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Biomedical subjects

B E Stabile

Publications and source records attributed to B E Stabile.

85 records · Page 5Linked to original sources
PubMed1981

Elevated serum prolactin level in the Zollinger-Ellison syndrome.

To estimate the prevalence of prolactinoma in the Zollinger-Ellison syndrome (ZES), serum prolactin (PRL) levels were measured by radioimmunoassay in 36 patients with ZES. Eight patients had elevated PRL levels; however, in one patient the finding was attributed to primary hypothyroidism rather than a prolactinoma. The seven other patients were believed to have previously undiagnosed prolactinomas on the basis of elevated serum PRL levels; the presence of pituitary tumors were confirmed in four by demonstration of sella turcica erosions or enlargement. Serial determinations over three to six years showed a tendency for serum PRL levels to increase modestly in four of six patients. Thus far, two patients have undergone transsphenoidal tumor resections with good results. This study suggests that the prevalence of prolactinoma in patients with ZES is substantial (10% for those with isolated ZES and 54% for those with ZES with multiple endocrine neoplasia, type 1, syndrome), and that early diagnosis is possible with measurement of serum PRL levels. Since levels of PRL tend to increase and clinically significant pituitary tumors can develop, determinations of serial serum PRL levels are recommended for all patients with ZES.

Adenoma, Islet Cell↗
PubMed1980

Serum gastrin and human chorionic gonadotropin in the Zollinger-Ellison syndrome.

Prior to total gastrectomy, serum levels of gastrin and human chorionic gonadotropin (HCG) and its alpha- and beta-subunits (alpha-HCG and beta-HCG) were determined by radioimmunoassays in 40 patients with the Zollinger-Ellison syndrome. Basal serum gastrin levels greater than 1,500 pg/mL were found only in patients with metastases to lymph nodes or liver, while levels greater than 8,000 indicated massive liver replacement by tumor. Gastrin levels less than 1,500 pg/mL had no correlation with malignant behavior. Neither the calcium-infusion nor secretin-injection test was useful in identifying tumors as benign or malignant. Basal serum levels of alpha-HCG were elevated (> 7 ng/mL) in four of 20 patients with metastatic gastrinoma and were normal in all 16 patients with benign disease. There was a significant correlation between basal gastrin and alpha-HCG levels in patients with malignant gastrinoma but not for those with benign tumors. The results suggest that serum gastrin and alpha-HCG levels can be useful in assessing the biologic behavior of gastrinomas and in planning appropriate surgical and nonsurgical treatment.

Adult↗
PubMed1980

Cancer in inguinal and femoral hernias.

Three cases of malignant tumors associated with hernial sacs are presented. One case of a primary liposarcoma of the spermatic cord illustrates the necessity of examining all excised specimens microscopically. The two cases of metastic disease from colonic and rectal primaries support the observation that the most frequent primary site for neoplastic disease within hernial sacs in the large bowel. Neoplasm within a hernial sac should be suspected in patients with previously diagnosed intraperitoneal malignancy who present with a new hernia, and in elderly patients who develop incarceration of a chronic, previously reducible hernia. Local phenomena such as intraperitoneal seeding by gravity are probably most important in explaining the unusual finding of metastatic tumor foci within hernial sacs. Suggestions for increasing diagnostic yield include biopsy and frozen-section examination of suspect specimens and, in cases in which tumor is confirmed, thorough intraperitoneal digital palpation and laparoscopy. The hernial sac offers a unique opportunity for peritoneal biopsy that should not be overlooked.

Adenocarcinoma↗
PubMed1979

'Kissing' duodenal ulcers.

Among 70 cases of perforated duodenal ulcers treated by plication, eight were complicated by massive postoperative hemorrhage from a syncronous posterior "kissing" duodenal ulcer. Critical analysis revealed that only signs of gastrointestinal (GI) bleeding preoperatively had predictive value for postoperative hemorrhage. Twenty-four patients had one or more predictive signs, and eight actually bled postoperatively. There was a 50% mortality and 75% additional complication rate for the bleeders. In contrast, the nonbleeders had a mortality and a complication rate of only 18% and 35%, respectively. There was no observed superiority of either surgical or medical treatment for postoperative hemorrhage. In perforated duodenal ulcer with evidence of GI blood loss, an intraoperative search for a posterior kissing ulcer is recommended. If a kissing ulcer is found, an acid-reducing operation and suture ligation of the ulcer is indicated.

Aged↗
PubMed1977

The profunda femoris-popliteal artery bypass.

The profunda femoris artery can be used for the origin of a femoropopliteal bypass in cases of previous aorto femoral bypass graft, short saphenous vein, and other less common conditions that render the common femoral artery unsuitable for proximal anastomosis. Fourteen profunda-popliteal bypass procedures were performed in 12 patients between 1973 and 1976. The indications for surgery were incapacitating claudication in seven, and rest pain or tissue necrosis in five patients. Electromagnetic flow measurements at operation in ten patients indicated a mean graft blood flow of 146 +/- 51 ml/min. The mean Doppler ankle/wrist pressure ratio improved from 0.48 +/- 0.11 preoperatively to 0.87 +/- 0.14 postoperatively, while the plethysmographic mean pulse volume increased from 1.1 +/- 0.6 microliter to 2.4 +/- 0.4 microliter. Thirteen of the 14 grafts remain patient at one to three years' follow-up. The profunda-popiteal bypass is an effective alternative to standard femoropopliteal bypass in cases where the common femoral artery is not available for proximal graft anastomosis.

Aged↗
PubMed1976

Recurrent peptic ulcer.

From 1 to 5% of patients can be expected to develop recurrent ulceration following current surgical therapy for peptic ulcer disease. The development of recurrent ulcer frequently reflects an inadequacy of the initial procedure. The nature of the inadequacy is often difficult to delineate because of alterations in anatomy and physiology and the lack of accurate diagnostic procedures. Incomplete vagotomy and inadequate gastric resection account for the vast majority of surgical deficiencies. Gastrinoma, retained gastric antrum, and hyperparathyroidism are the most frequently encountered endocrine causes. A thorough evaluation must include gastrointestinal X-rays, fiberoptic endoscopy, multiple serum calcium and gastrin determinations, and provocative testing. Medical management of recurrent ulcer fails in the vast majority of cases. Reoperation is successful in about 70% of cases and has a mortality rate of 4%. Recurrent ulcer after simple gastroenterostomy is best treated by gastric resection or vagotomy and resection. After initial adequate gastric resection, vagotomy alone usually suffices. Antrectomy and, if necessary, re-vagotomy should be done for recurrent ulcer after vagotomy and drainage. Re-vagotomy alone is usually effective therapy for recurrent ulcer after initial vagotomy and resection. Non-acid reducing operations should not be done, as they result in high mortality and high second recurrence rates.

Calcium↗
PubMedDate not supplied

Pancreatic secretory responses to intravenous hyperalimentation and intraduodenal elemental and full liquid diets.

Intravenous hyperalimentation and enteral elemental diets have both been advocated for the nutritional support of patients with acute pancreatitis, pancreatic fistula, and proximal small bowel fistula. The exocrine pancreatic responses to these nutrients compared to one another and to full liquid diet have been inadequately studied. Therefore, pancreatic protein, volume, and bicarbonate responses to graded doses of (1) intravenous hyperalimentation, (2) intraduodenal elemental diet, and (3) intraduodenal full liquid diet were compared in duplicate experiments in five dogs with chronic pancreatic fistulas. Both intraduodenal elemental and full liquid diets caused comparable and significant dose-related increases in pancreatic protein, volume, and bicarbonate outputs over basal levels (p less than 0.05). In contrast, there was no stimulation of pancreatic secretion by intravenous hyperalimentation. It therefore appears that of the methods studied, only intravenous hyperalimentation can provide full nutritional support while maintaining the pancreas at rest.

Animals↗
PubMedDate not supplied

Extrahepatic biliary obstruction due to post-laparoscopic cholecystectomy biloma.

BACKGROUND: Jaundice presenting after cholecystectomy may be the initial manifestation of a serious surgical misadventure and requires rigorous diagnostic pursuit and therapeutic intervention. Biloma is a well recognized postcholecystectomy complication that often accompanies biliary ductal injury. CASE REPORT: A 23-year-old female underwent laparoscopic cholecystectomy for symptomatic gallstones and three weeks postoperatively developed painless jaundice. Radiographic and endoscopic studies revealed a subhepatic biloma causing extrinsic compression and obstruction of the common hepatic duct. RESULTS: Percutaneous catheter drainage of the biloma combined with endoscopic sphincterotomy successfully relieved the extrahepatic biliary obstruction and resolved the intrahepatic ductal leak responsible for the biloma. CONCLUSION: Although heretofore undescribed, postcholecystectomy jaundice due to extrahepatic bile duct obstruction caused by biloma may occur and can be successfully treated by means of standard radiologic and endoscopic interventions.

Adult↗