Biomedical subjects
Publications and source records attributed to E D Davidson.
A 33-year-old woman had severe progressive intestinal ischemia secondary to three-vessel intraabdominal occlusive disease. Oral contraceptives and cigarette smoking were the only identified risk factors.
In 21 patients with nonresected stomachs and symptoms of delayed gastric emptying, obstruction was excluded by upper gastrointestinal series and upper endoscopy; all had abnormal results of barium test meal (BTM) study. Each had repeat BTM after the administration of 10 mg of metoclopramide. Each patient also had two gamma camera studies after a technetium Tc 99m sulfur colloid labeled meal; normal saline or metoclopramide was administered before each test in a blinded and random manner. Half-time (T1/2) and percentage of isotope remaining at six hours (GC6) were recorded. Ten asymptomatic controls had a gamma camera scanning study, and seven of these had a BTM. Nine of 19 patients had a T1/2 in the normal range, and in 12 of 19 patients the GC6 was in the normal range. The magnitude of retention of barium at six hours on the BTM did not correlate with the T1/2 (r = 0.076) or the GC6 (r= 0.296). Thus, these tests were not comparable in this study. By regression analysis, a significant reduction was shown in the amount of retained food and barium (P less than .01), the T1/2 (P less than .01), and the GC6 (P less than .01) after intramuscular administration of metoclopramide, indicating that both tests were able to evaluate the effects of this drug.
Seventeen patients who underwent operations for pancreatic abscess are the subject of this article. In a nonselective manner, 11 patients were treated by debridement and sump drainage, whereas six patients were treated with similar debridement with open packing (marsupialization) of the abscess. There was a 55% mortality rate in those patients who underwent sump drainage and 0% mortality rate in those who underwent marsupialization. No differences could be found between the groups to account for this variation in survival, except the method of treatment. We suggest that marsupialization to considered for patients with pancreatic abscess, particularly when they have extensive necrosis.
This case describes a 40-year-old man with abdominal pain, nausea, and vomiting, who was found to have a cystic lesion in the tail of the pancreas. Distal pancreatectomy and splenectomy revealed a primary epidermoid cyst of the spleen lying in the substance of the tail of the pancreas. This represents the only report of a splenic cyst in an ectopic spleen that could be found in a search of the world literature.
This case report presents a rare complication of Crohn's disease in a 28-year-old presenting with an umbilicourachovesicoenteric fistula. Preoperative studies demonstrated communication of the umbilicus, bladder, ileum, and cecum. Preoperative nutritional support and en bloc resection with restoration of continuity primarily was performed with a successful outcome.
Fifty-nine patients underwent duodenogastric diversion for bile reflux gastritis. Sixty per cent of 37 patients who underwent measurement of solid food gastric emptying had delayed gastric emptying. Patients were also assessed in terms of the degree of gastritis present endoscopically. Fifty-six patients were available for follow-up of from six months up to six years. The results demonstrated the following: Patients with delayed gastric emptying and reflux gastritis fared poorly after duodenogastric diversion; the greater the severity of gastritis visible by endoscopy, the better the results of diversion. Only 47% of patients achieved a satisfactory result of duodenogastric diversion.
Examination of this series of 19 patients with antibiotic-associated pseudomembranous colitis revealed that most of the patients were given the antibiotics for trivial reasons. Many different antibiotics were identified as being related to the development of colitis. There were three deaths in this series; two of the 15 patients treated medically and one of the four treated surgically. The efficacy of all diagnostic procedures and medical therapies are discussed, and the role of surgery in treating patients with toxic state, sepsis, or perforation is presented.
Ten patients with idiopathic delayed gastric empyting were studied in a randomized double-blind fashion to examine the effects of coherin versus placebo upon their symptoms and objective measurements of gastric emptying. The results showed no significant effect of coherin on either symptom scores or gamma camera 99Technetium gastric emptying studies in this group of patients. There is a need to develop other agents in treatment of this poorly understood condition.
Fifty-five patients with delayed gastric emptying and the symptoms of nausea, vomiting, postprandial bloating and early satiety were treated with metoclopramide. Obstruction was excluded by upper endoscopy and standard upper gastrointestinal series. None were on medication known to retard gastric emptying. All patients had an abnormal barium burger radiologic study. Twenty-one patients had had previous vagotomy and drainage procedure, five had diabetic gastroparesis and 29 had idiopathic delayed gastric emptying. Metoclopramide significantly decreased the symptom scores of the surgical and idiopathic patients. When all patients were analyzed together, there was a significant improvement in both the metoclopramide and placebo treated patients. When, however, the improvement on metoclopramide was compared to the improvement on placebo, there was a significant metoclopramide effect beyond the placebo effect. Thus, metoclopramide is an effective agent in treating the symptom-complex of patients with delayed gastric emptying.
Twenty-eight patients with delayed gastric emptying as measured by an abnormal barium "burger" were treated with metoclopramide in a randomized, double-blind fashion. Five had diabetic gastroparesis, four had undergone vagotomy and pyloroplasty, and 19 were idiopathic. Patients received either metoclopramide or placebo for a three-week period and symptoms were scored prestudy, at weekly intervals, and at termination of the study. Ten of 17 patients on metoclopramide and four of 14 on placebo decreased their symptom score to a level below entry criteria, indicating a significant metoclopramide effect when compared to placebo. The mean total sumptom score for the metoclopramide group was 18.4 prestudy and 7.2 poststudy while for placebo was 19.1 prestudy and 12.9 poststudy. Although improvement on placebo was significant, these patients were still symptomatic. The improvement on metoclopramide was significantly greater than the improvement on placebo. Metoclopramide is an effective agent in treating the symptom complex of delayed gastric emptying.
Metoclopramide or placebo was administered postoperatively in a randomized, double-blind fashion to 115 patients undergoing laparotomy. The effect of metoclopramide on postoperative adynamic ileus (PAI) was evaluated. The patients were stratified into two groups: Group A--those with laparotomy without a gastrointestinal anastomosis or ostomy procedure, and group B--those with laparotomy undergoing an anastomosis or ostomy procedure. Metoclopramide reduced nausea and emesis postoperatively. However, the only significant effect on postoperative adynamic ileus was an earlier return to tolerance of solid foods in the patients in Group A.
A report of a 38-year-old man with a 10 month course of illness characterized by recurrent pericardial and pleural high-protein, high-amylase effusions is presented. Operative pancreatogram demonstrated fistulization from the mid-pancreas through the mediastinum into both pleural spaces and the pericardium. Surgical detachment of the fistula and Roux-en-Y decompression of the pancreatic duct resulted in cure of the condition.
We report two cases in which necrotizing vasculitis with tenosynovitis arthralgia/arthritis syndrome developed after intestinal bypass surgery. Each of these patients had jejunoileostomies, and the excluded segment was placed in an ileal-colonic anastomosis. We speculate that since the attachment of the excluded segment to the large intestine predisposes it to increased bowel overgrowth of bacteria, these bacteria or their debris may have served as antigens for circulating immune complexes, which were detected in both patients by one or more techniques. Patients who have had an end-to-side anastomosis may be less predisposed to the more severe vasculitis syndrome because there is less likelihood of bacterial overgrowth in the bypassed intestinal segment.
Two patients with persistent obstructive jaundice secondary to chronic pancreatitis and one patient with this picture secondary to a periduodenal fibrosis are reported. The infrequent occurrence of obstructive jaundice in such inflammatory processes is noted and it is suggested that the presence of a circular muscle coat in the common bile duct protects it from inflammatory narrowing. The need for preoperative anatomic evaluation by radiographic techniques is discussed along with methods of therapy.
This study demonstrates that hepatic abscesses are highly lethal when untreated. There was an overall mortality of 29 per cent; however, if autopsy cases are excluded the mortality was only 13 per cent. Positive blood cultures (especially if multiple or anaerobic organisms), significant anemia, elevated bilirubin levels, multiple abscesses, and being Caucasian were identified as factors associated with increased mortality. Early diagnosis coupled with aggressive surgical and antibiotic therapy is needed.
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A case of rectal carcinoid tumor with liver metastases is reported in which a markedly elevated serum acid phosphatase level was found. Tissue assays of the patient's tumor, liver metastasis, and uninvolved liver were performed which demonstrated very high tumor levels of acid phosphatase. The patient also had elevated plasma serotonin levels and urinary 5-hydroxyindole acetic acid levels and did not exhibit the carcinoid syndrome. Autopsy showed no prostate cancer or metastatic bone lesions. Serum acid phosphatase elevation may occur with carcinoid lesions of the rectum.