Biomedical subjects
J Y McCullough
Publications and source records attributed to J Y McCullough.
Pneumoperitoneum in infants without gastrointestinal perforation.
Pneumoperitoneum signals gastrointestinal perforation and, as a rule, requires prompt laparotomy. However, we have recently encountered infants with severe respiratory distress who developed pneumoperitoneum without any gastrointestinal leak. These 10 patients were managed without operations. Three patients survived the respiratory distress and subsequently manifested no gastrointestinal disturbances. Five patients who died of pulmonary disease after conservative management of pneumoperitoneum had autopsies that revealed no gastrointestinal disease. We found no clinical or radiographic signs of peritonitis in these patients. Paracentesis and gastrointestinal x-rays revealed no gastrointestinal perforation. These critically ill newborns were thereby spared an unnecessary laparotomy. This experience confirms previous reports in the literature that, by clinical and radiographic correlations, "medical" pneumoperitoneum can often by distinguished from "surgical" pneumoperitoneum in critically ill infants with respiratory distress who may not easily tolerate an unnecessary laparotomy.
Pathophysiology of peptic ulcer disease. Prevailing concepts of ulcer diathesis.
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Hidden impact of the malpractice problem.
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Clinical evaluation of truncal vagotomy performed in a community hospital.
A consecutive personal experience in a community hospital involving 871 operations during a 30 year period indicates that truncal vagotomy provides excellent long term results with minimal mortality. In the surgical management of peptic ulcer disease associated with increased risk not only are highly acceptable results obtained, but also truncal vagotomy and pyloroplasty constitute an effective conservative operation with a decreased morbidity rate and lowest mortality. An over-all mortality of 0.9 per cent and a mortality of 3 per cent in the patients presenting with gross bleeding emphasizes the need for early surgical care of the patient with an actively bleeding ulcer.