Biomedical subjects
Publications and source records attributed to J T Mullen.
Operative cholangiography and extraductal palpation are both accurate means of demonstrating common duct stones. When used in combination, accuracy was 94.4%. Routine extraductal palpation and selective cholangiography will prevent excessive and fruitless common duct exploration.
Two patients with pancreatic ascites secondary to acute pancreatitis are presented. Successful drainage was carried out in one patient with distal pancreatectomy and Roux-en-Y pancreaticojejunostomy and in the other by cystoduodenostomy. Most cases of pancreatic ascites are due to a mild peritoneal reaction casued by inactivated pancreatic enzymes liberated after ductal or pseudocyst disruption. A majority of cases are successfully treated by surgical correction of the underlying pathology.
Five patients with Barrett's esophagus, each with a differing presentation, serve as the basis of this report. Hiatal hernia is noted to be frequently present in Barrett's esophagus, and the incidence of adenocarcinoma is thought to be distinctly increased. The condition is easily diagnosed by fiberoptic endoscopy and verified by direct biopsy. The increasing use of fiberoptic panendoscopy may lead to an increased frequency of diagnosis of the columnar cell-lined lower esophagus and its complications.
Three out of every four patients undergoing breast biopsy found the outpatient local-anesthesia method acceptable in this study. Patient acceptance was greater among those who experienced less pain and anxiety. This suggests that acceptance could be increased by more complete preoperative explanation to the patient, adequate premedication, properly administered local anesthesia and gentle technique. Acceptance would also probably be far greater in a private practice setting than in the instititutional and sometimes impersonal setting of a large federal hospital. Breast biopsy under local anesthesia has not compromised survival rates or increased local recurrence. When it is done on an outpatient basis, hospital costs have been reduced at least threefold. It is apparent, then, that patient objection is not a deterrent to the use of breast biopsy under local anesthesia on an outpatient basis. For patients with dominant breast masses, this modality can be added to any plan of management which seeks to reduce patient risk and inconvencience, diminish hospital costs and alleviate bed demand all without impairing diagnostic accuracy or long-term survival.
Three hundred sixty-six patients undergoing elective inguinal hernioplasty were randomized to receive either local anesthesia or traditional spinal or general anesthesia. Overall operative complication rates were nearly the same, but wound complication predominated in the local anesthesia group while problems related to anesthesia were more common with spinal or general technique. Patients who had local anesthesia had significantly fewer postoperative symptoms than did the others.
Esophagogastric fistula developed in two patients following operations combining fundoplication and other operative procedures on the esophagus. To our knowledge, this complication has not been previously reported or described. Accurate endoscopy and appropriate barium roentgenographic studies provided the definitive diagnosis. A second reconstruction was successful in one patient; conservative treatment was sufficient in the other.
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A case of primary adenocarcinoma of the appendix in which the patient had the usual symptoms of acute appendicitis is presented. A review of the literature showed the potential for early extension and nodal metastasis in this lesion and led to the recommendation of right hemicolectomy as the treatment of choice. The operation should be done either primarily or secondarily after an appendectomy and should lead to a five-year survival of approximately 45%. Every effort should be made to make the diagnosis and provide definitive treatment at the primary operation by examining the appendix grossly and obtaining frozen section microscopic study of any suspicious tumor or ulceration.
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