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Biomedical subjects

H W Trueblood

Publications and source records attributed to H W Trueblood.

16 recordsLinked to original sources

Clinical presentation of mucin-secreting tumors of the pancreas.

BACKGROUND: Pancreatitis and jaundice secondary to ductal obstruction are common in intraductal papillary mucinous tumors (IPMT) of the pancreas. However, the incidence and severity of the complications of obstruction are not well documented. The aim of the study was to investigate the clinical presentation and outcome of 10 patients with IPMT. METHODS: All cases of IPMT diagnosed between 1994 and 1999 were reviewed. RESULTS: Four of the 10 patients developed severe acute illness with systemic complications resulting from ductal obstruction. Three suffered acute cholangitis with sepsis, and 1 developed necrotizing pancreatitis and ARDS. There was 1 postoperative death in a patient with adenocarcinoma. All other patients are alive and well with a median follow-up of 26 months (survival 90%). CONCLUSIONS: Pancreatic or common bile duct obstruction in IPMT may result in acute, life-threatening disease. Aggressive surgical therapy is warranted before development of complications of ductal obstruction or progression of tumor occurs.

Acute Disease↗

Splenectomy for hypersplenism.

The five-year experience with 75 consecutive splenectomies has been reviewed. Special detail was given to eight critically ill hypersplenic patients. Their diagnoses included Hodgkin's disease, lymphoma, leukemia, myelofibrosis and Felty's syndrome. Three presented with sepsis, two with anemia not responsive to transfusion, three had pathologic bleeding and two could not receive additional needed therapy of underlying disease because of low counts. All cases responded to splenectomy favorably. Hypersplenism is primarily a loss of balance between the splenic destruction-sequestration and bone marrow production. The demonstrated rapid consumption of transfused cells and some degree of functional reserve of the bone marrow is the prerequisite and clue for splenectomy response in critically ill patients.

Adult↗

Aneurysmal rupture following resection of abdominal malignancy.

Four cases of ruptured abdominal aortic aneurysms as a postoperative complication are reported. This represents a 24 per cent mortality for elective operation in patients with known abdominal aortic aneurysm. Three cases followed resection of abdominal malignancy. The possibility exists that subtle trauma during operative manipulation may have heightened the risk of rupture. The risk to life from large abdominal aortic aneurysms (more than 6 cm) exceeds the risk of most malignancies. Abdominal aortic aneurysm should be resected first when co-incidental to a malignancy, unless the malignancy is complicated by hemorrhage, obstruction or perforation.

Abdominal Neoplasms↗