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Biomedical subjects

J J Ferrara

Publications and source records attributed to J J Ferrara.

At least 91 records · Page 5Linked to original sources
PubMed1987

Fibromatosis of the breast: a case report and literature review.

Fibromatosis is an uncommon, relatively benign though locally infiltrating neoplasm consisting of well-differentiated fibroblasts surrounded by collagen bundles. The majority of the literature suggests that prevention of local recurrence mandates wide (en bloc) excision. Few more than a dozen cases of primary breast fibromatosis have been reported. Herein the clinical characteristics, diagnostic evaluation, and therapeutic options are presented. Management should be based upon principles utilized for extra-mammary primary disease-en bloc resection. This may require total mastectomy and removal of pectoralis major muscle. Breast reconstruction should be deferred for a minimum of 3 years, during which time the majority of recurrences will have become manifest.

Adult↗
PubMed1986

Preoperative barium contrast enema in patients with inguinal hernia.

Whether patients over age 40 should have a barium contrast enema (BCE) examination for possible identification of an unsuspected colon carcinoma before elective inguinal herniorrhaphy remains an unanswered question. We reviewed the medical records of all patients over age 40 who had inguinal herniorrhaphy at our institution between January 1980 and December 1984. Of 80 patients, 46 received a preoperative barium enema. One asymptomatic colon carcinoma (2.1%) was discovered. The reported incidence of asymptomatic colon cancer found by BCE in association with inguinal hernia ranges from 0 to 2.5%. We conclude that if there is a cause and effect relationship between asymptomatic colon cancer and inguinal hernia, the mechanism is as yet unknown.

Adult↗
PubMed1986

The selective role of endoscopic sclerotherapy in the management of bleeding esophageal varices.

Twenty-one patients (62% Child's C) underwent endoscopic sclerotherapy (ES) to control hemorrhage from esophageal varices. Four patients exsanguinated; bleeding was controlled in the remaining 17 patients (81%). Of this latter group, 14 patients were discharged from the hospital and three patients died from causes other than hemorrhage. A protocol of continued ES was offered to those patients with estimated poor hepatic reserve and to those with excellent reserve who refused portasystemic shunt procedures. During a mean 13 month follow-up of the six patients in this group, rebleeding occurred in two patients (one of whom died). All three patients with excellent hepatic reserve who underwent elective portacaval shunt have suffered neither morbidity nor further hemorrhagic episodes. No significant morbidity related to ES was encountered. ES is recommended in the acute phase of managing all patients with unremittent variceal hemorrhage, and on a continued basis for those with poor hepatic reserve. Patients with excellent reserve should be offered elective portasystemic shunt, accepting the risk of surgical intervention as fair trade-off for its superiority over ES in controlling hemorrhage.

Esophageal and Gastric Varices↗
PubMed1985

Effectiveness of scalene node biopsy for staging of lung cancer in the absence of palpable adenopathy.

Scalene node biopsy (SNB) has been performed in patients with lung cancer at the Saint Francis Hospital and Medical Center if any of the following criteria has been present: (1) potentially resectable central lesion by chest radiograph, or (2) significant cardiac or pulmonary dysfunction, thereby placing the patient at increased risk for thoracotomy, or (3) a diagnosis of adenocarcinoma prior to SNB. Within these guidelines, a retrospective study was undertaken to determine the benefit of routine SNB in the absence of clinically palpable scalene nodes. In a 2-year period beginning April 1981, 56 patients (37 males) presented with radiographic evidence of lung carcinoma without clinical evidence of scalene adenopathy. Approximately half of the lesions were of a central position. While the majority had symptoms of cough, hemoptysis, or chest pain, the primary lung lesion was identified on routine chest radiograph in 15 (27%). In only three was there no history of smoking, the remainder having at least a 20-pack-year history of cigarette use. Following a routine evaluation, 57 SNBs were performed alone or in concert with other surgical procedures (mediastinoscopy, bronchoscopy). Of these, only two (3.5%) were diagnostic and indicative of unresectable disease. While in one patient no additional procedure was performed, a simultaneous Chamberlain procedure in the other confirmed that the patient was unresectable for cure. In the remaining patients, tissue diagnosis of cancer was obtained through other maneuvers. Because of the low probability that SNB in the absence of clinically palpable nodes altered the management of lung cancer, we do not believe it to be of benefit in the diagnosis or staging of this disease.

Adenocarcinoma↗
PubMed1985

Evolving changes in the pathogenesis and treatment of the perforated gallbladder. A combined hospital study.

Perforation of the gallbladder occurred in 35 patients in this 6 year review, with a 2.3:1 male predominance in contrast with a female dominance in nonperforated acute cholecystitis. Thirty-three percent of patients with gallstones had a history of symptomatic cholelithiasis which emphasizes that if elective cholecystectomy had been performed, this complication could have been avoided. Further, a large number of cases (40 percent) were found to be of the acalculous variety which suggests a possible changing trend in the pathogenesis of perforated gallbladder. Cholecystectomy with intraoperative cholangiography and adequate drainage appears to be the procedure of choice, and aggressive operative intervention without delay is thought to contribute to the relatively low mortality of 8.6 percent in this series.

Adult↗
PubMed1985

Preoperative serum creatinine as a predictor of survival in perforated gastroduodenal ulcer.

Factors affecting survival were retrospectively analyzed in 89 patients (50 men) operated upon for perforated peptic ulcer. Mean age was 52 years. Only 18 per cent had no history of significant medical illness; almost 26 per cent were termed immune suppressed from high-dose steroid therapy or the presence of diffuse, metastatic cancer. The estimated interval between perforation and operation was over 24 hours in one-third. Preoperative serum creatinine, determined in 83 patients, ranged from 0.1 to 6.4 mg/dl (mean, 1.5 mg/dl); no patients were dialysis-dependent. At celiotomy, 75 per cent underwent ulcer plication only; the remainder had a definitive acid reduction procedure. Stepwise logistic regression analysis revealed that a normal preoperative serum creatinine (less than 1.5 mg/dl) was the most powerful predictor of survival (P less than 0.00001), followed by absence of immune suppression, and age under 60 years. The interval between perforation and operation, the site of perforation, and the type of operation did not statistically affect survival.

Adolescent↗
PubMed1982

Surgical management of pancreas divisum.

Pancreas divisum is a congenital anatomic variant characterized by nonunion of dorsal and ventral pancreatic ducts in an otherwise fused pancreas. Of 21 patients with divisum documented by endoscopic retrograde cholangiopancreatography, 6 (28 percent) were found to have no reason other than divisum to account for multiple attacks of pancreatitis. Cholelithiasis was present in one patient, who remains free of recurrent pancreatitis after cholecystectomy only. The remaining five patients underwent surgical treatment directed at pancreas divisum in the belief that stenosis of the duct of Santorini at the entrance into the duodenum is responsible for recurrent attacks of pancreatitis. Four of five have done well with follow-up of 12, 13, 18 and 28 months. Successful sphincteroplasty of the duct of Santorini appears to prevent recurrent attacks of pancreatitis due to pancreas divisum. Pancreaticojejunostomy is reserved for those with markedly dilated ducts secondary to chronic pancreatitis.

Acute Disease↗
PubMed1982

Morbidity of emergency operations in patients with metastatic cancer receiving chemotherapy.

During a 5-year period, 21 patients with metastatic cancer receiving chemotherapy for periods ranging from 2 months to 5 years have required emergency abdominal operations. Symptoms in 15 indicated perforated viscus, whereas six developed massive, unremitting hemorrhage. All were operated upon with the sole intent of correcting the life-threatening problem, and every attempt was made to maintain or normalize physiologic parameters postoperatively. Despite this, 51 major complications occurred in 19 patients, and 17 died in the immediate postoperative period, 11 following multiple systems failure. Two died within 1 month of transfer to another hospital nearer home. A single patient lived 5 months at a nursing facility. The only survivor is living in a complete state of remission 9 months after discharge. No distinguishing features that might preoperatively predict which patient might survive emergency operation were found. The monetary cost of returning the sole survivor to society was over $500,000, discounting the emotional expenditure required of patients, families, and hospital staff. The dilemma the surgeon faces in making therapeutic decisions regarding such patients requires careful weighing of realities and the willingness to assume responsibility for the best possible choice in order to free the patient and family from agonizing deliberations.

Abdomen, Acute↗
PubMed1981

Endoscopic retrograde cholangiopancreatography. Its use in the evaluation of nonjaundiced patients with the postcholecystectomy syndrome.

Forty-two patients with the postcholecystectomy syndrome were studied by endoscopic retrograde cholangiopancreatography (ERCP). Both the biliary ductal system and pancreatic duct were well visualized in all patients. The ERCP was abnormal in 22 patients (52%). Abnormal findings included choledocholithiasis, papillary stenosis, pancreas divisum, pancreatic carcinoma, sclerosing cholangitis, incomplete cholecystectomy, and chronic pancreatitis. The results of one or more standard liver function tests and/or other noninvasive tests were abnormal in 36 patients; however, none reliably predicted the presence or specific anatomical type of pancreaticobiliary tract disease. Our data indicate that ERCP is essential in the diagnosis and management of the postcholecystectomy syndrome. The high yield of abnormal findings amenable to surgical correction in patients with recurrent biliary tract symptoms following cholecystectomy justifies the use of this procedure in all such patients.

Adult↗
PubMed1981

Endocrine ablation in breast cancer patients who have failed cytotoxic therapy.

Between 1972 and 1979, forty-six women underwent endocrine ablative surgery, having failed combinations of chemotherapy, radiation, and surgery (including oophorectomy). All had clinically measurable disease; nearly half were afflicted with bone pain. Each was judged to be a candidate for the procedure by estrogen receptor studies (52%), response to L-dopa (39%), or response to prior oophorectomy (8%). All were followed to their death or to the present, with a minimum of 12 months for those alive. Thirty-one (67%) were improved, and disease was arrested in five (11%) for a median time of 13.5 months. There was no difference in response rates or intervals between estrogen receptor-positive and L-dopa-positive groups. Response was not correlated with disease-free interval or menopausal status. Best results were achieved in those with metastases confined to an organ system, particularly the skeletal complex. The procedure is withheld in those with brain metastases. Postablative chemotherapy appeared to prolong the control interval, though numbers are small. The low morbidity and mortality (one death) of midline adrenaloophorectomy combined with the high incidence of recapture of disease leads us to recommend this procedure in appropriately selected patients who have previously failed other therapeutic modalities.

Adrenalectomy↗
PubMed1981

Idiopathic acute pancreatitis: the value of endoscopic retrograde cholangiopancreatography.

Acute pancreatitis is classified as idiopathic when an underlying cause cannot be identified through a careful history and appropriate noninvasive tests. Unless a cause can be identified, recurrent attacks cannot be effectively prevented. Endoscopic retrograde cholangiopancreatography (ERCP) was performed in 35 patients considered to have idiopathic recurrent acute pancreatitis, and an anatomic abnormality of either the pancreatic or biliary ductal system was demonstrated in 16. Ten underwent appropriate surgical procedures based on the results of ERCP, and 80% had no further episodes of acute pancreatitis. ERCP established the precise nature of potentially correctable anomalies and thereby facilitated precise preoperative planning. The wider use of ERCP in these patients may lessen the number of cases of acute pancreatitis considered to be idiopathic and lead to appropriate surgical therapy.

Acute Disease↗
PubMedDate not supplied

Dopexamine maintains mesenteric blood flow during systemic hypoxemia in the neonatal piglet.

In adults, dopexamine is a specific dopaminergic and Beta2-adrenergic agonist; its effects in neonates are unknown. Ultrasonic flow probes were placed around the ascending and descending aorta and cranial mesenteric artery of 0- to 2-day-old and 2-week-old piglets. Animals of each age group (9 to 14 per group) were subjected to (1) dopexamine infusion (5 microg/kg/min); (2) 30 minutes of hypoxia (inspired oxygen content 0.12) followed by 30 minutes of reoxygenation; and (3) dopexamine infusion during hypoxia and reoxygenation. In both age groups dopexamine alone increased ascending aorta blood flow (cardiac output minus coronary artery blood flow), mildly decreased mean arterial pressure, and increased cranial mesenteric artery blood flow. Compared to baseline values, 30 minutes of hypoxia produced significant (P <0.05, analysis of variance) decreases in cranial mesenteric artery blood flow in 0- to 2-day-old (58 +/- 13 ml/min vs. 30 +/- 8 ml/min) and 2-week-old (125 +/- 18 ml/min vs. 60 +/- 11 ml/min) piglets. In all cases blood flow returned to baseline values after reoxygenation. In both animal groups treated with dopexamine before hypoxia, the decreases in cranial mesenteric artery blood flow were eliminated (47 +/- 5 ml/min vs. 44 +/- 6 ml/min in 0- to 2-day-old piglets; 140 +/- 27 ml/min vs. 117 +/- 18 ml/min in 2-week-old piglets). Dopexamine may prove to be of clinical benefit when neonates are threatened by hypoxemia-induced decreases in intestinal blood flow.

Adrenergic beta-2 Receptor Agonists↗