Search PubMed⌕ Search

Biomedical subjects

S Lelcuk

Publications and source records attributed to S Lelcuk.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Transanal endoscopic microsurgery for local excision of rectal neoplasms].

We removed 30 benign, sessile, rectal polyps by the transanal approach between January 1990 and April 1994. In 16 patients we used transanal endoscopic microsurgery (TEM), while in 14 the adenoma was removed by submucosal excision (SE). There were 3 local recurrences in the SE group, but none as yet in the TEM group. There was no operative mortality. Early complications included myocardial infarction in 1 patient and persistent postoperative fever which responded to antibiotic treatment in another. Late complications included temporary, anal mucous leakage in 10% and 5% of the TEM and SE groups, respectively. TEM was found to be efficient for the removal of polyps in the upper and middle thirds of the rectum, and SE for those in the lower third. This enables safe removal of rectal polyps, avoiding the need for complex operations involving greater risks.

Adenomatous Polyps↗
PubMed1994

[Anterior resection with colo-anal anastomosis for low rectal cancer].

Between May 1989 and April 1993 we treated 108 patients, aged 44-82 years, for rectal cancer. Of them, 7 men and 2 women underwent anterior resection with colo-anal anastomosis. In this group the average distance of the tumor from the anal verge was 6 cm. Follow-up ranged from 12-48 months. There was no operative mortality. Perioperative morbidity included wound infection in 1 patient and pelvic sepsis in another; temporary disturbances in micturition occurred in 4; 1 developed an anastomotic stricture and another intestinal obstruction; 1 died of systemic spread; another was reoperated and salvaged, but had a local recurrence 3 years after the first operation. Continence was achieved in 6, while 3 had minor impairment of control. Frank incontinence did not occur. We believe that anterior resection with colo-anal anastomosis in low rectal cancer avoids a permanent colostomy, while meeting oncological and functional criteria. We advocate this procedure in selected patients with low rectal cancer.

Adult↗
PubMed1994

[Surgical treatment of thoracic esophageal diverticula].

Symptomatic pulsion or "true" diverticula of the lower and mid-esophagus (thoracic esophagus) are relatively rare. Associated motility disorders occur in most patients with epi-phrenic diverticula. These functional and obstructive disturbances should be looked for, diagnosed and treated. Surgical intervention such as diverticulectomy might prevent respiratory and nutritional complications and give significant relief of symptoms. We describe our experience in the surgical treatment of a 67-year-old man and 2 women, aged 69 and 73, respectively, with symptomatic thoracic diverticula.

Aged↗
PubMed1994

[Large simple liver cyst treated laparoscopically].

Simple liver cysts of various sizes are present in 1% of the population. Most are found incidentally and require no treatment. However, in a few the cyst is symptomatic and requires surgery: celiotomy and unroofing of the cyst. A 64-year-old woman with a symptomatic, simple cyst of the liver underwent laparoscopic surgery. After an uneventful course she was discharged on the 3rd postoperative day. Simple liver cysts can be safely treated by laparoscopic surgery.

Cysts↗
PubMed1993

[Pharyngo-gastric anastomosis following pharyngo-laryngo-esophagectomy for cancer].

Cancer of the hypopharynx and cervical esophagus usually presents in an advanced stage. Treatment is therefore aggressive and involves a combination of surgery and radiotherapy. Pharyngo-laryngo-esophagectomy, gastric pull-up and pharyngo-gastric anastomosis has become the method of choice for extensive tumors in the past decade. 3 men, aged 51, 51 and 74, respectively, who had extensive cancer of the hypopharynx and cervical esophagus and underwent this procedure are described. 2 made full, rapid recoveries without complications, but in the third, there were postoperative complications due to severe chronic lung disease. Proper selection of patients may reduce considerably the morbidity and mortality of this surgical procedure.

Aged↗
PubMed1993

Fecal peritonitis--the effect on anastomotic healing.

The present study evaluates colonic anastomosis healing in the presence of fecal peritonitis in rats. After induction of fecal peritonitis, the animals were treated by surgery alone or with the addition of systemic supportive treatment. It is shown that survival in the latter group was significantly better, while burst strength of anastomoses in surviving animals in both groups was identical. The results suggest that the outcome of fecal peritonitis depends mainly on fluid resuscitation and antimicrobial therapy, but not on primary repair.

Anastomosis, Surgical↗
PubMed1993

Posthernioplasty urinary retention: a noninvasive work-up for prediction.

The prognostic value of various subjective and objective noninvasive urological parameters was evaluated for their possible role in the prediction of post-hernioplasty urinary retention. In a prospective study, 35 patients aged 55-85 years without previous micturition complaints or urological surgery were evaluated 1 day prior to inguinal hernioplasty. This included medical history for modified Madsen subjective scoring profile, physical examination and uroflowmetry. Bladder capacity, residual urine and prostatic volume were measured by ultrasound. All patients underwent a similar method of hernioplasty, were closely followed 48 h postoperatively and any voiding difficulties or urinary retention were noted. Urinary retention occurred in 12 patients. None of the remaining 23 patients had urination difficulties. Comparing these two groups, we concluded that patient age, bladder capacity and prostatic volume have no prognostic value for potential postoperative urinary obstruction. On the other hand, obtaining a good anamnesis of obstructive and irritative symptoms for scoring, measuring maximal flow rate on urinary flowmetry and estimating residual urine volume may predict patients who are potentially at high risk for posthernioplasty urinary retention.

Aged↗
PubMed1992

[Surgery for complete rectal prolapse in adults].

Surgery for complete rectal prolapse was performed in 17 women and 3 men between November 1986 and April 1991. An abdominal approach with posterior rectopexy was used in 17. The Thiersch procedure of anal narrowing was performed in 3 high risk patients. All recovered without major complications. Urinary tract infection developed in 15% and postoperative fecal impaction in 10%. Anal continence improved in 70% of those previously incontinent. There was no recurrence of complete rectal prolapse during follow-up. All patients rated the operative results as either good or very good.

Adult↗
PubMed1991

The role of oxygen free radicals and prostaglandins in reperfusion injury to warm ischemic kidneys.

The present study was designed to determine whether the administration of superoxide dismutase (SOD) can alleviate ischemic kidney damage and whether there is a relationship between oxygen free radicals and thromboxane (Tx). In 17 dogs, the right kidney was removed and the vascular pedicle of the left kidney was clamped for 75 min. Prior to reperfusion, the ischemic kidney was rinsed with 5 mg SOD and an additional 20 mg SOD was infused systemically. Blood samples were drawn from the renal vein before ischemia and after reperfusion to determine serum levels of thromboxane B2 (TxB2). All eight untreated dogs died within 1 week of renal failure, and the nine treated dogs demonstrated transient renal failure, with a significant difference (P less than 0.001) being found between the two groups. A significant difference (P less than 0.001) in TxB2 levels was found in the untreated dogs before and after ischemia and between the two groups following reperfusion. Animals that are treated with SOD after the ischemic event has occurred but before reperfusion exhibit a favorable clinical course in terms of survival and renal function. Tx synthesis in the kidney can be blocked by the administration of SOD.

Animals↗
PubMed1991

Interleukin-2-induced lung injury is mediated by oxygen free radicals.

Interleukin-2 therapy leads to respiratory dysfunction caused by increased vascular permeability. This study examines the role of oxygen-derived free radicals (OFR). Sheep (n = 6) with chronic lung lymph fistulae were given interleukin-2, 10(5) units/kg, as an intravenous bolus. The mean pulmonary artery pressure rose from 13 to 23 mm Hg (p less than 0.05) at 1 hour and remained elevated for 4 hours, although the pulmonary artery wedge pressure was unchanged at 4 mm Hg. Arterial oxygen tension fell from 88 to 77 mm Hg (p less than 0.05). Lung lymph flow rose from 2.2 to 6.4 ml/30 min (p less than 0.05) at 3 hours. This rise coincided with an increase in the lymph/plasma protein ratio from 0.67 to 0.77 (p less than 0.05) and lymph protein clearance from 1.5 to 4.4 ml/30 min (p less than 0.05), indicating increased lung microvascular permeability. Interleukin-2 led to transient increases in plasma thromboxane B2 from 168 to 388 pg/ml (p less than 0.05) and lung lymph thromboxane B2 from 235 to 694 pg/ml (p less than 0.05). The leukocyte count fell from 8156 to 4375/mm3 (p less than 0.05) primarily caused by a 78% drop in lymphocyte count. Platelet count declined from 292 to 184 X 10(3)/mm3 (p less than 0.05). Pretreatment with the hydroxyl radical scavenger dimethylthiourea, 1 gm/kg, intravenously, (n = 6) prevented the interleukin-2-induced increase in mean pulmonary artery pressure, lung lymph flow, lymph/plasma protein ration, lymph protein clearance, and thromboxane B2 levels in plasma and lung lymph. The arterial oxygen tension decreased from 85 to 80 mm Hg (p less than 0.05). The leukocyte count declined from 7854 to 6229/mm3 (p less than 0.05), but this was not as low nor as prolonged as the interleukin-2 group. Further, the decrease in platelet count was prevented (p less than 0.05). Interleukin-2 incubated with sheep or human leukocytes led to a dose-dependent increase in intracellular hydrogen peroxide production by neutrophils as measured by flow cytometry of dichlorofluorescein oxidation. These data indicate that interleukin-2 stimulates OFR generation and that OFR moderate the interleukin-2-induced increased lung permeability.

Animals↗
PubMed1990

Enhanced thromboxane synthesis with extradural anaesthesia.

Reperfusion of a limb following tourniquet ischaemia increases plasma concentrations of thromboxane (TxB2). The study examined TxB2 production during the ischaemia and reperfusion of femoral-popliteal bypass surgery and the effect of anaesthetic technique. Patients (n = 19) were randomly allocated to receive either general (GA) or extradural (EA) anaesthesia. TxB2 concentrations were similar both before and after anaesthesia in the two groups. Clamping the femoral artery in patients given GA resulted in a small but insignificant increase in TxB2 concentration. However, in the EA group clamping resulted in a 10-fold increase in TxB2 concentration (P less than 0.05). To demonstrate that anaesthesia itself was not the stimulus to TxB2 synthesis, patients undergoing inguinal herniorrhaphy (n = 13) received either GA or EA. There were no subsequent changes in TxB2 concentrations in each group. The results indicate that EA but not GA maintains collateral flow during femoral arterial clamping and provides the oxygen needed for generation of TxB2 during ischaemia.

Anesthesia, Epidural↗
PubMed1989

[Retroperitoneal ganglioneuroma].

Ganglioneuroma is an infrequent tumor composed of sympathetic ganglion cells and sheathed neurites. It arises mainly from the large sympathetic chains, most frequently in the posterior mediastinum and retroperitoneum, but rarely may develop from the peripheral sympathetic chains. It is usually benign, and may grow asymptomatically to relatively large size. However, it can cause symptoms due to local expansion and pressure on adjacent structures. It does not seem to have hormonal activity. Some ganglioneuromas contain immature cells or elements of neuroblastoma or pheochromacytoma and can metastasize. The preoperative diagnosis of retroperitoneal tumors has now become more frequent due to the extensive use of imaging modalities, mainly computed axial tomography. Whenever the imaging correlates with the clinical presentation, or there is a reasonable suspicion of a malignancy, operation is indicated. Many retroperitoneal space-occupying lesions are found in asymptomatic patients during attempts to diagnose other diseases. In these cases opinions differ as to therapeutic approach. Many adrenal tumors may be benign adenomas, and several therapeutic protocols have been proposed. The clinician can decide on the basis of clinical presentation and radiographic features whether a conservative approach rather than operation is indicated. Since the majority of retroperitoneal tumors are malignant, histologic diagnosis is essential and in such cases surgical intervention is warranted. A young patient with a retroperitoneal ganglioneuroma is presented.

Adult↗
PubMed1989

[Dieulafoy's lesion].

Massive upper gastrointestinal tract bleeding from a ruptured abnormal gastric artery was reported by Gallard in 1884. The lesion is rare and its characteristics were only described 24 years later by the French surgeon Dieulafoy. It is characterized by an abnormal, tortuous, submucosal artery protruding from a small lesion in otherwise normal gastric mucosa, and is usually located in the posterior wall of the lesser curvature near the cardia. Preoperative diagnosis is very difficult and it is easily overlooked, even during operation. Hence, rebleeding and second laparatomy are common. Treatment is mainly surgical: by wedge resection or oversewing the lesion. A 30-year-old patient with this condition who was operated on for upper gastrointestinal bleeding is presented.

Adult↗
PubMed1989

Penetration of prophylactic antibiotics into peritoneal fluid.

This study evaluates the penetration of cephalosporins into the peritoneal fluid. Forty-six patients scheduled for abdominal surgery were randomized into three groups. On call to the operating room each patient was given a single 1 g dose of cefazolin, cefuroxime, or ceftazidime. Samples of the peritoneal fluid and blood were simultaneously obtained immediately after opening the peritoneal cavity. The mean serum cefazolin concentration was the highest. High peritoneal fluid levels of all three antibiotics were found; however, the antibacterial activity against common intestinal pathogens varied significantly. Cefazolin is the only study drug that possesses marginal in vitro activity against Streptococcus faecalis, a species generally considered resistent to cephalosporins. This study suggests that prophylactic second and third generation cephalosporins are not superior to cefazolin.

Abdomen↗
PubMed1989

Acute left colonic obstruction: a new nonsurgical treatment.

Acute obstruction of the left side of the colon is traditionally treated by colostomy, which entails two or three surgical procedures usually in a high-risk group of patients. We present a new nonsurgical approach by which decompression of the bowel is achieved with a tube introduced proximal to the obstruction with the aid of a flexible sigmoidoscope. This procedure was successful in six of nine patients with left-sided large-bowel obstruction, thus avoiding staged surgery and allowing one definitive operation. No complications were encountered.

Aged↗