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M L Eckhauser

Publications and source records attributed to M L Eckhauser.

30 records · Page 2Linked to original sources
PubMed1987

Nesidioblastosis in an adult: an illustrative case and collective review.

Nesidioblastosis is a term that describes multifocal hyperplasia of all pancreatic cell components and is characterized primarily by their disorganization and proliferation throughout the entire pancreas. This condition is the most common cause of persistent neonatal hypoglycemia. Since it is so exceedingly rare in adults no consensus regarding its surgical management is available. Our patient underwent celiotomy with a presumptive diagnosis of insulinoma. No adenoma was found and frozen sections suggested hyperplasia. Even when Whipple's triad is met and all biochemical and roentgenographic analyses suggest insulinoma, another etiology may be the cause. Intraoperative ultrasonography may aid in the diagnosis especially after a negative exploration. The diagnosis of nesidioblastosis can be confirmed by frozen section especially if adenomatosis is present. The degree of resection required is problematic because no large series exists. This case is presented with special emphasis given to etiology, pathology, preoperative work-up, and operative strategy.

Blood Chemical Analysis↗
PubMed1987

Diuretic-associated pancreatitis: a collective review and illustrative cases.

Three patients are presented as illustrative examples of severe necrotizing pancreatitis associated with diuretic therapy. The presumed initiating factor was use of a benzothiadiazine (chlorothiazide, hydrochlorothiazide) or phthalimidine (chlorthalidone) diuretic to control hypertension, after the exclusion of other etiologies. We present these illustrative cases and a collective review, emphasizing that pancreatitis associated with these widely prescribed medications can be fatal and may be more common that previously thought.

Acute Disease↗
PubMed1985

Pancreas divisum. A cause of chronic relapsing pancreatitis.

A 36-year-old man, followed for 14 years with recurrent abdominal pain, developed chronic calcific pancreatitis and was found to have pancreas divisum on endoscopic retrograde pancreatography. An intraoperative biopsy showed normal acinar tissue in the head of the pancreas, while the body and tail were replaced by fibrous tissue. His pain resolved following surgical drainage of the dorsal pancreatic duct. Evaluation of the clinical course of this patient and critical review of other such cases in the literature support the role of compromised ductal drainage of the dorsal pancreas in the pathogenesis of chronic pancreatitis in pancreas divisum.

Adult↗
PubMed1985

The efficacy of polyethylene glycol-electrolyte lavage solution versus traditional mechanical bowel preparation for elective colonic surgery: a randomized, prospective, blinded clinical trial.

This study documents the efficacy, safety and patient tolerance of GoLYTELY (Braintree Laboratories, Inc., Braintree, Mass.) an orally administered, nonexplosive, polyethylene glycol-electrolyte lavage solution, in elective colonic surgery. Fifty-three patients admitted for colonic surgery were randomized to either GoLYTELY or a traditional 3-day bowel preparation. Both groups received oral and perioperative antibiotics. Pre- and postpreparation weights, blood chemistries, and hematologic values were obtained. Postpreparation patient tolerance was assessed. During surgery the surgeon scored the bowel for the presence of retained air, fluid, or feces. Standardized semiquantitative aerobic and anaerobic bacterial counts were obtained from sigmoid aspirates. Postoperative infectious complications were recorded. Mechanical preparation with GoLYTELY resulted in a greater feeling of fullness, while the traditional preparation produced more hunger and abdominal cramping. The use of GoLYTELY resulted in better scores of overall quality and bowel appearance, reflecting a greater efficiency with which it removed air, fluid, and feces from the bowel. GoLYTELY also resulted in significantly fewer total aerobic and anaerobic organisms in sigmoid aspirates. This study suggests that GoLYTELY is a safe, well-tolerated, and effective orthograde lavage solution that has significant advantages over other mechanical preparations and should be considered the preparation of choice for elective colonic surgery.

Adult↗
PubMed1985

Acid ingestion in an experimental model.

Following acid ingestion, the mortality of operative intervention is clearly related to late recognition of perforation. Experimentally, fiber-optic endoscopy can be used to accurately predict the depth of gastric injury. Operative intervention can be undertaken before gross perforation. Flexible endoscopy should be performed upon admission and repeated at intervals of 12 to 24 hours until one is satisfied that the injury is stable, reversible and will not progress. The risk of gastric perforation is minimal if the endoscopic procedure is performed by a competent individual. Continued careful medical follow-up examination and nutritional support is indicated when major damage to the stomach occurs to ensure that the patient will tolerate anticipated operative reconstruction.

Acids↗
PubMed1983

Postoperative management of a severely anemic Jehovah's Witness.

Preoperative preparation and intraoperative techniques to minimize blood loss comprise standard therapy for the patient who refuses blood products on religious grounds. The severely anemic postoperative patient presents a particular problem in dealing with oxygen transport and consumption. The management of a Jehovah's Witness with a hematocrit of 6.6% is presented. Oxygen consumption (VO2) was decreased 30-50% by the use of body surface cooling, neuromuscular blocking agents, and narcotic-barbiturate administration.

Adult↗
PubMedDate not supplied

Diagnostic laparoscopy in the intensive care patient. Avoiding the nontherapeutic laparotomy.

Evaluation of a potential acute abdomen in patients who require intensive care for concurrent medical/surgical problems is often difficult due to ambiguities in the physical exam and ancillary diagnostic tests. Between August 1990, and February 1992, 25 ICU patients underwent diagnostic laparoscopy to evaluate a suspected acute intraabdominal process. Thirteen laparoscopies were negative, and 12 were positive. The overall accuracy for laparoscopy was 96% as confirmed by subsequent laparotomy, autopsy, or clinical course. Laparoscopic findings led to a change in management in nine patients (36%), leading to earlier exploration in four patients, and avoidance of laparotomy in five. No significant hemodynamic effects were noted during laparoscopy, and the procedure-related morbidity was low (8.0%). Diagnostic laparoscopy is a safe and accurate guide for managing the ICU patient with a suspected acute surgical abdomen. The use of laparoscopy can help avoid nontherapeutic laparotomy or confirm the need for operative intervention in these complex cases.

Abdomen, Acute↗
PubMedDate not supplied

Laser therapy of gastrointestinal tumors.

Surgical resection remains the therapy of choice for the treatment of potentially curable gastrointestinal tract (GI) malignancies. Many of these tumors are incurable at the time of diagnosis and therapy should be directed towards palliation with the intent of minimizing pain, bleeding, obstruction, and potential morbidity. Endoscopic laser therapy is uniquely applicable for the palliation of GI tumors and in selective instances may be appropriate for the treatment of early lesions. Eighty-six patients with GI malignancy have been treated at our institution since 1985. Thirty-one patients had advanced upper GI lesions (esophagus: 26, gastric: 3, duodenal: 1, and pancreatic: 1) and 55 patients had lower GI tumors (colon: 37 and rectal: 18). Pre-resectional recanalization for obstructing colorectal carcinomas obviating initial operative diversion was performed in 31 (56%) of 55 patients. Twenty-four patients had palliative laser therapy (obstruction: 17 and hemorrhage: 7) with resolution of their symptoms. There was 1 laser related perforation in the pre-resectional group and the overall complication rate was 1.2%. Endoscopic Nd:YAG and currently photodynamic laser therapy for GI tumors has proven to be an effective mode of therapy for advanced GI neoplasms with minimal morbidity. The utility of photodynamic therapy for the treatment of early stage esophageal and gastric cancers remains controversial.

Adenocarcinoma↗