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Biomedical subjects

R Pfeffermann

Publications and source records attributed to R Pfeffermann.

At least 19 recordsLinked to original sources
PubMed1996

Recurrent mucinous adenocarcinoma of the ovary presenting as an inguino-labial hernia.

We report a case of a 65-year-old woman who nine years previously had undergone total abdominal hysterectomy and bilateral salpingoophorectomy for a large ovarian cyst. During surgery the cyst had ruptured and some mucinous material had been spilled intraabdominally. Histopathological studies demonstrated the cyst to be a mucinous adenocarcinoma of low malignant potential. Appendectomy had also been performed due to an enlarged appendix, which proved to be a mucocoele. The patient had been lost to subsequent follow-up. Her current presenting symptom was a giant inguino-labial hernia of 25 cm diameter with two small skin perforations leaking a gelatinous discharge. Subsequent laparotomy and inguinal exploration have disclosed herniated small intestine with an attached metastatic multicystic mucinous adenocarcinoma. This case represents a case of borderline mucinous adeno-carcinoma-pseudomyxoma peritonei recurring in a unique pattern as a huge inguino-labial hernia, and serves to emphasize the possible consequences of spillage of ovarian cyst contents during surgery.

Adenocarcinoma, Mucinous↗
PubMed1992

[Rupture of hepatic echinococcal cyst by minimal blunt abdominal trauma].

Hepatic echinococcosis is endemic in Israel, with about 90 new cases diagnosed each year. Although many are asymptomatic for years, 40% develop complications. We describe a man of 37 and women aged 22 and 35, respectively, in whom rupture of an echinococcal cyst followed minimal, blunt abdominal trauma. In each patient the rupture led to complications consisting of massive intra-abdominal bleeding in 1, diffuse peritonitis in another and cystocutaneous fistula with ureteral obstruction due to reactive retroperitoneal fibrosis in the third. All 3 underwent surgery to resolve the immediate complication, with no mortality. A striking feature was the disproportion between the stormy clinical presentation and the relatively innocent nature of the trauma. In only 1 of our cases was the correct preoperative diagnosis made, which in this condition depends primarily on a high index of suspicion.

Abdominal Injuries↗
PubMed1992

Unilateral ureteral obstruction secondary to rupture of liver echinococcal cyst.

We report a case of ureteral obstruction by reactive retroperitoneal fibrosis secondary to rupture of a liver echinococcal cyst after minimal blunt flank trauma. The patient presented initially with a cyst-cutaneous fistula and was treated with mebendazole, since surgery was refused. Unilateral ureteral obstruction due to reactive dense retroperitoneal fibrosis developed 2 years later, which presumably was initiated by intense inflammatory reaction to the cyst content. Diagnosis was established by excretory urography, ultrasonography and computerized tomography, and was histologically confirmed. Hydronephrosis and hydroureter resolved following ureterolysis. This complication is anticipated to be encountered more frequently with the use of the new potent anthelmintic agents, which may successfully prevent daughter cyst formation but fail to abolish reactive retroperitonitis.

Aged↗
PubMed1992

Acute symptomatic hernia.

Acute symptomatic hernia is a clinical entity characterized by the coexistence of acute incarceration of an abdominal wall hernia together with an acute abdominal disease. Thirteen such cases are described. Increased awareness of this entity, both pre- and intraoperatively, is probably the basis for the improved rate of correct diagnosis (60%) and the decreased mortality (7%).

Adolescent↗
PubMed1991

[Management of radiation-induced injuries of the intestine].

Radiation-induced injury of the intestine (RII) is a chronic iatrogenic disorder which often necessitates complex surgical intervention. We describe our experience with the surgical management of 9 patients with RII, 8 of whom suffered injuries of the small bowel and 1 of the rectosigmoid. There were 3 deaths, 2 from postoperative complications of ongoing RII and 1 from recurrence of the original tumor. 3 of the survivors continued to suffer from complications attributed to active RII, while only 3 remained symptom-free during follow-up. Our study emphasizes the fundamental role of good nutritional support during the perioperative period in these patients. It also indicates the desirability of using nonirradiated bowel for the anastomosis, and of a bypass procedure instead of resection and primary anastomosis in cases of radiation-induced frozen pelvis. Creating a barrier between the peritoneal cavity and the lower pelvis by an omental flap or other means, should be considered in patients operated on for pelvic cancer who might need adjuvant radiotherapy. This procedure shields the bowel from the radiation field, thus hopefully reducing the incidence of RII.

Humans↗
PubMed1990

[Nissen fundoplication for reflux esophagitis].

Nissen fundoplication was performed in 20 patients suffering from esophageal reflux. Failure of medical therapy was the indication in 60% of the patients, and complications of reflux (bleeding, stricture, Barrett's esophagus) in the others. There was no operative mortality; wound infection was the most common postoperative complication (4 patients). Follow-up after 1-8 years showed good results in 85%. The results of Nissen fundoplication in the world literature, as well as in this series, prove it to be effective for esophageal reflux. Those not responding to appropriate medical therapy should be referred earlier for surgery, prior to development of the complications of reflux.

Esophagitis, Peptic↗
PubMed1990

[Gastrointestinal bleeding and ascending biliary infection secondary to duodenal diverticulum].

We describe a 77-year-old man with recurrent upper gastrointestinal tract bleeding and ascending biliary infection secondary to a duodenal diverticulum. Although such diverticula are relatively common, the great majority are asymptomatic and are only discovered incidentally. Only 1% manifest clinically, usually secondary to a variety of complications such as bleeding, perforation, ascending biliary infection or pancreatitis. Most often the diagnosis is made by exclusion, which accounts for the usual delay in starting treatment. When present, one must consider the possibility that the duodenal diverticulum may be responsible for the patient's symptoms. The preferred approach to a bleeding diverticulum is complete excision, while bypassing the diverticulum by Roux-en-Y duodenojejunostomy is the operation of choice for pancreaticobiliary complications.

Aged↗
PubMed1989

Anti-tumor immunity in breast cancer evaluated by a computerized tube leukocyte adherence inhibition (LAI) assay.

Seventy-four women admitted for breast biopsy were monitored before surgery for anti-tumor cell-mediated immunity using a computerized tube leukocyte adherence inhibition (LAI) assay. Spent medium from breast, lung and colon adenocarcinoma cell lines was used as the source of organ-specific neoantigens for standardization of the assay. Peripheral blood leukocytes from 25/40 (62.5%) patients diagnosed after surgery as breast cancer responded to spent medium with a positive non-adherence index (NAI). A positive NAI was inversely related to tumor mass because only 7/18 (38.8%) of those with Stage III or IV had a positive NAI; while 18/22 (81.8%) of those with Stage I or II were positive. Cross-reactive antigenicity was not observed when spent medium from breast cancer was incubated with leukocytes from patients with several other solid tumors nor when leukocytes from breast cancer patients were incubated with spent medium from lung or colon carcinoma cell lines. The antigenic material in the spent medium appears to be an organ-specific neoantigen because only 1/34 patients with benign breast disease had a positive NAI and all normal healthy control individuals were negative. The results of this study show that spent medium of a breast carcinoma cell line is more reliable than crude cancer extracts for use in LAI to detect specific anti-tumor cellular immune responses. The improved method presented in this report can be a useful tool in the early diagnosis of breast cancer and for monitoring of patients with this disease.

Adult↗
PubMed1989

[Mammary tuberculosis mimicking breast cancer].

Breast masses in the 7th decade of life should be considered cancerous and immediate diagnosis and treatment are indicated. Mammary tuberculosis is rare, especially in developed countries. It usually results from reactivation of dormant pulmonary and pleural tuberculous foci. We present a 66-year-old woman who was hospitalized for biopsy of a breast mass. 4 years previously there had been trauma to the chest, and several pleurocenteses were required to remove sterile exudate. The past history, recent immigration from an endemic area, physical examination and chest X-ray, suggested tuberculosis. Needle aspiration of the affected breast yielded M. tuberculosis. Specific therapy and corticosteroids resulted in complete cure.

Aged↗
PubMed1986

The use of laser in rectal surgery.

Ten patients with rectal tumors were treated by surgical excision of the tumor using a CO2 laser Sharplan 733 CO2 laser, Laser Industries Ltd., Israel. The laser permitted sharp excision, evaporization, or fulguration of tissue. Good hemostasis was achieved. Anesthesia was unnecessary in cooperative, calm patients. There was no mortality or morbidity related to the procedure. In five patients with villous adenoma the tumor was resected with one recurrence as yet (followup 4-16 months). Five patients with inoperable carcinoma were treated for palliation with good results. Our preliminary results indicate that the CO2 laser can be a useful asset in rectal tumor surgery, especially in elderly, moribund patients and in the definite treatment of benign tumors of the rectum.

Adenocarcinoma↗
PubMed1986

Leukocyte adherence inhibition assay in the diagnosis and follow-up of colorectal cancer patients.

Antitumor immune response to colorectal cancer extract was tested by the tube leukocyte adherence inhibition (LAI) assay. Of 70 colorectal cancer patients, 38 (54%) were LAI-positive. In contrast, 15 of 159 (9%) healthy individuals and 2 of 28 (7%) patients with nonmalignant diseases were positive. The LAI activity disappeared a few months after surgery and remained negative in patients with no evidence of disease as well as in patients with disseminated progressed disease. A change of LAI from negative to positive during the follow up period correlated in some cases with the recurrence of the disease, but was observed also in cases with no clinical evidence of disease.

Colonic Neoplasms↗
PubMed1985

Leukocyte adherence inhibition (LAI) for detecting specific tumor immunity in colorectal cancer.

Immunity to colorectal cancer antigen was tested by the tube leukocyte adherence inhibition (LAI) assay, using spent medium of human carcinoma cell lines as a source of antigen. The assay was positive in 18 out of 43 patients (41%) with colorectal tumor in comparison to only 2 out of 34 (5.8%) of colorectal cancer patients clinically free of disease, and to 4 out of 150 (2.6%) healthy subjects. The frequency of positive results correlated negatively with the tumor burden, 16 out of 29 (55.1%) patients with Dukes' A, B and C being positive compared to only 2 out of 14 (14.2%) patients with Dukes' stage D disease. Addition of PGE2 enhanced the sensitivity of the assay without affecting its specificity. The number of positive assays increased from 18 to 32 (41.8% to 74.4%) in the whole group of 43 colorectal cancer patients without altering significantly the frequency of positive results in the control group. The results with all groups of patients were influenced similarly by the addition of prostaglandins, the frequency of positive assays increasing from 55.1% to 82.7% and from 14.1% to 57.1% in early and advanced disease, respectively. These results lend further support to the value of the LAI assay in diagnosis and monitoring of the immune response in human colorectal cancer.

Antigens, Neoplasm↗
PubMed1979

Carcinoma of colon after ureterocolic anastomosis: implantation on calyceal mucosa.

Two cases are reported of the development of mucoid adenocarcinoma of the colon in young patients, nineteen and thirty-four years after ureterocolic anastomosis for benign conditions. One patient showed implantation of the colonic neoplasm on the mucosa of an upper calyx in the obstructed kidney. Patients who have undergone ureterocolic anastomosis have a greatly increased risk of the development of large-bowel neoplasms. When suspected, radiologic examination of the colon using a water-soluble contrast material, together with rectosigmoidoscopy or colonoscopy, is essential. Because of the serious nature of this complication, it is suggested that the recent trend to return to the use of large bowel in urinary diversion may be hazardous, especially in the young patient with a benign disease.

Adenocarcinoma, Mucinous↗
PubMed1978

Primary neoplasms of the small bowel.

The treatment of thirty-one malignant and eleven benign neoplasms of the small intestine is reported. The most common symptom was abdominal pain followed by vomiting, diarrhea, weight loss, constipation, and gastrointestinal bleeding. In four cases small bowel perforated. Intestinal obstruction occurred in 31 per cent of patients. Preoperative diagnosis was made in 19 per cent of patients. All eleven patients with benign neoplasms were curatively treated by resection and primary anastomosis. Eighteen of the thirty-one patients with malignant tumors had curative resection, five had palliative resection, and eight had laparotomy and biopsy only. The most common benign tumor was leiomyoma. The most common malignant tumor was lymphoma (67 per cent) followed by adenocarcinoma (16 per cent), carcinoid (10 per cent), and leiomyosarcoma (3 per cent). Twenty-four patients were available for follow up; thirteen remain alive and eleven died, seven within one year and four within two years.

Adenocarcinoma↗
PubMed1977

The prevention and correction of hypocalcemia in the parathyroidectomized rat by portacaval shunt.

Adult rats underwent end-to-side portacaval shunt either 30 days prior to or 12 days following parathyroidectomy. When portacaval shunt was performed initially, the serum calcium failed to decrease following subsequent parathyroidectomy and remained within normal levels up to 110 days. When parathyroidectomy first was done, the significant hypocalcemia was corrected subsequently by portacaval shunt and serum calcium remained close to the normal level up to 75 days. The effect of portacaval shunt depended on the calcium content of the food and was obtained only when rats were fed by a regular diet. Rats on a calcium-deficient diet were hypocalcemic, similar to the parathyroidectomized rats without the portacaval shunt. Prolonged calcium-deficient diet alone, without parathyroidectomy, did not by itself result in hypocalcemia either in the intact rat or in the portacaval shunted rat. The data indicate that portacaval shunt prevents and corrects hypocalcemia in the parathyroidectomized Lewis rat as long as sufficient calcium is available in the diet.

Animals↗
PubMed1977

On the origin of the regeneration factor.

The data presented indicate a complexity of the process through which the hepatocyte replication is controled after partial hepatectomy. It can be said that several factors may be working together, including hepatic inhibitor, splenic inhibitor, intestine associated stimulator and pancreatic factor.

Animals↗