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Biomedical subjects

A J Walt

Publications and source records attributed to A J Walt.

At least 19 recordsLinked to original sources
PubMed1992

The continuing dilemma of lobular carcinoma in situ.

We reviewed the courses of 250 consecutive women with lobular carcinoma in situ of the breast entered into the Surveillance, Epidemiology, and End Results program of the Michigan Cancer Foundation, Detroit, Mich, between 1973 and 1986. No patient had known invasive cancer at the time of initial entry. The average follow-up was 93.1 months; 212 patients had mastectomy for the initial lesion and 65 patients had less than mastectomy, of whom one developed a new lesion in the ipsilateral breast. Thirty-seven patients (14.8%) were later found to have lesions in the contralateral breast, 25 within the first year. Thirteen of the 38 lesions (5.2% of the total series) were invasive, and 11 were primarily ductal. Seventeen patients died, two of breast cancer, two of unknown causes, and 13 of non-breast-related causes. The maximum mortality from breast cancer is 1.6% to this point. The frequency of mastectomy fell from 78.1% in the years 1973 through 1983 to 52% in 1984 through 1986, reflecting a change in surgical philosophy. Although no guarantees can be given to any individual patient, the great majority of patients with LCIS unassociated with a proved invasive cancer can be safely treated with less than mastectomy.

Breast Neoplasms↗
PubMed1990

The impact of technology on the management of pancreatic pseudocyst. Fifth annual Samuel Jason Mixter Lecture.

The records of 299 patients with 357 admissions for pancreatic pseudocysts seen between 1960 and 1989 were studied; 233 patients underwent operation. The natural history of pancreatic pseudocysts has been clarified by newer technology, such as ultrasonography, computer tomography, amylase isoenzyme measurements, and endoscopic retrograde cholangiopancreatography. All have influenced diagnosis, nonoperative management, and surgical operation. Differences between pancreatic pseudocysts associated with acute pancreatitis in contrast with chronic pancreatitis, and the complications of obstruction, hemorrhage, rupture, pancreatic ascites, infection, and jaundice can now be more rationally treated. Pancreatic pseudocysts and pancreatic ductal changes are now revealed earlier, especially by endoscopic retrograde cholangiopancreatography. Paradoxically, this information has encouraged nonoperative conservative therapy and also larger operations, eg, resection and adjunctive pancreaticojejunostomy. Partial resection of the pancreas together with the pancreatic pseudocysts was performed in 58 (25%) of the 233 patients. Recent technology permits cautious exploration of selective pancreatic pseudocyst drainage percutaneously or transgastroduodenally avoiding laparotomy.

Adult↗
PubMed1987

Pancreas divisum: is it a normal anatomic variant?

One thousand five hundred twenty-nine pancreatograms were obtained between 1973 and 1985. Complete pancreas divisum was demonstrated in 41 patients, for an incidence of 2.7 percent, and incomplete pancreas divisum in 14 cases, for an incidence of 0.9 percent. No increased incidence of pancreas divisum was found in any of four groups: an incidental group, a group with alcoholic pancreatitis, a group with unexplained upper abdominal pain, and an idiopathic pancreatitis group. The majority of patients (80 percent) were found to have pancreas divisum as an incidental finding or in association with alcoholic pancreatitis. Of 82 patients with idiopathic pancreatitis, only 2 had pancreas divisum. The three patients with pancreas divisum who had sphincteroplasty of the minor papilla were not helped by the procedure. We conclude that pancreas divisum is a normal anatomic variant and is very seldom a cause of pancreatic pain.

Abdomen↗
PubMed1987

Gastrojejunostomy: is it helpful for patients with pancreatic cancer?

A retrospective review of palliative outcome of gastrojejunostomy in patients with pancreatic cancer was conducted. Eighty-one patients were analyzed in two groups depending on duodenal patency. Forty-five patients (group I) had no evidence of duodenal obstruction. Thirty-six patients (group II) had evidence of impingement on the duodenum by the pancreatic cancer. A third subset of patients was also studied for outcome. These 21 patients (five group I and 16 group II) had nausea and vomiting as major symptoms and were judged to have the most to gain from gastrojejunostomy. Patients were categorized by outcome. Poor outcome was defined as either death during the hospitalization for gastrojejunostomy or death within 30 days of operation even if the patient left the hospital. Risk for poor outcome depended on group. In group I, 18 of 45 patients (40%) had a poor outcome compared with 25 of 36 (70%) patients in group II (p less than 0.001). Nineteen of the 21 (90%) patients with nausea and vomiting had a poor outcome. It is an unfortunate paradox that the more patients need gastrojejunostomy for pancreatic cancer, the less likely they are to have a favorable outcome. Gastric outlet obstruction in pancreatic cancer appears to be a terminal event. A prospective study is needed to see if any true palliation of vomiting can be affected in these patients.

Adult↗
PubMed1986

Endoscopic hemostasis of bleeding of the upper gastrointestinal tract by local injection of ninety-eight per cent dehydrated ethanol.

Endoscopic dehydrated ethanol injection was attempted in 48 patients with substantial bleeding of the upper gastrointestinal tract; most of the patients had associated serious medical conditions. The causes of bleeding were: gastric ulcer in 17; duodenal ulcer in 11; gastric or duodenal vascular ectasias, or both, in five; Mallory-Weiss tear in three; acute gastric mucosal lesion in six; esophageal ulcer in two; marginal ulcer in two; gastric leiomyoma in one, and carcinoma of the stomach in one. The mean age was 57 years old (a range of 18 to 91 years old). The mean amount of blood loss prior to time of injection was 4.5 units (a range of 3 to 10 units). Ethanol injection was initially successful in 45 of 48 patients but rebleeding occurred within 72 hours in three of these patients. All instances of treated vascular ectasia disappeared by the time of follow-up endoscopy. No complications were attributable to the injections. Endoscopic local ethanol injection may be the treatment of choice in selected patients with bleeding of the upper gastrointestinal tract.

Adolescent↗
PubMed1985

Cholecystectomy in patients with cirrhosis. A surgical challenge.

Cholecystectomy or cholecystostomy was performed in 49 patients with cirrhosis with a mortality of 10.2%. Massive intraoperative blood loss was found in 16.3% and major wound problems (dehiscence, abscess) in 12.2%. Intraoperative blood loss, amount of blood transfused, and mortality were correlated with the Child classification of hepatic reserve. Mortality was 23.5% for Child C patients vs 0% for Child A patients. Excessive blood loss from a hypervascular biliary bed and resulting liver failure and sepsis were the usual causes of death. Elective surgical intervention for Child A and B patients with symptomatic cholelithiasis is warranted. In Child C patients, however, every attempt should be made to increase the class to a Child B.

Adult↗
PubMed1985

The training and role of the surgeon in the intensive care unit.

The central question for surgeons is whether the patient in the surgical intensive care unit (SICU) is better served by a surgeon or a nonsurgeon as the responsible physician and as administrator of the SICU. This article explores the challenge of the SICU and the need for solutions, reviews the qualifications of the consultant in surgical critical care, and provides a job description of the director of an SICU.

Consultants↗