Biomedical subjects
Publications and source records attributed to J R Hines.
A case of a patient who had colonic obstruction caused by scleroderma is described. The obstruction initially was treated by means of a colostomy, and later subtotal colectomy was carried out. This is the fifth report of a patient with symptomatic colonic scleroderma successfully treated by colonic resection. A review of colonic scleroderma is included.
One hundred and twenty patients operated upon for peptic ulcer diathesis had intraluminal digital examination of the duodenum seeking post-bulbar ulcers. Twelve such ulcers were found, an incidence of 10 per cent. In six of these patients, the postbulbar ulcer was an unexpected finding, and in two patients, a second ulcer was present. A review of the patients with postbulbar ulcers revealed that these patients had severe ulcer symptoms that responded poorly to medical management. Our patients were treated by truncal vagotomy and an outlet procedure. In ten patients, the anterior duodenotomy was extended to include the stenotic area. A Jaboulay gastroduodenostomy was performed in one patient, and duodenoplasty with pyloroplasty in another patient. These 12 patients were observed from one to six years. There were no deaths. Two patients had temporary gastric atony and one patient had a dumping syndrome. Three patients have had possible recurrence of the ulcer, reoperation being required in one patient. It is possible that unrecognized postbulbar stenosis may be a cause of recurrent peptic ulcer following some surgical procedures. To recognize these ulcers, we believe that the duodenum should be inspected by intraluminal palpation in all patients operated upon for peptic ulcer disease.
A group of 31 patients with a variety of gastric ulcers were treated by vagotomy, biopsy, oversewing of bleeding points and a wide double pyloroplasty. On patient, a quadriplegic with multiple stress ulcers, rebled and had to undergo resection. He died a month later of progressive respiratory problems. A second quadriplegic died a month after a bleeding episode from myelitis and encephalitis resulting from a gunshot wound of the neck. He had no rebleeding. A third patient died two years after a gastric operation as a result of bronchial carcinoma. He had no recurrence of the ulcer problem. The remaining 28 patients were observed from six months to five years, an average of two and one-half years. There were no recurrences and only minimal untoward symptoms. It would appear that, for this period of observation, vagotomy with double pyloroplasty offers good treatment for patients with benign gastric ulcers.
A retrospective study is reported of 38 patients with breast carcinoma treated by radical mastectomy and a short course of nitrogen mustard. They were followed up for an average of 10 years. There were no serious untoward reactions to the drug. The 5- and 10-year correct survival rates were 71 and 71 per cent respectively. There would appear to be a renewal of interest in adjuvant chemotherapy for patients with breast carcinoma.
Seventy patients with peptic ulcers (55 duodenal and 15 gastric) were treated by truncal vagotomy and doulbe pyloroplasty during the past four years. Clinical and experimental data as presented lead us to believe that transecting the pylorus twice produces an incontinent pyloric sphincter and a larger gastric outlet than is found in other methods of pyloroplasty. This decreases gastric stasis and has led to a lower ulcer recurrence rate (1.5%). In addition the untoward postoperative sequelae are minimal. The 70 patients treated (for the most pare consecutive cases) exhibited the usual complications of peptic ulcer disease. Thirty-three had intractable pain, 23 bleeding (15 massive), 13 obstruction, and one acute perforation. There were no operative or postoperative deaths and the only serious postoperative complication was unrelated to the double pyloroplasty. During the followup period four patients have died of unrelated diseases. Of the remaining 66 patients one developed a probable recurrent peptic ulcer which has responded to medical management. Four patients have intermittent dumping, three have mild diarrhea and one has failed to gain weight, Constipation and weight gain are more common complaints. It would appear that vagotomy with double pyloroplasty is a safe and effective operation for peptic ulcers and that further clinical trials are warranted.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
A case of a patient with adenocarcinoma in an abscess cavity that resulted from perforated diverticulitis of the descending colon is described. Serial barium-enema studies over a nine-year period show the diverticulosis, perforation, abscess cavity, and finally the adenocarcinoma in the abscess cavity. Although it is infrequent, the possibility of carcinoma must be considered in cases of patients who have unhealed pericolonic abscess cavities.
Explore the source record for details and available documents.
Explore the source record for details and available documents.