Search PubMed⌕ Search

Biomedical subjects

W E Strodel

Publications and source records attributed to W E Strodel.

At least 91 records · Page 5Linked to original sources
PubMed1986

Emergency gastrointestinal endoscopy and endoscopy for the emergency department.

Endoscopic procedures usually are not performed in the Emergency Department. However, on some occasions, it is essential that trained emergency physicians be able to perform endoscopic examinations. All physicians working in the Emergency Department should have an understanding of the role of endoscopy in the evaluation and treatment of gastrointestinal disorders, since in some cases, for example, those of massive upper and lower gastrointestinal hemorrhage, foreign body extraction, or functional and obstructive disorders of the colon, endoscopic procedures may be required on an emergency basis.

Colonoscopy↗
PubMed1986

Covert splenic abscess: a continuing challenge.

Although splenic abscess is a rare cause of intra-abdominal sepsis, the mortality rate remains high especially in patients with silent or covert lesions. The clinical presentation and course of five patients with overt splenic abscess and seven patients with covert splenic abscess seen during a thirty year period were analyzed. Average age of patients with overt lesions was 44.5 years. Direct extension from a contiguous source, hematogenous spread from a distant site (metastatic) and trauma comprised the known etiologies. Clinical features of localized left upper quadrant sepsis were commonly present but only one patient exhibited multiple organ failure. The clinical diagnosis was established preoperatively in four patients (80%) and all underwent splenectomy without mortality. All resected spleens contained solitary abscesses. In contrast, patients with covert lesions tended to be older (average age 56.1 years), uniformly exhibited multiple organ failure and rarely demonstrated local clinical findings of left upper quadrant sepsis. Trauma was a less common etiology than metastatic infection and direct extension. Four patients died without operation. Three patients underwent exploration for unrelated reasons, but the diagnosis of splenic abscess was made intraoperatively in only one patient. Mortality among patients with covert lesions was 86%. Multiple splenic abscesses were demonstrated in all patients with covert lesions. Splenic abscess presents as a spectrum of clinical disease. Solitary lesions can be readily diagnosed and treated by splenectomy. Multiple abscesses are usually covert, associated with multiple organ failure and highly lethal. The role of splenectomy in patients with covert lesions remains unknown.

Abscess↗
PubMed1986

Symptomatic biliary tract disease in the elderly patient.

Acute symptomatic biliary tract disease in the elderly is usually associated with a tenfold increase in operative morbidity and mortality when compared to the disease in non-elderly patients. Over a 10-year period 118 elderly patients with a mean age of 77.2 years (range 65 to 98 years) were operated on for benign biliary tract disease. Acute cholecystitis was found at operation in 33 patients (28%), empyema in nine (7.6%), gangrene of the gallbladder in three (2.5%), and 24 patients (20.3%) were found to have common bile duct stones. Seventy-three patients had chronic cholecystitis. Complications occurred in 29 patients (24.6%), with pneumonia and wound infection as the two most common. Fifteen patients died, making the overall mortality rate 12.7 per cent. The mean age of the patients who died was 81.5 years. Two patients died following elective operations (mortality rate 1.7%), while the remainder died after emergent or urgent operations (11%). Elective biliary tract surgery in the elderly for symptomatic disease is safe and will reduce postoperative morbidity and mortality.

Age Factors↗
PubMed1985

Efficacy of pharmacologic glucagon in acute experimental pancreatitis.

Microcirculatory derangements in the pancreas associated with acute pancreatitis may contribute to a low-flow state and lead to pancreatic necrosis. This study investigated the effects of glucagon, a selective mesenteric arterial dilator, on pancreatic ischemia in canine bile-trypsin-induced pancreatitis (BTP). Measurements of cardiac Index (CI), total pancreatic blood flow (QP), pancreatic oxygen consumption (O2CP), and pancreatic arteriovenous shunt flow (QAVS) were obtained prior to and after inducing BTP. Bile-trypsin-induced pancreatitis was induced in 18 dogs. Nine received lactated Ringer's solution alone (LRPAN) at 6.5 mL/kg/hr, nine received lactated Ringer's solution plus continuous Intravenous (IV) glucagon hydrochloride (GLUPAN) at 1.0 micrograms/kg/min, and nine undergoing periportal dissection without BTP received IV glucagon (GLUCON). Following BTP, CI, QP, and O2CP decreased significantly and QAVS remained unchanged in crystalloid-treated animals (LRPAN). Glucagon administration (GLUPAN) transiently increased CI and QP but failed to improve O2CP and did not change QAVS. The decrease in O2CP observed after BTP in association with a constant QAVS suggests a metabolic block to oxygen uptake at the cellular level. Glucagon in pharmacologic doses does not reverse abnormalities in O2CP and is therefore of questionable physiologic benefit in the treatment of acute pancreatitis.

Acute Disease↗
PubMed1985

Morbid obesity treated by gastroplasty: radionuclide gastric emptying studies.

Mechanisms by which gastroplasty for morbid obesity causes weight loss are poorly understood. We studied the role of altered gastric emptying in 50 patients before surgery, 1-4 weeks after surgery, and 2-24 months after surgery using technetium-99m pentetate in water for liquid meals and a Tc-99m styrene divinylbenzene copolymer resin in oatmeal for semisolid meals. We determined the emptying half-times of the stomach before and after surgery in the proximal and distal compartments. The proximal compartment emptied promptly in the early and late postoperative periods. The distal compartment emptied liquids at rates similar to those before surgery, while the late postoperative emptying of semisolids was significantly faster. The stoma connecting the two compartments thus permits rapid transit of liquids and semisolids without delay of distal compartment emptying. No correlation was seen between the emptying half-times or changes thereof and eventual weight loss. Delayed gastric emptying is therefore not the mechanism for satiety and weight loss after gastroplasty has been performed.

Adult↗
PubMed1985

Preliminary characterization of enterooxyntic activity on the guinea pig oxyntic cell.

Stimuli originating in the small intestine enhance gastric acid secretion, an effect termed the intestinal phase of gastric secretion. A humoral agent, enterooxyntin (EO) may mediate this effect. Mechanical distension of an ex vivo-perfused segment of canine jejunum caused the release of EO measured by cytochemical quantification of hydroxyl ion production (HIP) in guinea pig gastric oxyntic cells, an index of acid secretion. The H2 receptor antagonist, cimetidine (10(-5) M), and diamine oxidase, which hydrolyzes endogenous histamine, reduced HIP by 60% and 48%, respectively. Atropine (10(-5) M), the muscarinic cholinergic antagonist, reduced HIP by 75%. EO-induced HIP was also inhibited partially by the Ca2+ antagonist EGTA (10(-6) M) and by blockade of calcium channels with LaCl3 (10(-6) M). EO does not appear to operate through any single pathway. EO may be a single substance, different from gastrin, or a mixture of substances that have stimulatory effects on the oxyntic cell. Its action on the oxyntic cell is apparently mediated by both histaminergic and cholinergic pathways. Since neither cimetidine nor atropine completely inhibited EO-induced HIP, a direct effect of EO on the oxyntic cell seems likely and appears to depend on Ca2+. Isolation and purification of EO will be necessary to better assess the potency, efficacy, and the detailed cellular mechanisms of EO action.

Amine Oxidase (Copper-Containing)↗
PubMed1985

Hyperparathyroidism and gastroenteropancreatic hormone levels.

The diagnosis of multiple endocrine neoplasia (MEN) in patients with presumed hyperparathyroidism has important ramifications for patient management especially since as many as 20% of patients with hyperparathyroidism may have associated MEN. Gut hormone levels were measured before and after surgery in 28 patients who underwent resection of a single parathyroid adenoma for biochemical or clinical evidence of hyperparathyroidism. The mean serum calcium level was 11.9 +/- 0.2 mg/dl before surgery and 9.3 +/- 0.3 mg/dl after surgery (p less than 0.001). Two or more hormone levels were elevated in 32% of patients before surgery and 21% after surgery. The same hormone abnormalities (pancreatic polypeptide [PP] and gastrin) occurred 56% of the time. Of elevated preoperative levels of PP, 91% were in the normal range after surgery. In patients with elevated preoperative PP levels, the postoperative level of PP decreased by an average of 64% of the preoperative level. In 27% of patients the level increased more than double the preoperative value. In two of four patients with high levels of PP after surgery the serum calcium level failed to fall. Of 18 patients whose PP levels fell, 17 had a fall in serum calcium levels. Of six patients whose PP levels rose, four had a significant fall in calcium levels. There was no correlation between the absolute levels or the decremental change of calcium and the change in PP. Several abnormalities in gut hormone secretion occur in patients with primary hyperparathyroidism and a parathyroid adenoma. An elevated serum level of PP does not signify MEN syndrome and must be reevaluated after resection of the parathyroid adenoma. Failure of adequate tumor resection is attended by persistent elevation of serum calcium and PP levels.

Adult↗
PubMed1985

Routine endoscopy of the upper gastrointestinal tract in the evaluation of obstructive jaundice.

Our experience with flexible end-viewing EGD in the patient with jaundice demonstrated an over-all low specificity (19 per cent) for clinically significant lesions in this patient population. The discovery of synchronous lesions of the upper gastrointestinal tract in 12 patients did not change our diagnostic or therapeutic planning. Therefore, we believe that there is little justification for the increased costs and patient discomfort involved in routine EGD which should be abandoned in instances of obstructive jaundice and should be used only when more specific indications for its use are present.

Adult↗
PubMed1985

Extrapancreatic gastrinomas.

From 1978 to 1984, six patients (four men and two women) with functioning extrapancreatic gastrinomas were treated at the University of Michigan Medical Center. In all but one patient, who was known to have a liver metastasis, selective portal and peripheral venous sampling was performed to localize the site(s) of increased gastrin levels. Serum levels of carboxy (C) and amino (N) terminal gastrin moieties were measured before surgery with region-specific antisera and N/C ratios were calculated. All patients underwent operative exploration and successful resection of all gastrinomas present including a single large liver metastasis in one case. The C-terminal gastrin level was elevated in all cases and the N/C ratios were well below 1.0 (greater than 1 is consistent with malignancy and metastases) in all but the one patient with a liver metastasis. All patients have remained clinically free of tumor and have had normal basal and secretin-stimulated gastrin levels for as long as 5 years after operation. Three of the patients had undergone previous total gastrectomies and had done well apart from persistent hypergastrinemia before resection of the tumor. Two patients have not undergone any type of gastric operation. Appropriately selected patients with Zollinger-Ellison syndrome, particularly those with extrapancreatic primary lesions, may be candidates for a curative resection.

Adult↗
PubMed1984

Pancreatic polypeptide-producing tumors. Silent lesions of the pancreas?

Eight patients with pancreatic polypeptide (PP)-producing islet cell tumors and one patient with pseudo-PP-producing tumors were examined. Their age range was 20 to 74 years. Clinical features included abdominal pain in four patients, weight loss in four patients, diarrhea in two patients, gastrointestinal bleeding in two patients, and jaundice in one patient. The range of the basal serum level of PP was 394 to 35,100 pg/mL. In two patients the PP-producing tumors were associated with multiple endocrine neoplasia. Two patients had diffuse hepatic metastases at the time of diagnosis and four patients had disease limited to the pancreas. Pancreaticoduodenectomy and 80% pancreatectomy were performed in four and two patients, respectively. Immunohistochemical staining was positive for PP and neuron-specific enolase in all cases and was negative for other peptides except in one specimen with microadenomatosis. Patients who underwent curative resection are asymptomatic with normal serum levels of PP.

Abdomen↗
PubMed1984

Efficacy of preoperative biliary tract decompression in patients with obstructive jaundice.

Fifty consecutive matched patients with benign or malignant biliary tract obstruction were compared to determine the efficacy of preoperative percutaneous biliary drainage (PBD). Twenty-five patients underwent PBD for an average of nine days before operation; 25 patients underwent percutaneous transhepatic cholangiography ( PTHC ) followed immediately by operation. Serum bilirubin levels before PTHC were 16.5 +/- 7.6 mg/dL and 14.9 +/- 7.6 mg/dL in PBD and non-PBD groups, respectively. Serum bilirubin levels decreased to 6.5 +/- 6.2 mg/dL preoperatively in patients having PBD. One week after operation, bilirubin levels were 4.2 +/- 4.3 mg/dL and 9.0 +/- 5.2 mg/dL in the PBD and non-PBD groups, respectively. Major morbidity (sepsis, abscess, renal failure, or bleeding) occurred in two patients (8%) having PBD and in 13 patients (52%) without PBD. One patient (4%) with PBD, and five patients (20%) without PBD, died. The mean hospital stay was shorter for the PBD group. Preoperative PBD reduces operative mortality and morbidity and results in a more rapid resolution of hyperbilirubinemia during the postoperative period.

Biliary Tract Surgical Procedures↗
PubMed1984

Complicated access for regional infusion chemotherapy. A consequence of variant hepatic artery anatomy.

Arterial access for regional infusion chemotherapy of primary or metastatic liver cancers may be complicated because of inadequate vessel size or variant hepatic artery anatomy. Recently, an unusual case required that we devise an extemporaneous method of single-catheter access. This approach may, in selected cases, be an acceptable and safe alternative to a more traditional access technique.

Adenocarcinoma↗
PubMed1984

Substance P in the localization of a carcinoid tumor.

A 55-year-old woman with an ovarian carcinoid presented with intermittent facial and cervical flushing for 10 years, watery diarrhea for 4 years, and abdominal pain without hepatomegaly. Markedly elevated systemic venous and arterial serotonin levels (830 ng/ml; nl = 50-200 ng/ml) were found. The highest serotonin levels were observed in the superior vena caval system, but serotonin as a marker for tumor localization was inaccurate and led to an unproductive neck exploration. The histological pattern of this tumor contained purely insular elements. No hepatic or nodal metastases were identified and the lesion was unilateral. Substance P levels were elevated in the venous drainage of the left ovary and in retrospect correctly localized the ovarian tumor. This peptide may prove to be another carcinoid tumor marker in addition to serotonin and 5-hydroxyindoleacetic acid. Substance P may also be an important mediator of symptoms in patients with carcinoid syndrome.

Carcinoid Tumor↗
PubMed1984

Effects of portacaval shunt and portacaval transposition on hepatocellular and hepatic reticuloendothelial cell activity in the dog.

UNLABELLED: Quantitative reduction of portal blood flow following a portacaval shunt (PCS) adversely affects hepatocyte function, but does not alter HRES activity [L. P. Edgcomb , J. A. Knol , and F. E. Eckhauser . J. Surg . Res. 33: 233, 1982]. To determine whether similar changes occur after qualitative alteration of portal blood flow, portacaval transpositions (PCT) were constructed in six conditioned mongrel dogs. Estimated hepatic blood flow (EHBF) was determined scintigraphically by the rate of hepatic uptake of a 500-microCi dose of 99mTc -sulfur colloid (Tsc). Hepatic reticuloendothelial cell (RES) phagocytic (PI) and degradative (DI) indices were calculated from the half-time blood disappearance of 131I-labeled RES test lipid emulsion, and the half-time urine appearance of free 131I, respectively. Opsonic activity (OI) was determined by gelatin latex particle agglutination and normalized to control values. Hepatocellular function was assessed by serial determinations of albumin (Alb), and pyruvic and glutamic oxaloacetic transaminases (SGPT and SGOT). All studies were performed prior to and at 3, 6, and 9 weeks following PCS or PCT. CONCLUSIONS: In the dog, neither PCS nor PCT adversely affected HRES activity. Hepatocellular function and OI remained unchanged following PCT but deteriorated significantly after PCS. Observed changes in hepatocyte function and OI following PCS suggest that hepatocellular integrity and serum opsonic activity may be interrelated.

Alanine Transaminase↗
PubMed1984

Cystic neuroendocrine neoplasms of the pancreas and liver.

Four cases involving cystic endocrine neoplasms of the pancreas and liver are reported. Because of their rich collateral blood supply, islet cell tumors of the pancreas, even if large in size, rarely undergo central or cystic degeneration. However, failure to appreciate that a small percentage of these neoplasms may mimic benign pancreatic pseudocysts by their clinical and radiological appearance can lead to inappropriate surgical therapy. Ultrasound, computerized tomography, and/or angiography are rarely helpful in distinguishing between benign and neoplastic cysts. The definitive diagnosis can be made with assurance only by obtaining a generous biopsy of the cyst wall or any intracystic excrescences for histologic examination. Functional cystic tumors of the pancreas or liver should be excised totally whenever possible, and efforts should be made to remove as much of the tumor mass as possible even when a curative resection cannot be accomplished. Internal drainage may be acceptable as palliation for large, unresectable tumors.

Adenoma, Islet Cell↗