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Biomedical subjects

N B Halpern

Publications and source records attributed to N B Halpern.

33 records · Page 2Linked to original sources
PubMed1983

Neurogenic tumors of the duodenum in patients with neurofibromatosis.

Neurogenic tumors of the duodenum may occur in patients with neurofibromatosis. They may be solitary or multiple and are located distal to the duodenal bulb. The presenting complaints may be hematemesis, vomiting, or jaundice. The lesions are generally benign and have a low potential for malignant degeneration. Four cases are reported.

Adolescent↗
PubMed1982

Effects of various operations on the electrical activity of the human stomach recorded during the postoperative recovery period.

This study attempts to characterize any changes occurring in the human gastric control electrical rhythm (CER), following a variety of gastric surgical procedures. Pairs of electrodes were implanted in selected specific sites on the stomachs of 57 patients undergoing either antrectomy and vagotomy, proximal gastric vagotomy (PGV), vagotomy and drainage, gastric resection without vagotomy, or fundoplication. Five patients undergoing nongastric operations served as controls. After operation recordings were obtained with differential preamplifiers, an oscilloscope, and a dual-channel tape recorder. An electrical signal compatible with a CER was found almost always in the distal body or antrum, regardless of whether vagotomy was performed. In contrast, a CER was found only occasionally in the fundus, and was never found following PGV. Although there was a difference in the frequency of occurrence of fundic CER in patients with and without vagotomy, it was not statistically significant (p = 0.0668). Patients with prolonged postoperative convalescence because of gastric atony were compared with patients with normal postoperative courses regarding the presence or absence of CER in the gastric antrum or fundus. A statistically significant relationship between abnormal gastric motility and absence of CER was not established.

Eating↗
PubMed1981

Acute chylous peritonitis.

The extravasation of chyle into the peritoneal cavity is rarely associated with the sudden development of clinical signs and symptoms of peritonitis. A review of the English literature has documented 56 cases of this unusual disorder. We report a recent case at our institution, describing the pertinent clinical, laboratory, and operative findings. The chronic form of chylous ascites, usually associated with malignant obstruction of the lymphatics, does not cause this acute syndrome. With the acute form exploration is usually undertaken because of the clinical findings of peritonitis. A surgically correctable etiology is frequently found, although 55% of the cases have not been clearly associated with a causative factor. In those cases considered idiopathic, the natural history of the disease is spontaneous closure of the chyle leak with regression of the ascites.

Acute Disease↗
PubMed1980

Evaluation and treatment of acute and chronic pancreatitis. A review of 380 cases.

The cases of 380 patients with pancreatitis were analyzed retrospectively. There were 237 men (62%) and 143 women (38%). Etiologic factors included: alcoholism, 62%; biliary lithiasis, 16.6%; idiopathic, 12%; miscellaneous, 7%; and trauma, 2.4%. Acute pancreatitis occurred in 279 patients (73%); 189 (67%) were treated nonoperatively, 90 (33%) underwent operation; electively in 43 and urgently in 47. Postoperatively, one patient (2.3%) died in the elective group and 14 (30%) in the emergency group. Chronic pancreatitis occurred in 101 patients. Their pertinent findings were: alcoholism in 78%, biliary lithiasis in 8%, absence of abdominal pain in 15%, diabetes in 40%, and jaundice in 20%. Fifty patients were treated without operation; 43 were alcoholics, 17 of them died in the follow-up period. Fifty-one patients, 36 of them alcoholics, underwent a variety of operations, with three deaths (6%); 21 were improved after operation. It was concluded that 30% of patients with acute pancreatitis require operation, mainly to correct biliary lithiasis. Emergency operations dictated by relentless deterioration or uncertain diagnosis had a high operative mortality (30%), particularly in patients with necrotizing or hemorrhagic pancreatitis. Operative treatment for chronic pancreatitis was most effective when directed toward specific goals, including pseudocysts, obstructed pancreatic or common bile ducts. Operations done without specific anatomical objectives were often therapeutic failures.

Acute Disease↗
PubMed1979

Factors influencing mortality and morbidity from injuries to tha abdominal aorta and inferior vena cava.

Fifty patients having undergone operation for injury to the abdominal aorta and/or vena cava at the University of Alabama Hospital are reviewed. Factors influencing mortality include mechanism and location of injury, presence of shock, associated vascular and visceral organ injuries, and delay in treatment. Rapid restoration of blood volume and control of hemorrhage are the primary goals of resuscitative measures. Only with a preconceived and coordinated plan can the surgeon fully employ the necessary skills in the management of these serious injuries.

Adolescent↗
PubMed1979

Factors determining the mortality and morbidity in hepatic injuries. Analysis of 108 cases.

The experience with 108 cases of hepatic injuries was reviewed retrospectively and a classification based on the severity of the hepatic injury was used to group these patients accordingly. Using this criteria, the factors determining the observed morbidity and mortality were analyzed. Hepatic injuries amenable to relatively simple surgical treatment were found in 72 patients (67%). Nine deaths occurring in this group were attributed to the commonly encountered associated injuries inside and outside the abdomen. Moderately severe imjuries requiring suturing of the hepatic parenchyma and ligation of injured vessels and bile ducts were seen in 15 patients (14%). Two of these patients died. Severe hepatic injuries resulting in major blood loss requiring partial hepatectomy were seen in 21 patients (19%). Seven of the eight deaths (7.4%) attributable to the hepatic injury occurred in this group. As noted, ten other patients died from causes other than the hepatic injury for an overall mortality of 16.7%. A pre-established patient management program based on the classification of hepatic injuries is proposed as a method for improving the management of patients with hepatic injuries.

Abdominal Injuries↗
PubMed1979

Zollinger-Ellison syndrome unresponsive to cimetidine.

A patient with Zollinger-Ellison syndrome appeared initially to respond to cimetidine with a reduction in gastric acid secretion. Symptoms immediately improved but after three days recurred with increasing severity. Intravenous cimetidine had only a short-lived and partial inhibitory effect on the rate of acid production and because of continuing pain and progressive bleeding from his duodenal ulcer, total gastrectomy was performed. Evidence of the effect of atropine and of oral and intravenous cimetidine is presented. Despite recent optimism, cimetidine is not always adequate treatment for Zollinger-Ellison syndrome.

Administration, Oral↗
PubMed1978

A multifactorial analysis of melanoma: prognostic histopathological features comparing Clark's and Breslow's staging methods.

A multifactorial analysis was used to identify the dominant prognostic variables affecting survival from a computerized data base of 339 melanoma patients treated at this institution during the past 17 years. Five of the 13 parameters examined simultaneously were found to independently influence five year survival rates: 1) pathological stage (I vs II, p = 0.0014), 2) lesion ulceration (present vs absent, p = 0.006), 3) surgical treatment (wide excision vs wide excision plus lymphadenectomy, p = 0.024), 4) melanoma thickness (p = 0.032), and 5) location (upper extremity vs lower extremity vs trunk vs head and neck, p = 0.038). Additional factors considered that had either indirect or no influence on survival rates were clinical stage of disease, age, sex, level of invasion, pigmentation, lymphocyte infiltration, growth pattern, and regression. Most of these latter variables derived their prognostic value from correlation with melanoma thickness, except sex which correlated with location (extremity lesions were more frequent on females, trunk lesions on males). This statistical analysis enabled us to derive a mathematical equation for predicting an individual patient's probability of five year survival. Three categories of risk were delineated by measuring tumor thickness (Breslow microstaging) in Stage I patients: 1) thin melanomas (<0.76 mm) were associated with localized disease and a 100% cure rate: 2) intermediate thickness melanomas (0.76-4.00 mm) had an increasing risk (up to 80%) of harboring regional and/or distant metastases and 3) thick melanomas (>/=4.00 mm) had a 80% risk of occult distant metastases at the time of initial presentation. The level of invasion (Clark's microstaging) correlated with survival, but was less predictive than measuring tumor thickness. Within each of Clark's Level II, III and IV groups, there were gradations of thickness with statistically different survival rates. Both microstaging methods (Breslow and Clark) were less predictive factors in patients with lymph node or distant metastases. Clinical trials evaluating alternative surgical treatments or adjunctive therapy modalities for melanoma patients should incorporate these parameters into their assessment, especially in Stage I (localized) disease where tumor thickness and the anatomical site of the primary melanoma are dominant prognostic factors.

Aged↗
PubMedDate not supplied

Pancreaticoduodenectomy for metastatic tumors to the periampullary region.

Although operative resection of metastatic lesions to the liver, lung, and brain has proved to be useful, only recently have there been a few reports of pancreaticoduodenectomies in selected cases of metastases to the periampullary region. In this report we present four cases of proven metastatic disease to the periampullary region in which the lesions were treated by pancreaticoduodenectomy. Metastatic tumors corresponded to a melanoma of unknown primary site, choriocarcinoma, high-grade liposarcoma of the leg, and a small cell cancer of the lung. All four patients survived the operation and had no major complications. Two patients died of recurrence of their tumors, 6 and 63 months, respectively, after operation; the other two patients are alive 21 and 12 months, respectively, after operation. It can be inferred from this small but documented experience, as well as a review of the literature, that pancreaticoduodenectomy for metastatic disease can be considered in selected patients, as long as this operation is performed by experienced surgeons who have achieved minimal or no morbidity and mortality with it.

Adult↗
PubMedDate not supplied

Ultrastructural and immunocytochemical features of a case of neuroendocrine carcinoma developing in a prior ileostomy site.

A patient who developed a mixed neuroendocrine carcinoma and adenocarcinoma at the site of a previous long-standing ileostomy is reported. The neuroendocrine features are documented by both ultrastructural and immunocytochemical findings. Carcinoma arising in an ileostomy site is rare but has been recorded in patients with long-standing ileostomies after colectomy for chronic inflammatory bowel disease, as in this patient. Neuroendocrine carcinoma developing in this setting apparently has not been described before, however.

Adenocarcinoma↗