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Biomedical subjects

D Ilstrup

Publications and source records attributed to D Ilstrup.

43 records · Page 3Linked to original sources
PubMed1982

Metachronous colorectal malignancies.

Sixty-two patients with metachronous colorectal malignancies who underwent surgery at the Mayo Clinic were reviewed. Fifty per cent of the patients developed a second carcinoma within 5.5 years from the time of resection of their first tumor, and the time interval for the entire group ranged from one to 23 years. Adenomas of the colon or rectum occurred in 25 of the 62 patients (40 per cent). A negative correlation was noted between the age of the patients at the time of their first operation and the time interval in years from the first to second resections. The five-year cumulative probability of survival of the 62 patients after resection of the metachronous lesions was 59 per cent. Seven of the 62 patients (11 per cent) developed a third metachronous lesion. Adequate treatment for metachronous colorectal malignancies should imply surgery with a curative intent, and after resection of a first colorectal carcinoma, lifelong, periodic, total colonic evaluation is essential.

Adenoma↗
PubMed1981

Factors affecting revision rate after continent ileostomy.

Our aim was to determine factors that may predispose to malfunction of a continent ileostomy. Among 299 patients who underwent continent ileostomy and were followed up for at least one year, the need for revision of the ileostomy was compared by sex, age, type of initial operation, and type of revision. Revision was required less often in females, younger patients, and patients undergoing proctocolectomy and continent ileostomy. However, the rate of subsequent revision was similar after the two types of repair (repair of old valve vs construction of new valve). Constructing a continent ileostomy in stages is not necessary; patients undergoing proctocolectomy and continent ileostomy required fewer revisions than did those who had a Brooke ileostomy prior to their continent ileostomy. Moreover, a malfunctioning valve should be revised rather than a new one created; revision was technically simpler and gave comparable results.

Adolescent↗
PubMed1979

Comparison of three immunoassays for immune complexes in rheumatoid arthritis.

Three widely used radioassays that depend on different principles for the measurement of circulating immune complexes (CIC) in biologic fluids are the monoclonal rheumatoid factor (mRF), Raji cell, and C1q binding tests. A comparison of the ability of these methods to measure immune complex-like material in 71 sera and 30 synovial fluids of 91 patients with rheumatoid arthritis (RA) was carried out by a group working in adjacent laboratories in a single institution. The highest number of abnormal levels in the seropositive group was detected by the C1q binding assay (91%). Levels of CIC by the mRF and Raji cell tests were elevated in 81% and 76% of the patients, respectively. The closest correlation was between the Raji and mRF tests (r = 0.44 and P = 0.002) although one depends on complement fixation and one does not. Though significant correlations between the levels of CIC determined by the C1q test and either the mRF (P = 0.2) or Raji cell (P = 0.3) assay were not found in this group, 59% of the samples had elevated levels by all three tests. The frequency of CIC in the sera of patients with seronegative RA was much lower, with the C1q test again giving the highest number of abnormal results (29% versus 16% and 12% for the Raji and mRF tests). In view of the technical problems associated with these tests, particularly lack of a uniform reliable standard, it is likely that all three tests measure the same material in most RA sera and that some of the differences observed are related to inherent variability in the tests themselves rather than intrinsic differences among the CIC detected in these samples.

Adult↗
PubMed1979

Mechanical cornpicker hand injuries.

The mechanical cornpicker causes tearing anse injuries from 1962 to 1975 were studied with regard to mechanism and extent ohe time of injury in 36% of hands, and in 73% of the remainder following treatmophylaxis, and antibiotics, and 73% hands required some form of delayed surgical treatment. Antibiotics did not appear to be helpful. Eighty-nine ps the most common cause given for farmers for their injuries. Excluding four pr permanently disabled patients, the average length of disability was 135 days. Eighty-nine per cent of patients experienced some permanent impairment of hand function. The mechanical cornpicker is described, and the importance of its proper use and physician's emphasis on accident prevention as well as treatment are stressed.

Adolescent↗
PubMedDate not supplied

Long-term consequences of intraoperative spillage of bile and gallstones during laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is associated with a higher incidence of iatrogenic perforation of the gallbladder than open cholecystectomy. The long-term consequences of spilled bile and gallstones are unknown. Data were collected prospectively from 1059 consecutive patients undergoing laparoscopic cholecystectomy over a 3-year period. Details of the operative procedures and postoperative course of patients in whom gallbladder perforation occurred were reviewed. Long-term follow-up (range 24 to 59 months) was available for 92% of patients. Intraoperative perforation of the gallbladder occurred in 306 patients (29%); it was more common in men and was associated with increasing age, body weight, and the presence of omental adhesions (each P < 0.001). There was no increased risk in patients with acute cholecystitis (P = 0.13). Postoperatively pyrexia was more common in patients with spillage of gallbladder contents (18% vs. 9%; P < 0.001). Of the patients with long-term follow-up, intra- abdominal abscess developed in 1 (0.6%) of 177 with spillage of only bile, and in 3 (2.9%) of 103 patients with spillage of both bile and gallstones, whereas no intra- abdominal abscesses occurred in the 697 patients in whom the gallbladder was removed intact ( P < 0.001). Intraperitoneal spillage of gallbladder contents during laparoscopic cholecystectomy is associated with an increased risk of intra-abdominal abscess. Attempts should be made to irrigate the operative field to evacuate spilled bile and to retrieve all gallstones spilled during the operative procedure.

Bile↗
PubMedDate not supplied

Use of medical services and satisfaction with ambulatory care among a rural Minnesota population.

Patient satisfaction with health care services and the use of ambulatory care in rural southeastern Minnesota were surveyed before and after physician manpower was increased. This report is confined to the findings in 1974, before the three local practicing physicians were joined by two additional physicians. The physician to population ratio at the time of the initial survey was 1 to 6,200 in 1974 and 1 to 2,500 with the additional physicians in 1975.In this area the population of 12,400 centered around the town of Zumbrota. A total of 1,332 persons completed questionnaires, and 796 filled out a second questionnaire concerning patient satisfaction with health care. The scores on 40 items formed 18 satisfaction indices.Use of health services was lower than in the National Health Survey of 1969; the mean number of visits per year in Zumbrota was 3.3 compared with 4.3 for the national sample. The volume of use in the Zumbrota region was low, particularly among adults. Use of services was not significantly related to the education, occupation and income of the residents. About 10 percent of the population accounted for half of the total number of visits.Only a few of the 18 patient satisfaction indices were related to the respondent's income and occupation, but 5 were related to educational level. Satisfaction with health care services was generally higher in this rural population than among the people in four urban areas that were surveyed using the same satisfaction indices.The question raised by the findings in this survey-are rural areas in general as deprived and unsatisfied with health care as the literature suggests-remains unsettled. Changes over time in use and patient satisfaction are being assessed in the resurvey to seek possible explanations of the low utilization and high degree of patient satisfaction in this area.

Adolescent↗