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Biomedical subjects

W M McKinnon

Publications and source records attributed to W M McKinnon.

At least 19 recordsLinked to original sources
PubMed1992

Current management of male breast cancer. A review of 104 cases.

Between 1975 and 1990, 104 male patients with a total of 106 breast cancers were treated at Memorial Hospital or the Ochsner Clinic and their records reviewed. The patients were followed for a median of 67 months (range, 0.5 to 14.4 years). Analysis of the frequency distribution by stage showed that 16 (17%) patients were stage 0 and 26 (27%) patients were stage I. The median duration of symptoms before diagnosis was 18 weeks (mean, 5 weeks; range, 1 to 156 weeks). Modified radical mastectomy was undertaken in 71 (67%) patients. The actuarial 5-year relapse-free survival for the entire group was 68% and the actuarial 5-year overall survival was 85%. Relapse-free survival at 5 years for axillary node-negative patients was 87% and for node-positive patients was 30% (p less than 0.001). Overall survival figures for the same subsets showed a 5-year survival of 100% for the node-negative subset and 60% for the node-positive subset. On multivariate analysis, the most powerful predictor of outcome in men was the status of the axillary lymph nodes, and the only prognostic factor that added significantly to this predictive power was the duration of symptoms. Patients who sought treatment less than 6 months after the onset of symptoms experienced a significant survival advantage when compared with patients whose symptoms were present for more than 6 months (p = 0.03). The profile of the stages at diagnosis, the treatment approach, and the survival rates approximate those reported in series of female breast cancers, and overall, the two diseases are remarkably similar.

Actuarial Analysis↗
PubMed1991

Roentgenographic evaluation of the augmented breast.

We performed a retrospective study to determine the sensitivity of mammography in detecting breast cancer arising in women with augmented breasts. Of eight women with breast implants in whom breast cancer developed, six had mammograms before biopsy. Only two of the six cancers were identified mammographically (sensitivity = 33%), and one of these two was seen only in retrospect. In both cases, the mammographic findings suggested a benign rather than a malignant process. All eight women had a palpable mass and early disease, and all are clinically disease-free at present. The sensitivity of mammography in detecting palpable cancers in a control group of women without implants was 92% (118 of 128). For tumors of 2 cm or less, the sensitivity was 88% (58 of 66). These results suggest that the sensitivity of mammography in detecting breast cancer is decreased when implants are present. Further investigations are needed to determine the effects of prostheses on mammographic evaluations.

Adult↗
PubMed1991

Foreign body in the gastrointestinal tract: intraluminal migration of laparotomy sponge.

We have reported a case of complete transluminal migration of a retained laparotomy sponge that caused repeated partial small bowel obstruction. Diagnosis was made when roentgenograms showed multiple positions of the laparotomy marker. The sponge was surgically removed. This is the 69th reported case of complete transluminal migration and distal movement of a laparotomy sponge.

Abdominal Pain↗
PubMed1991

Outpatient cholecystectomy simulated in an inpatient population.

This prospective clinical trial evaluates the feasibility and safety of elective cholecystectomy in a simulated outpatient protocol in 40 patients. Results were compared with a 19-patient control group managed by conventional postoperative methods. Oral liquids were begun in the recovery room, intravenous fluids were discontinued 4 hours after surgery, and enteral analgesics and antiemetics were provided on the ward. Protocol patients were randomized in a double-blind fashion to receive metoclopramide or placebo after surgery to assess its influence on the early tolerance of oral intake. In the protocol group, nausea without emesis occurred in nine patients (23%); 11 others (28%) had nausea with emesis. This was not significantly different from the control group. Metoclopramide-treated patients did not demonstrate a lower incidence of nausea or emesis but did tolerate oral liquids earlier after surgery than the placebo group (P less than 0.05). After release from recovery, eight protocol patients (20%) requested parenteral narcotics for relief of pain. Postoperative urinary catheterization was required in nine protocol patients (23%) and five control patients (26%). No major complications occurred. Outpatient cholecystectomy is both feasible and safe. Metoclopramide may allow earlier tolerance of enteral liquids postoperatively.

Abdomen↗
PubMed1991

Patterns of utilization of mammography comparison by physician specialties in 6,000 consecutive mammograms.

Mammography is regarded as the most important screening test for breast cancer. The combination of physical examination of the breast by a physician and mammography can result in reduced breast cancer mortality. Evidence is mounting that mammography alone can produce similar results. Despite these facts, mammography is underutilized in the United States. In an attempt to define the utilization of mammography in the Ochsner Medical Institutions, New Orleans, Louisiana, the records of 6,000 consecutive patients who underwent mammography were reviewed with respect to the specialty of the physician ordering the test. The ratio of the number of mammograms ordered by each service to the number of eligible patients (women over age 50) visiting that service provided insight into the patterns of utilization of mammography in the Ochsner Clinic. This information will allow for efficient utilization of time and resources in planning continuing education programs geared toward mammographic screening.

Adult↗
PubMed1991

The significance of mammographic findings after breast-conserving therapy for carcinoma of the breast.

Mammographic changes after lumpectomy, axillary dissection and irradiation are common and unpredictable. To study the significance of these changes at the first follow-up mammogram, we retrospectively reviewed reports of 172 women treated in this manner between 1979 and 1988. The mean follow-up time was 50 months. Eight patients had recurrences in the same breast, while 13 patients had carcinoma develop in the opposite breast. The mean time of follow-up mammograms was 11 months (range of one to 48 months). Twenty-six patients had a normal mammogram, while 146 patients had some changes within the irradiated breast. Thirty-one patients had suspicious findings--a mass, speculation or new microcalcifications. None of these 31 patients had carcinoma confirmed by biopsy or follow-up examination. Of eight patients with recurrence in the same breast, six had a biopsy because of findings on physical examination, while two had changes from previous mammograms. The mean time to recurrence was 50 months (range of 24 to 81 months). We conclude that mammographic changes in the irradiated breast are common after lumpectomy and irradiation for carcinoma of the breast. A baseline mammogram should be done six months after irradiation is completed. Changes that occur at this time should be considered secondary to surgical treatment and irradiation and are not an indication for immediate biopsy. These findings should be reconfirmed by a mammogram performed one year after irradiation to prove that these changes are stable. Physical examination and yearly mammography of both breasts are imperative in the follow-up evaluation of patients treated in this manner.

Adult↗
PubMed1987

Rupture of a previously bypassed popliteal aneurysm: a case report.

A case of rupture of a previously excluded popliteal aneurysm is reported and the pertinent literature reviewed. Symptoms of aneurysm expansion with nerve compression preceded the rupture. The need for continued follow-up after treatment of popliteal aneurysms is emphasized.

Aged↗
PubMed1981

Improved operative risk after myocardial revascularization.

At Ochsner Medical Institutions from 1970 to 1979, 96 patients who had previously had myocardial revascularization later had a total of 136 noncardiac operations. There were no postoperative myocardial infarctions and only one noncardiac death. Transitory postoperative arrhythmias occurred in 3.6% of patients. It appears that myocardial revascularization protects the cardiac patient from myocardial infarction and cardiac-related deaths during and after noncardiac operations. Patients with cardiac disease scheduled for elective surgery should have exercise testing or coronary cineangiography or both to evaluate the severity and significance of the coronary disease. If significant coronary lesions are demonstrated that are amenable to a bypass procedure, the operative risk will be lessened by prior revascularization.

Adult↗
PubMed1981

Ruptured hepatic artery aneurysm with hepatic artery-to-portal vein fistula. Preservation of portal flow by autogenous vein reconstruction.

Hepatic artery aneurysms are uncommon lesions that have varied clinical presentations. Rupture into the portal vein has occasionally been reported, as has associated gastrointestinal bleeding. A case is described in which an unusually large hepatic artery aneurysm ruptured into the portal vein, destroying a major portion of its wall. Reconstruction was accomplished successfully by use of an autogenous saphenous vein patch with preservation of hepatopetal portal flow.

Aged↗
PubMed1980

Current surgical management of pheochromocytoma during pregnancy.

The diagnosis of pheochromocytoma during pregnancy has rarely been made correctly prior to delivery, only 42 cases having been reported. Antepartum diagnosis markedly decreases the maternal and fetal mortality. We report a case of pheochromocytoma manifesting during the third trimester of pregnancy. Preoperative control of blood pressure with phenoxybenzamine and phentolamine therapy was carried out. Simultaneous cesarean section and excision of the tumor resulted in a healthy mother and newborn infant. We review the perioperative and intraoperative management of patients with a pheochromocytoma during pregnancy.

Adrenal Gland Neoplasms↗
PubMed1980

Techniques for operative reduction of pubic symphysis disruptions.

Occasionally, a pelvic fracture is an exceedingly difficult injury to manage in the multiple trauma victim. Accompanying hemorrhage can not only be life-threatening but often confuses the evaluation as to sources of blood loss. Reduction of a Malgaigne's or open book pelvic fracture aids significantly in stemming this extraperitoneal venous bleeding. If operative intervention for associated injuries is required, reapproximation of any pubic disruption should be performed concomitantly. Use of the rib approximator for this reduction saves considerable time and can be accomplished with relatively little effort.

Adult↗
PubMed1979

Metastatic melanoma of the gallbladder.

Metastatic involvement of the gallbladder in melanoma is rare, but constitutes the most common metastatic lesion involving this organ. Two cases of metastatic melanoma to the gallbladder with radiographic evidence of gallbladder abnormality prior to surgery are presented. These cases are compared to the nine previously reported cases of metastatic melanoma to the gallbladder with abnormal cholecystograms. All eleven cases presented with signs and symptoms compatible with cholecystitis. Nine of the eleven patients had a previous melanoma primary and most had other extrabiliary metastases. Associated cholelithiasis appeared to be only incidental. In addition, nine reported cases of "primary" biliary melanoma were reviewed. Clinical and pathologic presentations in the latter cases were similar to the former cases with metastases. Seventy-eight percent had extrabiliary sites of metastasis at some time in the course of their disease, tending to refute the impression of "primary" biliary melanoma. Melanoma in the gallbladder is much more likely to have metastasized from a regressed skin primary than to have arisen de novo. The two reported cases and the 18 cases from the literature indicate that the physician must consider gallbladder metastasis in melanoma patients presenting with symptoms compatible with cholecystitis.

Adult↗
PubMed1975

Evaluation of mini-dose heparin administration as a prophylaxis against postoperative pulmonary embolism: a prospective double-blind study.

A prospective double-blind study was instituted in a group of 150 general surgical patients to test the effectiveness of mini-dose heparinization in the pre- and postoperative periods. There was a 21 per cent reduction in the incidence of deep venous thrombosis in the heparin treated group. A radiopharmaceutical imaging technique with 99m-technetium macroaggregated albumin was used to evaluate the deep venous system. The procedure proved to be simple, safe, and painless; however, it was difficult to differentiate venous stasis from deep venous thrombosis. A negative study was good evidence that deep venous thrombosis did not exist. An additional benefit of this procedure was that a perfusion lung study could be obtained which provided additional information regarding pulmonary embolism without injecting additional radiopharmaceutical. Again, the negative perfusion lung study provided more information.

Adult↗