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Biomedical subjects

R Helgerson

Publications and source records attributed to R Helgerson.

6 recordsLinked to original sources
PubMed1998

Fungal sacral osteomyelitis as the initial presentation of Crohn's disease of the small bowel: report of a case.

We report a unique case of Candida albicans sacral osteomyelitis in a 48 year-old female with previously undiagnosed Crohn's disease. The patient was ill for one year with fatigue, weakness, and a 60-lb weight loss. At the time of presentation, she developed chills, fever, right lower quadrant abdominal pain, and right knee pain. Physical examination was significant for a palpable right lower quadrant abdominal mass. A computed tomographic scan of the abdomen and pelvis identified a large right-sided retroperitoneal mass, severe right hydronephrosis, and air within the right sacrum. Findings at laparotomy included small-bowel changes consistent with Crohn's disease, a multiloculated retroperitoneal abscess, and evidence of sacral osteomyelitis. A right hemicolectomy with sacral debridement and placement of presacral drains was performed. Bone cultures from the sacrum demonstrated a predominance of C. albicans, in addition to coliforms and enterococcus. The patient was placed on amphotericin B and intravenous antibiotics. Because serial computed tomographic scans of her pelvis demonstrated progression of her pelvic osteomyelitis to include the sacrum, right ilium, right acetabulum, and right femoral head, a repeat debridement with resection of the right femoral head was performed. After 12 months of follow-up, she was doing well without medications and had no constitutional symptoms or radiographic evidence of disease progression. This report illustrates a unique case of Crohn's disease presenting as sacral osteomyelitis secondary to small-bowel fistulization. Aggressive multidisciplinary surgical and medical management were the key to the successful management of this difficult case.

Abscess↗
PubMed1998

Computed tomographic angiography with three-dimensional reconstruction in patients with complex diverticular disease and portal hypertension: report of a case.

We report a case of a patient with portal hypertension secondary to alcoholic cirrhosis (Child's Class C) who initially presented with a colovaginal fistula secondary to acute sigmoid diverticulitis. The patient had a prior history of hepatic cirrhosis with ascites, coagulopathy, and portal hypertension. Computed tomography of the abdomen and pelvis demonstrated a large diverticular phlegmon and ascites. Computed tomographic angiography demonstrated a large left anterior abdominal wall varix in the region of the anticipated sigmoid resection. Three-dimensional reconstruction of the computed tomographic angiography further delineated the path of this large varix, confirming the increased risk from surgical intervention. Following initial conservative treatment with intravenous antibiotics, parenteral nutrition, and percutaneous abscess drainage, a transjugular intrahepatic portosystemic shunt procedure was performed to decompress the portal system varices. A repeat computed tomographic scan with three-dimensional reconstruction confirmed decompression of the varix. A successful sigmoid resection was subsequently performed. Preoperative computed tomographic angiography with three-dimensional reconstruction is a useful adjunct in planning the operative strategy in patients with complex intraabdominal pathology and collateral portovenous flow secondary to portal hypertension.

Abdomen↗
PubMed1998

Limb salvage for streptococcal gangrene of the extremity.

BACKGROUND: Extremity soft tissue infections from group A, beta-hemolytic streptococcus frequently culminate in amputation. This study compares our protocol for limb salvage with expected results. METHODS: Patients with extremity streptococcal gangrene treated from 1989 to 1995 were reviewed. The management protocol mandated immediate, radical excision of involved skin and subcutaneous tissue, with preservation of fascia. Patients were managed in the burn unit, and wounds were covered with split-thickness skin grafts. Amputation rate and mortality were measured. RESULTS: Fourteen cases of extremity streptococcal gangrene were identified. Delay to surgical referral was 5 days. Eleven (79%) patients were septic. Ten (71%) were managed with a single debridement before grafting. Limb salvage was 93% (13 of 14). One patient (7%) died on day 150 from acute myelogenous leukemia. CONCLUSIONS: Delay in referral of extremity streptococcal gangrene is common, contributing to a high incidence of sepsis. Our management protocol of a single, radical debridement with preservation of fascia maximizes limb salvage and survival.

Adult↗
PubMed1987

Diaphragmatic injuries following blunt trauma.

Over the last 10 years, 26 patients have undergone repair of blunt traumatic diaphragmatic injury. Motor vehicle accidents were the cause in 77 per cent of these cases. The diagnosis was made immediately by chest x-ray in eight of 26 cases, and in ten cases, the diagnosis was made at celiotomy because of other suspected intraabdominal injury. The other eight cases fell into two categories; delayed (diagnosis made within same hospitalization) and late (diagnosis made at subsequent presentation). In many cases in which diaphragmatic injuries were missed or delays in diagnosis occurred, radiologic evidence for possible injury was present on the initial chest x-ray, but the diagnosis was not suspected. Seventy-seven per cent of patients (20 of 26) had associated major injuries (spleen, chest, extremities). The left hemidiaphragm was involved in 19 patients and right diaphragmatic injuries in seven patients. Repair was accomplished in 23 cases transabdominally with a thoracoabdominal extension required in three patients because of severe liver trauma. The three cases in which the diagnosis was delayed had diaphragmatic defects repaired by a transthoracic approach.

Adult↗
PubMed1982

A modification for preparing the chronic lung-lymph fistula in sheep.

The sheep lung-lymph model has proven to be a valuable research tool. Preparing this model can be time consuming and may cause considerable trauma to the animal. The standard procedure of Staub et al., the only other published technique, requires three thoracotomies performed on three separate occasions. The objective of this study is to develop and evaluate a less traumatic and time-consuming surgical protocol for preparing the lung-lymph model. This technique enables us to cannulate the efferent lymph duct draining the lung, divide the caudal mediastinal lymph node, and catheterize the left atrium with one thoracotomy. The modified approach, along with some minor changes in aftercare, enables us to have a success rate of over 70% with an average patent flow of 8 days (range 3-21 days) and saves time and surgical trauma to the animal.

Animals↗