107 results on '"Adson MA"'
Search Results
2. PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY: THE DIFFERENTIAL DIAGNOSIS OF BILE DUCT PATHOLOGY
- Author
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Fleming Mp, Adson Ma, and Carlson Hc
- Subjects
medicine.medical_specialty ,Biliary Tract Diseases ,Biopsy ,medicine.medical_treatment ,Percutaneous transhepatic cholangiography ,Diagnosis, Differential ,Cholangiography ,Cholelithiasis ,Methods ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Technology, Radiologic ,medicine.diagnostic_test ,Bile duct ,business.industry ,General Medicine ,Bile Ducts, Intrahepatic ,medicine.anatomical_structure ,Bile Duct Neoplasms ,Surgical Procedures, Operative ,Bile Ducts ,Radiology ,Differential diagnosis ,business - Abstract
We studied 88 attempts at cholangiography on 87 patients.Sixty were successful and we analyzed these in an effort to establish criteria for the differential diagnosis of bile duct pathology.Twenty-eight were unsuccessful; operative or T-tube cholangiograms were studied in 10 of these cases and biopsy results in 9, in order to determine the reason for failure and its inferential value. Seven of the 28 patients in whom cholangiography was unsuccessful were found to have obstructed bile ducts at operation.
- Published
- 1972
3. Resection of the liver for colorectal carcinoma metastases - A multi-institutional study of long-term survivors
- Author
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Hughes, KS, Rosenstein, RB, Songhorabodi, S, Adson, MA, Ilstrup, DM, Fortner, JG, Maclean, BJ, Foster, JH, Daly, JM, Fitzherbert, D, Sugarbaker, PH, Iwatsuki, S, Starzl, T, Ramming, KP, Longmire, WP, O'Toole, K, Petrelli, NJ, Herrera, L, Cady, B, McDermott, W, Nims, T, Enker, WE, Coppa, GF, Blumgart, LH, Bradpiece, H, Urist, M, Aldrete, JS, Schlag, P, Hohenberger, P, Steele, G, Hodgson, WJ, Hardy, TG, Harbora, D, McPherson, TA, Lim, C, Dillon, D, Happ, R, Ripepi, P, Villella, E, Smith, W, Rossi, RL, Remine, SG, Oster, M, Connolly, DP, Abrams, J, Al-Jurf, A, Hobbs, KEF, Li, MKW, Howard, T, Lee, E, Hughes, KS, Rosenstein, RB, Songhorabodi, S, Adson, MA, Ilstrup, DM, Fortner, JG, Maclean, BJ, Foster, JH, Daly, JM, Fitzherbert, D, Sugarbaker, PH, Iwatsuki, S, Starzl, T, Ramming, KP, Longmire, WP, O'Toole, K, Petrelli, NJ, Herrera, L, Cady, B, McDermott, W, Nims, T, Enker, WE, Coppa, GF, Blumgart, LH, Bradpiece, H, Urist, M, Aldrete, JS, Schlag, P, Hohenberger, P, Steele, G, Hodgson, WJ, Hardy, TG, Harbora, D, McPherson, TA, Lim, C, Dillon, D, Happ, R, Ripepi, P, Villella, E, Smith, W, Rossi, RL, Remine, SG, Oster, M, Connolly, DP, Abrams, J, Al-Jurf, A, Hobbs, KEF, Li, MKW, Howard, T, and Lee, E
- Abstract
In this review of a collected series of patients undergoing hepatic resection for colorectal metastases, 100 patients were found to have survived greater than five years from the time of resection. Of these 100 long-term survivors, 71 remain disease-free through the last follow-up, 19 recurred prior to five years, and ten recurred after five years. Patient characteristics that may have contributed to survival were examined. Procedures performed included five trisegmentectomies, 32 lobectomies, 16 left lateral segmentectomies, and 45 wedge resections. The margin of resection was recorded in 27 patients, one of whom had a positive margin, nine of whom had a less than or equal to 1-cm margin, and 17 of whom had a greater than 1-cm margin. Eighty-one patients had a solitary metastasis to the liver, 11 patients had two metastases, one patient had three metastases, and four patients had four metastases. Thirty patients had Stage C primary carcinoma, 40 had Stage B primary carcinoma, and one had Stage A primarycarcinoma. The disease-free interval from the time of colon resection to the time of liver resection was less than one year in 65 patients, and greater than one year in 34 patients. Three patients had bilobar metastases. Four of the patients had extrahepatic disease resected simultaneously with the liver resection. Though several contraindications to hepatic resection have been proposed in the past, five-year survival has been found in patients with extrahepatic disease resected simultaneously, patients with bilobar metastases, patients with multiple metastases, and patients with positive margins. Five-year disease-free survivors are also present in each of these subsets. It is concluded that five-year survival is possible in the presence of reported contraindications to resection, and therefore that the decision to resect the liver must be individualized. © 1988 American Society of Colon and Rectal Surgeons.
- Published
- 1988
4. Advances in the radiology of jaundice: a symposium and review
- Author
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Ferrucci, JT, primary, Adson, MA, additional, Mueller, PR, additional, Stanley, RJ, additional, and Stewart, ET, additional
- Published
- 1983
- Full Text
- View/download PDF
5. Percutaneous biliary decompression: internal and external drainage in 50 patients
- Author
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Berquist, TH, primary, May, GR, additional, Johnson, CM, additional, Adson, MA, additional, and Thistle, JL, additional
- Published
- 1981
- Full Text
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6. Pantothenic acid, coenzyme A, and human chronic ulcerative and granulomatous colitis
- Author
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Ellestad-Sayed, JJ, primary, Nelson, RA, additional, Adson, MA, additional, Palmer, WM, additional, and Soule, EH, additional
- Published
- 1976
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7. An endangered ethic--the capacity for caring.
- Author
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Adson MA
- Subjects
- Ethical Theory, Humans, Minnesota, Patient Advocacy, Patient-Centered Care, Social Change, Virtues, Ethics, Institutional, Ethics, Medical, Hospitals, Teaching
- Published
- 1995
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8. Trends in morbidity and mortality of hepatic resection for malignancy. A matched comparative analysis.
- Author
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Tsao JI, Loftus JP, Nagorney DM, Adson MA, and Ilstrup DM
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- Adolescent, Adult, Aged, Aged, 80 and over, Blood Transfusion statistics & numerical data, Carcinoma, Hepatocellular surgery, Colon surgery, Diaphragm surgery, Drainage, Female, Fluid Therapy statistics & numerical data, Hepatectomy methods, Humans, Intestinal Obstruction epidemiology, Intraoperative Care, Length of Stay statistics & numerical data, Liver Neoplasms complications, Liver Neoplasms secondary, Lung surgery, Male, Middle Aged, Minnesota epidemiology, Reoperation, Retrospective Studies, Surgical Wound Infection epidemiology, Hepatectomy adverse effects, Hepatectomy mortality, Liver Neoplasms surgery
- Abstract
Objective: The authors define more clearly the trends in morbidity and mortality after hepatic resection for malignant disease in matched patient groups during two discrete time periods., Summary Background Data: Recent reports have shown improvement in operative morbidity and mortality associated with hepatic resection; however, results often included resections for benign disease and trauma. Furthermore, specific factors contributing to the improvement in operative risks between the last two decades have not been defined., Methods: A retrospective matched comparative analysis was conducted of patients with primary and metastatic hepatic malignancy resected with curative intent between two periods (1976 to 1980 and 1986 to 1990). Eighty-one patients met our inclusion criteria in the early period; this group was matched with 81 patients from the latter period by the following four parameters: age, gender, type of malignant disease, and extent of resection. Records of these two patient groups were abstracted for clinical presentation, co-morbid factors, operative techniques, and perioperative morbidity and mortality., Results: The authors found a significant decrease in operative morbidity, median perioperative transfusion, and length of hospital stay in the latter period (1986 to 1990). The incidence of postoperative subphrenic abscess and intra-abdominal hemorrhage was significantly lower during this period. Operative mortality rate was similar for both periods, 4.9% and 1.2%, respectively (p > 0.05)., Conclusion: Hepatic resection for malignant disease currently can be performed with a low morbidity and mortality in the hands of trained and experienced hepatic surgeons; operative risks of hepatic resection should not deter its application in the treatment of primary and metastatic malignant disease of the liver.
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- 1994
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9. Perioperative blood transfusion and determinants of survival after liver resection for metastatic colorectal carcinoma.
- Author
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Rosen CB, Nagorney DM, Taswell HF, Helgeson SL, Ilstrup DM, van Heerden JA, and Adson MA
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- Aged, Colorectal Neoplasms mortality, Female, Hepatectomy, Humans, Liver Neoplasms mortality, Male, Middle Aged, Prognosis, Retrospective Studies, Survival Rate, Blood Transfusion, Colorectal Neoplasms pathology, Liver Neoplasms secondary, Liver Neoplasms surgery
- Abstract
The authors reviewed their institutional experience with liver resection for metastatic colorectal carcinoma to (1) determine whether perioperative blood transfusion affects survival; (2) identify prognostic determinants; and (3) estimate the patient requirement for a prospective randomized trial designed to demonstrate efficacy of liver resection. Two hundred eighty consecutive patients treated by potentially curative liver resection between 1960 and 1987 were included. Data were obtained for all but 10 patients for at least 5 years after operation or through 1990. Actuarial survival curves related to potential prognostic determinants were analyzed with the log-rank test. Overall, survival was 47 +/- 3% at 3 years and 25 +/- 3% at 5 years, including 4% 60-day operative mortality rate. Eighty-one patients who did not receive blood 7 days before to 14 days after operation had 60 +/- 6% 3-year and 32 +/- 6% 5-year survival compared with 40 +/- 4% and 21 +/- 3% survival rates for 183 patients who received at least one unit (p = 0.03, operative deaths excluded). Extrahepatic disease (p = 0.015), extrahepatic lymph node involvement (p = 0.002), satellite configuration of multiple metastases (p = 0.0052), and initial detection by abnormal liver enzymes (p = 0.0005) were associated with poor survival rates. Synchronous presentation of metastatic and stage B primary disease was associated with a favorable prognosis (p = 0.003). The requirement for a prospective randomized trial estimated by an exponential survival model would be 36, 74, 168, or 428 patients if 5-year survival without resection were 1, 5, 10, or 15%. We conclude that (1) perioperative blood transfusion may be adversely associated with survival; (2) extrahepatic disease, extrahepatic lymph node involvement, satellite configuration, and initial detection by clinical examination or a liver enzyme abnormality portend a poor prognosis; and (3) a prospective randomized trial of liver resection is impractical because of the large patient requirement, at least by a single institution.
- Published
- 1992
- Full Text
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10. Intrahepatic cholangiocarcinoma: clinical aspects, pathology and treatment.
- Author
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Schlinkert RT, Nagorney DM, Van Heerden JA, and Adson MA
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Neoplasm Staging, Survival Rate, Adenoma, Bile Duct complications, Adenoma, Bile Duct mortality, Adenoma, Bile Duct pathology, Adenoma, Bile Duct surgery, Liver Neoplasms complications, Liver Neoplasms mortality, Liver Neoplasms pathology, Liver Neoplasms surgery
- Abstract
Intrahepatic cholangiocarcinoma (ICC) is the second most common primary tumor of the liver. To further define its clinicopathology and surgical management, we reviewed our experience. Clinical presentations of 32 patients with ICC was similar to that with hepatocellular carcinoma. Jaundice occurred in only 27 percent. ICC was unresectable due to advanced disease stage in 81 percent. Six patients had curative resections with two 5 year disease free survivors. Underlying liver disease was associated with ICC in 34 percent of patients.
- Published
- 1992
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11. Carcinoma of the gallbladder. Does radical resection improve outcome?
- Author
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Donohue JH, Nagorney DM, Grant CS, Tsushima K, Ilstrup DM, and Adson MA
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- Adult, Aged, Aged, 80 and over, Carcinoma mortality, Carcinoma pathology, Carcinoma secondary, Cholecystectomy mortality, DNA, Neoplasm analysis, Female, Flow Cytometry, Gallbladder Neoplasms mortality, Gallbladder Neoplasms pathology, Humans, Male, Middle Aged, Neoplasm Staging, Prognosis, Retrospective Studies, Survival Rate, Carcinoma surgery, Cholecystectomy statistics & numerical data, Gallbladder Neoplasms surgery
- Abstract
The records of 111 patients with gallbladder carcinoma operatively treated between 1972 and 1984 were retrospectively reviewed. Fifty-seven percent of patients had distant metastases; another 16% had nodal metastases without distant disease. Median survival was 0.5 years, and 5-year survival was 13%. Clinical jaundice, tumor stage, and tumor grade were all predictive of patient outcome. DNA ploidy, measured in 70 patients, was not a prognostic indicator. In 36% of patients, cholecystectomy (20%) or radical cholecystectomy (16%), which included adjacent liver and regional lymph node resection, was potentially curative. Median survival for patients undergoing radical procedures was 3.6 years, and survival was 0.8 years for patients following cholecystectomy. The 5-year survival rates were comparable (33% vs 32%). While radical cholecystectomy may benefit individual patients and can be accomplished with low morbidity, there was no overall survival advantage compared with cholecystectomy.
- Published
- 1990
- Full Text
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12. Primary hepatic malignancy: surgical management and determinants of survival.
- Author
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Nagorney DM, van Heerden JA, Ilstrup DM, and Adson MA
- Subjects
- Adolescent, Adult, Aged, Child, Child, Preschool, Female, Humans, Infant, Liver Cirrhosis complications, Liver Diseases complications, Liver Neoplasms mortality, Liver Neoplasms pathology, Male, Middle Aged, Morbidity, Prognosis, Time Factors, Liver Neoplasms surgery
- Abstract
To further define the clinicopathologic features and determinants of survival, we reviewed the cases of 110 patients with primary hepatic malignancy managed surgically between 1975 and 1986. Presenting signs of symptoms were pain (57%), fatigue (48%), abdominal mass (40%), and weight loss (33%). Twenty-six percent of patients had a history of hepatitis or cirrhosis. Histopathologically, tumors were hepatocarcinoma (72%), fibrolamellar variant (7%), cholangiocarcinoma (9%), mixed (7%), and other (5%). Resectability rate with curative intention was 67%. Exploration and biopsy alone was performed in 27% and palliative resection in 6%. Hospital mortality was 9%, and serious morbidity was 22%. Perioperative morbidity and mortality were significantly associated with operative blood loss. Median survival was 12.6 months, with a 5-year survival of 18%. Median survival after curative resection was 22.8 months, and 5-year survival was 27%. Univariate analysis showed that female sex, normal performance status, well-differentiated tumor, and curative resection were associated with increased survival; cholangiocarcinoma, nodal metastases, cirrhosis, hypocalcemia, prolonged prothrombin time, and increased serum transaminase and alkaline phosphatase were associated with decreased survival. Cox multivariate analysis showed that curative resection, normal performance status, and well-differentiated tumors were associated with increased survival, and prolonged prothrombin time and hypocalcemia were associated with decreased survival.
- Published
- 1989
13. Prognostic significance of nuclear deoxyribonucleic acid ploidy patterns in resected hepatic metastases from colorectal carcinoma.
- Author
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Tsushima K, Nagorney DM, Rainwater LM, Adson MA, Farrow GM, Ilstrup DM, and Lieber MM
- Subjects
- DNA, Neoplasm analysis, Female, Flow Cytometry, Humans, Liver Neoplasms secondary, Male, Middle Aged, Prognosis, Colonic Neoplasms analysis, DNA, Neoplasm genetics, Liver Neoplasms analysis, Ploidies, Rectal Neoplasms analysis
- Abstract
Nuclear deoxyribonucleic acid (DNA) ploidy studies of paraffin-embedded archival tumor specimen blocks were performed by flow cytometry on extracted nuclei from 101 surgically resected hepatic metastases from colorectal cancer. In 28 patients, the corresponding primary carcinoma of the metastases was also studied. Tumor clinicopathology and clinical course of the patients were reviewed. Preparation of paraffin-embedded tissue specimens was performed by the technique of Hedley et al. and stained with propidium iodide according to the method of Vindelov et al. Eighty-eight of 101 metastatic tumors and 26 of 28 primary tumors yielded evaluable DNA histograms. Twenty-six metastases showed a DNA diploid pattern, 25 showed a significantly increased 4C peak (DNA tetraploid/polyploid), and 37 had a DNA aneuploid peak. Ploidy pattern was constant between primary and metastases in 84.6% of tumors. No significant relationship between host and tumor characteristics and ploidy pattern was found except for a correlation between grade 3 metastases and DNA aneuploid. Survival of patients with DNA aneuploid metastases was significantly less than that of patients with DNA diploid metastases (p = 0.03). However, among DNA nondiploid metastases, survival was significantly less for low DNA index metastases (less than or equal to 1.5) than for high DNA index (greater than 1.5) metastases (p less than 0.05). Flow cytometric DNA ploidy measurements may have prognostic value for patients with resected hepatic metastases from colorectal carcinoma.
- Published
- 1987
14. Biliary decompression in hilar obstruction. Round ligament approach.
- Author
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Dudley SE, Edis AJ, and Adson MA
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- Biliary Tract Diseases complications, Biliary Tract Diseases surgery, Cholangiography, Cholestasis complications, Humans, Liver surgery, Liver Neoplasms complications, Cholestasis surgery, Hepatic Duct, Common surgery
- Abstract
In some patients with biliary obstruction, access to the hepatic hilus is hindered by extensive tumor or by dense vascular scar tissue. In such patients, the biliary tract may be decompressed via the left hepatic duct away from the affected hilus. Access to the left hepatic duct in the left intersegmental plane is gained by dividing the round ligament, freeing it from the undersurface of the liver, and following it to its junction with the left portal vein. The left hepatic duct, which lies superior to the vein, is exposed by dividing the liver overlying the round ligament in the relatively avascular plane between the lateral and the medial segments of the left hepatic lobe. Decompression can be effected by simple tube drainage or, if the duct is large enough, by Roux-en-Y hepaticojejunostomy.
- Published
- 1979
- Full Text
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15. Rectal cancer following colectomy for polyposis.
- Author
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Bess MA, Adson MA, Elveback LR, and Moertel CG
- Subjects
- Actuarial Analysis, Adenocarcinoma mortality, Adolescent, Adult, Aged, Analysis of Variance, Child, Colonic Neoplasms mortality, Female, Follow-Up Studies, Humans, Intestinal Polyps mortality, Male, Middle Aged, Postoperative Complications, Rectal Neoplasms mortality, Adenocarcinoma complications, Colectomy, Colonic Neoplasms surgery, Intestinal Polyps surgery, Rectal Neoplasms complications
- Abstract
Reevaluation of 178 patients treated for multiple colonic polyposis by abdominal colectomy and restoration of bowel continuity confirmed that patients with both rectal and colonic polyps are at substantial risk of having rectal cancer develop postoperatively. Rectal cancer has not occurred in any of 35 patients who had no rectal polyps preoperatively. However, 46 (32%) of 143 patients with multiple colorectal polyposis have had cancer develop during a median follow-up of nearly 20 years. Multivariate analysis showed a highly significant association between the number of rectal polyps present preoperatively and decreased survivorship free of rectal cancer (P less than .001), and a strong correlation between the presence of cancer in the resected colon and subsequent development of rectal carcinoma (P less than .01). No correlation could be established between low anastomosis and prevention of rectal carcinoma. The risk of cancer developing in the retained segment of large bowel can be established only by extended postoperative observation.
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- 1980
- Full Text
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16. Gallstone pancreatitis.
- Author
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Linos DA and Adson MA
- Subjects
- Adult, Aged, Amylases blood, Cholelithiasis blood, Female, Follow-Up Studies, Gallstones blood, Gallstones complications, Humans, Male, Middle Aged, Pancreatitis blood, Cholelithiasis complications, Pancreatitis etiology
- Abstract
The charts of 55 patients with clinical and surgical evidence of pancreatitis, secondary to gallstones, were reviewed. Patients with a history of high alcoholic intake were excluded. Gallstones were retrieved from all patients, 18 (33%) of whom had choledocholithiasis. Severe pancreatitis with extensive fat necrosis was documented during surgery in 27 patients (49%). We found an inverse relationship between the preoperative serum amylase levels and the severity of pancreatitis. Cholecystectomy was performed in 53 patients (96%). The operative mortality rate was 5.5%, and severe postoperative complications developed in five patients (9%). The follow-up period ranged from two to 24 years, and 39 of the patients in the follow-up evaluation remained completely asymptomatic postoperatively.
- Published
- 1983
17. Is proximal pancreatoduodenectomy with pyloric preservation superior to total pancreatectomy?
- Author
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McAfee MK, van Heerden JA, and Adson MA
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Gastrostomy, Humans, Male, Middle Aged, Pancreatectomy adverse effects, Postoperative Complications etiology, Pylorus, Stomach physiology, Stomach Ulcer etiology, Duodenum surgery, Pancreatectomy methods
- Abstract
The records of all patients who underwent pylorus-preserving pancreatic resection (29 subtotal and 4 total pancreatectomies) during a 10-year period at the Mayo Clinic were reviewed. Thirty-day operative mortality was 6%. Early postoperative morbidity occurred in 45% of patients and necessitated reoperation in four patients. One patient had a hemorrhage from a marginal ulcer in the early postoperative period. The incidence of late postoperative morbidity was 18%. Marginal ulcers developed in the late postoperative period in three additional patients, for an overall incidence of 13%. One patient underwent vagotomy and pyloroplasty because of intractable bleeding 2 years after initial operation. The 29 patients who underwent pylorus-preserving pancreatoduodenectomy (PPW) were compared (retrospectively) with 200 patients who had undergone standard pancreatoduodenectomy (Whipple operation) during the same 10-year period. The overall incidences of marginal ulcer were 10% in the PPW group and 5% in the Whipple group; the incidences of delayed gastric emptying were similar in these groups. We believe that caution is warranted in the use of PPW, as yet an unproved procedure.
- Published
- 1989
18. Stromal invasion of cancer in pedunculated adenomatous colorectal polyps: significance for surgical management.
- Author
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Okike N, Weiland LH, Anderson MJ, and Adson MA
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- Adenocarcinoma pathology, Adult, Aged, Carcinoma in Situ pathology, Colon pathology, Female, Humans, Intestinal Polyps surgery, Lymph Node Excision, Male, Middle Aged, Neoplasm Invasiveness, Rectum pathology, Colonic Neoplasms pathology, Intestinal Polyps pathology, Rectal Neoplasms pathology
- Abstract
Fifty-three patients were treated for pedunculated adenomatous polyps that contained foci of invasive cancer confined to the stroma. This entity is a stage of malignant involvement intermediate between in situ carcinoma and frank infiltrative cancer that invades the muscularis mucosae. Metastases to regional lymphatics were not observed. Local removal of such lesions without regional lymphadenectomy is adequate treatment.
- Published
- 1977
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19. Fibrolamellar hepatoma.
- Author
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Nagorney DM, Adson MA, Weiland LH, Knight CD Jr, Smalley SR, and Zinsmeister AR
- Subjects
- Adolescent, Adult, Aged, Carcinoma, Hepatocellular mortality, Carcinoma, Hepatocellular surgery, Carcinoma, Hepatocellular ultrastructure, Female, Humans, Liver Neoplasms mortality, Liver Neoplasms surgery, Liver Neoplasms ultrastructure, Male, Middle Aged, Neoplasm Metastasis, Neoplasm Recurrence, Local, Prognosis, Carcinoma, Hepatocellular pathology, Liver Neoplasms pathology
- Abstract
We found the clinical features of fibrolamellar hepatoma similar to those of nonfibrolamellar hepatoma with the exception of patient age. Although the histopathologic findings of fibrolamellar hepatoma are distinct and easily recognizable, we found that fibrolamellar hepatomas may be histologically heterogeneous. The overall length of survival of patients with fibrolamellar hepatoma was greater than that of patients with nonfibrolamellar hepatoma, but the survival resection was similar, regardless of histologic characteristics. Differences in overall survival between histologic subtypes probably reflects differences in the rate of resectability between fibrolamellar and nonfibrolamellar hepatomas.
- Published
- 1985
- Full Text
- View/download PDF
20. Resection of primary solid hepatic tumors.
- Author
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Adson MA and Weiland LH
- Subjects
- Adolescent, Adult, Aged, Carcinoma, Hepatocellular mortality, Carcinoma, Hepatocellular surgery, Child, Female, Humans, Length of Stay, Liver Neoplasms mortality, Male, Middle Aged, Postoperative Complications, Liver Neoplasms surgery
- Abstract
Experience with surgical management of 60 solid hepatic tumors was analyzed with respect to the size and type of lesion, extent of resection, operative risk, postoperative complications and survival after resection. The present study concerns 46 primary hepatic malignancies and 14 benign lesions. Lesions varied in size from 5 to 29 cm (average 13). The extent of resection required for removal was related to both the size and location of lesions. Twelve trisegmentectomies, 33 hemihepatectomies and 15 major segmentectomies were done. There were three postoperative hospital deaths, two of which were related to extensions of tumor that precluded safe resection. Postoperative complications necessitated hospital convalescence for more than 21 days in 9 of the 57 surviving patients; the hospital stay of the remaining patients averaged 12 days. The 10, 5 and 3 year survival rates of patients who had resection of malignant lesions were 33, 36 and 65 percent, respectively. We conclude that aggressive treatment of primary hepatic malignancy is justified by acceptable operative risk and significant palliation or improved survival.
- Published
- 1981
- Full Text
- View/download PDF
21. Resection of the liver for colorectal carcinoma metastases. A multi-institutional study of long-term survivors.
- Author
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Hughes KS, Rosenstein RB, Songhorabodi S, Adson MA, Ilstrup DM, Fortner JG, Maclean BJ, Foster JH, Daly JM, and Fitzherbert D
- Subjects
- Adult, Aged, Female, Humans, Liver Neoplasms mortality, Liver Neoplasms surgery, Male, Middle Aged, Prognosis, Retrospective Studies, Colonic Neoplasms, Hepatectomy, Liver Neoplasms secondary, Rectal Neoplasms
- Abstract
In this review of a collected series of patients undergoing hepatic resection for colorectal metastases, 100 patients were found to have survived greater than five years from the time of resection. Of these 100 long-term survivors, 71 remain disease-free through the last follow-up, 19 recurred prior to five years, and ten recurred after five years. Patient characteristics that may have contributed to survival were examined. Procedures performed included five trisegmentectomies, 32 lobectomies, 16 left lateral segmentectomies, and 45 wedge resections. The margin of resection was recorded in 27 patients, one of whom had a positive margin, nine of whom had a less than or equal to 1-cm margin, and 17 of whom had a greater than 1-cm margin. Eighty-one patients had a solitary metastasis to the liver, 11 patients had two metastases, one patient had three metastases, and four patients had four metastases. Thirty patients had Stage C primary carcinoma, 40 had Stage B primary carcinoma, and one had Stage A primary carcinoma. The disease-free interval from the time of colon resection to the time of liver resection was less than one year in 65 patients, and greater than one year in 34 patients. Three patients had bilobar metastases. Four of the patients had extrahepatic disease resected simultaneously with the liver resection. Though several contraindications to hepatic resection have been proposed in the past, five-year survival has been found in patients with extrahepatic disease resected simultaneously, patients with bilobar metastases, patients with multiple metastases, and patients with positive margins. Five-year disease-free survivors are also present in each of these subsets. It is concluded that five-year survival is possible in the presence of reported contraindications to resection, and therefore that the decision to resect the liver must be individualized.
- Published
- 1988
- Full Text
- View/download PDF
22. Focal nodular hyperplasia and hepatic adenoma: comparison of angiography, CT, US, and scintigraphy.
- Author
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Welch TJ, Sheedy PF 2nd, Johnson CM, Stephens DH, Charboneau JW, Brown ML, May GR, Adson MA, and McGill DB
- Subjects
- Adenoma diagnostic imaging, Adolescent, Adult, Angiography, Female, Humans, Hyperplasia diagnosis, Liver Neoplasms diagnostic imaging, Male, Middle Aged, Radionuclide Imaging, Tomography, X-Ray Computed, Ultrasonography, Adenoma diagnosis, Liver pathology, Liver Neoplasms diagnosis
- Abstract
The authors reviewed 23 cases of focal nodular hyperplasia and 13 cases of hepatic adenoma, all of which were confirmed pathologically. All solitary masses that exhibited normal or increased uptake of technetium 99m-sulfur colloid were shown to be hyperplasia; while previous criteria such as a central blood supply on angiograms or a central scar on computed tomography (CT) or ultrasound (US) scans were helpful, they were relatively infrequent. A mass that was slightly hypodense and homogeneous on a CT or US scan and highly vascular with an intense capillary stain on an angiogram was almost always hyperplasia. Acute hemorrhage within a focal hepatic tumor was common in adenoma but did not occur in hyperplasia.
- Published
- 1985
- Full Text
- View/download PDF
23. Advances in the radiology of jaundice: a symposium and review.
- Author
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Ferrucci JT Jr, Adson MA, Mueller PR, Stanley RJ, and Stewart ET
- Subjects
- Bile Duct Diseases surgery, Bile Ducts pathology, Biopsy methods, Catheterization methods, Cholangiopancreatography, Endoscopic Retrograde, Cholestasis etiology, Cholestasis therapy, Cholestasis, Intrahepatic diagnosis, Common Bile Duct Diseases diagnostic imaging, Cysts diagnostic imaging, Digestive System Neoplasms surgery, Dilatation methods, Dilatation, Pathologic diagnosis, Drainage methods, Endoscopy, Humans, Tomography, X-Ray Computed, Ultrasonography, Cholestasis diagnostic imaging
- Abstract
New radiologic imaging and interventional techniques have transformed the clinical management of biliary obstruction. Selected aspects of their application were reviewed in a symposium conducted at the 12th annual meeting of the Society of Gastrointestinal Radiologists held recently at Banff, Alberta, Canada. There is a consensus that sonography is the preferred initial screening procedure for bile duct dilatation because of its accuracy and sensitivity although computed tomography more precisely displays the level and cause of obstruction. Transhepatic drainage provides effective decompression for malignant obstruction, but the high rate of postprocedure catheter dysfunction suggests that an indwelling endoprosthesis may be more suitable for short-term palliation. Endoscopic papillotomy has proven to be successful nonoperative therapy for choledocholithiasis and also permits retrograde placement of transpapillary stents. Communication and collaboration among the radiologist, endoscopist, and biliary surgeon are essential if these new methods are to be applied optimally to the various clinical problems encountered with bile duct obstruction.
- Published
- 1983
- Full Text
- View/download PDF
24. Resection of liver metastases--when is it worthwhile?
- Author
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Adson MA
- Subjects
- Humans, Liver Neoplasms surgery, Prognosis, Colonic Neoplasms surgery, Liver Neoplasms secondary, Rectal Neoplasms surgery
- Published
- 1987
- Full Text
- View/download PDF
25. Clinical trial of adjuvant chemotherapy after surgical resection of colorectal cancer metastatic to the liver.
- Author
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O'Connell MJ, Adson MA, Schutt AJ, Rubin J, Moertel CG, and Ilstrup DM
- Subjects
- Adult, Aged, Clinical Trials as Topic, Combined Modality Therapy, Female, Fluorouracil administration & dosage, Fluorouracil adverse effects, Humans, Liver Neoplasms secondary, Liver Neoplasms surgery, Male, Middle Aged, Semustine administration & dosage, Semustine adverse effects, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Colonic Neoplasms, Liver Neoplasms drug therapy, Rectal Neoplasms
- Abstract
Adjuvant chemotherapy consisting of 5-fluorouracil and semustine was given to 26 patients who had undergone resection (with curative intent) of hepatic metastatic lesions from a primary colorectal carcinoma. Our objective was to obtain preliminary observations regarding the effectiveness of this regimen for improving the long-term survival associated with hepatic resection alone in these patients (the overall 5-year survival after hepatic resection is 25% at our institution). At the time of analysis, the malignant disease had progressed in 19 of our patients, and 17 patients had died. For all patients who receive adjuvant chemotherapy, the median duration of survival is 34 months, and the estimated 5-year survival is 15%. Statistical analysis indicated no significant advantage in survival for the study patients in comparison with 26 control patients who were treated with hepatic resection only and were closely matched for prognostic factors. Because 5-fluorouracil plus semustine conferred no apparent beneficial effects as an adjuvant treatment in this exploratory study, we do not recommend a definitive randomized trial of this regimen.
- Published
- 1985
- Full Text
- View/download PDF
26. Surgical management of inflammatory bowel disease.
- Author
-
Beart RW Jr, McIlrath DC, Kelly KA, Van Heerden JA, Mucha P Jr, Dozois RR, Adson MA, and Culp CE
- Subjects
- Adult, Anus Diseases complications, Carcinoma complications, Child, Female, Humans, Ileostomy, Inflammation surgery, Intestinal Diseases complications, Intestinal Diseases diagnosis, Intestinal Fistula complications, Intestinal Neoplasms complications, Male, Perineum, Stomach Diseases surgery, Colitis, Ulcerative surgery, Crohn Disease surgery, Intestinal Diseases surgery
- Abstract
Indications for operation in patients with inflammatory bowel disease are now standardized as a result of the vast surgicaL experience that has been accumulated during the past 40 years. The surgical indications in Crohn's disease and chronic ulcerative colitis vary minimally with the anatomic distribution of either disease, and can be recognized easily in a particular patient. Consequently, decision or judgment regarding the need for operation is rarely difficult. Delaying operation on the basis of fear of recurrence of Crohn's disease is unrealistic because (1) indications for operation are complications of the disease that have not responded or cannot be expected to respond to medical treatment, (2) conservative resection primarily removes diseased bowel that will never return to normal, (3) many patients, perhaps 50%, will never have recurrence of disease, and (4) those who have recurrence will have experienced varying periods when they were free of disease and relieved of the serious complications for which their operations were performed. The value of surgery in the treatment of patients with chronic ulcerative colitis can be stated even more positively, because recurrence of disease is never a concern after proctocolectomy.
- Published
- 1980
- Full Text
- View/download PDF
27. The ileal stoma and protal hypertension: an uncommon site of variceal bleeding.
- Author
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Adson MA and Fulton RE
- Subjects
- Adult, Angiography, Colectomy, Colitis, Ulcerative complications, Colitis, Ulcerative surgery, Collateral Circulation, Esophageal and Gastric Varices surgery, Female, Hemorrhage surgery, Hepatic Encephalopathy complications, Humans, Liver Cirrhosis complications, Male, Middle Aged, Portacaval Shunt, Surgical, Portal System diagnostic imaging, Postoperative Complications surgery, Hypertension, Portal complications, Ileostomy, Ileum blood supply, Varicose Veins surgery
- Abstract
Patients who have chronic ulcerative colitis coexisting with liver disease and portal hypertension may suffer hemorrhagic parastomal varices after proctocolectomy and ileostomy. Large portal systemic collateral vessels between the superior mesenteric venous tributaries and the abdominal wall can be demonstrated by portal venography. Hemorrhage occurs from the mucocutaneous junction, a vulnerable point in this collateral circuit. Management by major and minor stomal revisions has been unsuccessful. Three patients who have bled from stomal and from esophagogastric varices were treated with portasystemic shunts. None of the three has had recurrent bleeding or postshunt encephalopathy during the 19 to 27 months after these operations.
- Published
- 1977
- Full Text
- View/download PDF
28. Bile duct carcinoma associated with ulcerative colitis.
- Author
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Akwari OE, van Heerden JA, Adson MA, Foulk WT, and Baggenstoss AH
- Subjects
- Adult, Female, Humans, Male, Adenocarcinoma complications, Bile Duct Neoplasms complications, Colitis, Ulcerative complications
- Published
- 1976
29. The resection of hepatic metastases. Another view.
- Author
-
Adson MA
- Subjects
- Humans, Liver Neoplasms mortality, Prognosis, Research Design, Colorectal Neoplasms, Liver Neoplasms secondary, Liver Neoplasms surgery
- Published
- 1989
- Full Text
- View/download PDF
30. Computed tomography and angiography of cavernous hemangiomas of the liver.
- Author
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Johnson CM, Sheedy PF 2nd, Stanson AW, Stephens DH, Hattery RR, and Adson MA
- Subjects
- Female, Hemangioma, Cavernous blood supply, Humans, Liver Neoplasms blood supply, Male, Middle Aged, Angiography, Hemangioma, Cavernous diagnostic imaging, Hepatic Artery diagnostic imaging, Liver Neoplasms diagnostic imaging, Tomography, X-Ray Computed
- Abstract
Cavernous hemangioma is the most common benign tumor of the liver. Eighteen patients were studied by both computed tomography (CT) and angiography. The angiographic features were classic, consisting of normal hepatic arteries, no tumor vessels, and densely stained blood-filled spaces producing a "cotton-wool" appearance. Before contrast infusion, CT scans showed roughly spherical, well-demarcated low-density masses; afterward there was a peripheral zone of enhancement which varied in thickness and sometimes had a corrugated inner margin, though the center remained low in density and the overall size of the lesion did not change. The authors feel that the CT findings are characteristic and that in some cases angiography is unnecessary.
- Published
- 1981
- Full Text
- View/download PDF
31. Patterns of total and ionized calcium and other electrolytes in plasma during and after general surgery.
- Author
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Rodriguez R, Jones RR, Adson MA, and Moffitt EA
- Subjects
- Adult, Aged, Blood Proteins analysis, Carbon Dioxide blood, Female, Hematocrit, Humans, Magnesium blood, Male, Middle Aged, Parathyroid Hormone blood, Phosphates blood, Potassium blood, Sodium blood, Time Factors, Calcium blood, Surgical Procedures, Operative
- Abstract
Thirteen patients were studied during two hours of anaesthesia for abdmonial operations and for an hour post-operatively. Serial venous blood samples were taken for determination of plasma total and ionized calcium, acid-base variables, Na, K, Mg, PO4 total proteins and parathyroid hormone. One group of patients received 5 per cent dextrose/water and the other 5 per cent dextrose in Ringer's solution, at 250 ml per hour. Total and ionized calcium levels decreased toward the end of operation and an hour later, associated with respiratory alkalosis. Parathyroid hormone increased at the end of operation, as an effect of the decreased ionized calcium. The general effect was mild haemodilution with all the other electrolytes decreasing, as did total protein concentration.
- Published
- 1976
- Full Text
- View/download PDF
32. Postoperative reflux gastritis.
- Author
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van Heerden JA, Phillips SF, Adson MA, and McIlrath DC
- Subjects
- Adult, Aged, Anemia, Hypochromic etiology, Dumping Syndrome etiology, Endoscopy, Female, Follow-Up Studies, Gastritis complications, Gastritis surgery, Gastrointestinal Hemorrhage etiology, Humans, Male, Middle Aged, Pain etiology, Postgastrectomy Syndromes surgery, Postoperative Complications surgery, Vagotomy, Vomiting etiology, Gastritis diagnosis, Gastroenterostomy, Postgastrectomy Syndromes diagnosis, Postoperative Complications diagnosis
- Abstract
The chief clinical features of forty-nine patients with the syndrome of reflux "alkaline" gastritis were epigastric pain, bilious vomiting, anemia, and the dumping syndrome. Separation of the symptoms of this syndrome from the symptoms of a multitude of other postgastrectomy syndromes is difficult, being complicated by a high incidence of emotional instability in these patients. Endoscopy remains the mainstay in diagnosis; among the characteristic endoscopic features are adherent mucus, edema, mucosal friability, and erosions, most severe on the gastric aspect of the stoma. The surgical treatment of choice is Roux-en-Y gastrojejunostomy accompanied by vagectomy.
- Published
- 1975
- Full Text
- View/download PDF
33. Hepatobiliary cancer--surgical considerations.
- Author
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Adson MA and Farnell MB
- Subjects
- Adenoma, Bile Duct pathology, Adenoma, Bile Duct surgery, Bile Duct Neoplasms pathology, Carcinoma, Hepatocellular pathology, Carcinoma, Hepatocellular surgery, Gallbladder Neoplasms pathology, Hamartoma pathology, Hamartoma surgery, Humans, Liver Neoplasms pathology, Preoperative Care, Bile Duct Neoplasms surgery, Gallbladder Neoplasms surgery, Liver Neoplasms surgery
- Abstract
Most cancers of the hepatobiliary system will have grown beyond the limits of curative resection by the time they become clinically evident. This reality has fostered therapeutic nihilism, and most physicians and surgeons in their pessimism have failed to study the early modes of spread of these tumors--patterns of growth that are relevant to proper treatment of those patients who do have lesions that can be removed with hope of achieving a cure. Moreover, anatomic and technical complexities may beget surgical reluctance in the management of potentially curable lesions. Therefore, this review is offered for orientation and perspective for those who would hope to offer optimal treatment for patients who have primary cancers of the liver, gallbladder, or biliary ducts. The review includes considerations of (1) surgical anatomy, (2) modes of spread, (3) assessment of resectability, (4) surgical technique, and (5) results of operative treatment in relation to "curative" resection. Also offered are some guides to palliative surgical management of tumors that have reached the hepatic hilus.
- Published
- 1981
34. The surgical aspects of chronic mucosal inflammatory bowel disease (chronic ulcerative colitis).
- Author
-
Van Heerden JA, McIlrath DC, and Adson MA
- Subjects
- Adult, Age Factors, Chronic Disease, Colectomy, Colitis, Ulcerative complications, Colonic Neoplasms complications, Emergencies, Female, Follow-Up Studies, Humans, Ileostomy, Male, Megacolon, Toxic surgery, Methods, Postoperative Complications mortality, Rectal Diseases surgery, Colitis, Ulcerative surgery
- Abstract
The surgical aspects of chronic mucosal inflammatory bowel disease were reviewed by comparing the experience at our institution between two periods, one a decade later than the other (1961-1965 and 1971-1975). The striking findings were a marked decrease in the incidence of carcinoma and toxic megacolon and a marked increase in use of one-stage proctocolectomy with either Brooke ileostomy or Kock pouch. There was, in addition, a corresponding decrease in the operative mortality for elective cases, from 2.4 to 1.3%; yet the operative mortality for emergency cases remained relatively stable at about 25%. The reason for the decrease in the incidence of carcinoma and toxic megacolon appears to be on the basis of selection outside of our institution, in that fewer of these cases are being referred.
- Published
- 1978
- Full Text
- View/download PDF
35. Surgical treatment of functioning metastatic carcinoid tumors.
- Author
-
Martin JK Jr, Moertel CG, Adson MA, and Schutt AJ
- Subjects
- Aged, Carcinoid Tumor blood, Carcinoid Tumor drug therapy, Female, Hepatic Artery surgery, Humans, Hydroxyindoleacetic Acid blood, Ligation, Liver Neoplasms blood, Liver Neoplasms drug therapy, Male, Middle Aged, Carcinoid Tumor secondary, Carcinoid Tumor surgery, Liver Neoplasms secondary, Liver Neoplasms surgery
- Abstract
Thirteen patients with functioning carcinoid syndrome and hepatic metastases were surgically treated. Localized hepatic metastases were resected in five patients, and diffuse hepatic metastases were treated with hepatic artery ligation in eight. There were no postoperative deaths, and follow-up ranged from six to 46 months. All patients were symptom-free after operation. In all patients with resection, levels of 5-hydroxyindoleacetic acid (5-HIAA) returned to normal or near normal, whereas in patients who underwent hepatic artery ligation, the average reduction in 5-HIAA level was 76%. Three patients died during the follow-up period--two of metastatic carcinoids and one without evidence of disease. The mean duration of response was 36 months for resection and 4.8 months for hepatic artery ligation. The addition of postoperative intra-arterial chemotherapy and sequential systemic chemotherapy may enhance the response to hepatic artery ligation.
- Published
- 1983
- Full Text
- View/download PDF
36. Diagnosis and treatment of jaundice.
- Author
-
May GR, James EM, Bender CE, Williams HJ Jr, and Adson MA
- Subjects
- Adenoma, Bile Duct complications, Adenoma, Bile Duct diagnostic imaging, Bile Duct Diseases complications, Bile Duct Diseases diagnostic imaging, Bile Duct Neoplasms complications, Bile Duct Neoplasms diagnostic imaging, Catheterization, Cholangiopancreatography, Endoscopic Retrograde, Cholangitis complications, Cholangitis diagnostic imaging, Diagnosis, Differential, Drainage, Gallstones complications, Gallstones diagnostic imaging, Humans, Jaundice etiology, Liver Neoplasms complications, Liver Neoplasms diagnostic imaging, Pancreatic Neoplasms complications, Pancreatic Neoplasms diagnostic imaging, Tomography, X-Ray Computed, Jaundice diagnostic imaging, Jaundice therapy
- Abstract
1. CT and sonography are helpful in distinguishing between an obstructing lesion and hepatocellular disease as the cause of jaundice. 2. CT and sonography can demonstrate the level and extent of an obstructing lesion, and can define its nature if a mass more than 1-2 cm is present; sonography is usually the preferred screening study because of its availability, relatively low cost and lack of radiation hazard. 3. PTC or ERCP is useful in the evaluation of jaundice when sonography and CT are equivocal, fail to provide information necessary to establish proper therapy, or are at variance with the clinical impression of obstructive jaundice; in addition to defining obstructions these techniques can detect atrophy, sequestra, stones, abscesses, fistulas, primary sclerosing cholangitis, etc. 4. PBD offers an expedient alternative to surgical decompression in patients with obstructive jaundice, since most cancers that cause biliary obstruction are not resectable for cure at the time of diagnosis.
- Published
- 1986
- Full Text
- View/download PDF
37. Surgical management of chronic pancreatitis: long-term results in 141 patients.
- Author
-
Mannell A, Adson MA, McIlrath DC, and Ilstrup DM
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Chronic Disease, Female, Follow-Up Studies, Humans, Male, Middle Aged, Minnesota, Pancreatitis mortality, Pancreatitis surgery
- Abstract
The management of pancreatic pain is a controversial subject and the treatment recommended varies from one extreme to the other. Some authorities advise simply waiting for chronic pancreatitis to 'burn out', while others practise removal of the entire gland. In this paper we present 141 patients who underwent surgery for chronic pancreatitis at the Mayo Clinic. The main indication for operation was pancreatic pain and the choice of operation was based on anatomical abnormalities in the gland. The long-term results of the policy are reviewed (mean follow-up 8.5 years). Length of history, aetiology of disease, pancreatic dysfunction and pathology, time after operation and continued alcohol abuse were computer analysed for a statistically significant influence on pain relief, ability to work, pancreatic function and survival. There was one operative death (mortality rate 0.7 per cent). Continued drinking was not shown to affect postoperative pain relief but 10-year survival was significantly less in alcoholics than in those with non-alcoholic pancreatitis (P less than 0.02). Dilated ducts and duct calculi were associated with good results for pain relief although this association did not achieve statistical significance. Parenchymal calcification and time after operation did not influence the results of surgery. When the operation failed to relieve pain, spontaneous remission occurred in a few cases only. Seventy-seven per cent of patients had lasting relief of pain and operations selected on the basis of gross pathology were equally effective in relieving pain. Longitudinal pancreaticojejunostomy in those with dilated ducts and a Whipple operation for disease of the pancreatic head gave good results.(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1988
- Full Text
- View/download PDF
38. Hepatic resection for intrahepatic ductal stones.
- Author
-
Adson MA and Nagorney DM
- Subjects
- Aged, Cholelithiasis diagnosis, Female, Humans, Methods, Bile Ducts, Intrahepatic surgery, Cholelithiasis surgery, Liver surgery
- Abstract
Intrahepatic stones that have caused irreversible ductal damage may need unusual treatment. When other treatments fail, resection of the affected portion of the liver is usually curative. Clinical features may be misleading: pain and sepsis are common, but jaundice is not. Diagnosis depends on awareness and critical use of special tests; ducts unseen may be culprits. Resection most often is easy, for usually the left hepatic ducts are affected.
- Published
- 1982
- Full Text
- View/download PDF
39. The distal splenorenal shunt.
- Author
-
Adson MA, van Heerden JA, and Ilstrup DM
- Subjects
- Adolescent, Adult, Aged, Arterial Occlusive Diseases etiology, Female, Gastrointestinal Hemorrhage surgery, Hepatic Encephalopathy etiology, Humans, Liver Cirrhosis complications, Male, Middle Aged, Postoperative Complications, Prognosis, Splenorenal Shunt, Surgical methods, Esophageal and Gastric Varices surgery, Portasystemic Shunt, Surgical mortality, Splenorenal Shunt, Surgical mortality
- Abstract
Our initial use of the distal splenorenal shunt (DSRS) in 1973 was fostered by disappointment with the results of so-called total shunts. This selective shunt was, when anatomically feasible, our preferred therapy until 1980, when surgical referral was affected by enthusiasm for sclerotherapy. Our study of 71 DSRSs is uncontrolled because we could not recruit patients for a prospective randomized trial that involved either no treatment of operations that had proven faults. Our experience shows that operative risk (4%) and incidence of postshunt encephalopathy (6%) are low, that the rate of shunt occlusion is acceptable (10%), and that bleeding is as well controlled as with other shunts. Survival rates correlate with the cause of portal hypertension and with hepatic functional reserve. Analysis of the causes of death shows that the natural history of cirrhosis and coexistent disease are major determinants of prognosis.
- Published
- 1984
- Full Text
- View/download PDF
40. Radical pancreatoduodenectomy--a procedure to be abandoned?
- Author
-
van Heerden JA, McIlrath DC, Dozois RR, and Adson MA
- Subjects
- Adult, Aged, Chronic Disease, Female, Humans, Jejunum surgery, Male, Middle Aged, Pancreatectomy methods, Pancreatitis surgery, Postoperative Complications, Adenocarcinoma surgery, Duodenum surgery, Pancreatectomy mortality, Pancreatic Neoplasms surgery
- Abstract
Radical pancreatoduodenectomy, or Whipple's procedure, has gradually fallen into disrepute during the past decade. This loss of popularity has resulted from excessive postoperative mortality and morbidity due to inherent technical difficulties, the dismal long-term survival when the procedure is done for adenocarcinoma of the pancreas, and the current enthusiasm for total pancreatectomy. Our objective was to assess the technical aspects of the Whipple procedure as they relate to subsequent morbidity and mortality. Conclusions are drawn from the evaluation of 146 consecutive patients who underwent this procedure between 1970 and 1979 for either benign (10 patients) or malignant (136 patients) diseases of the pancreas and periampullary region. The postoperative mortality was 4.1%. Significant morbidity occurred in 34% of patients, and early reoperation was required in 7.5% of these patients. The median postoperative hospital stay was 19 days. The relatively low postoperative mortality indicates that inherent technical difficulties of the Whipple procedure can be overcome and supports its continued use in carefully selected patients. The persistent high morbidity and the rather poor long-term results following treatment of certain pancreatic malignancies place individual surgical judgment and technical expertise at a premium when ever this classic operation is contemplated.
- Published
- 1981
41. Endoscopic variceal sclerosis: a one-year experience.
- Author
-
Hughes RW Jr, Larson DE, Viggiano TR, Adson MA, van Heerden JA, and Reeves CB
- Subjects
- Adolescent, Adult, Aged, Child, Endoscopes, Endoscopy adverse effects, Endoscopy methods, Female, Fiber Optic Technology, Humans, Male, Middle Aged, Gastrointestinal Diseases therapy, Hemorrhage therapy, Varicose Veins therapy
- Abstract
Our first year's experience with endoscopic variceal sclerosis (EVS) performed with a cuffed balloon fiberoptic endoscope is presented. Seventy-five patients have been treated with EVS without requiring the use of general anesthesia. All but one patient had endoscopically documented variceal hemorrhage and underwent EVS while bleeding or shortly thereafter. Ninety-two per cent of the patients were discharged from the hospital after initial treatment with the current overall survival rate being 89.3%. Complications resulting in a prolonged hospitalization were infrequent, but two deaths occurred in which EVS complications may have been a contributing factor. Based on these results, EVS is recommended for managing variceal hemorrhage and is a reasonable alternative for shunt surgery in the management of variceal bleeding.
- Published
- 1982
- Full Text
- View/download PDF
42. Sigmoid diverticulitis with perforation and generalized peritonitis.
- Author
-
Nagorney DM, Adson MA, and Pemberton JH
- Subjects
- Adult, Aged, Colostomy, Diverticulitis, Colonic complications, Diverticulitis, Colonic mortality, Drainage, Female, Humans, Intestinal Perforation complications, Intestinal Perforation etiology, Male, Methods, Middle Aged, Peritonitis surgery, Sigmoid Diseases complications, Sigmoid Diseases mortality, Diverticulitis, Colonic surgery, Intestinal Perforation surgery, Peritonitis etiology, Sigmoid Diseases surgery
- Abstract
Sigmoid diverticulitis with perforation and generalized peritonitis is a grave complication of diverticular disease. To compare accurately the results of two operative approaches--proximal colostomy with drainage and proximal colostomy with resection or exteriorization--the authors assessed the clinical and pathologic features of 121 consecutive patients with perforating sigmoid diverticulitis. There were no differences between treatment groups in age, sex, mean duration of symptoms, clinical presentation, number of coexistent diseases, type of peritonitis or chronic corticosteroid use. Overall mortality for emergency operation was 12 percent. Mortality was significantly greater (P less than 0.05) among the 31 patients treated by colostomy and drainage (26 percent) than among the 90 patients treated by colostomy and resection or exteriorization (7 percent). Seven of the nine patients who died from persistent sepsis had undergone colostomy and drainage. Four clinical factors were found to be predictive of mortality (P less than 0.05): persistent postoperative sepsis, fecal peritonitis, preoperative hypotension, and prolonged duration of symptoms. These factors identified a subgroup of patients who, because of an increased risk of death, would be likely to benefit from the more complete eradication of the septic focus that is achieved by colostomy and resection.
- Published
- 1985
- Full Text
- View/download PDF
43. Resection of hepatic metastases from colorectal cancer.
- Author
-
Adson MA, van Heerden JA, Adson MH, Wagner JS, and Ilstrup DM
- Subjects
- Carcinoma mortality, Carcinoma surgery, Colonic Neoplasms mortality, Female, Humans, Liver Neoplasms mortality, Liver Neoplasms surgery, Male, Middle Aged, Rectal Neoplasms mortality, Carcinoma secondary, Colonic Neoplasms surgery, Liver Neoplasms secondary, Rectal Neoplasms surgery
- Abstract
We studied 141 patients who had resection of hepatic metastases from colorectal cancer, considering all such lesions removed between 1948 and 1982. The study involved extended observations of patients described previously. Also included were 21 patients who had wedge resections of small metastases done since 1976, who, therefore, did not qualify for analysis of major hepatic resections reported recently (1980 and 1983). The overall five-year survival rate was 25%, significantly higher than that of a group of historical controls who had resectable metastases that were not removed. The size and nature of our extended sample allowed identification of some determinants of favorable prognosis: Dukes' stage of the primary lesion, absence of extrahepatic metastases, and being female. Contrary to our earlier observations, this study justified removal of some multiple hepatic metastases.
- Published
- 1984
- Full Text
- View/download PDF
44. Proceedings: Resection of primary hepatic malignant lesions.
- Author
-
Adson MA and Sheedy PF
- Subjects
- Adenoma, Bile Duct diagnostic imaging, Adenoma, Bile Duct mortality, Angiography, Carcinoma diagnostic imaging, Carcinoma mortality, Carcinoma, Hepatocellular diagnostic imaging, Carcinoma, Hepatocellular mortality, Cystadenocarcinoma diagnostic imaging, Cystadenocarcinoma mortality, Hepatic Artery diagnostic imaging, Humans, Liver Neoplasms diagnostic imaging, Liver Neoplasms mortality, Methods, Neoplasm Metastasis, Palliative Care, Adenoma, Bile Duct surgery, Carcinoma surgery, Carcinoma, Hepatocellular surgery, Cystadenocarcinoma surgery, Hepatectomy, Liver Neoplasms surgery
- Published
- 1974
- Full Text
- View/download PDF
45. Radionuclide image patterns of hepatic metastasis and pyogenic abscess: difficulties in differential diagnosis.
- Author
-
Bess MA, Bartholomew LG, Wahner HW, and Adson MA
- Subjects
- Diagnosis, Differential, Gallium Radioisotopes, Humans, Male, Middle Aged, Neoplasm Metastasis, Radionuclide Imaging, Adenocarcinoma diagnostic imaging, Liver Abscess diagnostic imaging, Liver Abscess, Amebic diagnostic imaging, Liver Neoplasms diagnostic imaging
- Abstract
A case of hepatic metastasis with a clinical differential diagnosis of amebic and bacterial abscess is presented. Hepatic scanning with 67Ga-citrate did not diagnostically differentiate the lesion. Hepatic arteriography combined with a therapeutic trial of metronidazole proved useful in defining the lesion. An understanding of the pathophysiologic process involved in 67Ga scanning of hepatic lesions suggests a non-invasive method of discriminating among these clinical diagnostic possibilities.
- Published
- 1978
- Full Text
- View/download PDF
46. Surgical treatment of hepatic metastases from colorectal cancers.
- Author
-
Wilson SM and Adson MA
- Subjects
- Adult, Aged, Follow-Up Studies, Humans, Liver Neoplasms mortality, Male, Middle Aged, Neoplasm Metastasis, Prognosis, Time Factors, Colonic Neoplasms pathology, Liver Neoplasms surgery, Rectal Neoplasms pathology
- Abstract
Follow-up data covering periods of two to 23 years have been collected on 60 patients who had resection of hepatic metastases for colorectal cancer. Multiple lesions were removed from 20 patients, and solitary lesions were excised from the other 40 patients. Only one patient died during hospital convalescence. No patient who had multiple lesions excised lived for five years. In contrast, 15 of the 36 patients eligible for five-year survival study who had resection of apparent solitary lesions lived for five years or more, and eight patients were alive without evidence of recurrence ten years or more after operation. These surprisingly favorable results of surgical treatment were analyzed in relation to results in patients who had biopsy specimens taken of lesions of comparable size and number, but no removal at the time of colonic resection. No patient in this control group lived for five years. Aggressive surgical treatment of apparent solitary hepatic metastatic lesions from colorectal cancer seems to be justified by the survival rate of surgically treated patients.
- Published
- 1976
- Full Text
- View/download PDF
47. Regression of renal cell hepatic metastasis following removal of primary lesions.
- Author
-
Deweerd JH, Hawthorne NJ, and Adson MA
- Subjects
- Adenocarcinoma diagnosis, Humans, Kidney Neoplasms diagnosis, Male, Middle Aged, Neoplasm Metastasis, Adenocarcinoma surgery, Kidney Neoplasms surgery, Liver Neoplasms, Neoplasm Regression, Spontaneous
- Abstract
Although spontaneous regression of metastatic renal cell carcinoma occurs it is so uncommon that it should not be considered the primary basis for recommending removal of the asymptomatic primary lesion. Such a recommendation should be made when other treatment modalitis are available to augment the factors influencing the patient-tumor interface. Spontaneous regression of a documented solitary liver metastatic lesion is reported. Removal of the residual hepatic lesion failed to prolong the patient's life.
- Published
- 1977
- Full Text
- View/download PDF
48. Conventional splenorenal shunts. A reconsideration.
- Author
-
Pliam MB, Adson MA, and Foulk WT
- Subjects
- Activities of Daily Living, Brain Diseases mortality, Esophageal and Gastric Varices complications, Gastrointestinal Hemorrhage surgery, Humans, Liver Cirrhosis complications, Methods, Minnesota, Portacaval Shunt, Surgical, Postoperative Complications mortality, Prognosis, Retrospective Studies, Time Factors, Hypertension, Portal surgery, Renal Veins surgery, Splenic Vein surgery
- Abstract
From 1961 to 1971, 73 central splenorenal and 66 portacaval shunts were done for cirrhotic patients who had bled from esophageal varices. Comparative analysis revealed low (3% and 2%, respectively) operative mortality for elective operations, equal (93%) effectiveness in control of variceal bleeding, but substantial diferences in the incidence of postshunt encephalopathy. For patients who had mimal hepatic dysfunction before operation, disabling disorders in mentation developed in 5% of patients who had splenorenal shunts, in contrast to 50% of patients who had portacaval shunts. Survival rates after the two shunts were nearly identical. Thus, the advantages of splenorenal shunts concern the quality of life but not the length of survival. These observations are considered in relation to available therapeutic alternatives.
- Published
- 1975
- Full Text
- View/download PDF
49. Analysis of failure following curative irradiation of gallbladder and extrahepatic bile duct carcinoma.
- Author
-
Buskirk SJ, Gunderson LL, Adson MA, Martinez A, May GR, McIlrath DC, Nagorney DM, Edmundson GK, Bender CE, and Martin JK Jr
- Subjects
- Adult, Aged, Bile Duct Neoplasms drug therapy, Brachytherapy, Combined Modality Therapy, Electrons, Female, Fluorouracil therapeutic use, Follow-Up Studies, Gallbladder Neoplasms drug therapy, Humans, Intraoperative Period, Iridium therapeutic use, Male, Middle Aged, Radioisotopes therapeutic use, Radiotherapy, High-Energy, Bile Duct Neoplasms radiotherapy, Gallbladder Neoplasms radiotherapy
- Abstract
Twenty patients with carcinoma of the gallbladder (GB-4 patients) or extrahepatic bile ducts (EHBD-16 patients) received radiation therapy with curative intent between January, 1980 and December, 1982. All 20 received 4500-5000 rad in 180-200 rad fractions to the tumor and regional lymph nodes. A 1000 to 1500 rad external beam boost was delivered in 180-200 rad fractions in 10 patients who received external beam alone or concomitant 5-Fluorouracil (5-FU). Three of the four GB and 5 of the 16 EHBD patients received a transcatheter boost with 192-Iridium (192Ir) to a dose of 2000-2500 rad calculated at a 0.5-0.1 cm radius. An additional 2 patients with EHBD lesions received an intraoperative electron (IORT) boost of 1500-2000 rad in one fraction calculated to the 90% isodose. Survival and patterns of failure were analyzed by site and treatment method. All four patients with GB carcinoma are dead of disease at 5 1/2, 6, 9 and 10 months from the date of diagnosis respectively. Three of the four developed diffuse peritoneal carcinomatosis. Five of the 16 patients with EHBD carcinoma are alive with a median follow-up of 18 months (range 6-23 months). Four of the 5 patients received a transcatheter 192Ir or IORT boost and all are without evidence of disease. Four of 9 patients who had a subtotal resection with transection of tumor, dilatation of the bile ducts with probes or curettement of the bile ducts developed either diffuse peritoneal carcinomatosis (3 patients) or a recurrence in the surgical scar (2 patients). Local failure was documented in 3 of the nine patients treated with external beam alone +/- 5-FU, and has been documented in one of the seven patients who received an IORT or transcatheter 192Ir boost. Further experience is necessary to determine whether this aggressive treatment will result in long-term disease-free survival in these patients.
- Published
- 1984
- Full Text
- View/download PDF
50. Cavernous hemangiomas of the liver: resect or observe?
- Author
-
Trastek VF, van Heerden JA, Sheedy PF 2nd, and Adson MA
- Subjects
- Adult, Angiography, Female, Follow-Up Studies, Hemangioma, Cavernous diagnosis, Humans, Infant, Liver Neoplasms diagnosis, Male, Middle Aged, Retrospective Studies, Risk, Tomography, X-Ray Computed, Ultrasonography, Hemangioma, Cavernous surgery, Liver Neoplasms surgery
- Abstract
Surgical decisions regarding cavernous hemangioma of the liver require consideration of the natural history of the lesion. To provide background, we retrospectively evaluated 49 cases of such hemangiomas exceeding 4 cm in diameter. There were 36 female patients (including 4 infants) and 13 males. Their ages ranged from 1 month to 68 years and averaged 44 years. Surgical procedures that ranged from simple excision to hepatic lobectomy were performed on 13 patients. Four had postoperative complications. There were no surgical deaths or any late deaths attributable to hemangioma. The other 36 patients have been observed for up to 15 years (mean 5.5 years) without the need for surgery. None of the patients in this group died, and none has experienced intraperitoneal hemorrhage or intensification of symptoms, although the size of four lesions increased. The benign course should be considered when deciding on management of lesions that are asymptomatic or so large as to pose significant operative risk.
- Published
- 1983
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