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Biomedical subjects

C M Ferguson

Publications and source records attributed to C M Ferguson.

35 records · Page 2Linked to original sources
PubMed1990

Current management of choledocholithiasis.

Choledocholithiasis may be managed by surgical extraction of stones or endoscopic papillotomy with extraction of stones. To evaluate these methods of management, the charts of all patients with choledocholithiasis admitted to Crawford Long Hospital of Emory University between April 1, 1983, and April 30, 1988, were reviewed. One hundred patients were identified; 42 were treated by common bile duct exploration (CBDE) and 58 had endoscopic papillotomy with extraction of stones (EP) as their initial treatment. The two groups were similar in regards to age, but the CBDE group had more comorbid conditions (average 2.5/patient in CBDE vs 1.8/patient in EP) and a higher incidence of acute cholecystitis and/or cholangitis (74% of CBDE patients; 24% of EP patients). Successful extraction of all stones occurred in 79 per cent of CBDE patients and 90 per cent of EP patients. Of those patients with retained stones following CBDE, all were later extracted by EP. Of patients having EP as their initial procedure, 24 per cent required repeat endoscopic procedures for extraction of residual stones and only six patients (10.4%) required CBDE for retained stones. Morbidity was lower (10% vs 23%) and hospital stay shorter (3.6 days vs 10.4 days) in the EP than CBDE patients; thus, the two groups are not completely comparable. Mortality was similar in the two groups (1.7% EP, 2.3% CBDE).

Adolescent↗
PubMed1990

Use of omental pedicle grafts in abdominoperineal resection.

Following abdominoperineal resection, the empty space of the pelvic hollow is filled by loops of small intestine, which may become fixed and cause obstruction. In patients who require adjuvant radiotherapy, such loops of intestine fixed in the pelvis may predispose the patient to radiation enteritis. Proposed methods to prevent such fixed loops of small intestine in the pelvis include closure of the pelvic peritoneum with subperitoneal drainage, fixation of the bladder to the sacrum, retroversion of the uterus, placement of prosthetic mesh, and placement of an omental pedicle graft in the pelvic hollow. The omental pedicle graft has the advantages of ease of performance, use of autologous tissue, and filling the pelvic hollow with vascularized tissue, which should decrease the risk of postoperative pelvic abscess. This study reviews the technique of omental pedicle graft closure of the pelvis and the results of it in our initial eight patients. The omental pedicle graft has become the preferred method of pelvic reconstruction following abdominoperineal resection at Grady Memorial Hospital, Atlanta, Georgia.

Abdomen↗
PubMed1990

Determinants of primary therapy of early stage breast cancer.

Controversy exists in the local treatment of early stage breast cancer. In an effort to determine what criteria are used in selection of therapy for patients with breast cancer, we reviewed the experience of early stage breast cancer at Crawford Long Hospital of Emory University during 1986 and 1987. One hundred eighty-three patients were identified with Stage 0, I, or II breast cancer. A total of 11% of patients were treated by lumpectomy and radiotherapy. Residence distant from the hospital was associated with a low rate of utilization of lumpectomy and radiotherapy (p = .05). The strongest predictor of therapy was the surgeon involved in the patient's care (p = 0.001). For surgeons who cared for five or more patients with breast cancer over this time period, rates of utilization of lumpectomy and radiotherapy ranged from 0 to 20% of patients. The results of this study suggest that the surgeon consulted is the major determinant of the type of therapy used in the primary management of breast cancer.

Breast Neoplasms↗
PubMed1989

Breast masses in young women.

To better define the risk of breast cancer in young patients, a retrospective review of all breast biopsies in women under age 40 years at Grady Memorial Hospital, Atlanta, from Dec 1, 1981, to Aug 15, 1987, was performed. During this time, 751 biopsies were performed on patients aged 9 to 40 years. None of the 128 patients aged 20 years or less had carcinoma. Of 150 patients aged 21 to 25 years, two had carcinoma. At age 26, there began a steady rise in the incidence of carcinoma, such that in the 36- to 40-year age group, carcinoma was present in 24.4% of the specimens. This retrospective review confirms previous reports that suggest that carcinoma of the breast is distinctly unusual in patients under age 20 and that breast masses in these young patients should be managed conservatively. As the incidence of carcinoma increases with the age of the patient, one's threshold for excisional biopsy should decrease.

Adenofibroma↗
PubMed1988

Splenectomy for immune thrombocytopenia related to human immunodeficiency virus.

From 1 January 1984 to 31 August 1987, 11 patients underwent splenectomy for treatment of thrombocytopenia related to human immunodeficiency virus (HIV). Six of the patients had been previously treated with prednisone, five of whom showed some response. None of those who responded to the prednisone had a sustained response and, thus, all required splenectomy. All 11 patients had an excellent response to splenectomy. The average preoperative and postoperative platelet counts were 19,700 and 498,000, respectively. All patients have maintained normal platelet counts at an average follow-up period of 12.4 months (range of one to 37 months). There were no postoperative deaths. Morbidity was minimal; in two patients, wound seromas developed. In one patient, acquired immunodeficiency syndrome (AIDS) developed 12 months after splenectomy, but none of the other patients have evidence of AIDS. Splenectomy is a safe and effective therapy for HIV-related immune thrombocytopenia.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Perianal infections in acute leukemia. Second place winner: Conrad Jobst Award.

Perianal infections in patients with acute leukemia and granulocytopenia are potentially lethal conditions. To evaluate the management of perianal infections in patients with granulocytopenia and acute leukemia, all such patients treated at Emory University Hospital between January 1, 1980, and December 31, 1985, were reviewed. Twenty patients were found to have severe granulocytopenia (fewer than 500 polymorphonuclear leukocytes/mm3) and perianal infection, representing 5.7 per cent of all hematology service admissions during that period. Eleven patients were managed conservatively with broad-spectrum antibiotics and supportive measures, and nine patients underwent operative drainage of the perianal infection in addition to conservative measures. The two groups were similar in respect to age, associated conditions, length of hospitalization, and degree of perianal infection, with the exception that operatively drained patients were more likely to have positive blood cultures (7/9 operatively drained; 4/11 conservatively managed). Mortality was higher in the operatively drained group (44.4% vs 9% in the conservatively managed), and three patients had progression of the local infection after drainage, two of whom required a diverting colostomy. The overall mortality attributed to perianal disease in these severely granulocytopenic patients was 25 per cent. From this review, operative drainage of perianal infection does not appear to increase survival or decrease morbidity in patients with severe granulocytopenia.

Acute Disease↗
PubMed1988

Surgical complications of human immunodeficiency virus infection.

To assess the role of the general surgeon in the care of patients with acquired immunodeficiency syndrome (AIDS) and AIDS-related complex (ARC) the hospital records of all patients with AIDS or ARC who underwent a major operation at the General Surgical Service of Crawford W. Long Memorial Hospital were reviewed. Of 79 patients with AIDS or ARC diagnosed since 1982, 14 required major abdominal surgery. Operations performed were for gastrointestinal (GI) complications of opportunistic infections and neoplasms (four), diagnosis of major retroperitoneal lymphadenopathy (four), and treatment of AIDS-related immune thrombocytopenia (six). GI complications consisted of two cases of cytomegalovirus perforation of ileum and colon, one case of bleeding ileocolonic lymphoma, and one case of cryptosporidium cholecystitis. Laparotomy for diagnosis of retroperitoneal lymphadenopathy was performed in four patients and provided diagnostic material in three of them. Six patients underwent splenectomy for AIDS-related immune thrombocytopenia. Four of these patients had previously been treated with prednisone without impressive results. All patients had marked improvement of their platelet counts and clinical bleeding after splenectomy. Postoperative complications were common and consisted of wound infection, disseminated intravascular coagulation, GI bleeding, pneumocystis pneumonia, small-bowel obstruction, and cytomegalovirus pneumonia. One patient died after laparotomy for perforated ulcers of the ileum and colon.

AIDS-Related Complex↗
PubMed1987

Needle aspiration cytology of breast masses.

Needle aspiration cytology has been reported to be a highly sensitive and specific method of evaluation of solid breast masses when used by a single individual or closely knit group of clinicians and cytopathologists. This report summarizes the experience in 86 patients in whom needle aspiration cytology and excisional biopsy of solid breast masses were performed. All clinical evaluations, including needle aspirations and excisional biopsies, were performed by surgical residents in the Breast Clinic of Grady Memorial Hospital. The cytologic and histologic interpretations were performed by members of the Department of Pathology without direct interaction with the patients. Of the entire group of 86 patients, 27 had cancer and 59 had benign breast disease. There were no false-positive findings and five (11.9%) false-negative findings. The sensitivity of fine-needle aspiration was 73.7 per cent and specificity 100 per cent. The results are compatible with previously reported studies and it is believed that needle aspiration cytology is an integral part of evaluation of breast masses.

Adult↗
PubMed1985

Benign duodenocolic fistula.

Three cases of benign duodenocolic fistula are presented, and the diagnosis and treatment reviewed. Patients with benign duodenocolic fistulas usually complain of diarrhea, and occasionally nausea and feculent vomiting. Physical examinations are nonspecific, revealing wasting from the chronic diarrhea. Barium enemas are usually diagnostic. Therapy consists of excision of the fistula and repair of the duodenal and colonic defects.

Aged↗
PubMed1985

Esophagogastrostomy using the EEA stapling instrument.

A technique of esophagogastric anastomosis using the end-to-end anastamotic (EEA) stapler following esophagectomy is described in detail. Twenty-two patients underwent esophagectomy for carcinoma at various levels. There were no anastomotic leaks and no operative mortalities. Complications included wound infection (3), pneumonia (1), and late stricture (2). The strictures resulted from use of the small (25-mm) cartridge and responded to dilatation. Technical details of the technique include complete division of the esophagus before inserting the stapler, use of the pursestring instrument, use of "guy" sutures to aid in introduction of the anvil, and use of a proximal esophageal "traction clamp" to avoid tearing the esophagus. The 31-mm cartridge is used whenever possible. It is concluded that EEA is a very safe method of esophagogastrostomy when used with strict attention to technical details.

Adult↗
PubMed1983

Improved limb salvage in popliteal artery injuries.

This study reviews the recent experience with popliteal artery injuries at the Massachusetts General Hospital. Twenty-two patients suffered 24 injuries. The overall limb salvage was 83%. Blunt trauma accounted for 19 of the cases and was associated with femur fractures, knee dislocations, and tibia-fibular and plateau fractures: four amputations (21%) resulted. There were five penetrating injuries from three gunshot wounds, one stab wound, and one laceration: no amputations occurred. The major factor in the amputated limbs was delay in diagnosis and therapy of the arterial injury associated with blunt trauma. Arterial disruption secondary to penetrating injuries was recognized more quickly and had a better outcome. A higher index of suspicion in blunt trauma may improve results. Recommendations for therapy are: arterial reconstruction should generally precede orthopedic operation. Venous ligation was not associated with increased limb loss, but we recommend repair if possible. Arterial repair includes thrombo-embolectomy in distal arteries. If necessary, reverse saphenous vein is grafted. When operation is unsuccessful, revision should be performed.

Adolescent↗