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Biomedical subjects

H C Polk

Publications and source records attributed to H C Polk.

At least 19 recordsLinked to original sources
PubMed1979

The nonoperative approach to esophageal perforation due to celestin tube placement.

Perforation of the esophagus during placement of esophageal tubes for palliation of obstructing inoperable cancer is a well-known complication that may preclude satisfactory amelioration of symptoms. Experience with two such patients suggests that the complication can best be treated by proper placement of the tube so that it seals the leak and bypasses the obstruction. Judicious use of antibiotics is beneficial. Drainage of the mediastinum may also be necessary. Resectional or extensive operative therapy is probably not wise in these ill and debilitated patients, particularly if the cancer is incurable.

Aged↗
PubMed1979

Further definition of antibiotic use and abuse in the surgical setting.

Surveys of the use of antimicrobial agents were conducted at three university-affiliated teaching hospitals to ascertain the current use of antibiotics associated with surgery and to compare this use to the presently accepted standards. The survey included 300 consecutive surgical patients representing three surgical specialities. Evaluation was based on accepted therapeutic criteria with respect to the presence of an infection, appropriate in vitro antibiotic sensitivity testing, and recognized forms of prophylaxis. The results of our survey disclosed that although nonuse was usually appropriate, more often than not use of antibiotics was inappropriate. Errors, in order of frequency, included (1) misjudgments in attempted prophylaxis of operative wound infection, such as failure to use preoperative administration or use in clean operations without implanted foreign bodies, such as prosthesis, and (2) attempted treatment of undefined and undiagnosed fever.

Anti-Bacterial Agents↗
PubMed1979

Relation between mammary cancer growth kinetics and the intervals between screenings.

The purpose of this study was to consider the time interval for periodic mammographic screening for breast cancer. One hundred fifteen breast cancers occurring in 10,128 women receiving over 30,000 mammograms over a four year period were reviewed. Tumors were diagnosed at three time intervals: 1) first screening (39/115); 2) annual examination (27/115); and 3) at an examination that occurred less than twelve months from a previous annual examination (10/115). Also, there were tumors that grew to a palpable dimensions and were self-detected between annual examinations (39/115). Our opinion is that screening intervals should be individualized to each patient according to risk factors and suspicious mammographic findings. Further, there is a significant number of breast cancers that grow too fast to be detected effectively by annual mammography. Suspicious mammographic findings did not exist before these cancers reached palpable dimensions. Other risk factors characterizing the hosts who develop these fast growing cancers are yet to be determined.

Biopsy↗
PubMed1979

The results of treatment of perineal recurrence of cancer of the rectum.

A study of 36 patients with adenocarcinoma of the rectum recurrent in the perineum after Miles abdominoperineal resection defined a subgroup of 21 patients in whom curative re-excision of the perineum, with or without associated resection of viscera as warranted by operative findings, was performed. Recurrence without palpable disease was disclosed microscopically in seven patients (33%). None of the 21 patients had clinical or laboratory evidence of dissemination at the time of re-excision. Mortality and morbidity were low and yield in terms of pain control was excellent. Results achieved in patients treated with pre- and/or postoperative radiotherapy did not differ quantitatively or qualitatively from those treated by operation alone. Survival free of disease proved to be disappointing and underlines at present the palliative nature of this approach when the primary operation has been an adequate standard abdominoperineal operation. This report provides further evidence as to the value of the better definition of high risk primary rectal cancers and the need for continuing refinement of the follow-up and retreatment process.

Adenocarcinoma↗
PubMed1979

Growth rates of primary breast cancers.

The growth rates of breast cancers are a critical aspect of the natural history of the disease. Growth rates of 32 primary breast cancers were determined from serial mammographic views of tumor nucleus shadows in a population of 109 cancers. These cancers were found in a screening population of 10,120 women receiving over 30,000 mammograms over 3 years. Tumor volume doubling times ranged from 109 days to 944 days with mean doubling time of 325 days in 23 cases with 9 tumors showing no growth. Additional cancers surfaced that were growing too fast to be measured. These cancers were significantly more likely to metastasize but because of the small sample size the absolute percentage of tumors in that fast growing subset was not determinable but ranged between 17 and 77% of the 109 cancers.

Breast Neoplasms↗
PubMed1979

Definitive control of bleeding from severe pelvic fractures.

Forty patients with severe pelvic fracture and extraperitoneal hemorrhage were reviewed. Eighteen patients seen prior to 1975 (group I) were clinically similar to 22 patients seen subsequently (group II). Major pelvic fracture hemorrhage was defined as bleeding in excess of 2,000 ml over and above initial resuscitation volumes. Ten of 22 group II patients met the criteria for continued extraperitioneal bleeding and were immobilized in an inflatable G-suit after surgically remediable lesions had been excluded. Ventilator support and hemodynamic monitoring were instituted and clinical response recorded. Prompt cessation of bleeding was observed in nine of ten patients. One patient required selective catheterization of a bleeding artery with subsequent embolic occlusion. Significant reductions in overall mortality and the frequency of shock related death were observed in group II patients. Sepsis was the leading cause of late death in survivors. Immobilization of pelvic fracture patients in the G-suit is recommended as a means of controlling continuing retroperitoneal hemorrhage when surgically correctable bleeding points have been dealt with. Failure of patients to respond promptly to the G-suit strongly suggests arterial bleeding amenable to selective catheterization and embolic occlusion.

Adolescent↗
PubMed1979

Selective hepatic artery ligation: limitations and failures.

The hospital records of 540 consecutive patients with hepatic trauma were reviewed. Persistent arterial bleeding from hepatic wounds was encountered in approximately 10% of severe liver injuries. Compression of the porta hepatis will result in cessation of bleeding in such patients and subsequent ligature of the appropriate lobar artery will provide permanent, safe control of bleeding. Failures of selective hepatic artery ligation commonly result from incomplete diagnosis of the extent of injury to portal veins and hepatic veins.

Evaluation Studies as Topic↗
PubMed1979

Evaluation of management of the emergency right hemicolectomy.

To evaluate the morbidity and mortality attending emergency resection of the right colon, we studied retrospectively 119 consecutive patients from two major centers, particularly examining the role of delayed anastomosis (initial ileostomy with subsequent ileocolic anastomosis). Emergency right colectomy was defined as an operative procedure in which partial resection of the terminal ileum and total or partial resection of the cecum and/or ascending colon were necessary before the colon could be evacuated and prepared as might be the case in elective resection. Ninety patients underwent primary anastomosis; hospital mortality and morbidity were 26 and 11%, respectively. Among 29 patients who underwent ileostomy, hospital mortality was 38%; hospital morbidity was 10%. In general, the patients selected for ileostomy were somewhat more ill or had more severe injury. only 17% of all deaths and 8% of all serious complications could be attributed to the anastomosis, leaving little statistical opportunity for improvement by deleting it. The data indicate that a very high mortality (29%) attends emergency right hemicolectomy. Our study indicates that ileostomy in lieu of anastomosis does not reduce this high mortality.

Adolescent↗
PubMed1979

Results of corrective surgery for alkaline reflux gastritis.

Reflux alkaline gastritis and esophagitis have been incriminated as a source of symptoms in achlorhydric patients afer operation for duodenal ulcer. Documentation of such pathologic findings has increased due to widespread use of fiberoptic endoscopy. As reported in the literature, results of remedial operations have ranged from encouraging to excellent, and evaluations have been uniformly laudatory. Correlation of the extent of symptoms and of pathologic findings has been difficult, and our results have not been as good as those reported in the literature. During a six-year period, the diagnosis of bile reflux gastritis in 13 patients was based on a characteristic symptom complex, endoscopic appearance, and histopathologic confirmation. Either a Roux-en-Y gastrojejunostomy or a Tanner-Roux 19 was the corrective procedure. There was complete relief of symptoms in five patients (38%) and partial relief in four, but no apparent relief in four others. In at least three of the patients, chronic gastritis and/or esophagitis have persisted and have not improved despite biliary diversion. Tabulation of the results of 13 remedial operations for reflux alkaline gastritis disclosed that copmlete relief of symptoms was achieved in 50% of those who had the Roux-en-Y and in 20% of those who had the Tanner 19 procedure. Based on our findings, we recommend a cautious approach to the surgical management of alkaline gastritis.

Adult↗
PubMed1979

Clinical implications in bacteroides bacteremia.

The clinical presentation and results of treatment of 98 patients with documented bacteroides bacteremia have been reviewed. Surgically treatable causes were documented in three-quarters of the patients. No one antibiotic or combination thereof significantly influenced survival. Patterns of death from sepsis were through multiple organ failure. Early recognition, or surgical drainage or debridement, or both, and specific aerobe directed antibiotic therapy remain the first line of therapeutic endeavor.

Adolescent↗
PubMed1979

The effect of splenectomy on pulmonary infection in newborn mice.

Overwhelming postsplenectomy infection is a widely discussed and studied problem. The route of infection, the specific organisms involved, and the age at splenectomy and bacterial challenge are crucial factors in determining the genuine threat of the disease. We studied Staphylococcus aureus respiratory infection in 10-day-old mice who had undergone splenectomy or sham operation 7 days earlier. We did not find an increase in fatal staphylococcal pneumonitis under these conditions. Further laboratory definition of this complex issue is warranted.

Animals↗