PubMed Health⌕ Search

Biomedical subjects

C R Hitchcock

Publications and source records attributed to C R Hitchcock.

At least 19 recordsLinked to original sources
PubMed1988

Diffuse spreading Clostridium septicum infection, malignant disease and immune suppression.

Nineteen patients have been treated with gas gangrene infection proved on cultures to be caused by Clostridium septicum. Infection occurred after trauma in three patients and occurred spontaneously in 16, including six patients with peritonitis. None of the instances occurred as a postoperative infection. Ten of the patients had an associated malignant disease including carcinoma of the colon and rectum in six, hematologic malignant conditions in three and carcinoma of the gallbladder in one. Of the remaining six patients, four had evidence of immune suppression (two had leukopenia, one was preleukemic and one had undergone a postcadaver renal transplant), one had diabetes and one had overwhelming sepsis due to a perforated gallbladder with peritonitis. Only three of the 19 patients were otherwise healthy, and infection occurred after trauma in all of these patients. Four patients were moribund upon admission and died before initial therapy was completed. In the other 15 patients, treatment consisted of administration of penicillins and broad spectrum antibiotics and débridement, as well as hyperbaric oxygen in 13 patients. Thirteen of 19 patients died and eight of ten with malignant disease died. The data show a striking relationship between Clostridium septicum and both malignant disease and immune suppression.

Aged↗
PubMed1987

Overwhelming infections in trauma.

Following trauma, wound contamination with aerobic and/or anaerobic bacteria should always be suspected. Treatment with antibacterial antibiotics should begin immediately in the emergency room, particularly for those patients with fractures. Patients with serious trauma are best treated by a team of specialists including general surgeons, orthopedists, infectious disease specialists, and intensive care specialists. The author recommends transport of seriously injured patients to major hospitals specializing in the care of trauma. Particularly when gas gangrene secondary to clostridial infection is suspected, the patient should be moved to a major trauma center with the capability for hyperbaric oxygen therapy.

Anti-Bacterial Agents↗
PubMed1986

Safety of low anterior resection in the presence of chronic radiation changes in dogs.

Thirty mongrel dogs underwent 4000- or 5000-rad single treatment orthovoltage irradiation to the pelvis according to the nominal standard dose equation. Following a resting period of six months, 21 dogs were randomized to low anterior resection with either stapled or handsewn anastomoses. Anastomotic leaks were evaluated on clinical and radiographic grounds. The radiographic leak rate was 81 percent for sutured and 0 percent for stapled anastomoses. The clinical leak rate was 18 percent for sutured and 0 percent for stapled anastomoses. The difference between the 4000- and 5000-rad groups was not significant. The data suggest that late effects of irradiation do not preclude the safe construction of low anterior anastomoses, and that the circular stapling device is superior to hand-sewn techniques.

Animals↗
PubMed1985

Implantable infusion pump management of insulin resistant diabetes mellitus.

Diabetes mellitus with resistance to insulin administered subcutaneously or intramuscularly (DRIASM) is a rare and brittle form of Type I diabetes, found predominantly in young females and characterized by inadequate glycemic response to subcutaneous or intramuscular insulin administration. DRIASM leads to frequent ketoacidosis and obligatory hospitalization for administration of intravenous insulin. The use of a totally implantable infusion pump effected dramatic improvement in the treatment of five patients with this difficult form of diabetes. Frequency of clinical ketoacidosis was reduced from 37 episodes per year to 0.4 episodes per year (99%), and average in-hospital days per month were reduced from 20.8 days to 2.2 days (89%) with a mean follow-up period of 14.4 months. Cost savings were approximately +10,000 per patient month. Quality of life was greatly improved for these individuals.

Adolescent↗
PubMed1985

Reduction of plasma cholesterol and LDL-cholesterol by continuous intravenous insulin infusion.

We studied lipid profiles in 10 patients with insulin-requiring type II diabetes. Patients began the study under conventional subcutaneous insulin injection therapy. Treatment was then optimized on subcutaneous therapy and finally converted to continuous intravenous therapy from a single flow rate implantable pump. Pump management proved reliable and safe. Implantable pump therapy showed a statistically significant reduction in the average plasma cholesterol level from 205.7 to 184.7 mg/dl. The mean low-density lipoproteins (LDL)-cholesterol level decreased from 114.6 to 108.1 mg/dl, the high-density lipoproteins (HDL)-cholesterol average changed from 50.6 to 51.0 mg/dl, and the HDL/LDL ratio increased from 0.478 to 0.500. Glycemic control did not improve on single-rate intravenous therapy compared with intensive conventional subcutaneous injection during the short observation period. The authors conclude that additional studies should be performed to confirm the improvement in the lipid profile on intravenous pump therapy.

Adult↗
PubMed1985

Changes in the surgical treatment of acid peptic disease.

The surgical treatment of acid peptic disease at Hennpin County Medical Center (Minneapolis, MN) during two time periods separated by a 12-year interval was reviewed. In comparing the more recent period with the earlier, the following was observed: 1) total number of operations decreased by one-third, but the number of emergency operations was the same; 2) overall operative mortality did not change even though more patients in the recent period had associated systemic disease; 3) the location of ulcers did not change; 4) hemorrhage, as an indication for emergency surgery, increased both relatively and absolutely; and 5) the preferred surgical procedure during both periods was vagotomy and antrectomy, but vagotomy and drainage was done with increased frequency in the more recent period. During both time periods, emergency surgery was associated with almost a tenfold increase in operative mortality.

Drainage↗
PubMed1984

Low anterior anastomotic dehiscence following preoperative irradiation with 6000 rads.

Twenty mongrel dogs received 6000 rads of irradiation to the rectum and colon using the Nominal Standard Dosage Equation. Three weeks after irradiation each dog underwent anterior resection of the rectosigmoid with reconstruction randomized to either an EEA stapled or a two layer handsewn anastomosis. Each dog was studied digitally and by barium enema at the time of surgery, on the seventh postoperative day, and at autopsy. Five clinically significant leaks and three radiographic leaks occurred in the EEA stapled anastomoses. The handsewn anastomoses had five clinically significant leaks and two radiographic leaks. The data indicate that low anterior resection with either an EEA stapled or handsewn anastomosis cannot be done safely after 6000 rad preoperative irradiation.

Animals↗
PubMed1984

Management of pancreatic pseudocysts.

Fifty-five patients with pancreatic pseudocysts were evaluated over a ten year period and most of these cysts were diagnosed over the last five years with the aid of CT scans, ultrasound and ERCP. Among 39 patients who underwent surgical treatment, ultrasound was correct in 17 of 20 (10 per cent) and falsely positive in one patient out of 20 patients (5 per cent). The CT scan was correct in 12 of 13 patients (92 per cent) and falsely positive in one patient out of 13 patients (8 per cent). ERCP was correct in ten of 12 patients (83 per cent) with one false-negative (8 per cent) and one indeterminate (8 per cent) result. The mortality for 39 surgical patients was 21 per cent and most deaths were because of sepsis. Among 15 patients who did not undergo operative treatment, five had pseudocysts greater than 4 centimeters in diameter and only one patient had clinical regression of the pseudocyst. Ten of the 15 patients had pseudocysts less than 4 centimeters and nine of these patients had clinical regression of the pseudocysts. The results of the data suggest that pseudocysts 4 centimeter in size or smaller may be safely observed by serial CT examination or ultrasound.

Adult↗
PubMed1983

Enterocutaneous fistulas. Effects of total parenteral nutrition and surgery.

Fifty patients with 68 enterocutaneous fistulas were retrospectively reviewed at Hennepin County Medical Center from 1967 to June 1981. Eleven of 28 patients, treated with total parenteral nutrition (TPN) as the initial therapy for their fistulas, had spontaneous closure of 22 of 44 fistulas (three gastroduodenal, 17 small-bowel, two colonic fistulas). There were 35 operative procedures resulting in the closure of 26 fistulas, ten of which had failed to close with TPN (two gastroduodenal, ten small-bowel, and fourteen colonic fistulas). Overall mortality was 22 per cent, with five postoperative deaths and four deaths of patients treated with TPN. Aggressive use of TPN has not obviated the need for surgical closure in the authors' experience, particularly low in the gastrointestinal tract. Management should include TPN for up to four weeks and surgery if there has been no improvement with conservative therapy.

Adolescent↗
PubMed1983

Surgical treatment of renal hyperparathyroidism.

Renal hyperparathyroidism can be a major clinical problem in those receiving dialysis treatment and in those having renal transplants. This review of 66 patients during a five year period has led us to believe that laboratory data are useful for confirming the clinical diagnosis or for following the outcome of medical or surgical therapy. The screening for renal hyperparathyroidism should be on clinical grounds and not on isolated biochemical tests. All patients with renal failure, whether receiving dialysis therapy or renal transplantation, are at risk for having renal hyperparathyroidism develop. A careful assessment of the clinical and biochemical data is required to ensure proper patient selection for operation. Bone disease and persistent pruritus unresponsive to medical management remain the principle clinical indications for operation. Our preferred procedure is the standard subtotal parathyroidectomy.

Adenoma↗
PubMed1982

The value of operative cholangiography.

A retrospective review was made of the records of 152 patients undergoing cholangiography at the time of cholecystectomy. Of the 152 cholangiograms, 65 revealed major technical deficiencies. In spite of this, the use of cholangiography allowed 31 patients with classical indications to be spared common duct exploration. Furthermore, the procedure detected unsuspected common duct stones in nine patients. As a result of these findings, we recommend the use of cystic duct cholangiography routinely in patients undergoing cholecystectomy.

Cholangiography↗
PubMed1981

Melanoma of the female urethra.

Our patient had a highly malignant and poorly differentiated tumor in the distal urethra. A conservative operation was performed because the precise nature of the tumor was not clear with light microscopy. An ultrastructural study established the final diagnosis of malignant urethral melanoma and anterior exenteration was performed. An aggressive operation should be considered as the primary approach once malignant melanoma is diagnosed. Ultrastructural studies should be introduced early in the diagnostic process when light microscopy is insufficient to provide a definitive diagnosis of urethral malignancy.

Female↗
PubMed1981

A comparative radiographic study of low anterior colon anastomoses in dogs.

A radiographic animal study comparing two-layer and hand-sewn colorectal anastomoses to anastomoses made with an inverting circular stapling device revealed a highly significant difference in anastomotic leak rate: 13 anastomotic dehiscences were demonstrated in 20 dogs with hand-sewn anastomosis (65%), and four leaks (20%) were found in 20 dogs with stapled anastomoses. All leaks occurred between the third and seventh postoperative days and most were not clinically significant. A marginally significant difference in mortality rate was found, with four deaths among the hand-sewn group (20%) and two among the stapled group (10%). The data suggest that the EEA stapling device may be preferable to hand-sewn techniques, particularly for low extraperitoneal colorectal anastomoses.

Animals↗
PubMed1980

Mallory-Weiss syndrome: analysis of fifty-nine cases.

Fifty-nine patients with Mallory-Weiss gastroesophageal lacerations are described. These patients consisted of 6% of all cases of upper gastrointestinal tract hemorrhage we evaluated. The most common symptoms were hematemesis (92%) and retching (61%). A history of chronic alcoholism was present in 69.5%, and recent binge drinking in 52.5% of our patients. Diagnosis was made endoscopically (55 patients) or surgically (four patients). Two deaths occurred in the 51 patients who were managed nonoperatively and two deaths occurred in the eight patients who underwent surgery. None of the deaths was related to delay in operative treatment. Eleven patients had late rebleeding, but in only three of these patients was this due to recurrent Mallory-Weiss lesions. We believe the Mallory-Weiss laceration can now be considered to be a relatively benign condition that can be managed successfully by nonoperative means in the majority of cases.

Adult↗
PubMed1979

Duodenal perforation in blunt abdominal trauma.

Ten patients with duodenal perforation secondary to blunt abdominal trauma are reviewed. All 10 patients survived. Most of the injuries were related to motor vehicle accidents. Early recognition requires a high index of suspicion because preoperative signs and symptoms tend to be nonspecific and x-rays are usually not helpful. A careful exploration of the duodenum at laparotomy including both the Kocher maneuver and the Cattell-Braasch exposure is essential. Suitable methods of surgical repair are numerous, but those providing for restoration of normal gastrointestinal tract continuity are preferred.

Abdominal Injuries↗
PubMed1979

Necrotizing anorectal and perineal infections.

Sixteen cases of spontaneous necrotizing infection of the anorectum and perineum are described. Thirteen patients had clostridial infections and three had infections with nonclostridial organisms. Six patients were diabetic and two had leukemia. All 16 patients presented with pain, tenderness, swelling, and crepitation. Four had an ominous black spot on the scrotum or posterior labia. Shortly after initial recognition by the patient, all infections rapidly disseminated to include all surrounding areas such as the external genitalia, the anterior abdominal wall, and thighs. Treatment consisted of radical debridement and antibiotics; hyperbaric oxygen was used in the clostridial cases. Ten of the 16 patients survived. Delayed diagnosis and delayed treatment were the primary factors responsible for death.

Adult↗