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Biomedical subjects

F Glenn

Publications and source records attributed to F Glenn.

At least 19 recordsLinked to original sources
PubMed1982

Acute acalculous cholecystitis. An increasing entity.

Acute acalculous cholecystitis was observed to increase in frequency between 1950 and 1979, an increase that was statistically significant. The greatest part of this increase occurred between 1965 and 1979. Acute acalculous cholecystitis was also found to be associated with a higher mortality rate, more than twice that of acute calculous cholecystitis. Acute acalculous cholecystitis occurred in a variety of clinical settings including bacterial sepsis, severe trauma including surgical trauma and burns, multiple transfusions, and severe debilitation. The lesion in the gallbladder consists of intense injury of blood vessels in the muscularis and serosa similar to those induced experimentally by in vivo activation of factor XII dependent pathways. Possibly because of the intensity of vascular injury, acute acalculous cholecystitis with minimal clinical manifestations may rapidly progress to gangrene with perforation. Undelayed surgical treatment, which has become more widely accepted over the past 50 years, is essential. It may have also contributed to the increased recognition of this clinical entity.

Adult↗
PubMed1982

Induction of acalculous cholecystitis and pneumonitis in dogs following inhalation of constituents of cigarette smoke condensate.

In previous studies in this laboratory it was demonstrated that 1) constituents of the water-soluble phase of cigarette smoke condensate can activate Hageman-factor-dependent pathways of coagulation, fibrinolysis, and kinin generation; and 2) that in vivo activation of Hageman-factor-dependent pathways by intravenous injection of plant polyphenols in dogs and AFrican Green monkeys can induce acute acalculous cholecystitis and alveolitis. The purpose of this communication is to report that inhalation of the water-soluble, nondialyzable constituents of cigarette smoke condensate, or "tar," can activate Hageman-factor-dependent pathways in the dog and induce acute acalculous cholecystitis, pneumonitis, and the formation of thrombi in branches of pulmonary vessels.

Animals↗
PubMed1981

Surgical management of acute cholecystitis in patients 65 years of age and older.

The proportion of the population of the U.S. 65 years of age and over is increasing. Biliary tract disease is estimated to involve 15% of the adult population. A review of 12,200 patients treated surgically at one medical center reveals that 2401 (20%) had acute cholecystitis. There were 93 deaths, for a mortality rate of 3.8%. Sixty-five of the 93 deaths, for a mortality rate of 3.8%. Sixty-five of the 93 deaths occurred in 665 patients 65 years of age and older, for a mortality rate of 9.8%. These elderly patients accounted for 69.9% of the deaths from acute cholecystitis. It is suggested that acute cholecystitis in patients 65 years of age and older may be prevented by a more aggressive surgical approach to cholelithiasis when those patients are younger. Indeed, the present improved methods of diagnosis and an awareness of gallstones by the public is resulting in many more patients seeking medical advice in the early years of the disease. On the basis of a review of an experience in the surgical treatment of acute cholecystitis two proposals are made concerning the management of patients 65 years of age and over. First, the operation should be performed with minimal delay following diagnosis, and such specific correction of physiologic impairment should be performed as is feasible. Second, the procedure to be performed on the elderly patient should be one that alleviates the present problem, and accomplished by imposing the minimal burden upon the patient.

Acute Disease↗
PubMed1981

Biliary tract surgery concomitant with other intra-abdominal operations.

Biliary tract operations were performed in conjunction with another intra-abdominal operation in 253 patients. Of this group, 137 patients had unplanned or "incidental" biliary procedures, with a morbidity rate of 15% and a mortality rate of 7%. Three of the 20 nonfatal complications were related to the biliary tract surgery. A planned biliary tract operation concomitant with another intra-abdominal procedure was performed in 65 patients, with a morbidity rate of 20% and mortality rate of 2%. None of these postoperative complications or deaths were attributed to the biliary tract operation. A planned biliary tract procedure plus another incidental and unplanned operation were performed in 51 patients, with a morbidity rate of 11.8% and no deaths. The complications were not specific to the biliary tract operation. The data suggest that it is feasible to perform concomitant cholecystectomy for cholecystostomy for calculous biliary tract disease in patients operated on for nonbiliary diseases. It is also reasonable to perform definitive surgery for most gastrointestinal diseases discovered incidental to a planned cholecystectomy. These recommendations are valid only if the condition of the patient permits the additional operative stress and the exposure is adequate to perform a safe procedure on the gallbladder. Concomitant operations that require choledochotomy are not recommended, except under unusual circumstances.

Abdomen↗
PubMed1981

Biliary enteric fistula.

From 1932 to 1978, 105 patients with biliary enteric fistulas are reported upon from The New York Hospital-Cornell Medical Center. During this 46 year period, 11,808 patients were operated upon for nonmalignant biliary tract disease, representing an incidence of biliary enteric fistulas of 0.9 per cent. The most common location of the fistula was cholecystoduodenal in 77 per cent and cholecystocolic in 15 per cent. Ninety-eight of the 105 patients underwent 109 surgical procedures for symptoms and complications associated with the fistula. The operative mortality was 6 per cent. The recommended definitive procedure includes cholecystectomy, excision of the fistula, common bile duct exploration and operative cholangiography. Among the 105 patients were 22 who presented with intestinal obstruction or ileus due to gallstones. The operative mortality in this group was 4.5 per cent. The recommended treatment for this condition is operative relief of the obstruction with correction of the biliary enteric fistula at an elective second stage operation.

Adult↗
PubMed1980

Induction of acute cholecystitis by activation of factor XII.

Acute, acalculous cholecystitis is seen among patients suffering with bacterial sepsis, burns, trauma, or cancer; clinical conditions that could lead to activation of factor XII-dependent pathways and result in inflammation of the gall bladder. To test this hypothesis, dogs were injected intravenously with ellagic acid or rutin, known polyphenol activators of factor XII, or with Escherichia coli endotoxin, also known to activate factor XII, and monkeys were injected intravenously with ellagic acid. In both species, in vivo activation of factor XII-dependent pathways with polyphenol activator resulted in rapid and selective development of acute vasculitis in the serosa and muscularis of the gallbladder and margination of polymorphonuclear neutrophils in pulmonary blood vessels. Intravenous injection of E. coli endotoxin in dogs resulted in necrosis and thrombosis of vessels that were especially severe in the serosa and muscularis of the gallbladder but also present in vessels of many other organs. These observations indicate that blood vessels of the gall bladder and, to a lesser degree, the lung are especially sensitive to injury consequent to in vivo activation of factor XII-dependent pathways and, in view of the common ingestion of plant polyphenols, may provide important insight into the pathogenesis of cholecystitis in man.

Animals↗
PubMed1980

The incidence and causes of death following surgery for nonmalignant biliary tract disease.

In the 46-year period from September 1, 1932 to September 1, 1978, 11,808 patients were operated on for nonmalignant biliary tract disease. In 80.1% of these patients, the disease was considered chronic, and in 19.9%, acute inflammation was superimposed on the existing condition. There were 207 postoperative deaths, a mortality rate of 1.7%. Advanced age, acute cholecystitis and common duct stones were the principal determinants of operative mortality. Cholecystectomy for chronic cholecystitis was performed in 7,413 patients with an operative mortality of 0.5%. Choledochotomy in search of residual or recurrent common duct calculi was performed in 341 patients with a mortality of 2.1%. Detailed analysis of the causes of death in 105 patients who died during the years 1962 through 1978 revealed that cardiovascular disease, especially myocardial infarction, was the most frequent cause of death. Liver disease, most commonly cirrhosis, was also a major factor in operative mortality.

Acute Disease↗
PubMed1980

Developing trends in acute cholecystitis and choledocholithiasis.

Among 2,347 operations performed for acute cholecystitis during a 46 year period, 1932 to 1978, choledochotomy was combined with either cholecystectomy or cholecystostomy in 364 instances. A report published for the first period, 1932 to 1955, is compared with a comparable period, 1955 to 1978. A greater number of patients were operated upon during the second period, 83 for the first 23 years and 276 for the second 23 year period. The average age increased from 49.6 to 65.3 years. The incidence of choledocholithiasis increased from 59 to 62 per cent. The ratio of females to males shifted from 4.2:1.0 for 1932 to 1955 to 1.6:1.0 for 1955 to 1978. Associated conditions recognized preoperatively increased from 2.5 per patient to 4.9 per patient. Postoperative complications increased from 27 in 83 patients, 1932 to 1955, to 250 complications in the 276 patients, 281 operations, in the second series, 1955 to 1978. The mortality increased from 2.5 to 10.9 per cent. In the past 46 years, 97 per cent of the deaths occurred in patients 50 years of age or older, with only one death, 3 per cent, occurring in a patient less than 50 years old, and this patient was operated upon in the second series, 1955 to 1978. It is suggested that the increased age and associated conditions at the time of operation for a sequelae of calculous biliary tract disease account fort the increased mortality. Undelayed cholecystectomy for cholelithiasis following the establishment of the diagnosis should prevent the sequelae of acute cholecystitis with presumed choledocholithiasis.

Acute Disease↗
PubMed1978

Iatrogenic injuries to the biliary ductal system.

One hundred patients who sustained complete transection or ligation of the common bile duct during cholecystectomy were selected from a much larger number of patients admitted to The New York Hospital for surgical correction from 1932 to 1976 for review. The methods of restoration of bile flow from the liver to the intestine were described with an indication of the success and failure that followed. The results were varied and unpredictable. Perhaps the propensity of the transected or ischemic duct wall to form scar tissue with sufficient reduction of the lumen to cause partial to complete obstruction is the reason for some of the failure.

Bile Ducts↗