Biomedical subjects
Publications and source records attributed to J C Russell.
Malignant melanoma can involve any organ of the body and commonly involves the gastrointestinal tract. The first case of melanoma in the world's literature involving the cystic duct and the first in the English literature involving the common bile duct is described. This case is compared with the two cases in the world's literature with common duct involvement.
We require repeated blood samples from rats over long periods in our studies on obese hyperlipemic animals and normal controls. Under our conditions of lipid adnormality and exercise previously reported techniques did not give long-term cannula patency. We have thus developed a technique using thromboresistant heparin-treated Silastic tubing and a mesh-stabilized metal cannula at the base of the skull. The tubing is inserted into the vena cava without occlusion and the tip lying in the region of the termination of the hepatic veins. The tubing exists from the abdomen through the incision and runs subcutaneously to a metal tube protruding from the skin. It is closed with a short length of polyethylene tubing folded over and secured with a tight Teflon sleeve. Heparinized saline is used to fill the cannula and flush it at biweekly intervals. The cannulas remain patent for long periods with 59% permitting withdrawal of blood at 120 days. Loss of function is random after 30 days when 100% were patent. A significant number remain functional at 200 days.
Gastric carcinoma following surgery for benign peptic ulcer disease is being increasingly reported. The authors have reviewed their experience at Saint Francis Hospital and Medical Center and Mount Sinai Hospital from 1970 to 1980 and found 319 cases of gastric carcinoma, 16 of whom had undergone previous surgical procedures for peptic ulcer disease, with an incidence of 5 per cent of gastric stump carcinoma. The average time interval for the development of gastric stump carcinoma was 17.4 years, ranging from 5 to 49 years. The average survival after the diagnosis was 4.6 months, making the prognosis uniformly poor, probably due to delayed diagnosis. Treatment modalities consisted of major and minor surgical procedures, medical therapy, and no treatment in some instances. It is recommended that all patients who undergo operations for peptic ulcers have careful long-term follow-up. Vague gastrointestinal symptoms occurring in these patients, especially 10 years or more after surgery, require endoscopy and biopsies of the gastric stump to exclude gastric stump carcinoma.
We undertook a prospective study to ascertain the accuracy of the noninvasive venous vascular laboratory in diagnosing clinically suspected deep-vein thrombosis. Of 88 patients studied with contrast venography and bilateral plethysmography, 41% had normal venograms; 15%, isolated venous thrombosis in the calf; and 44%, proximal deep-vein thrombosis. Clinical and Doppler examinations could not differentiate these three groups. The composite venous score was reliable at extreme values. By considering scores of 3.9 or less as negative, 8.0 or more as positive, and 4.0 to 7.9 as indeterminate, a suitable combination of sensitivity (75%), specificity (100%), and overall accuracy (90%) was obtained. Low-risk patients with scores of 3.9 or less should be observed. Patients with scores of 8.0 or greater can undergo anticoagulation without contrast venography, which is mandatory for patients with indeterminate venous scores and high-risk patients with scores of 3.9 or less.
Streptococcus bovis bacteremia is known to be associated with gastrointestinal disease, especially colon lesions. Two patients are presented with a previously unreported syndrome: S. bovis bacteremia, endocarditis, colon neoplasms, and splenic abscess. In one case, the colonic lesion was occult and required colonoscopy for identification (normal barium enema). S. bovis bacteremia is an important marker for occult gastrointestinal neoplasia.
Colonic involvement should be suspected in patients with severe acute pancreatitis, especially in the following clinical settings: plain abdominal radiographs suggesting bowel ischemia, colonic obstruction, acute lower gastrointestinal hemorrhage, gram-negative septicemia, enteric bacteria on Gram stain or culture of peritoneal fluid, and feculent abdominal drainage from a previously drained pancreatic abscess. Intraoperatively, the pancreas should be widely drained and the fecal stream diverted. Colonic hemorrhage and nonviable bowel require immediate resection. Broad-spectrum antibiotic administration and vigorous nutritional support also are required in these critically ill patients. Although proximal diversion and pancreatic diversion alone may suffice, colonic resection may be required later for persistent obstruction or fistulization, but in a more elective setting. Colonic anastomoses should be performed only when pancreatic inflammation and associated sepsis have resolved completely.
We have made continuous measurements of exhaled ethanol concentration vs volume during slow expiration in subjects with plasma ethanol concentrations up to 700 mg/L. Subjects included individuals with normal pulmonary function and those with severe chronic obstructive pulmonary disease (COPD). In addition to the measurements of breath ethanol made using a flame ionization detector, paired measurements were also made of plasma ethanol and breath ethanol using a Model 900A Breathalyser. In normal subjects, the breath ethanol concentration was found to increase continuously during expiration until the very end of the expiration when a decline in concentration was noted. In the presence of COPD the ethanol concentration/volume tracing was essentially flat during the middle portion of expiration, but many subjects showed a decrease in concentration at the end of the expiration. One subject showed a sharp rise in breath concentration at the end of expiration. The results suggest that fluctuations in the ethanol concentration are caused by variation in the ventilation/perfusion ratio of regions of the lung supplying the expirate, and that breath with ethanol in equilibrium with the plasma is not routinely obtained, especially at the end of a maximal expiration. Thus, exhaled air at the end of maximal expiration does not always provide the best, or a close, indication of the plasma (or blood) ethanol concentration. The peak breath ethanol concentrations found were, as an equivalent plasma concentration, = -25 + 0.924 X plasma ethanol, mg/L. The Breathalyser readings = -45 + 0.898 X plasma ethanol, mg/L, with a mean difference of -81 mg/L.
In 44 patients neck wounds penetrating the platysma were evaluated over a 5-year period. Twenty-one patients were admitted and observed; 22 patients were explored immediately. One was dead upon arrival in the emergency room. The decision to explore was based upon initial clinical evaluation using criteria of unstable vital signs, bleeding, hematoma, subcutaneous emphysema, respiratory distress, or neurologic deficits. Of the 21 patients selected for observation, none had complications or required later surgery. There was a negative exploration rate of 23%. Had all patients been explored, the negative exploration rate would have been 60%. We conclude that selective exploration, based upon careful clinical evaluation, is both safe and reasonable in cases of penetrating neck trauma.
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Routine prophylaxis of deep vein thrombosis and pulmonary embolism is justified by the importance of these complications as sources of major morbidity and mortality in otherwise healthy patients more than 40 years old undergoing extensive elective operations. As no one prophylactic technique is ideal, the continuing controversy is over the choice of technique for each patient. Appropriate selection of a prophylactic technique requires a careful preoperative assessment based upon the relative risk of thromboembolism due to associated disease, the risk of bleeding complications secondary to an underlying bleeding diathesis, the possibility of major morbidity from unexpected postoperative bleeding determined by the anatomic site of surgical procedure and the risk of thromboembolism imposed by the surgical procedure itself (57). For patients at high risk, warfarin remains the prophylactic agent of choice. To date, the available data on combinations of mechanical and chemical techniques are incomplete and contradictory, but future studies may identify synergistic combinations. In patients at high risk who also greatly risk having bleeding complications, vena caval interruption should be considered. In patients undergoing operation at moderate risk, low dose heparin, dextran and external pneumatic compression devices are beneficial. In patients undergoing elective hip and knee operation at moderate risk, aspirin appears especially safe and effective. When major morbidity may result from anticoagulation in patients at moderate risk for deep vein thrombosis and pulmonary embolism, external pneumatic compression devices, gradient elastic stockings or elevation of the leg should be used. Further carefully controlled clinical trials are needed to identify even better options for prophylaxis.
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Twenty patients sustaining gunshot wounds (GSW) to the buttocks (including one shotgun wound) were treated at two affiliated institutions during the last 5 years. Male patients predominated nine to one. Fifteen patients with extraperitoneal injuries had a benign course. One underwent negative exploratory laparotomy based upon positive physical findings. The remaining five patients had clinical abdominal findings consistent with severe intra-abdominal injuries (four organs per patient). Although the morbidity was high, there was no mortality in this series. Careful analysis of a bullet's trajectory will allow detection of a possible intraabdominal component of this type of injury, mandating early surgical management.
Pancreatic pseudocyst is a relatively rare complication of pancreatitis with a reported incidence of 1 to 5 per cent in patients with pancreatitis. The 5-year experience with pancreatic pseudocyst at Saint Francis Hospital and Medical Center and Mount Sinai Hospital has been reviewed in an effort to determine optimum diagnostic and therapeutic techniques. Twenty-eight patients were treated for this problem during the period of June 1976 through June 1981 with one death. All patients had operative therapy, with internal drainage being the procedure of choice. The most common presenting symptom was abdominal pain. The most useful diagnostic study proved to be ultrasonography. Complications occurred in nine patients (32%). These included bleeding, obstructive jaundice, infection, rupture, and recurrence.
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Explore the source record for details and available documents.