An unusual cause of intraabdominal hemorrhage: ruptured hepatic artery aneurysm.
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Aged↗
Biomedical subjects
N Hananel
Publications and source records attributed to N Hananel.
Adenocarcinoma of the appendix: an unusual disease.
OBJECTIVE: To describe our experience with primary appendiceal tumours. DESIGN: Retrospective study. SETTING: University hospital, Israel. SUBJECTS: 2520 patients who had appendectomies during the 14 years, January 1982-December 1996. RESULTS: 22 patients 5 male and 17 female, mean age 56.2 years, had primary neoplasms; 14 were carcinoid tumours and villous adenomas and were treated by appendicectomy only. Adenocarcinoma was diagnosed in 8 patients (0.3%), 5 after appendicectomy (0.2%) which is twice the reported incidence. They were all treated by right hemicolectomy. Seven of the patients were classified as Dukes' B and one as Dukes' C. All patients were alive and disease-free after a mean follow-up period of 57.4 months. CONCLUSION: Right hemicolectomy is the treatment of choice for adenocarcinoma of the appendix.
Adenocarcinoma↗
Re-examination of clinical manifestations and response to therapy of fissure-in-ano.
PURPOSE: This study was designed to reassess clinical manifestations of fissure-in-ano, in particular, the frequency of constipation and rate of response to medical management. METHODS: Records of 876 patients with fissure-in-ano seen between February 1975 and December 1993 were reviewed. Information gathered included age, gender, site, symptoms, bowel habits, associated anorectal problems, response, failure, and recurrence rates. RESULTS: There were 439 women (51.1 percent) and 437 men (49.9 percent); mean age was 39.9 (range, 13.5-95) years. The fissure was located in the posterior mid line in 644 patients (73.5 percent), the anterior mid line in 144 patients (16.4 percent), both in 23 patients (2.6 percent), and only tenderness documented in 65 patients (7.4 percent). The fissure was located in the anterior midline in 12.6 percent of women and 7.7 percent of men. Dominant presenting symptoms included pain in 90.8 percent and bleeding in 71.4 percent of patients. Infrequent hard bowel movements (> or = 3 days) occurred in only 13.8 percent of patients. Mean follow-up was 26 (range, 0.5-215) months. A total of 44.7 percent of patients responded to nonoperative therapy, 60 percent of them in the first two months; of these, 18.6 percent developed recurrent symptoms. Of the latter group, 60 percent responded to further medical therapy, and 20 percent underwent a lateral internal sphincterotomy. Of the patients who initially did not respond to medical treatment (50.5 percent), lateral internal sphincterotomy was recommended. CONCLUSION: Anterior fissures are much more common in both men and women than previously reported, and constipation and hard bowel movement are not universally present in patients with fissure-in-ano.
Adult↗
Lateral internal sphincterotomy for fissure-in-ano--revisited.
PURPOSE: A disturbing complication rate following lateral internal sphincterotomy (LIS) has recently been reported, and this study assessed our complication rate. METHODS: Charts of 312 patients who were operated on between January 1975 and December 1993 were reviewed. RESULTS: There were 148 men (47.5 percent) and 164 women (52.5 percent), ranging in age from 16 to 95 (mean, 40) years. Two hundred sixty-five patients underwent LIS as a primary and sole procedure. Mean follow-up time was 20.4 months (range, 2 weeks-215 months). Healing times were less than one month (11.6 percent), one month (73.2 percent), one to two months (9.6 percent), and more than two months, 5.6 percent. Twenty-three complications (8.7 percent) occurred in 20 (7.5 percent) of the 265 patients: delayed healing (> 60 days) of the sphincterotomy site (13); persistence or recurrence of the fissure (3); wound infection (2); incontinence to flatus (1); soiling (1); temporary incontinence to flatus and stool (1); prolapsed hemorrhoids (1); fecal impaction (1). Most complications were minor and resolved spontaneously. Reoperations included one revision and one hemorrhoidectomy. CONCLUSIONS: This review supports the belief that LIS is a good operation for patients with chronic anal fissure and can successfully be performed under local anesthetic as an outpatient procedure with an acceptable complication rate.
Adolescent↗
Effect of 5-fluorouracil and leucovorin on the integrity of colonic anastomoses in the rat.
PURPOSE: This study was designed to determine the effects of 5-fluorouracil and leucovorin on the healing of colonic anastomoses and assess the safety of conducting a colonic resection and anastomosis during and shortly after a course of this chemotherapy in a rat model. METHODS: Fifty-six male Wistar rats, weighing 200 to 250 gm, were divided into four groups, each consisting of 14 animals. Animals in Group I (control group) underwent colon resection and primary anastomosis. Animals in Group II received 10 mg/kg intravenous 5-fluorouracil and 10 mg/kg leucovorin once a week for four weeks and then underwent the same operation. Animals in Groups III and IV received the same drug dosage for six weeks and were operated at different intervals: Group III at one week and Group IV at two weeks after completion of chemotherapy. Within each group, one-half of the animals were sacrificed on the third postoperative day and one-half on the seventh postoperative day, and anastomotic bursting pressure measurements were performed. RESULTS: At three and seven days, mean bursting pressure of the anastomoses were determined: 98 mmHg and 180.7 mmHg in Group I, 95 and 197.8 in Group II, 85.7 and 189.2 in Group III, and 98.6 and 179.2 in Group IV, respectively. There was no significant difference in bursting pressure between treated animals and controls by the third postoperative day or by the seventh day. The burst occurred at the anastomosis in all specimens tested on the third postoperative day and in the bowel wall adjacent to the anastomosis in all specimens tested on the seventh postoperative day. CONCLUSION: This study demonstrates that the above regimen of chemotherapy has no effect on the healing of colonic anastomoses and that surgery can be performed safely during and shortly after this regimen of chemotherapy.
Anastomosis, Surgical↗
Hepatic resection for colorectal liver metastases.
The lack of other effective treatment for colorectal liver metastases makes hepatic resection a primary treatment consideration. Between January 1980 and December 1990, 26 selected patients with liver colorectal metastases who underwent hepatic resection were reviewed. The age, sex, site of primary lesion, histological grade, lymph node involvement, location, size, and number of hepatic metastases, type of hepatic resection, and preoperative CEA blood levels were documented. Complete removal with histologically negative resection margins were accomplished in 24 patients. The extent of resection performed was hepatic lobectomy in 12 patients. Segmentectomy in eight patients, and wedge resection in four patients. The 5-year survival rate was 30.5 per cent. Patients with metachronous metastases showed a better survival rate than those with synchronous lesions--46.6% versus 13.6% respectively (P = 0.08). None of the other factors studied showed a significant effect on survival. All patients were followed from the time of hepatic resection to the time of this study or death. During a median follow-up of 30.9 months, 20 patients developed recurrence of their disease (60 per cent in the liver). There was no perioperative mortality. Morbidity arose in 66.6 per cent of patients, with a majority of the complications being minor. We conclude that hepatic resection can be performed safely enough to be recommended in selected patients.
Adult↗
[Recurrent spontaneous jejunal perforation].
A 70-year-old woman had recurrent spontaneous perforations of the jejunum. The first perforation, located 40 cm distal to the ligament of Treitz, was treated by debridement and suture closure. The second perforation, 2 months later, was located 20 cm distal to the first perforation and was treated by resection and primary anastomosis. On both occasions the postoperative course was uneventful and at follow-up 4 years later there were no gastrointestinal complaints. The resected specimen revealed a thinner-than-normal muscularis propria, most probably of congenital origin.
Aged↗
Primary appendiceal neoplasms.
A retrospective review of the files of 1,740 appendectomies performed during a 10-year period disclosed 13 patients (0.7%) with primary appendiceal tumors. Adenocarcinoma of the appendix was diagnosed in 6 patients (0.3%), which is a two- to four-fold higher incidence than reported in the literature. The other seven patients had benign tumors and only appendectomy was performed. The female to male ratio of adenocarcinoma was 5:1. All six adenocarcinoma patients, classified histologically as Dukes' B stage, underwent right hemicolectomy, and were disease free following a mean follow-up of 35 months. The results of our policy, also recommended by others, confirmed the benefit of right hemicolectomy in all patients with confirmed primary appendiceal carcinomas.
Adenocarcinoma↗
[Duodenal duplication cyst].
Duodenal duplication cysts are rare and are usually found in neonates or young children who present with obstructive symptoms. It accounts for 4-12% of all duplications in the gastrointestinal tract. The rate of other developmental abnormalities has been reported as high as 38%. In few instances have duodenal duplication cysts been described in adults. A case of duodenal duplication cyst in a 46-year-old woman is presented. The diagnosis was established preoperatively by computerized tomography and ultrasound examination.
Cysts↗
[False aneurysm: a complication of carotid endarterectomy].
False aneurysm of the carotid artery is a rare complication of carotid endarterectomy. We present a 65-year-old woman and a 68-year-old man with this condition. In 1 the artery had been closed with a Dacron patch graft, and in the other by direct suture. In the first case the aneurysm was successfully repaired with an expanded GoreTex (PTFE) patch graft sutured with monofilament nylon. In neither case was an organism grown from cultures taken at operation. The incidence of false carotid aneurysm as a complication of endarterectomy is only 0.3%. Usually infection is the main cause. It is therefore surprising that closure with a synthetic patch-graft is not a predisposing factor in the development of false carotid aneurysms, neither according to the literature nor in our own very limited experience with this complication.
Aged↗
[Spermatic cord liposarcoma].
In a 36-year-old man with a left scrotal mass a tumor was found and excised through an inguinal incision, together with the testis and the contents of the inguinal canal, in continuity. Histological examination showed a liposarcoma of the spermatic cord. Only 55 cases of this rare scrotal tumor have been reported. The literature indicates that while there is a tendency to local recurrence, there have been no reports of distant metastases. It appears that radiotherapy and chemotherapy are not necessary in this condition.
Adult↗