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Biomedical subjects

M A Adson

Publications and source records attributed to M A Adson.

At least 19 recordsLinked to original sources
PubMed1992

Perioperative blood transfusion and determinants of survival after liver resection for metastatic colorectal carcinoma.

The authors reviewed their institutional experience with liver resection for metastatic colorectal carcinoma to (1) determine whether perioperative blood transfusion affects survival; (2) identify prognostic determinants; and (3) estimate the patient requirement for a prospective randomized trial designed to demonstrate efficacy of liver resection. Two hundred eighty consecutive patients treated by potentially curative liver resection between 1960 and 1987 were included. Data were obtained for all but 10 patients for at least 5 years after operation or through 1990. Actuarial survival curves related to potential prognostic determinants were analyzed with the log-rank test. Overall, survival was 47 +/- 3% at 3 years and 25 +/- 3% at 5 years, including 4% 60-day operative mortality rate. Eighty-one patients who did not receive blood 7 days before to 14 days after operation had 60 +/- 6% 3-year and 32 +/- 6% 5-year survival compared with 40 +/- 4% and 21 +/- 3% survival rates for 183 patients who received at least one unit (p = 0.03, operative deaths excluded). Extrahepatic disease (p = 0.015), extrahepatic lymph node involvement (p = 0.002), satellite configuration of multiple metastases (p = 0.0052), and initial detection by abnormal liver enzymes (p = 0.0005) were associated with poor survival rates. Synchronous presentation of metastatic and stage B primary disease was associated with a favorable prognosis (p = 0.003). The requirement for a prospective randomized trial estimated by an exponential survival model would be 36, 74, 168, or 428 patients if 5-year survival without resection were 1, 5, 10, or 15%. We conclude that (1) perioperative blood transfusion may be adversely associated with survival; (2) extrahepatic disease, extrahepatic lymph node involvement, satellite configuration, and initial detection by clinical examination or a liver enzyme abnormality portend a poor prognosis; and (3) a prospective randomized trial of liver resection is impractical because of the large patient requirement, at least by a single institution.

Aged↗
PubMed1992

Intrahepatic cholangiocarcinoma: clinical aspects, pathology and treatment.

Intrahepatic cholangiocarcinoma (ICC) is the second most common primary tumor of the liver. To further define its clinicopathology and surgical management, we reviewed our experience. Clinical presentations of 32 patients with ICC was similar to that with hepatocellular carcinoma. Jaundice occurred in only 27 percent. ICC was unresectable due to advanced disease stage in 81 percent. Six patients had curative resections with two 5 year disease free survivors. Underlying liver disease was associated with ICC in 34 percent of patients.

Adenoma, Bile Duct↗
PubMed1990

Carcinoma of the gallbladder. Does radical resection improve outcome?

The records of 111 patients with gallbladder carcinoma operatively treated between 1972 and 1984 were retrospectively reviewed. Fifty-seven percent of patients had distant metastases; another 16% had nodal metastases without distant disease. Median survival was 0.5 years, and 5-year survival was 13%. Clinical jaundice, tumor stage, and tumor grade were all predictive of patient outcome. DNA ploidy, measured in 70 patients, was not a prognostic indicator. In 36% of patients, cholecystectomy (20%) or radical cholecystectomy (16%), which included adjacent liver and regional lymph node resection, was potentially curative. Median survival for patients undergoing radical procedures was 3.6 years, and survival was 0.8 years for patients following cholecystectomy. The 5-year survival rates were comparable (33% vs 32%). While radical cholecystectomy may benefit individual patients and can be accomplished with low morbidity, there was no overall survival advantage compared with cholecystectomy.

Adult↗
PubMed1979

Biliary decompression in hilar obstruction. Round ligament approach.

In some patients with biliary obstruction, access to the hepatic hilus is hindered by extensive tumor or by dense vascular scar tissue. In such patients, the biliary tract may be decompressed via the left hepatic duct away from the affected hilus. Access to the left hepatic duct in the left intersegmental plane is gained by dividing the round ligament, freeing it from the undersurface of the liver, and following it to its junction with the left portal vein. The left hepatic duct, which lies superior to the vein, is exposed by dividing the liver overlying the round ligament in the relatively avascular plane between the lateral and the medial segments of the left hepatic lobe. Decompression can be effected by simple tube drainage or, if the duct is large enough, by Roux-en-Y hepaticojejunostomy.

Biliary Tract Diseases↗
PubMed1979

Surgical treatment of pancreatitis: review of a series.

In this review of the surgical experience with pancreatitis, 55 patients had acute relapsing pancreatitis associated with gallstones and 47 had chronic pancreatitis of alcoholic, idiopathic, or familial causation. The severity of pancreatitis associated with gallstones could not be correlated with results of preoperative biochemical tests; only one-third of patients were found to have stones within the biliary ductal system; and postoperative mortality (5%) could not be correlated with the severity of pancreatic inflammation or the timing of surgical intervention. Postoperative observations have revealed that all but four of the patients have remained asymptomatic. With regard to the patients with alcoholic, idiopathic, or familial disease who had significant pancreatic ductal dilatation or obstruction, ductal drainage procedures with or without resection benefited 80%. In the absence of ductal dilatation or obstruction, major resective surgery benefited 50% of patients. Continuing alcohol abuse limited the effectiveness of any operative procedure, and diabetes occurred more often after major resective procedures.

Alcoholism↗
PubMed1978

Misdiagnosis of atrial septal defect in patients with hereditary telangiectasia (Osler-Weber-Rendu disease) and hepatic arteriovenous fistulas.

Two patients with hereditary telangiectasia (Osler-Weber-Rendu disease) and high-output congestive heart failure secondary to large hepatic arteriovenous malformations had preoperative heart catheterization and exploratory cardiotomy to correct presumed intracardiac left-to-right shunts at the atrial level. At operation, both patients had oxygen-enriched blood returning from the inferior vena cava. Subsequent hepatic angiography demonstrated large hepatic arteriovenous fistulas, and both patients underwent hepatic artery banding and ligation, with reduction of left-to-right shunting.

Adult↗
PubMed1978

The surgical aspects of chronic mucosal inflammatory bowel disease (chronic ulcerative colitis).

The surgical aspects of chronic mucosal inflammatory bowel disease were reviewed by comparing the experience at our institution between two periods, one a decade later than the other (1961-1965 and 1971-1975). The striking findings were a marked decrease in the incidence of carcinoma and toxic megacolon and a marked increase in use of one-stage proctocolectomy with either Brooke ileostomy or Kock pouch. There was, in addition, a corresponding decrease in the operative mortality for elective cases, from 2.4 to 1.3%; yet the operative mortality for emergency cases remained relatively stable at about 25%. The reason for the decrease in the incidence of carcinoma and toxic megacolon appears to be on the basis of selection outside of our institution, in that fewer of these cases are being referred.

Adult↗
PubMed1978

Radionuclide image patterns of hepatic metastasis and pyogenic abscess: difficulties in differential diagnosis.

A case of hepatic metastasis with a clinical differential diagnosis of amebic and bacterial abscess is presented. Hepatic scanning with 67Ga-citrate did not diagnostically differentiate the lesion. Hepatic arteriography combined with a therapeutic trial of metronidazole proved useful in defining the lesion. An understanding of the pathophysiologic process involved in 67Ga scanning of hepatic lesions suggests a non-invasive method of discriminating among these clinical diagnostic possibilities.

Adenocarcinoma↗
PubMed1977

Radical pancreatoduodenectomy for cancer of the papilla of Vater.

Over a 22-year span, 87 patients with carcinoma of the papilla of Vater underwent radical pancreatoduodenectomy. No patient was lost to follow-up, and extended observation was possible in most cases: the definitive operation was at least five years earlier than this study in 87% and at least ten years earlier in 73%. Operative mortality was 11.5% among patients who had a single definitive operative procedure and 15.4% among those whose treatment involved reoperation after prior exploration elsewhere. Overall survival rates at two, five, and ten years were 56%, 34%, and 20% respectively. Factors associated with favorable survival were histologic differentiation (Broders grades 1 and 2), absence of nodal metastasis, and papillary histologic characteristics. Noteworthy is the fact that no patient having resection of an undifferentiated carcinoma (Broders grade 3 or 4) survived four years.

Adenocarcinoma, Papillary↗
PubMed1977

The ileal stoma and protal hypertension: an uncommon site of variceal bleeding.

Patients who have chronic ulcerative colitis coexisting with liver disease and portal hypertension may suffer hemorrhagic parastomal varices after proctocolectomy and ileostomy. Large portal systemic collateral vessels between the superior mesenteric venous tributaries and the abdominal wall can be demonstrated by portal venography. Hemorrhage occurs from the mucocutaneous junction, a vulnerable point in this collateral circuit. Management by major and minor stomal revisions has been unsuccessful. Three patients who have bled from stomal and from esophagogastric varices were treated with portasystemic shunts. None of the three has had recurrent bleeding or postshunt encephalopathy during the 19 to 27 months after these operations.

Adult↗
PubMed1977

Stromal invasion of cancer in pedunculated adenomatous colorectal polyps: significance for surgical management.

Fifty-three patients were treated for pedunculated adenomatous polyps that contained foci of invasive cancer confined to the stroma. This entity is a stage of malignant involvement intermediate between in situ carcinoma and frank infiltrative cancer that invades the muscularis mucosae. Metastases to regional lymphatics were not observed. Local removal of such lesions without regional lymphadenectomy is adequate treatment.

Adenocarcinoma↗
PubMed1977

Regression of renal cell hepatic metastasis following removal of primary lesions.

Although spontaneous regression of metastatic renal cell carcinoma occurs it is so uncommon that it should not be considered the primary basis for recommending removal of the asymptomatic primary lesion. Such a recommendation should be made when other treatment modalitis are available to augment the factors influencing the patient-tumor interface. Spontaneous regression of a documented solitary liver metastatic lesion is reported. Removal of the residual hepatic lesion failed to prolong the patient's life.

Adenocarcinoma↗
PubMed1976

Surgical treatment of hepatic metastases from colorectal cancers.

Follow-up data covering periods of two to 23 years have been collected on 60 patients who had resection of hepatic metastases for colorectal cancer. Multiple lesions were removed from 20 patients, and solitary lesions were excised from the other 40 patients. Only one patient died during hospital convalescence. No patient who had multiple lesions excised lived for five years. In contrast, 15 of the 36 patients eligible for five-year survival study who had resection of apparent solitary lesions lived for five years or more, and eight patients were alive without evidence of recurrence ten years or more after operation. These surprisingly favorable results of surgical treatment were analyzed in relation to results in patients who had biopsy specimens taken of lesions of comparable size and number, but no removal at the time of colonic resection. No patient in this control group lived for five years. Aggressive surgical treatment of apparent solitary hepatic metastatic lesions from colorectal cancer seems to be justified by the survival rate of surgically treated patients.

Adult↗
PubMed1976

Patterns of total and ionized calcium and other electrolytes in plasma during and after general surgery.

Thirteen patients were studied during two hours of anaesthesia for abdmonial operations and for an hour post-operatively. Serial venous blood samples were taken for determination of plasma total and ionized calcium, acid-base variables, Na, K, Mg, PO4 total proteins and parathyroid hormone. One group of patients received 5 per cent dextrose/water and the other 5 per cent dextrose in Ringer's solution, at 250 ml per hour. Total and ionized calcium levels decreased toward the end of operation and an hour later, associated with respiratory alkalosis. Parathyroid hormone increased at the end of operation, as an effect of the decreased ionized calcium. The general effect was mild haemodilution with all the other electrolytes decreasing, as did total protein concentration.

Adult↗
PubMed1976

Pantothenic acid, coenzyme A, and human chronic ulcerative and granulomatous colitis.

To investigate further an apparent relationship between chronic ulcerative and granulomatous colitis and pantothenic acid deficiency, colonic tissues obtained at the time of colectomy in 29 patients with these disorders were assayed for pantothenic acid and for coenzyme A (CoA) activity. For comparison, normal colonic tissues free of pathological lesions were obtained from 31 patients having colectomy for carcinoma or diverticulitis. Plasma, red blood cells, and colonic mucosa were assayed microbiologically for free and total pantothenic acid. The activity of CoA in colonic mucosa was determined by assaying the acetylation of sulfanilamide. Concentrations of free, bound, and total pantothenic acid in blood and in colonic mucosa did not differ between the two groups of patients. Bound pantothenic acid increased linearly with total pantothenic acid. Colonic mucosa concentrated free pantothenic acid to about 50 times the level of blood, and pantothenic acid in red cells was similar to the concentration in plasma. Compared to normal gut mucosa, CoA activity was markedly low in mucosa from patients with chronic ulcerative or granulomatous disease despite the presence of normal amounts of free and bound pantothenic acid. A block in the conversion of bound pantothenic acid to CoA in diseased mucosa is suggested.

Adult↗
PubMed1975

Conventional splenorenal shunts. A reconsideration.

From 1961 to 1971, 73 central splenorenal and 66 portacaval shunts were done for cirrhotic patients who had bled from esophageal varices. Comparative analysis revealed low (3% and 2%, respectively) operative mortality for elective operations, equal (93%) effectiveness in control of variceal bleeding, but substantial diferences in the incidence of postshunt encephalopathy. For patients who had mimal hepatic dysfunction before operation, disabling disorders in mentation developed in 5% of patients who had splenorenal shunts, in contrast to 50% of patients who had portacaval shunts. Survival rates after the two shunts were nearly identical. Thus, the advantages of splenorenal shunts concern the quality of life but not the length of survival. These observations are considered in relation to available therapeutic alternatives.

Activities of Daily Living↗