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Biomedical subjects

C L Snyder

Publications and source records attributed to C L Snyder.

44 records · Page 3Linked to original sources
PubMed1990

Nonoperative management of small-bowel obstruction with endoscopic long intestinal tube placement.

Intestinal obstruction remains a major cause of morbidity and mortality in surgical patients. We reviewed the records of 77 patients with mechanical small-bowel obstruction who were treated with endoscopically and fluoroscopically placed Leonard long intestinal tube decompression. Most patients (59%) had failed a trial of nasogastric tube or Miller-Abbott tube decompression. Overall, 29 per cent of patients were able to resolve their obstruction with Leonard tube decompression alone. Subdivision of patients on the basis of the etiology of their obstruction demonstrated a much higher rate of success for tube decompression in adhesive obstruction (37%) versus malignant obstruction (12%) or inflammatory obstruction (no successes). Patients with radiographic and clinical evidence of complete intestinal obstruction were significantly less likely to respond to long intestinal tube treatment (13%). The long intestinal tube was easily passed in all patients. There were no complications of the intubation procedure in our series, and the incidence of tube-related complications was four per cent. We conclude that an initial period of long intestinal tube decompression allows a significant percentage of patients with mechanical small-bowel obstruction to be treated nonoperatively, particularly if a partial obstruction from postoperative adhesions is present. Patients who have failed a trial of nasogastric tube decompression and are poor operative risks should also be considered for long intestinal tube placement.

Duodenal Obstruction↗
PubMed1989

Operative therapy of gallbladder disease in patients with cystic fibrosis.

We retrospectively studied 20 patients with cystic fibrosis who underwent surgery for gallbladder disease from 1973 to 1986. A long delay between the onset of symptoms and the diagnosis was noted (mean 7.4 months). This delay was attributed to masking of the symptoms of biliary disease by the malabsorption and pulmonary symptoms seen in this patient population. There was a notable lack of common bile duct disease in our patients as well as in those reported in the literature. This may have been due to a combination of factors: the increased viscosity of the mucus, the small caliber of the gallbladder and ductal system, and the hypotonicity of the gallbladder. We do not recommend routine intraoperative cholangiography in patients with cystic fibrosis and gallbladder disease. Cystic fibrosis is a disease with progressive pulmonary deterioration. Cholecystectomy can be performed in these patients with relative safety if careful preoperative and postoperative care is provided. We recommend early operative intervention in the patient with gallbladder disease and cystic fibrosis.

Adolescent↗
PubMed1989

Giant inguinal hernia in a 5-year-old boy with hydrocephalus: a case report.

A case of giant left inguinal hernia in a 5-year-old boy is presented. The patient had multiple neurosurgical procedures performed in the neonatal period for spina bifida and hydrocephalus, including the placement of a ventriculoperitoneal shunt. The hernia was first noted during this period but was not repaired, and the child was lost to follow-up until age 5. The hernia underwent progressive enlargement over this interval, and the eventual development of gastrointestinal symptoms prompted the "rediscovery" of the defect. The majority of the child's intestines were within the hernia, with at least partial loss of domain. The unique preoperative and postoperative management of this difficult problem is described.

Age Factors↗
PubMed1989

Blunt chest trauma with transection of the azygos vein: case report.

A review of the world literature revealed only five reported cases of azygos vein disruption from blunt chest trauma. Four of these were isolated injuries. We report a case of isolated complete azygos vein transection as a result of blunt motor vehicular trauma. Emergency thoracotomy and venous ligation resulted in successful resuscitation. Shearing forces as a result of deceleration were felt to be a possible etiology.

Accidents, Traffic↗
PubMed1988

Hemangiomatosis of the colon and peritoneum: case report and management discussion.

A 3-month-old infant presented with ascites, anemia, minimal rectal bleeding, and thrombocytopenia. He was found to have several hundred small cavernous hemangiomas of the colon and peritoneal surfaces. Treatment consisted of laser surgery, subtotal colectomy, and steroids. A brief review of the literature on intestinal hemangiomatosis is included as well as the complications of the disease and current therapy.

Adrenal Cortex Hormones↗
PubMed1987

Cuff-occluded rate of rise of peripheral venous pressure: a new, highly sensitive technique for monitoring blood volume status during hemorrhage and resuscitation.

We investigated the cuff-occluded rate of rise of peripheral venous pressure (CORRP)--a new, nearly noninvasive peripheral hemodynamic monitoring parameter--in dogs subjected to hemorrhage and resuscitation. Twelve adult mongrel dogs under general anesthesia were subjected to hemorrhage of 30% of their estimated total blood volume (TBV) for 30 minutes; after this time the extracted blood was reinfused. Arterial pressure (AP), central venous pressure (CVP), pulmonary arterial pressure (PAP), cardiac output (CO), pulmonary venous pressure (PWP), heart rate, and CORRP were continuously monitored. A "clinically significant change" (CSC) in CORRP and CO was defined as a change that exceeded two standard deviations from the mean of five baseline measurements made before the onset of hemorrhage, whereas a CSC in PWP or CVP was conservatively defined as a change that exceeded 2 mm Hg from the average of five baseline measurements, and a CSC in PAP and AP was defined as a change that exceeded 3 mm Hg and 5 mm Hg, respectively from the average of the baseline measurements. There was no consistent change in heart rate during hemorrhage. Thus defined, a CSC in CORRP occurred after an average extraction of 9.2% +/- 4.7% TBV, whereas a CSC was not seen until an average loss of 16.5% +/- 8.1% TBV for AP, 21% +/- 13% TBV for PWP, 15.5% +/- 7% TBV for PAP, and 35% +/- 3% TBV for CVP. These average blood losses are all significantly different from the average blood loss required to effect a CSC in CORRP. The blood loss required to effect a CSC in CO averaged 9.7% +/- 6%. We conclude that in these anesthetized dogs, CORRP detected blood loss earlier than other commonly used hemodynamic parameters, including several invasive parameters such as CVP, PAP, and PWP; CORRP and CO were equivalent in their ability to detect early stages of blood loss.

Animals↗
PubMed1984

Type A behavior and coronary heart disease.

Coronary-prone (Type A) behavior is an independent risk factor for ischemic heart disease (coronary heart disease). Recent investigations indicate that modification of Type A behavior is possible and that such treatment reduces the likelihood of subsequent coronary events. Type A behavior is not difficult to recognize in day-to-day family practice. By recognizing and responding to coronary-prone behavior, family physicians can play an active role in the prevention and treatment of coronary heart disease.

Behavior Therapy↗