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Biomedical subjects

M H Worth

Publications and source records attributed to M H Worth.

At least 19 recordsLinked to original sources
PubMed1994

The utility of laparoscopic common bile duct exploration in the treatment of choledocholithiasis.

Laparoscopic common bile duct exploration (CBDE) was performed in 24 patients over a 23-month period. Fourteen of these patients were suspected preoperatively of harboring common bile duct (CBD) calculi. Of these, endoscopic sphincterotomy was unsuccessful in eight. Laparoscopic CBDE was performed either transcystically or via a choledochotomy. In all cases, completion cholangiography demonstrated that the CBD was free of stones. All patients were sent home with drains placed in their extrahepatic biliary system. Mean hospital stay was 2.7 days. There was no mortality. The overall morbidity rate was 29.1%. It included one trocar site infection (4.1%), four cases of mild postoperative amylasemia (16.6%), and two cases of retained stones (8.3%) seen in two patients on follow-up tube cholangiography that were successfully extracted percutaneously. The authors feel that laparoscopic CBDE is a safe and effective method of CBD stone removal that offers an alternative to preoperative ERCP and sphincterotomy.

Adult↗
PubMed1990

Barium enema in the diagnosis of acute appendicitis.

Acute appendicitis is still a difficult diagnosis to make. Reports place the rate of incorrect diagnosis--the rate of negative laparotomy--at 15 to 42 per cent. This study is a prospective analysis of barium enema (BE) examinations performed upon 101 patients who presented with a history accompanied by signs and symptoms suggestive of, but not clearly diagnostic of, acute appendicitis. The over-all accuracy rate was 91.5 per cent. Sensitivity and specificity rates were 83 and 96 per cent, respectively. BE had a positive predictive value of 88 per cent and a negative predictive value of 95 per cent in this study. No complications resulted from the use of BE in this study, which included three instances of perforated appendicitis. We conclude that emergent BE is an inexpensive, safe and readily available adjunct to the diagnosis of acute appendicitis. Its use in the presence of a clear-cut presentation of acute appendicitis is not necessary. When clinical data were equivocal, BE reduced the rate of negative laparotomy to 7.2 per cent.

Acute Disease↗
PubMed1987

Mesenteric chylous cyst associated with Crohn's disease.

Mesenteric cysts are rare, and mesenteric chylous cysts are extremely rare. A case report is presented of a patient with Crohn's disease and a mesenteric chylous cyst. Included in this case report is a full discussion of the preoperative radiological work-up (including barium enema, sonogram, and CT scan), the operative findings, and the pathological findings. It is suggested that there may be a causal relationship between the Crohn's disease and the mesenteric chylous cyst.

Adult↗
PubMed1986

Direct anastomotic visualization in stapled Billroth II gastrectomy.

An alternative technique of performing a posterior gastroenterostomy using the EEA stapler during the Billroth II procedure is presented. It avoids overlooking bleeding points or defection the anastomosis, thus decreasing the likelihood of postoperative complications. The classic sequence of dissection is modified, but it should not alter the results.

Gastrectomy↗
PubMed1983

Giant cavernous hemangioma of the liver complicated by abscess and thrombosis.

A case of giant cavernous hemangioma of the liver complicated by abscess formation and thrombosis is presented. To our knowledge, complication of hepatic hemangioma by an abscess has not been previously reported. The clinical and radiographic features, as well as the management of giant hepatic cavernous hemangiomas is discussed.

Female↗
PubMed1979

The effect of total hip replacement and general surgery on antithrombin III in relation to venous thrombosis.

This investigation was undertaken to identify and correlate one factor that makes patients undergoing total hip replacement more susceptible to venous thrombosis and pulmonary embolism than those who have almost any other elective orthopaedic procedure, and to determine why the operation of total hip replacement has proved to be relatively resistant to antithrombotic prophylaxis compared with general surgical procedures. Using the depletion of antithrombin III as a marker of activation of the coagulation system, two groups of patients were compared: twenty-one who were subjected to hip arthroplasty and fourteen who underwent general surgical procedures. Both during and after operation the decrease in the quantity of antithrombin III in hip-arthroplasty patients was significantly greater (p less than 0.05) than the decrease in general surgical patients. Seventy-three per cent of hip-replacement patients had venographic evidence of recent thrombosis, 60 per cent of which were discontinuous femoral-vein thrombi. Femoral-vein thrombosis occurs frequently in hip-arthroplasty patients and is relatively resistant to current antithrombotic prophylaxis. The data presented suggest that during hip surgery there is a strong systemic activation of the clotting cascade that is associated with local vessel injury and local stasis in the femoral vein, an association not found in most general surgical procedures.

Abdomen↗
PubMed1977

Reversible hypertension. Caused by the hypercalcemia of hyperparathyroidism, vitamin D toxicity, and calcium infusion.

Reversible hypertension occurred in a patient during episodes of hypercalcemia caused by hyperparathyroidism, vitamin D toxicity, and an infusion of calcium during an 11-year period of observation. It is suggested that normal renal function may be required for the hypertension of hyperparathyroidism to be reversible and that the hypertension may be directly related to the hypercalcemia in some patients. Early surgery is suggested for otherwise asymptomatic, mildly hypercalcemia hyperparathyroidism that is accompanied by hypertension.

Adult↗
PubMed1976

Abdominal trauma.

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Abdominal Injuries↗
PubMed1975

Traumatic perforation of the sigmoid colon through schistosomal ulcerations.

A case is presented in which the colon was perforated through a S. mansoni ulcer after blunt abdominal trauma. This is believed to be a unique situation. The colonic complications of schistosomiasis are discussed, and it is expected that they will be seen more frequently in the United States.

Abdominal Injuries↗