PubMed Health⌕ Search

Biomedical subjects

G L Juler

Publications and source records attributed to G L Juler.

At least 19 recordsLinked to original sources
PubMed1990

Peritoneal catheters: a comparative study of column disc and Tenckhoff catheters.

A functioning peritoneal access is crucial to the success of peritoneal dialysis. We report retrospective analysis of our experience using 44 Tenckhoff and 23 column disc, double-cuff, catheters in 46 patients receiving peritoneal dialysis. Postoperative care was identical in both groups. Both catheter groups were comparable with regards to age, sex, obesity and prior abdominal surgery. Catheter removal due to drainage failure was significantly greater with the column disc than the Tenckhoff catheters (22% vs 5%, p = 0.04). In addition, 39% of column disc catheters compared to 11% Tenckhoff catheters were removed as a result of therapy resistant peritonitis (p = 0.011). Furthermore, there was a greater incidence of peritonitis with the column disc than with the Tenckhoff catheters at the end of the first year (71% vs 42%, p less than 0.01). There was no difference between the two groups with respect to other complications, such as pericatheter leak, catheter infections, catheter cuff-extrusion or hernia. Our experience indicates that the column disc catheter is associated with higher complication rates and does not offer any advantage over the Tenckhoff catheter.

Adult↗
PubMed1989

Repair of incisional hernia.

Because wound infection is a major cause of incisional hernia, the question posed is whether or not repairs of incisional hernias are at a higher risk for wound infection also. To answer this, we analyzed the incidence of wound infection after repair of incisional hernias during a 30 month period and compared it with the infection rate in all other clean procedures performed during the same period. All repairs of incisional hernias were performed upon patients with completely healed incisions without clinical signs of infection. Patients undergoing concomitant procedures upon the gastrointestinal tract were excluded. During the 30 month period, 995 clean operations were performed. In the 80 repairs of incisional hernias, there were 13 infections proved by culture, yielding an over-all infection rate of 16 per cent. In the remaining 915 clean procedures, there were 14 wound infections (1.5 per cent, p less than 0.0001). Of these 915 clean operations, 241 were repairs of inguinal hernias. Two infections occurred in this subgroup (0.8 per cent, p less than 0.0001, compared with repairs of incisional hernias). In patients undergoing repairs of incisional hernias with previously documented wound infections, 41 per cent had infected repairs. By comparison, only 12 per cent of patients without a prior infection had infections develop in the hernial repair (p less than 0.05). The infection rate for patients not receiving prophylactic antibiotics (21 per cent) was almost twice the rate for those receiving antibiotics (11 per cent), p = 0.07. We concluded that repair of incisional hernias has a significantly higher rate of infection than do other clean general surgical procedures. Herniorrhaphy of a wound that was previously infected is at a higher risk for reinfection, despite complete healing of the skin and absence of clinical signs of infection. Perioperative antibiotic prophylaxis may be indicated, but randomized studies are needed. For reporting and surveillance purposes, repairs of incisional hernias should not be classified as clean surgical procedures.

Abdominal Muscles↗
PubMed1988

A prospective, randomized clinical investigation of cholecystoenterostomy and choledochoenterostomy.

A prospective, randomized clinical trial was conducted to assess the efficacy of bilioenteric bypass in noncalculous distal biliary obstruction. Thirty-one patients required bypass for either malignant obstruction or chronic pancreatitis and were randomized into two groups: cholecystoenterostomy or choledochoenterostomy with cholecystectomy. Nine bypasses failed after cholecystoenterostomy and two after choledochoenterostomy (p less than 0.04). Eight of the 9 failures occurred in the subgroup of 22 patients with malignant biliary obstruction. In this subgroup, five bypasses failed within 90 days of operation, all after cholecystoenterostomy (p = 0.03 compared with choledochoenterostomy). The results indicate that choledochoenterostomy is the superior operation for malignant distal biliary obstruction. Additional studies will be necessary to identify the procedure of choice for benign noncalculous obstructions.

Aged↗
PubMed1988

Asymptomatic peptic disease in patients undergoing major elective operations: a prospective endoscopic study.

Postoperative bleeding is usually attributed to stress ulcers; however, occult preoperative lesions could also be responsible. To determine their frequency and nature, we prospectively examined 72 patients endoscopically prior to major elective operations. Entry criteria included a planned stay in the Surgical Intensive Care Unit, greater than 2 days, and a negative history, physical examination, and stool guaiac. Gastric and duodenal mucosae were scored separately, using a 0- to 7-point scale. Scores were graded negative (0), hyperemia (1), gastroduodenitis (2-5), mucosal erosions (6), and ulcers (7). Erosions or ulcers were found in 14% of patients and gastroduodenitis is an additional 10%. We found that none of the 27 risk factors or any combination of factors tested correlated with ulcers, erosions, or gastroduodenitis. Thus, patients with asymptomatic gastroduodenal erosions or ulcerations could not be identified preoperatively, except by endoscopy. Until the significance of these lesions as cause of postoperative bleeding is determined, we recommend routine postoperative gastric pH titration with antacids for patients undergoing major elective operations.

Gastrointestinal Hemorrhage↗
PubMed1987

The role of percutaneous transhepatic internal biliary drainage in preoperative patients.

Routine percutaneous transhepatic drainage (PTD) has been recommended for minimizing morbidity after operations for obstructive jaundice. This approach assumes that early complications of PTD are rare or insignificant. It has also been suggested that internal (transsphincteric) drainage is superior to external drainage. To assess its safety, a consecutive series of 18 patients in whom PTD was performed prior to definitive operations for obstructive jaundice was reviewed. Internal biliary drainage was attempted in every instance. The biliary system was successfully cannulated in 100 per cent and the drainage catheter was passed into the duodenum in 16 patients (88%). Five patients (28%) had serious complications of PTD requiring emergency operations; three died. Complications after internal PTD were no rarer or less serious than those after transhepatic cholangiography without drainage. We recommend early surgical exploration once the site of complete biliary obstruction is demonstrated by cholangiography.

Cholangiography↗
PubMed1986

The inguinal darn.

We performed 115 nylon darn repairs in 100 patients with inguinal hernia; 61 were primary and 54 secondary repairs, with 50 patients in each group. The Kinmonth modification of the Moloney darn was used. Thirty-seven percent of secondary repairs were done in patients with two or more previous repairs. Thirteen patients had indirect hernia repairs. The follow-up on 105 repairs in 90 patients averaged 62 months. There were two (3.5%) primary and four (8.3%) secondary repair recurrences. The six failures (5.7%) overall were either technical errors or improper patient selection. Three superficial wound infections (2.6%) healed without complications or suture sinuses. The inguinal darn for recurrent inguinal hernias appears to have a lower recurrence rate than the reported 15% to 30% following other techniques.

Adult↗
PubMed1985

The acute abdomen in spinal cord injury patients.

After return of the reflex arc below the level of anaesthesia, the spinal cord injury (SCI) patient will manifest an intra-abdominal emergency by the clinical signs of dysreflexia depending upon the level and completeness of the cord lesion. Thirty-six SCI patients are presented to correlate the autonomic response to visceral disease with the level of their cord lesion demonstrating that early recognition and diagnosis is possible in these patients.

Abdomen, Acute↗
PubMed1985

Carcinoma of the thyroid with a mixed medullary, papillary, follicular, and undifferentiated pattern.

While papillary and follicular thyroid carcinomas are frequently mixed, this is a case of a medullary, papillary, follicular, and undifferentiated carcinoma of the same gland. In addition, all four tumor types were metastatic to regional lymph nodes. The patient described herein did not demonstrate features of the multiple endocrine neoplasia type 2 syndrome. Immunoperoxidase staining for calcitonin and thyroglobulin was positive in the follicular and medullary areas of tumor. Because the embryologic origin of the thyroidal follicular cells is from the endoderm and the origin of the parafollicular cells of the medullary carcinoma is from the ectodermal neural crest, this case seems noteworthy for demonstrating mixed metastatic tumor of composite embryologic origin. Alternatively, this case may represent an extension of what has recently been termed differentiated thyroid carcinoma, intermediate type by Ljungberg and co-workers.

Calcitonin↗
PubMed1985

Natural history of repaired umbilical hernias in patients with and without ascites.

A retrospective chart review was undertaken to determine the natural history of repaired umbilical hernias in patients with and without a history of ascites. Eighty-five patients underwent umbilical herniorrhaphy during the interval from January 1973 to March 1983. The length of hospital stay was significantly longer for the 22 patients who had a history of ascites; however, the complication rate of elective repair of umbilical hernias that were caused by ascites was not different from that of the 63 patients without a history of ascites. There was no operative mortality in either group. Sixty-eight patients were reevaluated at least 1 month postoperatively. Of the 51 patients who had never had ascites, six (12%) developed a recurrent hernia. Of the 17 patients whose hernias were caused by ascites, eight (47%) developed recurrences. Of the 11 herniorrhaphies performed when ascitic fluid was present, eight (73%) resulted in a recurrence, whereas only one (17%) patient had a recurrence among the group of seven patients who underwent herniorrhaphy at a time when the ascitic fluid was no longer present. Umbilical hernias caused by ascites can be repaired with acceptable morbidity and probably should be repaired after the fluid has been medically removed.

Ascites↗
PubMed1984

Efficacy of MER immunotherapy when added to a regimen of 5-fluorouracil and methyl-CCNU following resection for carcinoma of the large bowel. A Veterans Administration Surgical Oncology Group report.

Two hundred four patients with a microscopically incomplete resection for carcinoma of the colon or rectum were accepted for study. All patients were treated with 5-fluorouracil and methyl-CCNU beginning about the second postoperative week. Concurrent immunotherapy with the methanol extraction residue of bacillus Calmette-Guérin (MER) was randomly assigned to 103 patients. Treatment was continued as long as acceptable to the patient, and until clinical recurrence. Toxic reactions to the drug were not increased by the addition of MER, and seldom were severe enough to require the discrimination of therapy. No evidence of improved survival was seen in treated patients. On the contrary, survival in patients who experienced severe reactions to treatment may have been impaired by MER, with the period of impairment continuing after all adjuvant therapy was stopped. Similar proportions of treated and control deaths were attributable to residual or recurrent disease.

Adult↗
PubMed1984

The pathogenesis of Dieulafoy's gastric erosion.

The solitary gastric erosion of Dieulafoy is rarely recognized but is not an uncommon cause of massive upper gastrointestinal hemorrhage. The English literature has only recently described this lesson in vivo. Its etiology and pathogenesis has remained poorly defined since first described in 1896. We have recently studied a series of nine cases (the largest English literature series), five of which were recognized and diagnosed at operation. Multiple tissue staining techniques were used to study the biopsy specimens for "clues" as to the pathogenesis of this lesion to be a vascular dysplasia that is associated with chronic gastritis and that thrombosis and necrosis of the abnormally tortuous submucosal artery occurs before perforation and exigent bleeding. The total lack of inflammatory reaction at the base of the lesion precludes a diagnosis of "ulceratio simplex" as originally described.

Adult↗
PubMed1983

Fournier's gangrene of the scrotum. A poorly defined syndrome or a misnomer?

Fournier's gangrene is defined classically as a fulminant, rapidly spreading infection of the scrotum that also involves the perineum, penis, and abdominal wall. The pathologic findings are described as synergistic gangrene secondary to a polymicrobial flora with a poorly defined portal of entry. In our experience with 12 cases, the portal of entry was well defined and the causative organisms were those typically found in the lower bowel. Portals of entry were perirectal abscesses in five patients, urethral infections in three, and surgical procedures in four patients. All patients required aggressive surgical debridement, broad-spectrum antibiotics, and adjunctive measures. The fact that four patients died in spite of aggressive treatment demonstrates the lethal nature of this disease. This study suggests that this syndrome is no longer "idiopathic" but is primarily a necrotizing cellulitis of the perineum with subsequent involvement of the genitalia and surrounding tissues.

Anti-Bacterial Agents↗
PubMed1983

Glucagon enhancement of cholangiography. A preliminary report.

Fourteen patients having cholecystectomies under general anesthesia were divided into two groups in a double-blind study. All had intraoperative cholangiograms, before which half had glucagon hydrochloride given intravenously in a dose of 1 mg; the others received only normal saline solution. There was a consistently superior visualization of the biliary tree in those given glucagon, and the difference was statistically significant. No significant changes in blood glucose level, heart rate, or ECG patterns were noted in either group. One patient with preoperative hypertension had a brief rise in BP after the glucagon was given. This study confirms previous anecdotal reports suggesting that glucagon in low dose enhances the quality of cholangiography without producing side effects.

Cholangiography↗
PubMed1983

Control of pelvic cancer with hyperthermic isolation-perfusion.

Eight patients with refractory pelvic cancer were treated with a technique of hyperthermic pelvic isolation-perfusion (rectosigmoid colon 7, bladder 1). The procedure was successful in achieving regional hyperthermia in all patients. All five patients experiencing severe pelvic pain prior to surgery had resolution of pain, although in one patient this relief was transient. Five patients had additional intraabdominal procedures at the time of laparotomy to control unsuspected foci of recurrent cancer. There were no operative deaths. Five complications occurred in four patients although only one was considered life threatening (fracture of aorta at the time of cross-clamping). Sloughing of necrotic tumor occurred between 1 and 2 weeks postperfusion and at times was dramatic. The efficacy of this technique is impressive and it is suggested that it be utilized earlier in the course of disease in patients with uncontrolled pelvic cancer.

Aged↗
PubMed1982

Results of surgical management of hemorrhagic gastritis in patients with gastroesophageal varices.

The records of 13 patients with gastroesophageal varices, operated upon for the prevention or control of hemorrhage from gastritis, were reviewed. Bleeding was controlled postoperatively in all nine patients in whom the operations included variceal decompression, while the remainder had recurrent or continuing hemorrhage, p = 0.0013. The over-all operative mortality was 69 per cent, reflecting excessive blood loss preoperatively in the 11 actively bleeding patients. It is concluded that hemorrhagic gastritis in patients with varices should be viewed as portal hypertensive bleeding and that the basis for therapy must be the early institution of measures which effect a reduction of portal pressure.

Esophageal and Gastric Varices↗
PubMed1982

Upper gastrointestinal hemorrhage in cirrhosis: timing and indications for active intervention.

The medical treatment of upper gastrointestinal hemorrhage was assessed in 101 patients with alcoholic liver disease. Mortality was proportional to the number of blood transfusions required, regardless of the severity of liver disease. Overall mortality was 73% when transfusion requirements exceeded four units, compared with 19% when less than this amount was required (p less than 0.05). A more direct approach to the control of variceal hemorrhage is indicated when blood loss reaches 21.

Adult↗
PubMed1981

Clinical significance of erosive gastritis in patients with alcoholic liver disease and upper gastrointestinal hemorrhage.

Since, in many patients with alcoholic liver disease and upper gastrointestinal hemorrhage, varices and erosive gastritis frequently coexist, the purpose of this study was to assess the severity of hemorrhage, rebleeding and mortality rates when these lesions are present singly or concomitantly. In 104 patients not operated upon, 31 had both lesions present on endoscopic examination, and their clinical courses paralleled the severity of 29 patients who had bleeding varices as the sole finding. In 13 patients with alcoholic liver disease and upper gastrointestinal hemorrhage who were found to have erosive gastritis as the sole lesion, the clinical course was as benign as in 31 patients with ethanol-induced gastritis without liver disease, and their blood loss, rebleeding and mortality rates were significantly less than in patients with both varices and gastritis. It is concluded that the course and prognosis of upper gastrointestinal hemorrhage in patients with alcoholic liver disease and erosive gastritis is dependent upon the presence or absence of gastroesophageal varices.

Esophageal and Gastric Varices↗