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Biomedical subjects

F Glenn

Publications and source records attributed to F Glenn.

13 recordsLinked to original sources
PubMed1978

Iatrogenic injuries to the biliary ductal system.

One hundred patients who sustained complete transection or ligation of the common bile duct during cholecystectomy were selected from a much larger number of patients admitted to The New York Hospital for surgical correction from 1932 to 1976 for review. The methods of restoration of bile flow from the liver to the intestine were described with an indication of the success and failure that followed. The results were varied and unpredictable. Perhaps the propensity of the transected or ischemic duct wall to form scar tissue with sufficient reduction of the lumen to cause partial to complete obstruction is the reason for some of the failure.

Bile Ducts↗
PubMed1977

Cholecystostomy in the high risk patient with biliary tract disease.

The morbidity of complications and mortality following surgical operations for nonmalignant disease of the biliary tract is greatest among those 65 years and older. The reported overall mortality regardless of age ranges upward from 0.88%. At The New York Hospital-Cornell Medical Center for a 43-year period (1932-1975) it was 1.77%. For those 65 and older it was 5.1%. For patients with acute cholecystitis it was 3.5% and of those in this category 65 and older it was 9.2%. This experience and that reported from other comparable clinics is the basis for advocating that the procedure selected be within the capacity of the patient to tolerate it. Specifically a cholecystostomy, a compromise procedure, may be lifesaving for the presenting situation deferring cholecystectomy until later. Admittedly the more effectual approach is undelayed definite surgery when calculous disease is demonstrated.

Abdomen↗
PubMed1977

Biliary lipid metabolism in the pregnant baboon.

The serum cholesterol value, bile acid pool size and kinetics as well as lipid composition of gallbladder bile have been studied in seven baboons during nine pregnancies. During pregnancy, the per cent decrease in the average serum cholesterol value ranged from 25.6 to 74.4 per cent, mean 54.5 +/- 14.3 per cent, compared with that of antepartum averages. In seven of the nine pregnancies, chenodeoxycholic acid pool size decreased in the range of 40.1 to 86.6 per cent. In two pregnancies, the pool size of this bile acid was essentially unchanged. Total bile acid pool size also decreased from a mean of 990 +/- 260 milligrams antepartum to 520 +/- 200 milligrams in the third trimester, p less than 0.01. With regard to the cholesterol, phospholipid and bile salt content of gallbladder bile, cholesterol value decreased from an antepartum mean of 19.1 +/- 3.9 to 14.1 +/- 4.5 micromoles per milliliter in the third trimester. As a consequence, the lithogenic index of gallbladder bile decreased during pregnancy. The changes in chenodeoxycholic and total bile acid pool size are qualitatively similar to those reported by other investigators following the administration of estrogens to both baboons and other animal species. In the pregnant baboon, the decrease in pool size and in synthesis rate of bile acids is accompanied by a decrease in the cholesterol content of gallbladder bile. These changes in the lipid content of gallbladder bile are reflected in a decrease in the mean lithogenic index. These data suggest that the baboon may be an inappropriate model for studies of the relationship of pregnancy to cholesterol cholelithiasis in humans. In the baboon, both serum and biliary cholesterol values decrease during pregnancy. In humans, serum cholesterol levels increase during pregnancy. If the content of biliary cholesterol is a reflection of the serum concentration of this lipid, as has been suggested in recent studies, human bile may be more lithogenic during pregnancy. Additional studies are necessary to define the role of gallbladder contractility and bile stasis to gallstone formation during pregnancy.

Animals↗
PubMed1976

Functional tumors of the organ of Zuckerkandl.

Chromaffin-reacting pheochromocytomas of the adrenal medulla are the most frequently encountered functional paraganglionic neoplasms. However, extra-adrenal pheochromocytomas as well as non-chromaffin paragangliomas, including those of the carotid body and glomus jugulare, may produce symptoms from catecholamine secretion. One of the extra-adrenal sites from which these tumors arise is from a collection of para-aortic, paraganglion cells around the origin of the inferior mesenteric artery. This collection of paraganglia was described in fetuses by Zuckerkandl in 1901 and has subsequently been referred to as the organ of Zuckerkandl. The diagnosis and management of these neoplasms differ somewhat from that of adrenal pheochromocytomas, but excellent results are often obtained by excision of these lesions. Four patients with functional tumors of the organ of Zuckerkandl are reviewed together with the other reported cases in the literature.

Adolescent↗
PubMed1976

Chenodeoxycholic acid induced liver injury in pregnant and neonatal baboons.

The prolonged feeding of chenodeoxycholic acid produces hepatic injury in both pregnant and non-pregnant baboons. CDC feeding does not adversely affect ovarina function and no teratogenic effects of this bile acid were noted in 16 live birth and two stillborn progeny of CDC fed animals. However, 10 of the 16 live birth neonates and one stillborn had focal hepatic lesions histologically similar to those observed in the adult animals. In addition one neonate had gross hepatic necrosis. The severity of the liver damage was related to the content of lithocholic acid in the bile of both the neonates and their mothers. Experiments with 14C-chenodeoxycholic and 14C-lithocholic acid demonstrate that the lithocholate in the enterohepatic circulation of the neonate is derived from the CDC fed to the pregnant adult. In the gallbladder bile of the neonate most, but not all, of the lithocholate is conjugated but unsulfated. Both newborn and adult baboons sulfate lithocholic acid but to an extent less than that reported for man. Less efficient sulfation of lithocholic acid in the baboon may exaggerate the toxicity of CDC feeding in this species compared to man. Nevertheless, the potential for adverse effects on the fetal liver must be recognized as a risk associated with the use of chenodeoxycholic acid in women of child-bearing age.

Animals↗
PubMed1976

Critical sequelae in biliary tract disease.

The high incidence of calculous biliary tract disease accounts for surgical operation upon the biliary tract disease accounts for surgical operation upon the biliary tract being the most frequently performed within the abdomen. Untreated surgically critical sequelae tend to occur with advancing age and duration of the disease. The more common of these are: acute cholecystitis, choledocholithiasis, acute obstructive suppurative cholangitis, biliary enteric fistulas, liver abscess, related pancreatitis, and biliary cirrhosis. The greater the pathological changes in the biliary tract and the more debilitated the individual, the greater is the risk of surgery. However, the risk is even greater without operation.

Acute Disease↗
PubMed1976

Acute cholecystitis.

Two thousand and twenty-one patients treated surgically for acute cholecystitis over a 42 year period with a mortality of 3.4 per cent are reported. This experience reveals that acute cholecystitis among patients 65 years of age and older is a serious condition and is associated with an appreciable operative mortality. However, nonsurgical management results in an even greater mortality. An aggressive surgical approach, cholecystectomy without prolonged delay after the demonstration of calculous disease of the biliary tract, is urged. In the future, this should diminish the proportion of patients 65 years of age and older with acute cholecystitis.

Acute Disease↗
PubMed1975

Trends in surgical treatment of calculous disease of the biliary tract.

From the data presented, there are five distinct trends in operations for calculous biliary tract disease. There is less delay in operation following diagnosis than ever before. Diagnosis is being made early in those with symptoms. Asymptomatic calculi are being revealed more frequently by complete over-all medical evaluations including cholecystography. Acute obstructive cholecystitis, a complication of cholelithiasis, is becoming less frequent in proportion to the total patients admitted to hsopitals. The operative mortality is concentrated among those in the elderly group, 65 years old and older. The limited capacity of many patients in this category to tolerate the burden of any surgical procedure is being met by palliative, temporary procedures such as cholecystostomy and ductal decompression rather than definitive cholecystectomy and choledochotomy. Roentgenologic facilities are becoming available to provide visualization and critical evaluation of the entire ductal system at the beginning of an operation. This provides a more realistic basis for common duct exploration, an increment associated with morbidity. More important is the assurance against overlooking calculi, retained ductal stones.

Age Factors↗