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Biomedical subjects

T R Gadacz

Publications and source records attributed to T R Gadacz.

At least 73 records · Page 4Linked to original sources
PubMed1983

Common bile duct complications of pancreatitis evaluation and treatment.

Five cases that illustrate the spectrum of biliary complications of pancreatitis and pancreatic pseudocyst are discussed. Obstructive jaundice, hemobilia, and bilious ascites were the major problems in these five patients. Sonography, transhepatic cholangiogram, endoscopic retrograde cholangiopancreatography, operative cholangiography, and arteriography are important in establishing the diagnosis and planning the treatment. Three patients had biliary obstruction caused by chronic pancreatitis, a pancreatic pseudocyst, or both. Two patients had a fistula between the common duct and the pseudocyst. Simple decompression of the pseudocyst was curative for only one patient. Three patients required decompression of the biliary tract, which emphasizes the need for intraoperative cholangiography. One patient required a Whipple operation to control hemorrhage but died in the immediate postoperative period. The operative findings determine the specific procedures for biliary tract decompression and pseudocyst drainage.

Alcoholism↗
PubMed1982

Suppression of lymphocyte function after aortic reconstruction. Use of nonimmunosuppressive anesthesia.

Serial estimations of lymphocyte responses to antigens and mitogens and in mixed lymphocyte culture in 13 major vascular surgical patients were carried out before and after operation, which was performed using anesthetic agents that have been shown not to depress lymphocyte function. All responses were significantly depressed up to five to eight days, and some up to nine to 11 days. Such depression, attributable to surgical trauma, may underline the vulnerability to infection of these patients who are having prostheses inserted.

Aged↗
PubMed1982

Selection of patients for dissolution of retained common duct stones with mono-octanoin.

Mono-octanoin is effective in the dissolution of retained common duct stones. Some of the failures of this solution to dissolve retained common duct stones are attributed to the low cholesterol content of the stones. This assumption was evaluated by analyzing gallbladder stones from 58 patients following cholecystectomy. Each stone was also incubated in mono-octanoin, and the composition of the stone was compared with the rate of dissolution. Stones containing 10% or less cholesterol did not appreciably dissolve in mono-octanoin. Stones 40% or greater in cholesterol content dissolved within an average of 3.3 days, which was significantly faster than those low in cholesterol (p less than 0.001). Following common duct exploration, stones should be saved for analysis or in vitro determination of the rate of dissolution in mono-octanoin. The use of mono-octanoin is recommended only for retained stones that are high in cholesterol or dissolve rapidly when incubated in mono-octanoin and should be effective in 91% of the cases.

Caprylates↗
PubMed1982

An appraisal of en bloc resection of peripheral bronchogenic carcinoma involving the thoracic wall.

Thirty-two patients with peripheral bronchogenic neoplasms adherent to the chest wall underwent en bloc pulmonary and thoracic wall resections. Presenting symptoms were thoracic wall pain (75 percent), hemoptysis (12.5 percent), and cough with weight loss (12.5 percent). Patients were selected for surgical resection only after a search for metastatic disease, including mediastinoscopy, showed negative results. A standard posterolateral thoracotomy incision was used which did not require skeletal reconstruction or prosthetic material for closure. There were nine major postoperative complications (28.8 percent), principally respiratory, and one operative death (3.1 percent). The five-year actuarial survival was 35 percent. None of the patients with regional lymph node involvement or positive chest wall margins lived more than two years after surgery. Preoperative irradiation performed in 12 patients (37.5 percent) improved operability, but did not significantly alter survival. These results indicate that patients with peripheral bronchogenic carcinoma involving the thoracic wall may be successfully managed with en bloc pulmonary and chest wall resection, particularly if surgery is performed in the early stage of the disease.

Adult↗
PubMed1982

Substernal gastric bypass for palliation of esophageal carcinoma: rationale and technique.

A review of sixteen consecutive patients who underwent substernal gastric bypass (SSGB) for middle and upper thoracic esophageal cancer is presented. All patients were alcoholics and heavy smokers with significant medical risk factors. All had locally advanced, long, circumferential, obstructing lesions with regional metastases. The operative mortality rate was 36% in this group of high-risk patients with advanced disease. This high mortality rate may decrease with the modifications discussed. The previously described technique of SSGB is detailed with special reference to a modification for widening the thoracic inlet. The palliation afforded was excellent in all survivors, and the median survival time was a surprisingly long 10 months. Alternative approaches are discussed in a review of the literature. SSGB provides quite possibly the superior approach for palliative management of these difficult lesions.

Aged↗
PubMed1982

The role of topical antibiotics in "high-risk" biliary surgery.

Controlled studies have demonstrated that systemic prophylactic antibiotics significantly reduce the sepsis rate after biliary tract surgery. Other studies have documented the efficacy of topical antibiotic irrigation in decreasing the incidence of wound infection after a wide variety of procedures. Whether systemic antibiotics or the combination of systemic and topical antibiotics provide any advantage over topical antibiotics alone, however, has not been determined. Therefore, a prospective, randomized study was carried out comparing topical intra-abdominal and wound antibiotic irrigation (neomycin and polymyxin) with topical antibiotic irrigation plus parenteral antibiotics (gentamicin and penicillin) in 54 patients undergoing "high-risk" biliary surgery. All patients underwent either an elective common bile duct exploration or a biliary-enteric anastomosis for obstructive jaundice. Twenty-five patients were randomized to the group receiving only topical antibiotics, and 29 received topical plus systemic antibiotics. The two groups were similar with respect to age, sex, presence of common duct stones, incidence of jaundice, positive bile cultures at surgery, and type of surgery performed. There were three wound infections in each group, and no patient developed an intra-abdominal abscess. Other infectious complications occurred with similar frequency in the two study groups. This study suggests that topical antibiotics provide effective prophylaxis in biliary tract surgery and that broad-spectrum systemic antibiotic therapy is of no additional benefit. Topical antibiotics provide an alternative means of prophylaxis for patients discovered intraoperatively to be at "high risk" for infection.

Administration, Topical↗
PubMed1982

Transhepatic decompression of the biliary tree in Caroli's disease.

Caroli's disease, defined as a congenital cystic dilatation of the intrahepatic segmental bile ducts, has responded poorly to conventional methods of treatment. Medical treatment has not been useful, and the various surgical procedures that have been proposed have met with limited success. The course of this disease is characterized by recurrent episodes of cholangitis, liver failure, and hemorrhage from esophageal varices. Two cases of Caroli's disease are presented. Both failed to respond to standard forms of internal and/or external drainage. However, one of the patients has been asymptomatic for 4 years after insertion of a silicone rubber transhepatic stent, despite suffering from recurrent cholangitis and other symptoms for more than 20 years previously. We therefore propose the use of a silicone rubber transhepatic stent as a possible approach to the treatment problem posed by Caroli's disease.

Adolescent↗
PubMed1981

Factors affecting mortality in biliary tract surgery.

Fifteen clinical and laboratory parameters in 155 consecutive patients having bile duct surgery over a 3 year period were analyzed in an effort to define the factors associated with a poor outcome and to define the subpopulation of patients at greatest risk. Ten of the 15 parameters evaluated were found to correlate significantly (p < 0.05) with hospital mortality. Five or more risk factors correlated significantly with mortality (p < 0.0001) and with postoperative renal failure, bacteremia and upper gastrointestinal hemorrhage (p < 0.005). This risk-factor analysis has the advantages of providing information rapidly and employing only clinical observations and readily available laboratory tests. Patients with five or more risk factors should be considered for preoperative percutaneous transhepatic decompression.

Adolescent↗
PubMed1981

Prolonged WBC depression after cimetidine in a patient with chronic myelogenous leukemia.

A patient with chronic myelogenous leukemia was treated with cimetidine and antibiotics after pneumonectomy. The prolonged suppression of the WBC that followed may be related to cimetidine administration in a stressed patient. Such patients should have periodic white blood cell counts because substituting the cyanoguanidine group for the thiourea group may not eliminate the hematologic effects of the H2 receptor antagonists.

Aged↗
PubMed1981

The effect of monooctanoin on retained common duct stones.

Monooctanoin is a medium-chain diglyceride that is effective in dissolving cholesterol gallstones in vitro. The in vivo efficacy of monooctanoin was evaluated in eight patients who had monooctanoin infused through the T tube to dissolve retained common duct stones. Five of eight (62%) experienced success. Abdominal cramps and diarrhea were the only side effects, and these resolved by temporarily stopping the infusion or decreasing the rate of the infusion. Since bilirubinate stones accounted for the three failures, the composition of the stone is the determining factor in selecting a treatment plan for retained common duct stones. Retained cholesterol stones can be successfully treated within 4 to 7 days by T-tube infusion of monooctanoin. Pigment stones should be removed by extraction through the T-tube tract or by endoscopic papillotomy.

Adult↗
PubMed1981

Construction of an ileocecal valve and its role in massive resection of the small intestine.

A method of construction a nonrefluxing valve to use as a substitute for the ileocecal valve in patients with massive resection of the small intestine has been described. We believe that this represents a safe and simple alternative to other valve mechanisms previously reported in the literature. Results using this valve in one patients and also in the laboratory are presented and discussed. The use of this valve significantly decreased mortality in laboratory dogs following massive resection of the small intestine and is associated with a decrease in weight loss and bacterial overgrowth when compared with the dogs in the group without the valve. It also results in an increase in intestinal transit time. While the final mechanism of the action of the valve is unclear, prevention of stasis of the small intestine and of regurgitation of the colonic contents seems to be of major importance.

Adolescent↗
PubMed1979

Postcholecystectomy diarrhea.

Diarrhea developed in three patients following cholecystectomy. Fecal bile-acid excretion was elevated in the two patients for whom it was measured. All three patients' diarrhea resolved with cholestyramine resin therapy. This experience suggests that gallbladder removal may lead to a bile-acid-mediated diarrhea in some patients, and that this condition appears to respond to cholestyramine therapy.

Bile Acids and Salts↗
PubMed1979

Intussusception of the excluded segment following jejuno-ileal bypass.

Intussusception of the defunctionalized intestinal segment following jejuno-ileal bypass for obesity has rarely been reported. Persistent crampy abdominal pain (often accompanied by nausea and vomiting) and normal radiologic evaluation are suggestive of this entity. The routine use of silver clips, although helpful in some instances, cannot exclude this diagnosis. A high index of suspicion and the use of sonography may prove that intussusception of the defunctionalized segment is more common than has been previously reported.

Humans↗
PubMed1978

Visceral vessel erosion associated with pancreatitis. Case reports and a review of the literature.

Visceral artery erosion is an uncommon but disasterous complication of pancreatitis. When gastrointestinal bleeding or severe intra-abdominal hemorrhage is associated with pancreatitis and the usual sources of bleeding are not detected by endoscopy or barium studies, erosion of a visceral vessel should be suspected. We present nine cases and an additional 44 cases from previous reports are reviewed. A palpable abdominal mass was present in 59% of the patients; however, a pseudocyst was present in 78%. Arteriography was performed in 15 patients and the source of bleeding was evident in 14. The splenic artery was the most common site of bleeding, although the other branches of the celiac axis and the middle colic artery have been involved. Successful treatment consisted of ligation of the bleeding vessel and, if present, drainage of the pseudocyst. Depending on the location of the vessel and the pseudocyst, major resections may be necessary. When bleeding and the pancreatic inflammatory process involved the colon, ligation of the bleeding site, drainage of the area, and colostomy was the most successful form of treatment.

Abdomen↗
PubMed1978

Bile acid composition in patients with and without symptoms of postoperative refulx gastritis.

Reflux of bile into the stomach is common after surgery for duodenal ulcer disease; however, only a minority of patients may develop significant gastritis and pain. Gastric aspirates from two groups of patients after operation for duodenal ulcer were quantitatively and qualitatively analyzed. Group A patients were asymptomatic and the bile composition was normal. Group B patients were symptomatic and had a significant increase in the secondary bile acid, deoxycholic acid. The concentration of bile acid was similar in the two groups. This alteration in bile acid composition, with an increase in deoxycholic acid, may be an important factor in determining which patients with bile reflux develop gastritis.

Bile↗