Samuel Eldar - Academia.edu (original) (raw)

Papers by Samuel Eldar

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PubMed, Feb 1, 1995

Nonmedullary thyroid carcinoma is known to occur in association with primary hyperparathyroidism.... more Nonmedullary thyroid carcinoma is known to occur in association with primary hyperparathyroidism. A combination of secondary, uremic, hyperparathyroidism and non-medullary thyroid carcinoma is rare and was hitherto reported in only 12 cases. We report another three patients with this parathyroid/thyroid disease combination, suggesting that it may represent not merely a coincidence. A number of factors active in secondary hyperparathyroidism may play a role in the induction and/or promotion of the thyroid cancer. These include parathyroid endocrinopathy, goiterogenic effect of prolonged hypercalcemia, and uremia. During surgery on the parathyroid glands, associated thyroid lesions demand special considerations.

PubMed, Jul 9, 2003

FIGURE 1. Mean T SE plasma A" 40 levels in dose groups among subjects completing the 6-month stud... more FIGURE 1. Mean T SE plasma A" 40 levels in dose groups among subjects completing the 6-month study: placebo (open circles), 1 g/d curcumin (small closed circles), and 4 g/d curcumin (large closed circles).

PubMed, Jun 1, 1981

A 70-yr-old man developed acute localized and generalized symptoms and signs associated with a la... more A 70-yr-old man developed acute localized and generalized symptoms and signs associated with a large aneurysm of the abdominal aorta. During an emergency operation, it was found that the aneurysm had ruptured into the inferior vena cava (IVC). The fistula was closed and the aneurysm replaced by a bifurcated synthetic graft. Important factors in the operative management were: clamping of the aorta above and the common iliac arteries below the aneurysm; opening of the aneurysm through a vertical incision; control of back bleeding through the fistula by external pressure on the IVC; closure of the fistula by a continuous braided dacron suture incorporating the walls of the aneurysm and the IVC; and replacement of the aneurysm by a bifurcated synthetic graft without excision of the aneurysm.

PubMed, Jun 1, 1995

Sclerosing encapsulating peritonitis (SEP) is a syndrome of multiple causes which, perhaps via a ... more Sclerosing encapsulating peritonitis (SEP) is a syndrome of multiple causes which, perhaps via a common pathway, affects the small bowel in particular. When persistent intestinal obstruction develops, laparotomy and careful disobstruction of the bowel are indicated. Generally, the prognosis of SEP depends on its cause and the premorbid condition of the individual patient.

PubMed, Oct 1, 1997

Objective: To ascertain the incidence of obstruction after various operations and find out if the... more Objective: To ascertain the incidence of obstruction after various operations and find out if the index operation influenced the course and outcome of adhesive small bowel obstruction. Design: Retrospective study. Setting: Teaching hospital, Israel. Subjects: 190 of 248 patients who presented with small bowel obstruction between January 1980 and December 1994. Interventions: All patients were treated conservatively and operated on only if they did not improve or deteriorated. Main outcome measures: Incidence of obstruction depending on site of index operation, and response to treatment. Results: 46 Patients (24%) had undergone upper abdominal operations, 26 (14%) small bowel resection, 47 (25%) appendicectomy, 27 (14%) gynaecological operations, and 44 (23%) colonic resections. The annual incidence of obstructive complications among the 190 patients in the groups studied was highest after appendicectomy (3.1/year) and colonic resections (2.9/year) and lowest after operations on the gallbladder and pancreas (1.1/year). Postoperative adhesive obstruction presented earlier after operations on the small bowel (median 1 year, range 5.4-20) and colon (median 1 year, range 2.2-40) than after the other operations. 60 (32%) of patients with acute small bowel obstruction had a history of abdominal malignancy, and obstruction was more likely to be complete after small bowel resection (20/26, 77%) compared with 39/74 (53%) after appendicectomy or gynaecological surgery, 17/46 (37%) after upper abdominal surgery, and 15/44 (34%) after colonic resection. Patients who developed obstruction after colonic resection had the longest period of conservative treatment (median 60 hours, range 24-216) and had the highest morbidity (8/44, 18%) although only 2 required bowel resection. Two patients died, both after obstruction following upper abdominal operations. Conclusions: Patients who present with obstruction after small bowel resection are extremely likely to be completely obstructed. Perhaps the morbidity associated with obstruction after colonic resection could be reduced if patients were operated on earlier.

PubMed, Oct 1, 1985

Eighty-four of 1,081 patients with carcinoma of the colon and rectum operated upon at our institu... more Eighty-four of 1,081 patients with carcinoma of the colon and rectum operated upon at our institution between 1951 and 1980 had extended resections involving adjacent organs. The types of presenting symptoms or the duration had no affect on the survival time of these patients. Survival time was most significantly correlated with pathologic penetration and Dukes' stage. The operative mortality was 5.9 per cent with a complication rate of 28.5 per cent. The nature of the individual organs involved did not affect the survival time. Patients with carcinoma of the colon and rectum extending to adjacent organs can undergo resection with a five year survival rate comparable with all patients with surgically treated carcinoma of the colon and rectum.

The Journal of Pathology, 2002

American Journal of Surgery, Nov 1, 1984

Surgical Endoscopy and Other Interventional Techniques, Aug 1, 2000

Recent observations point to a seemingly high conversion rate to laparotomy in cases of laparosco... more Recent observations point to a seemingly high conversion rate to laparotomy in cases of laparoscopie operations for acute cholecystitis that are performed by surgical residents. The purpose of the study is to evaluate those observations. In a retrospective nonrandomized study, conducted between February 1992 and December 1997, 285 laparoscopie operations for acute cholecystitis were analyzed. Those performed by attending surgeons were compared with those performed by residents assisted by attending surgeons. Of 123 laparoscopie operations performed by laparoscopie surgeons between Feburary 1992 and September 1995, 20.3% were converted to laparotomy, compared with 41.3% of the 29 operations performed by the residents (p < 0.017), with no increase in complication rate. Factors like male sex, duration of upper abdominal pain, and severity of the inflammatory process were not significantly different in both groups. The residents' seniority did not influence the conversion rate. A constant and significant decrease in conversion rate to laparotomy was observed over the course of time, as the study proceeded to December 31, 1997 (p < 0.01). We conclude that the performance of difficult laparoscopie choleeysteetomy by residents with the assistance of attending surgeons is feasible, but carries a higher conversion rate to laparotomy for reasons that are not entirely clear. The possibility of a learning curve of the residents is suggested.

Journal of Steroid Biochemistry, 1987

Journal of Laparoendoscopic & Advanced Surgical Techniques, Apr 1, 2009

Aim: Recent clinical experience suggests that minimal access portoenterostomy (the Kasai procedur... more Aim: Recent clinical experience suggests that minimal access portoenterostomy (the Kasai procedure) for biliary atresia leads to transplantation sooner, compared to the traditional open approach. It should be emphasized that elevated intra-abdominal pressure (IAP) may reduce hepatic and portal blood flow and thus may cause histologic liver damage. The aim of the present study was to evaluate the effects of IAP on blood flow in the portal vein (PV), compared to the superior mesenteric artery (SMA), and on the systemic mean arterial blood pressure (MABP). Materials and Methods: Male Sprague-Dawley rats were anesthetized with intraperitoneal ketamine (90 mg per kg) and xylasine (13 mg per kg). Polyethylene catheters (PE-50) were introduced into the right carotid artery for the measurement of MABP. After a midline laparotomy, the SMA and PV were isolated. Ultrasonic bloodflow probes were placed on the vessels for the continuous measurement of regional blood flow. Two large-caliber percutaneous peripheral intravenous catheters were introduced into the peritoneal cavity for inflation of air and for the measurement of IAP. The time course of MABP and SMA and PV flow as well as the relationship between IAP and SMA and PV flow were determined. Results: Although all three hemodynamic parameters decreased with the increase in the IAP, the most significant changes were observed in PV blood flow. IAP at 3 mm Hg resulted in a 26% decrease in PV flow (P Ͻ 0.05), a 19% decrease in SMA flow (P Ͻ 0.05), and an 11% decrease in MABP (P Ͻ 0.05). IAP at 6 mm Hg caused a twofold decrease in PV flow (P Ͻ 0.05), a 30% decrease in SMA flow (P Ͻ 0.05), and a 19% decrease in MABP (P Ͻ 0.05). There were no changes in the time course of MABP and PV and SMA flow. PV and SMA flow returned to normal values immediately after abdominal deflation. Conclusions: Persistent IAP decreased MABP, SMA, and, especially, PV flow by 50%. We speculate that in biliary atresia patients with already present liver dysfunction, decrease in SMA flow and even a greater decrease in PV flow from increased IAP, which occurs during a laparoscopic Kasai procedure, may further compromise liver function. This may be one of the explanations for the progression to earlier transplantation in infants undergoing a laparoscopic Kasai procedure.

International Orthopaedics, Apr 1, 1988

When acute cholecystitis follows orthopaedic operations, the disease is frequently obscure and fu... more When acute cholecystitis follows orthopaedic operations, the disease is frequently obscure and fulminating, with rapid progress to gangrene and perforation of the gallbladder, which may be fatal. Three cases are reported and the literature is reviewed. Various aspects of the disorder are discussed. It is important that orthopaedic surgeons should be aware of the condition in order to be able to make an early diagnosis and so prevent a lethal outcome. R+sum& Lorsqu'une cholbcystite survient aprOs une intervention orthopddique, elle est souvent d la lois masqube et suraigiie, kvoluant rapidement vers la gangrene et la perforation de la v~sicule, et pouvant ~tre fatale. Les auteurs en rapportent trois cas et font une rbvision de la litt~rature sur ce sujet. Ils discutent les diffkrents tableaux cliniques de cette complication. II est important que les chirurgiens orthopbdistes soient au courant de cette ~ventualitk, de fa~on d e n faire rapidement le diagnostic et d'bviter ainsi une kvolution mortelle.

European Journal of Surgery, Jan 24, 2000

Urology, Jun 1, 1988

Histoplasmosis is a well-known infectious disease that can sometimes run a mysterious and unexpec... more Histoplasmosis is a well-known infectious disease that can sometimes run a mysterious and unexpected course. A case is reported that presented as a chronic renal process, with right pyelocutaneous fistula and prolonged purulent discharge as well as focal calcifications of the left kidney with recurrent stone formation. Histopathologic examination of the right kidney, removed in 1975, showed noncaseating granulomas, but the precise diagnosis was not made until 1983, when histopathologic re-examination followed partial resection of the left kidney, for recurrent stone formation. This article emphasizes the difficulty in diagnosing a noncaseating granulomatous disease in general and histoplasmosis in particular, especially when the urogenital tract is involved, with isolated local manifestations. It underlines the progressive and damaging character of this chronic disease, the variety of its manifestations, and attempts to increase awareness of this potentially treatable disease.

Journal of Surgical Oncology, Nov 1, 1991

In order to determine whether current programs for the management of metastatic breast cancer hav... more In order to determine whether current programs for the management of metastatic breast cancer have led to improved patient survival, we determined the median survival times for five‐year intervals of 849 patients admitted to the City of Hope National Medical Center with metastatic breast cancer from 1955 to 1980. Survival curves were constructed from the dates of first diagnosis of breast cancer and to the first metastasis for all population subsets and clinical subsets: menopausal status, presence or absence of visceral metastases, length of disease‐free interval, and pattern of palliative therapy. In this analysis, the median survival in each successive interval of five years from diagnosis of the primary tumor was 52.1, 45.0, 49.9, 41.1, and 36.0 months, and the survival times from the first metastasis were 31.9, 23.0, 24.2, 23.9, and 18.7 months. Survival times in each of the clinical subsets remained unchanged during the period of observation, regardless of the therapeutic modalities included in the treatment regimens. This study indicates that changes in palliative therapy for metastatic breast cancer during the 25 years of observation have not influenced overall survival. Therefore, it seems appropriate that the therapeutic risk/benefit ratio and impact on quality of life should be reassessed when asymptomatic patients are treated, or when aggressive palliative therapy is used outside a clinical research setting.

Colorectal Disease, Apr 1, 2010

Objective Complex anal fistulas traverse a significant portion of the external sphincter muscle,... more Objective Complex anal fistulas traverse a significant portion of the external sphincter muscle, making their treatment a surgical challenge. Several surgical options are used with conflicting results. The aim of this study was to analyse the results of permanent loose seton in the management of high anal fistulas in Crohn’s disease (CD) patients and two‐stage seton fistulotomy in patients without CD.Method We retrospectively reviewed the clinical records of 77 patients with complex anal fistula treated by loose seton over a 4‐year period, in two medical centres. Recorded parameters included demographics, medical history, type of fistula, disease duration, previous surgery, morbidity, recurrence and mortality.Results Sixty patients without CD underwent 107 fistula‐related surgical procedures, and 17 CD patients underwent 29 procedures. Early postoperative complications were recorded in eight (10%) patients. Perioperative complications, mainly local sepsis or bleeding, were recorded in eight (10%) patients. Long‐term complications were observed in nine non‐CD and four CD patients. During a median follow‐up period of 24 months, the recurrence rate was 40% in CD patients and 47% in patients without CD. Five patients (four non‐CD patients and one CD patient) developed some degree of faecal incontinence.Conclusion The fistula recurrence rate following two‐stage seton fistulotomy in non‐CD patients was high. In CD patients the use of permanent loose seton is effective in controlling local sepsis in about half of patients and has low rates of subsequent incontinence.