Biomedical subjects

R D Wilcox

Publications and source records attributed to R D Wilcox.

6 recordsLinked to original sources

PubMed1990

Surgical significance of acquired ileal diverticulosis.

Acquired (non-Meckel's) ileal diverticular disease is uncommon, and most surgeons have limited, if any, experience with this condition. To gain insight into the frequency of surgical complications of ileal diverticula, we reviewed our experience during the past ten years with 21 patients, 12 women, and nine men. The mean patient age was 62 years; 16 patients (76%) were more than 50 years of age. Thirteen patients had associated diverticula in another segment of the small intestine. In 15 patients ileal diverticulosis was diagnosed during gastrointestinal (GI) radiologic evaluation of abdominal symptomatology. Ileal diverticula were identified intraoperatively in the remaining six patients. In three patients ileal diverticulosis was an incidental finding. Documented surgical complications of acquired ileal diverticula occurred in four patients (19%). Three patients had acute diverticular perforation, and one patient had diverticulitis without perforation. These patients underwent successful operative intervention. Three other patients, all managed nonoperatively, had abdominal symptoms that may have been related to ileal diverticula and were of potential surgical significance. Two patients experienced recurrent rectal bleeding, and the third patient had severe chronic abdominal pain. Although the majority of patients with acquired ileal diverticula do not require surgical treatment, complications such as perforation, bleeding, or incapacitating abdominal pain may necessitate ileal resection.

Adult↗

PubMed1988

Surgical implications of jejunal diverticula.

To gain insight into the surgical significance of acquired jejunal diverticula, we reviewed the experience at the teaching hospitals in our city during the past ten years. An antemortem diagnosis of jejunal diverticulosis was made in 27 men and 59 women with a mean age of 69.6 years. In 71 patients the diagnosis was made during upper gastrointestinal roentgenologic evaluation for abdominal symptoms, in three it was made during mesenteric arteriography or bleeding scan for massive rectal bleeding, in six it was made during exploratory laparotomy for acute abdominal signs and symptoms, and in the remaining six it was an incidental intraoperative finding. Surgical indications occurred in 13 patients (15%) and consisted of massive lower gastrointestinal bleeding in four patients, blind loop syndrome in three, small bowel obstruction in three, diverticular perforation in two, and chronic abdominal pain requiring jejunal resection in one. In three additional patients with melena and nine with chronic abdominal pain, jejunal diverticulosis was the only abnormality detected; none of these patients had operation. Although the majority of patients with jejunal diverticula do not require surgical treatment, it may be necessitated by complications such as bleeding, perforation, obstruction, blind loop syndrome, or intractable abdominal pain.

Abdomen↗

PubMed1987

Massive rectal bleeding from jejunal diverticula.

During a ten year interval, four patients with extensive rectal bleeding from jejunal diverticula were treated in a city of 750,000 people. Patient ages ranged from 54 to 66 years. All of the patients presented with bright red rectal bleeding. Bleeding scans demonstrated a source of blood loss high in the small intestine in two patients who had jejunal diverticula at exploratory laparotomy. In another patient, the results of preoperative evaluation did not reveal the site of hemorrhage. Jejunal diverticula were found at exploratory laparotomy. These three patients underwent jejunal resection and have since remained free of gastrointestinal bleeding. In the fourth patient, mesenteric arteriography revealed extravasation from a jejunal diverticulum. After angiography, the patient experienced no further hemorrhage, and surgical treatment was not performed. This patient remained asymptomatic and died of myocardial infarction five years later. The successful nonoperative management of this patient belies the high reported incidence of recurrent hemorrhage associated with jejunal diverticula. Thus, patients with rectal bleeding who are found to have jejunal diverticula should undergo removal of the involved jejunum, even if preoperative evaluation results implicate another source. The results of this study suggest that jejunal diverticula are a more frequent cause of extensive rectal bleeding than heretofore appreciated, particularly in the elderly.

Aged↗

PubMed1983

Acute cranial polyneuritis with vertigo after stapedectomy.

Acute vertigo occurring 48 hours after stapedectomy is assumed to be related to inner ear trauma. Similarly, acute vertigo occurring weeks after stapedectomy could be related to a fistula of the oval window. No one has tested the hypothesis that some of these cases could represent concomitant cranial polyneuritis. We report the development after stapedectomy of five cases of acute cranial polyneuritis with vertigo diagnosed by physical examination of the cranial nerves. In another case we determined that vertigo occurring after stapedectomy was not related to concomitant cranial polyneuritis. Although all the patients were treated with corticosteroids, the vertigo resolved within 12 to 24 hours only in those whose vertigo we had ascribed to polyneuritis.

Adult↗

PubMed1980

Ménière's disease as a form of cranial polyganglionitis.

Although endolymphatic hydrops is generally considered to be the most prominent factor in the etiology and pathology of Ménière's disease, we have concluded that this condition more probably represents a polyganglionitis caused by the herpes simplex virus with secondary hydrops changes. The wide range of symptoms occurring in the Ménière's disease complex is illustrated in seven selected cases which support this conclusion. Vestibular nerve section can stabilize hearing and relieve episodic vertigo by removing the locus of viral infection and precluding recurrent activation.

Adult↗

PubMed1977

PKU as a factor in the development of self-esteem.

Self-esteem of ten children with phenylketonuria was compared with that of seven unaffected siblings of children with PKU in a total of 11 families. Ages of the nine girls and eight boys ranged from 8 to 15 years. The study examined several variables that might affect self-esteem. From this study, it appears that PKU status and lowered IQ together contribute to lowered self-concept and that PKU status alone (i.e. with the effects of IQ removed) has a strong tendency to influence self-esteem.

Adolescent↗