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Biomedical subjects

B A Runyon

Publications and source records attributed to B A Runyon.

At least 73 records · Page 4Linked to original sources
PubMed1986

Surgical procedures are well tolerated by patients with asymptomatic chronic hepatitis.

In a retrospective study I assessed operative mortality in patients with biopsy-proven chronic hepatitis. Most patients had no symptoms from their liver disease. All patients were considered to have a viral cause of their chronic hepatitis--five were hepatitis-B surface antigen positive. Seven patients had chronic persistent hepatitis, and 13 had chronic active hepatitis (including four with cirrhosis). Twenty patients underwent 34 operative procedures, including 28 general endotracheal anesthesia and six spinal anesthesia. Although two patients who had preoperative bilirubin levels of 2.5 mg/dl or greater sustained further increases in serum bilirubin postoperatively, the serum liver chemistries of the entire group did not significantly worsen postoperatively. There was no anesthesia-related liver failure or operative mortality. Patients with asymptomatic chronic hepatitis tolerate surgical procedures well.

Anesthesia, Endotracheal↗
PubMed1986

Fatal bacterial peritonitis secondary to nonobstructive colonic dilatation (Ogilvie's syndrome) in cirrhotic ascites.

A cirrhotic woman developed pneumococcal pneumonia with sepsis. Antibiotic therapy initially resulted in defervescence. However, nonobstructive colonic dilatation developed along with fever and clinical deterioration. Abdominal paracentesis and blood cultures revealed Escherichia coli bacterial peritonitis and bacteremia. The patient died. Autopsy revealed massive cecal mucosal ulceration, which was interpreted as the cause of the bacterial peritonitis.

Adult↗
PubMed1986

Paracentesis of ascitic fluid. A safe procedure.

A prospective study of 229 abdominal paracenteses performed on 125 patients with ascites revealed only two major complications (transfusion-requiring abdominal wall hematomas) in a single patient (0.9% of paracenteses and 0.8% of patients), and two minor complications (non-transfusion-requiring hematomas) in two patients (0.9% of paracenteses and 1.6% of patients). No paracentesis resulted in bacterial peritonitis or death. Abdominal paracentesis in patients with ascites is a safe procedure. Fear of complications of the procedure should not preclude performing a paracentesis, provided certain precautions are taken.

Abdominal Muscles↗
PubMed1986

Hepatic hydrothorax is a relative contraindication to chest tube insertion.

Two patients with known chronic ascites developed new massive right-sided pleural effusions. Chest tube placement led to massive protein and electrolyte depletion and death of both patients. Patients who have cirrhosis and massive right-sided pleural effusions, in general, have congenital diaphragmatic defects that predispose them to life-threatening fluid depletion when chest tubes are inserted. Hepatic hydrothorax is a relative contraindication to chest tube insertion.

Adult↗
PubMed1986

Disseminated macronodular cutaneous candidiasis in chronic alcoholism.

Disseminated candidiasis usually occurs in profoundly immunocompromised hosts. We described a case of disseminated macronodular cutaneous candidiasis in a man with no known risk for immunosuppression other than alcoholic liver disease and a second case of multiple macronodular cutaneous abscesses in an alcoholic man who had no evidence of systemic dissemination. One patient had testicular candidiasis, a previously unreported site of infection in disseminated candidiasis. Tests showed neutrophil and lymphocyte function to be normal; however, a marked defect in serum opsonization was demonstrated in one patient. It is postulated that chronic alcoholism with alcoholic liver disease resulted in impaired serum opsonization, which, in turn, predisposed these patients to candidal infection.

Alcoholism↗
PubMed1986

Peritoneal lymphomatosis with ascites. A characterization.

Three patients had autopsy-proved peritoneal lymphomatosis with ascites. Ascitic fluid analysis was characteristic in that the total protein level was greater than 2.5 g/dL, the lactate dehydrogenase level was greater than 225 mU/mL (the upper limit of normal for serum), and the glucose level was less than 50 mg/dL in all patients. Atypical cells were noted on ascitic fluid cytologic studies, and peritoneoscopic biopsy specimens were diagnostic of lymphoma in all three cases. Gut ulceration was present in all patients; a gastric ulcer, a duodenal ulcer, and a colonic ulcer were found to have invasion by lymphoma at autopsy. No patient lived long enough to receive chemotherapy. Perhaps if the diagnosis of lymphoma could have been made earlier, their lives could have been prolonged.

Ascites↗
PubMed1985

Spontaneous bacterial peritonitis.

Spontaneous bacterial peritonitis is an infection of the ascitic fluid of patients who, in general, have severe chronic liver disease. Several variants of this disease exist including bacterascites, culture-negative neutrocytic ascites, and secondary bacterial peritonitis. Spontaneous bacterial peritonitis is frequently manifested by signs and symptoms of peritonitis although the findings may be subtle; however, occasionally it may be completely without clinical manifestation. The clinician must have a high index of suspicion in order to make this diagnosis at a relatively earlier stage of infection. An abdominal paracentesis is required to make the diagnosis of spontaneous bacterial peritonitis. This paracentesis should be performed on all patients who are admitted to the hospital for ascites and should be repeated if there is any manifestation of bacterial infection during the hospitalization. Patients with severe intrahepatic shunting--as manifested by marked redistribution of activity from the liver to the spleen and to the bone marrow on liver-spleen scan as well as patients with an ascitic fluid total protein concentration of less than 1 g/dl--appear to be particularly susceptible to bacterial infection of their ascites. In order to optimize the yield of ascitic fluid culture, it is probably appropriate to inject blood culture bottles with ascites at the bedside immediately after the abdominal paracentesis. The mortality of spontaneous bacterial peritonitis continues to be very high. Perhaps routine admission paracentesis and prompt empiric antibiotic therapy with a third-generation cephalosporin will decrease the mortality of this infection if the Gram stain of the ascitic fluid demonstrates bacteria or the ascitic fluid neutrophil count is greater than 250 cells/cu mm. Repeating the paracentesis after 48 hours of treatment to reculture the fluid and reassess the ascitic fluid neutrophil count appears to be the best way to assess efficacy of treatment. After 48 hours of treatment the ascitic fluid neutrophil count should be less than 50% of the original value if the antimicrobial therapy is appropriate. The optimal duration of antibiotic treatment is unknown; however, until controlled trials provide data regarding duration of treatment it is appropriate to treat with parenteral antibiotics for 10 to 14 days. Research is also needed to determine if there are measures which can be taken to prevent the development of spontaneous peritonitis.

Adolescent↗
PubMed1985

Natural history of repaired umbilical hernias in patients with and without ascites.

A retrospective chart review was undertaken to determine the natural history of repaired umbilical hernias in patients with and without a history of ascites. Eighty-five patients underwent umbilical herniorrhaphy during the interval from January 1973 to March 1983. The length of hospital stay was significantly longer for the 22 patients who had a history of ascites; however, the complication rate of elective repair of umbilical hernias that were caused by ascites was not different from that of the 63 patients without a history of ascites. There was no operative mortality in either group. Sixty-eight patients were reevaluated at least 1 month postoperatively. Of the 51 patients who had never had ascites, six (12%) developed a recurrent hernia. Of the 17 patients whose hernias were caused by ascites, eight (47%) developed recurrences. Of the 11 herniorrhaphies performed when ascitic fluid was present, eight (73%) resulted in a recurrence, whereas only one (17%) patient had a recurrence among the group of seven patients who underwent herniorrhaphy at a time when the ascitic fluid was no longer present. Umbilical hernias caused by ascites can be repaired with acceptable morbidity and probably should be repaired after the fluid has been medically removed.

Ascites↗
PubMed1984

Sclerotherapy induced pseudo-carcinoma.

Endoscopic sclerotherapy has been suggested as the therapy of choice for acute hemorrhage from esophageal varices. It not only controls such episodes, but also prevents rebleeding, and prolongs life. After treatment, patients may present with endoscopic and radiographic findings which mimic esophageal carcinoma including ulceration, non-pliable walls, irregular mucosal pattern and overhanging edges.

Diagnosis, Differential↗
PubMed1984

Spontaneous bacterial peritonitis associated with cardiac ascites.

A patient who developed fatal spontaneous bacterial peritonitis associated with cardiac ascites is reported. Spontaneous bacterial peritonitis most frequently occurs in patients with decompensated cirrhosis of alcoholic or nonalcoholic type. Although there are reports of spontaneous bacterial peritonitis occurring in patients with nephrotic syndrome, or with acute or chronic hepatitis, there appear to be no reports of spontaneous bacterial infection developing in cardiac ascites.

Aged↗
PubMed1980

The spectrum of liver disease in systemic lupus erythematosus. Report of 33 histologically-proved cases and review of the literature.

The charts of 238 patients with systemic lupus erythematosus (SLE) were reviewed. Although not routinely screened for biochemical evidence of liver disease, 124 of 206 patients tested had at least one abnormal result, and 43 met strict criteria for the existence of liver disease. In most patients, a specific viral or drug etiology could not be implicated. The spectrum of liver disease in 33 patients from whom liver tissue was available included cirrhosis, chronic active hepatitis, granulomatous hepatitis, chronic persistent hepatitis and steatosis. Three of four cirrhotic patients demonstrated a peculiar form of cholestasis which resembled a "canalicular cast" of bile. Of the nine patients who had serial liver biopsies, four showed progression of their disease. Three patients died of liver failure. Liver involvement in SLE is more common than previously recognized. Severe and even fatal liver disease can occur.

Adolescent↗
PubMed1979

Pleural-fluid kinetics in a patient with primary lymphedema, pleural effusions, and yellow nails.

We present the clinical findings in the thirteenth recorded patient with lymphedema, pleural effusions, and ungual dystrophy--the so-called "yellow nail" syndrome. The rate of pleural-fluid turnover was measured by using radioiodinated albumin to trace the efflux of fluid by lymphatics. The rate of pleural lymphatic flow was low in comparison to previous estimates obtained by the same method in a variety of other conditions. Such slow lymphatic flow is consistent with the postulate that accumulation of pleural fluid in this syndrome is due to defective lymphatic drainage.

Drainage↗
PubMedDate not supplied

Ascitic fluid analysis in the differentiation of spontaneous bacterial peritonitis from gastrointestinal tract perforation into ascitic fluid.

A review of patients with bacterial peritonitis and ascites revealed six patients with gastrointestinal tract perforation into their ascitic fluid and 33 episodes of spontaneous bacterial peritonitis in 32 patients. Signs and symptoms were not helpful in differentiating the two groups; however, ascitic fluid analysis was found to be useful. All patients with perforation peritonitis fulfilled at least two of the following criteria: ascitic fluid total protein greater than 1 gm per dl, glucose less than 50 mg per dl and lactate dehydrogenase greater than 225 mU per ml. In only two episodes of spontaneous bacterial peritonitis were two of the criteria fulfilled.

Ascitic Fluid↗