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Biomedical subjects

M H Max

Publications and source records attributed to M H Max.

At least 55 records · Page 3Linked to original sources
PubMed1979

Detection of intracolonic lesion by barium contrast enema. The importance of adequate colon preparation to diagnostic accuracy.

Frequently, the clinical significance of the barium contrast enema is minimal because of inadequate colon preparation prior to examination. The frequency of false-positive routine barium enemas was 17% in 230 consecutive patients who underwent colonoscopy for removal of specific radiographically identified polypoid colon lesions. Initial barium enema inaccuracies were documented with postendoscopic air-contrast radiography in colons that were endoscopically proved to be mechanically clean following a two-day colon preparation. These results suggest that more emphasis on a two-day colon preparation, before the initial barium contrast enema, would substantially reduce the frequency of false-positive interpretations.

Barium Sulfate↗
PubMed1979

Diagnostic and therapeutic colonoscopy. A critical review of 662 examinations.

The results of 662 therapeutic and diagnostic colonoscopic examinations were reviewed to assess the morbidity, clinical benefit, diagnostic accuracy, and indications for the procedure, with special emphasis on detection and endoscopic excision of small, occult, invasive cancers. Overall, the frequency of detecting occult lesions (19%), the (89%) ability to clarify questionable radiographic findings, and a substantial reduction in laparotomy-colotomy procedures required for removal of colonic polyps (88%), coupled with a low morbidity (3%) and low false-negative examination rate (1%) established colonoscopy as one of the most important advances in the management of colon disease in recent years. Although early experience suggests that small, occult, invasive carcinomas, when properly selected, could be adequately treated by endoscopic excision, larger series and longer follow-up periods are necessary to validate any conclusions regarding the decision to manage these lesions conservatively.

Carcinoid Tumor↗
PubMed1979

Failure of cimetidine prophylaxis in the critically ill.

Stress ulcers with subsequent hemorrhage are a well-recognized cause of morbidity and mortality in patients hospitalized for other serious illnesses. In 39 critically ill patients, cimetidine was used as a prophylaxis against stress ulcers with the intent to keep the gastric pH level above 4. In 11 of the 39 patients, cimetidine alone did not effect consistent elevation of the gastric pH level above 4. Of the 11 patients, nine had positive blood cultures or clinical infection and five also developed renal failure. Five comatose patients never had pH greater than 4 on cimetidine alone. The mortality for those whose conditions failed to respond to cimetidine was five times greater than for those whose conditions responded to cimetidine. These data imply that a high-risk group of patients can be identified whose conditions may not respond to cimetidine treatment and whose gastric pH must be regularly monitored.

Acute Kidney Injury↗
PubMed1979

Cholate sodium infusion for retained common bile duct stones.

Eight patients with stones retained in the extrahepatic biliary tract underwent cholate sodium infusion for dissolution of the stones. In six patients, the stones disappeared. However, in two of the patients, the stones did not disappear, and they were removed with the ureteral basket. Infusion of cholate sodium was well tolerated by six patients, but was accompanied by nausea, vomiting, and abdominal pain in two patients. In one case, mucosal deformity of the common bile duct was noticed during the infusion, but it was not apparent on a subsequent cholangiogram. As a result of our experience, we conclude that cholate sodium infusion is a safe procedure for the attempted dissolution of retained common bile duct stones.

Adult↗
PubMed1979

Umbilical metastasis as the presenting symptom of cecal carcinoma.

Umbilical metastases were encountered as the initial presentation of cecal adenocarcinoma in a 62-year-old woman. Intravenous infusion of 5-fluorouracil, along with intralesional injections of 10% 5-fluorouracil, resulted in regression of the tumor masses on the abdominal wall. Although umbilical metastasis is rare, its significance in diagnosing an otherwise silent colorectal cancer warrants the physician's awareness.

Adenocarcinoma, Mucinous↗
PubMed1979

The association of pyloric antral tissue levels of 5-hydroxytryptamine and restraint stress ulceration in the rat.

To determine the possible role of 5-hydroxytryptamine (5-HT) in the formation of restraint ulcerations, we investigated the relationship among mucosal tissue levels of 5-HT, vagotomy, and restraint ulcerations. Three murine experimental groups and one control group were used to compare the ulcerogenic effects of restraint with and without prior vagotomy. Ulcers were graded as to frequency, size, and hemorrhage on a 0-4+ scale. 5HT was measured in the gastric mucosa of each animal. Restraint caused significant ulcerations. The mean tissue level of 5-HT was significantly higher in the group with marked ulcerations (p less than 0.001). Our data suggest an increased cellular production of 5-HT during the development of the restraint ulcers. Vagotomy protected the animals against restraint ulcerations without depleting the baseline levels of 5-HT. Previous experiments have shown that urine levels of 5-hydroxyindoleacetic acid (5-HIAA) increase during the restraint period. Thus, increased tissue and urine levels of 5-HT appear to coincide with the development of restraint stress ulcers in the rat. Accordingly, if the coincidence occurs in humans, the measurement of urinary levels of 5-HIAA may be an indirect means of determining those patients at high risk for the development of stress ulcers.

Animals↗
PubMed1978

Surgical management of hyperparathyroidism.

Twenty-one patients with hyperpara-thyroidism were studied to determine the outcome of surgical treatment by a variety of surgeons using a variety of techniques. Primary surgical treatment was excision of an adenoma in 11 patients with primary hyperparathyroidism. One patient (7%) had a true recurrence. One patient (7%) had persistent disease. Subtotal parathyroidectomies were carried out in three patients with primary diffuse hyperplasia and in five patients with chronic renal disease. Total parathyroidectomy and autotransplantation were performed in two more recent patients with chronic renal disease. Permanent hypoparathyroidism was not seen postoperatively in patients with primary hyperparathyroidism. Identification of all four glands at the operating table is essential. The low recurrence rate following selective excision of diseases parathyroid glands in this series suggests that the approach can be undertaken safely in most instances.

Adenoma↗
PubMed1978

Bleeding vascular malformations of the intestine.

Thirty-nine patients with bleeding vascular malformations were evaluated. The age range was from 3 to 78 years, with a bimodal age distribution. The younger patients had no associated diseases, while those in the older category invariably had an associated cardiac lesion (aortic stenosis in 12 patients and severe atherosclerotic disease in 11 patients). With experience, colonoscopy has become a valuable adjunct to arteriography with the lesion visualized in 12 patients. Arteriography is the most useful study being diagnostic in 35 of 38 cases. Exploration alone was diagnostic in only one of 39 patients. The most common site of bleeding was the cecum (21 patients) followed by the proximal small intestine (eight patients), terminal ileum (seven patients), and ascending colon (five patients). The lesions in the proximal small bowel were much more common in the younger patients and were believed to be congenital. Resection controlled the bleeding in the majority of patients, although four recurrences have been noted. All have been documented angiographically to have been from a new lesion and two were controlled with reoperation. The key elements to control of these patient's bleeding include: (1) systematic work-up with a team approach emphasizing careful visceral angiography, and (2) the avoidance of a premature laparotomy prior to complete evaluation.

Adolescent↗
PubMed1977

Squamous cell carcinoma of the thyroid: a report of two cases.

Two patients with squamous cell carcinoma, which accounts for 1.1% of all primary thyroid carcinomas, are described. Squamous metaplasia is the most likely etiology, but an occasional carcinoma may be derived from remnants of embryonic origin. Although squamous metaplasia has been documented in several conditions involving the thyroid, no evidence exists that this predisposes to squamous cell carcinoma. Metastases and direct extension of squamous cell carcinoma in the thyroid gland are much more frequent than primary involvement and are always part of a generalized carcinomatosis. A primary lesion must always be sought; however, diagnosis may not be possible until an initially occult tumor becomes evident or even until autopsy. Because this lesion typically runs a fulminant course, radical surgical resection at the earliest opportunity offers the best hope for cure. The lesions are usually radioresistant, and chemotherapy has not been shown to alter the course of this disease.

Aged↗
PubMed1977

Routine preoperative upper gastrointestinal series (UGIS) in patients with biliary tract disease: a plea for more selectivity.

Preoperative upper gastrointestinal x-ray series (UGIS) in patients with documented biliary tract disease commonly is carried out before cholecystectomy. Of 250 patients who had consecutive cholecystectomies performed in a 400-bed private hospital, 105 patients did not have UGIS prior to operation and no gastroduodenal disease was discovered at operation. Thirty-nine positive x-ray examinations were obtained among the 145 patients who had preoperative UGIS. In only three of these patients was a gastric procedure added at operation; no unexpected cancers were found. In the other 36, "positive" findings consisted of small hiatal hernias, diverticula of the esophagus, stomach, or duodenum not clinically significant or postgastrectomy anatomic abnormalities. This review suggests that routine preoperative UGIS may not be warranted in such patients and urges greater selectivity of patients having this procedure.

Biliary Tract Diseases↗