Biomedical subjects

J C d'Avis

Publications and source records attributed to J C d'Avis.

9 recordsLinked to original sources

PubMed1997

Appendectomy. Improving care through quality improvement.

OBJECTIVE: To evaluate the practice of appendectomy in Department of Defense hospitals worldwide in a large-scale quality improvement initiative. DESIGN: Case series study. POPULATION AND SETTING: A total of 4950 consecutive nonincidental appendectomies performed in 147 Department of Defense hospitals worldwide during a 12-month period ending January 31, 1993. RESULTS: The mean age was 25.5 years, with 64% males and 36% females. The patients were assigned a diagnosis of normal appendix (negative appendectomy) in 632 cases (12.8%), acute appendicitis in 3286 cases (66.4%), and perforative appendicitis in 1032 cases (20.9%). The influence of inpatient and outpatient delays on perforation and negative appendectomy rates were studied. In at least 52% of all patients ultimately assigned a diagnosis of perforative appendicitis, the perforation occurred before the first outpatient contact with the health care system, and in at least 68% of all patients ultimately assigned the diagnosis of perforative appendicitis, the perforation occurred before surgical evaluation and admission. Neither outpatient delay in diagnosis nor inpatient delay in diagnosis and treatment was associated with a significant change in the rate of negative appendectomy. CONCLUSIONS: Perforation rates are determined predominantly by patient- and primary care-related factors over which surgeons have little control. Negative appendectomies are predominantly related to the wide overlap in presenting signs and symptoms between appendicitis and the diseases that most often mimic it but do not require operative intervention. Whereas studies of this type are useful for identifying potential problems at the health care system level, the relatively small number of appendectomies performed by each surgeon precludes analysis at the practitioner level.

Adolescent↗

PubMed1990

Biliary tract melanoma.

A case of melanoma of the upper extremity with a solitary metastasis to the common bile duct is reported. A comprehensive review of melanoma in the biliary tree is presented. Antemortem diagnoses of such cases are rare but are associated with a high percentage of disease clinically confined to the biliary tree. Patients with such lesions have survived long periods of time after palliative surgery. Therefore, surgical resection is recommended as the treatment of choice in patients able to tolerate surgery.

Adult↗

PubMed1988

Long-term followup of penetrating abdominal aortic injuries after 15 years.

Eleven of 14 survivors who sustained trauma to the abdominal aorta have been evaluated 16 to 18 years after injury through personal interview, physical examination, and abdominal contrast computerized tomography (CCT). The average age of survivors was 39 years (range, 37-47). All patients had minimal debridement of the aortic injury with lateral arteriorrhaphy. No patients had symptoms of arterial insufficiency. However, five patients had abnormal ankle/brachial indices (ABI). In four patients, ABI was less than 1.00 at rest and a fifth patient's ABI decreased significantly: 0.60 left and 0.65 right from an average of 1.00 bilaterally after standardized exercise treadmill. CCT evaluation revealed aortic calcification in five patients in the area of aortic injury. Aortic calcification occurred only in the patients with abnormal ABI's. This long-term followup identifies no evidence for late compromise in the aorta; however, there is a suggestion that injury and repair may contribute to the accelerated development of atherosclerosis.

Adult↗

PubMed1986

Spindle cell carcinoma of the breast: case report and review.

Spindle cell carcinoma is a distinct, but unusual, variant of squamous cell carcinoma. It is seen most frequently in the upper aerodigestive tract and esophagus. The natural history seems to be similar to that of the more typical squamous cell carcinoma. A case of spindle cell carcinoma arising from the ductal epithelium of the breast is reported. The light and electron microscopic histology is described. A review of the literature suggests that this rare neoplasm should be managed in a fashion similar to that for more common types of epithelial breast duct malignancies.

Aged↗

PubMed1986

Adult duodenal web associated with reflux esophagitis.

Duodenal webs are the third leading cause of alimentary tract obstruction in infants. They rarely present in adulthood, with 47 cases reported in the literature. These seems to be an association with peptic ulcer disease. They most frequently occur in the vicinity of the ampulla of Vater. A case of adult duodenal web associated with peptic ulcer disease and reflux esophagitis is reported. This appears to be the second reported case associated with significant reflux esophagitis. Etiology, presentation, diagnosis, and management are discussed.

Aged↗

PubMed1985

Mycobacterium avium infection in a silicone-injected breast.

A case of atypical mycobacterial infection (M. avium intracellulare) in a silicone-injection augmented breast is described. The silicone injection may have been a contributing factor to the development of this unusual infection. Disseminated M. avium was present in this patient, with breast involvement being suggested by the rapid appearance and disappearance of localized areas of erythema and tenderness. Aggressive treatment of these breast infections while they are still localized may prevent systemic spread. Conventional incision and drainage of the breast abscess combined with multidrug treatment directed against M. avium is the recommended therapy.

Adult↗

PubMed1985

Heterotopic brain presenting as a cystic neck mass with mandibular deformity.

A congenital cystic neck mass causing respiratory distress and hypoplasia of the mandible was excised from a 3-month-old infant. The lesion was subsequently diagnosed as heterotopic brain, a rare, benign condition that should be considered in the differential diagnosis of the neonatal head and neck mass.

Brain↗

PubMed1984

Paraduodenal hernia: diagnosis and surgical management.

Paraduodenal hernia is an unusual cause of intestinal obstruction, but one with which all surgeons should be familiar. We reviewed the anatomy, pathophysiology, initial symptoms, radiographic criteria for diagnosis, and subsequent therapy of five patients treated for paraduodenal hernia at Walter Reed Army Medical Center. Contrast radiography of the small intestine remains the mainstay of preoperative diagnosis. Essential components of treatment include bowel reduction and obliteration of the hernia defect by simple closure or by wide opening of the sac. Further recommendations include sparing the inferior mesenteric vessels during the repair of left paraduodenal hernias and transpositioning the right colon to the left side of the abdomen for repair of right paraduodenal hernias.

Adult↗

PubMed1983

Intramuscular hemangioma.

In two cases of intramuscular hemangioma of the paraspinous muscles, the tumors were treated with arteriographic embolization followed by immediate local excision. We found that this technique creates a hypovascular surgical field and facilitates the dissection. We believe this approach will decrease morbidity and potential mortality.

Adult↗