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Biomedical subjects

H M Delany

Publications and source records attributed to H M Delany.

At least 19 recordsLinked to original sources
PubMed1993

Nutritional support by tube jejunostomy.

Access to the jejunum by orogastric intubation or insertion of a surgical tube provides a method for nutrient infusion in clinical conditions that involve abnormal upper gastrointestinal function. Despite the physiologically extraordinary nature of jejunostomy intubation-with enteral infusions beyond the stomach, biliary tract, pancreas, and duodenum--the current view is that jejunal feeding is an acceptable alternative to parenteral nutritional support. Because jejunostomies utilize the gastrointestinal tract, administering feedings by this route can minimize some of the major adverse effects of total intravenous nutrition. The problems with jejunal intubation relate to the technical difficulty of the procedure itself, indications for its general use, and its adaptation as an adjunct in the management of the surgical patient. The timing, composition, and metabolic effects of jejunal nutrient infusions are the subject of continuing debate and study.

Animals↗
PubMed1992

Diagnostic tests for intestinal ischemia.

Mesenteric ischemia is a devastating disease. Without early diagnosis and intervention, the process proceeds to intestinal gangrene with its associated high morbidity and mortality rates. Although newer operative techniques and better intensive care unit management may improve patient outcome, it is only by obtaining an earlier diagnosis that greater patient survival rates will be possible. In an attempt to improve diagnostic accuracy, many modalities have been explored. These include serum biochemical markers, peritoneal fluid analysis, tonometry, radionuclide imaging, laparoscopy, and endoscopic techniques. At present, no single test has enabled the clinician to improve the patient's outcome. We are hopeful that the newer techniques, including radionuclide-labeled antibodies, tonometry, and reflectance spectrophotometry, may in the future be of assistance in improving the results for patients sustaining intestinal ischemia.

Animals↗
PubMed1990

Spare the spleen: rationale and techniques.

For many years, a role for splenic function could not be established. Myths and folklore took the place of fact when it came to the spleen. Currently, splenic function is known to be important enough to justify surgical efforts that repair rather than excise the spleen after traumatic injury. Various repair techniques have been described, including many procedures that are appropriate to severe fragmenting splenic trauma. In a review of the experiences of 48 patients following splenorrhaphy using a variety of repair procedures, satisfactory results were achieved in 16 cases using a polyglycolic acid mesh wrap for splenic envelopment and parenchymal tamponade. There were no treatment failures or intra-abdominal infections associated with this newly described procedure.

Humans↗
PubMed1988

Limited role of arteriography in penetrating neck trauma.

Of the patients with penetrating neck wounds treated between 1979 and 1986, 61 patients with 65 injuries had arteriography during their evaluation. Twenty-seven patients had stab wounds and 34 had gunshot wounds, with a relatively equal distribution between the zones of injury. Fifty-seven arteriograms were normal and six were abnormal. Of the six arteriographic defects, three were thought to be spurious on subsequent review, two were clinically insignificant, and one required surgery. No significant arterial injuries were identified by arteriography in the absence of suggestive physical findings. No major arterial injuries were discovered during neck surgery that were missed preoperatively. Neither abnormal nor normal angiograms significantly altered the course of management, including the approach to neck exploration. These data suggest that arteriography for penetrating neck trauma is usually unnecessary for observation of patients in stable condition without suggestive physical findings. Thorough neck exploration with dissection of the carotid sheath in patients with physical diagnostic criteria for surgery eliminates the need for angiography in most cases and avoids the consequences of a possible false-negative study.

Adolescent↗
PubMed1987

Renorrhaphy using knitted polyglycolic acid mesh.

Surgical techniques for treatment of penetrating trauma to the kidney have ranged from simple drainage to nephrectomy, depending on the severity of the injury. Based upon successful experience in the surgical management of splenic injuries using knitted polyglycolic acid mesh, we report a case in which absorbable mesh was used to repair a laceration of the kidney.

Adolescent↗
PubMed1986

Free falls from heights: a persistent urban problem.

In order to determine the significance and implications of falls from heights in the North Central Bronx Hospital (NCBH) patient population area, the records of 203 patients who fell from heights of 5 to 72 feet and who died or were admitted to NCBH over a five-year-period were reviewed. Demographic and clinical data were collected and analyzed for 192 of those patients. The findings show a male-to-female ratio of two to one, an age range of four months to 86 years, and a disproportionately high incidence of falls among minority group children.Seventy-six percent of patients had skeletal, 12 percent abdominal, and 10 percent skull fractures and cerebral edema. Twenty-two percent of juveniles (0 to 17 years) and 5 percent of adults had craniocerebral trauma. Thirty-one percent required surgery. Ten percent of the admitted patients had permanent disabilities. A trauma scoring system, the Injury Severity Score, correlated directly with height fallen. Overall mortality was 28 percent but only 6.6 percent in the juvenile group. Most of the falls were accidental (45 percent) or suicide attempts (22 percent).Although recognized as a health problem at least since 1965, falls from heights continue to be a cause of morbidity and mortality in urban people 20 years later. Renewed efforts at education and the passage and enforcement of public health laws are needed if their numbers are to be decreased.

Accidents↗
PubMed1985

Preliminary clinical experience with the use of absorbable mesh splenorrhaphy.

Splenorrhaphy was performed in six patients using absorbable polyglycolic acid mesh. The sustained injuries included blunt and penetrating trauma and varied from through-and-through puncture with hematoma and deep lacerations to amputation of a portion of the spleen. A number of different splenorrhaphy techniques were required. In all six cases, the procedure was accomplished without abscess formation, postoperative bleeding, or complications related to the use of the mesh.

Absorption↗
PubMed1982

Splenic capping: an experimental study of a new technique for splenorrhaphy using woven polyglycolic acid mesh.

The use of polyglycolic acid (PGA) stretchable mesh applied to the experimentally injured canine spleen can achieve satisfactory immediate hemostasis by tamponade and simplifies the use of sutures to control remaining areas of hemorrhage. PGA mesh with 1/4" and 1/8" openings was utilized for splenorrhaphy in 12 adult mongrel dogs subjected to sharp splenic trauma. By gross and histologic examination, the PGA mesh material appears to undergo progressive absorption to complete absorption by 85 days. For the 12 animals and 30 operative procedures the only complications of the use of the mesh were the occurrence of an intrasplenic seroma in a single animal at 6 weeks after operation and three wound infections. With this material, rapid, simple canine splenic injury repair can be achieved. PGA mesh further assists in the healing process, and in maintaining maximum splenic architecture and function. The material used in this study was manufactured and supplied by Davis & Geck, American Cyanamid, Danbury, Connecticut.

Animals↗
PubMed1981

Small bowel obstruction: the role of nonoperative treatment in simple intestinal obstruction and predictive criteria for strangulation obstruction.

The clinical presentation, treatment, and results of 405 patients with mechanical small intestinal obstruction admitted to the Montefiore Hospital and North Central Bronx Hospitals were reviewed. The etiology of obstruction was adhesions 74%, malignancy 8.6%, hernia 8.1%, inflammatory bowel disease 5.2%, and miscellaneous causes 4.1%. The overall mortality rate for the series was 6.7%, and the incidence of bowel strangulation was 10.1%. Strangulation occurred in 33.3% of the hernia group, 9.0% of the adhesions group, and 2.8% of the malignancy group. The largest single cause of death was related to malignant disease--12 cases (44.4%). Six deaths (22.2%) were caused by bowel strangulation. Of the patients who received more than 24 hours of nonoperative therapy, 46% had relief of obstruction. There was no statistically significant difference in successful results between patients managed with long tubes compared to patients managed with nasogastric tubes. Conservative therapy for malignant obstruction was not successful in 85% of cases. The presence of bowel strangulation shows a positive correlation with age (greater than 70 years), feculant vomiting, peristaltic sounds, and a white blood cell count higher than 18,000/mm3. It shows no correlation with onset, localization or type of pain, duration of symptoms, temperature, tachycardia, or x-ray findings. The results of the study indicate that accurate criteria for small bowel obstruction therapy have not been clearly defined except in patients with incarcerated hernias. Nonoperative management is successful in a significnt percentage of patients.

Adolescent↗
PubMed1981

Intrasplenic abscess: two case reports and review of the literature.

The occurrence of splenic abscess, sickle cell trait, and drug addiction is described in two patients. The coincidence of sickle cell disease and drug addiction in the possible etiology of splenic abscess should be noted. The first patient had a splenic abscess in the inferior pole of the spleen with signs and symptoms of left upper quadrant peritoneal irritation. The second patient had an intrasplenic abscess in the superior pole with pleuritic type chest pain and large left pleural effusion. In both cases, the upper gastrointestinal series was of aid in establishing the diagnosis. In one case, a splenic scan was helpful. Clostridium perfringens were cultured from the abscess of one patient; and Clostridium species, Staphylococcus aureus and Propionibacterium acnes were cultured from the other. Both patients were successfully treated with splenectomy and drainage of the splenic bed.

Abscess↗
PubMed1980

An improved technique for needle catheter jejunostomy.

A modification of the needle catheter jejunostomy technique employs a No. 11 needle and a 13-gauge catheter. Because it utilizes a larger tube, the new technique requires a subserosal saline injection and a small stab serosal incision. The large-needle catheter jejunostomy allows the administration of viscous whole liquid feedings as well as elemental diets. In addition, the larger catheter offers an opportunity to vary the constituents of the infusion solution to specific patient needs, thereby broadening the uses of jejunal catheter feeding.

Catheterization↗
PubMed1977

Fiberoptic intraoperative illumination of the stomach as an aid in the management of acute gastric hemorrhage.

Intragastric illumination using a flexible light source is described as a technical aid in the management of gastric bleeding. The flexible light source can be recommended for illumination of the proximal intragastric area to facilitate surgical control of bleeding from Mallory-Weiss lacerations, ulcers, varices, and mucosal erosions. The sterile sheath-covered flexible neck of the light allows exact positioning of the light in the surgical field by the operating surgeon.

Fiber Optic Technology↗
PubMed1977

Postoperative nutritional support using needle catheter feeding jejunostomy.

Needle catheter jejunostomy was used as an adjunctive surgical procedure in 110 patients. In 19 patients (or 17%) the jejunostomy was of value for the administration of post-operative nutritional support using an elemental diet and it may serve as an alternative route for the administration of supplementing fluids and electrolytes if intestinal function is intact. The clinical experience with the catheter jejunostomy establishes it as a satisfactory technique for postoperative nutritional support in patients requiring esophageal and proximal gastric resection and repair, and gastric surgery in the elderly and debilitated. It is also useful in patients undergoing complicated biliary, pancreatic, and duodenal surgery in whom anastomotic difficulties are anticipated.

Adult↗
PubMed1976

A "Bikini" incision for appendectomy.

An incision is described for adaptation to the young female requiring an appendectomy. The incision is designed to allow the use of brief bathing suits and to preserve the normal contoured appearance of teh abdominal wall.

Appendectomy↗