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Biomedical subjects

M A Adson

Publications and source records attributed to M A Adson.

At least 55 records · Page 3Linked to original sources
PubMed1981

Resection of primary solid hepatic tumors.

Experience with surgical management of 60 solid hepatic tumors was analyzed with respect to the size and type of lesion, extent of resection, operative risk, postoperative complications and survival after resection. The present study concerns 46 primary hepatic malignancies and 14 benign lesions. Lesions varied in size from 5 to 29 cm (average 13). The extent of resection required for removal was related to both the size and location of lesions. Twelve trisegmentectomies, 33 hemihepatectomies and 15 major segmentectomies were done. There were three postoperative hospital deaths, two of which were related to extensions of tumor that precluded safe resection. Postoperative complications necessitated hospital convalescence for more than 21 days in 9 of the 57 surviving patients; the hospital stay of the remaining patients averaged 12 days. The 10, 5 and 3 year survival rates of patients who had resection of malignant lesions were 33, 36 and 65 percent, respectively. We conclude that aggressive treatment of primary hepatic malignancy is justified by acceptable operative risk and significant palliation or improved survival.

Adolescent↗
PubMed1981

Diagnosis and surgical treatment of primary and secondary solid hepatic tumors in the adult.

The apparent efficacy and limitations of resective treatment have been considered. In summary, it can be said that some patients may be helped by removal of their hepatic tumors. At times, the need for and benefits of such treatment are obvious. All too often, however, decisions about proper treatment are less clear. In the future, physicians and surgeons may act more wisely only if more is known about the biology and natural history of hepatic tumors. In the meantime, surgeons must be circumspect in their efforts to help and should try to judge the results of their efforts objectively.

Adult↗
PubMed1981

Computed tomography and angiography of cavernous hemangiomas of the liver.

Cavernous hemangioma is the most common benign tumor of the liver. Eighteen patients were studied by both computed tomography (CT) and angiography. The angiographic features were classic, consisting of normal hepatic arteries, no tumor vessels, and densely stained blood-filled spaces producing a "cotton-wool" appearance. Before contrast infusion, CT scans showed roughly spherical, well-demarcated low-density masses; afterward there was a peripheral zone of enhancement which varied in thickness and sometimes had a corrugated inner margin, though the center remained low in density and the overall size of the lesion did not change. The authors feel that the CT findings are characteristic and that in some cases angiography is unnecessary.

Angiography↗
PubMed1981

Percutaneous biliary decompression: internal and external drainage in 50 patients.

A review of percutaneous biliary decompression performed at the Mayo Clinic was initiated to study indications, technique, technical problems, and short- and long-term complications. Data were collected on the initial 50 patients in whom biliary decompression had been performed. More than 80% of patients presented with lesions or a record of previous surgery near the ductal bifurcation that resulted in increased difficulty in obtaining internal drainage. Follow-up data were available in 40 patients and allowed careful evaluation of immediate and long-term complications. Significant complications were limited to intraabdominal bleeding, which occurred in four patients and resulted in death in one. Four patients experienced sepsis immediately after the procedure, and episodes of cholangitis occurred in seven patients who had long-term drainage catheters in place.

Adult↗
PubMed1981

Hepatobiliary cancer--surgical considerations.

Most cancers of the hepatobiliary system will have grown beyond the limits of curative resection by the time they become clinically evident. This reality has fostered therapeutic nihilism, and most physicians and surgeons in their pessimism have failed to study the early modes of spread of these tumors--patterns of growth that are relevant to proper treatment of those patients who do have lesions that can be removed with hope of achieving a cure. Moreover, anatomic and technical complexities may beget surgical reluctance in the management of potentially curable lesions. Therefore, this review is offered for orientation and perspective for those who would hope to offer optimal treatment for patients who have primary cancers of the liver, gallbladder, or biliary ducts. The review includes considerations of (1) surgical anatomy, (2) modes of spread, (3) assessment of resectability, (4) surgical technique, and (5) results of operative treatment in relation to "curative" resection. Also offered are some guides to palliative surgical management of tumors that have reached the hepatic hilus.

Adenoma, Bile Duct↗
PubMed1981

Radical pancreatoduodenectomy--a procedure to be abandoned?

Radical pancreatoduodenectomy, or Whipple's procedure, has gradually fallen into disrepute during the past decade. This loss of popularity has resulted from excessive postoperative mortality and morbidity due to inherent technical difficulties, the dismal long-term survival when the procedure is done for adenocarcinoma of the pancreas, and the current enthusiasm for total pancreatectomy. Our objective was to assess the technical aspects of the Whipple procedure as they relate to subsequent morbidity and mortality. Conclusions are drawn from the evaluation of 146 consecutive patients who underwent this procedure between 1970 and 1979 for either benign (10 patients) or malignant (136 patients) diseases of the pancreas and periampullary region. The postoperative mortality was 4.1%. Significant morbidity occurred in 34% of patients, and early reoperation was required in 7.5% of these patients. The median postoperative hospital stay was 19 days. The relatively low postoperative mortality indicates that inherent technical difficulties of the Whipple procedure can be overcome and supports its continued use in carefully selected patients. The persistent high morbidity and the rather poor long-term results following treatment of certain pancreatic malignancies place individual surgical judgment and technical expertise at a premium when ever this classic operation is contemplated.

Adenocarcinoma↗
PubMed1980

Rectal cancer following colectomy for polyposis.

Reevaluation of 178 patients treated for multiple colonic polyposis by abdominal colectomy and restoration of bowel continuity confirmed that patients with both rectal and colonic polyps are at substantial risk of having rectal cancer develop postoperatively. Rectal cancer has not occurred in any of 35 patients who had no rectal polyps preoperatively. However, 46 (32%) of 143 patients with multiple colorectal polyposis have had cancer develop during a median follow-up of nearly 20 years. Multivariate analysis showed a highly significant association between the number of rectal polyps present preoperatively and decreased survivorship free of rectal cancer (P less than .001), and a strong correlation between the presence of cancer in the resected colon and subsequent development of rectal carcinoma (P less than .01). No correlation could be established between low anastomosis and prevention of rectal carcinoma. The risk of cancer developing in the retained segment of large bowel can be established only by extended postoperative observation.

Actuarial Analysis↗
PubMed1980

Surgical management of inflammatory bowel disease.

Indications for operation in patients with inflammatory bowel disease are now standardized as a result of the vast surgicaL experience that has been accumulated during the past 40 years. The surgical indications in Crohn's disease and chronic ulcerative colitis vary minimally with the anatomic distribution of either disease, and can be recognized easily in a particular patient. Consequently, decision or judgment regarding the need for operation is rarely difficult. Delaying operation on the basis of fear of recurrence of Crohn's disease is unrealistic because (1) indications for operation are complications of the disease that have not responded or cannot be expected to respond to medical treatment, (2) conservative resection primarily removes diseased bowel that will never return to normal, (3) many patients, perhaps 50%, will never have recurrence of disease, and (4) those who have recurrence will have experienced varying periods when they were free of disease and relieved of the serious complications for which their operations were performed. The value of surgery in the treatment of patients with chronic ulcerative colitis can be stated even more positively, because recurrence of disease is never a concern after proctocolectomy.

Adult↗
PubMed1980

Major hepatic resections for metastatic colorectal cancer.

In 1973, our study of patients with resectable hepatic metastases from colorectal cancer compared survival of 60 patients who had metastases removed with survival of 60 patients with similar lesions that had been biopsied only. We concluded that excision of small, apparently solitary metastatic lesions could be justified on the basis of the low operative risk and prolonged survival. However, the risks and benefits of resection of larger metastatic lesions could not be determined by that earlier study, because only seven of those patients had lesions so large as to require major hepatic resection. Therefore, to evaluate size as a determinant of prognosis after resection, we added to those 7 patients 27 others who were managed since 1973 by major hepatic resection of larger metastases. There were two hospital deaths. Of the 32 surviving patients, 82% lived one year or more, 77% 18 months or more, 58% two years or more, and 41% three years or more postoperatively. Three patients are living 10--22 years after resection. We conclude from a critical analysis of the duration and quality of life of surviving patients that at least 20% and perhaps 30% of these patients were benefited by major hepatic resection of their large hepatic metastasis.

Aged↗
PubMed1980

Proximal gastric vagotomy. Initial experience.

Proximal gastric vagotomy was performed in 223 patients with chronic duodenal ulceration between 1973 and 1977. The follow-up ranged from 6 to 78 months with a mean of 39 months. There was no operative mortality. Adverse postoperative sequelae, including delayed gastric emptying, dumping, diarrhea, and reflux gastritis, were seen in less than 3% of patients. Ulcers recurred in 11 patients (4.9%). We conclude that proximal gastric vagotomy is an effective, safe, and satisfactory operation for chronic duodenal ulcer over the short term.

Chronic Disease↗
PubMed1979

Biliary decompression in hilar obstruction. Round ligament approach.

In some patients with biliary obstruction, access to the hepatic hilus is hindered by extensive tumor or by dense vascular scar tissue. In such patients, the biliary tract may be decompressed via the left hepatic duct away from the affected hilus. Access to the left hepatic duct in the left intersegmental plane is gained by dividing the round ligament, freeing it from the undersurface of the liver, and following it to its junction with the left portal vein. The left hepatic duct, which lies superior to the vein, is exposed by dividing the liver overlying the round ligament in the relatively avascular plane between the lateral and the medial segments of the left hepatic lobe. Decompression can be effected by simple tube drainage or, if the duct is large enough, by Roux-en-Y hepaticojejunostomy.

Biliary Tract Diseases↗
PubMed1979

Surgical treatment of pancreatitis: review of a series.

In this review of the surgical experience with pancreatitis, 55 patients had acute relapsing pancreatitis associated with gallstones and 47 had chronic pancreatitis of alcoholic, idiopathic, or familial causation. The severity of pancreatitis associated with gallstones could not be correlated with results of preoperative biochemical tests; only one-third of patients were found to have stones within the biliary ductal system; and postoperative mortality (5%) could not be correlated with the severity of pancreatic inflammation or the timing of surgical intervention. Postoperative observations have revealed that all but four of the patients have remained asymptomatic. With regard to the patients with alcoholic, idiopathic, or familial disease who had significant pancreatic ductal dilatation or obstruction, ductal drainage procedures with or without resection benefited 80%. In the absence of ductal dilatation or obstruction, major resective surgery benefited 50% of patients. Continuing alcohol abuse limited the effectiveness of any operative procedure, and diabetes occurred more often after major resective procedures.

Alcoholism↗
PubMed1978

Misdiagnosis of atrial septal defect in patients with hereditary telangiectasia (Osler-Weber-Rendu disease) and hepatic arteriovenous fistulas.

Two patients with hereditary telangiectasia (Osler-Weber-Rendu disease) and high-output congestive heart failure secondary to large hepatic arteriovenous malformations had preoperative heart catheterization and exploratory cardiotomy to correct presumed intracardiac left-to-right shunts at the atrial level. At operation, both patients had oxygen-enriched blood returning from the inferior vena cava. Subsequent hepatic angiography demonstrated large hepatic arteriovenous fistulas, and both patients underwent hepatic artery banding and ligation, with reduction of left-to-right shunting.

Adult↗
PubMed1978

The surgical aspects of chronic mucosal inflammatory bowel disease (chronic ulcerative colitis).

The surgical aspects of chronic mucosal inflammatory bowel disease were reviewed by comparing the experience at our institution between two periods, one a decade later than the other (1961-1965 and 1971-1975). The striking findings were a marked decrease in the incidence of carcinoma and toxic megacolon and a marked increase in use of one-stage proctocolectomy with either Brooke ileostomy or Kock pouch. There was, in addition, a corresponding decrease in the operative mortality for elective cases, from 2.4 to 1.3%; yet the operative mortality for emergency cases remained relatively stable at about 25%. The reason for the decrease in the incidence of carcinoma and toxic megacolon appears to be on the basis of selection outside of our institution, in that fewer of these cases are being referred.

Adult↗
PubMed1978

Radionuclide image patterns of hepatic metastasis and pyogenic abscess: difficulties in differential diagnosis.

A case of hepatic metastasis with a clinical differential diagnosis of amebic and bacterial abscess is presented. Hepatic scanning with 67Ga-citrate did not diagnostically differentiate the lesion. Hepatic arteriography combined with a therapeutic trial of metronidazole proved useful in defining the lesion. An understanding of the pathophysiologic process involved in 67Ga scanning of hepatic lesions suggests a non-invasive method of discriminating among these clinical diagnostic possibilities.

Adenocarcinoma↗
PubMed1977

Radical pancreatoduodenectomy for cancer of the papilla of Vater.

Over a 22-year span, 87 patients with carcinoma of the papilla of Vater underwent radical pancreatoduodenectomy. No patient was lost to follow-up, and extended observation was possible in most cases: the definitive operation was at least five years earlier than this study in 87% and at least ten years earlier in 73%. Operative mortality was 11.5% among patients who had a single definitive operative procedure and 15.4% among those whose treatment involved reoperation after prior exploration elsewhere. Overall survival rates at two, five, and ten years were 56%, 34%, and 20% respectively. Factors associated with favorable survival were histologic differentiation (Broders grades 1 and 2), absence of nodal metastasis, and papillary histologic characteristics. Noteworthy is the fact that no patient having resection of an undifferentiated carcinoma (Broders grade 3 or 4) survived four years.

Adenocarcinoma, Papillary↗
PubMed1977

The ileal stoma and protal hypertension: an uncommon site of variceal bleeding.

Patients who have chronic ulcerative colitis coexisting with liver disease and portal hypertension may suffer hemorrhagic parastomal varices after proctocolectomy and ileostomy. Large portal systemic collateral vessels between the superior mesenteric venous tributaries and the abdominal wall can be demonstrated by portal venography. Hemorrhage occurs from the mucocutaneous junction, a vulnerable point in this collateral circuit. Management by major and minor stomal revisions has been unsuccessful. Three patients who have bled from stomal and from esophagogastric varices were treated with portasystemic shunts. None of the three has had recurrent bleeding or postshunt encephalopathy during the 19 to 27 months after these operations.

Adult↗