Chronic lymphocytic leukaemia presenting with bilateral breast involvement.
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Biomedical subjects
Publications and source records attributed to G D Dunn.
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To assess our clinical experience with this method of enteral feeding, we conducted a retrospective study and follow-up of 73 patients having percutaneous endoscopic gastrostomy (PEG). In addition, we conducted a telephone survey of 42 persons who cared for the PEG tube. The most common indication was neurologic impairment of deglutition. Early and late complications occurred in 12% and 33% of cases, respectively, and were usually minor. Our 30-day survival was 74%. Most patients (77%) maintained their weight with standard tube feedings. Satisfaction with and acceptance of the PEG was almost universal. Patients should be carefully selected, with attention to long-range benefit.
The results of ultrasound imaging combined with Doppler studies of blood flow are presented in two patients with surgical portacaval shunts performed for portal hypertension. Duplex scanning proved a quick and noninvasive method of confirming the patency of the anastomoses. The demonstration of appropriate Doppler flow signals across the shunt is the most convincing ultrasound evidence of patency. Portacaval shunts are more amenable to study by ultrasound than more peripheral shunts because the liver can be used as an acoustic window.
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In three patients with phaeochromocytomas, computed tomography or iodobenzylguanidine scanning gave misleading or negative results. These patients were found to have a functioning middle mediastinal paraganglioma in association with one or two intercarotid paragangliomas. The possibility of this association should be considered in patients with functioning extra-adrenal paragangliomas.
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Eight children (aged 8 mo to 13 yr) with cystic fibrosis (CF) and growth failure were given home nocturnal nasogastric feeding of an elemental diet for 3 mo and re-evaluated 3 mo after cessation of tube feeding. An increase in energy intake (p less than 0.05) resulted in increased serum transferrin (p less than 0.005), retinol-binding protein (p less than 0.05), and clinical scores (p less than 0.05) during the study. Height and growth velocity increased by 60% (p less than 0.05), and weight growth velocity increased by 63%. Arm-muscle circumference, triceps skinfolds, serum albumin, vitamin A, vitamin E, zinc, and copper did not change significantly during tube feeding. Nocturnal feeding were safe and effective in promoting growth; however, most children with severe lung disease did not sustain the gains after cessation of tube feeding. Our findings indicate that continued nutritional support is needed to maintain the growth in malnourished children with severe lung disease.
We have reported a case of occult, diffuse gastric cancer in a young adult with progressive shortness of breath and bilateral pulmonary interstitial infiltrates. Progressive shortness of breath may be the first or only manifestation of occult gastric cancer caused by either lymphangitic carcinomatosis or microscopic tumor emboli to the lungs. Widespread recognition of this syndrome, a high index of suspicion, and prompt lung biopsy are necessary to make the correct diagnosis. With progress in chemotherapy for malignant diseases, early diagnosis and specific treatment may improve the prognosis of this condition.
Ultrasonography (US) performed in nine patients (two with pancreatic carcinoma, one with hepatomegaly, six with no relevant abdominal disease) showed the pancreas to lie wholly to the left of the aorta. This not uncommon location may give rise to difficulty in demonstrating the pancreas on real-time US scans. The superior mesenteric vessels and splenic vein remain useful landmarks for locating the head of the pancreas in this position.
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A 65-yr-old man who developed sudden respiratory arrest was found to have a long, smooth, esophageal filling defect on esophagogram. Endoscopy eventually proved this to be a large esophageal polypoid lesion that had arisen in the hypopharynx and extended to the midesophagus. He was successfully treated with a lateral pharyngotomy and excision of the hypopharyngeal polyp.
Upper gastrointestinal polyps commonly occur in patients with familial polyposis coli; but the occurrence of gastric carcinoma is very rare in this disorder. We report a case of intramucosal gastric carcinoma in a patient with familial polyposis coli and multiple gastrointestinal adenomatous polyps.
A 40-year-old man with a history of insulin-dependent diabetes mellitus was admitted to the hospital because of jaundice and pruritus. During his evaluation the diagnosis of primary sclerosing cholangitis and "microscopic" ulcerative colitis were established. Massive intraabdominal lymphadenopathy was discovered on CT scan and histological examination eventually proved this to be follicular hyperplasia. The case herein reported documents the association of primary sclerosing cholangitis with diabetes mellitus and ulcerative colitis as well as reporting the occurrence of massive intraabdominal lymphadenopathy.
A 59-yr-old man was admitted to the hospital for evaluation of right upper quadrant pain, anorexia, weight loss, and low-grade fever of 2-mo duration. During his evaluation, an abnormal liver ultrasound and computed tomography scan demonstrated what proved to be an avascular hepatic lesion. At surgery, the diagnosis of malignant fibrous histiocytoma was established. We present herein our findings of what we believe to be the first reported study of malignant fibrous histiocytoma of the liver.
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Primary sclerosing cholangitis is a chronic, cholestatic disease affecting the biliary tree. Recent data suggest an autoimmune etiology. Clinical findings, roentgenographic characteristics, and compatible liver histology will help in establishing the diagnosis. There is no known treatment for cure, though relief of symptoms may be accomplished with certain drugs, such as antibiotics for cholangitis and cholestyramine for pruritus. Death usually ensues within five to seven years after diagnosis, as a consequence of liver failure, cholangitis, and cholangiocarcinoma.