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Biomedical subjects

C Grodsinsky

Publications and source records attributed to C Grodsinsky.

At least 19 recordsLinked to original sources
PubMed1985

Differentiation between benign and malignant disease of the breast using digital subtraction angiography of the breast.

The authors have investigated digital subtraction angiography (DSA) for the differential diagnosis of breast lesions detected initially by mammography. Eighteen patients scheduled for biopsy first underwent digital subtraction angiography of the breast (DSAB). Criteria for malignancy included the presence of abnormal vessels and a "blush" in the area of the lesion. A total of 17 lesions are currently available for histopathologic correlation. Although this is a small series, the initial results of DSAB suggest its potential utility for differentiating between benign and malignant lesions.

Angiography↗
PubMed1983

The spectrum of radiation enteritis. Surgical considerations.

Radiation therapy, often used to treat gynecologic and urologic pelvic malignancies, has varying, adverse effects on the bowel. Radiation enteritis may occur from one month to 20 years after irradiation, and disabling symptoms may require surgery in 10 to 20 per cent of patients. From our experience with 20 patients who required surgery for radiation enteritis and who were followed for up to 20 years, we were able to identify three clinical groups. Patients in the first group need only medical treatment for their symptoms, and observation, whereas patients in the second group may present with acute, debilitating, life-threatening symptoms that may require emergency surgery. Patients in the third group have a long-standing history of intermittent bowel obstruction and/or enteric fistulas that are best treated with adequate nutritional support followed by timely surgical intervention.

Adult↗
PubMed1981

Islet cell autotransplantation after pancreatectomy for chronic pancreatitis. Its limitations.

Of 12 patients operated on for intractable pain from chronic pancreatitis, only the three with adequate preoperative insulin reserve were selected to undergo islet-cell replantation after subtotal pancreatectomy. Fourteen, nine, and four months postoperatively, they require no therapy with insulin. Since most techniques for obtaining islet cells have been performed with normal pancreata, chronic pancreatitis was produced in ten dogs by ligating the main and accessory pancreatic ducts. These dogs 162.6 +/- 15.8 days later underwent total pancreatectomy. The scarred pancreatic fragments were dissociated with collagenase for 20 minutes in five dogs or subjected to two intermittent digestions of ten minutes in the other five dogs and were autotransplanted to the liver. One dog from each group became normoglycemic within one week of replantation, and their percent per minute decreases of serum glucose level were 2.72 and 3.46, respectively. Our experimental and clinical data suggest that (1) present techniques for dissociating fibrotic tissue are unsatisfactory and lead to a very low yield of islet cells; (2) postoperative assessment of islet-cell function involves complicated invasive procedures (portal and hepatic vein cannulation) to determine accurately the source of insulin; and (3) careful preoperative evaluation of beta-cell function is needed.

Adult↗
PubMed1980

Surgical treatment of chronic pancreatitis. A review after a ten-year experience.

Seventy-five operative procedures were done in 63 patients to correct one or more complications of chronic pancreatitis. Operations included resection, pancreaticojejunostomy, choledochoduodenostomy, draining and/or excision of pseudocysts, sphincteroplasty, and bypass surgery for relief of duodenal obstruction. All patients were followed up for up to 10 years, with 22 being followed up longer than five years. Recurrent pancreatitis occurred in three patients after resection and in two after drainage procedures, but attacks were milder with only an occasional occurrence. Operative procedures to relieve specific complications of chronic pancreatitis provided good results. However, because internal drainage of pseudocysts associated with chronic pancreatitis was frequently accompanied by recurrence of symptoms, excision offered better results. When the pancreatic duct was dilated, good results were obtained by pancreaticojejunostomy. In the absence of dilation, after strict preoperative slection of patients, and in the presence of diffuse parenchymal fibrosis, subtotal pancreatectomy is the procedure of choice.

Adult↗
PubMed1978

The management of colonic and rectal injuries.

One hundred fifty cases of patients treated at the Henry Ford Hospital with traumatic injuries of the colon and rectum are reviewed. Five of 119 patients treated with exteriorization died, two of them from multiple visceral injuries, shortly after operation. The mortality rate for the primary-closure group of 24 patients was 8.3 per cent. In this group, 11 patients had postoperative complications. Thirty-nine of the 119 patients in Group II nad 62 complications. Infection was the predominant problem in both groups of patients. We still believe that exteriorization of the injured colon remains the safest method of managing these patients.

Adolescent↗
PubMed1977

Absence of pancreatic duct dilation in chronic pancreatitis: surgical significance.

Of 22 patients treated surgically for intractable pain from chronic alcoholic pancreatitis, eight did not show notable dilation of the main pancreatic duct by endoscopic retrograde cholangiopancreatography (ERCP), operative pancreatography, and/or operative and microscopical studies of the pancreas after subtotal pancreatectomy. In all patients, far advanced parenchymal pancreatitis was evident at operation and by microscopical study of the removed portion of the pancreas. These findings indicate that the basic problem in a considerable number of patients with symptomatic alcoholic chronic pancreatitis is not related primarily to obstruction with dilation of the major pancreatic duct, but to intrinsic changes in the parenchymal pancreas. The preoperative use of ERCP and individualization of operative procedures with a preference for subtotal or partial pancreatectomy for symptomatic chronic alcoholic pancreatitis are supported.

Adult↗
PubMedDate not supplied

Volvulus of the colon.

We have reviewed the records of 48 patients who had colonic volvulus. Volvulus occurred in the sigmoid colon in 27 (56%) and in the right colon in 19 (40%). Volvulus elsewhere in the colon is rare, requiring unusual anatomic circumstances of a long mesentery and a mobile colon. The clinical history is characterized by a long history of bowel dysfunction followed by an episode of acute intestinal obstruction. The patient is often aged and is plagued by mental disorders and a number of degenerative diseases. Distention of the abdomen is the most significant finding, and tenderness may indicate peritonitis due to ischemic changes in the bowel. Three-positional films of the abdomen are most valuable, showing great distention of the colon and air-fluid levels in the bowel with regularity. Barium-enema studies will more accurately reveal the site and nature of obstruction. The barium-enema examination must be done carefully. It is omitted when peritonitis is present. Operative treatment is necessary for volvulus of the right colon. Non-operative reduction is effective for nonstrangulating volvulus of the sigmoid colon as an emergency procedure. Sigmoidoscopic examination and insertion of a long rubber tube will give dramatic relief to a substantial number of patients. Operative intervention is necessary when conservative measures fail. When gangrene is found at operation, exteriorization resection of the colon may be life-saving. Elective resections are recommended for patients who are in otherwise good health in order to prevent recurrences. The mortality rate in this series of 48 cases was 12.5 per cent. Cecal volvulus was present in each of the six patients who died. Sepsis and cardiopulmonary diseases were common in patients who died.

Adult↗
PubMedDate not supplied

The spectrum of colonic involvement in pancreatitis.

Colonic involvement as a result of pancreatitis is an uncommon but interesting complication of the disease. Among the significant manifestations we have seen are: 1) adynamic ileus of the transverse colon, 2) fibrosing, stenosing pericolitis localized to the splenic flexure area, and 3) colonic hemorrhage secondary to necrosis and fistula formation. Ordinarily, conservative treatment will suffice, but in complicated cases, individualized surgical treatment becomes necessary.

Adult↗
PubMedDate not supplied

Pneumatosis intestinalis: a clinical classification.

Review of our experience with pneumatosis intestinalis has allowed identification of three major clinical groups of patients. In each of these groups, the etiology of pneumatosis intestinalis usually can be identified, and it frequently has an ominous prognosis. Treatment should be directed to the underlying condition when possible, and hence must be individualized. Those patients who would be categorized as Group I can simply be kept under observation. Patients in Group II might obtain relief from breathing increased concentrations of oxygen. For patients in Group III vigorous therapeutic measures generally are necessary to ensure survival. The increasing use of mechanically controlled ventilation and positive end-expiratory pressure may be contributing to the incidence of pneumatosis intestinalis. The ileus sometimes observed in these patients may accompany or precede the development of intramural air, a condition identifiable on roentgenographic examination. Awareness of the possible presence of intramural air may help in identifying patients who may not need operation. But even when roentgenographic examination has confirmed the presence of intramural air, abdominal exploration still may be necessary to rule out a diagnosis of perforated viscus. We hope that these concepts and our emphasis upon individualization of treatment may improve the prognosis for patients who have pneumatosis intestinalis.

Adolescent↗