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Biomedical subjects

M Schein

Publications and source records attributed to M Schein.

At least 73 records · Page 4Linked to original sources
PubMed1996

Safety of laparoscopic cholecystectomy on a teaching service: a prospective trial.

In a prospective audit of our first 213 laparoscopic cholecystectomies (LC), we compared the results obtained by qualified surgeons to those obtained by residents. The first group started performing LC after undergoing formal laboratory laparoscopic courses. The second group was introduced to LC by standard attending-resident teaching in the operating room. In all, 137 LC wer performed by qualified surgeons and 76 by residents. Patients' clinical and laboratory characteristics were not significantly different in the two groups. The conversion rate to laparotomy (11.5% and 12.5%), mean duration of surgery (88 and 83 min), iatrogenic perforation of the gallbladder (16% and 18.5%), "lost stones" (7% and 4%), use of drains (12% and 13%), and extension of the umbilical port incision (about 30% in both groups) were similar in the two groups. The incidence of biliary (3% and 4%) and infectious (3.5% and 4%) complications was equivalent in both groups. We conclude that with the traditional attending-resident approach to surgical education, residents safely and quickly acquire the necessary skills to perform LC without jeopardizing the safety of patients.

Adult↗
PubMed1996

Duration of antibiotic treatment in surgical infections of the abdomen. Forum statement: a plea for selective and controlled postoperative antibiotic administration.

Excessive duration of antibiotics appears to be the principal reason for their inappropriate use in current surgical practice. The main factors to blame are the inability of the clinician to distinguish between contamination and infection, infection and inflammation, and failure to stratify the latter. Consequently, and unnecessarily, prophylactic drugs are carried through into the postoperative period and treatment is continued for long periods. Most experts who contributed to this Discussion Forum favour a trend away from the use of therapeutic courses of fixed duration, and towards attempts to stratify the infective processes, minimising administration by tailoring the duration to the clinical findings. As a consensus of this forum specific recommendations are: Contamination (gastroduodenal peptic perforations operated within 12 hours, traumatic enteric perforations operated with 12 hours, peritoneal contamination with bowel contents during elective or emergency procedures, early or phlegmonous appendicitis or phlegmonous cholecystitis): single dose prophylaxis. Resectable infection (appendicectomy for gangrenous appendicitis, cholecystectomy for gangrenous cholecystitis, bowel resection for ischaemic or strangulated dead bowel without frank perforation): 24 hours postoperative antibiotics. Advanced infection (intra-abdominal infection from diverse sources): 48 hours to 5 days, based on operative findings and patient's condition. Severe intra-abdominal infection with the source not easily controllable (infected pancreatic necrosis, postoperative intra-abdominal infection): longer courses may be necessary.

Anti-Bacterial Agents↗
PubMed1995

Inflammatory response in peritoneal exudate and plasma of patients undergoing planned relaparotomy for severe secondary peritonitis.

OBJECTIVE: To study the pattern of intraperitoneal cytokine release in secondary peritonitis and its correlation with plasma levels and prognosis. DESIGN: Noncomparative descriptive case series. SETTING: Department of surgery in a university hospital. PATIENTS: Seventeen consecutive patients undergoing planned relaparotomy for severe intra-abdominal infection (Acute Physiological and Chronic Health Evaluation [APACHE II] score > 10; mean score, 17.5). INTERVENTIONS: The following were measured at the first and last serial operations in the peritoneal exudate and plasma: endotoxin, tumor necrosis factor alpha (TNF-alpha), interleukin-1 (IL-1), interleukin-6 (IL-6), elastase, and neopterin. MAIN OUTCOME MEASURES: Survival and death. RESULTS: Six patients died. Peritoneal endotoxin levels were significantly higher than in the plasma and were significantly higher in the nonsurvivors. Plasma TNF-alpha, IL-6, elastase, and neopterin levels remained elevated in the nonsurvivors prior to death. Levels of TNF-alpha, IL-6, elastase, and endotoxin were 19, 993, 239, and 7 times higher, respectively, in the peritoneal exudate than in plasma, all significant differences. Elastase and TNF-alpha levels decreased in survivors during the operative treatment but remained elevated in the nonsurvivors. CONCLUSIONS: Secondary peritonitis is associated with a significant cytokine-mediated inflammatory response that is compartmentalized in the peritoneal cavity and indicates an adverse prognosis. Levels of cytokines in the exudate of peritonitis may be used to better stratify the severity of peritonitis and, in future, to guide local therapy.

Adult↗
PubMed1995

Is mechanical bowel preparation necessary before primary colonic anastomosis? An experimental study.

UNLABELLED: The necessity of preoperative or intraoperative mechanical bowel preparation of the colon, before primary anastomosis, has been recently challenged in clinical elective and emergency situations. PURPOSE: This experimental study in dogs investigated the safety of segmental resection and primary anastomosis in the unprepared or loaded colon. METHODS: Two segments of the descended colon were resected and anastomosed in each animal. Group I (12 anastomoses) received preoperative mechanical bowel preparation; the colon was not prepared in Group II (16 anastomoses); in Group III (12 anastomoses), a preliminary distal colonic obstruction was produced, and during the subsequent resection the colon was loaded. Postoperatively, animals were observed clinically, and anastomoses were assessed at autopsy on the ninth day. RESULTS: All animals recovered uneventfully. At autopsy there was no evidence of anastomotic leakage. CONCLUSIONS: In light of recent clinical reports and this experimental study, the ritual of mechanical bowel preparation should be further scrutinized.

Anastomosis, Surgical↗
PubMed1995

Pyoderma fistulans sinifica (fox den disease): a distinctive soft-tissue infection.

Pyoderma fistulans sinifica (PFS, also referred to as fox den disease because its multiple fistulae and sinuses resemble the structure of a fox den) is a distinct chronic infectious disease in which epithelialized tracts form within the subdermal fatty tissue. PFS, which has not been previously described in the English-language literature, must be differentiated from hidradenitis suppurativa, pilonidal sinus, and perianal fistula. The fistulous tracts of PFS are always lined by stratified squamous-cell epithelium but, unlike those of hidradenitis, reach deep into the subcutaneous fat, run epifascially for long distances, and have no relation to skin appendices. We report on 10 men (mean age +/- SD, 36 +/- 5 years) with PFS (mean duration +/- SD, 11 +/- 7 years). Bacterial cultures of affected tissue from these patients yielded a total of 14 facultative and 31 obligate anaerobic species. Treatment consisted of wide en-bloc excision down to the fascia, including all fistulae. Antibiotic therapy temporarily reduced purulent discharge but did not eradicate the infection. Two patients who underwent fistulotomy without wide en-bloc excision developed recurrences.

Abscess↗
PubMed1995

Soft tissue abscesses associated with parenteral drug abuse: presentation, microbiology, and treatment.

Abscess formation at the site of drug injection is the commonest infectious complication in drug addicts. This study characterizes the clinical presentation of the condition, its current microbiology, and treatment outcome. All patients presenting for treatment of soft tissue abscesses associated with parenteral drug abuse over a 21-month period were studied. Sixty-six patients with 70 subcutaneous abscesses after injection of cocaine (85%), heroin (5%), or unreported drugs (10%) were identified. Only 42% were febrile (T > 37.5 degrees C), 54 percent had leukocytosis, and 47 percent had wound fluctuance. Wound cultures (243 isolates in 57 patients) grew predominately anaerobes (143 isolates) and facultative gram-positive cocci (88 isolates). Twenty-six blood cultures were obtained, and five (19%) were positive, two with the same bacteria isolated from the wound. Of the patients tested, 29 percent were positive for hepatitis B surface antigen and 9 percent for HIV. Simple incision and drainage was effective in all cases. Classical signs and symptoms of infection and abscess formation may be absent in this patient population. Many of these patients carry other blood-borne infections which the health professional must guard against. Cocaine injection, and "mixed" aerobic-anaerobic infections predominated, in contrast to earlier reports, when narcotics and aerobes predominated. Simple incision and drainage is adequate treatment; antibiotics, when given, should cover gram-positive and anaerobic bacteria; gram-negative coverage is unnecessary.

Abscess↗
PubMed1995

Sclerosing encapsulating peritonitis--a review.

Sclerosing encapsulating peritonitis (SEP) is a syndrome of multiple causes which, perhaps via a common pathway, affects the small bowel in particular. When persistent intestinal obstruction develops, laparotomy and careful disobstruction of the bowel are indicated. Generally, the prognosis of SEP depends on its cause and the premorbid condition of the individual patient.

Humans↗
PubMed1995

The menstrual cycle and acute appendicitis.

OBJECTIVE: To examine the influence of the menstrual cycle on the incidence and presentation of acute appendicitis. DESIGN: Retrospective study. SETTING: University hospital, Israel. SUBJECTS: 144 women of child bearing age operated on for suspected acute appendicitis and subdivided according to the menstrual phase during which they presented. MAIN OUTCOME MEASURES: The final diagnoses, clinical presentation, and laboratory data. RESULTS: There were no significant differences in the incidence of acute, gangrenous, or perforated appendicitis in patients operated on during the various phases of the menstrual cycle. During menstruation, however, a normal appendix not accompanied by other disease was found significantly more often (p = 0.04). Clinical presentation, physical findings, and laboratory results did not vary throughout the menstrual cycle except for the "classic shifting pain" which was significantly more common during the luteal phase. CONCLUSIONS: Acute appendicitis occurs randomly during the various phases of the menstrual cycle. The incidence of operations for uninflamed appendixes may be higher during the menstrual phase. Significantly more negative laparotomies are done during the menstrual phase, which suggests the existence of a functional disorder that mimics acute appendicitis.

Acute Disease↗