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D M Ilstrup

Publications and source records attributed to D M Ilstrup.

At least 127 records · Page 7Linked to original sources
PubMed1995

Distinction between cavernous hemangiomas of the liver and hepatic metastases on CT: value of contrast enhancement patterns.

OBJECTIVE: Differentiating between cavernous hemangiomas of the liver and hepatic metastases on the basis of single-pass, contrast-enhanced CT is a significant and frequently encountered diagnostic challenge. Recognition of characteristic enhancement features of cavernous hemangiomas can aid in effectively distinguishing between these lesions. The purpose of this study was to determine sensitivity and specificity of dense, globular enhancement for differentiating cavernos hemangiomas and metastases during single-pass, contrast-enhanced CT. MATERIALS AND METHODS: CT appearance of 133 lesions in 91 patients with cavernous hemangiomas (44 patients) or metastases (47 patients) was retrospectively evaluated in a blinded review. CT examinations were performed with nonhelical technique following injection of 150 ml of contrast material. All patients with metastases had pathologic proof (n = 47). Patients with cavernous hemangiomas were clinically stable for at least 2 years after CT (n = 43) or had tissue proof (n = 1). All lesions were evaluated based on the following criteria: (1) Type of enhancement: globular, linear, diffuse and homogeneous, or diffuse and heterogeneous. (Globular enhancement was considered to be present when enhancing nodules less than 1 cm in diameter were seen within lesions.) (2) Continuity of enhancing tissue: continuous or noncontinuous. (Uninterrupted collections of contrast material within at least 50% of a lesion were considered continuous. Multiple, separate collections of contrast material were considered noncontinuous.) (3) Degree of enhancement: hypo-, iso-, or hyperdense relative to the aorta. (4) Distribution of enhancement: peripheral, central, or mixed. RESULTS: Seventy-six percent of cavernous hemangiomas had globular enhancement, compared to 10% of metastases (p < .001). Seventy-two percent of cavernous hemangiomas had enhancement isodense with the aorta, and 96% of metastases were hypodense (p < .001). Sixty-seven percent of cavernous hemangiomas had peripheral enhancement, compared to 38% of metastases (p < .001). The combined finding of globular, isodense enhancement was seen in 67% of cavernous hemangiomas and none of the metastases. Only 10% of cavernous hemangiomas had nonglobular, hypodense enhancement, compared with 90% of metastases. Combining all criteria, reviewers correctly classified 122 (92%) of the lesions. Presence of globular enhancement, isodense with the aorta, was 67% sensitive and 100% specific in differentiating cavernous hemangiomas from hepatic metastases. CONCLUSION: In most cases, differentiation of cavernous hemangiomas from hepatic metastases can confidently be made with single-pass, contrast-enhanced CT. Globular enhancement, isodense with the aorta, is 67% sensitive and 100% specific in differentiating cavernous hemangiomas and hepatic metastases.

Adult↗
PubMed1995

Single-pass CT of hepatic tumors: value of globular enhancement in distinguishing hemangiomas from hypervascular metastases.

OBJECTIVE: The purpose of this study was to evaluate the sensitivity and specificity of globular enhancement for differentiating hepatic hemangiomas from hypervascular metastases on single-pass, contrast-enhanced CT scans. Globular enhancement was defined as enhancing nodules less than 1 cm seen within a lesion. MATERIALS AND METHODS: Fifty CT examinations were retrospectively evaluated in a blinded fashion by two independent reviewers. The CT studies were done with nonhelical technique after the IV injection of 150 ml of contrast material. The series included 25 patients with histologically proven hypervascular hepatic metastases (carcinoid, islet cell carcinoma, and leiomyosarcoma) and 25 patients with clinically proven hepatic hemangiomas. Patients with hemangiomas were clinically stable for at least 2 years after the CT studies. A single lesion was isolated from the first-pass, contrast-enhanced portion of each examination; the remainder of the examination was excluded from the review to minimize reviewer bias. Each lesion was evaluated for (1) the presence or absence of globular enhancement (defined as enhancing nodules less than 1 cm seen within a lesion), (2) the density of globular enhancement relative to that of the aorta, (3) the degree of border definition (well or poorly marginated), and (4) the presence or absence of a hypodense halo. A diagnostic impression was then recorded for each lesion. RESULTS: Globular enhancement was 88% sensitive and 84-100% specific for differentiating hepatic hemangiomas from hypervascular metastases (p < .001). A mean of 62% of hemangiomas showed globular enhancement isodense relative to that of the aorta; none of the metastases showed globular, isodense enhancement. The majority of the metastases showed nonglobular enhancement (mean, 92%). The reviewers showed 84% agreement in the identification of (1) globular enhancement in hemangiomas, (2) lack of globular enhancement in metastases, and (3) globular enhancement in the combined set of all lesions. Neither the presence of a hypodense halo nor the degree of border definition was significant in distinguishing between the two groups of lesions. The reviewers showed 96% agreement in the categorization of metastases and 76% agreement in the categorization of hemangiomas. There was 86% agreement in the categorization of all lesions. Overall, reviewers diagnosed a mean of 89% of lesions correctly. A mean of 98% of metastases and a mean of 80% of hemangiomas were diagnosed correctly. CONCLUSIONS: Globular enhancement is highly sensitive (88%) and specific (84-100%) for differentiating hepatic hemangiomas from hypervascular metastases on single-pass, contrast-enhanced CT scans.

Adult↗
PubMed1995

Early and late survival after surgical treatment of culture-positive active endocarditis.

OBJECTIVE: To describe a 30-year experience with surgically treated culture-positive active endocarditis. DESIGN: We retrospectively reviewed the microbiologic, clinical, and operative findings and the survival data in 151 patients with culture-positive active endocarditis encountered between 1961 and 1991. RESULTS: The mean age of the 110 male and 41 female patients was 49.8 years. Native valve endocarditis was present in 86 patients, and prosthetic valve endocarditis (PVE) was diagnosed in 65. The aortic valve was involved in 62% of patients, the mitral valve in 25%, and both valves in 10%. The operative mortality was 26%. The most important univariate determinants of mortality were an abscess at operation (P = 0.01) and renal failure (P = 0.03). A trend toward a higher mortality with PVE and staphylococcal infection was noted. For hospital survivors, the 5- and 10-year survival was 71% and 60%, respectively. Univariate determinants of an adverse long-term survival were annular abscess (P = 0.01), renal impairment (P = 0.01), heart failure (P = 0.02), and aortic valve involvement (P = 0.05). On multivariate analysis, the most important adverse determinants of long-term survival were heart failure (P = 0.02), renal impairment (P = 0.02), and PVE (P = 0.03). Thirty patients required a subsequent reoperation; of these, seven required a second and two a third operation. The most common reason for reoperation was periprosthetic regurgitation without infection (N = 19). Four operations were performed for recurrent endocarditis. At 5 and 10 years, the risk of reoperation was 23% and 36%, respectively. CONCLUSION: Although surgical treatment of culture-positive active endocarditis is still associated with substantial mortality, the long-term outcome of hospital survivors is excellent. Subsequent reoperations for periprosthetic leak are common, but recurrent infection is uncommon.

Adolescent↗
PubMed1995

Late results of pulmonary ventricle to pulmonary artery conduits.

The development of the extracardiac conduit has been one of the greatest advances in cardiac surgery. Conduits have decreased the mortality rate of several standard operations and have made possible the correction of numerous complex congenital cardiac anomalies that previously were uncorrectable. However, the ideal conduit has not yet been developed. We have reviewed the long-term (16 to 29 years) results of our early experience with this technique.

Adolescent↗
PubMed1995

Central venous oxygen saturation, arterial base deficit, and lactate concentration in trauma patients.

Our object was to explore the usefulness of central venous oxygen saturation, arterial base deficit, and lactate concentration in the evaluation of trauma patients. In busy urban trauma centers, limited operating room availability may necessitate that certain hemodynamically stable patients experience some delay between diagnosis of injury and surgery. Because hemodynamic compromise may occur before operation is undertaken, some means of identifying those patients who have the most severe injuries or who are at greatest risk for hemodynamic instability would be useful. We prospectively studied 40 patients with operative truncal injuries admitted to the Cook County Trauma Unit, Chicago, to examine the usefulness of postresuscitation central venous oxygen saturation (ScvO2), arterial lactate concentration, and arterial base deficit in this regard. Preoperative hypotension occurred in 12.5 per cent of these initially stable patients. ScvO2 did not significantly correlate with any of the parameters of blood loss and severity of injury examined. However, both base deficit and lactate concentration correlated with transfusion requirements; in addition, base deficit correlated with trauma score, and lactate correlated with peritoneal shed blood volume. Our data suggest that, after resuscitation, arterial base deficit and lactate concentration may be better indicators of blood loss than is ScvO2.

Abdominal Injuries↗
PubMed1994

Lack of evidence for gender bias in the utilization of total hip arthroplasty among Olmsted County, Minnesota residents with osteoarthritis.

OBJECTIVE: To evaluate whether women have more advanced osteoarthritis (OA) than men prior to total hip arthroplasty (THA). METHODS: Preoperative clinical and radiographic severity of hip OA was determined among Olmsted County, Minnesota residents who underwent THA. The time from first radiographic changes and first symptoms to THA was compared between genders. RESULTS: Fifty men and 80 women underwent their first THA between 1985 and 1990. Men had higher disease activity levels preoperatively; however, 16 other clinical severity variables and 2 summary measures of OA severity were similar for both genders. Men had radiographically more advanced hip OA preoperatively. The time from first symptom of hip OA to THA was similar for both genders, while the time from first radiographic change to THA was significantly longer for men. CONCLUSION: These results fail to support the hypothesis that hip OA prior to THA is more severe among women compared with men.

Bias↗
PubMed1994

Low intensity ultrasound treatment increases strength in a rat femoral fracture model.

Bilateral closed femoral shaft fractures were made in 22 male Long-Evans rats. In 16 animals, ultrasound was applied to one limb for 15 minutes daily 10 times within the first 14 postoperative days. The treated limbs received a 200 microseconds burst of 1.5 or 0.5 MHz sine waves repeated at 1.0 kHz at a spatial average and temporal average intensity of 30 mW/cm2. The contralateral limb of each animal served as a nontreated control. Six remaining animals with fractures and six additional animals without fractures received sham ultrasound treatment to control for the effects of anesthesia and handling. Fracture repair was evaluated on postoperative day 21 by radiography, mechanical testing in torsion, and histology. Five of 16 ultrasound-treated fractures showed obliteration of the fracture gap on radiographs, whereas none of the 28 controls did. The average maximum torque of fractures treated with either signal was 22% greater than that of the contralateral controls (p < 0.05). The stiffness of treated fractures was greater than that of control fractures, but the difference was significant only in animals treated with the 1.5 MHz signal (p < 0.02). Sham treatment did not affect repair in the control group. These results indicate that low-intensity pulsed ultrasound at either 0.5 or 1.5 MHz can accelerate fracture repair at 21 days in this highly controlled model.

Animals↗
PubMed1994

Carcinoma of the rectum. Profiles of intraoperative and early postoperative complications.

PURPOSE: The aim of this study was to determine the incidence and risk factors that were significant in contributing the intraoperative and early postoperative complications for operations of carcinoma of the rectum. METHODS: Between 1984 and 1986 inclusive, 426 patients underwent surgery for primary adenocarcinoma of the rectum. Cases of local excision were excluded. The relationship between each complication and nominal risk factors were studied. The types of surgery included an abdominoperineal resection, low anterior resection, low anterior resection with coloanal anastomosis, anterior resection, colostomy, and Hartmann's procedure. RESULTS: There were two (0.5 percent) deaths. Intraoperative complications occurred in 34 (8 percent) patients. The most common intraoperative complication was presacral bleeding which occurred in 14 patients. Postoperative complications occurred in 214 (50 percent) patients. The two most common complications were urinary retention and urinary tract infection. Abdominoperineal resection had the highest early postoperative complication rate (59 percent). There were 17 clinical anastomotic leaks (7 percent in 221 patients with unprotected anastomoses). The development of complications reached statistical significance with increasing age (P = 0.003), male sex (P = 0.003), increasing weight (P = 0.006), and types of operative procedure (P = 0.001). CONCLUSIONS: Operations for carcinoma of the rectum can be performed with low mortality. Although the overall early postoperative complications were high, the majority was not life-threatening and usually resolved with time and proper management.

Adenocarcinoma↗
PubMed1994

Results of surgical resection in patients with N2 non-small cell lung cancer.

From January 1982 to December 1986, 167 patients (121 men and 46 women) with non-small cell lung cancer and a clinically negative mediastinum were found to have N2 lymph node metastases at thoracotomy and underwent pulmonary resection. Ages ranged from 31 to 86 years (median, 66 years). Adenocarcinoma was present in 70 patients (41.9%), squamous cell carcinoma in 64 (38.3%), large cell carcinoma in 20 (12.0%), adenosquamous cell carcinoma in 7 (4.2%), and bronchoalveolar cell carcinoma in 6 (3.6%). Forty-seven patients (28.1%) underwent mediastinoscopy; all results were negative. Pneumonectomy was performed in 64 patients, bilobectomy in 4, lobectomy in 76, segmentectomy in 2, and wedge excision in 21. Twenty patients had an incomplete resection. Thirty-five patients (21.0%) had complications, and the operative mortality was 4.8% (8 of 167 patients). Sixty-seven patients (40.1%) received adjuvant radiation therapy. The 5-year survival for the 147 patients who underwent complete resection was 23.7%. In contrast, 19 of the 20 patients (95.0%) who underwent incomplete resection died within 3 years. Other factors that significantly affected the 5-year survival were the number and location of metastatic lymph node stations, age, type of resection, and whether adjuvant radiation therapy was administered. We conclude that, when N2 disease is found at thoracotomy, complete resection is warranted to achieve long-term survival.

Adult↗
PubMed1994

Pulmonary resection for metastatic breast cancer.

Between 1982 and 1992, 60 consecutive female patients underwent pulmonary resection for metastatic breast carcinoma. Median age was 58 years (range, 21 to 81 years). The median tumor-free interval after primary breast cancer operation was 2.2 years (range, 7 days to 20.6 years). Thirty-one patients (51.6%) had solitary pulmonary metastases. Forty patients (66.7%) had complete pulmonary resection, which consisted of wedge excision in 33, lobectomy in 6, and pneumonectomy in 1. The remaining 20 patients had incomplete resection, which consisted of wedge excision in all. Altogether, 8 patients (13.3%) had development of postoperative complications, which included pneumothorax, prolonged air leak, pulmonary embolism, retained secretions requiring bronchoscopy, atrial fibrillation, and chest tube site infection. There was one operative death (1.7%). Follow-up was complete in all patients and ranged from 23 days to 10.7 years (median, 3.5 years). Recurrence developed in 32 of the 39 survivors (82.1%) who had complete resection. Median disease-free interval after lung resection was 1.6 years (range, 23 days to 9.3 years). Overall 5-year survival was 37.8% (95% confidence interval, 25.1% to 50.5%). The 40 patients who had complete resection had a 5-year survival of 35.6% (95% confidence interval, 20.4% to 50.8%) as compared with 42.1% (95% confidence interval, 19.0% to 65.3%) for the 20 patients with incomplete resection (p = not significant). Although pulmonary resection is safe, we could not demonstrate improved survival after complete pulmonary resection of metastatic breast carcinoma in this highly selected group of patients.

Adult↗
PubMed1994

Polymorphic reticulosis: a reappraisal.

We studied 18 patients (15 men and three women) evaluated for a destructive sinonasal lesion that had been diagnosed as "polymorphic reticulosis." The histologic features of each lesion were those of angiocentric immunoproliferative lesions," characterized by atypical lymphoid infiltrates with polymorphous, angiocentric, and necrotic features; 13 were grade 2 and five were grade 3. The neoplastic cells in each patient had a T-cell phenotype. Epstein-Barr virus RNA was detected in the neoplastic cells of 17 of the 18 T-cell lesions. Initial treatment consisted of local radiation therapy in each patient, chemotherapy in two patients, and prednisone in another patient. Two patients were lost to follow-up and the other 16 had a median follow-up of 14 years, 2 months (range, 4 months to 32 years, 5 months). Four patients are alive and disease free, four patients died not of disease or complication of therapy, and eight patients died of disease. The Kaplan-Meier estimate of survival was 63% at 5 years and 50% at 15 years. Histologic progression of angiocentric immunoproliferative lesions from grade 2 to grade 3 was observed in two patients, and a correlation between angiocentric immunoproliferative grade and survival could not be detected. These data suggest that polymorphic reticulosis is an Epstein-Barr virus-related angiocentric T-cell lymphoma.

Adult↗
PubMed1994

Anterior wrist ganglion.

This study examined the treatment of anterior wrist ganglions by aspiration and injection or surgical excision. Eighty-four patients treated for an anterior wrist ganglion were studied, with an average followup period of 5 years. Initial treatment by aspiration and injection with corticosteroid was performed in 24 patients, with recurrence in 20. A second aspiration and injection was associated with recurrence in all. Of the 72 patients who underwent surgical excision 14 experienced a recurrence of the ganglion. Four patients with a recurrence underwent a second surgical procedure with successful excision in two patients. The origin of the majority of surgically treated ganglions was on the scaphotrapeziotrapezoid joint and radiocarpal joint. Because of a large number of recurrences after nonoperative treatment, surgical excision is recommended as the primary definitive treatment for anterior wrist ganglions Aspiration and injection may provide palliative relief of symptoms.

Adolescent↗
PubMed1994

Pancreatic anastomotic leak after pancreaticoduodenectomy: incidence, significance, and management.

Anastomotic leak at the pancreaticojejunostomy remains a common and dreaded complication after pancreaticoduodenectomy. Our aim was to determine the incidence, presentation, methods of management, and preoperative and postoperative factors that influence the clinical outcome. We reviewed our collective experience with 375 consecutive patients undergoing pancreaticoduodenectomy from 1980 to 1992 for a variety of pathologic indications. Clinical, biochemical, intraoperative, and postoperative factors were reviewed in an attempt to determine prognostic factors. Sixty-six patients (18%) developed a pancreatic anastomotic leak as determined by increased amylase in drainage fluid (44%), radiographic documentation (41%), operative re-exploration (9%), or percutaneous drainage of a peripancreatic, amylase-containing fluid collection (6%). Most leaks (73%) were clinically insignificant and were managed by simple maintenance of intraoperatively placed drains. Active intervention was required in 18 patients (27%) and included percutaneous drainage in 8, completion pancreatectomy in 7, and reoperative drainage with or without anastomotic repair in 3. Although octreotide was used therapeutically in 13 patients (20%), a significant, objective response was noted in only 1 patient. Five (8%) of the 66 patients died, all related directly to the pancreatic leak. The overall operative mortality was lower, 15 (4%) of 375 patients. Of the clinical, biochemical, intraoperative, and postoperative factors reviewed to determine prognostic factors, only postoperative intra-abdominal hemorrhage predisposed the patient to mortality as a result of the pancreatic anastomotic leak. We conclude that most anastomotic leaks at the pancreaticojejunostomy after pancreaticoduodenectomy can be managed conservatively. Use of octreotide to aid in closure of the pancreatic leak was disappointing, whereas patients with postoperative intra-abdominal hemorrhage or those requiring completion pancreatectomy to manage the anastomotic leak have increased mortality.

Adult↗
PubMed1994

Lactobacillemia in liver transplant patients.

Lactobacillemia is rare and, to our knowledge, previously undescribed in liver transplant patients. We reviewed the clinical records of all patients who had undergone orthotopic liver transplantation between January 1985 and August 1992 for whom a blood culture after transplantation yielded Lactobacillus species. A case-control study for determination of risk factors for lactobacillemia in this patient population was also performed. Eight cases of lactobacillus bacteremia were identified. All patients received nonabsorbable oral antibiotics for selective bowel decontamination. In addition, six of eight case patients received intravenous vancomycin prior to the development of lactobacillemia. The biliary anastomosis in each case patient was a Roux-en-Y choledochojejunostomy. Analysis of the case-control study revealed that the presence of a Roux-en-Y choledochojejunostomy at the time of lactobacillemia is a statistically significant risk factor (odds ratio [OR] = infinity, 95% confidence interval [CI] = 1.8-infinity, P < or = .05) but that prior administration of intravenous vancomycin is not a statistically significant risk factor (OR = 2.6, 95% CI = 0.38-30.0, P value not significant) for lactobacillemia. The use of selective bowel decontamination and of intravenous vancomycin in liver transplant patients may select for Lactobacillus species. Furthermore, a Roux-en-Y choledochojejunostomy may allow colonization of the intrahepatic biliary tract with enteric flora.

Adult↗
PubMed1994

Trends in morbidity and mortality of hepatic resection for malignancy. A matched comparative analysis.

OBJECTIVE: The authors define more clearly the trends in morbidity and mortality after hepatic resection for malignant disease in matched patient groups during two discrete time periods. SUMMARY BACKGROUND DATA: Recent reports have shown improvement in operative morbidity and mortality associated with hepatic resection; however, results often included resections for benign disease and trauma. Furthermore, specific factors contributing to the improvement in operative risks between the last two decades have not been defined. METHODS: A retrospective matched comparative analysis was conducted of patients with primary and metastatic hepatic malignancy resected with curative intent between two periods (1976 to 1980 and 1986 to 1990). Eighty-one patients met our inclusion criteria in the early period; this group was matched with 81 patients from the latter period by the following four parameters: age, gender, type of malignant disease, and extent of resection. Records of these two patient groups were abstracted for clinical presentation, co-morbid factors, operative techniques, and perioperative morbidity and mortality. RESULTS: The authors found a significant decrease in operative morbidity, median perioperative transfusion, and length of hospital stay in the latter period (1986 to 1990). The incidence of postoperative subphrenic abscess and intra-abdominal hemorrhage was significantly lower during this period. Operative mortality rate was similar for both periods, 4.9% and 1.2%, respectively (p > 0.05). CONCLUSION: Hepatic resection for malignant disease currently can be performed with a low morbidity and mortality in the hands of trained and experienced hepatic surgeons; operative risks of hepatic resection should not deter its application in the treatment of primary and metastatic malignant disease of the liver.

Adolescent↗
PubMed1994

Cigarette smoking and nonunion after ankle arthrodesis.

The relative risk of nonunion in smokers versus nonsmokers after ankle arthrodesis was determined in a case control study. Twenty-two patients were matched to 22 controls by age, sex, surgeon, surgical technique, and preoperative diagnosis. Information on duration, amount, and past history of smoking was obtained for these 44 patients. Ten of the patients were actively smoking at the time of surgery compared with four of the controls. Six of the patients had no history of smoking and six had stopped smoking before surgery. Eleven of the controls had no history of cigarette smoking and 7 had stopped smoking before surgery. The relative risk of nonunion was increased 3.75 times for active smokers. When patients did not have any known risk factors for nonunion, the risk of nonunion for smokers was 16 times the risk of nonunion for nonsmokers.

Ankle Joint↗
PubMed1994

Definitive therapy for prostate carcinoma: Mayo Clinic results at 15 years after treatment.

Data on long-term follow-up for definitive therapy of prostate cancer are limited, especially for radiation therapy. Either surgery or radiation was used in 322 patients for treatment with curative intent, and follow-up was for a minimum of 15 years. Overall survival was nearly identical to that in age-matched cohort. 5-, 10-, and 15-year recurrence-free survival rates were 77%, 63% and 53%, respectively. Grade and stage were significant prognostic factors for both recurrence and survival. More than 60% of the initial failures were local, and more than 25% of the failures occurred after 10 years. Radiation therapy was used in 137 patients with clinically staged disease. Radical retropubic prostatectomy and perineal prostatectomy were performed in 133 and 44 patients, respectively. In this group, pathological staging was used. Survival rates for surgically treated patients were better than those in the cohort population. In conclusion, overall long-term follow-up demonstrates that definitive treatment does not have an adverse effect on survival from prostate cancer. Local recurrence is a frequent cause of failure. Caution must be used in interpreting any prostate study with less than 10 years of follow-up, because 25% to 50% of the failures occur after that time.

Aged↗