Using an interdisciplinary team for geriatric education in a nursing home.
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Biomedical subjects
Publications and source records attributed to R H Franklin.
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Hemobilia should be considered in all cases of blunt or penetrating trauma to the liver, no matter how trivial it may appear, whenever right upper quadrant pain and a persistently elevated alkaline phosphatase level give evidence of an otherwise unexplained biliary obstructin or hepatic mass lesion. Jaundice and evident gatrointestinal bleeding may not appear until late in the course. All available diagnostic modalities should be utilized to confirm the diagnosis, and angiography should be done early whenever the diagnosis is seriously considered. If hemobilia is documented at angiography, an attempt at selective embolization should always be made. Selective angiographic embolization may well save the patient an operative procedure, and appears to be an acceptable method of primary treatment of this condition. A case of hemobilia from penetrating abdominal trauma with successful operative treatment is described.
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Isolated complete transection of the common bile duct due to blunt trauma is rare. Its occurrence and successful treatment in an 8-year-old boy are described. Inital minor peritonism resolved quickly, followed by a deceptive asymptomatic period and insidious development of jaundice, anorexia, vomiting, pain, acholic stools and progressive abdominal distension due to sterile biliary ascites. A preliminary cholecystostomy was followed by construction of a Roux-en-Y cholecystojejunostomy.
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A wide variety of benign conditions affecting the oesophagus which have long been recognized in association with hiatus hernia are now known to be attributable to reflux oesophagitis. The development of modern methods of treatment of these conditions is described with reference to a number of illustrative cases.
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