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Research Interests: Surgery, Bariatric Surgery, Nonparametric Statistics, Medicine, Israel, and 15 moreHumans, Female, Male, cerebral Venous sinus thrombosis, Incidence, Body Mass Index, Length of Stay, Clinical Sciences, Adult, Retrospective Studies, Thrombosis, Chi Square Distribution, Laparoscopy, Portal vein, and Portal Vein Thrombosis
Preclinical studies have suggested that the Nitinol-based compression anastomosis might be a viable solution. A prospective multicentre open label study was designed to evaluate the performance of the ColonRing(™) in (low) colorectal... more
Preclinical studies have suggested that the Nitinol-based compression anastomosis might be a viable solution. A prospective multicentre open label study was designed to evaluate the performance of the ColonRing(™) in (low) colorectal anastomosis. The primary outcome measure was anastomotic leakage. Patients were recruited at 13 different colorectal surgical units in Europe, the United States and Israel. Institutional review board (IRB) approval was obtained. Between March 21 2010 and August 3 2011, 266 patients completed the study protocol,. The overall anastomotic leakage rate was 5.3% for all anastomoses, including a rate of 3.1% for low anastomoses. Overall septic anastomotic complications occurred in 8.3% and 8.2%. The Nitinol compression anastomosis is safe, effective, and easy to use and may offer an advantage for low colorectal anastomosis. A prospective randomized trial comparing ColonRing(™) with conventional stapling is needed. This article is protected by copyright. All r...
Research Interests: Medicine, Israel, Prospective studies, Humans, Europe, and 14 moreUnited States, Female, Male, Sepsis, Young Adult, Clinical Sciences, Aged, Middle Aged, Adult, Colorectal Disease, Colon, Alloys, Colectomy, and Rectum
We present a case of adrenocorticotropic hormone (ACTH)-independent Cushing's syndrome diagnosed in a patient in the third trimester of her... more
We present a case of adrenocorticotropic hormone (ACTH)-independent Cushing's syndrome diagnosed in a patient in the third trimester of her pregnancy, with an adrenal mass observed on imaging studies. Laparoscopic adrenalectomy was performed successfully at 32 weeks. To the best of our knowledge, this is the latest gestational age at which laparoscopic adrenalectomy has been reported. We present the various considerations for determining the surgical approach and the optimal timing for surgery. Adrenalectomy during pregnancy for the treatment of Cushing's syndrome caused by adrenocortical adenoma has been reported in 23 patients in the English-language medical literature to date and seems safe and beneficial. According to the data, surgical treatment has led to a reduction in perinatal mortality and maternal morbidity rates, but has not affected the occurrence of preterm birth and intrauterine growth restriction. The best outcome can be achieved by a multidisciplinary approach, with a team comprising a maternal-fetal medicine specialist, an endocrinologist and a surgeon. The timing of surgery and the surgical approach need to be determined according to the surgeon's expertise, the severity of the condition, the patient's preferences, and gestational age. Laparoscopy may prove to be the preferred surgical approach. The small number of cases precludes providing evidence-based recommendations.
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Only few studies have examined the impact of racial differences on the age of onset, course and outcomes of diverticulitis. To provide data about the epidemiology of diverticulitis in northern Israel, and to determine whether ethnicity is... more
Only few studies have examined the impact of racial differences on the age of onset, course and outcomes of diverticulitis. To provide data about the epidemiology of diverticulitis in northern Israel, and to determine whether ethnicity is a predictor of age of onset, complications, and need for surgery. Was conducted a retrospective review of the charts of all patients diagnosed with a first episode of diverticulitis in our hospital between 2005 and 2012. Were found 638 patients with a first episode of acute diverticulitis in the eight year interval. Israeli Arabs developed a first episode of diverticulitis at a younger age compared to Jews (51.2 vs 63.8 years, p<0.01). Arabs living in rural areas developed diverticulitis at a younger age than Arabs living in urban centers (49.4 vs 54.5 years, P=0.03). Jewish and Arabic men developed diverticulitis at younger age compared to their female counterparts (59.9 vs 66.09, p<0.01, and 47.31 vs 56.93, p<0.01, respectively). Arabs were more likely [odds ratio (OR)=1.81 ,95% confidence interval (CI)1.12-2.90, p=0.017] than Jews to require surgical treatment (urgent or elective) for diverticulitis. Israeli Arabs tend to develop diverticulitis at a younger age and are more likely to require surgical treatment for diverticulitis compared to Jews. Arabs living in rural areas develop diverticulitis at a younger age than Arabs living in urban centers. These findings highlight a need to address the root cause for ethnic differences in onset, course and outcome of acute diverticulitis.
Adult intussusception is a rare condition, chronic and recurring in nature, and presenting as intermittent intestinal obstruction. Surgeons generally have limited experience with it. We present 13 cases that have been treated in our... more
Adult intussusception is a rare condition, chronic and recurring in nature, and presenting as intermittent intestinal obstruction. Surgeons generally have limited experience with it. We present 13 cases that have been treated in our department over a period of 19 years. In most of the cases there is an identifiable cause and it is often a malignancy. Awareness, plain abdominal films, barium enema and CT are valuable tools for diagnosis. Resection without reduction is the treatment of choice in most cases. In instances where resection would necessitate a permanent stoma, attempts at manual reduction are justified. Timely treatment, properly carried out, should result in a good prognosis.
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Laparoscopic cholecystectomy (LC), the procedure of choice for elective cholelithiasis, is now also used in the management of acute cholecystitis. In the various types of gallbladder disease, favorable and unfavorable conditions may... more
Laparoscopic cholecystectomy (LC), the procedure of choice for elective cholelithiasis, is now also used in the management of acute cholecystitis. In the various types of gallbladder disease, favorable and unfavorable conditions may influence the conversion and complication rates. Information about these conditions may help elucidate the optimal circumstances for LC or indicate when the procedure is best avoided. We attempted to perform emergency LC on 215 patients with acute cholecystitis. The procedure was successful in 171 patients (79.5%), and conversion to open cholecystectomy (OC) was needed in 44 (20.5%). Complications occurred in 37 patients (17%). Uncomplicated acute cholecystitis was associated with age <50 years, duration of complaint <48 h, temperature <38.5 degrees C, a nonpalpable gallbladder, and an alkaline phosphatase >100 U/L. Acute gangrenous cholecystitis was associated with a negative gallbladder history, other associated diseases, temperature >38...
Research Interests: Probability, Multivariate Analysis, Prospective studies, Humans, Laparoscopic Cholecystectomy-Analgesia, and 13 moreFemale, Male, Risk factors, Aged, Middle Aged, Adult, Sex Factors, Analysis of Variance, Prognosis, Chi Square Distribution, Risk Factors, Sensitivity and Specificity, and Predictive value of tests
Laparoscopic sleeve gastrectomy (LSG) has been used more frequently over the past 10 years. As the population ages, a larger number of older people will suffer from weight-related comorbidities, resulting in bariatric surgery becoming a... more
Laparoscopic sleeve gastrectomy (LSG) has been used more frequently over the past 10 years. As the population ages, a larger number of older people will suffer from weight-related comorbidities, resulting in bariatric surgery becoming a dominant solution for improving health and quality of life. We assessed the long-term outcomes of LSG in elderly patients. We conducted a retrospective chart review of patients who underwent LSG between January 2007 and August 2009. We subdivided 123 patients into <35 (n = 43), 35-55 (n = 59), and >55 (n = 21) age groups. The respective mean excess body mass index loss and excess weight loss were 42.5 % ± 3.1 % and 41.3 % ± 12.3 % for the <35 age group, 48.7 % ± 4.1 % and 45.6 % ± 10.6 % for the 35-55 age group, and 53.6 % ± 4.6 % and 52.1 % ± 11.1 % for the >55 age group. The follow-up compliance rates at the 5-year visit were 23.85, 31.11, and 47.61 % for the <35, 35-55, and >55 age groups, respectively. The corresponding Bariatri...
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Mental training (MT) is used extensively by musicians and athletes to improve their performance. Recently, it has been suggested as a training method for surgical trainees. We assessed the influence of MT, induced by hypnosis, on the... more
Mental training (MT) is used extensively by musicians and athletes to improve their performance. Recently, it has been suggested as a training method for surgical trainees. We assessed the influence of MT, induced by hypnosis, on the performance of simulated tasks on a laparoscopic simulator, as compared to a non-specific relaxing intervention. 11 surgeons completed a proficiency-based training program on the Fundamentals of Laparoscopic Surgery (FLS) simulator, until they reached performance plateau of the peg transfer task. Thereafter, they received a single music session, as a relaxing intervention, followed by repeating of the peg transfer task. Then they went through a hypnosis session guided by an experienced psychologist, with suggestions of smooth flow of pegs from one position on the board to another, and re-performed the task. Plateau performance was 51.1 ± 6.9 s. After the music session performance improved by 6.3 % to 47.9 ± 5.4 s (p = 0.86). After the MT session perform...
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This 3-institution study assessed the short-term clinical outcome and safety profile of the NiTi Biodynamix ColonRingTM compression anastomosis in elective colorectal resection. A prospective, open-label, non-randomized trial was... more
This 3-institution study assessed the short-term clinical outcome and safety profile of the NiTi Biodynamix ColonRingTM compression anastomosis in elective colorectal resection. A prospective, open-label, non-randomized trial was conducted at 3 separate institutions between October 2008 to October 2009 in patients undergoing elective colorectal resection with the Biodynamix ColonRingTM compression anastomosis ring, assessing technical factors in its operative use, immediate and short-term clinical outcome parameters (length of hospital stay, time to first passage of flatus and stool and to oral intake) and peri-operative complications including anastomotic failure or stenosis and wound infection. Forty patients (22 females, mean age 65.9 years; range 36-83 years were included in the analysis with 14 cases being performed laparoscopically. The median duration of surgery was 120 minutes (range 60-456 minutes) with a mean anastomotic time of 14.8 minutes (range 1.75-50 minutes). The me...
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An otherwise healthy 17-year-old boy presented to the paediatric emergency department with acute severe epigastric pain. An admission abdominal radiograph demonstrated gastric dilation, associated with an elevated left hemidiaphragm.... more
An otherwise healthy 17-year-old boy presented to the paediatric emergency department with acute severe epigastric pain. An admission abdominal radiograph demonstrated gastric dilation, associated with an elevated left hemidiaphragm. Subsequent barium contrast imaging confirmed the diagnosis of organoaxial acute gastric volvulus (AGV). Emergent exploratory laparoscopy revealed AGV with migration of the stomach, spleen, pancreatic tail, splenic flexure, left kidney and adrenal through a left-sided Bochdalek diaphragmatic hernia. Following careful mobilisation of the displaced structures, a mesh closure of the diaphragmatic defect was performed. The patient's postoperative chest radiograph was unremarkable, and he was discharged on the sixth postoperative day after an uneventful recovery. At 2 months the patient was well and asymptomatic, with normal barium contrast imaging results.
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The authors report a case of a wandering spleen presenting as a right lower quadrant abdominal mass, 2 years post a transabdominal left diaphragmatic hernia repair in a 2-year-old child with a congenital diaphragmatic hernia. The... more
The authors report a case of a wandering spleen presenting as a right lower quadrant abdominal mass, 2 years post a transabdominal left diaphragmatic hernia repair in a 2-year-old child with a congenital diaphragmatic hernia. The wandering spleen was fixed laparoscopically in an extraperitoneal pouch.
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A 39-year-old woman presented to the gastroenterology clinic with recurrent right-upper-quadrant pain and elevated liver enzymes. Endoscopy revealed a small submucosal mass at the edge of the major duodenal papilla, which was not amenable... more
A 39-year-old woman presented to the gastroenterology clinic with recurrent right-upper-quadrant pain and elevated liver enzymes. Endoscopy revealed a small submucosal mass at the edge of the major duodenal papilla, which was not amenable to endoscopic resection. The mass was successfully resected by laparoscopy. The papilla was subsequently reconstructed and a cannula inserted in the common bile duct. The postoperative period was uneventful and the patient was discharged on the third postoperative day. Subsequent pathological examination of the excised mass revealed a gangliocytic paraganglioma. Six weeks later, the patient was free of symptoms and the cannula was removed by duodenoscopy.
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We performed 75 laparoscopic cholecystectomies during July and September 1996. In 3 men and 4 women, aged 32-87 years, there was obstructive jaundice caused by choledocholithiasis. During laparoscopy in the jaundiced patients, calculi... more
We performed 75 laparoscopic cholecystectomies during July and September 1996. In 3 men and 4 women, aged 32-87 years, there was obstructive jaundice caused by choledocholithiasis. During laparoscopy in the jaundiced patients, calculi were identified by cholangioscopy and intra-operative cholangiography. They were washed into the duodenum (confirmed cholangiographically) after intravenous glucagon injections and dilation of the papilla of Vater. Serum bilirubin and liver enzyme levels returned to normal within a few days. There was no operative or postoperative morbidity, nor any biliary-related systemic complications. Average postoperative hospitalization was 3 days.
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Elective laparoscopic cholecystectomy is established as the treatment of choice for symptomatic cholecystolithiasis and is now proposed for the treatment of acute cholecystitis. We initiated the present study in order to clarify the... more
Elective laparoscopic cholecystectomy is established as the treatment of choice for symptomatic cholecystolithiasis and is now proposed for the treatment of acute cholecystitis. We initiated the present study in order to clarify the question of safety of the procedure in the presence of an inflamed gallbladder, and to compare the results with those of a traditionally treated group with acute cholecystitis. We compared the preoperative, operative, and postoperative courses of 146 patients with acute cholecystitis, managed laparoscopically between 1994 and 1996, with those of 97 patients, treated traditionally by open cholecystectomy for the same diagnosis between 1992 and 1993. In the acute cholecystitis cases, when laparoscopic cholecystectomy was successfully performed, the operative and postoperative courses were superior to those of open cholecystectomy. The use of drains and NG tubes, the need for antibiotics and analgesia, the associated morbidity, and the hospital stay were si...
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This prospective study determines the indications for and the optimal timing of laparoscopic cholecystectomy (LC) following the onset of acute cholecystitis. It also evaluates preoperative and operative factors associated with conversion... more
This prospective study determines the indications for and the optimal timing of laparoscopic cholecystectomy (LC) following the onset of acute cholecystitis. It also evaluates preoperative and operative factors associated with conversion from laparoscopic cholecystectomy to open cholecystectomy in the presence of acute cholecystitis. Having been established as the procedure of choice for elective cholelithiasis, LC is now also used for management of acute cholecystitis. Under these circumstances the procedure may be difficult and challenging. Certain favorable and unfavorable conditions may be present that influence the conversion and complication rates. Information about these conditions may be helpful for elucidating the optimal circumstances for LC or when the procedure is best avoided. We performed LC on an emergency basis as soon as the diagnosis was made on all patients presenting with acute cholecystitis from January 1994 to December 1995. All preoperative, operative, and pos...
... Ann Surg 218 (1993), pp. 630634. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (112). 5. CK Kum, PMY Goh, JR Isaac et al., Laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 81 (1994), pp.... more
... Ann Surg 218 (1993), pp. 630634. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (112). 5. CK Kum, PMY Goh, JR Isaac et al., Laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 81 (1994), pp. 16511654. ...
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... Ann Surg 218 (1993), pp. 630634. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (112). 5. CK Kum, PMY Goh, JR Isaac et al., Laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 81 (1994), pp.... more
... Ann Surg 218 (1993), pp. 630634. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (112). 5. CK Kum, PMY Goh, JR Isaac et al., Laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 81 (1994), pp. 16511654. ...
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Cancer antigen 125 (CA 125) is a high molecular mass glycoprotein, usually used for monitoring the course of epithelial ovarian cancer. Recently it has been shown that liver cirrhosis is associated with increased levels of CA 125,... more
Cancer antigen 125 (CA 125) is a high molecular mass glycoprotein, usually used for monitoring the course of epithelial ovarian cancer. Recently it has been shown that liver cirrhosis is associated with increased levels of CA 125, particularly in the presence of ascites. The aim of this study was to evaluate CA 125 as a marker for the detection of ascites in patients with chronic liver disease. A total of 170 patients were studied. All had ultrasound scanning for detection of ascites. Group I consisted of 123 patients with chronic liver disease without ascites; whereas group II consisted of 47 patients with chronic liver disease with ascites. CA 125 levels were measured in all patients and also simultaneously in the ascitic fluid of 31 patients from group II. Of 47 patients, 46 (97.8%) of group II had elevated serum levels of CA 125 (mean 321 +/- 283 U/ml) as compared with only nine of 123 (7.3%) patients of group I [mean 13 +/- 15 U/ml]), p &lt; 0.001. The mean CA 125 concentration in the ascitic fluid of 31 cirrhotic patients (group II) was 624 +/- 397 U/ml and was always higher than corresponding serum levels (p &lt; 0.01). Serum CA 125 levels correlated with the amount of ascitic fluid (r = 0.78). A profound decrease in serum CA 125 concentration was noted 2-3 and 10 days after large volume paracentesis. CA 125 was more sensitive and preceded ultrasonography in detection of ascites in few cirrhotic patients. CA 125 is a highly sensitive marker to detect ascites in patients with liver cirrhosis. This marker may be useful to detect small to moderate amounts of ascitic fluid in cirrhotic patients when physical examination is difficult or equivocal for ascites.
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Laparoscopic sleeve gastrectomy (LSG) has gained worldwide popularity in recent years. Hemorrhagic complications (HC) are usually the result of stapler line bleeding and are probably underreported. The previous incidence of HC in our... more
Laparoscopic sleeve gastrectomy (LSG) has gained worldwide popularity in recent years. Hemorrhagic complications (HC) are usually the result of stapler line bleeding and are probably underreported. The previous incidence of HC in our department including minor bleeding and late hematomas was 15.0 %. The objective of this study is to assess the impact of stapler line reinforcement (SLR) and intraoperative blood pressure control on HC after LSG. Between February 2013 and March 2014, patients who were admitted to our department for LSG were randomly assigned to one of three arms: stapler line application of biologic glue-Evicel™ (E), over suture of the stapler line (S) or control (C). Surgical technique in all arms included blood pressure elevation to 140 mmHg before termination of the procedure. Data is presented as mean ± SD or median (IQR 25-75). One hundred sixty-five patients were randomized: 49 to E, 49 to S, and 67 to C. There were no demographic differences between arms. Operat...
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It is generally assumed that delayed diagnosis of acute appendicitis results in higher morbidity but this assumption is not strongly supported in the literature. We attempt to define the effect of patient and physician delay on the... more
It is generally assumed that delayed diagnosis of acute appendicitis results in higher morbidity but this assumption is not strongly supported in the literature. We attempt to define the effect of patient and physician delay on the outcome of patients with acute appendicitis. We studied 486 patients admitted between 1980 and 1992. Patient delay in presenting to a physician and surgeon delay from hospital admission to operation were studied in relation to stage of disease at operation as well as to postoperative complications. Postoperative complications occurred in 10% of cases with simple acute appendicitis versus about 20% of cases with gangrenous or perforated appendicitis (P &lt;0.001). The mean patient delay from onset of symptoms to presentation to a physician was 1.7 days in simple acute appendicitis versus 2.3 days in gangrenous or perforated appendicitis (P &lt;0.001). Mean surgeon delay was 13.6 hours in simple acute appendicitis versus 14.5 hours in advanced appendicitis (P = NS). Delay in patient presentation adversely affects the stage of disease in acute appendicitis and leads to increased incidence of infectious complications and to prolonged hospital stay. Conversely, physician delay does not affect the stage of disease. A surgeon&#39;s decision to observe patients in hospital in order to clarify the diagnosis is justified, as it does not adversely affect outcome.
Research Interests: Adolescent, Humans, Child, Female, Male, and 7 moreClinical Sciences, Aged, Middle Aged, Adult, Time Factors, Acute Appendicitis, and The American
Laparoscopic adrenalectomy (LA) is the treatment of choice for benign adrenal lesions. Size of the lesion and radiologic features define the risk for malignancy. In lesions at high risk of malignancy, the experience with the laparoscopic... more
Laparoscopic adrenalectomy (LA) is the treatment of choice for benign adrenal lesions. Size of the lesion and radiologic features define the risk for malignancy. In lesions at high risk of malignancy, the experience with the laparoscopic approach is limited and therefore controversial. The purpose of this study was to determine the feasibility and oncological safety of LA for malignant disease. Retrospective analysis of prospectively collected database. All LA performed in our department from 2003 to 2011 were reviewed and demographic, perioperative, and follow-up data for those who had malignancy in the final histological report was analyzed. Data are presented as mean ± standard deviation or median (range). Of 121 LA, we identified 20 patients with 21 malignant adrenal pathologies: 11 primary tumors, 5 adrenocortical carcinoma, 5 large B cell lymphoma, and 1 leiomyosarcoma. Ten metastatic lesions included 5 malignant melanoma (1 patient, both sides), 4 adenocarcinoma, and 1 renal cell carcinoma. There was no conversion to laparotomy. Tumor size was 4.5 (1-9.5) cm, operative duration was 79 (42-262) min, and estimated blood loss was 40 (0-250) ml. All patients resumed regular diet on postoperative day 1, and the median length of stay was 2 days after surgery. Two patients died at 6 and 24 months postoperatively. Three patients were lost to follow-up. All the rest of the patients were disease-free at a follow-up of 58 (7-96) months. LA for primary or metastatic malignant lesions is feasible and seems oncologically safe. Surgical principles should be the same for all LA: en bloc resection of all epinephric fat, minimal touch technique, and low threshold for conversion. Size of the lesion alone should not be an indication for open surgery.
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This study aims to examine the meaning and practical implications of integration of a complementary medicine-based surgery service in a hospital setting (CISS--Complementary/Integrative Surgery Service) through analysis of consultation... more
This study aims to examine the meaning and practical implications of integration of a complementary medicine-based surgery service in a hospital setting (CISS--Complementary/Integrative Surgery Service) through analysis of consultation reports associated with this service. Thematic analysis was used to evaluate CISS consultation reports in a hospital electronic consultant charting system during the first half year of the service&amp;amp;amp;amp;#39;s activity. 304 consultation reports were analyzed. Nurses initiated significantly more consultations than physicians (55% vs 7%). Consultation requests were gradually more focused on specific symptoms, possibly manifesting a better understanding of the scope of complementary medicine in the surgery setting. CISS practitioners responded in more biomedical language over time, albeit offering a more holistic perspective regarding patients&amp;amp;amp;amp;#39; needs as well as clarifications regarding the nature of the treatment they provided. Diverse communication patterns in consultations evolved over time representing dynamics in multiple levels of integration of the CISS. Documented communication through consultations can provide a window to the process of integration of complementary medicine-based services in health systems.
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Research Interests: Quality of life, Diet, Treatment Outcome, Adolescent, Humans, and 16 moreWeight Loss, Female, Male, Exercise, Follow-up studies, Body Mass Index, Feeding Behavior, Obesity Surgery, Clinical Sciences, Aged, Middle Aged, Adult, Public health systems and services research, Time Factors, Retrospective Studies, and Laparoscopy
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Non-operative management has become the standard approach for treating stable patients sustaining blunt hepatic or splenic injuries in the absence of other indications for laparotomy. The liberal use of computed tomography (CT) has... more
Non-operative management has become the standard approach for treating stable patients sustaining blunt hepatic or splenic injuries in the absence of other indications for laparotomy. The liberal use of computed tomography (CT) has reduced the rate of unnecessary immediate laparotomies; however, due to its limited sensitivity in the diagnosis of hollow viscus injuries (HVI), this may be at the expense of a rise in the incidence of missed HVI. The aim of this study was to assess the incidence of concomitant HVI in blunt trauma patients diagnosed with hepatic and/or splenic injuries, and to evaluate whether a correlation exists between this incidence and the severity of hepatic or splenic injuries. A retrospective cohort study involving blunt trauma patients with splenic and/or liver injuries, between the years 1998 and 2012 registered in the Israel National Trauma Registry. The association between the presence and severity of splenic and/or liver injuries and the incidence of HVI was examined. Of the 57,130 trauma victims identified as suffering from blunt torso injuries, 2335 (4%) sustained hepatic injuries without splenic injuries (H group), 3127 (5.4%) had splenic injuries without hepatic injuries (S group), and 564 (1%) suffered from both hepatic and splenic injuries (H+S group). Overall, 957 patients sustained 1063 HVI. The incidence of HVI among blunt torso trauma victims who sustained neither splenic nor hepatic injuries was 1.5% which is significantly lower than in the S (3.1%), H (3.1%), and H+S (6.7%) groups. In the S group, there was a clear correlation between the severity of the splenic injury and the incidence of HVI. This correlation was not found in the H group. The presence of blunt splenic and/or hepatic injuries predicts a higher incidence of HVI, especially if combined. While in blunt splenic injury patients there is a clear correlation between the incidence of HVI and the severity of splenic injury, such a correlation does not exist in patients with blunt hepatic injury.
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INTRODUCTION: Integrative medicine in a surgical department is an innovative phenomenon. Patients in acute conditions are treated with guided imagery, hypnosis, acupuncture and reflexology for perioperative symptoms in the surgical... more
INTRODUCTION: Integrative medicine in a surgical department is an innovative phenomenon. Patients in acute conditions are treated with guided imagery, hypnosis, acupuncture and reflexology for perioperative symptoms in the surgical department of an ...
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The purpose of the study was to review the clinical and radiologic features of giant colonic diverticulum (GCD). Medical records of 17 patients with GCD on computed tomographic (CT) examination were reviewed. CT examination revealed the... more
The purpose of the study was to review the clinical and radiologic features of giant colonic diverticulum (GCD). Medical records of 17 patients with GCD on computed tomographic (CT) examination were reviewed. CT examination revealed the GCD in all patients as a predominantly gas-filled structure communicating with the adjacent colon. Thirteen patients showed a gas-filled structure on abdominal radiograph. The mean GCD diameter was 7 cm. Most diverticula were found in the sigmoid colon. Associated diverticulosis was present in 71% of patients. Our experience suggests that GCD can often be diagnosed on the basis of the characteristic radiographic and CT findings in these patients.
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This prospective study determines the indications for and the optimal timing of laparoscopic cholecystectomy (LC) following the onset of acute cholecystitis. It also evaluates preoperative and operative factors associated with conversion... more
This prospective study determines the indications for and the optimal timing of laparoscopic cholecystectomy (LC) following the onset of acute cholecystitis. It also evaluates preoperative and operative factors associated with conversion from laparoscopic cholecystectomy to open cholecystectomy in the presence of acute cholecystitis. Having been established as the procedure of choice for elective cholelithiasis, LC is now also used for management of acute cholecystitis. Under these circumstances the procedure may be difficult and challenging. Certain favorable and unfavorable conditions may be present that influence the conversion and complication rates. Information about these conditions may be helpful for elucidating the optimal circumstances for LC or when the procedure is best avoided. We performed LC on an emergency basis as soon as the diagnosis was made on all patients presenting with acute cholecystitis from January 1994 to December 1995. All preoperative, operative, and pos...