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Biomedical subjects

J M Howard

Publications and source records attributed to J M Howard.

At least 73 records · Page 4Linked to original sources
PubMed1991

Sweat lead levels in persons with high blood lead levels: lead in sweat of lead workers in the tropics.

Samples of blood, sweat and urine were collected from eight control subjects and 19 lead workers in a battery manufacturing factory in the tropics. Sweat samples were collected while workers cycled on a bicycle ergometer at room temperature (27-31 degrees C). All samples were analysed by atomic absorption spectrophotometry. Workers with blood lead levels of 13-36 micrograms dl-1 had sweat levels of 72-256 micrograms l-1 and urinary levels of 28-288 micrograms/g creatinine, while controls had levels of 9-12.2 micrograms dl-1, 9-30 micrograms l-1 and 9-19.6 microgram/g creatinine, respectively. Estimations of sweat lead in lead workers can be masked by skin contamination.

Humans↗
PubMed1991

Efferent limb obstruction after pancreaticojejunostomy. A late cause of pancreatitis following Whipple resection.

A previously unreported late complication after Whipple resection of the head of the pancreas was recognized in two patients. Obstruction by adhesions and kinking of the efferent jejunal conduit between the proximal pancreaticojejunostomy and the distal choledochojejunostomy led to repetitive episodes of acute pancreatitis without jaundice. Operative recognition and correction of the obstruction resulted in prevention of further attacks.

Abdominal Pain↗
PubMed1991

Drunk driving among American blacks and Hispanics.

This paper reports the results of a literature search to determine the extent and nature of minority group involvement in drunk driving. Most of the research supports the view that American blacks and Hispanics are disproportionately more likely to be drunk drivers. However, the evidence is not fully consistent. The general relationship seems to be reduced or even reversed for minority youth. Furthermore, studies based on self-reported behavior contradict those based on official statistics such as alcohol-related deaths, traffic arrests, and accidents. Self reports generally show less drunk driving among the minority groups.

Black or African American↗
PubMed1991

Association of malignant lymphoma with pancreatic adenocarcinoma: a clinicopathologic study of three patients.

Three patients with pancreatic adenocarcinoma are studied who had a prior history of malignant lymphoma. No common predisposing factors for the development of pancreatic adenocarcinoma were identified. We conclude that patients with malignant lymphoma who have new or persistent pancreatic masses must be evaluated for the possibility of a second primary neoplasm.

Adenocarcinoma↗
PubMed1991

Malignant melanoma of the biliary tract: a case report.

A 58-year-old man was seen with obstructive jaundice and discomfort in the upper abdomen. Computed tomographic and ultrasound examinations revealed a soft-tissue mass in the gallbladder. Cholecystectomy and choledochotomy revealed a soft black mass in the gallbladder and a second one in the intrapancreatic portion of the common bile duct. Each was diagnosed as malignant melanoma. Subsequently, a Whipple resection of the pancreas, duodenum, and distal bile duct revealed a melanoma circumferentially invading and obstructing the distal common duct. No lymph node or distant metastasis was identified. Repetitive searches for another primary site have been negative. The tumor apparently originated in the biliary tract. The patient remains almost well 2 years after diagnosis.

Bile Duct Neoplasms↗
PubMed1990

CT of the abdomen after the Whipple procedure: value in depicting postoperative anatomy, surgical complications, and tumor recurrence.

We performed a retrospective study of CT scans in 29 patients who had undergone the Whipple procedure (radical pancreaticoduodenectomy) to study the CT appearance of the postsurgical anatomy and assess the use of CT in the evaluation of early postoperative complications and recurrent tumor. In the postoperative period, the scans from 15 patients revealed seven transient fluid collections; four deep abscesses, three of which were successfully drained under CT guidance; three superficial abscesses; and five cases of ascites. In 19 patients, CT scans were obtained up to 4 years after surgery to search for recurrent tumor. The most frequent site of recurrence was the liver. CT correctly identified liver metastases in six of seven patients and was falsely positive in one. Recurrence also was found twice in retroperitoneal lymph nodes; one time each in the mesenteric root, spleen, and lung base; and twice causing afferent loop blockage. Surgical proof of recurrence was obtained in eight cases. Our experience suggests that an understanding of the normal postoperative anatomy following the Whipple procedure is essential in evaluating postoperative CT scans. Scans obtained for detection of tumor recurrence should be optimized for imaging the liver because this was the most frequent site of recurrence.

Adult↗
PubMed1989

Secretin and calcium provocative tests in the Zollinger-Ellison syndrome. A prospective study.

STUDY OBJECTIVE: To evaluate criteria of positivity for and usefulness of both the secretin and calcium gastrin-provocative tests in patients with the Zollinger-Ellison syndrome. DESIGN: Prospective trial in consecutive patients. SETTING: Referrals to a clinical research center. PATIENTS: Consecutive sample of 80 patients with the Zollinger-Ellison syndrome. INTERVENTION: Kabi-secretin (2 U/kg body weight) given by intravenous bolus and calcium gluconate (10%) (54 mg/kg.h [5 mg/kg.h of calcium]) given by continuous intravenous infusion for 3 hours. Serum gastrin measured at -15, and -1 minutes before, and 2, 5, 10, 15, 20, and 30 minutes after secretin, or every 30 minutes for 3 hours during the calcium infusion. Serum calcium and serum gastrin were measured simultaneously during the calcium infusion. MEASUREMENTS AND MAIN RESULTS: There was no significant difference in the responses of patients with different extents or locations of the tumor, presence or absence of multiple endocrine neoplasia, type-I, or with fasting gastrin less than or greater than 1000 pg/mL. In patients with fasting gastrin of less than 1000 pg/mL, the sensitivity of the secretin test using the criterion of an increase in gastrin of at least 110 pg/mL was 93% (CI, 76% to 99%) and for an increase of 200 pg/mL it was 85% (CI, 66% to 96%), (P greater than 0.05). With the calcium infusion test, the sensitivity using the criterion of an increase of 395 pg/mL was 43%, (CI, 23% to 66%) and for an increase of 50% was 74% (CI, 52% to 90%), (P less than 0.01). The calcium infusion test was positive in 33% of patients with a negative secretin test. With the secretin test, 75% of patients had a positive response by 5 minutes, 95% by 10 minutes, 100% by 15 minutes, and 6% only at 2 minutes. With calcium infusion, patients had positive responses at 120 to 180 minutes. CONCLUSIONS: The secretin test is preferred over the calcium test because of its greater sensitivity and simplicity. The recommended criteria are a 200 pg/mL increase for the secretin test and a 395 pg/mL increase for the calcium test. The calcium test should be reserved for patients having a negative secretin test, gastric acid hypersecretion, and a strong clinical suspicion of the Zollinger-Ellison syndrome.

Adolescent↗
PubMed1989

Fatal clostridial pancreatitis following ERCP and percutaneous needle biopsy.

A patient with a large necrotic pancreatic carcinoma underwent ERCP and percutaneous biopsy of the cancer and of a suspected hepatic metastasis. On the second day, she developed a massive hemolysis with a 50% drop of hemoglobin level and a rise of serum bilirubin level from 1.3 to 37.5 mg%. Gas was noted on followup CT scan of the pancreas. Clostridium perfringens was found by needle aspiration of the pancreas and on multiple blood cultures. Death resulted from sepsis on the fourth day. Since ERCP and percutaneous needle biopsy of the pancreas are being done with increasing frequency, and since this complication has not been previously described, this case report is presented.

Acute Disease↗
PubMed1989

Treatment of cancer of the pancreas by precision high dose (PHD) external photon beam and intraoperative electron beam therapy (IOEBT).

Twenty-five patients with a diagnosis of unresectable adenocarcinoma of the pancreas were explored in the Clement O. Miniger (COMROC) IOEBT operating amphitheater at the Medical College of Ohio. Seventeen were treated with IOEBT (20-30 Gy, 15 or 18 meV electrons) PHD external beam radiation therapy (40-60 Gy, 1.8 Gy per fraction) plus appropriate operative biliary and gastrointestinal bypass procedures. No intraoperative complications were observed. Two patients died of causes that may have been treatment-related. Two patients developed abdominocutaneous fistulae. Pain was ameliorated in eleven of twelve patients. Jaundice was relieved in all patients. Four of ten patients with weight loss showed a reversal of that trend. Patient survival was not significantly different from that of patients treated with high-dose precision therapy alone.

Adenocarcinoma↗
PubMed1989

Prospective study of the standard meal provocative test in Zollinger-Ellison syndrome.

PURPOSE: The purpose of this work was to evaluate the proposed usefulness of a standard meal-stimulated gastrin provocative test in: (1) distinguishing Zollinger-Ellison syndrome (ZES) from antral syndromes; (2) localizing duodenal gastrinomas; or (3) suggesting that patients with multiple endocrine neoplasia type I (MEN-I) may have an increased incidence of antral syndromes. PATIENTS AND METHODS: Seventy-four consecutive patients with ZES referred to the National Institutes of Health were studied prospectively. The extent and location of gastrinomas, acid secretory studies, and the presence or absence of MEN-I were determined and correlated with the results of the gastrin response to standard meal provocative testing. RESULTS: For patients with fasting serum gastrin levels less than 1,000 pg/mL (n = 43), only 44% had a less than 50% increase over the pre-meal value, which is reported to be the typical response in ZES, and 40% had a 50% to 99% increase. Furthermore 16% had a 100% or greater increase, 9% a 150% or greater increase, and 5% a 200% or greater increase, which overlaps with values reported to be characteristic of 98%, 92%, and 46% of patients with antral syndromes. Results did not differ for patients with or without MEN-I, depend on the extent of the gastrinoma (duodenal versus pancreatic gastrinomas), the presence of previous gastric surgery or type of gastric surgery, or for patients with fasting serum gastrin concentrations greater than or equal to 1,000 pg/mL or less than 1,000 pg/mL. studies of four patients before and after resection of the gastrinoma, who prior to surgery had a greater than 100% increase in gastrin secretion after the meal, demonstrated that all patients had a less than 100% increase postoperatively even though no gastric resection was done. CONCLUSIONS: Approximately half of the patients with ZES have a greater than 50% increase in serum gastrin concentration following a standard test meal and one fifth have a 100% or greater increase. Therefore, they cannot be distinguished on this basis from patients with antral syndromes. The increased serum gastrin level after the meal in these patients with ZES appears to be due to the gastrinoma. Furthermore, the current study provides no evidence for the proposals that antral syndromes are more common in patients with MEN-I, that gastric surgery affects the meal response in patients with gastrinomas, or that the meal test is useful in localizing duodenal gastrinomas.

Adolescent↗
PubMed1989

Cystic neoplasms and true cysts of the pancreas.

As the spectrum of pancreatic cysts evolves, sped by the increasing utilization of CT scanning, it becomes apparent that the surgeon must gain information preoperatively about the family history, as well as the personal history of the patient. The presence of cysts in the liver or kidney should be sought. The relation of the lesion to the duodenum and biliary tract needs to be defined. The possibility that the "cyst" represents necrosis of a primary adenocarcinoma of the pancreatic duct should be considered prior to laparotomy. At the time of operation, biopsy of the cyst wall and frozen-section study are fundamental to a decision whether resection or drainage is the treatment of choice. Resection is generally the treatment of the cystic neoplasms, drainage the treatment of pseudocysts. The failure of the surgeon to distinguish between the two groups may be catastrophic. The true cysts and cystic neoplasms of the pancreas are rare lesions. The clinical and radiologic characteristics, the pathologic features, and the natural history of these lesions are not fully documented. Therefore, when they are encountered, the clinician who will carefully document their characteristics can make a contribution to our knowledge.

Choriocarcinoma↗
PubMed1989

Pancreatography after recovery from massive pancreatic necrosis.

Massive retroperitoneal necrosis may follow life-threatening acute pancreatitis. At delayed operation, the surgeon may not be able to delineate dead pancreas from dead adipose tissue. The question arises: has "gloved hand" debridement resulted in pancreatectomy? The histologists report only "necrotic debris, of uncertain origin." To obtain objective data, pancreatography was performed in 13 patients, 10 weeks to 23 months after onset of massive pancreatic necrosis. Each patient had required delayed laparotomy for debridement and external drainage at some earlier stage of their illness. Pancreatography was correlated with the clinical assessment of diabetes and steatorrhea. Except in specific cases involving internal fistulae, pancreatography has not been previously reported in such patients. The results demonstrate that the main pancreatic duct usually maintained its normal length and configuration. Necrosis or stricture of the main duct, if it occurred, was more likely to be followed by diabetes. Steatorrhea was clinically detected in a single patient only. The necrotic tissue, up to several kilograms in wet weight, is largely dead adipose tissue. The pancreas, especially its head, is resistant to necrosis, much more resistant than is the retroperitoneal fat.

Acute Disease↗
PubMed1989

Pancreatic abscess secondary to Candida albicans.

A case report is presented of a patient with acute postoperative pancreatitis who developed a pancreatic abscess secondary to Candida albicans. Recovery followed operative drainage and amphotericin B therapy. Because this is the only such patient in the author's career experience, and because only one other report currently addresses the problem, this report is offered.

Abscess↗
PubMed1989

Arterial anomaly of crucial importance in resection of head of pancreas.

In a patient with pancreatic cancer, an arterial anomaly was observed that apparently consisted of the congenital absence of the celiac axis and the replacement of the pancreaticoduodenal arcade by an anomalous vessel. The complete or near-complete arterial flow to the liver and spleen depended upon this anomalous prepancreatic vessel that arose from the superior mesenteric artery. The anomaly was demonstrated preoperatively by arteriography. At laparotomy, the anomalous artery was prominent, lying across the surface of the head of the pancreas. Unrecognized, its operative interruption might have threatened the life of the patient. Resection of the head of the pancreas would have required restoration of the arterial flow, preferably by vascular grafting. The anomaly appears to be different from those previously described.

Aged↗
PubMed1989

Arteriovenous fistula between the hepatic artery and the hepatic vein.

A patient is presented with multiple vascular anomalies in the branches of the celiac axis as well as in the portal vein and its branches. Apparently, unique in the literature is the presence of a large arteriovenous fistula between the hepatic artery and one of the hepatic veins. The anomalies are presumed to be congenital in origin.

Aged↗
PubMed1989

Malignant islet cell tumor of the pancreas associated with high plasma calcitonin and somatostatin levels.

In this case report we describe a 41-year-old man, without a recognizable preexisting syndrome, who had ascites of massive proportions and died. A malignant tumor of the endocrine pancreas was identified and associated with an extremely high plasma calcitonin level. The plasma somatostatin level was also significantly elevated. Only one previous case report of a tumor with comparable secretory characteristics has been identified.

Adenoma, Islet Cell↗
PubMed1989

Pancreatic cancer: today's frontier.

The Present State The incidence of cancer of the pancreas in the U.S. is increasing. The diagnosis can be made preoperatively with increasing precision. Resection can be accomplished with a mortality rate now reduced below 5%. Long-term survival remains low--about 5%. The Present Frontier Having accomplished the technical improvements in the safety of resection, the immediate frontier is the evaluation of combined modalities: resection, irradiation and chemotherapy as definitive, primary (intraoperative) treatment. The adjunctive use of intraoperative irradiation promises to extend the practicality of resection to numerous patients previously deemed unresectable.

Humans↗