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Biomedical subjects

A J Donovan

Publications and source records attributed to A J Donovan.

At least 37 records · Page 2Linked to original sources
PubMed1983

Abdominal colectomy for chronic encephalopathy due to portal-systemic shunt.

Chronic portal-systemic encephalopathy (CPSE) following portal-systemic shunts may be incapacitating and non-responsive to intensive medical management. Between 1960 and 1980, 12 patients with cirrhosis who were institutionalized with CPSE underwent colonic exclusion. Cirrhosis was due to alcohol in ten patients and to cryptogenic liver disease in two. Nine patients had previously undergone end-to-side portacaval shunts and two patients had had mesocaval shunts. One patient had a spontaneous shunt between splenic and renal veins. Ten patients underwent colectomy and ileosigmoidostomy; one had colectomy, ileostomy, and mucous fistula; and one had colonic bypass and ileosigmoidostomy. Four patients died postoperatively. Survivors were clinically improved and able to leave a closed institutional environment. Colectomy may be considered in disabling cases of CPSE unresponsive to medical therapy; it is a final effort at functional rehabilitation. Although mortality is high, improvement in functional status can be expected among survivors of the operation.

Adult↗
PubMed1983

Abdominal stab wound with omental evisceration.

Among 100 patients with omental evisceration due to abdominal stab wounds admitted consecutively to the Los Angeles County-University of Southern California Medical Center, Los Angeles, major intraperitoneal injuries occurred in 69 cases. These injuries involved the small bowel (28), large bowel (15), spleen (three), stomach (ten), liver (14), diaphragm (nine), and pancreas (four). The incidence of major visceral injury coincidental to stab wounds with omental evisceration supports a policy of routine exploratory celiotomy in cases of abdominal stab wounds with omental evisceration.

Abdominal Injuries↗
PubMed1982

Management of the transected pancreas following distal pancreatectomy.

Fifty-six patients are reported upon in whom distal pancreatectomy had been performed for pancreatic trauma with presumed major injury to the pancreatic ductal system. The transected pancreas was compressed with sutures in 27 patients and with a stapler in 29 patients. The postoperative morbidity was comparable in the two groups--three abscesses and four pancreatic fistulas with suture of the pancreas and three of each when the pancreas was stapled. Death was due to perioperative hemorrhage from associated injury in five patients and to severe neurologic damage in three patients. The mortality was 14 per cent.

Humans↗
PubMed1981

Synchronous anterior celiotomy and posterior drainage of pancreatic abscess.

Pancreatic abscess has been characterized by a high rate of reoperation for persistent sepsis and by a high mortality. Nine patients with pancreatic abscess have undergone synchronous anterior celiotomy and posterior drainage following resection of the 12th rib. Pancreatic abscess was secondary to acute pancreatitis in seven of the cases. In two cases, the combined procedure was a secondary operation to treat abscess that developed following surgery for pancreatic trauma. All of these nine patients survived. One patient required reoperation for drainage of a left retrocolic abscess. A synchronous approach permits adequate exploration of the abdomen, provides the exposure necessary to remove necrotic tissue, and allows dependent drainage of the left subphrenic space without fear of splenic, pancreatic, or vascular injury.

Abdomen↗
PubMed1981

Biliary lithiasis and helminthiasis.

The syndrome of Oriental cholangiohepatitis is characterized by helminthiasis, choledocholithiasis often without cholecystolithiasis, biliary duct stricture and hepatic abscess. The common duct stones are usually multiple, black and friable. Fourteen cases have been seen in recent immigrants to the United States. Thirteen patients had choledocholithiasis, and 1 had viable flukes in the ducts. Choledochoenterostomy is usually required because of multiple stones, including intrahepatic stones, or proven or presumed infestation with Clonorchis sinensis. The latter, the Chinese liver fluke, is an infestation for which medical therapy does not exist. Resection, particularly of the lateral segment of the left hepatic lobe, may be required in cases of abscess and stones associated with stricture of the left hepatic duct.

Adult↗
PubMed1981

Results of a 12-year randomized trial of portacaval shunt in patients with alcoholic liver disease and bleeding varices.

During a 7-yr period (1967-1974), 89 patients with alcoholic liver disease and at least one severe upper gastrointestinal hemorrhage thought to be from esophageal varices entered a randomized, controlled trial of medical therapy vs. end-to-side portacaval shunt. Follow-up continued to September, 1979, so that all surviving patients had at least 5 yr observation after randomization. Among 45 patients randomized to surgical therapy, 4 did not receive portacaval shunt, for various reasons. Among shunted patients there were 11 episodes of upper gastrointestinal bleeding, none fatal and none thought to be from esophageal varices. Thirty-seven percent of eligible patients have had moderate or severe hepatic encephalopathy ascribed to the shunt. Of 44 patients randomized to medical therapy, 7 eventually received portacaval shunt after multiple bleeding episodes. Since randomization there have been 190 episodes of bleeding requiring 589 transfusions and resulting in 23 deaths from bleeding or hepatic failure precipitated by bleeding. THere are 12 survivors in the surgically treated group and 8 in the group treated medically. Life-table analysis shows a small increase in survival in the surgically treated group throughout the study, which is not statistically significant. From our data, we could not identify risk factors that would improve the selection of patients for medical or surgical therapy.

Adult↗
PubMed1980

Histoculture of human breast cancers.

Breast cancers from 53 patients were explanted in culture, and 39 with two-year or more follow-up and documentable tissue forms of cancer in culture (histoculture) are the subject of this report. Clinicopathologic findings have been correlated with dynamic aspects of the cancers in short-term histocultures, including cell cohesiveness, yield and survival time of the cancer cells in culture, emigration of macrophages from the explants, and the occurrence of special interactions of lymphocytes with cancer cells. The outstanding finding was the association of special lymphocyte-cancer cell interactions with a more favorable prognosis; six of seven patients (86%) with infiltrating ductal cancer showing lymphocyte congregation, emperiopolesis, or other special activity were tumor-free survivors. Additional findings were: 1) patients having four or fewer lymph nodes positive for cancer had a survival rate of 50%, but this fell to 20% when emigrating macrophages were not present in the cancer cultures; 2) eight of the 12 patients (67%) having discoid histoculture survival time of less than one week were tumor-free, as opposed to three of eight patients (27%) where tumor survival in vitro was greater than one week. The reverse was true for nondiscoid, poorly cohesive colonies of cancer; 3) the combination of tumor-negative lymph nodes and low in vitro cancer yield was associated with the best patient survival rate, 64%. However, the combination of negative nodes and high in vitro yield was linked to the worst patient survival (20%). Although the overall study does not permit definitive conclusions, there is an undeniable potential for the use of histocultures in the evaluation of human cancers. Expanded studies are warranted, including larger numbers of tumors and cultures, and longer patient follow-up periods.

Breast Neoplasms↗
PubMed1979

Selective treatment of duodenal ulcer with perforation.

Selective treatment of duodenal ulcer with perforation has been based on several premises: 1) The natural history of the ulcer following closure of a perforation is generally favorable with an acute and unfavorable with a chronic ulcer. 2) An upper gastrointestinal series with water soluble contrast media can reliably document a spontaneously sealed perforation. 3) With a spontaneous seal, nonsurgical therapy is an acceptable option and is preferable for an acute ulcer or a chronic ulcer with poor surgical risk. 4) The treatment of choice for an unsealed perforation of an acute ulcer is simple surgical closure. 5) The treatment of choice of perforation of a chronic ulcer with acceptable surgical risk is an ulcer definitive operation. Sixty cases of perforation of duodenal ulcer have been treated. Nonsurgical therapy was employed without complication in eight cases with radiologically documented spontaneous seal. Truncal vagotomy and pyloroplasty in 36 cases and truncal vagotomy and antrectomy in two cases were each without mortality. Four fatalities occurred among 13 cases of closure and omental patch, each a case with severe associated disease. The mortality was 6.7% among the 60 cases; 2.4% for chronic ulcer and 16% for acute ulcer.

Acute Disease↗
PubMed1978

Cholecystosonography for the diagnosis of cholecystolithiasis.

The gallbladder can be visualized by ultrasound (cholecystosonography) and gallstones seen as echo producing densities. Under cholecystosonographic observation the gallbladder can be demonstrated to contract following stimulation by cholecystokinin. This establishes patency of the cystic duct and excludes a diagnosis of acute obstructive cholecystopathy. The gallbladder has been identified in 84 of 86 patients. Stones have been identified sonographically in 64% of 42 patients with proven gallstones (75% of the last 20 cases). The gallbladder contracted following stimulation in 18 of 20 cases with a patent cystic duct. Cholecystosonography is simple, safe and economical. Cholecystonography with cholecystokinin stimulation is the first diagnostic study to be performed when cholecystolithiasis is suspected and the following circumstances exists: a) an acute right upper quadrant (RUQ) syndrome consistant with acute obstructive cholecystopathy. b) cholestasis or hepatic dysfunction. c) a history of allergy to contrast media. Cholecystosonography may detect gallstones in a gallbladder visualized by oral cholangiography when stones are of the same density as the contrast media.

Cholangiography↗
PubMed1977

Breast cancer: lack of prognostic value of adrenal pathology at adrenalectomy.

The adrenal glands of 58 patients undergoing adrenalectomy for advanced breast cancer were reviewed and correlated with subsequent course of the patients' disease. Three patients had thecomatous metaplasia in the adrenal cortex, six patients had myelolipomatous changes, and 13 patients had metastatic breast cancer in their adrenal glands at the time of adrenalectomy. Neither the presence of metastases nor myelolipomatous changes were associated with a long disease-free interval, a long period from mastectomy to adrenalectomy, or a prolonged postadrenalectomy survival. The patients with metastatic breast cancer in the adrenal glands had more widespread disease than patients without adrenal metastases. The presence of breast cancer metastases in the adrenal glands at the time adrenalectomy identifies patients further advanced in the course of their disease, but is not related prognostically to the effect of adrenalectomy.

Adrenal Gland Neoplasms↗