomised trial.

The purpose of the present study was to compare the short term results of the "open" supraclavicular approach with the thoracoscopic access for T2-T4 sympathetic ganglionectomy in patients with palmar hyperhidrosis. Patients were randomly allocated into two groups of 12 each, and were operated on: one by the open supraclavicular access; the other by the transthoracoscopic approach. The effect on palmar perspiration, operative data, postoperative complications and patients's satisfaction on short term follow up were examined. All operations achieved dry hands. Only two significant differences were observed: longer anaesthesia and poorer patient satisfaction in the thoracoscopic group one week after surgery (probably because a higher proportion of cases developed prolonged postoperative chest pain). Both techniques similarly achieve dry hands. The open method is not longer or more difficult, is possibly associated with less morbidity, and gives a higher subjective satisfaction.

Adolescent↗
PubMed1994

Small bowel obstruction following laparoscopic cholecystectomy: diagnosis of incisional hernia by computed tomography.

As laparoscopic cholecystectomy has become the procedure of choice for symptomatic gallstones, specific complication related to this technique have been noted. We report a case of small bowel obstruction in the trocar puncture site following uneventful laparoscopic cholecystectomy in an extremely obese woman. Diagnosis was made by computed tomography, and reduction was possible by local approach, avoiding explorative laparotomy.

Cholecystectomy, Laparoscopic↗
PubMed1994

[National survey of antibiotic use after abdominal surgery].

A postal survey of 283 members of the Israeli Association of Surgeons was conducted to determine their current practices as to duration of antibiotic therapy following emergency abdominal operations (response rate 26.5%). The maximal acceptable length of antibiotic administration after various emergency operations was based on recommendations in the recent literature. By these criteria, about half those responding were using excessive courses of post-operative antibiotics. We conclude that failure to distinguish between contamination, which requires either minimal post-operative administration of antibiotics or none at all, and infection which requires a proper postoperative course, is the main reason for unnecessarily prolonged postoperative use of antibiotics.

Abdomen↗
PubMed1994

The management of penetrating trauma to the urinary tract.

Penetrating trauma to the urinary tract is best dealt with early in the overall management of the trauma patient. As there are usually other more obvious associated injuries, involvement of the urinary tract may be overlooked. Delayed management may be of severe consequence to the patient, causing delayed bleeding, retroperitoneal abscess and nephrectomy. Patients suspected for urinary trauma are those with flank or back wounds, retroperitoneal hematoma, pelvic trauma or those presenting with hematuria. The modern approach to trauma emphasizes the staging of injury prior to definite management. Appropriate roentgenographic studies of the urinary tract should be included in the initial evaluation of the patient with trauma. Renal injuries are staged according to severity and method of infliction. Stab wounds or low velocity GSW and those of minor or moderate degree may be managed conservatively with an acceptably good outcome. High velocity GSW usually cause extensive damage and surgical exploration is warranted. Ureteric injuries are rare, but prone to be missed at initial diagnosis. Emergency roentgenologic studies may be insufficient and must be augmented by thorough examination at the initial laparotomy. Hematuria accompanies nearly all instances of bladder trauma. The mandatory investigation is retrograde cystography. The standard approach to penetrating bladder trauma is surgical.

Female↗
PubMed1994

Therapeutic effect of oral Gastrografin in adhesive, partial small-bowel obstruction: a prospective randomized trial.

BACKGROUND: Previous published clinical observations claim that Gastrografin, a hyperosmolar gastrointestinal water-soluble contrast agent, speeds the resolution of postoperative ileus, barium impaction ileus, adhesive small-bowel obstruction, and intestinal obstruction caused by parasites and bezoars. However, no objective data exist that support the therapeutic effects of Gastrografin in these situations. METHODS: A total of 107 episodes of adhesive, partial small-bowel obstruction in 99 patients were randomized into a control group (48 episodes), who were treated with conventional methods, and a trial group (59 episodes), who were treated with 100 ml of Gastrografin administered through the nasogastric tube. The following variables were examined: time to resolution of partial small-bowel obstruction, the need for operation, complications, and hospital stay. RESULTS: Mean timing of the first stool was 23.3 hours in the control group and 6.2 hours in the patients receiving Gastrografin (p < 0.00001). Ten obstructive episodes (21%) in the control group required operative treatment compared with six (10%) in the trial group (p = 0.12). Mean hospital stay for the patients who responded to conservative treatment was 4.4 days and 2.2 days in the control and trial groups, respectively (p < 0.00001). One patient in each group died after operation. No Gastrografin-related complications were observed. CONCLUSIONS: Orally administered Gastrografin is safe and has a therapeutic role in adhesive, partial small-bowel obstruction. It significantly prompts the resolution of the obstructive episodes and shortens hospital stay. However, further studies are necessary to confirm the significance of our observation that it may reduce the need for operation.

Administration, Oral↗
PubMed1993

[Mediastinal abscess complicating perforated riding gastric ulcer].

Gastric ulcer in a diaphragmatic hernia is a specific clinical entity, different from other gastric ulcerations. A 71-year-old man with a perforated and bleeding gastric ulcer in a diaphragmatic hernia, complicated by a posterior mediastinal abscess, is presented.

Abscess↗
PubMed1993

[Thoracoscopic resection of upper dorsal sympathetic chain for palmar hyperhidrosis].

During the past year we have used the thoracoscopic approach in performing bilateral upper dorsal sympathectomies for the treatment of palmar hyperhidrosis. We present our first 16 patients. Histological examination proved that sympathetic ganglia had been resected in all 32 procedures. Immediately after operation all hands were completely dry and 31 of them remained so on follow-up 5 months later (97% success rate). The main operative complications were bleeding in 3 cases (9.4%; only 1 severe), and chest and back pain for more than 1 week in 8 (50%). The main late sequela was compensatory hyperhidrosis of the chest and back in 10 cases (62%).

Follow-Up Studies↗
PubMed1993

[Temporal artery biopsy--required or superfluous?].

Temporal arteritis is a systemic disease affecting large and medium-sized arteries in the elderly. The incidence of the disease increases with age and its major complications are blindness, cerebrovascular accidents and aortic dissection. Diagnosis is mainly based on clinical signs and symptoms. Temporal artery biopsy is a popular and simple diagnostic procedure and if positive confirms the diagnosis. However, a negative biopsy cannot exclude temporal arteritis due to its segmental nature, and the specific signs and symptoms still require treatment with corticosteroids. During the years 1982-1991 we performed 206 temporal artery biopsies, of which only 21 (10.2%) confirmed the presence of temporal arteritis. Our experience is presented with regard to the usefulness of temporal artery biopsy in particular. In view of the low biopsy yield we recommend more selective referral for this purpose.

Adult↗