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Biomedical subjects

W R Grafe

Publications and source records attributed to W R Grafe.

15 recordsLinked to original sources
PubMed1981

Biliary enteric fistula.

From 1932 to 1978, 105 patients with biliary enteric fistulas are reported upon from The New York Hospital-Cornell Medical Center. During this 46 year period, 11,808 patients were operated upon for nonmalignant biliary tract disease, representing an incidence of biliary enteric fistulas of 0.9 per cent. The most common location of the fistula was cholecystoduodenal in 77 per cent and cholecystocolic in 15 per cent. Ninety-eight of the 105 patients underwent 109 surgical procedures for symptoms and complications associated with the fistula. The operative mortality was 6 per cent. The recommended definitive procedure includes cholecystectomy, excision of the fistula, common bile duct exploration and operative cholangiography. Among the 105 patients were 22 who presented with intestinal obstruction or ileus due to gallstones. The operative mortality in this group was 4.5 per cent. The recommended treatment for this condition is operative relief of the obstruction with correction of the biliary enteric fistula at an elective second stage operation.

Adult↗
PubMed1978

The Elective Surgery Second Opinion Program.

The results of the Cornell Elective Surgery Second Opinion Program are presented. From February 1972 to January 1978, 7053 patients were evaluated for proposed elective surgery, and in 27.6% of these, the operations were not approved. The subspecialties of orthopedics and gynecology demonstrated the highest rates of non-confirmation, while that for general surgery was 18%. A group of 318 patients with general surgical diagnosis are reviewed. The percentage of nonconfirmed surgery for this group was 15 percent. The most common reasons for not approving the operations were absence of pathology and failure to utilize medical therapy when indicated.

Female↗
PubMed1976

Tuberculous peritonitis: 43 years' expereince in diagnosis and treatment.

The clinical course of 70 patients with tuberculous peritonitis seen over a 43 year period has been reviewed. Thirty-seven patients were diagnosed prior to the advent of anti-tuberculous chemotherapy and 33 after. Clinical manifestations remained unchanged over the period of study. Abdominal pain (93%), fever (63%), gastrointestinal upset (60%), weight loss (60%), and ascites (59%) continue to be the most common findings. Females outnumbered males 2:1. In 89% of patients the duration of symptoms prior to diagnosis was a week or longer, and in 47% it was longer than a month. Diagnosis was confirmed by histologic examination of intra-abdominal tissue in 44% of cases, by clinical suspicion with an extraperitoneal site of tuberculosis in 29%, by bacteriology of peritoneal fluid in 24%, and by autopsy alone in 3%. An extraperitoneal site of tuberculsis was present in 83% of patients. The importance of obtaining a definitive diagnosis, and of instituting immediate antimicrobial therapy is emphasized by the mortality of 49% in the pre-antibiotic era, and of 7% in patients receiving anti-microbial therapy. The conclusions from this review are that: 1) with suggestive clinical manifestations and bacteriologic proof of active tuberculosis anywhere in the patient, operation is not mandated; 2) in the presence of the above clinical manifestations, and in the absence of definitive bacteriologic proof, exploratory laparotomy is indicated for diagnostic purposes; 3) antituberculous chemotherapy is highly effective, and is the treatment of choice.

Adolescent↗