Biomedical subjects

S L Minken

Publications and source records attributed to S L Minken.

15 recordsLinked to original sources

PubMed1992

Subtotal colectomy as a last resort for unrelenting, unlocalized, lower gastrointestinal hemorrhage: experience with 12 cases.

A 7-year experience involving 12 cases of massive, unrelenting lower gastrointestinal hemorrhage is presented. In these patients, the bleeding could not be localized by multiple diagnostic modalities and was managed by blind subtotal colectomy. While the procedure was efficacious in arresting bleeding in all cases, a resultant mortality of four cases (33%) ensued. Morbidity among the survivors was significant. Only three patients (25%) survived without complications, which enabled an early discharge from the hospital. Diverticulosis was the most common cause (83%) of uncontrollable and preoperatively undiagnosed bleeding in this group of patients. These 12 cases of blind subtotal colectomy for massive lower gastrointestinal bleeding represent one of the larger series in the literature. These data are consistent with more recent reports that indicate that subtotal colectomy for lower gastrointestinal bleeding is an effective but a formidable procedure. This is contrary to the earlier published results.

Aged↗

PubMed1989

Lymphoscintigraphy to confirm the clinical diagnosis of lymphedema.

Confirmation of the diagnosis of lymphedema often requires lymphangiography, a procedure that is painful for the patient and technically demanding. Radioisotope lymphoscintigraphy is a relatively new technique that uses technetium 99 m antimony trisulfide colloid to produce a diagnostic image similar to a lymphangiogram. The procedure requires a single subcutaneous injection in the involved extremity, and images are obtained 3 hours later. It is technically easy to perform, produces minimal discomfort for the patient, and has no adverse effects. We have recently used radioisotope lymphoscintigraphy to evaluate 17 patients with extremity edema. These patients initially had a presumed diagnosis of lymphedema involving the upper or lower extremity. Lymphoscintigraphy confirmed the diagnosis of lymphedema in 12 (70.6%) patients. In five of the 17 patients (29.4%) the clinical impression of lymphedema was not supported by lymphoscintigraphy, leading to alternative diagnoses such as lipomatosis, venous insufficiency (two patients), congestive heart failure, and disuse edema. In all patients with secondary lymphedema the lymphatic system in the involved extremity could be partially visualized. Conversely, three of four patients with primary lymphedema had no ascent of the tracer from the foot and no lymphatic channels could be visualized. Lymphoscintigraphy is relatively easy to perform, safe, minimally invasive, and not uncomfortable for the patient. It is useful in differentiating lymphedema from other causes of extremity edema, allowing institution of appropriate therapy.

Adolescent↗

PubMed1988

Topical antibiotics in the high-risk biliary surgical patient. A prospective, randomized study.

This randomized, prospective study has evaluated the efficacy of topical antibiotics in preventing infective complications in patients undergoing high-risk biliary surgery. Sixty-nine patients who underwent bile duct exploration, choledochoenteric anastomosis, or cholecystectomy, either for acute cholecystitis or because they were older than 65 years of age, were randomized to the following three groups: Group I, topical antibiotics alone (22 patients); Group II, cefoxitin and topical antibiotics (24 patients); and Group III, penicillin, tobramycin, clindamycin, and topical antibiotics (23 patients). The incidence of infective complications was no different among the groups. There was one wound infection in each group, one episode of bacteremia in Group II, and no intraabdominal abscesses. This study has demonstrated that parenteral antibiotics administered prophylactically in the perioperative period offer no additional benefit over the use of effective topical antibiotics used intraoperatively in patients undergoing high-risk biliary surgery.

Aged↗

PubMed1988

Treatment of a case of thromboembolism resulting from thoracic outlet syndrome with intra-arterial urokinase infusion.

A 36-year-old man with thoracic outlet syndrome, admitted to the hospital with digital ischemia from subclavian artery thrombosis and distal embolization, was given intra-arterial urokinase. Thrombus in the subclavian artery was lysed successfully and peripheral emboli were partially cleared, resulting in relief of digital symptoms. Although surgical decompression and vascular reconstruction at the thoracic outlet may be necessary, this technique provides a means of recanalizing small distal vessels.

Adult↗

PubMed1988

Should we perform carotid endarterectomy synchronously with cardiac surgical procedures?

From Jan. 1, 1979 through July 31, 1987, 63 patients had carotid endarterectomy (CEA) concurrently with cardiac surgical procedures including coronary artery bypass grafting (CABG) in 61, CABG plus mitral value replacement in one, and aortic valve replacement in one. Among the 62 patients having CABG, unstable angina had been present in 36 (58%), left main coronary artery disease in 21 (34%), and both unstable angina and left main coronary artery disease in 13 (21%). Indications for carotid surgery included previous stroke, amaurosis fugax, or hemispheric transient ischemic attacks (TIAs) in 33 patients (52%); bilaterally significant carotid disease was noted in 48% of the patients. Major neurologic complications occurred in three patients (4.8%), including perioperative stroke in two (3.2%) (fatal in one) and a TIA in a third patient. Bilateral carotid lesions, a contralateral total carotid occlusion, previous cerebrovascular symptoms, and intraaortic balloon pump support did not increase neurologic risk. Seven patients died postoperatively (11%). The mortality rate was 2.8% in patients younger than 65 years vs 22% in patients 65 years or older, 19% in patients with left main coronary artery disease vs 7.3% in patients without, 13.3% in men vs 5.6% in women, 25% in patients with a history of congestive heart failure vs 7.8% in patients without failure, and 6.2% in patients with unilateral carotid disease, 17% in patients with bilateral carotid disease, and 23% in patients with bilateral disease including a contralateral carotid occlusion. A mortality predictive index (MPI) was developed to summarize individual risk for a fatal outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗

PubMed1987

Closed-suction versus Penrose drainage after cholecystectomy. A prospective, randomized evaluation.

Closed-suction drainage was compared prospectively to open, passive drainage (Penrose drains) in 128 patients undergoing cholecystectomy. Patients were randomized at the time of operation to receive either closed-suction drains (Group I, 67 patients) or Penrose drains (Group II, 61 patients). The preoperative clinical parameters of the two groups were similar. The patients in Group I when compared with those in Group II had a shorter duration of drainage (3.3 days and 4.1 days, respectively, p less than 0.01), a lesser volume of drainage in the first 48 hours postoperatively (78 ml and 132 ml, respectively, p less than 0.001), a decreased incidence of fever on the night of operation (24 of 67 patients and 39 of 61 patients, respectively, p less than 0.05) and on the first postoperative day (26 of 67 patients and 32 of 61 patients, respectively, p less than 0.05), and a lower leukocyte count on the first postoperative day (12,000 cells/mm3 and 14,100 cells/mm3, respectively, 0.05 less than p less than 0.1). Patients in Group I tended to have a lower rate of wound infection (1 of 67 patients versus 5 of 61 patients in Group II, 0.05 less than p less than 0.1) and had a much lower incidence of drain site tenderness (8 of 67 patients in Group I versus 24 of 61 patients in Group II, p less than 0.05). This study demonstrates the superiority of closed-suction drains over open, passive drains after cholecystectomy.

Cholecystectomy↗

PubMed1987

The placement of intracaval filters in an anomalous (left-sided) vena cava.

Diagnostic and therapeutic indications have increased the need for ready access to the inferior vena cava. Multiple anomalies of the inferior vena cava have been described. Correct placement of a Greenfield filter in a left-sided vena cava requires recognition of this anomaly. Placement through a right internal jugular vein is preferable; however, if this is not possible, the left femoral vein should be used. Because of the incidence of anomalous inferior vena cava, routine inferior venacavography is recommended when an intracaval device is to be placed.

Aged↗

PubMed1987

Mesenteric cysts.

Mesenteric cysts continue to be of special interest because of their diverse presentation and the lack of definitive diagnostic tests. Nine patients with mesenteric cysts were treated at St. Agnes Hospital between 1973 and 1984. The most common location was in small bowel mesentery (67%) followed by the mesocolon (33%). The mesenteric cysts were incidental findings in four of the nine patients (45%). Enucleation was the treatment of choice in eight patients (88%), followed by right hemicolectomy in one patient. Two patients had complications, one wound infection and one urinary tract infection. Simple enucleation has proven to be adequate treatment in most instances. Large bowel resection may be necessary when mesenteric cysts are located in the mesocolon and enucleation is not feasible without compromising the blood supply to the adjacent bowel.

Adolescent↗

PubMed1971