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Biomedical subjects

T C Pennell

Publications and source records attributed to T C Pennell.

At least 19 recordsLinked to original sources
PubMed1992

Prevalence of ischemic nephropathy in patients with renal insufficiency.

To estimate its clinically unsuspected prevalence among patients with renal insufficiency, renal duplex sonography (RDS) was used to estimate the presence of critical renal artery stenosis (RAS) in that population. Patients, aged 45 to 75 years, with a serum creatinine of greater than or equal to 2.0 mg% but without dialysis dependence, prior renal transplantation, or prior renal artery surgery were considered for RDS. Fifty-three patients who met criteria for study were randomly selected from the Section of Nephrology clinic files and each patient was contacted both by mail and by telephone. Twenty-five patients agreed to RDS, and renal artery anatomy was determined in 21 patients using standardized RDS techniques. These techniques have demonstrated an overall accuracy of 96 and 97 per cent when compared prospectively to conventional angiography during validity analyses in the authors' center. Results of RDS revealed significant findings in 5 of 21 patients (24%). Three patients demonstrated criteria for ischemic nephropathy (IN): one patient had RAS with contralateral renal artery occlusion confirmed by angiography, while 2 patients demonstrated unilateral RAS. An abdominal aortic aneurysm and unilateral hydronephrosis were discovered in the fourth and fifth patients. Evaluation of patient demographic data and functional parameters as predictors of IN revealed that the duration of renal insufficiency at the time of RDS and extra-renal organ-specific atherosclerotic damage were significantly different between the groups with and without IN. The authors preliminary findings suggest that unsuspected ischemic nephropathy may exist in a significant minority of patients with renal insufficiency.

Age Factors↗
PubMed1989

Retroperitoneal mucinous cystadenoma.

Twelve cases of retroperitoneal mucinous cystadenoma or mucinous cystadenocarcinoma in women have been reported in the literature. We report an additional case. The histogenesis of mucinous cystadenomas and mucinous cystadenocarcinomas in the retroperitoneum is not clear, but that these lesions may arise from teratomas, ectopic supernumerary or accessory ovaries, or coelomic metaplasia has been suggested. It is possible that small clusters of coelomic epithelial cells could be deposited along the route of ovarian embryonic descent and, by proliferation or metaplastic differentiation, develop into these cystic tumors. The histogenesis of the rare histologically similar lesions that have been seen in men is even less clear.

Adult↗
PubMed1989

Lithotripsy for bile duct stones.

Fragmentation of bile duct stones by mechanical, electrohydraulic, and laser intraluminal lithotripsy has greatly facilitated the ability to remove stones that are otherwise difficult to remove by standard manipulative techniques. Even these approaches fail when stones lack access or are impacted within the biliary tree. Extracorporeal shock-wave lithotripsy (ESWL) was evaluated in the United States in a multicenter trial with 56 patients. Stone fragmentation occurred in 91 percent of patients and duct clearance in 79 percent. Adjunctive procedures were used in 54 percent. Two ESWL treatments were required for fragmentation in 28 percent. Complications were mild and relatively infrequent. Hemobilia (8 percent), gross hematuria (6 percent), and biliary sepsis (4 percent) occurred less frequently than expected. There were no deaths during the 1 to 31 days of hospitalization (mean 9 days). We conclude that ESWL is a safe and effective adjunct to the treatment of difficult-to-remove bile duct stones under the conditions observed in this trial.

Bile Duct Diseases↗
PubMed1989

Extracorporeal shock-wave lithotripsy of bile duct calculi. An interim report of the Dornier U.S. Bile Duct Lithotripsy Prospective Study.

A multi-institutional study to evaluate the efficacy, clinical application, and safety of extracorporeal shock-wave lithotripsy (ESWL) with the Dornier HM-3 or HM-4 lithotripter for bile duct calculi (BDC) was initiated in September, 1987. Symptomatic patients who entered into this prospective trial had BDC in the common bile duct and/or the intrahepatic, cystic or lobar ducts of the liver that were inaccessible or untreatable by papillotomy or percutaneous stone extraction. The study excluded gallbladder stones. Nasobiliary (54.4%) or transhepatic catheters (10.5%) and T-tube or cholecystostomy tubes (17.5%) or combinations (14.0%) permitted access for radiographic contrast to allow fluoroscopic monitoring of stone position and fragmentation. Exclusion criteria included pregnancy, failure to localize the stone, disturbances of coagulation, pacemakers, or vascular aneurysms or large bones that lie in the focal axis of the shock waves. Eleven institutions treated 42 patients (23 male, 19 female) with BDC; age range was 25 to 95 years (mean +/- SD, 73.5 +/- 13.8) and ASA risk category was 1 to 4 (mean, 2.3 +/- 0.8). Fourteen patients (33.3%) had a single BDC; 28 had 2 to 8 stones (mean, 2.7 +/- 1.8) ranging in size from 6 mm to 30 mm (mean, 18.5 +/- 6.4). The majority (66.7%) of patients were postcholecystectomy. The 42 patients received 57 ESWL treatments consisting of 600 to 2400 shocks per treatment (mean, 1924 +/- 289) at 12 to 22 kV (mean, 18.5 +/- 1.9) administered over 20 to 125 minutes (mean, 52.9 +/- 20.8). General anesthesia was used in 32% of the treatments; the majority were treated with epidural or regional block (42.1%), local infiltration (28.1%), or intravenous sedation (38.6%). Fifteen patients (35.7%) required two ESWL treatments. Stone fragmentation occurred in 94.6% of evaluable patients and in 90.4% of ESWL treatments, respectively; however, BDC fragments remained in 59.5% of patients 24 hours after treatment (diameter less than or to 3 mm, 12%; 4 to 9 mm, 16%; greater than or equal to 10 mm, 68%). Some patients (50%) required adjunctive procedures to achieve stone removal that included endoscopic extraction (n = 10; 47.6%), biliary lavage (n = 8; 38.1%), endoscopic bile duct prosthesis (n = 1; 4.8%), and operation (n = 2; 9.5%). ESWL treatment complications during hospitalization were observed in 15 patients (35.7%) and were present in four (9.5%) at discharge. Complications included macrohematuria (5%), biliary pain (15%), biliary sepsis (5%), hemobilia (10%), ileus (2.5%), and adverse pulmonary changes (7.5%). One patient developed pancreatitis before ESWL at ERCP that resolved prior to discharge.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1989

Microscopic hematuria after blunt trauma. Is pyelography necessary?

Hematuria after blunt abdominal trauma is common with multiple organ system injuries, and many trauma centers routinely perform intravenous pyelography (IVP) on all trauma patients having any degree of hematuria. However, it has been suggested that many IVPs could be avoided if more selective criteria were used. To help determine the need for an IVP, we reviewed the records of 102 consecutive patients undergoing IVP after blunt abdominal trauma over a 17-month period. Twenty-six (25%) patients had gross hematuria. Of these, seven (27%) had abnormal IVPs, and two (7.7%) of those required urologic surgery. Seventy-six (75%) patients had microscopic hematuria. Of these, one (1.3%) had an abnormal IVP but required no urologic surgery. Thus, if IVP had been performed only when gross hematuria was present, then all surgically significant urinary tract lesions would have been recognized, and 75 per cent of these 102 patients would have been spared IVPs. We agree with others that microscopic hematuria alone is not an indication for emergency IVP in these trauma patients. However, gross hematuria or other strong clinical evidence of renal injury still mandates IVP early during the assessment of patients who have suffered blunt abdominal trauma.

Abdominal Injuries↗
PubMed1987

The management of snake and spider bites in the southeastern United States.

Of all snake bites reported in the United States of America each year, 75 per cent occur in the states that form the Southeastern Surgical Congress. Pit vipers, coral snakes, and exotic imported snakes are all found in that area. Deaths from those snake bites are rare, but morbidity is high and it is often due to overtreatment rather than undertreatment. Treatment in the field is rarely necessary for the victim who is less than 1 hour away from definitive care. The type and size of the snake and the age, size, and health of the patient are important guides to therapy. Envenomation may not occur. When envenomation occurs from pit viper bites, antivenom is not always necessary, and its inherent dangers (serum sickness and possible hypersensitivity) must be weighed against the severity of systemic and local manifestations. All coral snake bites resulting in envenomation must be treated vigorously with coral snake antivenom. The Oklahoma City Poison Control Center can guide the treatment of bites from exotic snakes. The most frequently encountered toxic spider bites in the Southeast are those of the black widow and brown recluse spiders. The symptoms of black widow envenomation are best controlled with calcium gluconate or a muscle relaxant. Antivenom should be reserved for severe reactions. Brown recluse necrotic lesions are best controlled with dapsone.

Humans↗
PubMed1987

Salvage of lower extremities following combined orthopedic and vascular trauma. A predictive salvage index.

A retrospective review of 676 tibial-fibular fractures and 985 femoral fractures treated over a 71-month period yielded associated major vascular trauma in 12 (1.7%) tibial-fibular fractures and in five (0.5%) femoral fractures. Vascular trauma combined with orthopedic trauma was also identified in four other cases--two disruptions of the pubic symphysis and two dislocations of the knee without fracture. Nine (43%) of the 21 involved limbs were eventually amputated. Limb survival was not related to the temporal relationship of vessel repair to skeletal stabilization; the presence or absence of shock on admission; the presence of associated but repaired venous injury; or the presence of unrelated injuries. Limb survival was related to the interval from injury to arrival in the operating room; the level of arterial injury; and the quantitative degree of muscle, bone, and skin injury. By combining these variables a limb salvage index was established that identified lower extremities likely to require amputation after combined orthopedic and vascular trauma (sensitivity 78%, specificity 100%). Use of this predictive salvage index may prevent the trauma surgeon from attempting to salvage a doomed or useless lower extremity and may thus permit early prosthetic rehabilitation to follow definitive primary amputation.

Adolescent↗
PubMed1985

Modified Thiersch operation for rectal prolapse. Technique and results.

Rectal prolapse is best treated by intra-abdominal or perineal procedures that either resect the redundant rectosigmoid colon or fix the rectum within the pelvis. We have found the Thiersch procedure to be adequate treatment in patients who are high risk or who have only mild to moderate prolapse of the rectum. Over the past 20 years, we have treated 15 patients with a modified Thiersch procedure, using a knitted Dacron vascular graft to encircle the anus. One patient required a second Thiersch procedure after failure of a Ripstein procedure that followed failure of a Thiersch procedure done with wire. A second Thiersch procedure was required in two patients after suture breakage, and in one patient after removal of an infected graft. Two other patients had graft infections necessitating removal of the Dacron graft; one patient had a perianal infection that was treated without removing the graft. Continence was achieved in six of nine patients previously incontinent, and maintained in the six patients who had been continent before operation. Prolapse was corrected in 13 of the 15 patients. Although the Thiersch procedure is not applicable to all patients with rectal prolapse, it can be used successfully when performed properly.

Aged↗
PubMed1984

Air gun injuries of the abdomen in children.

From July 18, 1978 to Sept 15, 1982, four boys were treated for air gun injuries of the abdomen at the North Carolina Baptist Hospital, Winston-Salem. Three patients had wounds of one or more of the hollow viscera, and one patient had an injury only of the liver. There was no morbidity or mortality following repair. Some present-day air (pneumatic) weapons have muzzle velocities that equal or exceed those of common civilian handguns, and they are frequently used by unsupervised children. These weapons are not restricted and regulated as are other firearms, and are believed to be incapable of serious injury other than to the eye. These cases and others in the literature dispute that belief.

Abdominal Injuries↗
PubMed1984

Diaphragmatic rupture from blunt trauma.

Records of 31 patients who sustained a ruptured diaphragm from blunt trauma form the basis for this report. There were 23 left-sided ruptures, one bilateral rupture, and seven right-sided ruptures. Viscus had herniated into the chest in 30 patients. Right-sided ruptures were associated with greater morbidity and mortality, mostly due to the more serious associated injuries. Chest roentgenograms were abnormal in all 31 patients; bowel could be seen in the chest in 11 patients. Pneumoperitoneum, upper gastrointestinal barium studies, and liver/spleen scans were all diagnostically helpful in selected patients. The correct diagnosis was made preoperatively in 25 of the 31 patients; one-third of all diagnoses were delayed. All exploratory laparotomies for blunt trauma should include careful inspection of the diaphragm, especially in the posterolateral region, and the area close to the esophageal hiatus to detect diaphragmatic rupture and prevent chronic herniations.

Adult↗
PubMed1981

Supradiaphragmatic correction of esophageal reflux strictures.

Intragastric pressure measurements and cineradiographic contrast studies were done in monkeys in order to determine the pressure at which esophageal reflux occurred. Antireflux operative procedures were performed above and below the diaphragm, and the results compared. The Nissen fundoplication proved to be the most effective type of mechanical antireflux valve and worked equally well placed above and below the diaphragm. Of 200 consecutive adult patients undergoing operative correction of esophageal reflux, 19 had severe esophageal strictures. Through a transthoracic approach, two patients had subdiaphragmatic Nissen fundoplications, one with adenocarcinoma of the esophagus had an esophageal resection, and 16 had supradiaphragmatic Nissen fundoplications; those 16 patients form the basis of this report. No patients died; superficial, temporary esophageal ulcerations developed in two. Follow-up times have ranged from six months to eight years; the results in all cases have been good. Experimental and clinical evidence supports the belief that this less radical approach is the treatment of choice in the management of severe esophageal strictures secondary to reflux esophagitis.

Animals↗
PubMed1980

Inflammatory fibroid polyp of the duodenum.

Inflammatory fibroid polyp of the gastrointestinal tract is an unusual lesion of apparent submucosal origin but of unknown etiology. The stomach is most commonly involved with typical presentation being a rounded or oval polyp in the gastric antrum. Occurrence in the duodenum is distinctly rare since only three previous cases have been reported. We present a patient with an unusually long inflammatory fibroid polyp arising in the third portion of the duodenum.

Duodenal Neoplasms↗