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Biomedical subjects

D A Dreiling

Publications and source records attributed to D A Dreiling.

At least 127 records · Page 7Linked to original sources
PubMed1975

Crohn's disease of the colon. IV. Clinical features of Crohn's (ileo) colitis.

Using accepted diagnostic criteria we have selected, for study, 160 patients with Crohn's disease involving the colon. There is a remarkable discrepancy between the clinical diagnosis prior to or at the time of initial admission to this hospital and the diagnosis following definitive investigation and observation of the progression of disease. The peak age incidence occurred in the second decade. The colitis group showed a greater percentage of patients over 30 years of age. Although histopathology was not obtained in all patients, there appeared to be sparing of the ascending colon in a small percentage (9 percent) of patients with ileocolitis. Comparison of the clinical features of granulomatous disease limited to the colon and granulomatous ileocolitis shows a significantly greater incidence of extraintestinal symptoms and overt bleeding in the former. Nausea, vomiting, subacute obstruction, abdominal mass and internal fistulas were substantially more common in ileocolitis but the difference was not statistically significant. In this series retroperitoneal abscess did not occur in patients with disease localized to the colon. In the 10 patients with ileocolitis who developed an abscess, however, the site of fistula was the colon in four patients. In one of these, the abscess was left-sided.

Abscess↗
PubMed1975

The retrogastric transventricular approach for drainage of the "supragastric" pancreatic pseudocyst.

The majority of pancreatic pseudocysts develop in a retrogastric situation and are amenable to transgastric cystogastrostomy through the anterior gastric wall. We have encountered two pseudocysts in an unusual situation, in which adherence of the anterior gastric wall to the anterior parietal peritoneum precluded this approach. A retrogastric exposure through the lesser sac allowed for the creation of a cystogastrostomy through the superior aspects of the anterior and posterior gastric walls, adjacent to the lesser curvature of the stomach. This type of drainage is successful despite the theoretical failure to satisfy the dictum of dependent drainage.

Adult↗
PubMed1975

Cardiovascular lesions in pancreatitis.

Data have been presented correlating changes of blood coagulability, capillary permeability, blood electrolyte content with electrocardiographic abnormalities and symptoms of coronary insufficiency. In acute pancreatitis and in acute exacerbation of chronic pancreatitis, accentuation of these vascular factors may induce symptoms of coronary disease. Data are also presented indicating abnormal blood coagulability and blood electrolyte content in patients with chronic pancreatitis. Minimal augmentation of these abnormalities may account for the "yoke" syndrome.

Acute Disease↗
PubMed1975

Studies of the effects of blockage of intestinal lymphatics. III. Temporary isolation of lymphedematous bowel from intestinal continuity.

Eight dogs underwent intestinal lymphatic block. Once intestinal lymphedema was established, a segment was excluded from continuity for four months and then restored to continuity. The lymphedema decreased during exclusion and reappeared after restoration to continuity. The relationship of the changes seen in the intestine following lymphatic block and to the changes observed in the bowel in regional enteritis suggests a pathogenetic role for lymphatic blockage and explains the pseudobeneficial effects of by-pass as well as the prompt recrudescence of pathology which follows reconstruction procedures.

Animals↗
PubMed1975

Hepatic lesions in pancreatitis. Clinicoexperimental data.

Patients with active liver cirrhosis display greater abnormality in pancreatic function tests, viz. steatorrhea, hyperamylasemia, than patients with inactive cirrhosis. In autopsy specimens taken from patients dying from cirrhosis, parallel morphologic changes were noted in the liver and pancreas, viz. in postnecrotic cirrhosis, necrosis and necrobiosis predominated in the pancreas. In patients with portal cirrhosis, sclerotic changes rather than necrobiosis was observed in the pancreas. On the other hand, experimental acute and chronic pancreatitis induced in dogs displayed hepatic lesions whose degree and extent were correlated with the duration of the pancreatic inflammation.

Amylases↗
PubMed1975

Standard and augmented secretin testing in chronic pancreatic alcoholic disease.

Sequential standard (1.0 U./kg.) and augmented (4.0-5.0 U./kg.) secretin response to the pancreas has been briefly compared in normal subjects and in patients with combinations of alcoholism, cirrhosis and alcoholic pancreatitis. The results of sequential testing led to the conclusion that, for clinical purposes, the standard test is adequate for the diagnosis of well established pancreatic pathologies causing gross destruction of the parenchyma. The augmented test is of particular value when the response to 1 U./kg. produced equivocal results, inasmuch as augmented stimulation enhances the masked secretory deficiency. The administration of the augmented stimulus to alcoholic patients yielded data which suggest a new hypothesis of pathogenesis for alcoholic pancreatitis, e.g., the postsecretin response pattern of minimal pancreatic inflammatory pathology is hypersecretion. Alcohol is thought to induce fatty degeneration of the pancreatic cell initially. Continued injury leads to necrosis and fibrosis.

Alcoholism↗
PubMed1975

Crohn's disease of the colon. V. Retroperitoneal lumbocrural abscess in Crohn's disease involving the colon.

Retroperitoneal lumbocrural abscess occurred in 12 patients of 231 with Crohn's colitis or ileocolitis. Although all patients with this complication fell within the group of 175 ileocolitis patients, at least four originated in fistulous tracts of the colon. Eleven of the 12 abscesses developed spontaneously as the first major complication of the disease. The prominent clinical features included pain radiating down the thigh, hip joint flexion, difficulty in walking, hydronephrosis and hydroureter. Internal and external fistulas were significantly more common in the abscess group of 12 patients than in the 219 patients without retroperitoneal abscess. Radiological evidence of granulomatous disease was found in all patients; fistulous tract formation was characteristic and the development of extraperitoneal gas bubbles, in four patients, pathognomonic of abscess with gast-forming organisms. In the presence of established retroperitoneal abscess, the surgical sequence suggested is drainage synchronous with, or followed by diversion and ultimately definitive resection. Resection with anastomosis should not be carried out in the presence of an acute inflammatory process with frank abscess or free pus communicating with the peritoneal cavity. The spontaneous development of retroperitoneal abscess is a serious development in the natural history of Crohn's (ileo) colitis. It frequently heralds the first of a series of operative procedures to deal with the abscess. It sequels are enterocutaneous fistulas and further extension of the disease process.

Abscess↗
PubMed1975

Crohn's disease of the colon. III. Toxic dilatation of the colon in Crohn's colitis.

In a group of 160 patients with Crohn's disease involving the colon, there were seven patients with toxic dilatation, four with granulomatous colitis and three with ileocolitis, all successfully treated without mortality. This complications is more common than previously recognized in Crohn's colitis. In Crohn's disease, toxic dilatation is less likely to proceed to perforation of the bowel, because of the nature of the pathology and is more likely to respond to conservative measures: intubation, with decompression, corticotropin, steroids and high-dose antibiotic administration. Although patients do recover from this life-threatening complication with conservative management, the majority of patients, if not all, will ultimately come to surgical excision of the colon. If surgery is mandatory, it should be carried out early, rather than late, in the patient who is failing to respond to medical therapy, certainly before the development of perforation, massive hemorrhage, or gram negative sepsis with shock. The surgical therapy will depend upon the state of the bowel at laparotomy. Thus, an intact bowel in a young patient, would favor subtotal colectomy or proctocolectomy; a sealed perforation, a diverting ileostomy with skin level colostomy decompression as suggested by Turnbull and a free perforation, the minimum adequate procedure which will tide the patient over the early postoperative period. Diverting ileostomy alone has been effective in two of our patients but should be avoided in ulcerative colitis. The critically ill patient with the ominous finding of "disintegrating colitis" and multiple leaks, will require nothing less than total radical excision of the diseased bowel in the hope of immediate salvage.

Adrenocorticotropic Hormone↗