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Biomedical subjects

R O Gregg

Publications and source records attributed to R O Gregg.

11 recordsLinked to original sources
PubMed1988

The case for selective cholangiography.

Seven hundred sixty-five patients were operated on in two hospitals in 1979 and 1980, 190 of whom were submitted to operative cholangiography, 41 to primary common duct exploration, and 534 to neither. The incidence of common duct stones was 4 percent in the minimal indications group, 21 percent in the moderate indications group, and 91 percent in the maximal indications group. Follow-up of 5 years revealed 1 recurrence in the minimal group subjected to cholangiography and none among the 534 in whom no cholangiogram was obtained. In the period from 1981 through 1985, eight patients returned with common duct stones, having had no common duct stones at the primary operation. In the same period, 1,722 of 2,533 patients were operated on without cholangiography. The ratio of recurrences to primary operations without cholangiography was 1:225 or 0.45 percent. From these findings, we conclude that on the basis of cost-effectiveness and insurance against subsequent disease and disability, cholangiography is only indicated in patients with moderate indications (minimal jaundice, moderately dilated common duct, pancreatitis, or an increased serum amylase level). Cholangiography is not indicated if there are no indications of obstruction of the common duct by stones (as a routine for small stones in the gallbladder, if the cystic duct is patent, or if there is an isolated increased serum alkaline phosphatase level). Cholangiography is also unnecessary, when the indications of common duct stones are maximal (deep jaundice, huge common duct, cholangitis, or palpable stone). In our geographic area, intraoperative cholangiography should be selected in 7 to 8 percent of patients.

Cholangiography↗
PubMed1987

An ideal operation for diverticulitis of the colon.

A review has been made of the records of 208 patients operated on for complications of diverticulitis of the colon. One hundred forty patients had emergency operations and 68, elective operations. Resection and anastomosis, with or without temporary diverting colostomy, practiced in the majority of emergency cases in the earlier years covered in this review, has been replaced in the past 10 years by resection without anastomosis. Transverse colostomy, first carried out as part of a three-stage procedure, has been partially replaced by descending colostomy in the past few years. A comparison of the findings at exploration in patient who underwent resection, anastomosis, and temporary transverse colostomy with the findings in those who had the Hartmann procedure showed a slightly higher incidence of free perforation or abscess in those who had the former procedure. The hospital stay was similar in the two groups, but time in the operating room and days of disability were much less in the resection group. Only 14 of the 23 patients who survived the Hartmann procedure underwent restoration of continuity, whereas all of those in the resection group did. Follow-up of the patients who had descending colostomy showed that only 6 of 11 surviving patients underwent resection and anastomosis, but that inflammation regularly subsided, and all those with continent sphincters under age 80 eventually had restoration of continuity. This is in contrast to a more than 20 percent incidence of permanent stomas in the transverse colostomy group, all of which were in patients under age 70.

Aged↗
PubMed1985

Bypass or amputation? Concomitant review of bypass arterial grafting and major amputations.

In this survey, the results of arterial bypass grafting procedures for occlusive disease and after major amputations have been reported. The two series have been evaluated separately and then some comparisons have been made. The bypass graft series covered risk, mortality, and patency of grafts, including patency at 1 year. The amputation series covered risk, mortality, and effect of previous bypass on the level of amputation, and the ability to ambulate.

Adult↗
PubMed1978

Diagnosis and management of spontaneous aortoenteric fistulas.

Spontaneous aortoenteric fistulas are rare but appear to be increasing. They may occur anywhere from the esophagus to the rectum but most often between the duodenum and an infrarenal abdominal aortic aneurysm. Four patients (two with aortoesophageal, one with aortoduodenal, and one with aortocolic fistulas) are presented. The patient usually presents with the clinical triad of aortic aneurysm, pain suggesting aortic disruption, and gastrointestinal hemorrhage. The final exsanguinating hemorrhage is usually preceded by prodomal hemorrhages of varying severity which may be present for weeks to months. Endsocopy is the most helpful diagnostic procedure. Prompt aggressive surgical therapy is the only hope for survival. Successful reconstruction requires placement of the graft in uninfected tissue--often in an extraanatomic position--and interposition of healthy tissues between the graft and the repaired enteric tract.

Aged↗
PubMed1976

Pancreatitis and severe metabolic abnormalities due to phenformin therapy.

Two elderly diabetic patients with abdominal pain were demonstrated to have complications of phenformin hydrochloride therapy. The first developed severe lactic acidosis treated with sodium bicarbonate given intravenously and followed by rebound alkalosis. The second showed severe acidosis (specimens for lactate determination were unfortunately unsatisfactory for analysis) and similar alkalotic rebound after therapy. She then developed severe pancreatitis, proved at operation, no cause for which other than phenformin was apparent. Poor renal and hepatic function predispose to these conditions by increasing serum phenformin levels and by decreasing urinary excretion of its metabolites. The acidosis should be treated judiciously with sodium bicarbonate administered intravenously. A rebound alkalosis, ensuring as the accumulated lactate is metabolized, is best treated by potassium chloride and ammonium chloride given intravenously. The mechanism by which phenformin causes pancreatitis is unknown, but termination of therapy causes cessation of the pancreatitis.

Acidosis↗
PubMed1966

Aortic compressor.

Explore the source record for details and available documents.

Aortic Aneurysm↗