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Biomedical subjects

R Reiss

Publications and source records attributed to R Reiss.

At least 181 records · Page 10Linked to original sources
PubMedDate not supplied

Inflammatory fibroid polyp of sigmoid colon.

A case of inflammatory fibroid polyp of the sigmoid colon is presented. This is the eight case of this type of polyp in the colon and, to the best of our knowledge, the first one involving the sigmoid and producing intussusception. Symptomatology of the inflamed fibroid polyp in this part of the gut closely simulates gastrointestinal malignancy. The treatment is surgical excision of the polyp, or colonoscopic resection when it is possible. Intraoperative colonoscopy helps the surgeon to localize the lesion and to role out the existence of other lesions.

Colon, Sigmoid↗
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Sensitivity to new generation of antibiotics in biliary surgery.

The treatment of septic complications of cholecystectomy patients requires special attention. In a prospective study of 1009 consecutive cholecystectomy patients (including all acute and elective patients, excluding cases of malignancy), we routinely took cultures from the cystic duct and the gallbladder, and checked the strain for sensitivity. Positive cultures were found in 31.4% of the series, the most frequent bacteria being E. coli (50.3%). The aminoglycosides and the second and third generations of cephaloridins were found more specific for the strains that were cultured. While the new cephaloridins are the first choice for prophylaxis, the combination of aminoglycosides with ampicillin is to be preferred from the medical and cost effective standpoint while the aim is therapeutic.

Aminoglycosides↗
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True aneurysm in a prosthetic aorto-femoral dacron graft.

Aneurysms occurring in prosthetic grafts are a very rare phenomenon. However, false aneurysms are a known complication which can appear in the anastomotic site of the graft, but very seldom in the middle of the prosthetic graft. True aneurysm of a dacron graft is extremely rare, and very few have been reported in the literature. We present a case report of true aneurysm of a dacron graft that was implanted seven years before, found on a routine examination and confirmed on a pathological examination and successfully operated upon.

Aged↗
PubMedDate not supplied

Multifactorial analysis of prognostic factors in emergency abdominal surgery in patients above 80 years. Analysis of 154 consecutive cases.

Patients above 80 have been the most rapidly growing group in the surgical department. The number of major laparotomies in this segment of the population has grown by 15% in the last two decades and is expected to grow by another 100% by the end of the century. The principal aim of the study was to identify by multifactorial analysis the combination of factors predictive of mortality in abdominal emergencies in this age group. A computer-held data base established by the Authors in 1978 was used to register all relevant information in 1327 major laparotomies performed in patients above 70. Of the base of 1327 patients, 219 (16.5%) were above 80. Of this group, 154 cases (70.3%) underwent emergency procedures and are the focus of this study. The principal conclusions of the Authors are as follows: A. The main differences between the two age groups 70-79 (Group A) and above 80 (Group B) are as follows: 1. Emergency laparotomies are much more frequent in Group B (70% versus 33%). 2. The overall mortality is over two and a half times as high (21.4% versus 8%). 3. The diagnostic profile and the mix of cases is different with an increased number of intestinal obstructions and malignancies in Group B. B. Unifactorial analysis of postoperative mortality disclosed the following factors associated with increased mortality: 1. Vital System Category III (Table 6-A). 2. Presence of generalized peritonitis or gangrenous bowel. 3. Presence of widespread malignant disease. 4. Belonging to the following diagnostic groups: carcinoma of pancreas, mesenteric thrombosis. 5. Age 85 or above.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗
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Surgical treatment of limb lymphedema.

Among 286 patients suffering from limb lymphedema seen in the outpatient clinic in the period 1977-1983, 13 were operated upon. The indication for operation and its type were dictated mainly by the gravity of the clinical findings and the failure to respond to conservative measures. Various conservative and surgical regimes are briefly reviewed emphasizing the way they were incorporated into this series. Six patients who underwent excisional operative procedures and five of the seven patients who underwent lymphatic venous bypass procedures benefitted from the operation and the adjuvant therapy.

Adult↗
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Assessment of surgical residents' competence based on postoperative complications.

The aim of this prospective study was to evaluate surgical residents' operative skills on the assumption that differences in training might have a significant effect on postoperative complications, their type and incidence. This was accomplished using a departmental microcomputer and special non-commercial personally-developed software. There was no significant clinical difference found in the postoperative complication rate in matched groups of patients treated by senior staff and resident staff of the Department. It is suggested that the close supervision by the senior staff might play a role in this outcome. Although analysis of subgroups of patients sustaining moderate to severe postoperative complications showed a statistically significant difference between these surgeon categories, we may consider this difference attributable to the more complex operative problems handled by the senior staff in the same circumstances.

Female↗
PubMedDate not supplied

Sciatic pain: a diagnostic pitfall.

Neurological signs such as lower spinal cord lesions and/or femoral neuritis may be the presenting symptoms of a dissecting abdominal aortic aneurysm (AAA). We describe a patient in whom a severe sciatic pain was the presenting symptom of a non-dissecting AAA. The resection of the vascular mass resulted in dramatic relief of sciatic pain, thus indicating that the neurological impairment was caused by the non-dissecting aneurysm.

Aorta, Abdominal↗
PubMedDate not supplied

Age profiles of benign gallbladder disease in 2,000 patients.

Hospital charts and operative notes on 2,000 consecutive cholecystectomies performed between 1965-1984 for benign gallbladder disease were reviewed and computer analyzed. Patients were divided into five age categories (1-29, 30-49, 50-69, 70-79, 80 years and above). Fifteen variables were examined for each age category, including total number, sex, presenting symptoms (jaundice, acute cholecystitis, pancreatitis), intraoperative findings (presence of stones, common bile duct width and stones), operative procedures, bile cultures, histology, postoperative course and mortality. In addition to critically assessing performance and permitting comparison with other series, this age-related analysis suggests the following conclusions: The female predominance in age category 1 diminishes in categories 4 and 5. Acute cholecystitis and suppurative cholangitis occur in 44% of age category 5, compared to 14-24% in other age categories. Intraoperative fluorocholangiography is mandatory; common bile duct stones were found in 14% of age category 1. Age category 2 seems to be the group least susceptible to choledochal pathology. Acalculous cholecystitis is closely related to gangrenous changes, especially (almost selectively) in age categories 4 and 5. The frequency of infected bile rises with age, and is found in 90% of patients in age category 5. Mortality from operations for benign gallbladder disease is ten times higher in patients over 70 years of age compared to younger patients. An ultrasonographic study should be performed before any major laparotomy, especially in the aged, in order to diagnose silent stones, and prepare the patient for concomitant cholecystectomy. Elective cholecystectomy in age categories 4 and 5 is still accompanied by high mortality rates.

Adolescent↗
PubMedDate not supplied

Primary hyperparathyroidism due to mediastinal parathyroid adenoma.

Of the 90 cases of primary hyperparathyroidism surgically treated in our department over the last decade (1975-1985), ten cases had a mediastinal parathyroidal adenoma. In only two of these patients was a median sternotomy required for excision of the mediastinal adenoma. Three of the ten patients underwent the initial operation in other institutions, having undergone a previous neck exploration. There were seven males and three females, ages ranging from 41-68 years. Six patients had nephrolithiasis, four had both renal stones and bone disease and two had peptic ulcer disease. One of them was operated on as an emergency because of hyperparathyroidism crisis with calcium levels of 15/16 mg%. Four patients were asymptomatic and had hypercalcemia detected by SMA screening. The calcium level ranged from 11.5-16.2 mg%. The phosphorus ranged from 1.6-2.8 mg% with a mean of 2.0 mg%. All ten patients had plasma PTH determination by radioimmunoassay, the values ranged from 1.5-3 times normal. In seven of the ten cases, the mediastinal parathyroid adenoma was localized within the thymus, the other three were adjacent to the great vessels, two to the aortic arch and one to the pulmonary artery-size ranging from 1.2-5.4 cm. Preoperative localization techniques: venous sampling in four cases; technetium scanning in three cases. No preoperative localization techniques were used in the other three cases. There was no mortality nor other significant postoperative complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma↗
PubMedDate not supplied

The use of far distal arterial bypass for limb salvage.

Thirty-four distal arterial reconstructions to the ankle and the foot for limb salvage were performed in 33 patients, 11 of whom underwent additional operative procedures. The follow-up period is up to 4 years. The operative mortality rate was 9.09%. The 6 month, 1 year and 2 year accumulated patency rates calculated by life table analysis were 85%, 86.7% and 77.3%, respectively. Limb salvage was achieved not only in patients with patent grafts but also in a considerable number of patients whose grafts were occluded between 3 and 24 months postoperatively.

Actuarial Analysis↗
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Clinical significance of choledochal diameter and hyperbilirubinemia in acute cholecystitis.

Persistent choledochal stones as well as negative choledochal explorations lead to increased morbidity and expense in surgery for acute cholecystitis. In an attempt to establish more precise criteria for the presence of CBD stones, 300 consecutive emergency cholecystectomies were studied and computer analyzed. Precise determination of the choledochal diameter and preoperative bilirubin levels permit a very accurate estimation of the probable presence of choledochal stones. On the basis of this information, more than 50% of patients can be classified in the low risk group, in which operative cholangiography can be omitted with minimal risk when technical difficulties are encountered, and choledochotomy may be avoided when cholangiography is unclear.

Acute Disease↗
PubMedDate not supplied

Right hepatectomy.

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Adolescent↗
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Selective antibiotic prophylaxis in biliary surgery.

Wound infections and septic complications are among the most frequent complications of biliary surgery. Such complications frequently occur in patients with infected bile. The presence of infected bile is predictable and can be expected in patients defined as high-risk patients. Short-term perioperative antibiotic prophylaxis was shown to be effective on an unselective basis by several authors. In this study of 231 consecutive biliary procedures, antibiotic prophylaxis was used on a selective basis in high-risk patients only. The high-risk patients were 55% of the entire group. Perioperative prophylaxis was given for 24 hours using four gentamicin injections starting two hours prior to anesthesia. Selective prophylaxis was shown to be highly effective reducing the wound infection rate to 3.5% in this group, compared to 12.5% in a similar group without prophylaxis. The selective use of prophylaxis was shown to be highly cost-effective as compared to the group without prophylaxis as well as reported groups of unselective prophylaxis in biliary surgery.

Bile↗