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Biomedical subjects

M Schein

Publications and source records attributed to M Schein.

At least 109 records · Page 6Linked to original sources
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↗
PubMed1993

[Isolated iliac aneurysm].

The incidence of isolated iliac artery aneurysm is 1-2% of that of abdominal aortic aneurysms. The natural history is of gradual enlargement, with rupture the most common clinical presentation. The signs and symptoms of such an aneurysm are influenced by its concealed location within the bony pelvis. Awareness of these special characteristics improves the chances of early diagnosis and proper surgical treatment before possible rupture. We report 2 cases which demonstrate the spectrum of the clinical presentation.

Aged↗
PubMed1993

[Total colectomy and mucosal proctectomy with J-pouch anal anastomosis for ulcerative colitis and familial colonic polyposis].

Total colectomy and mucosal proctectomy with ileal pouch-anal anastomosis is the accepted surgical procedure for ulcerative colitis and familial polyposis of the colon. During 1981-1990, 25 patients with ulcerative colitis or familial polyposis underwent this operation in our department. In the majority a J-pouch was performed. In the early years, an 8 cm rectal muscular sleeve was left. In later cases, in accordance with opinions expressed in the medical literature, the length of the sleeve was shortened to about 3 cm. We present the functional results and the early and late complications on follow-up of up to 10 years (mean 3.5 years). Although this operation is not the ideal solution, it is better than the alternatives and is the surgical procedure of choice.

Adolescent↗
PubMed1993

[Subtotal cholecystectomy: an emergency procedure for the difficult gallbladder and high-risk patient].

Emergency cholecystectomy in high-risk patients is still associated with significant morbidity and mortality. Occasionally technical difficulties and bleeding diathesis are complicating factors. Our prospective experience with subtotal cholecystectomy in 23 consecutive patients is presented. All presented as increased surgical risks (APACHE II above 10) and suffered from acute cholecystitis with empyema or perforation. 1 patient died (4.4%), but overall, surgical complications were minimal. We conclude that subtotal cholecystectomy combines the advantages of cholecystectomy and cholecystostomy. We believe that this short, simple and safe procedure is a logical choice for emergency situations in critically ill patients.

Adult↗