Early oral feeding following removal of nasogastric tube in gastrointestinal operations. A randomized prospective study.

A study was conducted over a 23-month period to determine the possibility of early postoperative oral feeding after removal of a nasogastric tube in patients undergoing gastrointestinal operations. One hundred seventy-one patients were prospectively randomized into two groups. The first group began liquid oral intake 4 hours after removal of the tube. The second group began an ordinary solid intake soon after nasogastric tube removal. The criterion to remove the tube was based on normal bowel sounds heard by at least two senior surgeons. There was no significant difference between both groups concerning the occurrence of gastrointestinal disturbances following tube removal. Most of the disorders were observed after lower intestinal tract operations. Nine patients in the first group and seven patients in the second group required reinsertion of a nasogastric tube. We suggest that early solid intake immediately after nasogastric tube removal can safely be used in gastrointestinal operations.

Posttraumatic autotransplantation of spleen tissue.

Clinical and laboratory studies have documented high susceptibility to pneumococcal infection in asplenic humans and animals. Splenic autotransplantation has been suggested as a method of preserving function. Autotransplantation of irreparably damaged spleens in humans preserved splenic functions. Ten patients operated on for blunt abdominal trauma required unavoidable splenectomy. In each, autotransplantation of the removed spleen (roughly 50 g) was performed. Postoperative studies of splenic functions revealed disappearance of Howell-Jolly bodies from peripheral blood. Levels of IgM, which were initially significantly depressed, returned to normal and there were normal technetium Tc 99m sulfur colloid scans ten weeks after surgery. All patients are alive and healthy. Our data suggest that autotransplantation of spleen is a safe alternative method for preserving splenic function when total splenectomy is mandatory for hemostasis.

Surgical approach and outcome in torsion of testis.

A total of 31 patients with acute torsion treated over a fifteen-year period are reviewed. The peak incidence of the disease, its seasonal variations, predisposing factors, surgical procedure, and clinical outcome are analyzed. Most of the patients were operated upon via an inguinal incision and underwent detorsion and fixation or untwisting only of the involved testis. The contralateral one was never anchored. All patients were asked to complete a questionnaire, with 2 of 3 responding from one to fifteen years (mean, 6.7 years) after surgery. None underwent recurrent surgery on either testicle. We conclude that fixation of the testes, both detorsioned and normal is not necessary.

Resurgence of hydatid disease (echinococcosis) in communities in northern Israel.

Hydatid disease (echinococcosis), formerly endemic in the area of Israel, has occurred only sporadically in the past 40 years, mostly in immigrants. An unusual spatial and temporal cluster of surgically confirmed infections in northern Israel led to a review of echinococcosis hospital records. This revealed a resurgence of the disease in some rural and semirural Arab and Druze communities. Between 1960 and 1989, 224 cases of hydatid disease were surgically confirmed in residents of these communities. During this period, as the Arab-Druze population doubled, the mean annual surgical incidence of new cases per 100,000 rose 5-fold from 1.4 to 7.1. In Yirka, a Druze community of 7500 persons, from which no cases were known before 1970 and in which 52 cases were surgically confirmed thereafter, the mean annual surgical incidence for 1980-1989 rose to 53/100,000, to become one of the highly endemic areas of the world. The probable explanation of the outbreak is that, since 1967 with the opening of the border, importation of infected sheep has occurred from the hydatid-endemic West Bank region to individual homes in the communities in northern Israel. The sheep are raised to maturity in pens before home slaughtering; the offal, available to dogs, resulted in canine and then human infections.

Laparoscopic subtotal cholecystectomy.

Subtotal cholecystectomy is a definitive and safe operation to treat diseases of the gallbladder, whenever there are major difficulties in dissection from the liver. Described herein is successful experience with 6 patients using this technique, through the laparoscopic approach. In cases with severe inflammatory changes, gallbladder embedded in liver tissue, and liver cirrhosis, they enabled reduction of operative time and avoidance of excessive bleeding that could have caused the conversion of the laparoscopic approach to open laparotomy.

Foreign body removal through an appendicostomy.

The removal of button cell batteries or small coins impacted in the terminal ileum or right colon through an appendicostomy is described. This technique was used effectively in three patients.

Laparoscopic treatment of hydatid cyst of the liver: initial experience with a small series of patients.

A laparoscopic technique to manage hydatid cyst of the liver is described. The technique is safe and simple and has the advantages of other abdominal laparoscopic operations. It also fulfills the prerequisite of open surgery of hydatid cyst of the liver, namely, the prevention of intraperitoneal spillage of cyst contents. Our technique enables treatment of the residual cyst cavity following aspiration of contents. In the past 15 months, 10 cysts (5-17 cm in diameter) in 6 patients were managed successfully using this approach, with no mortality or short-term recurrence.

A safe simple method for removal of the gallbladder through the umbilical trocar site during laparoscopic cholecystectomy.

After laparoscopic resection, the gallbladder must be removed, usually through the umbilical trocar site. Occasionally, there is difficulty in removing the gallbladder from the abdominal cavity due to its large dimensions or its contents. There are two main options to extract the gallbladder in such cases. One is evacuation of its content through the gallbladder neck protruding from the abdominal wall. The second is extension of the periumbilical fascial opening. In the first method, gallbladder content might sometimes spill into the peritoneal cavity or contaminate the incision site. In the second, there might not be enough control concerning the extent of injury caused to the periumbilical abdominal wall during enlargement of the fascial opening. A simple precise and safe method is suggested to enlarge the fascial incision by direct vision using transillumination.

Recurrent acute pancreatitis associated with pancreas divisum.

Described is the case of a 24-yr-old patient in whom recurrent attacks of acute pancreatitis following a cholecystectomy were found to be associated with anomaly of the pancreas--the so-called pancreas divisum. An examination by endoscopic retrograde cholangiopancreatography showed typical findings of a short duct of Wirsung. Cannulation of the secondary duct of Santorini revealed a grossly dilated and strictured duct full of stones. After drainage of the duct by a pancreaticojejunostomy (Puestow procedure), the patient has not had any further episodes of acute pancreatitis during a follow-up period of 4 yr.

Occupational acroosteolysis in vinyl chloride workers in Israel.

Exposure to vinyl chloride monomer (VCM) may result in a bizarre syndrome, which is characterized by lytic changes in the distal phalanges, cutaneous stigmata of scleroderma, and Raynaud's phenomenon. Detailed case histories of two such patients are presented. Epidemiologic, pathogenetic and radiological aspects of occupational acroosteolysis are briefly reviewed. The possibility is emphasized that the condition may result not only from industrial (i.e., occupational) exposure to VCM but also from exposure in the home or neighborhood (i.e., nonoccupational).