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Biomedical subjects

T L Dent

Publications and source records attributed to T L Dent.

At least 37 records · Page 2Linked to original sources
PubMed1984

Intraoperative fiberoptic endoscopy.

Conventional endoscopy is an indispensable tool in the diagnosis and management of many patients with gastrointestinal disease. Intraoperative use of the fiberoptic endoscope permits direct visualization of the mucosal surface, eliminating the need for enterotomy in many cases. Over a 4.5-year period, 32 patients underwent gastrointestinal endoscopy during laparotomy for a wide variety of surgical problems. In 15 cases, obscure or unknown sites of upper and lower gastrointestinal bleeding were localized. Replacement of percutaneously placed biliary drainage tubes was facilitated in four cases. In three patients artifactual lesions suggested by gastrointestinal (GI) contrast studies were excluded with intraoperative endoscopy at the time of exploratory laparotomy, and in four cases, retained foreign bodies were recovered easily without the need for enterotomy. In six additional patients intraoperative endoscopy was used to localize nonpalpable colon polyps or to determine the extent of mucosal ulceration. The average time for an intraoperative fiberoptic endoscopic examination was 20 minutes. No complications resulted from this technique. In summary, intraoperative fiberoptic endoscopy is of definite value in assessing selected patients with difficult GI surgical problems encountered during laparotomy. This technique enhances the surgeon's ability to identify and treat inaccessible and occult GI lesions.

Adult↗
PubMed1983

Therapeutic and diagnostic colonoscopy in nonobstructive colonic dilatation.

Cecal perforation has been well established as a consequence of mechanical obstruction of the distal colon and has been estimated to occur in 1.5% to 7% of patients with colon obstruction. Perforation of the cecum also occurs in cases of nonobstructive colonic dilatation (NCD). Although the incidence is unknown, the mortality rate is nearly 50%. Over an eight-year period, 44 patients (mean age 59 years) underwent 52 colonoscopic examinations for presumed NCD. Twelve patients (27%) developed NCD while convalescing from a recent operation and 29 patients (66%) had major systemic disorders that preceded the development of NCD. Medical treatment for an average of 2.6 days was uniformly unsuccessful. Mean cecal diameter prior to colonoscopy was 12.8 cm (range 9.5 to 17 cm). Based on radiographic or clinical criteria, 38 patients (86%) were successfully decompressed on the initial colonoscopic examination; mean cecal diameter decreased to 8.7 cm (p less than 0.01). Perforation of the cecum during colonsocopy occurred in one patient (2%) who survived. Fourteen patients died; six deaths were attributed solely to the patient's who underwent operation. In summary, colonoscopy is a safe and effective therapeutic and diagnostic tool in cases of massive cecal dilatation. It should be considered before cecostomy in patients without radiographic evidence of pneumoperitoneum or clinical signs of peritoneal irritation.

Adult↗
PubMed1983

Treatment alternatives in renal failure and renal transplantation patients with nonobstructive colonic dilatation.

The incidence of nonobstructive colonic dilatation (NCD) is unknown, but the attendant mortality associated with perforation is nearly 50%. Patients with chronic renal failure and transplant recipients may manifest many of the conditions that have been implicated in the development of NCD. Mechanical obstruction and ischemic bowel disease must be eliminated as causes for colon dilatation. Over a four-year period eight patients (mean age 50 years) were treated for presumed NCD. Six patients with a mean cecal diameter of 12.8 cm were treated initially with colonoscopy. Five patients (83%) had successful endoscopic decompression; of the three remaining patients, one underwent urgent ileocolectomy for cecal ischemia after unsuccessful endoscopic decompression, a second (cecal diameter 13 cm) had a tube cecostomy performed as an initial procedure, and the third (cecal diameter 9 cm) was managed successfully with enemas and nasogastric suction. Two deaths occurred in the series (25%), but both were unrelated to colon distension. No complications of colonoscopy were observed. The sequelae of massive NCD (cecal ischemia, perforation, and protracted sepsis) are poorly tolerated in the immunocompromised patient. Conservative management may be employed in patients with a cecal diameter of 9 cm, but urgent diagnostic and therapeutic colonoscopy is recommended for patients with a cecal diameter of 12 cm or greater. Operative tube cecostomy may be necessary if colonoscopic decompression is unsuccessful or cannot be performed.

Adult↗
PubMed1983

Limb-threatening potential of arteriosclerotic popliteal artery aneurysms.

Eighty-eight popliteal artery aneurysms were diagnosed in 59 men and two women (mean age 67 +/- 10 years). Bilateral aneurysms affected 27 patients (44%). Aneurysm diameter ranged from 1.3 to 12 cm (mean 4 +/- 2.6 cm). Most aneurysms were symptomatic (55%). Dominant symptoms included rest pain (19%), claudication (14%), local pain (13%), and gangrene (9%). The remainder of the aneurysms were asymptomatic (45%). Aneurysm thrombosis occurred in 24% of extremities. Associated aneurysms involved the abdominal aorta (62%), iliac artery (36%), and femoral artery (38%). Aneurysms that caused local pain were larger (6.2 +/- 1.9 cm) than asymptomatic aneurysms (2.9 +/- 2.1 cm, P less than 0.01). Aneurysms smaller than 2 cm were more likely to be asymptomatic than larger aneurysms (P less than 0.05). Operative intervention was undertaken for 56 aneurysms, with aneurysmal exclusion or excision with arterial reconstruction performed most often. Four primary and five secondary major amputations were associated with thrombosed aneurysms, compared to no amputations with asymptomatic aneurysms (P less than 0.01). Thirty-two aneurysms were not treated surgically. Limb loss resulted from ischemic complications which developed in 18% of aneurysms treated without operation. The duration of follow-up for patients who had operation and those who did not averaged 62 months and 25 months, respectively. Operative treatment for all bland popliteal artery aneurysms appears justified if complications leading to major amputation are to be avoided.

Adult↗
PubMed1983

The endorectal pull-through for the management of ulcerative colitis in children and adults.

Between June 1977 and November 1981, 26 children and adults with ulcerative colitis have undergone a total colectomy, an endorectal dissection of the rectal mucosa, and an ileoanostomy. A combined abdominoperineal approach was used to perform the operation, and the mucosal-submucosal rectal tube was dissected out intact from the abdominal approach. Every patient survived the operation and showed marked clinical improvement presumably due to resection of the diseased colon. Three patients developed intestinal obstruction that was successfully treated with an enterolysis. A rectal cuff abscess and a retroperitoneal abscess were the only other complications. The postoperative stooling pattern of each patient was obtained through detailed interviews. All the patients were continent during the day and at night one month after surgery. Twenty-two patients had a median stool frequency of seven per 24 hours one month after surgery. At one year, the average number of stools was seven per day. Six patients experienced a stool frequency of seven per 24 hours two years after surgery. The results with this series of patients had encouraged the authors to continue to recommend this approach to children and adults with ulcerative colitis, since it offers an alternative lifestyle that is more attractive to certain patients than the presence of an abdominal stoma.

Adolescent↗
PubMed1980

Clinical significance of arteriosclerotic femoral artery aneurysms.

One hundred seventy-two arteriosclerotic femoral artery aneurysms in 100 male patients, 47 to 91 years old, were evaluated. They were bilateral in 72% of the patients, and were associated with aortoiliac aneurysmal disease in 85% and with popilteal artery aneurysms in 44%. Femoral artery aneurysms were asymptomatic in 40 patients. Thirteen patients with thromboembolic episodes and two with rupture had ischemic limbs. Thirty-eight patients underwent primary operation for 50 femoral aneurysms, including 36 lower extremity arterial reconstructions, ten aortofemoral bypasses, one arterial ligation, and three amputations. Two operative deaths occurred, both associated with concomitant aortic surgery. Only three of 105 aneurysms in 58 patients followed nonoperatively were associated with later major limb-threatening complications. The low complication rate attending small, bland aneurysms justified nonoperative management. Large or symptomatic aneurysms warrant early operative intervention.

Aged↗
PubMed1980

Evaluation of the bleeding patient.

The recent development and widespread use of flexible fiberoptic endoscopy and visceral arteriography have revolutionized the evaluation of patients presenting with gastrointestinal hemorrhage. The bleeding lesion can now be precisely identified within a few minutes to hours of a patient's arrival, allowing specific treatment to begin much earlier than was previously possible. The logical sequence of diagnostic studies is different for three different groups of patients with gastrointestinal bleeding. Those whose bleeding is active or recent require rapid evaluation, while those with chronic bleeding may be evaluated first by the more traditional and less hazardous barium radiologic studies. This revolutionary improvement in diagnostic accuracy should improve the survival of patients with gastrointestinal hemorrhage.

Acute Disease↗
PubMed1977

Colonoscopic decompression of massive nonobstructive cecal dilation.

During the past three years, six patients with massive nonobstructive cecal dilation were treated by the surgical endoscopy service at the University of Michigan Medical Center. Case reports are presented on the five patients for whom decompression of the colon distention using the flexible fiberoptic colonoscope was successful. The sixth patient for whom nonoperative decompression was unsuccessful died following tube cecostomy. Colonoscopy, in our hands, has been a safe and effective method of nonoperatively decompressing the dilated cecum in seriously ill patients with a variety of severe associated conditions.

Aged↗
PubMed1976

Implications of precancerous rectal biopsy in patients with inflammatory bowel disease.

Sixty-five patients with an initial diagnosis of ulcerative colitis who underwent total proctocolectomy between 1955 and 1973 were studied retrospectively. Rectal mucosa in each patient was examined microscopically for the presence or absence of "precancerous" alterations as described by Morson and Pang. Histologic examination was made with no knowledge of concomitant colon carcinoma or the patients' clinical courses. Three of ten patients with precancerous rectal mucosa had invasive colon carcinoma, while none of the 55 patients without such changes had colon cancer (P less than .05, Fischer exact test). The duration of disease was significantly greater in those patients with rectal precancer (P less than .05). Reexamination changed the pathologic diagnosis in 15 patients from ulcerative colitis to granulomatous or "mixed" colitis. Two of three invasive cancers occurred in the reclassified group. Results support previous contentions that careful histologic evaluation of rectal biopsy specimens from individuals with inflammatory bowel disease may better define that population of patients with an increased risk of colonic carcinoma.

Colitis↗
PubMed1976

Flexible fiberoscopy of urinary conduits.

During the last 2 years 7 patients with intestinal urinary conduits, exhibiting symptoms of gross hematuria and ureteral stricture or other difficulty with the conduit, were examined with flexible fiberoptic endoscopes. The entire lumen of the intestinal conduit, all urinary-intestinal anastomoses and the bladder of 1 patient were visualized successfully. Retrograde pyelography was performed on 2 patients. In 4 of 7 patients we were able to demonstrate abnormalities that were not demonstrable by any other method.

Adolescent↗
PubMed1976

Long-term patency of vein grafts preserved in liquid nitrogen in dimethyl sulfoxide.

Autogenous canine jugular veins were stored in 15% dimethyl sulfoxide (DMSO) in liquid nitrogen vapor for one to 28 days and then implanted in the carotid artery as autografts. The patency rate at one year was 62.5-87.5%. The patency rate of fresh jugular vein autografts placed in the carotid artery for one year was 75%. Similar autografts stored in liquid nitrogen vapor for one to 28 days without the cryopreservative DMSO exhibited a zero to 12.5% patency rate at one year. Scanning electron microscope studies revealed preservation of theendothelium in DMSO protected veins and a damaged or sloughed endothelium in veins frozen without DMSO cryopreservation.

Animals↗
PubMed1976

Carotid body tumors.

Carotid body tumors are encounterd infrequently. During the past 30 years, 15 patients with 16 carotid body tumors have been treated at our medical center. All patients have been followed for a minimum of 7 years. The major findings relate to the areas of greatest controversy concerning carotid body tumor treatment: the need for excision, the value of preoperative arteriography, the role of radiation therapy, the criteria of malignancy, and the indications for and technique of carotid artery replacement. Discussed at length are our conclusions that (1) arteriography is absolutely diagnostic and therefore mandatory when carotid body tumor is suspected; (2) radiation therapy has little if any value and has increased the difficulty of excision; and (3) all carotid body tumors should be considered to be malignant. The familial tendency of this tumor is explored in relation to this last conclusion, and we report what we believe is the first finding of both a "benign" and "malignant" tumor occurring in the same family. The techniques of subadventitial excision and carotid artery replacement with autogenous saphenous vein, the latter necessary on three occasions, are demonstrated. There were no operative deaths, no serious complications after operation, and no recurrence or metastasis following total excision. However, two patients died as a direct result of tumor growth following biopsy without excision.

Adult↗
PubMed1975

Management of the recurrent ulcer.

One hundred seventeen patients with recurrent ulcer were treated at the University of Michigan Medical Center. The most satisfactory results were obtained when vagotomy was employed in the surgical therapy. Seventy-one of 91 patients treated by operation had a satisfactory result. In nine patients a second operation was required, and three patients underwent a third operative procedure. Twenty-one additional patients were satisfactorily treated medically so that, overall, 92 of 117 patients (79%) had a good result. Twelve patients had residual symptoms and 13 were lost to follow-up. There were no deaths attributable to recurrent ulcer in the entire series.

Adult↗