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Biomedical subjects

H M Spiro

Publications and source records attributed to H M Spiro.

At least 73 records · Page 4Linked to original sources
PubMed1979

Diagnostic imaging procedures in acute pancreatitis. Comparison of ultrasound, intravenous cholangiography, and oral cholecystography.

To evaluate the role of intravenous cholangiography (IVC), ultrasound andoral cholecystography in the diagnosis of gallstone pancreatitis, 20 patients with acute pancreatitis were studied during the first three days of an attack. The IVC successfully demonstrated the common bile duct and gallbladder in 17 (85%) 20 patients. The ultrasound studies showed the gallbladder in all 18 patients in whom the gallbladder was present. The common duct was not seen by ultrasound in any patient and the pancreas was abnormal in all patients. In the three patients with gallbladder stones these were identified on both IVC and ultrasound. Common duct stones in three patients were seen only by IVC (two of these patients had concurrent gallbladder stones and one after cholecystectomy). Oral cholecystography was of limited usefulness, although the 50% visualization rate was higher than the literature suggests.

Acute Disease↗
PubMed1979

Late appearance of intra-abdominal abscesses after total colectomy for inflammatory bowel disease.

Intra-abdominal abscesses after colon surgery usually appear within eight weeks. Over the past few years, we have observed nine patients who underwent colectomy for inflammatory bowel disease in whom large and relatively asymptomatic abscesses developed, requiring surgical drainage as long as three to five years after the operation. In five patients, there was no report of intraoperative complications such as perforation or fecal spillage. At the time of discharge from the hospital, all patients were afebrile. In three of these patients, abscesses were discovered when they were readmitted to the hospital for elective abdominal procedures; most of the others had localized abdominal pain.

Abdomen↗
PubMed1979

Effects of radiation on the human gastrointestinal tract.

Radiation therapy directed at the abdomen may damage the digestive tract, the type and extent of injury depending on the dose of the radiation and the radiation sensitivity of the gut. Characteristic early changes are manifest in the mucosa of the gut: for later ulceration, changes in the collagen tissues and particularly in the vascular channels occur. This paper describes and characterizes injuries to the esophagus, stomach, small intestine and colon. It emphasizes the importance of recognizing radiation-induced damage to the gut which may occur early or late after radiation.

Adult↗
PubMed1979

The outlook after total colectomy in patients with Crohn's colitis and ulcerative colitis.

The postoperative recurrence rates for Crohn's colitis (CC) and ulcerative colitis (UC) have varied markedly in different medical centers. We have reviewed the reasons for this variation and present our own series of patients in a manner which allows comparison with previous studies. In our study: 1) Patients with CC had an overall recurrence rate of 38% after total colectomy. By actuarial statistics, this recurrence rate computes to 48% by 12 years after operation. 2) Patients with ileal disease, even if totally removed at operation, had a recurrence rate of 48% whereas those with no obvious ileal involvement had a recurrence rate of 18%. 3) When nonspecific criteria are used for recurrence, which we call "complication," as has been the case in several previous studies of CC, even patients with UC had a complication rate of 33%. Such complications both in UC and CC represent postoperative occurrence rather than ileal recurrence of the inflammatory process. 4) Patients with CC develop more postoperative complications than patients with UC, but for most of the time they were asymptomatic. In this series there were no patients with disease originally or almost entirely limited to the colon who became "intestinal cripples" as a result of recurrent disease. 5) Patients with short preoperative intervals had the highest recurrence rate, whereas patients with disease of the terminal ileum had the highest postoperative complication rate. 6) Patients with "superficial" CC had a low recurrence rate, probably because of a shorter follow-up than the other patients. There were no true recurrences in patients with UC.

Adult↗
PubMed1979

The first attack of acute pancreatitis: a clinical study.

Acute pancreatitis of biliary tract origin and that of alcoholic origin may be difficult to separate on clinical grounds alone. Such separation is important since operation prevents recurrent attacks in gallstone pancreatitis. We examined the records of 78 patients in the first attack of pancreatitis from gallstones or alcohol. The gallstone group were usually women, older, and had a shorter period of abdominal pain. Pancreatic complications occurred more frequently in the alcoholic group and led to two deaths. Amylase values were diagnostically helpful in that a level greater than 1000 units in patients of the proper age and sex, and a level greater than 2000 units by itself indicated gallstone pancreatitis.

Acute Disease↗
PubMed1979

Diagnostic accuracy of gray scale ultrasongraphy for the jaundiced patient. A report of 275 cases.

This study of cholestatic jaundice suggests that gray scale ultrasonography should precede invasive techniques or surgery. The failure of ultrasound to demonstrate dilated ducts suggests intrahepatic cholestasis. Display of liver parenchyma by ultrasound provided the correct diagnosis of diffuse liver disease in 61% of the cases. Observation of a dilated biliary tree allowed differentiation between intrahepatic and extrahepatic obstruction, with an accuracy of 96.4%. One false positive (0.7%) occurred, and most false negatives were due to gallstones producing intermittent obstruction owing to a ball-valve effect. Observations of normal biliary canaliculi suggest that physiological distention of intrahepatic biliary vessels does not occur. Long-standing obstruction of biliary tree may result in permanent distention despite surgical relief, predisposing the patient to recurrent ascending cholangitis. This stresses the need for early diagnosis and prompt relief of extrahepatic biliary obstruction.

Bile Ducts, Intrahepatic↗
PubMed1978

Borderlands in the diagnosis of regional enteritis: trends in overdiagnosis and value of therapeutic trial.

Our regional experience in the state of Connecticut indicates that Crohn's disease is being overdiagnosed. Six patients with disorders mimicking regional enteritis are presented, one of whom had an atypical clinical course and the remainder had atypical therapeutic responses. The radiologist should be aware of clinical responses and make reassessments if necessary, in order not to overlook surgically treatable conditions.

Adolescent↗
PubMed1978

Cancer of the pancreas: diagnostic accuracy and survival statistics.

We have reviewed the natural history, reliability of diagnosis, and survivorship of 100 patients with adenocarcinoma of the pancreas, in the context of a thorough review of the literature on survival after therapy for adenocarcinoma of the pancreas. There is 40--62.5% error in the histologic confirmation of the diagnosis of pancreatic cancer. The error by inspection and palpation alone at the time of surgery may be as great as 25%. The absolute 5 year survival rate calculated from 61 clinical studies representing approximately 15,000 patients is 0.4%. The best series in the current literature has only 3% 5 year rate based upon the total population of pancreatic cancer patients. 12.3% of 5 year survivors from the world literature did not have curative surgery. This study shows the necessity for standardization of reporting methods. The same patients and survivors should not be used repeatedly in different reports. Some authors who claim the most effective palliation by pancreatic resection have the highest mortality rates.

Adenocarcinoma↗
PubMed1978

Prognosis in children with Crohn's disease.

The course of 86 children with Crohn's disease was examined during a 10-year period between 1966 and 1976. Patients were classified according to the initial site of disease. Ileocolitis was the most (52%) and colitis the least (9%) common form of disease with diffuse small bowel or ileal disease each comprising nearly 20% of the study group. These figures show a reversal from those of a previous decade when 42% of the patients had only terminal ileal disease and 17% had ileocolitis. Children with ileocolitis had the highest number of extracolonic manifestations and operations and required steroid therapy the longest. Those with only small bowel disease (with the exception of duodenal involvement) had fewer extraintestinal symptoms and operations and showed a consistently good response to medical treatment.

Adolescent↗