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Biomedical subjects

F L Greene

Publications and source records attributed to F L Greene.

At least 91 records · Page 5Linked to original sources
PubMed1985

Choledochocele and recurrent pancreatitis. Diagnosis and surgical management.

A case history has been presented that reports a rare type III choledochal cyst (choledochocele) and describes the association of a choledochocele and recurrent acute pancreatitis. The most reliable diagnostic technique, as used in our patient and supported by our literature review, is endoscopic retrograde cholangiopancreatography. This case further supports surgical correction employing transduodenal sphincteroplasty. This procedure is highly recommended for management of the intramural choledochocele (type IIIc), especially when associated with recurrent pancreatitis. Finally, patients who present with recurrent pancreatitis without the usual historical or diagnostic findings of biliary tract or alcoholic disease should have a choledochocele included in the differential diagnosis.

Acute Disease↗
PubMed1985

Mammography, sonomammography, and diaphanography (lightscanning). A prospective, comparative study with histologic correlation.

While mammography has become a routine method both for the screening and preoperative assessment of breast disease, the role of this modality, especially when compared with newer techniques of breast imaging, needs continued assessment. Recent advances using sonographic principles and diaphanography (light transillumination) must be compared with mammography to define specificity, sensitivity, and accuracy in assessing breast lesions. During a 16-month period between November 1982 and February 1984, 467 women with clinically apparent breast disease (symptoms or palpable lesions) were each studied using all three imaging techniques of mammography, sonomammography, and diaphanography. Of 168 women recommended for biopsy on the basis of these techniques, 84 women had histologic confirmation during this study period. Benign breast disease was diagnosed histologically in 38 women, while carcinoma was found in 46 patients. These techniques showed no significant differences in predicting benign or malignant disease when rates of sensitivity, accuracy, and specificity are computed. Diaphanography (lightscanning), allowed for consistently correct interpretation of cases proven to be histologically malignant and showed a false-negative rate comparable with x-ray mammography. We conclude that diaphanography is a sensitive indicator of both benign and malignant breast disease while serving as a reliable predictor of clinically apparent breast lesions without the potential problems of radiation exposure.

Adult↗
PubMed1984

Vascular injuries associated with pelvic fractures.

Pelvic fractures, which are most often caused by blunt abdominal trauma in our motor vehicle-oriented society, continue to be associated with significant mortality and morbidity. Hemorrhage is the cause of death in nearly 60 per cent of those patients who die of pelvic fractures. With increasing awareness of the problem and improved methods of management, the mortality rate of acute hemorrhage secondary to pelvic fracture should decrease. Four cases of vascular injuries associated with severe pelvic fractures are discussed. One patient presented with bleeding from a false aneurysm of the superior gluteal artery 3 months after his pelvic fracture. This complication was successfully managed by selective arteriographic embolization. The other three patients required early angiography with embolization of hypogastric vessels to control acute hemorrhage after pelvic fracture. Pelvic arteriography with selective embolization of injured vessels is recommended in the management of hemorrhage secondary to severe pelvic fractures. Application of the Military Antishock Trousers (MAST) suit may also be a useful maneuver. These principles of management and a pertinent review of the literature are presented.

Accidents, Traffic↗
PubMed1983

Repair of rectal prolapse using a puborectal sling procedure.

Many procedures have been described for the repair of rectal prolapse. Some are associated with a high recurrence rate and do not correct associated fecal incontinence. During the last four years, we have operated on 15 patients using a puborectal sling fashioned of polypropylene mesh. Nine were women and six were men, with ages ranging from 25 to 72 years. Eight patients had fecal incontinence. During a follow-up of six months to four years, rectal prolapse did not recur. Fecal incontinence was totally resolved in all cases. The morbidity and death rates were both 0%, and no long-term problems have been associated with use of the synthetic material. This procedure is a sound alternative for patients with complete rectal procidentia and fecal incontinence, as it corrects the associated anatomic defect of the anorectal angle.

Adult↗
PubMed1983

Distribution of colorectal neoplasms. A left to right shift of polyps and cancer.

A 20-year retrospective review was made of all patients undergoing operative procedures for both adenocarcinoma and benign polyps of the colorectum at the two teaching hospitals of the University of South Carolina. A total of 1,112 patients with adenocarcinoma and 429 patients with benign polypoid disease were identified. Classification of each adenocarcinoma according to location showed a 12 per cent increase in the number of right-sided lesions and a 44 per cent decrease in rectosigmoid lesions when compared with historical series. Despite this proximal shift, the rate of association of benign adenomatous polyps contained in cancer resections (13 per cent) is similar to previous series. Furthermore, evaluation of benign adenomatous polyps showed a similar increase of proximal colonic lesions and a decrease of rectosigmoid adenomas. The results of this retrospective study support the concept that adenocarcinoma is occurring with increasing frequency in the right colon. Despite this left to right shift, a constant association of benign polyps within cancer resections was found, supporting the concept of a polyp-cancer sequence. This study identified a similar shift in benign adenomatous polyps alone, supporting the concept that benign neoplasias are premalignant and are probably responsible for the increased incidence of proximally located colonic adenocarcinomas.

Adenocarcinoma↗
PubMed1977

Mesenteric and peripheral vascular ischemia secondary to ergotism.

At the present time ergotism is due primarily to excessive use or abuse of ergot preparations for migraine headaches. The diagnosis may be made with the evidence of vascular ischemia in the presence of a history of migraines and its treatment with this drug. The therapy for the vasospasm is directed chiefly at the discontinuation of the ergot preparation, with further treatment aimed at the relief of symptoms or prevention of complications. A case is presented of lower extremity ischemia with impending gangrene of both feet in a patient with a history of chronic schizophrenia. Arteriograms revealed symmetrical vasospasm in the lower extremities as well as spasm of the superior mesenteric artery and its intestinal branches. This is believed to be the first documented case of mesenteric vasospasm due to ergotism. Treatment was instituted with low molecular weight dextran, tolazoline, and reserpine with rapid and complete resolution. Caution is advised in the use of ergot preparations in neuropsychiatric disorders.

Adult↗
PubMed1975

Successful treatment of hepatic artery aneurysm with erosion into the common duct.

A patient with an hepatic artery aneurysm is presented with preoperative angiographs, and intra-operative photographs demonstrating erosion and fistulazation into the common duct. The aneurysm was ligated and excised, and the erosion of the common duct was treated successfully with a Roux-en-Y choledochoduodenstomy. This is the fourth case with erosion into the common duct to be treated successfully by surgery. The other three cases are discussed. A review of the literature reveals that hepatic artery aneurysms are rare, and successful treatment is based on several different techniques. Ligation of the hepatic artery, with or without excision of the aneurysm, is discussed as a method that may in fact be the safest treatment in a group of patients who because of their disease are already in a high risk category.

Aged↗