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Biomedical subjects

H W Scott

Publications and source records attributed to H W Scott.

At least 37 records · Page 2Linked to original sources
PubMed1985

Results of an aggressive surgical approach to gastric carcinoma during a twenty-three-year period.

The early work of Dr. William Longmire with total gastrectomy for gastric carcinoma prompted us to initiate an aggressive surgical approach to gastric carcinoma in 1960: in curative resections radical total gastrectomy with hepaticoceliac-left gastric arterial node dissection was to be performed for tumors involving the entire stomach or upper two thirds and radical 80% to 90% subtotal gastrectomy with similar node dissection for tumors located in the antrum. During a 23-year period 213 patients with confirmed gastric carcinoma were studied. Celiotomy was performed in 192: advanced gastric cancer was found in 185 and seven had early gastric cancer. In only 80 patients could resections for "cure" be done. In 31 patients who underwent total or extended total gastrectomy the operative mortality rate was 9.6%, and life table survival curves show a better survival rate than in 49 patients treated by subtotal gastrectomy, with an operative mortality rate of 16.3%. The study shows the urgent need for diagnosis of early gastric cancer by gastroscopic screening of adults at risk and the meager salvage by radical resection in advanced disease.

Actuarial Analysis↗
PubMed1985

Pseudotumor of the lung.

Benign lung tumors in children are rare. An equally uncommon finding is the inflammatory pseudotumor, a lesion that is grossly similar to a tumor and yet cannot be histologically defined as a neoplasm. They have been called xanthomas, histiocytomas, solitary mast cell granulomas, and xanthogranulomas by various authors. There is a tendency to overtreat these lesions as if they were malignant. In previous reports, lobectomy has been the usual treatment for these tumors. If a pseudotumor is suspected at exploratory thoracotomy, a wedge resection and frozen section should be considered. When these benign lesions are easily accessible, they can be enucleated, leaving all of the normal pulmonary tissue intact without compromising cure.

Adolescent↗
PubMed1984

Carcinosarcoma of ileum in regional enteritis.

A biphasic malignant neoplasm, carcinosarcoma, arose in a segment of ileum involved with regional enteritis. The tumor spread throughout the abdomen, and the patient died nine months after diagnosis. The spectrum of intraepithelial dysplasia, carcinoma with varying degrees of differentiation, and sarcomatous-appearing elements suggests that the histogenesis of this tumor is epithelial. This report provides further documentation of the relationship between regional enteritis and unusual neoplasms of the intestine.

Carcinosarcoma↗
PubMed1984

Experience with vagotomy--antrectomy and Roux-en-Y gastrojejunostomy in surgical treatment of duodenal, gastric, and stomal ulcers.

Gastroduodenostomy (Billroth I) is our reconstruction of choice following gastric resection for gastroduodenal ulcer. Dissatisfaction with a Billroth II anastomosis has led us in recent years to employ a Roux-en-Y diversion in selected cases, particularly those in which the pathologic state of the pyloroduodenal canal would render a Billroth I anastomosis unsafe. During the past 7 years, truncal vagotomy-antrectomy and Roux-en-Y (VARY) has been carried out in 50 selected patients: duodenal ulcer (DU) 13 patients, gastric ulcer (GU) 11 patients, and stomal ulcer (SU) 26 patients. Fourteen patients (28%) developed postoperative complications, of which nine (18%) were of major degree and five (10%) of a lesser degree. No hospital death occurred among the 50 patients. Five patients (10%) developed postoperative delayed gastric emptying and two of the five required revision of the Roux. Forty-five patients had no clinical problems with delayed emptying. Overall results showed a Visick grading of I in 72%, Visick II in 24%, and Visick III in 4%. Further analysis revealed that of the 13 patients with DU who had VARY, 62% were Visick I, 30% Visick II, and 8% Visick III. The 11 GU patients with VARY were graded Visick I 73% and Visick II 27%. Of 26 patients with SU who underwent VARY, 77% were Visick I, 19% Visick II, and 4% Visick III. Mild to moderate dumping took place in 8% of the 50 patients, mild diarrhea 10%, weight loss 10%, and no patient experienced alkaline reflux gastritis. Long-range postoperative gastric emptying studies among nine patients using a radionuclide revealed varying patterns of emptying. Overall clinical results have been satisfactory and we are continuing to use VARY in selected cases, particularly those in which a Billroth I reconstruction appears contraindicated.

Adult↗
PubMed1984

Longitudinal pancreaticojejunostomy in chronic relapsing pancreatitis with onset in childhood.

Despite the rarity of chronic relapsing pancreatitis in children, in the last 15 years at Vanderbilt University Medical Center and its Children's Hospital we have used longitudinal pancreaticojejunostomy in treatment of eight patients whose symptoms began in childhood. Duration of symptoms ranged from 2 to 36 years. Seven of the eight patients had hereditary pancreatitis. Recurrent epigastric pain was characteristic and serum amylase was elevated in all patients on admission or shortly thereafter. Demonstration of an obstructed dilated pancreatic duct in all and stones in seven of eight patients by operative pancreatography in three early patients and by endoscopic retrograde cholangiopancreatography (ERCP) in five others established the therapeutic problem and facilitated treatment by removal of stones and longitudinal pancreaticojejunostomy. Results were uniformly excellent, both in the early postoperative period and in long-range follow-ups. Early diagnosis and early surgical drainage of the obstructed pancreatic duct by longitudinal pancreaticojejunostomy are desirable objectives in chronic relapsing pancreatitis with onset in childhood.

Adolescent↗
PubMed1984

Surgical procedures in patients aged 90 years and older.

During the past five years 75 patients aged 90 years or more had 85 major surgical procedures at the Metropolitan Nashville General and Vanderbilt University hospitals. The most common operation was exploratory laparotomy. The second was lower extremity amputation for peripheral vascular disease and/or gangrene. Fifty-seven percent had general endotracheal anesthesia. Associated medical problems were common, and included congestive heart failure (24%), hypertension (21%), diabetes mellitus (13%), chronic arrhythmias (9%), history of myocardial infarction (8%), and history of cerebrovascular accident (5%). Eleven patients (13.4%), six of whom had general anesthesia, died after operation. Of these, two had postoperative pneumonia, two did not recover from bowel perforation and peritonitis, one had a postoperative myocardial infarction, another had a cerebrovascular accident, and one had sepsis. One patient's sudden death was likely due to myocardial infarction or pulmonary embolus. The other three deaths occurred in patients with extensive carcinomas (gallbladder carcinoma in one and widely metastatic carcinoma of unknown origin in two). These three patients died of the disease for which they were operated upon when the operation failed to alter its course. When surgical procedures are necessary to prolong and/or improve the quality of life in elderly patients, these procedures may be done in most cases with acceptable results.

Aged↗
PubMed1984

Oncologic aspects of pheochromocytoma: the importance of follow-up.

During a 33-year period at Vanderbilt University Medical Center and its long-standing affiliated hospitals, Veterans Administration Medical Center and Metropolitan Nashville General Hospital, 69 patients with pheochromocytoma were seen. Despite the fact that hypertension was present in all patients at initial admission, in 11 patients seen during the 1950s the clinical diagnosis of pheochromocytoma was not made and the existence of this tumor was discovered at autopsy examination. In 58 patients the clinical diagnosis of pheochromocytoma was made and surgical excision of pheochromocytoma (or biopsy only in two cases) was carried out. One patient died during the initial postoperative period (1.7%). All of the operative survivors were followed to date or the death, with the exception of three who were lost to follow-up at 18 months and 7 and 11 years, respectively. The incidence of malignant disease in this carefully followed group of patients with pheochromocytoma was impressive. Nine of 69 patients (13%) proved to have malignant pheochromoblastoma, all but one of whom have died. Additional malignant tumors have occurred in two of these nine patients (22%) with proved malignant pheochromoblastoma and in 14 of 60 patients (23%) with benign pheochromocytoma. The overall incidence of additional malignant tumors in the collective group of patients with the histopathologically confirmed diagnosis of pheochromocytoma was thus 23% (16/69 patients). It is also interesting that a variety of benign neoplasms occurred in the 60 patients with benign pheochromocytomas (9/60; 15%). If the nine patients with malignant pheochromoblastoma are added, the overall incidence of malignant disease in these 69 patients with pheochromocytoma is 25/69 or 36%. Follow-up of patients with pheochromocytoma is mandatory on a lifetime basis and preferably by the operating surgeon.

Adolescent↗
PubMed1983

Hazards in operative management of patients with systemic mastocytosis.

During the past two years, six patients with systemic mastocytosis have required general or regional anesthesia for operative correction of various surgical problems. Mastocytosis constitutes an extremely difficult problem in diagnosis and management. A large experience with patients with mastocytosis in the Vanderbilt Medical Center in the last decade has enhanced awareness of this disorder and increased its early recognition. The hazardous problems of systemic mastocytosis and the difficulties of its diagnosis and management are summarized and focussed on the increased hazard of those patients with this disease who require various surgical operations. Close collaboration between anesthesiologists, surgeons, and internists in this medical center in the past two years has made it possible to carry six of these patients through anesthesia, operation, and the postoperative period safely and without fatality.

Adult↗
PubMed1982

Jejunoileal bypass versus gastric bypass or gastroplasty in the operative treatment of obesity.

A comparative study has been made of three methods for the operative treatment of obesity. Of my own cases, 235 underwent a jejunoiliac bypass procedure, and the results have been analyzed: operative lethality 2.1%; postoperative complications 21%. Of the patients whose residual ileum was quite short (about 45 cm), about 70% reached their ideal weight. Metabolic late complications were considerable (e.g., liver damage in 15%, electrolyte deficit in 12%, and arthritis in 10%). In the late observation time of 14 years, 14 patients died, 10 of them as a result of the operation. Three different stomach-bypass procedures are described. The collective statistics compiled on 1585 patients indicated 1.6% postoperative lethality and 22% postoperative complications. Of the total patients. 90% were very satisfied with the procedure and in only 5% was a weight gain recorded after 5 years. The latest procedure is gastroplasty according to the Gomez method: the first 200 cases show 0.5% postoperative lethality and postoperative complications in 18.5%. Although this procedure is technically simple, the late observation time is not yet adequate for a definitive comparison.

Adolescent↗
PubMed1982

Surgical experience with carcinoma of the colon and rectum.

From September 1925 through December 1978 at Vanderbilt University Hospital, 1,279 patients with adenocarcinoma of the colon and rectum underwent operations. Reports of this cumulative series have been published previously; the last report in 1970 included 1,022 patients. The current report examines the progress made in our recognition and management of colorectal cancer. During this 54-year period, there has been a relative decrease in the incidence of carcinoma of the rectum and a relative increase in carcinomas elsewhere in large bowel. Resectability rate has steadily increased, culminating in a rate of 98.4% in the recent period (1969-1978). The operative mortality rate fell to 4.3% (1956-1960) but has shown a slight rise to 5.4% in the recent period (1969-1978). This reflects the increased number of patients in the eighth to the tenth decades of life. Five-year survival rates in 99% of 1,218 patients were computed. Absolute five-year survival for the recent period was 43.7%, compared with 17% for the initial period. Five-year survival rates for patients in the recent decade with Dukes A, B, and C lesions were 67%, 58.6%, and 33.3%, respectively. Comparison of survival data in the last two decades shows little improvement. However, in the last 20 years, 78 to 80% of patients had more advanced lesions.

Aged↗
PubMed1982

Long-term outcome of jejuno-ileal bypass surgery for superobesity: a psychiatric assessment.

In this study of the long-term psychosocial consequences of jejuno-ileal bypass, 24 patients were assessed with psychiatric interviews and psychological tests 4-12 years after the procedure. Twenty patients had had a good overall response to the surgery, and 4 had had a poor response. Most complications, physical and psychiatric, occurred during the first 3 years. Most patients with a good postoperative result maintained it for many years, gained occupationally and vocationally, were pleased with the results of the operation, and were willing to recommend it to others. Even those who had experienced complications tended to underrate their seriousness and to express satisfaction.

Adult↗
PubMed1982

Surgical experience with retrogastric and retropancreatic pheochromocytomas.

From 1972 to 1981 at Vanderbilt University Hospital there were seven patients with midline retrogastric or retropancreatic pheochromocytomas. Each of these tumors arose between the aorta and the inferior vena cava. This report details the difficulties in localization before and at operation in the smaller tumors in these sites. Our experience suggests that small midline pheochromocytomas in these sites may be readily missed by computerized tomographic scan, aortography, or surgical search at laparotomy unless subtraction arteriograms are used and the Kocher maneuver is employed at operation routinely.

Adolescent↗
PubMed1982

Clinical experience with malignant pheochromocytomas.

In a 30 year period at Vanderbilt University Hospital, the affiliated Nashville General Hospital and the Nashville Veterans Administration Hospital, 64 patients with pheochromocytoma have been observed. In eight of these, the tumor proved to be malignant. Retrospective review of biologic characteristics of pheochromocytomas in this series included clinical, diagnostic imaging, chemical and histopathologic data. Aside from presence of distant metastases, none of these features had predictive value in indicating the biologic malignant nature of the primary tumor. One patient has been cured by radical surgical resection for 16 years. Three others have died with metastatic tumor and three patients are alive with metastatic tumor.

Adolescent↗