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Biomedical subjects

J Pickleman

Publications and source records attributed to J Pickleman.

At least 55 records · Page 3Linked to original sources
PubMed1984

Neuropsychologic predictors of operative skill among general surgery residents.

The present study develops a rating scale method for evaluating operative skills, assesses the predictive utility of neuropsychologic tests of nonverbal cognitive and psychomotor abilities in accounting for individual differences in surgical skills, and compares the efficiency of these measures with those of traditional residency selection criteria. According to a multifactorial design, 120 general surgery residents were tested with a neuropsychologic test battery and then rated by attending surgeons on surgical skills exhibited during the course of 1445 surgical procedures. Analysis of the neuropsychologic battery resulted in three factors (complex visuo-spatial organization, stress tolerance, psychomotor abilities) that were statistically unrelated to traditional measures such as Medical College Admission Test and National Board scores. Multiple regression analyses indicated that academic predictors, taken alone, either do not correlate (National Board scores) or correlate negatively (Medical College Admission Test scores) with the surgery ratings. Conversely, neuropsychologic test scores show significant positive correlation (r = 0.68) with the ratings. When both sets of predictor variables are combined, a multiple regression coefficient of 0.80 is found with the ratings, with more than two thirds of the predictive power attributable to the neuropsychologic test scores. These tests may provide a useful addition to traditional methods of predicting operative skills.

Clinical Competence↗
PubMed1984

The reasons for gastrointestinal consultation after cardiac surgery.

Sixty-two (1.10%) of 5719 patients undergoing cardiac surgery between 1976 and 1982 required postoperative gastro-intestinal consultation, and 24 (0.4%) required operation. The major complications were gastrointestinal bleeding due to gastritis in 15, peptic ulcer in ten, and acute cholecystitis in 12. Acute diverticulitis was diagnosed in eight patients. Three patients had massive bowel necrosis, while eight patients had painless jaundice. Six patients had miscellaneous problems requiring consultation. Operative mortality was 10/25 (40%). Most complications occurred within 7 days of cardiac surgery. Seventeen of 62 patients required an intra-aortic balloon pump, and 29/62 had a hypotensive episode during cardiac surgery. Gastro-intestinal complications following cardiac surgery are rare but carry significant mortality. Patients with circulatory compromise and those requiring intra-aortic balloon pump are most likely to develop gastrointestinal complications. Careful monitoring and physical examination of these high-risk patients following cardiac surgery is required for early detection and effective treatment.

Acute Disease↗
PubMed1982

Biliary colic and functional gallbladder disease.

We carried out a review of 358 patients undergoing cholecystectomy during a seven-year period. Twenty-one patients were found to have classic biliary colic with a normal oral cholecystogram. All patients were female and had symptoms for three to 120 months (mean, 24 months). Cholecystosonography, upper gastrointestinal (GI) tract x-ray series, and infusion tomography of the gallbladder, when performed, were normal. Twelve patients underwent cholecystokinin (CCK) cholecystography. Failure of normal contraction of the gallbladder was noted in all 12. All 21 underwent cholecystectomy; three months postoperatively, all patients were relieved of their pain, and 15 of the 16 available for long-term follow-up (averaging 22 months) were completely cured of their symptoms. We conclude that the young woman with typical biliary colic and a normal oral cholecystogram, gallbladder ultrasound study, and upper GI tract x-ray series should undergo CCK cholecystography. If the results are positive, these patients can be reliably cured by cholecystectomy.

Adult↗
PubMed1982

Free perforation of the small intestine.

Surgeons operating on patients with an obscure peritonitis should be aware of the diverse etiologies of small intestinal perforation and the general principles of management of each. A series of 16 adult patients with free perforation of the small intestine and spreading peritonitis in the absence of bowel obstruction, incarcerated hernia, or trauma is reviewed. Etiologies were as follows: Crohn's disease, four patients; foreign body ingestion, two patients; jejunal diverticulosis, one patient; lymphoma, two patients; cancer chemotherapy, one patient, amyloidosis, one patient; idiopathic, five patients. Although all patient presented with diffuse peritonitis, the findings of fever and leukocytosis were inconstant. Free air was demonstrated on radiographs in only eight of 16 patients, and the correct preoperative diagnosis was not made except in the four patients with Crohn's disease. Resection and primary anastomosis were utilized successfully in ten patients, the remainder of the patients undergoing oversewing the the perforation. Four patients (25%) died.

Adult↗
PubMed1982

Feeding gastrostomy: a reappraisal.

A retrospective review of 67 patients undergoing feeding gastrostomy for nutritional support over a ten-year period disclosed a 30 day mortality rate of 30 per cent following this procedure. Patients with head and neck carcinoma and those patients who were not in coma at the time of the procedure enjoyed extended and useful long-term survival. Patients who were in coma at the time of the procedure had similar mortality rates, but no patient ever regained consciousness afterward despite survival times of over one year. It is our conclusion that feeding gastrostomy in comatose patients is a questionable procedure and one which is unlikely to benefit the patient. It would appear that the only present day rationale for the performance of a feeding gastrostomy in comatose patients lies in the facilitation of their nursing care and their transfer to a chronic care facility.

Aged↗
PubMed1979

Radiology of cholecystectomy complications.

Postoperative problems following simple removal of the gallbladder are infrequent. Radiographic studies may be valuable in suggesting or confirming the diagnosis when not clinically evident. Plain films, contrast studies, ultrasound, and computed tomography (CT) all can be useful modalities in this area. Several examples of complications related specifically to the operative field in cholecystectomy are reviewed.

Cholecystectomy↗
PubMed1979

Pancreatitis associated with thiazide administration. A role for the parathyroid glands?

Twenty-one of a total of 72 patients with acute pancreatitis admitted to a university hospital over a three-year period were found to have "idiopathic" pancreatitis. Of these, six nonalcoholic patients without gallbladder disease were receiving one of the thiazide diuretics prior to the onset of pancreatitis. Three patients taken from an earlier series likewise had pancreatitis associated with thiazide administration and at the time of autopsy harbored parathyroid hyperplasia. It is suggested that both the parathyroids and the pancreas may be affected by thiazide administration, and that a history of ingestion of these drugs should be sought in patients who have idiopathic pancreatitis.

Aged↗
PubMed1978

Common bile duct obstruction associated with a dacron H-graft portacaval shunt.

An unusual patient had ascending cholangitis secondary to common bile duct obstruction by stones and a Dacron graft previously utilized in the performance of an H-graft portacaval shunt. Erosion of this foreign body into the common bile duct appeared to be secondary to bacterial contamination of the graft and direct contact of the foreign material with the biliary tree.

Cholangitis↗
PubMed1978

Mediastinitis from odontogenic and deep cervical infection. Anatomic pathways of propagation.

Potentially lethal consequences can quickly occur once the mediastinum is subjected to the ravages of an anaerobic infection. Mediastinitis from odontogenic or deep cervical infections is extremely rare in the era of antibiotic drugs. We have recently encountered five such cases, with a rapid spread of the inflammatory process into the mediastinum resulting in a number of local and systemic complications. All were caused by anaerobic bacteria. Awareness of such complications and early roentgenographic diagnosis lead to prompt surgical drainage, proper antibiotic therapy, and survival after a stormy clinical course. The anatomic pathways between the various fascial planes of the neck and mediastinum will be described.

Adolescent↗
PubMed1978

Gastrocolic fistula in Crohn's disease.

The surgeon managing a patient with Crohn's disease should be aware of the possibility of a gastrocolic fistula being present. Readily available roentgenographic contrast studies, coupled with endoscopy, will undoubtedly provide all the necessary information with which to undertake a safe one stage en bloc resection of the diseased segments.

Adult↗
PubMed1977

Acute cholecystitis: 137 patients studied by infusion tomography of the gallbladder.

Clinical experience with inflammatory cholecystopathy recognized in 137 patients studied by infusion tomography of the gallbladder is presented. Diagnostic accuracy was 96% in positive and 94% in negative histologically proven cases. Our results show that infusion tomography of the gallbladder is an accurate, rapid, and safe diagnostic aid in the evaluation of acute cholecystitis. In cases of chronic cholecystitis, infusion tomography may be confirmatory but should not be relied on as a final diagnostic test due to a high percentage of false negative cases.

Acute Disease↗
PubMed1977

Infusion tomography of the gallbladder: mechanism of gallbladder wall opacification in experimental acute cholecystitis.

A canine model of acute cholecystitis was used to determine the mechanism of opacification of the gallbladder wall by infusion tomography. The experimental data indicate that opacification of the thickened wall of the gallbladder in acute cholecystitis is a function of hypervascularity and transport of the radiopaque material across the capillary wall by polymorphonuclear cells. Tissue-fluid equilibration of the contrast agent may also play a role.

Acute Disease↗