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Biomedical subjects

C D Johnson

Publications and source records attributed to C D Johnson.

At least 235 records · Page 13Linked to original sources
PubMed1990

Percutaneous endoscopic gastrostomy.

The many variations of surgical gastrostomy for nutritional support or for long-term gastric decompression all have a significant morbidity and mortality. An 'incisionless' technique under local anaesthesia, namely percutaneous endoscopic gastrostomy, was described in 1980. A review of the literature shows that the percutaneous technique is safer for the patient, easier and faster to perform and considerably cheaper than surgical gastrostomy. As the few complications usually require surgical management, percutaneous endoscopic gastrostomy should be considered a surgical technique. Few patients are unsuitable for the percutaneous endoscopic technique and this route should be considered for all patients referred for a gastrostomy.

Enteral Nutrition↗
PubMed1990

Ciliary muscle choline acetyltransferase and acetylcholinesterase after ciliary ganglionectomy.

Choline acetyltransferase (ChAT; EC 2.3.1.6) and acetylcholinesterase (AChE; EC 3.1.1.7) activities were measured in cynomolgus monkey ciliary muscle 1 month and 6 or more months after ciliary ganglionectomy (CG) or post-ganglionic ciliary neurectomy (PCN). ChAT activity was undetectable and AChE activity was elevated 1 month after CG or PCN, while both averaged about 30% of normal levels 6 or more months after denervation. Four out of six eyes reinnervated by functional criteria 6-12 months after CG or PCN. In one of the two remaining eyes permanently denervated, ChAT was absent from the ciliary muscle. In the other, ChAT activity was about 50% of normal, similar to the reinnervated eyes, but the regenerated cholinergic nerves were not approximated to the ciliary muscle fibers.

Acetylcholinesterase↗
PubMed1990

Quantitative relation between gastric acid secretion and changes in urinary acid excretion.

This study was designed to investigate the relations between gastric acid secretion and alkalinisation of the urine. Normal subjects underwent standard pentagastrin (6 micrograms/kg) (n = 5) and sham feeding (n = 6) tests, with additional collection of urine samples before and two and three hours after the start of the test for measurement of titratable urine acidity. Nine subjects provided urine before and two hours after a test meal. Sham feeding (n = 5) and meal (n = 6) tests were carried out in patients who had had a successful vagotomy for duodenal ulcer. There was a significant correlation of gastric acid response in the standard tests with simultaneous changes in urine acidity (r = -0.79, p less than 0.001) and also with urine acid output after the test meal, on another day (r = -0.73; p less than 0.02). The correlation was insufficient to predict gastric function from changes in urinary acidity, but there was clear separation of the results in normal subjects and patients with vagotomy. Changes in urine acidity after a standardised meal may prove to be useful as a screening test after vagotomy to select patients who are likely to have a persisting high gastric acid response to vagal stimulants.

Acids↗
PubMed1990

Surgical procedures in patients at risk of human immunodeficiency virus infection.

We have studied the outcome of 140 general surgical procedures in 112 patients known or suspected to be infected with human immunodeficiency virus (HIV) or hepatitis B virus. Forty patients had antibodies to HIV. A wide range of surgical procedures was performed, with an overall complication rate of 5.7%. Wound infection, wound haematoma and one unexplained pyrexia were the only complications seen. Some anorectal wounds in patients with HIV antibodies were noted to heal extremely slowly, but the aggressive anorectal sepsis reported by others was not seen. The postoperative course after general surgical procedures was unremarkable in patients with HIV antibodies, and in those suspected of HIV infection, but because anorectal wounds were found to heal slowly, we recommend that anorectal surgery be conservative in patients with HIV antibodies.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Diagnosis of bowel infarction: a comparison of plain films and CT scans in 23 cases.

We retrospectively reviewed abdominal CT and plain film findings in 23 proved cases of mesenteric infarction to compare the value of the two techniques. Criteria considered specific for infarction on CT were identified in nine (39%) of 23 patients and comprised pneumatosis in seven patients (30%), mesenteric or portal venous gas in three patients (13%), and focally thick-walled bowel in two patients (9%). Criteria considered specific for bowel infarction on plain films were identified in seven (30%) of 23 patients and comprised focally edematous bowel in six patients (26%) and pneumatosis intestinalis in one patient (4%). Only one patient had specific changes on both CT and plain films, but 15 (65%) of the 23 showed specific changes on at least one study. The results indicate that plain films remain an important tool in patients suspected of mesenteric infarction and can provide information that is complementary to CT. Also, as both studies were nonspecific in eight (35%) of our patients, negative or nonspecific findings should not deter further diagnostic or interventional procedures in patients in whom the clinical suspicion of bowel infarction is high.

Adolescent↗
PubMed1990

Islet cell tumors in von Hippel-Lindau disease: increased prevalence and relationship to the multiple endocrine neoplasias.

Von Hippel-Lindau disease is a rare, autosomal-dominant disorder characterized by CNS hemangioblastomas, retinal angiomas, renal cell carcinomas, pheochromocytomas, and visceral cysts. The occurrence of islet cell tumors in von Hippel-Lindau disease has been noted recently. Because of the coexistence of both islet cell tumors and pheochromocytomas in some patients with this disorder, it has been proposed that there may be a continuum of the multiple endocrine neoplasias. However, no large, multifamily study has been published evaluating the prevalence of islet cell tumors and pheochromocytomas in von Hippel-Lindau disease. To assess the frequency of islet cell tumors in this disorder and its relationship to the multiple endocrine neoplasias, we reviewed the clinical and imaging findings of all patients with von Hippel-Lindau disease evaluated at the Mayo Clinic between January 1979 and December 1989. Forty-three patients with von Hippel-Lindau disease from over 25 kindreds were found. Cross-sectional imaging of the pancreas had been performed in 35. Islet cell tumors were found in six (17%) of these, three islet cell adenomas and three islet cell carcinomas. No patient presented with endocrine-related symptoms; four tumors were detected during screening examinations of the abdomen. Two (33%) of these six patients had a coexisting pheochromocytoma. Our review of a large number of patients from many different families with von Hippel-Lindau disease revealed a high prevalence of islet cell tumors and the frequent coexistence of islet cell tumors and pheochromocytomas. This latter finding supports a continuum of the multiple endocrine neoplastic syndromes.

Adenoma, Islet Cell↗
PubMed1990

Admission to hospital after day case surgery.

This paper reports a 5-year experience of a surgical day case unit. Over 10,000 patients were treated in the three specialties of gynaecology, orthopaedics and general surgery. Seventy patients (0.7%) were admitted to the inpatient beds of the hospital directly from the day case unit. These patients were reviewed to determine if any avoidable factors had played a part. Two-fifths of the admissions after suction termination of pregnancy were of patients of more than 12 weeks' gestation. Admission was necessary on 10 occasions after orthopaedic and general surgical operations when the procedure was too extensive or too painful to allow the patient to be discharged home. Complications of anaesthesia, either local (n = 5) or general (n = 15), constituted the largest cause for admission. Postoperative nausea, vomiting and drowsiness became less frequent after a change in technique to the use of a short-acting anaesthetic agent (12 in the 3 years before; two in the 2 years after). Day case surgery is safe and should rarely be followed by the need for hospital admission. Based on our experience, we recommend the use of short-acting agents for general anaesthesia, and we advise against day case surgery in patients who require a general anaesthetic for longer than 60 min, or who need extensive surgery.

Abortion, Induced↗
PubMed1990

Pancreaticogastrostomy after pancreaticoduodenectomy.

Although the mortality following pancreaticoduodenectomy has fallen and is now below 5%, overall 14% of patients develop a leak at the pancreatic anastomosis. This complication carries a 24% mortality rate when pancreaticojejunostomy is the method of reconstruction. In order to reduce the incidence of this complication, pancreaticogastrostomy can be performed following pancreaticoduodenectomy. A total of 41 patients underwent this operation between 1968 and 1989. The indications for operations were carcinoma of the head of the pancreas (n = 19), carcinoma of the ampulla (n = 12), carcinoma of the lower end of the common bile duct (n = 6), chronic pancreatitis (n = 3) and one patient with a nonfunctioning islet cell tumour. One patient developed a pancreatic fistula which closed spontaneously in 5 days. This patient is alive and well 36 months after operation. Pancreaticogastrostomy with pancreatic duct to gastric mucosa anastomosis is recommended as a safe and straight-forward method of reconstruction following pancreaticoduodenectomy.

Adenoma, Islet Cell↗
PubMed1990

Surgery offers no more than medical treatment in the management of transient ischaemic attack.

This paper debates the motion that 'Surgery offers no more than medical treatment in the management of transient ischaemic attack' (TIA). The arguments in support of this motion are that surgical treatment has a high morbidity and mortality, and that even the investigation of patients by angiography prior to surgery entails a risk of stroke; that TIA is a marker of generalised vascular disease, and that medical treatment can reduce the incidence of stroke after TIA. The counter arguments are that TIA is associated with an increased risk of stroke and this risk can be reduced by surgery; that recent surgical results show an acceptable complication rate, and that modern methods of investigation permit accurate non-invasive assessment of patients at risk of stroke.

Aspirin↗
PubMed1990

Resection of liver metastases from a colorectal carcinoma does not benefit the patient.

This paper presents arguments for and against the motion that 'Resection of liver metastases from colorectal carcinoma does not benefit the patient'. The case for this proposition is summarised as follows: survival after resection of small metastases is not markedly different from the natural history of similar tumours; patients with metastases apparently localised to one area of the liver are uncommon, and thorough investigation further reduces the proportion of such patients; the operative mortality of liver resection has a significant adverse effect on survival after resection, and may cancel out the benefits of surgery, and finally the alternative non-operative methods of treating these patients may offer similar benefits to resection. The counter argument is simple: for a patient with liver metastases the only hope of eradication of liver disease lies in surgical resection. If this can be achieved then the prognosis is as good as for a similar primary tumour without liver metastases.

Colorectal Neoplasms↗
PubMed1990

A prospective study of bilateral inguinal hernia repair.

A prospective study of outcome after inguinal hernia repair in patients undergoing simultaneous repair of bilateral hernias (n = 31), sequential repair of bilateral hernias (n = 5), and unilateral hernia repair (n = 75) is reported. There were no differences in wound complications, post-operative respiratory complications, or other adverse effects in the three groups. Operating time was similar in the unilateral and bilateral simultaneous repairs (median 55 min), but was longer (100 min) for the combination of two sequential repairs. Hospital stay was shortest for patients undergoing unilateral repair (2 days) but was less with bilateral simultaneous repair (4 days) than after two sequential repairs (total of 6 days). There were 12 (11%) wound complications of which five (5%) were infections. There was no difference in complication rate between unilateral and bilateral hernia repair. Postoperative recovery was assessed prospectively and was recorded at 1 month. There was no difference between unilateral and bilateral simultaneous repairs in the number of days before the patient was able to climb stairs easily, drive a car or return to work. The duration of the requirement for analgesia was similar in each group. We conclude that bilateral simultaneous hernia repair can be carried out with no greater morbidity than a unilateral repair, and the return to normal activity is as rapid. Bilateral hernias should be repaired simultaneously rather than sequentially.

Adolescent↗
PubMed1990

Drainage or suture of the cavity after breast biopsy.

An initial series of 105 women who underwent excision biopsy of the breast were entered into a controlled randomised trial to determine the effect on postoperative morbidity of drainage of the cavity with a soft rubber Penrose drain. The use of this drain had no effect on the incidence of postoperative wound complications (drain 11 of 40 (28%), no drain 10 of 58 (17%]. A second series of 202 women were entered into a randomised controlled trial to determine the effect of closed suction drainage and suture of the cavity after breast biopsy. The use of this drain significantly reduced the incidence of postoperative wound complications (drain 9 of 93 (10%), no drain 22 of 105 (21%], but although suture of the cavity halved the number of wound complications (suture 11 of 97 (11%), no suture 20 of 101 (20%], this did not reach statistical significance. Wound complications were more frequent with large wounds (28%) than with smaller ones (15%), and with less experienced operators (registrar 21%, senior registrar/consultant 10%). We conclude that a closed suction drain will reduce the incidence of wound haematomas after breast biopsy but that a Penrose drain is ineffective in the prevention of wound complications.

Biopsy↗