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Biomedical subjects

H J Shull

Publications and source records attributed to H J Shull.

At least 19 recordsLinked to original sources
PubMed1998

Surgical clips: a cause of late recurrent gallstones.

The formation of gallstones around surgical clips after cholecystectomy is a rare complication, with only seven reported cases in the English literature since its initial description in 1979. Three other cases report clip migration into the common bile duct and obstruction. We report a recent experience with "clip cholelithiasis." A 78-year-old female, 16 years following cholecystectomy, presented with a several-month history of colicky abdominal pain worsened by meals, and a 1 week history of jaundice, anorexia, nausea, and vomiting. An abdominal ultrasound demonstrated dilatation of the biliary tree without visible choledocholithiasis. Endoscopic retrograde cholangiopancreatography demonstrated a 1.5-cm radiolucent stone in the common bile duct containing a central surgical clip. She was successfully treated with endoscopic sphincterotomy and stone retrieval. The first report of clip cholelithiasis occurred in 1979. Six additional cases have been reported as well as three cases of clip migration without stone formation into the common bile duct. The incidence of clip cholelithiasis may increase in frequency with the increased use of metallic clips during laparoscopic cholecystectomy. The occurrence of cholelithiasis around inert metals is rare and may be prevented using absorbable clips; however, stone formation is also reported around absorbable materials.

Absorption↗
PubMed1995

Osteomyelitis of the pubic symphysis in athletes: a case report and literature review.

Groin pain is a common problem in athletes. Osteitis pubis, a chronic inflammatory condition involving the pubic symphysis, is a rare cause, and pyogenic osteomyelitis of the pubis is seen even more rarely in healthy athletes. We report one of four cases of pyogenic osteomyelitis of the pubis seen at our institution, review our experience with all four cases, and present a review of the literature (7 cases). The diagnosis is established by the presence of extreme pain, point tenderness at the pubic symphysis, fever, and either a positive culture of blood, needle aspiration, or open biopsy of the pubis. White blood cell count, erythrocyte sedimentation rate, and the results of bone scan and computerized tomography may initially be normal and therefore cannot exclude the diagnosis. Prompt treatment with intravenous (i.v.) antibiotics effective against Staphylococcus aureus (causative organism in all documented cases-9/11) should initially be administered and then guided by culture and sensitivity information. Oral antibiotics should be given if the infection is responsive to i.v. antibiotic treatment. Prompt recognition and treatment with antibiotics may obviate the need for surgical debridement. All athletes who returned to sports activity did so by 6 months after diagnosis.

Adult↗
PubMed1987

Bypass arthritis and the blind intestinal loop.

Arthritis and other inflammatory processes are well established complications of intestinal bypass operations, and recently have been reported after other gastrointestinal procedures. Bacterial overgrowth in blind intestinal loops, actual or functional, appears to be the underlying pathophysiologic mechanism responsible for these systemic inflammatory disorders. In the case we have reported, arthritis was the primary manifestation of blind loop remaining after incomplete reversal of a jejunoileal bypass. Surgical elimination of the blind loop was curative.

Adult↗
PubMed1980

The pill bottle desiccant. A cause of partial gastrointestinal obstruction.

Two cases of partial upper gastrointestinal obstruction were found to be due to a pill bottle desiccant. In both patients, an organic stricture was present. The cylindrical nonsoluble container of the desiccant had a very characteristic radiological appearance. It is seen as a filling defect, with straight borders and square angles.

Accidents, Home↗
PubMed1977

Morbid obesity: problems associated with operative management.

A review of the problems associated with extensive jejunoileal bypass for morbid obesity in a series of 175 carefully selected patients is presented. Five postoperative deaths occurred (3%). Nonfatal complications occurred in 21%, with wound infections (14 patients) being the most common. Good results marked by weight reduction to the range of ideal weight without significant electrolyte or metabolic aberrations was observed in 82% of the patients receiving the current dimensional modificatiom of end-to-end jejunoileal bypass (30 cm to 20cm). An additional 13% had fair results and only 5% had poor results. There were six deaths during follow-up: liver failure in four patients (secondary to alcohol abuse in two), myocardial infarction in one, and one from unknown causes. Bypass reversal was necessary for refractory liver failure in three patients (two from alcohol abuse), and for persistent diarrhea with secondary electrolyte depletion in two patients. One of these patients was complicated by severe emotional instability. This experience suggests that the majority of carefully selected patients will have a good response to jejunoileal bypass.

Adolescent↗
PubMed1977

Results of jejunoileal bypass in two hundred patients with morbid obesity.

Two hundred massively obese patients were submitted to four variations of jejunoileal bypass during the last decade. The operative mortality rate was 2.5 per cent. Nonfatal postoperative complications occurred in patients who had the small intestine shortened to 18 to 20 inches by end-to-end jejunoileostomy. In follow-up periods up to ten years, there have been nine late fatalities, five of which were unrelated to jejunoileal bypass. Despite late complications which have included renal stones, enterohepatic syndrome and ventral hernia, 66 per cent of the survivors have achieved good results by the criteria used. Metabolic improvements include a profound and sustained reduction in plasma concentrations of cholesterol and triglyceride.

Adolescent↗
PubMed1976

Normal disposition of oxazepam in acute viral hepatitis and cirrhosis.

Oxazepam (Serax) is a tranquilizer-sedative of the benzodiazepine group that is predominantly metabolized to a pharmacologically inactive glucuronide and subsequently excreted by way of the kidneys. We administered this drug as a single oral dose to seven patients with acute viral hepatitis, to six with cirrhosis, and to age-matched control subjects. Elimination half-life (T1/2) and the apparent oral plasma clearance for the drug in patients with hepatitis and cirrhosis were comparable to values obtained in age-matched controls (P greater than 0.05). In addition, the apparent volume of distribution of oxazepam, its plasma binding, blood/plasma ratio, and the rate of urinary excretion of oxazepam, predominantly as the glucuronide, were comparable (p greater than 0.05) in the two groups of patients with liver disease and their respective controls. Unlike many other sedatives, oxazepam is eliminated normally in patients with parenchymal liver disease an therefore, on pharmacokinetic grounds, seems to be an excellent sedative for use in such persons.

Acute Disease↗
PubMed1975

Surgical management of Menetrier's disease with protein-losing gastropathy.

Three patients with Menetrier's disease and protein-losing gastropathy who were studied during a 12 year period have been presented. The characteristic findings which differentiate them from patients with hypertrophic hypersecretory gastropathy, including the Zollinger-Ellison syndrome, are: 1) hypertrophy of gastric mucosa with giant rugal folds involving the fundus, cardia and body of the stomach but sparing the antrum; 2) muscosal hypertrophy consisting of gastric mjcus-secreting cells while parietal cells and chief cells are diminished in number and may be absent from many microscopic sections; 3) gastric secretion of large volume containing excess mucus, low to absent hydrochloric acid and protein concentration 5 or 6 times normal (1.7 mg/ml); 4) hypoalbuminemia and hypoglobulinemia due to loss of serum proteins fron gastric mucosa into the gastric lumen; 5) rare association with gastric ulcer. Unlike the Zollinger-Ellison syndrome none of our patients had duodenal ucler or multiple endocrine adenomatosis or a family history of these conditions. We have found no authenticated reports in the literature which document a relationship of Menetrier's disease ( as defined above) with multiple endocrine adenomatosis. Menetrier's disease with protein-losing gastropathy is a potentially lethal disorder of unknown cause with no specific treatment. Resection of the site of gastric protein losses as first done by Waugh is logical and effective. One of our three patients died in hospital before gastrectomy was done. Two others have done well for 11 months and 12 years, respectively, after total gastrectomy with Roux-en-Y esophagojejunostomy and Hunt-Lawrence jejunal pouch.

Adult↗
PubMed1975

Bacteremia with upper gastrointestinal endoscopy.

Fifty patients undergoing upper gastrointestinal fiberoptic endoscopy were studied prospectively for the development of bacteremia by aerobic and anerobic blood cultures obtained before, during, and at 5 and 30 minutes after the procedure. Forty-six patients were culture negative; four had positive cultures at 5 or 30 minutes after the procedure, or at both times. The level of bacteremia as estimated by pour plates was very low. Bacteremia did not correlate with the performance of biopsy or the type of mucosal abnormality found. It is concluded that only very high-risk patients should receive antimicrobial prophylaxis before this procedure. The minor risk of this low-level bacteremia should not be considered a contraindication to the performance of upper gastrointestinal endoscopy.

Duodenal Diseases↗