Biomedical subjects

W W Krippaehne

Publications and source records attributed to W W Krippaehne.

At least 19 recordsLinked to original sources

PubMed1986

Improving the outcome in gallstone ileus.

A 32 year retrospective review of 24 cases of gallstone ileus from the hospitals of Oregon Health Sciences University has been presented. Nineteen patients (79 percent) were female and 18 (75 percent) were more than 70 years of age. Fifty-four percent of the patients had a correct preoperative diagnosis that correlated well with the roentgenographic findings. Enterolithotomy was the most frequently employed operation, and cholecystoduodenal fistulas were positively identified in 61 percent of the patients. Most obstructions occurred in the distal ileum (48 percent). Wound infections occurred in six patients (26 percent), and there were three deaths for a mortality rate of 13 percent. Of note, the incidence of wound infections and mortality is found to be decreasing. This is related to the more frequent use of prophylactic antibiotics. The controversy regarding performing an enterolithotomy alone versus a one stage procedure has been reviewed and several interesting and atypical cases have been briefly discussed.

Adult↗

PubMed1985

Breast carcinoma in situ. A retrospective review of 112 cases with a minimum 10 year follow-up.

We have retrospectively reviewed 112 cases of in situ carcinoma of the breast treated between 1960 to 1972, with a minimum 10 year follow-up to correlate treatment with outcome. We concluded that bilateral simple mastectomy with low axillary dissection is the treatment of choice for intraductal or lobular carcinoma in situ. This conclusion was based on the early age at diagnosis, the high incidence of bilaterality, and the long latency and probable progression from the in situ stage to the invasive stage. Lesser procedures can be endorsed for those patients of advanced age or who have associated medical problems whose life expectancy is estimated to be 10 years or less. Patients who refuse bilateral mastectomy should undergo biopsy of the involved or opposite breast at 3 to 5 year intervals regardless of physical findings or mammographic suspicions, especially when severe epithelial dysplasia is encountered in the biopsy specimens. This nonpalpable but potentially curable lesion remains difficult to detect even by mammography.

Adult↗

PubMed1984

Recurrent obstructive jaundice caused by fibrolamellar hepatocellular carcinoma.

A 24-year-old man with hepatocellular carcinoma presented with recurrent obstructive jaundice caused by bile duct invasion and distal migration of necrotic tumor fragments. After resection of an isolated left lobe tumor, he was well for 2 years until he again presented with obstructive jaundice caused by necrotic tumor and clot in the common bile duct. Analysis of his tumor revealed the fibrolamellar histologic variant of hepatocellular carcinoma. This case is unique in that the hepatocellular carcinoma was of the fibrolamellar variant and presented both initially and when recurrent 2 years later with obstructive jaundice caused by invasion of the common bile duct.

Adult↗

PubMed1984

Percutaneous transhepatic biliary decompression. Results and complications in 30 patients.

The palliative management of malignant obstruction of the biliary tree continues to challenge clinicians. The technique of PTBD has become increasingly popular to decompress the obstructed biliary system. Our initial experience with 30 consecutive patients treated with PTBD has been retrospectively reviewed. Internal drainage and effective biliary decompression was achieved in 90 and 86 percent of patients, respectively. Complications developed in 7 of 11 patients with long-term PTBD. Two patients died from septic complications. Three of 10 patients had major complications associated with preoperative PTBD. The remaining seven patients had permanent PTBD but did not derive any clinical improvement. Postoperative mortality after palliative procedures for malignant biliary obstruction is most often associated with carcinomatosis and advanced disease. Palliative biliary bypass provides effective palliation until the patient's death. There are groups of patients with an expected survival of more than 3 months and technically bypassable biliary obstruction who are best palliated by biliary enteric anastomosis. Patients with advanced disease are not candidates for either form of treatment. In patients with lesions not suitable for surgical bypass, PTBD remains a useful alternative.

Adult↗

PubMed1983

Colonic varices due to intestinal cavernous hemangiomas.

Colonic varices are an unusual cause of rectal bleeding. Occurring most often in the setting of portal hypertension, colonic varices have also been linked to congenital vascular lesions. One such vascular lesion, the cavernous hemangioma, is rarely found in the bowel. We report a patient with cavernous hemangiomas involving skin, lower extremities, and gastrointestinal tract, who presented with chronic rectal bleeding from colonic varices. The progression of his hemangiomatous lesions over an 18-year course is documented. The association of colonic varices and hemangiomas of the bowel is discussed.

Adult↗

PubMed1982

Pharmacoangiography in the diagnosis of recurrent massive lower gastrointestinal bleeding.

The source of recurrent massive lower gastrointestinal bleeding can sometimes escape detection by conventional diagnostic measures. In such situations, bleeding can be directly provoked by pharmacoangiography using vasodilators, anticoagulants, and/or fibrinolytic agents. Heparin, streptokinase, and tolazoline, used separately or in combination, can augment, prolong, or reactivate transient, covert bleeding, thereby facilitating angiographic identification and localization of the lesion. Physiological, clinical, and angiographic factors are discussed. Although rarely needed, this useful and sometimes crucial diagnostic approach demands the combined skills and support of the radiologist, clinician, and surgeon.

Aged↗

PubMed1980

Sterols of human gallstones: the recent identification of eight different digitonin precipitable sterols.

In this study, we report for the first time the presence of many noncholesterol sterols in human gallstones. Gallstones were obtained from 17 patients at cholesystectomy. They were rich in sterol composition, some 52.8% by weight. A number of different sterols were found: 22-dehydrocholesterol 0.29% of total sterols; cholestanol, 1.54%; lathosterol, 1.92%; 24-methylene cholesterol and campesterol, 0.64%; stigmasterol, 0.02%; beta-sitosterol, 0.21%; and cholesterol, 95.33%. These individual sterols were identified by a variety of methods which included final verification by combined gas chromatography-mass spectroscopy. These unusual sterols were derived either from the diet or from the metabolism of cholesterol in the body. Their presence might well affect the lithogenicity of the bile and raises questions about their metabolism and function generally in the body.

Cholelithiasis↗

PubMed1977

Diastatic perforation of the cecum without distal obstruction. Case report and review of the literature.

We present the first reported case to our knowledge of diastatic rupture of the normal cecum following cardiac surgery. All other reported cases of diastatic rupture of the cecum are reviewed. Nasotracheal intubation, hypoxemia, and enemas are thought to contribute to this complication. Prophylactic cecostomy for cecal diameters greater than 9 cm is recommended. Cecostomy and drainage are generally the treatment of choice should perforation occur.

Cecal Diseases↗

PubMed1974

Healing of the canine aorta after endarterectomy: a scanning electron microscopy study.

Endarterectomy sections of canine aorta were examined in various stages of healing by scanning electron microscopy. In all specimens the endarterectomy site was quickly covered by a thin fibrin-platelet coagulum with varying amounts of thrombus. Neoendothelization began before one week and was virtually completed by one month except on areas of heavy thrombus deposition. While this study does not prove the origin of the neoendothelial cell, it suggests that neoendothelial cells are derived from pre-existing endothelium and advance over the endarterectomy site from the junction zone of the normal aorta and to a lesser extent from the orifices of brancing vessels.

Animals↗

PubMed1974