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Biomedical subjects

L W Norton

Publications and source records attributed to L W Norton.

At least 37 records · Page 2Linked to original sources
PubMed1982

Utility of thyroid aspiration biopsy.

The utility of fine-needle aspiration biopsy to detect carcinoma in thyroid nodules was evaluated by a decision-analysis approach in 102 patients. The procedure caused no morbidity. Cytologic diagnoses were categorized as unsatisfactory (4), no abnormality detected (61), atypical (13), suspicious for malignancy (14), malignancy (2), and inflammation (8). The duration of follow-up averaged 13 months. Of 21 thyroidectomy patients, 10 (48%) had carcinoma. Half of the ten patients operated upon for suspicious cytologic findings were found to have malignancy. Assuming criterion I, that atypical, suspicious, or malignancy results indicated cancer, sensitivity was 90%, specificity 77%, false positive fraction 23%, positive predictive value 31%, negative predictive value 99%, and accuracy 79%. Assuming criterion II, that only suspicious or malignancy cytologic findings represented carcinoma, sensitivity was 70%, specificity 90%, false positive fraction 10%, positive predictive value 44%, negative predictive value 96%, and accuracy 88%. We conclude that sensitivity and specificity of fine-needle aspiration biopsy vary depending upon the use of criterion I or II. Accuracy is highest if atypical results are not considered to represent carcinoma. Positive predictive values remain low and negative predictive values are high in either case. The utility of fine-needle aspiration biopsy when interpreted in relation to clinical criteria is supported by these results.

Adolescent↗
PubMed1980

Selective intra-arterial vasopression in fusion for upper gastrointestinal tract hemorrhage: a controlled trial.

In a prospective randomized study, 38 patients with massive upper gastrointestinal tract hemorrhage, mostly due to esophageal varices or erosive gastritis, were treated with either standard medical therapy or standard therapy plus selective intra-arterial vasopressin infusion. Cessation of hemorrhage occurred more frequently in the vasopressin-treated group. The study design did not permit meaningful comparisons of mortality of transfusion requirements. We conclude that in patients bleeding from esophageal varices or gastritis, selective intra-arterial vasopressin is more effective in controlling hemorrhage than standard therapy.

Adult↗
PubMed1980

Outcome of operations for upper gastrointestinal tract bleeding.

The outcome of operations for upper gastrointestinal tract bleeding during a six-year period was compared with that of the previous four years, in which indications for operation and guidelines for surgical procedures were similar. Between 1973 and 1978, 392 patients were hospitalized for hemorrhage. Endoscopy diagnosed a bleeding lesion in 92% of 234 patients studied. Of 75 patients (19%) who required operation for uncontrollable hemorrhage, 20 (27%) died and two (3%) rebled postoperatively. Most deaths (80%) were caused by esophageal variceal bleeding. Among 47 patients with nonvariceal hemorrhage, mortality was only 9%. No patient with stress ulcer bleeding was encountered. Compared with our 1969 to 1972 experience, the present study shows no improvement in overall mortality. Rebleeding was less frequent than earlier. The most significant differences in outcome were decreased mortality in alcoholic gastritis patients, no deaths from stress ulcer, and increased mortality after portosystemic shunting. Endoscopy, used frequently from 1973 to 1978, helped to improve preoperative diagnostic rates (85% vs 65%). Combined with innovations in nonoperative treatment, such as infusion of vasopressin, it did not appear to decrease the proportion of patients requiring operation.

Adolescent↗
PubMed1979

Massive cecal dilation: pseudoobstruction versus cecal volvulus?

Seven patients with acute and progressive abdominal distension secondary to massive cecal and right colon ileus are analyzed. Five had pseudoobstruction of the colon and two had cecal volvulus. Two of the patients with pseudoobstruction and one with cecal volvulus died from preexisting diseases. Pseudoobstruction of the colon is not a rare complication of elderly, sick, bedridden patients. Differential diagnoses include cecal and sigmoid volvulus and acute gastric dilation. Initial conservative therapy is warranted if no peritoneal signs are present. If the cecal diameter is more than 12 cm, colonoscopic decompression with a fiberscope should be attempted. If unsuccessful, tube cecostomy will provide curative, life-saving therapy even if taenia splitting is present. Perforation or widely scattered areas of necrosis make resection mandatory.

Aged↗
PubMed1979

Caroli's: a surgical challenge.

A patient operated upon for acalculous cholecystitis was later found to have Caroli's disease, congenital ectasis of intrahepatic bile ducts. Cholangitis, calculi and abscesses occurred in both lobes of the liver. Sepsis was not controlled despite open drainage, hepatic segmentectomy and ductal lavage with antibiotics and saline. At autopsy the liver contained a dozen unsuspected cavities filled with calculi, bile and pus. Diagnosis of Caroli's disease is best made by operative cholangiography in patients with atypical biliary disease. Management with antibiotics alone is seldom successful. Hepatic resection is better than drainage procedures for unilateral lesions. In patients with bilateral abscesses and no extrahepatic ductal obstruction or dilation, surgical treatment is often ineffective.

Adult↗
PubMed1978

Condyloma. A new epidemic.

Condyloma acuminatum of the anus is an increasingly frequent disease that may require a combination of therapies. Large bulky lesions can be reduced with topical freezing, cautery, or the scapel. Topical chemotherapy with podophyllum resin can be supplemented with cancer chemotherapeutic agents. Many of these drugs probably act, at least in part, by stimulating a strong local cellular immune reaction. Dinitrochlorobenzene was used to eradicate lesions that had been resistant to treatment with podophyllum resin. 5-Flourouracil was used as a control. All 23 patients studied were initially skin tested with both agents and randomized to either treatment group. All but one of the dinitrochlorobenzene-treated patients had excellent regressions. Immunotherapeutic agents, such as dinitrochlorobenzene, warrant further study as adjuvant therapeutic agents for this disease.

Antineoplastic Agents↗
PubMed1977

Clinical indications and accuracy of gray scale ultrasonography in the patient with suspected biliary tract disease.

One hundred patients with suspected biliary tract disease underwent gray scale cholecystosonography (GSCS) and had diagnostic confirmation by oral cholecystogram (OCG) and/or operation. Ultrasonography demonstrated the gallbladder in 94 of the 100 patients; 2 patients had had previous cholecystectomy and 3 of the 4 remaining patients had documented stones with no confirmation of a nonvisualizing OCG in the other patient. Among the 88 patients with OCG, GSCS findings correlated in 91 per cent (2 per cent false-positive; 7 per cent false-negative). Among the 43 operative patients, GSCS was proven correct in 91 per cent (no false positive; 9 per cent false-negative). Of 12 patients with jaundice GSCS correlated with operative findings in 75 per cent (no false-positive; 25 per cent false-negative). Diagnostic errors occurred in patients with very small biliary calculi, particularly when a single stone was impacted in the cystic duct. Failure to identify the gallbladder with ultrasound signifies probable cholelithiasis in the patient without previous cholecystectomy. On the basis of this experience, we conclude that (1) GSCS is most useful when jaundice or acute illness precludes conventional studies; (2) GSCS provides an inexpensive, quick, accurate means of diagnosing cholelithiasis with a very high specificity (97 per cent) and moderate sensitivity (88 per cent); and (3) GSCS is the optimal diagnostic procedure for evaluating the biliary tract in the acutely ill, jaundiced, vomiting, allergic, and/or pregnant patient.

Biliary Tract Diseases↗
PubMed1976

Morbidity of colostomy closure.

An unexpectedly high morbidity (28 per cent) followed colostomy closure in 100 patients. One patient died postoperatively because of sepsis resulting from disruption of the colon anastomosis. Wound infection (10 per cent), intraperitoneal abscess (1 per cent), bowel obstruction (7 per cent), and fecal fistula (4 per cent) were other significant complications. Wound sepsis was greater after primary than after delayed wound closure. Obstruction did not correlate with the use of either an open or closed technic of anastomosis. Three patients required reoperation for complications. Temporary colostomy was constructed for colon injury in 85 per cent of patients. In view of the considerable morbidity of colostomy closure, alternate technics of managing colon trauma should be considered. Such technics include primary closure and exteriorization of repaired colon. When temporary colostomy is unavoidable, closure is best done by open, two layer anastomosis with delayed wound closure. Colostomy should be recognized as an important procedure associated with significant morbidity.

Abdominal Injuries↗
PubMed1975

Operative choice and technique following pancreatic injury.

During a five-year period, 50 patients were operated on for pancreatic injury. Forty had open trauma and ten closed. Half of each group were treated by drainage alone. Overall mortality was 14%, with all deaths following open injuries due to gunshots. Deaths were more frequent after drainage than after resection. Substantial complications occurred in 70%, with more frequent amd more serious morbidity in drained patients. Sump drainage was associated with less morbidity than Penrose drainage. Guidelines for management of pancreatic trauma are (1) resection of sinistral gland for perforating injuries of the body or tail; (2) drainage of perforations of the pancreatic head when the major duct is intact; (3) resection of duodenum and pancreatic head for devitalizing injury of both structures.

Adult↗
PubMed1975

Accuracy of ultrasound in diagnosing abdominal masses.

B-mode ultrasonography was performed in 246 patients with suspected abdominal masses over a seven-year period. In 105 (40 percent), the accuracy of ultrasonic diagnosis was evaluated surgically. Sonography was proven correct in 60 (57 percent) patients who had undergone operation. Among 141 patients who had not undergone operation and whose diagnoses were established by other means, ultrasonography agreed with the clinical diagnosis in 69 (31 percent). Ultrasound accuracy, as confirmed by operation, was highest for splenic masses (100 percent) and for aortic aneurysm (88 percent). Liver masses were correctly identified in 56 percent of patients and gallbladder lesions in 38 percent. While only a 48 percent accuracy was obtained in diagnosing pancreatic disease, 64 percent of all pseudocysts were localized. Ultrasonography correlated positively with operative findings in 56 percent of renal masses. Intraperitoneal abscess was accurately diagnosed in 61 percent of patients but retroperitoneal adenopathy in only 33 percent. Abdominal ultrasonography, while accurately diagnosing splenic and aortic masses, failed to identify approximately half of other mass lesions. Improved techniques hold promise of improving this diagnostic accuracy.

Abdomen↗
PubMed1975

Incidental appendicectomy with laparotomy for trauma.

Incidental appendicectomy was performed in 83 of 206 patients undergoing laparotomy for abdominal trauma. No organs were injured in 42 per cent of the appendicectomy patients and in 17 per cent of the non-appendicetomy patients, thus making comparison between the groups unreliable. While the incidence of intestinal perforation was 21 per cent in the appendicectomy patients, the rate of wound infection was only 7 per cent. One complication (pelvic abscess) was possibly attributable to incidental appendicetomy. Since males below the age of 50 face a significant risk of future appendicitis and represent the majority of patients with abdominal trauma, it may be advisable to perform incidental appendicectomy with laparotomy for trauma in such patients. Specific indications for incidental appendicectomy during laparotomy for trauma are suggested.

Abdominal Injuries↗