Biomedical subjects

H E Gordon

Publications and source records attributed to H E Gordon.

At least 19 recordsLinked to original sources

PubMed1983

Efficacy of oral and systemic antibiotic prophylaxis in colorectal operations.

A cooperative Veterans Administration study of the septic complication rate during large-bowel surgery was undertaken in two groups of patients. The first group received oral neomycin and erythromycin base plus parenteral placebo; the second, the oral antibiotics plus parenteral cephalothin sodium. During a five-year period, 1,128 patients were studied. The overall septic complication rate was 7.8% in patients receiving only oral antibiotics, and 5.7% in patients receiving both oral and parenteral antibiotics. This difference was not significant. The only significant finding was a greater incidence of fever of unknown origin in patients receiving only oral antibiotics. None of those patients were treated with additional antibiotics, and all fevers cleared spontaneously. There seems to be no discernible benefit from adding parenteral antibiotic prophylaxis when performing elective colon surgery if appropriate mechanical cleansing and oral neomycin and erythromycin therapy are employed.

Administration, Oral↗

PubMed1983

Cowden's disease: familial goiter and skin hamartomas. A report of three cases.

Multiple hamartoma syndrome (Cowden's disease) consists of characteristic skin lesions of the face, mucous membranes and distal extremities in association with a variety of benign and malignant internal tumors, especially of the thyroid and breast. We describe a family in which the father, daughter and son were found to have goiter associated with the skin lesions of Cowden's disease. Review of the 40 reported cases of this syndrome indicates that thyroid disease occurs in two thirds of patients with Cowden's disease and most often presents as goiter at an early age. Thyroid cancer has occurred in only three (7.5%) of the patients.Surgical removal of the large goiter of the son showed that it was composed of multiple encapsulated follicular adenomas and a few areas of lymphocytic thyroiditis. Studies of the thyroid tissue showed that peroxidase activity was decreased, the thyroglobulin had a reduced content of thyroxine and triiodothyronine (perhaps due to the therapeutic suppression of thyroid-stimulating hormone) and thyroxine 5'-monodeiodinase was greatly increased; increased outer ring monodeiodinase activity may be a characteristic of human follicular adenomas.

Adenoma↗

PubMed1983

Mediastinal parathyroid adenomas. A cause of persistent hyperparathyroidism.

Unrecognized mediastinal parathyroid adenomas that are inaccessible via a standard cervical exploration are an important cause of persistent primary hyperparathyroidism. Of 26 patients evaluated at UCLA Medical Center for persistent primary hyperparathyroidism, six required sternotomy (5) or thoracotomy (1) for cure of their disease. Analysis of these six patients suggests that aberrant embryologic development is the most logical explanation for the ectopic location of these mediastinal adenomas. In most instances, preoperative localization of the adenoma is possible. Permanent hypoparathyroidism occurs in a significant percentage of patients undergoing reoperative parathyroid surgery. Efforts to minimize postoperative morbidity should include a careful and systematic approach to the preoperative and intraoperative management of patients with mediastinal adenomas, as well as consideration of autotransplantation or cryopreservation of parathyroid tissue.

Adenoma↗

PubMed1981

Persistent and recurrent hyperparathyroidism.

Twenty-six patients with persistent or recurrent primary hyperparathyroidism after an initial cervical exploration are presented. Failure of the first operation was related in part to an ectopic location of the abnormal parathyroid tissue (in 58 percent), and to a discrepancy in the histologic diagnosis between the frozen-section analysis at the time of operation and the final pathologic interpretation (in 55 percent). Before secondary operation, selective venous sampling for parathormone levels and arteriography were accurate in localizing the lesion in 88 and 71 percent of cases, respectively. A plan for intraoperative management of these difficult problems is suggested.

Adenoma↗

PubMed1978

Salmonella arteritis: a precursor of aortic rupture and pseudoaneurysm formation.

Salmonella arteritis developed in three patients with subsequent arterial rupture and pseudoaneurysm formation. They had a one- to two-week history of chills and fever, and blood cultures were positive for salmonella. Pulsatile, tender abdominal masses developed in two patients with aortic infection while they were hospitalized. The third patient's femoral artery infection presented as a painful swelling behind the knee. Arteriography demonstrated large vessel rupture with pseudoaneurysm formation and allowed a planned operation in each case. The infected aortic aneurysms were totally excised, the aortic stump oversewn, and the retroperitoneum drained through the flank. Axillobifemoral grafts were constructed to bypass the infection area. Antibiotics effective against salmonella (ampicillin sodium, amoxicillin trihydrate, or chloramphenicol) were given for six weeks postoperatively. Allthree patients are alive without evidence of furhter infection. Recognition that microbial arteritis may be a complication of salmonella infections, particularly when Salmonella choleraesuis and Salmonella typhimurium are cultured, will lead to earlier detection of vascular lesions.

Aged↗

PubMed1977

Dextroamphetamine with morphine for the treatment of postoperative pain.

In a double-blind, single-dose study, dextroamphetamine combined with morphine was compared with morphine alone to determine the relative efficacy of the combination given intramuscularly for postoperative pain. Each of 450 patients received one treatment of morphine sulfate (3, 6 or 12 mg) with dextroamphetamine (0, 5 or 10 mg). Analgesia, as measured by the patients' subjective responses to questions about relief of pain, was augmented when dextroamphetamine was given with morphine; the combination of dextroamphetamine, 10 mg, with morphine was twice as potent as morphine alone, and the combination with 5 mg was 1 1/2 times as potent as morphine. In simple performance tests, and in measures of side effects, dextroamphetamine generally offset undesirable effects of morphine (sedation and loss of alertness) while increasing analgesia. Effects on blood pressure, pulse and respiratory rate were minimal.

Adult↗

PubMed1977

Carcinoma of the gastroesophageal junction. A ten year experience with esophagogastrectomy.

Eighty-six patients with carcinoma of the gastroesophageal junction were treated between 1966 and 1976. Adenocarcinoma was present in 62 patients and squamous cell carcinoma in 24. Surgical exploration was performed on 68 patients (79%) and 52 lesions (60%) were resected by combined midline laparotomy and right thoracotomy. There were 6 deaths (11%), 2 due to anastomotic leak. The mean survival for all resected patients was 2.1 years with a 22% three year life table survival (10/52). Five of 14 patients with negative nodes are alive more than five years. Palliative resection in 17 patients resulted in a mean survival of 10.5 months and no five year survivals. Esophagogastrectomy utilizing the Lewis technic reduces operative mortality and extends survival for patients with carcinoma of the gastroesophageal junction.

Adenocarcinoma↗

PubMed1977

Treatment of peptic ulcer disease in the renal transplant patient.

This study reviews previous reports of peptic ulcer disease in kidney transplant recipients and includes our own experience. Between 1968-1976, 12 transplant centers reported on gastrointestinal complications occurring in 1853 renal transplant recipients. Among these are 52 patients in whom peptic ulcers developed before trnasplantation and 72 patients in whom peptic ulcers developed after transplantation. Included are 21 patients with peptic ulcer from 115 renal transplant recipients at VA Wadsworth Hospital. Patients who were operated upon for peptic ulcer before trnasplant were compared to patients with peptic ulcer before transplant but who were not operated upon. Ulcer recurrence was significantly lower in the operated group p less than .0003. Following transplantation 59 of 68 patients with peptic ulcer disease presented with bleeding or perforation. Mortality was high: 31 deaths in 72 patients (43%). Symptoms usually occurred early, 74% in 6 months, but 19% occurred after one year. The mortality from duodenal, gastric, combined gastric and duodenal and recurrent ulcers did not differ significantly. Elective surgery is indicated for peptic ulcer when demonstrated before or after kidney transplantation.

Gastrectomy↗

PubMed1977

Perioperative antibiotic prophylaxis against vascular graft infection.

This study investigated the efficacy of perioperative antibiotics in preventing bacteremic infection of vascular suture lines, Dacron grafts, and bovine heterografts. One hundred forty-nine dogs had either segmental excision of the abdominal aorta with primary repair, Dacron prosthesis, or bovine heterograft placement. Animals were randomly assigned to a control group, to receive 10(8) S aureus, or to receive this same dose of staphylococci plus cephalothin (15 mg/kg). After six weeks, graft cultures were obtained. All control animals had negative cultures. Often dogs with an aortic suture line subjected to bacteremia, five were infected. Eight dogs with aortic suture lines received bactermia and antibiotics resulting in only one positive culture. Nineteen animals with bovine grafts were given S aureus resulting in 18 infections, and seven of 12 bovine grafts became infected even with antibiotic coverage. Twenty-eight dogs had a Dacron graft and infusion of Staphylococcus, yielding 23 infections. Of the 24 Dacron graft subjects with induced bacteremia and antibiotics, only four were infected. Intraoperative antibiotics are significantly effective in preventing infection of vascular suture lines and Dacron prostheses but afford less protection to bovine heterografts.

Animals↗

PubMed1976

Gastrointestinal complications after renal transplantation: predictive factors and morbidity.

In a ten-year study involving 109 renal transplant patients, 37 (34%) developed gastrointestinal complications. The immediate mortality from these complications was 27%. Three of four patients with erosive gastritis died. Five deaths occurred among 17 patients who developed ulcers after transplantation. Emergency surgery for ulcers resulted in two deaths. Patients with peptic ulcer disease, esophagitis, or bleeding before transplantation were much more likely to develop recurrences that patients not so affected. Peptic ulcer occurred notably more often in recipients whose kidneys came from cadavers than from related donors. Experience with gastrointestinal bleeding or its absence during a first transplant is a useful predictor of the results after a second transplant. The high recurrence rate and high mortality suggest that patients with ulcer disease demonstrated before kidney transplantation should either undergo elective surgery for ulcer disease or not be accepted for transplantation. Patients in whom ulcer disease develops after a kidney transplant shoud undergo early elective surgery.

Adult↗

PubMed1976

Assay of aspirin and naproxen analgesia.

To establish the relative potency of naproxen and aspirin for oral analgesia, a 4-point, noncrossover bioassay with placebo control was undertaken with 197 patients. Subjective-response methods were used to determine two measures of postoperative analgesia over a period of 6 hr. With reasonable confidence for an oral analgesic assay, we found 220 mg of naproxen to be equivalent to 600 mg of aspirin for pain relief and 330 mg of naproxen to be equivalent to 600 mg of aspirin for decreased pain intensity.

Administration, Oral↗

PubMed1976