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Biomedical subjects

W Rappaport

Publications and source records attributed to W Rappaport.

33 records · Page 2Linked to original sources
PubMed1991

Referral patterns and the results of antireflux operations in patients more than sixty years of age.

The role of antireflux operations in the elderly is ill-defined. Often, these patients are managed medically despite refractory symptoms for fear of surgical morbidity and mortality by referring physicians. This investigation was done to review the referral patterns and results of antireflux operations for patients more than 60 years old. The charts of all patients undergoing operation for reflux were reviewed during an eight year period from 1981 to 1989. One hundred and three patients underwent Nissen fundoplication. All patients had been treated with H2 blockers or antacids, or both, prior to referral for operation. Group 1 (N = 43) consisted of all patients who were 60 years of age and group 2 (N = 60), all patients less than 60 years of age. The mean age of those in group 1 was 70.6 years versus 43.7 years for those in group 2. The mean duration of symptoms was far greater in the elderly group versus the younger group (14.4 versus 4.1 years) (p less than 0.001). Twenty-eight patients in group 1 were referred for surgical treatment because of complications of reflux versus only four in group 2 (p less than 0.01) in whom intractability was the main indication for surgical treatment. The specific complications of gastroesophageal reflux disease that led to the referral of elderly patients for operation were stricture, bleeding, aspiration and Barrett's esophagus. There was one death and this occurred in a 46 year old woman who had a massive pulmonary embolism postoperatively. The mean duration of follow-up study was 5.1 years. Improvement in symptoms was noted by 37 patients in group 1 versus 56 in group 2. We conclude that elderly patients are most often referred for antireflux operations for complications of reflux versus younger patients in whom intractability is the most common indication. Earlier referral is warranted if reflux symptoms persist despite adequate medical therapy. Despite advanced esophageal disease, the results of antireflux operations are good, and surgical morbidity and mortality rates are low enough to warrant intervention in this group of patients, provided no medical contraindications exist.

Adult↗
PubMed1991

Complications associated with needle localization biopsy of the breast.

A review of 144 consecutive needle localization biopsies of the breast (NLBB) was performed to assess complications associated with this procedure. Thirty-four complications occurred in 27 patients. There were 11 wound infections associated with NLBB. During this time period, there were 1,583 clean general surgical operations performed, other than biopsy of the breast, yielding an over-all wound infection rate of 1.2 per cent (p less than 0.001). A trend was noted, suggesting that use of drains may have contributed to wound infection versus no drainage (25 versus 5 per cent, respectively). Electrocautery burns requiring local wound care occurred during seven biopsies and four of these patients subsequently had a wound infection develop. Four lesions required more than one excision to remove the abnormal mammary tissue, and in four, there was a failure to remove the lesion at the first operation. Fifty-three localization procedures were performed using methylene blue. In this group, only one patient required more than one biopsy to remove the abnormal mammary tissue, and there were no failures with this technique. Also, a smaller mean volume of tissue was removed in this group versus the standard NLBB (30.2 +/- 3.0 versus 53.3 +/- 4.6 cubic millimeters, respectively) (p less than 0.01). Four cardiovascular complications occurred, requiring overnight admission. All of these patients were more than 65 years old and had the procedure performed while under general anesthesia. Patient age, type of anesthesia, resident versus attending surgeon and length of procedure had no independent effect on local complication rate.

Aged↗
PubMed1990

The retained surgical sponge following intra-abdominal surgery. A continuing problem.

The surgical sponge retained following intra-abdominal surgery is a continuing problem. Despite precautions, the incidence of this problem is grossly underestimated. During the past 10 years, we have treated four patients with this problem. The presentation of a retained surgical sponge is highly variable, as is the time before the onset of symptoms. The clinical presentation, predisposing factors, and management are presented as well as guidelines for prevention.

Abdomen↗
PubMed1990

Tube enterostomy after small bowel resection.

Ostomy formation can be technically difficult when mesenteric shortening and thickening are present. In addition, the high output that follows a small bowel ostomy can be debilitating in the elderly patient or the patient with underlying medical illness. We describe a technique to avoid these difficulties.

Enterostomy↗
PubMed1990

Continuous ambulatory peritoneal dialysis associated with peritonitis in older patients.

Our recent experience with peritonitis in patients over the age of 55 years undergoing continuous ambulatory peritoneal dialysis between 1979 and 1989 is reviewed. Thirty-seven patients in this age group underwent Tenckhoff catheter insertion. Severe catheter-related peritonitis occurred at a rate of 1.41 episodes per patient per year. Overall, there were 61 episodes of peritonitis in 31 patients, with an overall mortality rate of 7%. When systemic signs of sepsis were present, this rate rose to 25%. All deaths were associated with fungal, pseudomonal, or polymicrobial infections. Management of these infections may require aggressive measures including repeated laparotomy for control of sepsis.

Age Factors↗
PubMed1990

A comparison of parallel versus perpendicular placement of retention sutures in abdominal wound closure.

A new technique for placement of retention sutures is described. Twenty-five rats underwent midline laparotomy incision. The control group was closed with traditional placement of through-and-through retention sutures placed in a perpendicular direction to the wound. The experimental group was closed with retention sutures placed in a parallel direction to the wound as described below. Wound bursting strength was significantly (P less than 0.001) greater at one to five days in the experimental group compared with the control animals. In addition, inflammatory reaction and pressure necrosis were greater in the control group. It appears that parallel placement of sutures has less of a tendency to cut through tissue when subjected to the distracting forces on a midline wound.

Abdomen↗
PubMed1990

The management of splenic trauma in the adult patient with blunt multiple injuries.

An analysis of 106 adult patients with blunt multiple organ injury and splenic trauma was carried out during an eight year period. Three groups were studied--group 1, splenectomy; group 2, splenorrhaphy, and group 3, observation. There was no statistically significant difference in initial blood pressure, pulse or hematocrit among the three groups. The mean injury severity score (ISS) was higher for those in groups 1 and 2 (26.8 and 25.6, respectively) versus patients in group 3 (17.9) (p). There were a total of 38 intra-abdominal injuries in 34 patients of which 21 required surgical repair. No patient in the nonoperative group required laparotomy for a missed associated intra-abdominal injury. There were a total of 15 intra-abdominal complications related to splenic management. In the observation group, seven patients ultimately required laparotomy for continued splenic bleeding. In the splenorrhaphy group, the complication rate was significantly lower versus the other two groups (p). We concluded that, if technically feasible, splenorrhaphy is a safe procedure in the multiply injured patient in the absence of hypotension and coagulopathy. Nonoperative management of blunt splenic trauma should be viewed with caution because of the high failure rate in the multiply injured patient.

Adult↗
PubMed1990

The surgical management of atypical mycobacterial soft-tissue infections.

Group IV atypical mycobacterial infections, especially Mycobacterium fortuitum and M. chelonei, are being reported with increased frequency. We report our experience with five cases of soft-tissue infection with these acid-fast bacilli. Often these infections are chronic, with formation of abscesses and multiple fistulas. Optimal surgical treatment often requires wide excision of all diseased tissue followed by delayed closure. Presentation, optimal surgical management, and antibiotic therapy are discussed.

Abscess↗
PubMed1981

Teleradiology: an evaluation of a microcomputer-based system.

A laboratory evaluation of a microcomputer-based teleradiology system is described. The system used state-of-the-art hardware, and provided for contrast and brightness control by the consulting radiologists. The transmitted, digitized images were compared with conventional radiographs. The radiologists' scores for findings, impressions, and confidence levels were significantly lower for radiographic images viewed on the teleradiology system. However, the quality of the images provided by the teleradiology system was high enough to warrant further study, especially since microcomputer-based teleradiology offers the advantage of providing access to radiology services for rural areas and small hospitals.

Computers↗
PubMed1979

Ontogeny of B-lymphocyte function. IX. Difference in the time of maturation of the capacity of B lymphocytes from foetal and neonatal mice to produce a heterogeneous antibody response to thymic-dependent and thymic-independent antigens.

The ontogeny of the capacity of the B-lymphocyte population to produce a response which is heterogeneous with respect to antibody affinity was studied in a cell transfer system. Lethally irradiated mice were reconstituted with B cells from donors of various ages, together with adult thymus cells when the response to T-dependent antigens was studied. The animals were immunized with one of a variety of antigens one day after cell transfer and the distribution of their splenic plaque-forming cells (PFC) with respect to affinity was assayed, by hapten inhibition of plaque formation, 2 to 3 weeks after immunization. Mice reconstituted with B cells from neonatal donors produced a response of low affinity and restricted heterogeneity. With four different thymic-dependent antigens (DNP-BGG, F-BGG, DNP-KLH and Dan-KLH) the splenic B-cell population acquired the capacity to reconstitute irradiated mice to produce a normal adult-like, highly heterogeneous, high affinity PFC response between 7 and 10 days after birth. The capacity to produce a heterogeneous response to the thymic-dependent protein antigen BGG matured just slightly later between 10 and 14 days of age. The bone marrow matures with regard to the capacity to reconstitute irradiated mice to give a heterogeneous response several days after the spleen, possibly as a consequence of the redistribution of peripheral B cells to the bone marrow. In contrast, maturation of the capacity of the splenic B-cell population to reconstitute irradiated recipients to give a heterogeneous, adult-like PFC response to three 'thymic-independent' antigens (TNP-PA, DNP-Ficoll and TNP-BA) takes place considerably later (between 3 and 4 weeks of age). These results suggest that the population of B-cell precursors which responds to thymic-dependent antigens may represent a different subpopulation of B cells from the population that responds to thymic independent antigens. Furthermore, the results suggest that these B-cell subsets mature at different times, presumably under independent controls.

Age Factors↗