Laparoscopic versus mini-incision cholecystectomy.
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Biomedical subjects
Publications and source records attributed to M Schein.
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An appendiceal mass is the end result of a walled-off appendiceal perforation and represents a pathological spectrum ranging from phlegmon to abscess. Over the past decade, improved imaging and interventional radiological techniques have allowed a more accurate definition of pathology and thus a more specific and less invasive management than was previously possible. A management policy should be possible that allows over 80 per cent of patients presenting with an appendiceal mass to be safely spared an open operation.
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Hartmann's procedure is often selected in situations in which the construction of a colorectal anastomosis is considered unsafe. Paradoxically, the creation of the rectal stump involves placement of an intestinal suture line that is prone to leakage. We report our experience with 11 patients with a clinically significant leakage from the rectal stump after Hartmann's procedure, which was manifested as persistent postoperative intra-abdominal infection. A method for the treatment and prevention of this potentially lethal complication is presented.
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Acute acalculous cholecystitis may develop in patients suffering from necrotizing pancreatitis. Conversely, acute pancreatitis may complicate acute gallbladder disease. We present a case that lends support to the existence of another possibility: gallbladder necrosis caused by direct extension of the necrotizing pancreatitic process.
Previous studies on autopsy specimens or surgically resected lobes or lungs have reached varying conclusions regarding the importance of small airways disease and emphysema in causing fixed expiratory airflow limitation in patients with chronic obstructive pulmonary disease (COPD). We obtained high resolution CT scans of the lung and lung function in 56 consecutive patients with fixed expiratory airflow limitation. There was poor correlation between CT emphysema score and either FEV1/FVC% (r = -0.36) or FEV1 % predicted (r = -0.20). In only 10 of the 35 patients with FEV1 < 50% predicted, the CT emphysema score was > 40, indicating significant emphysema. A strong negative correlation between diffusing capacity % predicted and diffusing capacity per alveolar volume and CT emphysema score was found only in patients with FEV1 > or = 1 L (r = -0.75, p < 0.0001). Thus, emphysema does not appear to be primarily responsible for expiratory airflow limitation in COPD. A low diffusing capacity may be spuriously misleading in patients with FEV1 < 1 L and no or trivial emphysema.
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The use of barium contrast study is considered accurate and safe in suspected intestinal obstruction. However, the use of barium in 2 patients with small-bowel obstruction converted their partial obstruction into a complete one. This complication has been previously mentioned but not documented. The use of water-soluble agents may be safer.
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In 11 of 21 patients with penetrating renal injury operated on during a year, salvage of the involved kidney or part of it was successful. We conclude that accurate diagnosis and staging of penetrating renal trauma, when combined with a conservative surgical approach, allows salvage of functional renal parenchyma in a large proportion of cases.
Sclerosing encapsulating peritonitis (SEP) is a rare complication of chronic ambulatory peritoneal dialysis. Although commonly involving the small bowel and associated with severe surgical complications, this entity has almost never been mentioned in the surgical literature. We report here another case of severe SEP and briefly discuss its surgical implications.
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