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Biomedical subjects

Z Dreznik

Publications and source records attributed to Z Dreznik.

At least 19 recordsLinked to original sources
PubMed2003

Rectal flap advancement--a simple and effective approach for the treatment of rectourethral fistula.

OBJECTIVE: Rectourethral fistula is a rare complication of prostatic surgery and other pelvic procedures. We report our experience of surgical repair of using a rectal advancement flap. PATIENTS: Three patients with rectourethral fistula following prostatic surgery were treated. Two patients had an anterior partial thickness of rectal flap advancement via a trans-anal approach without urinary or faecal diversion. In one patient a rectal flap repair was performed through a posterior transsphincteric approach following urinary and faecal diversion. RESULTS: No significant postoperative complications occurred. Healing was successful in each patient and faecal and urinary continence was normal. CONCLUSION: Transanal rectal advancement flap is a simple and effective technique for the treatment of a rectourethral fistula with no need for urinary or faecal diversion.

Aged↗
PubMed2002

Harmonic scalpel hemorrhoidectomy: preliminary results of a new alternative method.

Surgical treatment is considered to be the best therapeutic modality for severe hemorrhoidal disease. Different surgical methods of hemorrhoidectomy aim to decrease pain, bleeding, stenosis and discharge. The aim of this study was to evaluate the efficacy of harmonic scalpel hemorrhoidectomy. During a period of seven months, 54 consecutive patients with third- and fourth-degree hemorrhoids were prospectively randomized for harmonic scalpel hemorrhoidectomy (HS) or Milligan-Morgan procedure (MM). These patients were examined at one, two, and six weeks after the operation. All patients had a lower gastrointestinal investigation prior to operation to exclude other colorectal pathologies. All patients had the same kind of preoperative preparation and analgesia during the postoperative course. Pain was assessed using a visual analog scale from 0 to 10. Patient satisfaction was defined as decrease or absence of symptoms and return to normal daily activities. HS groups included 29 patients, while the MM group had 25 patients. There as no difference between the groups in terms of age, gender, hemorrhoidal degree and indication for operation. The types of intra-operative anesthesia administered to the two groups were similar. Duration of surgery was significantly higher in the MM group ( p<0.0001). Postoperative hospitalization was longer in the MM group ( p<0.0001), and the pain degree was higher in MM group ( p<0.0001). No significant difference was noted in the overall amount of analgesics used in the two groups at week 1, although it was significantly higher in the MM group 2 and 3 weeks after the operation. Early complication occurred more frequently in the MM group but overall the difference was not statistically significant. In conclusion, harmonic scalpel hemorrhoidectomy is virtually a bloodless operation with minimal tissue damage. It is associated with significant less postoperative pain and a fast return to normal activity.

Digestive System Surgical Procedures↗
PubMed2001

A lipophilic vasoactive intestinal peptide analog enhances the antiproliferative effect of chemotherapeutic agents on cancer cell lines.

BACKGROUND: Vasoactive intestinal peptide (VIP) is one of several small neuropeptides that affect cancer growth. A lipophilic VIP analog, stearyl-Nle(17)-neuroten-sin(6-11)VIP(7-28) (SNH) that inhibited lung carcinoma growth has been described previously. The experiments performed were clonogenic assays in vitro and tumor xenografts in nude mice in vivo. These studies were now extended to colon carcinoma and to combination therapy with chemotherapeutic agents. METHODS: Assays were performed with cell lines, and tumor proliferation was assessed using the (3-[4,5-dimethylthiazol-2-yl-5]-[3-carboxymethoxyphenyl]-2-[4-sulfophenyl]-2H tetrazolium) (MTS) colorimetric assay for mitochondrial function of living cells. RESULTS: The lipophilic analog (SNH) enhanced the antiproliferative activity of diverse chemotherapeutic agents: doxorubicine (antibiotic); vinorelbine (vinca alkaloid, antimicrotubule formation); paclitaxel (antimicrotubule agent); gemcitabine (antimetabolite); irinotecan (topoisomerase I inhibitor); and cisplatin (platinum compound acting as an alkylating agent). In all cases, the antiproliferative effect of SNH and the chemotheraputic agent was at least additive and for some combinations and concentrations even synergistic. For example, 2 microM of the antagonist that produced a 15-20% growth inhibition in the nonsmall cell lung carcinoma cell line reduced the IC(50) by 2-4-fold for most of the chemotherapeutic agents tested. Higher analog concentrations were even more efficacious. Similar results were obtained with colon carcinoma cell lines. CONCLUSIONS: Chemotherapeutic treatment of advanced solid tumors, such as nonsmall cell lung carcinoma, colon carcinoma, or prostate carcinoma, achieves a response rate of between 10% and 30% with significant toxicity. Combination therapy with the lipophilic VIP analog SNH and the preferred chemotherapeutic agent may greatly enhance the response rate, and by permitting a dose reduction, should significantly reduce side effects.

Animals↗
PubMed2001

Rectal prolapse: a possibly underrecognized complication of anorexia nervosa amenable to surgical correction.

OBJECTIVE: Rectal prolapse is a complication of anorexia nervosa (AN) that may be more common than previously recorded experience would suggest. METHOD: In this report we document, for the first time, the association of (AN) and rectal prolapse in a series of three patients seen in the past three years. An extensive review of the literature using Medline over the period from 1966 to Jan 2000 failed to reveal any previous example of this association. RESULTS AND CONCLUSION: The finding could have significant health care implications if confirmed. It would suggest that patients with either the psychiatric or surgical problem may not be receiving the appropriate complementary referrals: psychiatrist to surgeon and vice versa. The importance of recognition of this association in anorectic patients is the availability of effective surgical therapy.

Adolescent↗
PubMed2000

Silastic ring vertical gastroplasty- long-term results and complications.

BACKGROUND: Silicone ring vertical gastroplasty (SRVG) in some reports is associated with significant morbidity and a tendency to regain weight in the late postoperative period. The present study aims to evaluate our long-term results, along with early and late postoperative complications. METHODS: The early and late postoperative complications of 300 patients undergoing SRVG and followed for an average of 3.2 years, were reviewed retrospectively. The pre- and post-operative weight and body mass index (BMI) were recorded in a subgroup of 131 patients with an average follow-up of 5.2 years. RESULTS: Early postoperative complications occurred in 99 patients (33.1%), with mortality of one patient (0.3%). Vomiting was the most common late complication, occurring in 49.3%. Re-operation was performed in 19.7% of the patients, mostly for the repair of postoperative ventral hernia. Long-term results following SRVG showed a decrease in weight from 131 +/- 25 kg to 94 +/- 23.2 kg, and BMI decreased from 46.1 +/- 8.1 kg /m(2) to 32.9 +/- 7.4 kg/m(2). Excess body weight loss was 58.5 +/- 39.8%. CONCLUSIONS: Most patients (76%) reported their satisfaction following SRVG. Long-term results revealed a significant and sustained weight loss, mild complications and low mortality rate.

Adolescent↗
PubMed1999

[Tension-free repair of inguinal hernia with properitoneal mesh (by the method of Stoppa): results and conclusions].

The results of properitoneal mesh repair of inguinal hernia were evaluated in 38 of 43 consecutive patients operated by Stoppa's technique. In 33 patients the hernia was bilateral and in 10 unilateral; in 20 it was recurrent. In 33/43 patients the mesh was fixed either by sutures or metal clips. The overall recurrence rate after 22 (14-36) months of follow-up, was 10.5%. This result was composed of a 3.0% recurrence rate in the fixated-mesh group, and 30.0% among those with non-fixated mesh. The outcome following the Stoppa method for tension-free properitoneal mesh repair of inguinal hernia, compares favorably with those of other methods, provided proper attention is paid to adequate mesh placement and fixation. Further prospective studies are needed to define the role and indications for this technique in the laparoscopic era.

Adult↗
PubMed1994

Effect of ileal oleate on interdigestive intestinal motility of the dog.

To determine the effect of ileal oleate on fasting intestinal motility, pairs of duodenal and ileal catheters and bipolar duodenal and jejunal seromuscular electrodes were surgically implanted in six dogs. The ileum was perfused with either normal saline (154 mM NaCl) or oleic acid emulsion (152 mM), while intestinal myoelectric activity was continuously monitored. For transit studies, a bolus of [3H]PEG was injected into the duodenum, and jejunal and ileal alliquots were collected every 15 min for a 6-hr study period. Plasma samples were collected for radioimmunoassays of peptide YY and enteroglucagon. Ileal oleate infusion increased the MMC cycle length and decreased the number of MMCs (P < 0.001) and the myoelectric spike-burst frequency/10 min in the duodenum (P < 0.05). Both duodenal-jejunal (P < 0.05) and duodenal-ileal transit (P < 0.01) were delayed markedly by ileal perfusion with oleic acid emulsion as compared to control studies. Ileal oleate increased plasma levels of peptide YY (P < 0.01) and enteroglucagon (P < 0.01). Ileal perfusion with oleate therefore activated the so-called "ileal brake," diminishing duodenal myoelectric spike bursts and slowing intestinal transit while concurrently increasing plasma levels of peptide YY and enteroglucagon.

Animals↗
PubMed1993

Trocar site abscess due to spilled gallstones: an unusual late complication of laparoscopic cholecystectomy.

We describe a case of a 31-year-old woman who had an unusual complication after undergoing laparoscopic cholecystectomy. A subcutaneous abscess developed at the site of a 5-mm subcostal accessory port several months postoperatively. When drained, the abscess contained small gallstones that had spilled into the peritoneal cavity upon extraction of the gallbladder during laparoscopic cholecystectomy.

Abscess↗
PubMed1992

Early effect of external beam radiation therapy on the anal sphincter: a study using anal manometry and transrectal ultrasound.

The early of pelvic irradiation on the anal sphincter has not been previously investigated. This study prospectively evaluated the acute effect of preoperative radiation on anal function. Twenty patients with rectal carcinoma received 4,500 cGy of preoperative external beam radiation. The field of radiation included the sphincter in 10 patients and was delivered above the anorectal ring in 10 patients. Anal manometry and transrectal ultrasound were performed before and four weeks after radiotherapy. No significant difference in mean maximal squeeze or resting pressure was found after radiation therapy. An increase in mean minimal sensory threshold was significant. Histologic examination revealed minimal radiation changes at the distal margin in 8 of 10 patients who underwent low anterior resection and in 1 of 3 patients who underwent abdominoperineal resection. We conclude that preoperative radiation therapy has minimal immediate effect on the anal sphincter and is not a major contributing factor to postoperative incontinence in patients after sphincter-saving operations for rectal cancer.

Adult↗
PubMed1992

Outpatient protocol for biofeedback therapy of pelvic floor outlet obstruction.

Pelvic floor outlet obstruction is a rare cause of severe constipation. Anal myectomy, subtotal colectomy, and medical therapy have limited success. The purpose of this study was to develop a short outpatient treatment using biofeedback techniques. Nine patients with severe constipation and straining resulting from pelvic floor outlet obstruction underwent complete investigation of the pelvic floor musculature and anal sphincter mechanism. Patients were unable to expel a 60-cc rectal balloon and had nonrelaxing puborectalis on defecography. The treatment protocol utilized anal surface electromyography to document improper straining and retrain pelvic floor muscles to relax during defecation. Sensory retraining with a rectal balloon, behavioral relaxation techniques, and defecation of simulated stool using a 120-cc Metamucil (Procter & Gamble, Cincinnati, OH) slurry in the rectum allowed re-establishment of normal defecation in all nine patients. Repeat training was required in three patients during follow-up. Treatment of pelvic floor outlet obstruction with outpatient retraining techniques is possible.

Adult↗
PubMed1992

Balloon expulsion test facilitates diagnosis of pelvic floor outlet obstruction due to nonrelaxing puborectalis muscle.

We compared balloon expulsion, defecography, colonic transit times, anal manometry, and electromyography in 21 patients with severe constipation. Defecography demonstrated nonrelaxation of the sphincter during straining in all patients. Only 12 patients were unable to expel a balloon. Colonic transit was normal (five) or showed rectosigmoid delay (seven). All 12 patients were offered biofeedback. The nine patients able to expel a balloon had normal colonic transit (six) or colonic inertia (two). Rectosigmoid delay was due to severe intussusception in one patient. Anal manometry and pudendal nerve latencies revealed no difference between those who could and those who could not expel a balloon. Balloon expulsion seems to be a more reliable way to diagnose pelvic floor outlet obstruction due to nonrelaxation of the puborectalis muscle. Nonrelaxation of the sphincter on defecography should be correlated with balloon expulsion and colonic transit studies.

Adult↗
PubMed1991

Anal sphincter repair for obstetric injury: manometric evaluation of functional results.

Anal manometry before and after surgical repair on a homogeneous group of patients with anterior sphincter defect caused by obstetric injury defined the parameters affected by the repair to achieve anal continence. Between November 1985 and April 1989, 28 patients who underwent anterior anal sphincter reconstruction were studied using anal manometry and were graded for continence. Anal function was improved for 27 of 28 patients (96 percent) relative to their preoperative symptoms, and total control of solid and liquid stools was restored in 21 patients (75 percent). Anal manometry demonstrated that complete control of continence could be achieved if anal sphincter length, resting pressure, and squeeze pressure were restored to normal. Our results showed that sphincter length was improved in 20 patients (71 percent), resting pressure in 16 patients (57 percent), and squeeze pressure in 22 patients (79 percent). The most important factor in achieving normal function of the anal sphincter is restoration of a normal squeeze pressure.

Adult↗
PubMed1991

Inhibitory effect of ileal oleate on postprandial motility of the upper gut.

To determine the effect of ileal oleate on postprandial gastrointestinal motility, duodenal and paired perfusion-aspiration ileal catheters and bipolar duodenal and jejunal electrodes were surgically implanted in five dogs. The ileum was perfused with either saline or an isotonic oleic acid emulsion at 2 ml/min. A 205-kcal mixed meal containing 120 ml liquid nutrient labeled with 111In-diethylenetriamine pentaacetic acid (DTPA) and solid food labeled with 99mTc was then administered orally. Gastric emptying was assessed by a gamma camera, myoelectric activity was continuously monitored, and duodenal-ileal transit of phenol red was determined over the ensuing 240 min. Ileal oleate reduced duodenal spikeburst frequency by 50% (P less than 0.05) and delayed gastric emptying of liquids and solids. Four hours after ingesting the meal, 62% of solids and 34% of liquids were retained in the stomach during oleic acid perfusion compared with 25 and 4%, respectively, when saline was perfused (P less than 0.05). Duodenal-ileal transit was markedly slowed by ileal perfusion with the oleic acid emulsion (P less than 0.001). Ileal oleate therefore exerted a profound inhibitory effect on proximal gut motility in the early period after ingestion of a mixed-nutrient meal in dogs.

Animals↗