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Biomedical subjects

J J Peck

Publications and source records attributed to J J Peck.

12 recordsLinked to original sources
PubMed1999

The role of computed tomography with contrast and small bowel follow-through in management of small bowel obstruction.

BACKGROUND: In a significant percentage of patients, radiologic evaluation other than plain abdominal films are required to confirm or exclude the presence of small bowel obstruction. METHODS: Over a 1-year period, 55 patients had both computed tomography and small bowel follow-through studies. Patients were classified as having (1) paralytic ileus, (2) low-grade obstruction, (3) high-grade obstruction, or (4) complete mechanical obstruction. The gold standard for diagnosis was celiotomy in 42 patients and clinical follow-up in 13 patients. RESULTS: Thirty-six out of 42 patients had proven intestinal obstruction at the time of celiotomy. Computed tomography identified 32 out of the 36 high-grade and complete mechanical obstructions. Computed tomography was superior to small bowel follow-through in identifying masses, malignancies, and features of strangulation. Small bowel follow-through correctly identified "insignificant obstructions" when contrast reached the cecum within 4 hours in 18 of 19 patients. CONCLUSIONS: In patients with equivocal findings of small bowel obstruction, computed tomography should be used initially and then small bowel follow-through if computed tomography is not diagnostic. Computed tomography was superior in this study for detecting the cause of the intestinal obstruction and presence of strangulation.

Adolescent↗
PubMed1992

Aortoenteric fistulas.

During an 11-year period ending in December 1991, 36 patients with aortoenteric fistulas were assessed and treated. Twenty-five patients (69%) had previously undergone aortic reconstruction with Dacron grafts, and 11 (31%) had spontaneous aortoenteric fistulas. Of the 25 patients with secondary fistulas, 14 (56%) had undergone aortic aneurysmal rupture or multiple aortic vascular reconstructions. Preoperative diagnosis was established in only 13 (36%) of 36 patients. Remote bypass preceding removal of the infected arterial prosthesis had the least morbidity and mortality. Three primary fistulas were found in unusual locations: aortocolonic, aortobronchial, and aortoesophageal. The patient with the aortoesophageal fistulas was the fifth survivor described in the literature. The overall mortality was 56%. A positive preoperative blood culture predicted a poor outcome. There were four amputations, there due to infection of the extra-anatomical bypass. Prompt directed assessment to ensure appropriately staged operative intervention should improve survival.

Aged↗
PubMed1990

Popliteal vascular trauma. A community experience.

Preventing amputation continues to be a significant challenge when popliteal vascular injuries occur. A retrospective review of cases from the San Diego County (California) Trauma System identified 108 patients with 76 blunt and 32 penetrating arterial injuries. The limb preservation rate was 88%; there were 13 amputations. The fracture-dislocated knee injury and close-range shotgun blasts were particularly limb threatening. In general, the trauma system achieved rapid evaluation of injuries and early operative intervention. All 13 patients who underwent amputations presented with signs of severe ischemia. Concomitant injuries to the popliteal vein, tibial nerves, and soft tissue were significantly more frequent in patients who underwent amputations. The importance of complete fasciotomy for compartment hypertension, early reconstructive management of soft-tissue injuries, and expeditious arterial repair, frequently without preoperative roentgenographic suite arteriography, is emphasized. An aggressive, multidisciplinary approach is required to achieve a functional extremity when popliteal vascular trauma occurs.

Adolescent↗
PubMed1988

Management of carcinoma discovered unexpectedly at operation for acute appendicitis.

This review of 900 patients who underwent colon resection for carcinoma identified 33 patients who were explored with the preoperative diagnosis of appendicitis. In 19 patients, the appendix was acutely inflamed secondary to obstruction of the appendiceal lumen. The other 14 patients had perforating or obstructing cancer of the ascending colon or cecum. The clinical clues of a prolonged symptom history, weight loss, anemia, and a palpable mass were frequently, but not invariably, present. Results of contrast enema, computerized axial tomography, and colonoscopy in this select group were frequently misleading. The diagnosis is best made in the operating room by the thoughtful appendectomist. I recommend prompt resection and an appropriate cancer procedure in these patients. Carcinoma masquerading as appendicitis occurs more often than is generally realized and will be seen more frequently as our aging population increases.

Adult↗
PubMed1986

Extraperitoneal approach for aortoiliac reconstruction of the abdominal aorta.

The extraperitoneal approach is not usually used for reconstruction of the abdominal aorta; however, herein we have made an attempt to influence vascular surgeons to modify this practice. The results in 200 patients approached extraperitoneally have been compared with those of 70 patients explored by the traditional transperitoneal route. The expeditious technique of extraperitoneal exploration described results in significantly less postoperative morbidity due to the pulmonary complications of atelectasis and pneumonia. Intestinal ileus is uniformly brief, and rarely requires nasogastric suction. Patients explored extraperitoneally have demonstrably less pain and were discharged from the hospital sooner. Furthermore, prosthetic graft patency and mortality were comparable in both groups. Thus, the retroperitoneal approach should be the preferred method of aortoiliac reconstruction since the postoperative convalescence period is smoother and shorter.

Aged↗
PubMed1985

Exigent ileostomy hemorrhage. A complication of proctocolectomy in patients with chronic ulcerative colitis and primary sclerosing cholangitis.

The Portland experience with patients requiring proctocolectomy for chronic ulcerative colitis in association with primary sclerosing cholangitis has been reported. Nineteen patients had conventional ileostomy reconstruction, 5 of whom had development of stomal varices with recurrent hemorrhage due to cirrhosis and portal hypertension. When this combination of conditions exists, the therapeutic options must be carefully weighed. Perhaps ileal pouch to anal anastomosis should be considered when proctocolectomy becomes mandatory. Ileostomy is presently a contraindication to liver transplantation. In patients with ileostomies, control of hemorrhage by local measures, including ileostomy revisions, proved to be of only temporary value, yet it should be the preferred management of patients with a severely limited life expectancy. Successful shunts directed at portal decompression have always prevented further ileostomy hemorrhage, however, they have commonly accelerated liver failure and thus death. Furthermore, such shunts seriously complicate liver transplantation if it is considered.

Abdominal Muscles↗
PubMed1984

Antimicrobial prophylaxis in elective colon surgery. Experience of 1,035 operations in a community hospital.

An 11 year study of 1,035 elective colon resections reaffirmed the value of oral antibiotic prophylaxis. Five antibiotic regimens were used in 88 percent of the patients. The most effective and most frequently used regimen was the combination of parenteral cephalosporin with oral erythromycin and an aminoglycoside. The overall infection rate with this regimen was 11 percent and the wound sepsis rate was 2.5 percent. The use of parenteral cephalosporins alone was not effective. Furthermore, resistant bacteria were cultured from the wound infections of parenteral cephalosporin patients. A nondirective annual review of these data and each surgeon's infection rate resulted in a change in the antibiotic ordering practices and decreased infection rates. It is no longer acceptable surgical practice to omit antibiotic prophylaxis in colon operations.

Abscess↗
PubMed1983

Devastating distal arterial trauma and continuous intraarterial infusion of tolazoline.

Trauma due to motor vehicles accident and urban violence have made distal arterial reconstruction an increasingly important part of the surgeon's work. During the 20 month period from October 1980 to May 1982, 13 patients with below the knee and 2 patients with forearm trauma had nonviable extremities despite fastidious vascular and orthopedic reconstruction. A continuous intraarterial infusion of tolazoline into the femoral or brachial arteries restored vascular perfusion and viability in 13 of 15 patients (87 percent), with eventual limb salvage in 67 percent. Seven of 15 patients (47 percent) had transient systemic hypertension. There was no mortality. There exists in patients with these catastrophic injuries a local low-flow state due to a combination of distal arterial spasm and venous outflow obstruction. Tolazoline, a peripheral alpha-adrenergic blocking agent, increases blood flow, albeit nonnutritionally, and thus theoretically prevents thrombosis due to stasis in the repaired distal vessel. When limb loss seems inevitable, a trial of intraarterial tolazoline is justified.

Accidents, Traffic↗
PubMed1983

Carcinoid tumors of the ileum.

Thirty patients with carcinoid tumors of the ileum over a recent 10-year period have been analyzed. Seventeen patients were symptomatic and 13 others were found to have tumors incidentally at autopsy or celiotomy. Patients with symptoms almost invariably had metastatic disease, yet preoperative diagnosis was rarely achieved. Arteriography in five patients with intestinal angina demonstrated encasement, kinking, and irregularity of mesenteric branches due to nodal metastasis. In five patients, each with liver metastasis, the classic carcinoid syndrome developed. Multiple primary carcinoid tumors were found in 9 of 30 patients (30 percent); 14 had an associated second malignant neoplasm (47 percent), most frequently colorectal carcinoma. En block surgical excision was the only effective therapy. Despite a prolonged natural history, the 5-year actuarial survival rate from the date of diagnosis was only 31 percent.

Adult↗
PubMed1982

A case of neuroleptic malignant syndrome successfully treated with amantadine.

A paranoid schizophrenic patient developed the neuroleptic malignant syndrome after receiving three doses of fluphenazine HCl and two doses of thioridazine while he was recovering from major trauma. Treatment with diphenhydramine and benztropine mesylate was ineffective. Administration of amantadine HCl resulted in resolution of all symptoms within 24 hours. After 2 days, the amantadine was discontinued. The following day, the neuroleptic malignant syndrome appeared. Readministration of amantadine again resulted in prompt remission of symptoms.

Adult↗
PubMed1981

Posterior abdominal stab wounds.

Selective management of 465 patients with stab wounds limited to the posterior abdomen is reviewed. Celiotomy was based primarily on clinical findings. Tenderness not localized to the area of injury and absent or rare bowel sounds best identified patients with serious injuries. Peritoneal lavage and local wound exploration were used infrequently. All fatally injured patients were operated upon or expired within 5 hours of admission. Diagnosis was delayed in three serious injuries: one retroperitoneal colon perforation, and two diaphragmatic lacerations. The colonic and one diaphragmatic injury were identified and treated successfully in the initial hospital admission. The other diaphragmatic hernia was repaired uneventfully 3 months after injury. Eight per cent of the patients never required surgery. Fourteen per cent had significant organ injury. The flank was more vulnerable than the back. The colon was the most common organ injured. Six per cent had "nonessential' celiotomies. The overall morbidity was 11%, and mortality rate, 1.1%. Selective management of posterior abdominal stab wounds is a prudent and reliable approach.

Abdominal Injuries↗