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Biomedical subjects

F C Nance

Publications and source records attributed to F C Nance.

At least 19 recordsLinked to original sources
PubMed1991

Prospective, randomized trial of the biofragmentable anastomosis ring. The BAR Investigational Group.

A randomized trial was undertaken to compare the biofragmental anastomotic ring (BAR) with conventional intraperitoneal colorectal anastomotic techniques. Patients were randomized into one of two schemes: BAR versus sutured or BAR versus stapled anastomosis. There were 782 patients entered into the study and 283 patients (36%) had a sutured anastomosis, 104 patients (13%) had a stapled anastomosis, and 395 (51%) had the BAR. Comparison of the BAR with combined suture and stapled controls revealed no significant differences in wound complication, abscess rate, bleeding, anastomotic leaks, ileus, obstruction, or deaths. There were no differences in return of bowel function, return to normal diet, or hospital stay. Intraoperative difficulties occurred in 46 BAR patients (17%), and this was significantly higher (p less than 0.001) than for sutured (3%) but not for stapled anastomoses (11%). The occurrence of these problems did not adversely effect the outcome. The data suggest that the BAR is a safe, satisfactory alternative to sutured or stapled colorectal anastomoses.

Adolescent↗
PubMed1991

A traumatic splenic rupture in a healthy adult.

Splenic rupture in blunt and penetrating trauma is well documented. Other etiologies include hematologic and inflammatory disorders. The case presented documents occult splenic rupture. There was no history of trauma. Furthermore, no evidence of systemic disease or pathology could be found. Occult, spontaneous splenic rupture is rarely diagnosed, although the associated mortality/morbidity is high. The astute clinician must have a high index of suspicion relying on clinical and roentgenographic study for rapid diagnosis and management.

Adult↗
PubMed1989

The need for definitive therapy in the management of perforated gastric ulcers. Review of 202 cases.

A retrospective study of 202 patients who presented to three Louisiana hospitals with perforated gastric ulcers was performed. Patients were treated surgically, medically, or were not treated. Only those patients with gastric ulcers were included in the study, not those with "channel ulcers" or peptic ulcers. The mortality rate of the 185 patients who were treated with operation was 18%. Of those patients treated nonoperatively, the mortality was 95% (one survivor). There was a definite difference in mortality among those patients treated with definitive operative procedures (11.3%) versus those patients treated with nondefinitive surgery (22.9%). This difference was consistent even in the presence of purulent exudate in the abdominal cavity and among those patients presenting in shock. The mortality among those patients who presented with a initial blood pressure of 90 mmHg or less were defined as being in shock, and the mortality in this subgroup was 52.8%. The mortality among those patients who had purulent fluid within the abdominal cavity was about the same, regardless of type of surgical procedure. The patients who underwent nondefinitive procedures required subsequent operative treatment in 25.7% of cases. Also noted was the lack of correlation between symptoms of ulcer disease and perforation. Those patients treated with definitive surgery (57%) and those treated with nondefinitive surgery (41%) reported no symptoms consistent with ulcer disease before operation.

Adolescent↗
PubMed1989

Crohn's disease-associated carcinoma. A poorly recognized complication of inflammatory bowel disease.

We have reviewed eight cases of Crohn's disease associated carcinoma (CDAC) of the bowel treated at Saint Barnabas Medical Center since 1977. Five patients had colorectal carcinoma in areas of dysplasia within histologically recognizable Crohn's disease. One of the large bowel carcinomas was a diffusely infiltrating signet ring adenocarcinoma (linitis plastica), three were mucinous carcinomas, and one contained both cell types. Survival ranged from 4 to 55 months. Three patients developed ileal carcinomas in areas of dysplasia within histologically recognizable Crohn's disease. One of the ileal cancers was a moderately differentiated adenocarcinoma; two were poorly differentiated adenocarcinomas. Survival ranged from 8 to 44 months. The dysplastic changes seen in the bowel adjacent to the tumors in these patients were identical to the characteristic pre-cancerous (dysplastic) changes well described in ulcerative colitis. The histopathologic changes seen in this high-risk group of patients are also similar to those of previously reported CDAC. Those patients with the more diffuse dysplastic changes might have been detected before the development of invasive cancer had they undergone periodic colonoscopic surveillance. One patient in the series with an asymptomatic lesion was, in fact, identified at surveillance colonoscopy. It would appear that Crohn's disease patients have a similar risk for carcinoma previously recognized in ulcerative colitis patients and that surveillance protocols should be developed for this group of patients.

Adenocarcinoma↗
PubMed1988

Abdominal trauma at the Southern Surgical Association, 1888-1987.

Since 1888 98 papers have been presented to the Southern Surgical Association (SSA) dealing directly or indirectly with abdominal trauma. The papers reflect the progress over the century in the management of this injury. Almost two-thirds of the papers have originated from the major city hospitals of the south. An interest in abdominal trauma has been manifest among the officers of SSA. Twenty-two presidents have presented papers or taken part in discussions. Four 25-year eras were identified. In the earliest, exploration of abdominal wounds was firmly established as a principle. The second period was characterized by consolidation of principles and strengthening of supportive care. The third era encompassing World War II marked a nadir in productivity. In the last 25 years a reawakened interest has resulted in a marked increase in the number and quality of presentations, which have increasingly focused on specific organ injuries.

Abdominal Injuries↗
PubMed1984

Surgical judgment in the management of abdominal stab wounds. Utilizing clinical criteria from a 10-year experience.

A 10-year retrospective study of patients with stab wounds to the abdomen managed under a protocol of selective management has been performed. Patients were assessed on the basis of clinical presentation and physical examination, with minimal diagnostic studies. Peritoneal lavage was not utilized in the evaluation of the patients. Two hundred and nineteen such patients were identified. One hundred and eleven of these patients were treated nonoperatively. Ninety patients were treated by immediate laparotomy. Eighteen patients, initially observed, underwent delayed laparotomy. One patient, not explored despite clear-cut indications for laparotomy, died of sepsis, emphasizing the need for strict adherence to the stated protocol. The negative or unnecessary laparotomy rate was 7.8%. The false-negative examination rate was 5.5%. Overall mortality rate was 2.3%. The accuracy of careful clinical evaluation and observation is comparable to, or better than, any other method currently available to identify intra-abdominal injuries in patients with abdominal stab wounds. The study suggests that selective management of stab wounds of the abdomen may be safely practiced in a smaller community hospital.

Abdominal Injuries↗
PubMed1984

Effect of burn shock on myocardial function in guinea pigs.

The effect of burn shock on myocardial function was studied using an isolated working heart preparation. Guinea pig hearts were studied 2-, 4-, and 8-hr following burn injury as well as in time-matched controls. The hearts were excised from both burned (35% body surface area) and unburned unresuscitated animals, and ventricular function curves were generated on each heart. The 4- and 8-hr postburn hearts, particularly the 4-hr group, exhibited depression in cardiac output, stroke volume, coronary flow, peak systolic pressure, mean aortic pressure, estimated myocardial work, stroke work, and oxygen consumption when compared to controls. The ventricular function curve for the 4-hr postburn hearts was shifted to the right indicating a decrease in contractility, which complements a decrease seen in compliance. These pronounced changes seen in the 4-hr postburn hearts were not observed 2 hr after burn injury. The data suggest that intrinsic myocardial function following burn injury is depressed and the degree of dysfunction is influenced by the time from thermal injury.

Animals↗
PubMed1979

New techniques of gastrointestinal anastomoses with the EEA stapler.

A new instrument for accomplishing inverted stapled anastomoses in the gastrointestinal tract is described. Side-to-side, end-to-side and end-to-end anastomoses can be performed. Techniques developed for utilization of the instrument in virtually all gastrointestinal anastomoses are described. In most instances a proximal or distal enterotomy is required. Experience with 57 anastomoses in 42 patients is reported. One leak occurred; no other complications not recognized intraoperatively were observed. Anastomoses completed included gastroduodenostomy, gastrojejunostomy, cholecystojejunostomy, colocolostomy and ileocolostomy. Hazards and complications associated with the use of the instrument are described. It should be used only after the surgeon has acquired the skills to operate the instrument properly. The instrument saves time, creates better anastomoses than can be obtained by hand sewing and is extremely versatile. It may permit safer anastomoses in adverse conditions, such as in obstruction and peritonitis. The instrument opens new horizons in gastrointestinal surgery.

Animals↗
PubMed1978

Surgical restraint in the management of hepatic injury: a review of Charity Hospital Experience.

We have reviewed 546 cases of hepatic trauma treated from 1964 through 1976: 76 patients with blunt injury, 308 with gunshot wounds, and 162 with stab wounds. Hypovolemic shock was present in 22%. The overall mortality was 10%. Stab wounds had a negligible mortality of 0.6%, whereas 12% of patients with gunshots and 28% of patients with blunt trauma died. Management followed the general principles of control of hemorrhage and conservative debridement with avoidance of major procedures. Eighty-four per cent of patients required only drainage or suture and drainage. Only 8% had extensive debridement. An additional 5% (31 patients) underwent hepatic lobectomy. Hepatic artery ligation, as an isolated procedure, was not employed. Common bile duct cannulation was employed only six times. Mortality among patients treated by suture or drainage was 5.4%. When resection was required, a 52% mortality resulted. We conclude that the principles of conservative surgical treatment can give a satisfactory survival rate in most hepatic trauma.

Adolescent↗
PubMed1977

Periampullary malignancy in Gardner's syndrome.

Three cases of familial polyposis coli with associated periampullary malignancies are reported and the literature reviewed, which disclosed 16 additional cases. An additional five unreported cases are known to exist. The authors believe that the development of periampullary malignancy in FPC is a definite extracolonic manifestation of the disease and should be considered a variant of Gardner's syndrome. It is recommended that all FPC patients with colon polyps undergo routine surveillance of the upper gastrointestinal tract and that all duodenal polyps discovered be surgically removed when feasible.

Adolescent↗
PubMed1977

Pancreatitis following spinal cord injury.

Six cases of pancreatitis following spinal cord injury are presented. No single, etiologically accepted mechanism already postulated to cause pancreatitis can account for all the cases reported. The authors hypothesize that spinal cord disruption may produce pacreatitis by sympathetic-parasympathetic nervous system imbalance resulting in over-stimulation of the sphincter of Oddi. This may lead to stasis of secretions with absorption of amylase into the systemic circulation, and structural pancreatic damage. Pancreatitis in those with cord injuries is easily overlooked because abdominal pain is usually absent and fever is usually attributed to more frequently occurring pulmonary or urinary tract infections. Recognition of this complication is important in order to decrease the morbidity and mortality that follows spinal cord damage.

Adult↗
PubMed1976

Diagnosis and management of blunt abdominal trauma.

The records of 437 patients with blunt abdominal trauma admitted to Charity Hospital, New Orleans, from 1967-1973 have been reviewed and computer-analyzed. There was an 80% increase in the incidence of blunt abdominal trauma when compared with the preceding 15-year experience. Forty-three per cent of all the patients presented with no specific complaint or sign of injury. Blunt abdominal injury was usually diagnosed preoperatively using conventional methods including history, physical examination, and routine laboratory tests and x-rays. Abdominal paracentesis via a Potter needle had an 86% accuracy. The incidence and management of specific organ injuries with associated morbidity and mortality have been discussed. Mortality and morbidity continue to be significant in blunt abdominal trauma. Isolated abdominal injuries rarely (5%) resulted in death, even though abdominal injuries accounted for 41% of all deaths. Associated injuries, especially head injury, greatly increased the risk. The insidious nature of blunt abdominal injury is borne out by the fact that more than one-third of the "asymptomatic" patients had an abdominal organ injured. A high index of suspicion and an adequate observation period therefore are mandatory for proper care of patients subjected to blunt trauma.

Abdominal Injuries↗
PubMed1976

A time-management study of 25 patients with penetrating wounds of the chest and abdomen.

The present study prospectively reviewed the time management aspects of 25 patients with penetrating wounds of the chest or abdomen. Each diagnostic procedure or treatment carried out on each patient was recorded to the nearest minute after his arrival in the emergency department. This generated median elapsed times for procedures which could be compared (4+ minutes for starting an IV, 9 minutes for insertion of CVP, 31 minutes for insertion of a chest tube). Two of the 25 patients died; 20 were admitted of whom 8 required immediate surgery. Some preocedures carried out in the accident room were done indiscriminately and for questionable reasons. The tendency was to do as much as possible to "cover" the patient. Some redundancy in the acutely ill patient is desirable but the overtreatment in some cases may have reflected inexperience of some of the physicians. Delay in using radiography and defects in professional coverage appeared to be the most serious errors. Independent monitoring of the functioning of the accident room appears to be an affective means of self-evaluation.

Abdominal Injuries↗
PubMed1975

Changing patterns in the management of pancreatic pseudocysts.

The records of patients treated from 1938 through June, 1974, for pancreatic cysts have been reviewed. There was 205 cysts including 168 pseudocysts, 21 neoplastic, 13 retention, and 3 congenital pseudocysts. An analysis of two eras has been made: cysts treated prior to 1962 (56 patients) and cysts treated after 1962 (98 patients). In the earlier era 66.4% of patients were treated by external drainage and 34% by excision or internal drainage. By marked contrast in the more recent era only 27% were treated by external drainage and 73% by excision or internal drainage. The recurrence rate fell from 27% in the earlier era to 6% in the modern era. Improved morbidity was evidenced by a reduction from 32.2% to 15.3% in additional procedures required. Individualization in the treatment of pseudocyts with adherence to establish criteria for procedure selection with increased reliance on excision or internal drainage, as well as early diagnosis and timely intervention have improved the results of surgical therapy in this disease.

Acute Disease↗
PubMed1975

Penetrating abdominal injuries in children and adolescents.

One hundred thirty-two children and adolescents with penetrating abdominal trauma have been reported. Eighty-two of these patients had intraperitoneal injuries. Five of the injured patients died, and 35 suffered complications. Patterns of organ injuries were found to be similar to a previously studied adult series. Satisfactory results were obtained by simple management of specific injuries. Ninety-five per cent of the injured patients and 80% of uninjured patients could be accurately identified at initial physical examination. Selective observation of penetrating abdominal injuries can be safely employed in children and adolescents.

Abdominal Injuries↗
PubMed1975

Penetrating neck wounds: a review of 218 cases.

A series of 218 patients with penetrating wounds of the neck is presented. The overall mortality rate was 8 per cent. One hundred seventy-five patients were explored promptly after admission; 60 per cent had structural damage present within the neck. Six of the patients without signs or symptoms to suggest injury beneath the platysma had injury demonstrated at exploration. Of 38 patients who were observed, only one developed a significant late complication. Thirty-four per cent of the patients had associated extracervical injuries; 38 per cent developed one of more complications during their hospitalization. Negative neck explorations were not associated with an increase in morbidity or prolonged hospital stay. In our hospital, early exploration of all wounds that penetrate the platysma appears to be the best approach for management of penetrating neck wounds.

Adolescent↗