Biomedical subjects
Publications and source records attributed to G P Bloom.
Cholelithiasis and cholecystitis frequently necessitate cholecystectomy. Laparoscopic cholecystectomy, by avoiding a laparotomy incision, greatly reduces recovery time and thus may reduce postoperative complications. We describe the first reported case of laparoscopic cholecystectomy during pregnancy. This technique should be considered as an alternative to laparotomy in selected patients.
Four cases of spontaneous splenic rupture after infectious mononucleosis (IM) have been treated at this institution since 1978. The condition is rare, occurring in 0.1-0.5 per cent of patients with proven infectious mononucleosis. Splenectomy is considered the treatment of choice for these patients. However, because recent trends in the management of traumatic splenic rupture are moving towards nonoperative treatment with selected patients, a similar approach has been considered for the patient with spontaneous splenic rupture following IM. The major reason for avoiding splenectomy is the increased incidence of sepsis in splenectomized patients. Yet, splenic rupture is accompanied by hemorrhage and the risks associated with blood transfusion for ongoing hemorrhage are of similar magnitude as those of sepsis following splenectomy. In addition, the grossly abnormal spleens seen at operation tend to include large, contained hematomas that may also be prone to rupture. Therefore, operative management still appears to be the preferred treatment for spontaneous splenic rupture following IM. Splenectomy is curative, safe, and obviates the need for transfusion, extended hospitalization, and activity restriction.
The medical records of 87 patients with 89 malignant colorectal polyps removed endoscopically between 1971 and 1983 were reviewed retrospectively. Fifty-five polyps contained carcinoma-in-situ. Four polyps had "pseudo-invasion" by displaced mucosal glands. Thirty polyps contained invasive carcinoma. No patients with carcinoma-in-situ or "pseudo-invasion" had either local residual disease or metastatic disease at the time of colectomy or which was detected during subsequent follow-up. Four patients (14%) with invasive cancer would have been inadequately treated by polypectomy alone, since one had residual disease at the polypectomy site, one had nodal metastases, one had liver metastases at the time of colectomy, and one subsequently developed liver metastases. Three histologic criteria correctly predicted all four cases where residual or recurrent disease was present: involvement of the polypectomy resection margin, lymphatic invasion within the polyp, and poorly differentiated histology. Polyp size, histology (villous adenoma, adenomatous polyp, or villo-adenomatous polyp), or anatomic location did not identify those patients who warranted further therapy. We conclude that polypectomy alone is adequate treatment for polyps containing carcinoma-in-situ. Polypectomy alone is also adequate treatment for most polyps containing invasive carcinoma. However, patients with lymphatic involvement within the polyp, poorly differentiated cancer, or resection margin involvement should probably undergo colectomy.
Of 61 patients with appendiceal abscess, 32 were treated by incision and drainage without appendectomy, with 16% morbidity. Seventeen patients had incision and drainage with appendectomy, with 24% morbidity. One patient, admitted in septic shock, died without operation. Average hospitalization was shortest in the nine patients treated nonoperatively. Many patients with appendiceal mass or abscess do not require immediate operation. In the 42 patients discharged without appendectomy, the recurrence rate of appendicitis was 5% at 9.1 months' average follow-up. Thirty-two elective interval appendectomies were performed at an average interval of 96 days, with 13% morbidity. At interval appendectomy, those patients from whom a free fecalith had been removed at the time of drainage had the greatest degree of appendiceal destruction. Interval appendectomy is probably not necessary in such patients.
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The dust retention efficiency of a model fibrous filter operated in the high inertia regime has been measured over the size range 2-22 micrometer. The results of a program to measure the influence of loading on grade efficiency are reported. It is shown that the efficiency of particle retention increases with loading initially, then falls off as the filter becomes loaded to its maximum capacity. The effect of test dust feed size distribution has also been investigated. Under some circumstances this parameter may have a critical effect on the overall efficiency. The mechanisms responsible for the observed behavior are described and their implications in fibrous filtration discussed.
Two patients developed a focal mass in the head of the pancreas presumably following attempted endoscopic retrograde cholangiopancreatography (ERCP). These lesions grossly mimicked carcinomas of the pancreas. In one case a radical pancreatoduodenectomy was performed because of the misleading gross findings. A focal mass in the pancreas following ERCP may develop due to asymptomatic pancreatitis caused by the procedure.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.