Itamar Kott

The effects of electrosurgery and the surgical knife on the healing of intestinal anastomoses

SummaryIn two groups of 20 cats each, the healing processes in resected and anastomosed bowel after use of a stainless steel surgical knife and an electric knife were studied. The animals were sacrificed after 24 and 48 hours, and four, six and 11 days. The anastomoses were resected and specimens were examined. Histologic study of specimens of tissue from Group I (stainless steel surgical knife) on the fourth and sixth postoperative days revealed proliferation of fibroblasts, granulation tissue, epithelial healing, and fusion of the opposed aspects of the muscularis. The healing process in Group II (electric knife) was characterized by necrosis of tissue, exudate of fibrin and leukocytes, and incomplete fusion of the opposed muscularis. Histologic studies showed a lag in total tissue repair of two days in Group II. These results suggest that the stainless steel knife is preferable for colonic surgery.

Perianal Tuberculosis: Report of a Case and Review of the Literature

Tuberculosis of the perianal region is a proportionally rare and misdiagnosed disease. We present a patient who was operated upon 5 times for persistent perianal fistula and recurrent abscess formatio

Perianal abscess as a presenting sign of leukemia

SummaryTwo cases of leukemia, one of which presented as a perianal abscess and the other as a perianal infiltrate, are reported. It is advised that such perianal signs be accorded more attention. Should the diagnosis of leukemia be made, conservative treatment, not surgical intervention, is indicated.

Gastrointestinal complications after therapeutic irradiation

SummaryThe cases of three patients, two with carcinoma of the cervix and one with a tumor of the left kidney treated by nephrectomy, are presented. Following irradiation to the tumor sites, two of the patients developed proctitis and rectal stricture; in one, a colostomy was established. The second is still under observation. The third patient developed obstruction of the transverse colon which necessitated partial resection and end-to-end anastomosis.Aspects of the pathology, clinical presentation, and surgical management of the postirradiation syndrome in the gastrointestinal tract are reviewed, and diagnostic pitfalls in its recognition are emphasized.

Barrett's mucosa of distal esophagus with concomitant isolated Crohn's disease and intramucosal adenocarcinoma

SummaryThe presence in the esophagus of three distinct entities-Barretts mucosa, Crohns disease, and adenocarcinoma-is a very rare finding. In a 60-year-old man with a long history of heartburn and recently developed dysphagia, narrowing of the distal esophagus was found to be related to the presence of Barretts mucosa. A short time later repeated endoscopy revealed adenocarcinoma in this area. The patient underwent esophagogastrectomy and died a few days after surgery. Findings in the surgical specimen and upon autopsy were consistent with isolated Crohns disease of the distal esophagus as well as with intramucosal adenocarcinoma. Analysis of the data available in the literature reveals that Crohns disease of the esophagus, although rare, clearly possesses some definite characteristics of its own. It is suggested that the presence of these three features in a single patient constitutes no more than a chance coexistence.

Gangrenous Cholecystitis: Seventeen Years of Experience

Background: Gangrenous cholecystitis is a potentially lethal disease. We evaluated the magnitude of this complication from the aspect of pre- and postoperative findings and examined

Incarcerated Hernia: Are You Sure, Doctor?

Groin and abdominal wall hernias constitute a frequent condition and contribute substantially to both elective and emergency surgery. Incarcerated hernias, given their dangerous potential, are usually

Gallstone Disease in Pregnancy: Mere Coincidence or Physiologic Response?

Albeit there have been numerous reports, but it has still not been completely clarified what the exact role (if any) of pregnancy is in the development of gallstone disease, or its influence in previo

Carcinoma of the Gallbladder: Diagnosis, Treatment, Prognosis

Despite modern imaging techniques, the majority of gallbladder cancers are recognized at the time of laparotomy, when curative procedures are rarely possible. Predisposing factors include old age, female sex and cholelithiasis. Abdominal pain, vomiting, anorexia, weight loss and jaundice are the most prevalent signs and symptoms. The nonspecific clinical picture combined with low sonographic diagnostic value make preoperative diagnosis unlikely. The very low survival rates, with or without surgery, dictate a more palliative approach. Palliation includes primarily the relief of pain, jaundice and intestinal obstruction. Between 1987 and 1992, we have treated 21 patients with gallbladder carcinoma. The following paper reviews these cases in light of the current literature.

Enlargement of the Breast—A New Side Effect of Transaxillary Cervical Sympathectomy: Case Report

The phenomenon of hyperhidrosis is a pathological state caused by unknown stimulus of the sympathetic nervous system. When a variety of conservative treatments have failed, surgery which involves the removal of some ganglia of the cervical sympathetic chain, is the treatment of choice. In the last four years we operated on 253 patients for palmar hyperhidrosis using the transaxillary approach only. Recently, a new side effect of surgery has come to our attention. This phe nomenon is enlargement of the breast on the operated side. Our series show seven cases (2.4%) of women operated for palmar hyperhidrosis who mani fested this phenomenon, two of them bilaterally. The enlargement of the breast was found usually by the second follow-up visit after operation when, in most cases, the patient mentioned it. Examination of the breast revealed enlargement of a few centimeters which in several patients required a change to a larger brassiere size. In both of our patients who underwent bilateral surgery, the breasts enlarged until they were equal in size. The women then did not complain further. In our article we de scribe the cases of two young women with this phenomenon for which we still do not have a clear explanation of the phenomenon, but report our assumption only.