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Biomedical subjects

J R Pickleman

Publications and source records attributed to J R Pickleman.

10 recordsLinked to original sources
PubMed1976

Surgical significance of extrahepatic biliary tree anomalies.

A patient with an anomalous insertion of the right hepatic duct into the cystic duct was noted during cholecystectomy and confirmed by operative cholangiography. This case and related anomalies of the bile ducts are of sufficient importance that, because of the technical difficulties and dangers incidental to their presence, no surgeon who operates on the gallbladder and bile ducts can afford to be unaware of their existence. Adequate exposure, careful dissection, and accurate knowledge of the regional anatomy plus a realization of the frequency and multiplicity of abnormalities of the extrahepatic biliary tree are requisites for safe biliary tract surgery. In addition, carefully performed operative cholangiography can be an indispensable aid in the clarification of anatomic variations. In case of recognized operative injury to the extrahepatic biliary tree, primary repair or biliary-intestinal anastomosis can usually be carried out with good results.

Bile Ducts↗
PubMed1976

Anaerobic mediastinitis.

Three patients with anaerobic mediastinitis associated with retropharyngeal abscess have been encountered recently. Dental infections accounted for two instances, and the third instance resulted from rupture of the thoracic esophagus from blunt trauma. Each was marked by extreme difficulty in achieving complete abscess drainage due to the initially unrecognized virulence of the causative anaerobic bacteria. Complications were frequent and included empyema, pericarditis and aspiration pneumonia. The combination of vigorous diagnostic efforts, prompt operation and reoperation when necessary plus specific antibiotic effective against anaerobes led to a successful outcome for each patient.

Abscess↗
PubMed1976

Rapid roentgenologic diagnosis of acute cholecystitis.

A rapid and safe method of roentgenographic evaluation of the acutely inflamed wall of the gallbladder, infusion tomography of the gallbladder, was performed 146 times, and the correlation with 67 subsequent cholecystectomies was reviewed. If the results of infusion tomogram of the gallbladder are abnormal, the gallbladder is diseased; if acute cholecystitis is present, the results of the examination will be abnormal in 96 per cent; if results of the infusion tomogram of the gallbladder are normal, the results are questionable, and oral cholecystography should be performed to evaluate the condition further. If the results of a repeat dosage oral cholecystogram are abnormal, the gallbladder probably is diseased, even if the results of an infusion tomographic examination of the gallbladder are normal.

Acute Disease↗
PubMed1975

Thyroid hemangioma.

A case is presented of a fifty-six year old man with a thyroid hemangioma presenting as a neck mass with tracheal deviation and unilateral vocal cord paralysis. A standard thyroid scan yielded equivocal findings. The diagnosis was determined preoperatively by the use of a 99m-technetium angiogram that disclosed the vascular nature of the lesion. Subsequent arteriography demonstrated the main arterial supply of the mass to be from both inferior thyroid arteries. Operative removal of the mass was accomplished through a standard transverse cervical incision. Pathologic study revealed that the vascular tumor involved both the surrounding normal thyroid parenchyma and also a microfollicular adenoma. This case points out the value of utilizing all available diagnostic means in atypical cases of thyroid disease.

Angiography↗