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Biomedical subjects

R A Prinz

Publications and source records attributed to R A Prinz.

151 records · Page 9Linked to original sources
PubMed1976

Surgical significance of extrahepatic biliary tree anomalies.

A patient with an anomalous insertion of the right hepatic duct into the cystic duct was noted during cholecystectomy and confirmed by operative cholangiography. This case and related anomalies of the bile ducts are of sufficient importance that, because of the technical difficulties and dangers incidental to their presence, no surgeon who operates on the gallbladder and bile ducts can afford to be unaware of their existence. Adequate exposure, careful dissection, and accurate knowledge of the regional anatomy plus a realization of the frequency and multiplicity of abnormalities of the extrahepatic biliary tree are requisites for safe biliary tract surgery. In addition, carefully performed operative cholangiography can be an indispensable aid in the clarification of anatomic variations. In case of recognized operative injury to the extrahepatic biliary tree, primary repair or biliary-intestinal anastomosis can usually be carried out with good results.

Bile Ducts↗
PubMed1976

Anaerobic mediastinitis.

Three patients with anaerobic mediastinitis associated with retropharyngeal abscess have been encountered recently. Dental infections accounted for two instances, and the third instance resulted from rupture of the thoracic esophagus from blunt trauma. Each was marked by extreme difficulty in achieving complete abscess drainage due to the initially unrecognized virulence of the causative anaerobic bacteria. Complications were frequent and included empyema, pericarditis and aspiration pneumonia. The combination of vigorous diagnostic efforts, prompt operation and reoperation when necessary plus specific antibiotic effective against anaerobes led to a successful outcome for each patient.

Abscess↗
PubMedDate not supplied

Long-term results of side-to-side pancreaticojejunostomy.

Chronic alcoholism is the etiologic factor initiating most instances of chronic pancreatitis and its complications in the United States of America. The goal of operative intervention is to relieve incapacitating abdominal and back pain, while preserving as much endocrine and exocrine function as possible. Ultrasound and computed tomography scans are helpful for the identification of gross anatomical changes in the pancreas, but endoscopic retrograde cholangiopancreatography is critical for the precise delineation of pancreatic ductal anatomy. In patients who exhibit dilation of the pancreatic duct secondary to single or multiple sites of obstruction, pancreatic ductal drainage will provide complete or significant relief of pain in greater than 80% of patients. Side-to-side pancreaticojejunostomy has evolved as the operation which permits the widest drainage of the entire pancreatic ductal system. Although, initially, it was hoped that pancreatic exocrine and endocrine function would improve or stabilize after pancreatic ductal drainage, follow-up studies show that the destructive process in the pancreatic islets and acinar cells initiated by chronic alcoholism continues during the years after operation with an increasing incidence of diabetes and steatorrhea. Late mortality is primarily related to continued alcoholism and death secondary to alcohol-(and-smoking-) associated diseases. Correction of coexistent complications secondary to chronic pancreatitis including pseudocyst and biliary and/or duodenal obstruction should be considered at the time of pancreatic ductal drainage.

Alcoholism↗
PubMedDate not supplied

Pancreatic epithelial cyst in an adult treated by central pancreatectomy.

The infrequent occurrence of benign epithelial cysts of the pancreas is the reason why little is known regarding their clinical relevance and surgical management. We report the case of a 38-year-old woman with a benign epithelial cyst that was resected by the rarely performed central pancreatectomy. The presentation, evaluation, and differences between this and other cystic lesions of the pancreas are discussed. The benefits of central pancreatectomy for this benign lesion are reviewed.

Adult↗
PubMedDate not supplied

Systemic calciphylaxis in a patient with end-stage renal disease and a normal parathyroid hormone level taking erythropoietin intramuscularly.

OBJECTIVE: To describe a patient with systemic calciphylaxis. METHODS: We present a case of a 26-year-old woman with end-stage renal disease taking intramuscular injections of erythropoietin in whom systemic calciphylaxis subsequently developed. Both clinical and laboratory findings are reviewed. RESULTS: In a 26-year-old woman with end-stage renal disease who was taking erythropoietin intramuscularly, multiple, superficial ulcerative lesions developed on both lower extremities. Despite aggressive treatment, new lesions subsequently developed. Laboratory values showed an increased calcium-phosphate product and a normal parathyroid hormone level. A skin biopsy specimen showed necrotic skin and subcutaneous fat with foci of calcification around the vessels, findings that confirmed the diagnosis of calciphylaxis. The patient then underwent subtotal parathyroidectomy and responded with initial improvement; however, her condition later deteriorated, and she died of uncontrolled pulmonary hemorrhage. CONCLUSION: Systemic calciphylaxis is a rare but devastating complication of end-stage renal disease. This condition mimics many different disorders; therefore, a high index of suspicion is essential for early recognition and diagnosis, which is assisted by biopsy specimens of skin lesions. Treatment includes subtotal or total parathyroidectomy in conjunction with autotransplantation, administration of phosphate binders, aggressive treatment with antibiotics, and lowering of the calcium-phosphate product. Even though a successful outcome is possible when this disease is recognized early and treated aggressively, the morbidity and mortality associated with systemic calciphylaxis still remain high.

Journal Article↗