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Biomedical subjects

M Zer

Publications and source records attributed to M Zer.

At least 91 records · Page 5Linked to original sources
PubMed1977

The value of Gastrografin in the differential diagnosis of paralytic ileus versus mechanical intestinal obstruction: a critical review and report of two cases.

Two cases in which serious intra-abdominal complications were masked by results of the contrast examination using Gastrografin were encountered. This caused the authors to review critically the use of Gastrografin in the differential diagnosis of paralytic ileus versus mechanical intestinal obstruction. In a series of 41 cases in which the diagnostic problem was not solved initially by means of physical examination and plain abdominal roentgenograms, the Gastrografin examination proved reliable in 28 (68 per cent). The reliability of the examination was defined as the relative number of cases in which a correct decision could be made for or against surgical operation. It is concluded that Gastrografin is a valuable diagnostic aid in controversial cases of ileus. A "negative" result of the examination, however, would never be allowed to damp the surgeon's awareness of possible serious intra-abdominal conditions, which the contrast examination has failed to disclose and which require immediate surgical intervention.

Adult↗
PubMed1977

External biliary-pancreatic fistulas.

Twenty-seven patients treated for pancreatic and/or biliary-cutaneous fistulas have been reviewed. Four patients died mainly because of cardiopulmonary and septic complications. Spontaneous sealing of the fistula occurred in 81% of the conservatively treated cases (48% of all cases). All the LO fistulas but only 68% of the HO fistulas treated conservatively sealed spontaneously. Eleven patients were treated surgically. There were three deaths and three failures (reappearance of fistula). All the patients who died had been operated on within three months after the appearance of HO fistulas. There was no mortality among the patients with LO fistulas or among patients operated on at a later stage. We have reached the following conclusions: 1. There is a significant difference in prognosis between low output and high output fistulas. 2. In LO fistulas, there is no need for a surgical intervention aimed to close the fistula unless it persists for at least one year. 3. In HO fistulas, if a corrective operation is necessary, it should be withheld for at least three months whenever possible. 4. Roux-en-Y fistulojejunostomy is considered to be the procedure of choice. 5. Infection and premature colsure of the external part of the fistulous tract should be avoided by insertion of drains and repeated surgical drainage, where necessary. 6. High caloric feeding, elemental diet and intravenous hyperalimentation are very important factors that enhance recovery in the surgically and conservatively treated patients.

Adult↗
PubMed1977

The influence of biliary infection on the postoperative course after biliary tract surgery.

A prospective clinicobacteriological study was undertaken in 167 patients undergoing biliary surgery so as to assess the possible influence of the endogenous preoperative biliary infection on postoperative morbidity. Bile cultures were positive in 33% (55 patients); in those undergoing cholecystectomy alone this finding was present in 23% while in those in whom a choledochotomy was also performed cultures were positive in 65%. The incidence of wound infection was found to be twice as high in those undergoin choledochotomy as in those undergoing cholecystectomy alone--37.8% vs. 18.5%. There was no appreciable difference in the rate of wound infection when a routine appendectomy was performed during biliary tract surgery. Among the 38 patients with wound infection, bile cultures were positive in 16. In 13 cases the offending organism in the wound was identical with that recovered from the bile coulture. This finding suggests an endogenous source for the wound infection. This study further indicated that wound infection is most likely to be encountered in patients with pathogenic organisms in the bile, in the aged and in those whose resistance to infection has been lowered by concomitant disease.

Adolescent↗
PubMed1976

Axillary metastases from an unknown primary source.

The appropriate therapeutic approach is considered in patients who present with carcinomatous metastases in the axillary lymph nodes and in whom the site of the primary tumor remains obscure. Eight patients with axillary lymph node metastases are reported, in five of whom the location of the primary tumor could not be established. In three patients the primary growth was ultimately found to be in the adjacent breast. Early death occurred in only one patient, and in this instance the primary site proved to be in the breast. The remaining seven patients have all shown a relatively good prognosis when compared with those in similar series reported in the literature. The conservative policy of using radiotherapy alone for such cases, and the more aggressive approach of blind radical mastectomy of the adjacent breast, are both rejected. Instead, the more conservative sector mastectomy of the upper outer quadrant of the ipsilateral breast is proposed as a diagnostic procedure. Should this, together with general investigation of the patient, fail to detect the primary tumor, therapeutic axillary block dissection followed by radiotherapy is then advocated. If the primary tumor is found in the breast on sector mastectomy, a modified radical mastectomy of the affected breast should be performed and followed by irradiation.

Adult↗
PubMed1975

Staged orchiorrhaphy. Therapeutic procedure in cryptorchic testicle with a short spermatic cord.

In 62 planned staged orchiorrhaphies for a "short" spermatic cord, satisfactory location of the testicle following the second operation was achieved in 90% of cases. The testicle was atrophic and had to be excised in only 3.2%. After a follow-up period of two to ten years, the testicle remained satisfactorily located in 77% of cases; adequate size and configuration of the testicle (compared to the contralateral side) was found in 64.5%. In 17%, a partial or complete atrophy developed. No correlation was found between the initial size of the testicle and the late results. It is advocated, therefore, that excision be avoided unless definite atrophy exists. Planned staged orchiorrhaphy is recommended for testicles in high locations that are difficult to bring down. The late preschool period (5 to 6 years) is suggested as the optimal age for the first attempt at orchiorrhaphy and the second stage two years later, if required.

Adolescent↗
PubMed1975

The use of metoclopramide in acute pyloric obstruction. A clinical trial.

Twelve patients with complete, or nearly complete, pyloric obstruction due to duodenal ulcer, were treated conservatively with metoclopramide. The purpose of this therapeutic trial was to avoid emergency operations in these patients and to enable a better radiological evaluation and clinical preparation before surgery. The treatment, in addition to the usual gastric decompression and fluid and electrolyte replacement therapy, was effective in 10 patients (83.4 percent). In eight of these patients the results of the trial was regarded as "very good". Six of them were operated upon electively later and two were not operated upon at all. In two patients the results were regarded as "good". These patients underwent early elective surgery. In the remaining two patients (16.6 percent) the trial failed and semiurgent operation could not be avoided. As no side-effects are evident following the administration of metoclopramide and no harm is done by delaying surgery for three days, it is suggested that this therapeutic trial should be undertaken in every case of pyloric stenosis or obstruction. This may markedly reduce the need for emergency operation and prevent many postoperative complications which not uncommonly follow emergency surgery for pyloric stenosis.

Adolescent↗