Does supplemental perioperative oxygen administration reduce the incidence of wound infection in elective colorectal surgery?
Minerva anestesiologica
An association has been proposed between perioperative administration of 80% oxygen and a lower i... more An association has been proposed between perioperative administration of 80% oxygen and a lower incidence of wound infection after colorectal surgery. The present study was conducted to assess this hypothesis. Thirty-eight patients (ASA classification 1 and 2) undergoing elective colorectal cancer surgery were allocated at random to 2 groups. Group 1 consisted of 19 patients who received an admixture of 80% oxygen and 20% nitrogen during anesthesia through an orotracheal tube and during the 2 first hours in the recovery room through a tight facemask with reservoir. Group 2 consisted of 19 patients who received an admixture of 70% nitrous oxide and 30% oxygen during anesthesia, followed by administration of 30% oxygen delivered by a blender through a tight facemask with reservoir in the same manner than group 1, during the first 2 hours in the recovery room. Wound infection was evaluated daily during hospital stay and after 7 days, 2 weeks, and 1 month. The incidence of wound infection was 12.5% in group 1 and 17.6% in group 2 (p=0.53). The results of this study showed no reduction in the incidence of wound infection following elective colorectal surgery in patients receiving 80% oxygen during the perioperative period.
Type II diabetes after combined kidney and pancreas transplantation for type I diabetes mellitus and end-stage renal disease
Clinical Transplantation
We report a case of a patient who developed type II diabetes after receiving a successful combine... more We report a case of a patient who developed type II diabetes after receiving a successful combined kidney and pancreas transplant for type I diabetes and end-stage renal disease. This patient underwent a combined kidney and pancreas transplant and had no evidence of rejection with good function following the transplant for nine months. The patient developed significant post-transplant obesity with her transplant weight of 80 kg rising to 109 kg. At this level of obesity, the patient developed fasting hyperglycemia of 180 mg/dl with no change in her renal function or her pancreas exocrine function. She developed hyperinsulinemia to this fasting hyperglycemia. The clinical course of this patient demonstrates that rapid weight gain following transplantation can result in type II diabetes.
[Selective embolization of hepatic arteries--an additional precaution to control hemorrhage in the management of severe liver trauma]
Harefuah
Two cases of severe hepatic injury in which selective hepatic artery embolization was used to con... more Two cases of severe hepatic injury in which selective hepatic artery embolization was used to control hemorrhage are presented. The first case is that of a 35 year old patient who sustained a severe liver injury after a car accident. A CAT scan of the abdomen revealed an AAST grade 5 liver injury, pooling of contrast material within the liver parenchyma, and blood within the peritoneal cavity. The patient was given fluid resuscitation and taken to angiography where bleeding from branches of the right hepatic artery was demonstrated. While angiography was being undertaken the hemodynamic status of the patient deteriorated, blood transfusion was started, and a selective embolization of the right hepatic artery was performed. The bleeding stopped promptly and hemodynamic stability was regained. The second case is that of a 40 year old pedestrian run over by a car. Abdominal ultrasound revealed free fluid in the peritoneal cavity and the patient was rushed to the O.R. Crushed right lobe of the liver, and inferior vena cava and bowel tears were found. After perihepatic packing and resection of the right and sigmoid colons retrohepatic vena cava tear was repaired and perihepatic packing restored. The abdominal cavity was closed and the patient was taken to the ICU for the correction of hypothermia, metabolic acidosis, and coagulopathy that had developed during the surgery. After 8 hours in the ICU the patient was transferred for angiography and a selective embolization of branches of the right hepatic artery was performed. The clinical course of the patients after angiographic embolization of the hepatic arteries is described and the literature that discusses the use of angiography and embolization of hepatic arteries after traumatic hepatic bleeding is reviewed.
Boudreaux JP, Hayes DH, Mizrahi S, Maggiore P, Blazek J, Dick DUse of water-soluble liquid vitamin E to enhance cyclosporine absorption in children after liver transplant. Transplant Proc 25: 1875
Modified vascular reconstruction for pancreaticoduodenal allograft
Surgery, gynecology & obstetrics, 1993
The simultaneous recovery of the cadaveric liver and pancreaticoduodenal allograft is well establ... more The simultaneous recovery of the cadaveric liver and pancreaticoduodenal allograft is well established. The current technique for procurement enables the retrieval of both organs in most multiorgan donor operations. Vascular complications may account for 45 percent of pancreatic graft failures, most of which are thromboses of the portal vein caused by low flow in the entire pancreatic vasculature, a twisted venous anastomosis or an acutely angled arterial reconstruction that can contribute to the thrombosis and, thereby, to graft failure. Because a diabetic recipient may have severely atherosclerotic vessels, an interposition autograft of the internal iliac artery of the recipient is not recommended. Our modified vascular reconstruction prevents compromised arterial blood supply when donor arterial grafts (iliac, carotid or femoral) are not available and when direct splenic to SMA reconstruction is not feasible.
[Suspected free air--a case report of a patient with a huge fecaloma]
Harefuah, 2009
Abdominal free air upon X-ray examination implies a medical emergency, but there is an extensive ... more Abdominal free air upon X-ray examination implies a medical emergency, but there is an extensive differential diagnosis that should be considered. Fecaloma is one of the possible imitators of free abdominal air. Fecaloma is a complication of chronic constipation, in which a large fecal mass impacts the bowel, imitating a tumor mass. This phenomenon is not uncommon in the elderly, and requires prompt recognition and immediate medical treatment. A 29-year-old woman, known to suffer from mental retardation, was admitted due to frequent vomiting and diarrhea following constipation a few days prior to her admission. The patient was treated in her institution by an enema, with partial decompression, that was followed by recurrent vomiting and fever. Physical examination upon admittance revealed a distended abdomen without peritoneal signs. An abdominal X-ray series demonstrated a distended large bowel with an abundance of fecal contents, and suspected free air in the abdominal cavity. Due...
Journal of the American Medical Association, Jan 19, 1954
While primary torsion of the omentum is unusual in adults, it is exceedingly rare in children. Wh... more While primary torsion of the omentum is unusual in adults, it is exceedingly rare in children. When MacLean 1 reviewed the literature in 1950, he found two instances of omental torsion in children and he reported three others from England. In one instance, however, MacLean pointed ...
Does supplemental perioperative oxygen administration reduce the incidence of wound infection in elective colorectal surgery?
Minerva anestesiologica
An association has been proposed between perioperative administration of 80% oxygen and a lower i... more An association has been proposed between perioperative administration of 80% oxygen and a lower incidence of wound infection after colorectal surgery. The present study was conducted to assess this hypothesis. Thirty-eight patients (ASA classification 1 and 2) undergoing elective colorectal cancer surgery were allocated at random to 2 groups. Group 1 consisted of 19 patients who received an admixture of 80% oxygen and 20% nitrogen during anesthesia through an orotracheal tube and during the 2 first hours in the recovery room through a tight facemask with reservoir. Group 2 consisted of 19 patients who received an admixture of 70% nitrous oxide and 30% oxygen during anesthesia, followed by administration of 30% oxygen delivered by a blender through a tight facemask with reservoir in the same manner than group 1, during the first 2 hours in the recovery room. Wound infection was evaluated daily during hospital stay and after 7 days, 2 weeks, and 1 month. The incidence of wound infection was 12.5% in group 1 and 17.6% in group 2 (p=0.53). The results of this study showed no reduction in the incidence of wound infection following elective colorectal surgery in patients receiving 80% oxygen during the perioperative period.
Type II diabetes after combined kidney and pancreas transplantation for type I diabetes mellitus and end-stage renal disease
Clinical Transplantation
We report a case of a patient who developed type II diabetes after receiving a successful combine... more We report a case of a patient who developed type II diabetes after receiving a successful combined kidney and pancreas transplant for type I diabetes and end-stage renal disease. This patient underwent a combined kidney and pancreas transplant and had no evidence of rejection with good function following the transplant for nine months. The patient developed significant post-transplant obesity with her transplant weight of 80 kg rising to 109 kg. At this level of obesity, the patient developed fasting hyperglycemia of 180 mg/dl with no change in her renal function or her pancreas exocrine function. She developed hyperinsulinemia to this fasting hyperglycemia. The clinical course of this patient demonstrates that rapid weight gain following transplantation can result in type II diabetes.
[Selective embolization of hepatic arteries--an additional precaution to control hemorrhage in the management of severe liver trauma]
Harefuah
Two cases of severe hepatic injury in which selective hepatic artery embolization was used to con... more Two cases of severe hepatic injury in which selective hepatic artery embolization was used to control hemorrhage are presented. The first case is that of a 35 year old patient who sustained a severe liver injury after a car accident. A CAT scan of the abdomen revealed an AAST grade 5 liver injury, pooling of contrast material within the liver parenchyma, and blood within the peritoneal cavity. The patient was given fluid resuscitation and taken to angiography where bleeding from branches of the right hepatic artery was demonstrated. While angiography was being undertaken the hemodynamic status of the patient deteriorated, blood transfusion was started, and a selective embolization of the right hepatic artery was performed. The bleeding stopped promptly and hemodynamic stability was regained. The second case is that of a 40 year old pedestrian run over by a car. Abdominal ultrasound revealed free fluid in the peritoneal cavity and the patient was rushed to the O.R. Crushed right lobe of the liver, and inferior vena cava and bowel tears were found. After perihepatic packing and resection of the right and sigmoid colons retrohepatic vena cava tear was repaired and perihepatic packing restored. The abdominal cavity was closed and the patient was taken to the ICU for the correction of hypothermia, metabolic acidosis, and coagulopathy that had developed during the surgery. After 8 hours in the ICU the patient was transferred for angiography and a selective embolization of branches of the right hepatic artery was performed. The clinical course of the patients after angiographic embolization of the hepatic arteries is described and the literature that discusses the use of angiography and embolization of hepatic arteries after traumatic hepatic bleeding is reviewed.
Boudreaux JP, Hayes DH, Mizrahi S, Maggiore P, Blazek J, Dick DUse of water-soluble liquid vitamin E to enhance cyclosporine absorption in children after liver transplant. Transplant Proc 25: 1875
Modified vascular reconstruction for pancreaticoduodenal allograft
Surgery, gynecology & obstetrics, 1993
The simultaneous recovery of the cadaveric liver and pancreaticoduodenal allograft is well establ... more The simultaneous recovery of the cadaveric liver and pancreaticoduodenal allograft is well established. The current technique for procurement enables the retrieval of both organs in most multiorgan donor operations. Vascular complications may account for 45 percent of pancreatic graft failures, most of which are thromboses of the portal vein caused by low flow in the entire pancreatic vasculature, a twisted venous anastomosis or an acutely angled arterial reconstruction that can contribute to the thrombosis and, thereby, to graft failure. Because a diabetic recipient may have severely atherosclerotic vessels, an interposition autograft of the internal iliac artery of the recipient is not recommended. Our modified vascular reconstruction prevents compromised arterial blood supply when donor arterial grafts (iliac, carotid or femoral) are not available and when direct splenic to SMA reconstruction is not feasible.
[Suspected free air--a case report of a patient with a huge fecaloma]
Harefuah, 2009
Abdominal free air upon X-ray examination implies a medical emergency, but there is an extensive ... more Abdominal free air upon X-ray examination implies a medical emergency, but there is an extensive differential diagnosis that should be considered. Fecaloma is one of the possible imitators of free abdominal air. Fecaloma is a complication of chronic constipation, in which a large fecal mass impacts the bowel, imitating a tumor mass. This phenomenon is not uncommon in the elderly, and requires prompt recognition and immediate medical treatment. A 29-year-old woman, known to suffer from mental retardation, was admitted due to frequent vomiting and diarrhea following constipation a few days prior to her admission. The patient was treated in her institution by an enema, with partial decompression, that was followed by recurrent vomiting and fever. Physical examination upon admittance revealed a distended abdomen without peritoneal signs. An abdominal X-ray series demonstrated a distended large bowel with an abundance of fecal contents, and suspected free air in the abdominal cavity. Due...
Journal of the American Medical Association, Jan 19, 1954
While primary torsion of the omentum is unusual in adults, it is exceedingly rare in children. Wh... more While primary torsion of the omentum is unusual in adults, it is exceedingly rare in children. When MacLean 1 reviewed the literature in 1950, he found two instances of omental torsion in children and he reported three others from England. In one instance, however, MacLean pointed ...
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