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Biomedical subjects

F C Nance

Publications and source records attributed to F C Nance.

At least 19 recordsLinked to original sources
PubMed1999

Management of adrenal cysts.

Adrenal cysts have been traditionally managed by excision to rule out malignancy. We reviewed the 613 cases of adrenal cysts (including 6 new cases of our own) to evaluate whether this is still appropriate. Descriptive statistics and distribution of each pathologic type have been updated, based on 515 cases, and have changed from statistics compiled on 155 cases by G. A. Absehouse et al. Only seven per cent of all adrenal cysts are malignant or potentially malignant. There is only one reported case of a malignancy found in a nonfunctioning adrenal cyst that was initially thought to be benign. In this case, no CT or aspiration was performed. There have been 19 cases of adrenal cysts managed with aspiration. All were nonfunctioning and benign. One had a bloody aspirate. Reaccumulation occurred in 32 per cent of the cases (six cases); six per cent were symptomatic, four per cent were excised. Follow up was available in 15 cases from 4 months to 3.5 years. Management of the patient with a suspected adrenal cyst should include a careful history and physical and biochemical screening to rule out a functioning lesion. A CT scan, and aspiration of the cyst with a cystogram should be performed to confirm a simple cyst of the adrenal. If the suspicion of malignancy is low, and the lesion is nonfunctional, the adrenal cyst may be managed by aspiration alone. If the cyst recurs and is asymptomatic, it may be observed. If a symptomatic cyst recurs, it may be reaspirated or excised.

Adrenal Gland Diseases↗
PubMed1997

Intraoperative cholangiography in laparoscopic cholecystectomy: a review of 734 consecutive cases.

Intraoperative cholangiography was first introduced by Mirizzi in 1931. He recommended its routine use. The debate over the appropriate role of intraoperative cholangiography was renewed by the widespread acceptance of laparoscopic cholecystectomy in 1988. We reviewed our experience to determine the most appropriate use of intraoperative cholangiography. Seven hundred thirty-four consecutive cases of laparoscopic cholecystectomy performed between January 1, 1991 and December 31, 1993 were reviewed. The Routine Group of 276 cases, performed by 3 surgeons practicing routine cholangiography, was compared to the Selective Group of 458 cases, performed by 16 surgeons practicing selective cholangiography. The groups were similar in terms of age, sex, and extent of disease. No statistically significant difference was found between the two groups in number of successful cholangiograms, filling defects, misinterpretation of cholangiograms, complications, or length of hospitalization. One common duct injury occurred in the Routine Group. The rate of conversion to open cholecystectomy was higher in the Routine Group. A cholangiogram added 14 minutes to the average duration of surgery and $737 to the average cost. We found that routine cholangiography did not increase common duct stone detection, did not decrease common duct injury, and did not increase technical skill, but it did increase cost. We feel that intraoperative cholangiography should be used selectively where choledocholithiasis is suspected or biliary anatomy is unclear.

Case-Control Studies↗
PubMed1997

Choledochal cyst and neoplasm: a comprehensive review of 106 cases and presentation of two original cases.

Choledochal cysts are prone to complications: cholangitis, biliary cirrhosis, portal hypertension, lithiasis, rupture, pancreatitis, and carcinoma. The coincidence of choledochal cysts and neoplasia ranges from 2.5 to 26 per cent. One hundred six cases of choledochal cysts with neoplasms have been collected from the literature. We have tabulated the results of 68 cases found to have a neoplasm at the initial laparotomy and of 38 patients with pristine choledochal cysts treated electively who subsequently developed a neoplasm. Two original cases are presented. The primary site of neoplasia was not confined only to choledochal cysts. There appears to be a propensity for malignancy to develop anywhere in the biliary tract or gallbladder or pancreas in conjunction with the choledochal cyst. Accompanying choledochal cysts is a high incidence of an anomalous relation at the pancreaticobiliary junction with subsequent malignancy formation. A pathogenetic basis is postulated.

Adenocarcinoma↗
PubMed1991

Prospective, randomized trial of the biofragmentable anastomosis ring. The BAR Investigational Group.

A randomized trial was undertaken to compare the biofragmental anastomotic ring (BAR) with conventional intraperitoneal colorectal anastomotic techniques. Patients were randomized into one of two schemes: BAR versus sutured or BAR versus stapled anastomosis. There were 782 patients entered into the study and 283 patients (36%) had a sutured anastomosis, 104 patients (13%) had a stapled anastomosis, and 395 (51%) had the BAR. Comparison of the BAR with combined suture and stapled controls revealed no significant differences in wound complication, abscess rate, bleeding, anastomotic leaks, ileus, obstruction, or deaths. There were no differences in return of bowel function, return to normal diet, or hospital stay. Intraoperative difficulties occurred in 46 BAR patients (17%), and this was significantly higher (p less than 0.001) than for sutured (3%) but not for stapled anastomoses (11%). The occurrence of these problems did not adversely effect the outcome. The data suggest that the BAR is a safe, satisfactory alternative to sutured or stapled colorectal anastomoses.

Adolescent↗
PubMed1991

A traumatic splenic rupture in a healthy adult.

Splenic rupture in blunt and penetrating trauma is well documented. Other etiologies include hematologic and inflammatory disorders. The case presented documents occult splenic rupture. There was no history of trauma. Furthermore, no evidence of systemic disease or pathology could be found. Occult, spontaneous splenic rupture is rarely diagnosed, although the associated mortality/morbidity is high. The astute clinician must have a high index of suspicion relying on clinical and roentgenographic study for rapid diagnosis and management.

Adult↗
PubMed1989

The need for definitive therapy in the management of perforated gastric ulcers. Review of 202 cases.

A retrospective study of 202 patients who presented to three Louisiana hospitals with perforated gastric ulcers was performed. Patients were treated surgically, medically, or were not treated. Only those patients with gastric ulcers were included in the study, not those with "channel ulcers" or peptic ulcers. The mortality rate of the 185 patients who were treated with operation was 18%. Of those patients treated nonoperatively, the mortality was 95% (one survivor). There was a definite difference in mortality among those patients treated with definitive operative procedures (11.3%) versus those patients treated with nondefinitive surgery (22.9%). This difference was consistent even in the presence of purulent exudate in the abdominal cavity and among those patients presenting in shock. The mortality among those patients who presented with a initial blood pressure of 90 mmHg or less were defined as being in shock, and the mortality in this subgroup was 52.8%. The mortality among those patients who had purulent fluid within the abdominal cavity was about the same, regardless of type of surgical procedure. The patients who underwent nondefinitive procedures required subsequent operative treatment in 25.7% of cases. Also noted was the lack of correlation between symptoms of ulcer disease and perforation. Those patients treated with definitive surgery (57%) and those treated with nondefinitive surgery (41%) reported no symptoms consistent with ulcer disease before operation.

Adolescent↗
PubMed1989

Crohn's disease-associated carcinoma. A poorly recognized complication of inflammatory bowel disease.

We have reviewed eight cases of Crohn's disease associated carcinoma (CDAC) of the bowel treated at Saint Barnabas Medical Center since 1977. Five patients had colorectal carcinoma in areas of dysplasia within histologically recognizable Crohn's disease. One of the large bowel carcinomas was a diffusely infiltrating signet ring adenocarcinoma (linitis plastica), three were mucinous carcinomas, and one contained both cell types. Survival ranged from 4 to 55 months. Three patients developed ileal carcinomas in areas of dysplasia within histologically recognizable Crohn's disease. One of the ileal cancers was a moderately differentiated adenocarcinoma; two were poorly differentiated adenocarcinomas. Survival ranged from 8 to 44 months. The dysplastic changes seen in the bowel adjacent to the tumors in these patients were identical to the characteristic pre-cancerous (dysplastic) changes well described in ulcerative colitis. The histopathologic changes seen in this high-risk group of patients are also similar to those of previously reported CDAC. Those patients with the more diffuse dysplastic changes might have been detected before the development of invasive cancer had they undergone periodic colonoscopic surveillance. One patient in the series with an asymptomatic lesion was, in fact, identified at surveillance colonoscopy. It would appear that Crohn's disease patients have a similar risk for carcinoma previously recognized in ulcerative colitis patients and that surveillance protocols should be developed for this group of patients.

Adenocarcinoma↗
PubMed1988

Abdominal trauma at the Southern Surgical Association, 1888-1987.

Since 1888 98 papers have been presented to the Southern Surgical Association (SSA) dealing directly or indirectly with abdominal trauma. The papers reflect the progress over the century in the management of this injury. Almost two-thirds of the papers have originated from the major city hospitals of the south. An interest in abdominal trauma has been manifest among the officers of SSA. Twenty-two presidents have presented papers or taken part in discussions. Four 25-year eras were identified. In the earliest, exploration of abdominal wounds was firmly established as a principle. The second period was characterized by consolidation of principles and strengthening of supportive care. The third era encompassing World War II marked a nadir in productivity. In the last 25 years a reawakened interest has resulted in a marked increase in the number and quality of presentations, which have increasingly focused on specific organ injuries.

Abdominal Injuries↗
PubMed1984

Surgical judgment in the management of abdominal stab wounds. Utilizing clinical criteria from a 10-year experience.

A 10-year retrospective study of patients with stab wounds to the abdomen managed under a protocol of selective management has been performed. Patients were assessed on the basis of clinical presentation and physical examination, with minimal diagnostic studies. Peritoneal lavage was not utilized in the evaluation of the patients. Two hundred and nineteen such patients were identified. One hundred and eleven of these patients were treated nonoperatively. Ninety patients were treated by immediate laparotomy. Eighteen patients, initially observed, underwent delayed laparotomy. One patient, not explored despite clear-cut indications for laparotomy, died of sepsis, emphasizing the need for strict adherence to the stated protocol. The negative or unnecessary laparotomy rate was 7.8%. The false-negative examination rate was 5.5%. Overall mortality rate was 2.3%. The accuracy of careful clinical evaluation and observation is comparable to, or better than, any other method currently available to identify intra-abdominal injuries in patients with abdominal stab wounds. The study suggests that selective management of stab wounds of the abdomen may be safely practiced in a smaller community hospital.

Abdominal Injuries↗
PubMed1984

Effect of burn shock on myocardial function in guinea pigs.

The effect of burn shock on myocardial function was studied using an isolated working heart preparation. Guinea pig hearts were studied 2-, 4-, and 8-hr following burn injury as well as in time-matched controls. The hearts were excised from both burned (35% body surface area) and unburned unresuscitated animals, and ventricular function curves were generated on each heart. The 4- and 8-hr postburn hearts, particularly the 4-hr group, exhibited depression in cardiac output, stroke volume, coronary flow, peak systolic pressure, mean aortic pressure, estimated myocardial work, stroke work, and oxygen consumption when compared to controls. The ventricular function curve for the 4-hr postburn hearts was shifted to the right indicating a decrease in contractility, which complements a decrease seen in compliance. These pronounced changes seen in the 4-hr postburn hearts were not observed 2 hr after burn injury. The data suggest that intrinsic myocardial function following burn injury is depressed and the degree of dysfunction is influenced by the time from thermal injury.

Animals↗
PubMed1982

Sepsis-induced depression of phagocytosis in experimental canine peritonitis.

Experimental canine peritonitis was produced in 14 dogs by appendiceal ligation. Phagocytic activity in blood and peritoneal fluid was examined during the peritonitis and following surgical intervention. In nine dogs, the gangrenous appendix was resected after 43 hours, the peritoneal cavity was irrigated, and fibrinous exudate debrided. The remaining five dogs were not tested. Leukocytes in blood and peritoneal fluid were counted preligation and at 24, 43, 46, and 55 hours postligation. Polymorphonuclear leukocytes (PMNs) predominated. Phagocytosis and killing of Candida tropicalis by blood and peritoneal PMNs were assayed by a coverslip method. As sepsis progressed, phagocytosis by blood PMNs declined and at 43 hours was 60 per cent of the preoperative level. After resection of the gangrenous appendix, phagocytic activity returned to 90 per cent of preoperative levels at 12 hours postresection. Peritoneal PMNs exhibited a similar, but more depressed pattern of phagocytic activity. Phagocytosis in five sham-operated dogs was unchanged. Thus, phagocytosis by blood and peritoneal PMNs was depressed in peritonitis and was restored following surgical treatment.

Animals↗
PubMed1980

Primary lymphoma of the gastrointestinal tract.

Primary gastrointestinal lymphoma represents approximately 1% of all gastrointestinal neoplasms. Gastric involvement is more common than small or large intestine and carries a better prognosis. Abdominal pain and weight loss may be the only manifestations and may be present for months or years before the diagnosis is made. Perforation and obstruction occur infrequently. Multiple tumors constitute 8% of cases. Although barium studies and endoscopy reveal the lesion in a high percentage of cases, exploratory celiotomy is not infrequently required for diagnosis. Only one-third of lymphomas are confined to the bowel at laparotomy. Histologically one-third are reticulum cell sarcomas and the remainder lymphosarcoma or lymphocytic lymphoma. Five year survival overall was 38%. Curative resections yielded a survival of 60% regardless of site while palliative resections offered only a 17% chance of cure. As expected, survival was inversely proportional to extent of nodal spread. Postoperative radiotherapy is recommended for residual disease.

Adolescent↗
PubMed1979

New techniques of gastrointestinal anastomoses with the EEA stapler.

A new instrument for accomplishing inverted stapled anastomoses in the gastrointestinal tract is described. Side-to-side, end-to-side and end-to-end anastomoses can be performed. Techniques developed for utilization of the instrument in virtually all gastrointestinal anastomoses are described. In most instances a proximal or distal enterotomy is required. Experience with 57 anastomoses in 42 patients is reported. One leak occurred; no other complications not recognized intraoperatively were observed. Anastomoses completed included gastroduodenostomy, gastrojejunostomy, cholecystojejunostomy, colocolostomy and ileocolostomy. Hazards and complications associated with the use of the instrument are described. It should be used only after the surgeon has acquired the skills to operate the instrument properly. The instrument saves time, creates better anastomoses than can be obtained by hand sewing and is extremely versatile. It may permit safer anastomoses in adverse conditions, such as in obstruction and peritonitis. The instrument opens new horizons in gastrointestinal surgery.

Animals↗