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Biomedical subjects

D Ilstrup

Publications and source records attributed to D Ilstrup.

At least 37 records · Page 2Linked to original sources
PubMed1993

Sinistral portal hypertension. Splenectomy or expectant management.

Splenectomy has been considered the treatment of choice for patients with bleeding from sinistral portal hypertension (SPH) and varices, but is controversial for asymptomatic patients. To further define the role of splenectomy for SPH, the authors compared the clinical presentations and outcomes of 25 patients treated with splenectomy with those of 12 observed patients. Clinical features were similar except for transfusions administered (60% vs. 25%, p < 0.05), hemoglobin (9.8 +/- 2.2 g/dL vs. 12.5 +/- 2.1 g/dL, p < 0.05), and history of prior bleeding episodes (56% vs. 8%, p < 0.05), splenectomy versus no splenectomy, respectively. At 3 years, neither survival (78% vs. 64%, p = 1.0) nor new or recurrent bleeding (16% vs. 24%, p = 0.2) differed, splenectomy versus no splenectomy, respectively. The authors conclude that in the absence of prior bleeding episodes, anemia, or severe hemorrhage, observation of patients with SPH is justified.

Esophageal and Gastric Varices↗
PubMed1993

[Colorectal cancers associated with ulcero-hemorrhagic rectocolitis. Detection of and prognosis for postoperative patients].

Between January 1976 and December 1986, 86 patients underwent surgery for colorectal adenocarcinoma (AC) complicating ulcerative colitis (UC) at Mayo Medical Center in Rochester, Minnesota. Seventy-two percent were men, contrasting with only 55% in the population operated for UC without AC during the same time period at the same institution (p = 0.001). The mean duration of UC symptoms was 19.2 years. The diagnosis of cancer was established preoperatively in 65% of patients, while the remainder of patients, except for three (n = 30, 35%) were at high risk for cancer. A colonoscopy performed in 16 of those 30 patients less than six months prior to the operation did not detect cancer. Overall, cancer was either proven or highly suspected preoperatively in 96.5% of patients, while the sensitivity of colonoscopy was 78%. During the study period, histological tumor features, such as number of tumors, Dukes' stage, Broder's stage, and curative/palliative ratio, remained unchanged, and the five-actuarial survival of 50% did not improve with time (p = 0.37). Multivariant analysis indicated that Dukes' stage and male gender were two poor prognosis factors. For patients with long-standing UC, we offer either proctocolectomy, possibly with ileal pouch-anal anastomosis, or surveillance colonoscopy, emphasizing their respective hazards and limitations.

Adenocarcinoma↗
PubMed1992

Complications following pancreaticoduodenectomy. Current management.

From 1980 to 1989, 279 patients underwent pancreaticoduodenectomy at a single institution with a postoperative mortality of 4%. The aim of this study was to determine incidence, origin, and present management strategy of early complications following this operation. Significant morbidity occurred in 46% of the patients, including delayed gastric emptying (23%), pancreaticojejunal anastomotic leak (17%), intra-abdominal sepsis (10%), biliary-enteric anastomotic leak (9%), gastrointestinal tract bleeding (5%), and intra-abdominal hemorrhage (3%). Complications were associated with advanced age, prolonged operations, and increased operative blood loss. Most complications were managed nonoperatively. Mortality was increased when a reoperation was required, a biliary-enteric leak occurred, or an intra-abdominal abscess developed. Pancreaticoduodenectomy continues to carry a high postoperative morbidity; however, operative mortality is low, and management of complications has been made simpler with more sophisticated, nonoperative therapeutic options.

Abscess↗
PubMed1992

Heteroconjugated antibodies enhance lymphocyte-mediated tumour cell lysis in vitro and in vivo.

Covalent linkage of an antitumour antibody specific for a tumour cell surface antigen to an antilymphocyte antibody specific for the T lymphocyte receptor complex produces a heteroconjugated antibody that can activate and redirect cytotoxic T lymphocytes to lyse tumour cells. The ability of an antilymphocyte-antitumour heteroconjugate (500A2 x 96.5) to direct the lysis of murine melanoma cells by cultured murine lymphocytes was tested in vitro using a 4-h chromium release assay and in vivo with a tumour neutralization assay. In vitro, the addition of heteroconjugated antibody significantly increased tumour lysis by murine C3H/HeN lymphocytes (median specific lysis 82.7 per cent with lymphocytes plus heteroconjugate versus 9.5 per cent for lymphocytes alone, P less than 0.001). In vivo, treatment with heteroconjugated antibody plus lymphocytes significantly reduced the development of pulmonary metastases after intravenous tumour administration (median number of pulmonary metastases 28.5 for combined treatment versus 250 for heteroconjugate or lymphocytes alone, P less than 0.001).

Animals↗
PubMed1992

Evaluation of DNA nuclear pattern as a prognostic determinant in resected pancreatic ductal adenocarcinoma.

From a cohort of 72 patients who underwent radical resection for ductal adenocarcinoma of the pancreas between 1951 and 1980, 62 paraffin-embedded specimens were analyzed by flow cytometry. Patients were divided into two groups according to the length of survival: long-term survivors (19 patients who survived 3 or more years after operation) and short-term survivors (43 patients who died within 12 months after resection). In 30 specimens (48%), the nuclear DNA pattern was diploid, whereas 32 were nondiploid (two tetraploid and 30 aneuploid). There were no significant differences in the number of diploid/nondiploid patterns, the fraction of cells in DNA synthetic (S) phase, or the DNA index between the two groups. These data suggest that there is no difference in the DNA content analysis of patients with pancreatic ductal adenocarcinoma when comparing long-term with short-term survivors following resection.

Carcinoma, Intraductal, Noninfiltrating↗
PubMed1990

Effect of femoral head size on wear of the polyethylene acetabular component.

A technique was developed to determine the wear of the acetabular component of a total hip replacement by examination of standardized initial and follow-up radiographs. Three hundred and eighty-five hips were followed for at least 9.5 years after replacement. The least amount and rate of linear wear were associated with use of a femoral head that had a diameter of twenty-eight millimeters (p less than 0.001). The greatest amount and mean rate of linear wear occurred with twenty-two-millimeter components, but these differences were not statistically significant. The greatest volumetric wear and mean rate rate of volumetric wear were seen with thirty-two-millimeter components (p less than 0.001). A wider radiolucent line in acetabular Zone 1 was associated with use of the thirty-two-millimeter head. The amounts of resorption of the proximal part of the femoral neck and of lysis of the proximal part of the femur both correlated positively with the extent of linear and volumetric wear; this suggests an association between the amount of debris from wear and these changes in the femoral neck and proximal part of the femur.

Acetabulum↗
PubMed1990

Pouchitis and extraintestinal manifestations of inflammatory bowel disease after ileal pouch-anal anastomosis.

Although the etiology of pouchitis after ileal pouch-anal anastomosis (IPAA) is unknown, its manifestations resemble those of nonspecific inflammatory bowel disease, including, anecdotally, the apparent ability to evoke extraintestinal manifestations (EIM) of inflammatory bowel disease (IBD). Our aim was to determine in what manner pouchitis and EIMs were associated. The computerized records of 819 consecutive patients who underwent IPAA between January 1981 and December 1988 were reviewed. Eighty-five patients were excluded (because of incomplete follow-up, death, or permanent ileostomy). Follow-up of the remaining 734 patients was complete (mean, 41 months). The mean age was 32 years and the ratio of men to women was 1:1. Ileal pouch-anal anastomosis was performed for chronic ulcerative colitis in 91% of patients and for familial adenomatous polyposis in 9%. Pouchitis occurred in 31% of chronic ulcerative colitis patients and 6% of familial adenomatous polyposis patients (p less than 0.01). The mean time to first occurrence was 17 months. Pouchitis recurred in 61% of patients at risk. Patients with preoperative and postoperative EIMs had significantly higher rates of pouchitis than did patients without EIMs (39% preoperative EIMs versus 26% with no EIMs, p less than 0.001; 53% postoperative EIMs versus 25% with no EIMs, p less than 0.001). Of patients with pouchitis in whom EIMs resolved after IPAA but then recurred (n = 12), EIMs recurred when pouchitis occurred and abated when pouchitis was treated in seven patients. We concluded that pouchitis occurred frequently after IPAA and that patients with EIMs were at higher risk of developing pouchitis than were patients who never had EIMs. Furthermore some patients experienced a temporal relationship between flares of EIMs and pouchitis. These results imply that pouchitis may be a novel manifestation of inflammatory bowel disease persisting after operation.

Adult↗
PubMed1989

Ocular surgery on patients receiving long-term warfarin therapy.

We analyzed data of 50 patients receiving long-term warfarin sodium therapy who underwent ocular surgery between 1982 and 1986. The frequency of hemorrhagic and thrombotic complications was compared in patients in whom anticoagulants were continued, those in whom the anticoagulants were discontinued in the perioperative period, and a group of matched control patients. There were six perioperative hemorrhagic complications in the warfarin-treated group (12%) compared to none in the control group. This difference was significant (P less than .03). However, no significant difference in hemorrhagic complications was seen between patients in whom warfarin sodium was continued and those in whom it was discontinued.

Adult↗
PubMed1989

Size of the femoral head and acetabular revision in total hip-replacement arthroplasty.

Fifty-nine revisions that were done for aseptic acetabular loosening after 6,128 total hip arthroplasties for degenerative arthritis or traumatic arthritis were studied. These revisions were in forty-four (approximately 1 per cent) of 4,576 hips that had a twenty-two-millimeter femoral-head component, in two of 520 that had a twenty-eight-millimeter femoral-head component, and in thirteen (approximately 2.5 per cent) of 487 that had a thirty-two-millimeter femoral-head component. Therefore, the thirty-two-millimeter femoral component was associated with the highest rate of acetabular revision (p less than 0.001). The dimensions of the acetabular wall were thinner in the hips that had the thirty-two-millimeter component than in those that had the twenty-two-millimeter component (p less than 0.05). Multivariate analysis demonstrated a significantly increased risk of acetabular loosening in men and in patients who were less than sixty years old.

Acetabulum↗
PubMed1988

Old sepsis prior to total knee arthroplasty.

A retrospective study of 65 cemented total knee arthroplasties in previously infected knees was performed. Two subgroups were identified: in Group I there was prior infection of both the bone and joint (20 patients) and in Group II there was only joint involvement (45 patients). Following primary total knee arthroplasty, deep infection occurred in three of 20 (15%) in Group I and in two of 45 (4%) in Group II, or five of 65 (7.7%) overall. Subsequent revision arthroplasty was required in 18. Of these 18 knees, three (17%) developed deep infection. Old sepsis, especially with associated osteomyelitis, results in a high rate of infection following total knee arthroplasty.

Adult↗
PubMed1987

Minimizing blood transfusions during abdominal aortic surgery: recent advances in rapid autotransfusion.

The purpose of this study was to determine what percentage of patients could avoid the transfusion of any homologous bank blood products during elective abdominal aortic surgery with a recently developed semicontinuous, rapid autotransfusion device. Fifty patients (26 with abdominal aortic aneurysms and 24 with aortic occlusive disease) prospectively received intraoperative autologous transfusion (group 1) and were matched for comparison with 50 patients receiving homologous blood without use of any autotransfusion equipment (group 2). For the entire perioperative period, 34 group 1 patients (68%) received only their own autotransfused blood and no other homologous blood components compared with group 2 in which 48 patients (96%) required some bank blood (p less than 0.0001). Rapid autotransfusion reduced usage of homologous red cell transfusion by 75%. The mean postoperative hemoglobin was similar in both groups (group 1, 11.91 gm/dl vs. group 2, 11.90 gm/dl, p = 0.73). Rapid autotransfusion was not associated with significant hemolysis, air embolism, or coagulopathy and did not increase morbidity or death. By eliminating the need for any bank blood components in most patients, rapid autotransfusion minimizes the risk of blood-borne diseases and transfusion reactions. New rapid autotransfusion devices offer a distinct advantage over past equipment and allow significant changes in current transfusion practices during elective abdominal aortic reconstructions.

Aged↗
PubMed1986

Early and late results following repair of dissections of the descending thoracic aorta.

Management of dissections of the descending thoracic aorta remains controversial, especially with regard to timing and method of repair. To clarify these and other issues we have reviewed our total experience with repair of descending aortic dissections between 1962 and 1983. The 44 men and 20 women had a mean (+/- SEM) age of 59 +/- 2 years (range, 19 to 83 years), and in all patients the dissection originated in and was limited to the aorta distal to the left carotid artery (Stanford type B, DeBakey types IIIa and IIIb). Twenty-nine patients underwent operation within 2 weeks of the onset of symptoms (acute), and the remainder had later repair (chronic). During repair, circulation distal to the aortic cross-clamp was supported with cardiopulmonary bypass or shunt in two thirds of patients. Overall, 18 deaths occurred less than or equal to 30 days postoperatively (operative risk 28%), and risk was higher in acute (45%) than in chronic (14%) dissections. Operative risk was not significantly related to protection of the distal circulation. The most serious postoperative complication was spinal cord ischemia manifested by paraplegia in five patients (8%) and transient or permanent paraparesis in six patients (9%). Risk of spinal cord ischemia was significantly lower in patients who had protection of the distal circulation during operative repair (8% vs. 44%, p = 0.003). Late survival, including hospital deaths, was 49% +/- 7% at 5 years after operation; 22 of the 46 patients who survived repair were found to have aneurysms involving the thoracic and/or abdominal segments of the aorta. Our results indicate that repair of chronic dissection of the thoracic aorta has a lower operative risk than repair of acute dissections, and initial medical management of acute dissection may be indicated if no early complications occur. Risk of spinal cord ischemia is significantly reduced by cardiopulmonary bypass or shunt and is preferred over aortic cross-clamping alone. Finally, these patients require careful long-term follow-up because of the high incidence of residual or recurrent aortic aneurysms.

Acute Disease↗
PubMed1986

Plasma carnitine levels in patients receiving home parenteral nutrition.

Patients on long-term home parenteral nutrition (HPN) are known to frequently develop hepatic steatosis or steatohepatitis. The etiology of this steatosis or steatohepatitis is unknown, but carnitine deficiency has been one of the postulated mechanisms. The importance of L-carnitine in hepatic fatty acid oxidation and the steatosis observed in primary and acquired carnitine deficiencies prompted us to determine plasma carnitine levels in 37 patients receiving long-term HPN. Thirteen patients (35%) had low total and free plasma carnitine levels. Fifteen of the 37 HPN patients were matched for age and sex with 15 patients with Crohn's disease who did not require HPN. Mean total and free plasma carnitine values were significantly lower (p less than 0.001) in these 15 HPN patients (32.2 +/- 11.9 and 28.4 +/- 10.8) when compared to Crohn's patients not requiring HPN (49.1 +/- 10.9 and 46.4 +/- 11.5). Associations were not detected between plasma carnitine and clinical or biochemical parameters that might have explained the low values.

Adolescent↗
PubMed1986

Controlled open lesser sac drainage for pancreatic abscess.

Recent studies suggest that morbidity and mortality in patients with pancreatic abscess can be lessened if controlled open lesser sac drainage (COLD) is performed rather than traditional closed drainage (CD). To determine whether the outcome of patients treated by COLD was more favorable, 81 consecutive patients with pancreatic abscess managed surgically between 1966 and 1985 were studied. COLD, consisting of initial wide debridement of the abscess cavity, open packing, suction drainage, repeated operative pack changes, and lavage was used in 17 patients and CD in 64 patients. Age, sex, etiology of pancreatitis, and radiographic and laboratory findings were similar between treatment groups. However, the number of patients with overt systemic sepsis and those at increased risk of death based on Ranson signs associated with the predisposing episode of pancreatitis were greater in the COLD group than in the CD group (100% vs. 61%, and 92% vs. 44%, respectively; p less than or equal to 0.05 for both). Overall mortality in COLD and CD patients was 18% and 44%, respectively (p less than 0.05). However, in patients at increased risk of death (positive Ranson signs greater than or equal to 3), mortality after COLD and CD was 18% and 70%, respectively (p less than 0.05). Controlled open drainage may be the treatment of choice in patients with pancreatic abscess precipitated by severe pancreatitis (Ranson signs greater than or equal to 3) and associated with overt systemic sepsis.

Abscess↗
PubMed1984

The dexamethasone suppression test in normal control subjects: comparison of two assays and effect of age.

he authors used competitive protein binding assay and radioimmunoassay to measure cortisol levels in 38 normal control subjects three times before and three times after administration of 1 mg of dexamethasone. They found significant interassay differences at 11:00 p.m. before dexamethasone and at all three postdexamethasone times. Analysis of variance revealed significant overall positive relationships between age and cortisol levels measured by both techniques. Age correlated significantly with postdexamethasone cortisol levels measured by radioimmunoassay but not when measured by competitive protein binding assay. Clinicians should obtain data from their laboratories as to appropriate cutoffs for cortisol suppression on the specific assay used.

Adult↗
PubMed1983

Direct, indirect, and sham laser photocoagulation in the management of central serous chorioretinopathy.

The role of argon laser photocoagulation in the management of central serous choriorectinopathy was evaluated in a prospective randomized study of eyes with leaks smaller than 250 microns in diameter in the early frames of the angiogram. Eyes were assigned to Group A when the leak was located in the papillomacular bundle or within 500 microns of the capillary-free zone and to Group B when the leakage site was located outside the papillomacular bundle and more than 500 microns from the capillary-free zone. Thirty eyes in Group A underwent either a sham argon laser treatment or a real argon laser treatment directed to the pigment epithelium under the elevated retina at a site remote from the site of fluorescein dye leakage (indirect laser photocoagulation). Twelve eyes in Group B underwent either a laser treatment directed to the site of fluorescein dye leakage (direct laser photocoagulation) or indirect laser photocoagulation. Compared with indirect photocoagulation, direct laser photocoagulation shortened the duration of central serous chorioretinopathy by approximately two months, a statistically significant difference. When compared to sham treatment, indirect photocoagulation did not significantly alter the duration of central serous chorioretinopathy. During an 18-month interval, the recurrence rate in the eyes treated with sham and indirect laser photocoagulation was 34%, whereas no recurrences were observed in the eyes treated with direct photocoagulation. There were no complications from photocoagulation in any of the eyes.

Adult↗