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Biomedical subjects

W F Ballinger

Publications and source records attributed to W F Ballinger.

At least 37 records · Page 2Linked to original sources
PubMed1977

Review of elective surgical treatment of chronic duodenal ulcer.

This article is a review of 20 clinical trials of various forms of elective surgical treatment of chronic duodenal ulcer conducted between 1964 and 1975, some of them prospective and others retrospective in nature. Comparisons have been made of the results following truncal vagotomy with drainage, truncal vagotomy with antrectomy, and partial gastrectomy. Additionally, selective vagotomy and truncal vagotomy have been compared in some studies and various forms of drainage, such as pyloroplasty and gastrojejunostomy, have been compared in others. In general, the results of all current forms of elective surgery for chronic duodenal ulcer have been very good, and the differences among the effects of the various procedures have been small. There have been no significant differences in the mortality rates associated with the several operations when they have been performed electively. The rate of ulcer recurrence and incidence of diarrhea have been somewhat higher after truncal vagotomy with drainage, whereas the frequency of dumping and amount of weight loss have been somewhat greater after all forms of gastric resection. Selective vagotomy appears to be associated with less frequent and severe diarrhea than does truncal vagotomy. There have been no apparent differences in the results of the various drainage procedure that have been combined with vagotomy. Highly selective vagotomy without drainage, the most recent operation for duodenal ulcer, has resulted in the lowest incidence of post-operative side effects of any surgical procedure in current use. However, the frequency of ulcer recurrence after this therapeutic measure remains to be determined by long-term studies.

Adult↗
PubMed1977

Gastric complications after radiotherapy for Hodgkin's disease and other lymphomas.

Six patients who originally received radiotherapy for Hodgkin's disease or primary gastric lymphoma developed radiation injury of the stomach requiring surgical management. Only two of these patients had evidence of gastric neoplastic involvement at the time of treatment. Experience with these patients leads us to draw the following conclusions: (1) Symptoms of radiation injury mimic those of recurrent neoplastic disease. (2) The effects of radiation are progressive and may be resistant to medical management. (3) The indications for surgical management include perforation, hemorrhage, obstruction, intractable pain, fistula formation, and inability to rule out recurrence. (4) Parenteral hyperalimentation can be an important adjunct in preparing debilitated patients for operation. (5) Gastric resection with gastrojejunostomy is the preferred operation. (6) Frozen section examination can be useful in determining the proper level of resection.

Adolescent↗
PubMed1977

A morphologic study of intrahepatic portal-vein islet isografts.

Isologous pancreatic islets were implanted into the portal vein of rats with streptozotocin-induced diabetes. At intervals of from one to 32 days after transplantation, the intrahepatic islet grafts were examined histologically and ultrastructurally, and their vascular supply was determined by later perfusion studies. Implanted islets were found widely dispersed throughout the liver in peripheral interlobular portal venules and surrounded by vacuolated liver cells containing large stores of glycogen. The endocrine cells were structurally normal in each interval examined. By the third day after transplantation the beta cells were depleted of secretory granules in aldehyde-fuchsin preparations. Regranulation returned by the 14th day and was associated with secretory organelle hypertrophy and hyperplasia. Islet cells were found outside the portal areas in direct apposition to hepatocytes forming distinct desmosomes by the first day. While hemoperfusion of the grafts occurred from the moment of implantation into the portal venule, a dual vascular supply derived from periportal arterial and venous sources developed by the 11th day after transplantation, establishing full vascularization of the grafts. Preliminary work is presented to show that an active ingrowth of nerves in the islet graft occurs in association with the process of vascularization.

Animals↗
PubMed1977

Intrasplenic islet isografts.

Sufficient numbers of pancreatic islets transplanted into the splenic pulp of streptozotocin-induced diabetic rats can result in complete reversal of hyperglycemia, glycosuria, and polyuria while promoting weight gain. These changes are constant for at least 3 months. Animals transplanted in this way, however, fail to exhibit a normal biphasic insulin response during an intravenous glucose tolerance test. This lack of biphasic response is in marked contrast to that observed in portal-vein--transplanted animals. Basal serum insulin in intrasplenic-transplanted animals is twice that observed in normal animals and portal-vein--transplanted animals which have received the same number of islet isografts. Direct injection of islets into the splenic pulp does not insure that subsequently all islets will remain in the splenic pulp, and, in fact, subsequent splenectomy suggests that in some cases a majority of transplanted tissue lodges in other organs--most likely, the liver.

Animals↗
PubMed1976

Serosal patch repair for benign duodenocolic fistula secondary to duodenal diverticulum.

A case of duodenocolic fistula secondary to a perforating diverticulum of the third portion of the duodenum was successfully managed by primary repair with use of a serosal patch over a difficult duodenal closure. The advantages of the serosal patch technic are discussed in light of other technics used for dealing with duodenal defects and fistulas.

Adult↗
PubMed1976

Anaerobic infections in surgery: clinical review.

Anaerobic bacteria are being recognized with increasing frequency as important micro-organisms in surgical infections. Clostridium, Bacteriodes, Fusobacterium, and Peptostreptococcus are the clinically prominent pathological anaerobes. All are commensals and, consequently, most anaerobic infections are endogenous in origin. In the colon, anaerobes are 1,000 times more prevalent than aerobes. This has important implications regarding the management of gastrointestinal tract operations and the treatment of infections originating from the bowel. Typical anaerobic infections include gas gangrene, brain abscess, oral infections, putrid lung abscesses, intra-abdominal abscesses, and wound infections following gynecologic and bowel surgery, perirectal abscesses, postabortal infections, and septic thrombophlebitis. Infections with anaerobic organisms must be suspected when there is feculent odor and/or gas production following gynecologic or bowel surgery, when there are organisms on gram staining but no growth on aerobic cultures, or when septicemia is associated with repeatedly negative blood cultures. Debridement and drainage constitute the main stay of treatment. All anaerobes are sensitive to chloramphenicol and clindamycin and all but Bacteroides fragils are sensitive to penicillin. Identification of anaerobes requires proper specimen sampling, immediate culturing on prereduced media, and careful gram staining of clinical material. The frequency of anaerobic organisms in surgical infections generally is not recognized by many surgeons; their importance needs to be stressed in the future.

Abscess↗
PubMed1975

Drug-induced colitis mimicking an acute surgical condition of the abdomen.

Pseudomembranous colitis secondary to antibiotic therapy has received increasing recognition. During a one-year period, eight of 42 patients with this entity had findings closely resembling an acute surgical condition of the abdomen manifested by fever, leukocytosis, and severe abdominal pain and tenderness. All eight patients received clindamycin and two were also given lincomycin hydrochloride monohydrate. Differentiation from an acute surgical condition of the abdomen was difficult until the characteristic findings of pseudomembranous colitis were noted on proctoscopic examination. Unnecessary celiotomy was averted in all patients. Seven of eight patients responded to discontinuation of the antibiotic and supportive measures; one required a diverting ileostomy. Drug-induced colitis must be an important consideration in any patient recently receiving antibiotics who develops fever, abdominal pain, and diarrhea.

Abdomen, Acute↗
PubMed1975

Lack of effect of an experimental prepaid group practice on utilization of surgical care.

The utilization of surgical care in an experimental period group practice for a 3 year period is reported. In contrast to what was expected, prepaid enrollees used the same or more surgical care than did control enrollees. The same proportion of emergency, urgent, and nonurgent admissions, occurred in both groups. Likewise there was no difference in the proportion of various procedures often thought to be overutilized in the traditional medical care system. High quality of surgical care in the area where the study was conducted was considered the most likely explanation for failure to show differences in the prepaid growth practice. Few, if any, unnecessary operations were performed in either group studied. Thus, under the conditions of this study, no significant measurable effect on surgical utilization by a change in the method of medical care organization and payment could be demonstrated.

Adult↗
PubMed1975

Transplantation of islets of Langerhans in diabetic rhesus monkeys.

Islets of Langerhans from unrelated donor rhesus monkeys were transplanted into the portal vein of five rhesus monkeys which had been made diabetic by partial pancreatectomy and Streptozotocin. There was definite improvement of the diabetic state with an increase in the mean KT1/2 from 0.71 to 1.52 percent per minute. The islets were isolated by a more efficient digestion-filtration process than previously had been described. This process has allowed, for the first time, successful isolation of large masses of islets permitting islet transplants in subhuman primates.

Animals↗