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Biomedical subjects

A Cooperman

Publications and source records attributed to A Cooperman.

At least 19 recordsLinked to original sources
PubMed1990

Effectiveness of endoscopic drainage for pancreas divisum: endoscopic and surgical results in 31 patients.

Thirty-one patients with symptomatic pancreatitis and pancreas divisum were treated prospectively by inserting an endoprosthesis into the dorsal pancreatic duct for drainage. Pain was a feature characteristic of all 31 patients; of these 92% had an improvement in their subjective complaints of pain after sphincterotomy and insertion of a prosthesis in the minor papilla. During a two-year follow-up period, 84% (26/31) of the group showed improvement in all the signs and symptoms associated with their pancreatitis, and this improvement was sustained in all patients for at least several months. A group of twenty-six patients subsequently underwent pancreatic surgery for recurrent symptoms. Those patients who had improved with endoscopic drainage did significantly better following surgical drainage than those who had shown little or no improvement with an endoprosthesis. On the basis of the above preliminary results, we recommend preoperative insertion of an endoprosthesis into the dorsal duct as a therapeutic predictor of eventual surgical outcome.

Adolescent↗
PubMed1988

Optimal palliation of malignant bile duct obstruction: experience with endoscopic 12 French prostheses.

Large-caliber prostheses, 11.5-12 French, were placed in 167 patients (183 attempts, 91% success) presenting with obstructive jaundice. Thirty-three patients had additional prostheses placed to selectively decompress intrahepatic ducts obstructed by cholangiocarcinoma. In this prospective unrandomized series, there were 43 lesions of the common hepatic duct, 123 of the common bile duct (96 pancreas, 27 cholangiocarcinoma) and 17 ampullary. Transient fever responding to parenteral antibiotics occurred in 11 patients who did not receive prophylaxis, whereas only 2 patients who received antibiotics prior to the procedure developed fever subsequently. Four patients bled subsequent to sphincterotomy, 1 requiring a 2-unit transfusion. Pancreatitis occurred in only 1 patient. The mean hospital stay was only 3 days, range 1-10 days, with most patients being discharged within 48 hours. No procedural deaths occurred. The patency rate of this new, larger 12 Fr. prosthesis is significantly longer than that for the 10 Fr. stent, 190 days for 12 Fr., 150 days for 10 Fr. Given the advantages of the larger prosthesis, i. e., increased patency and function and decreased rehospitalization rate, the authors recommend this method of palliation for obstructive jaundice.

Adult↗
PubMed1988

Duodenoscopic sphincterotomy in patients with gallbladders in situ: report of a series of 1272 patients.

We present a prospective, unrandomized, uncontrolled series of 1272 patients in whom endoscopic sphincterotomy (ES) was performed, and who had not previously undergone cholecystectomy. These patients were culled from our combined experience of a total of 4177 patients in whom ES was performed over the last 13 yr. Of the group reported here, 1208 patients had demonstrable gallbladder stones, and 64 had acalculous gallbladders. The group included 896 females and 396 males whose mean age was 73.3 yr and who ranged from 17 to 101 yr old. Cholangitis was present in 317 patients (25%), and gallstone pancreatitis in 134 (10.5%) patients. After sphincterotomy, 109 patients (8.6%) developed cholecystitis; 23 developed this within 48 h, and 86 developed this within 10 days of the procedure. Emergency surgery was performed on 25 of these patients, and 84 responded to medical therapy alone. Two deaths occurred within 30 days of sphincterotomy (0.15%), in both cases following emergency surgery in elderly patients. One hundred-eight patients underwent elective cholecystectomy within 3 yr of their sphincterotomy because of recurrent symptoms referrable to the biliary tract. In a subset of 337 patients in whom long-term followup was possible, two patients died of complications related to recurrent cholecystitis, both at approximately 2 yr after sphincterotomy. Although followup was less than optimal in this large series of patients, the data presented here suggest that an intact gallbladder is not a contraindication to ES in the management of common bile duct stones, and that the morbidity and mortality of ES compare favorably over the long and short term with surgical management.

Adolescent↗
PubMed1984

The problem of liver metastasis.

The detection and management of tumors metastatic to the liver is still unsettled. The uniformly poor prognosis only underlines the need to diagnose and treat the primary malignant lesion earlier, before systemic metastases lodge in the liver, lung or brain. Serologic markers are not specific or sensitive enough although when used serially they may follow the course of some tumors. The exciting advances in radiologic diagnosis have allowed a more accurate and pictorial representation of disease, exciting cross-sectional views but not earlier diagnosis. The use of scans and ultrasound as a screening measure is investigational only as there is not good evidence to support this as a routine screening test. The treatment of hepatic metastases is also insoluble. For primary lesions that are controlled surgically and whose natural history is measured in years (not months) a more aggressive approach is justified. Lesions confined to one lobe, particularly single lesions, lend themselves to resection. Segmental or wedge resection is the equal of formal hepatic lobectomy and is safer for patients and surgeons. For most patients (70 to 85 percent) operation is not a reasonable choice. How does one select from no therapy, intravenous chemotherapy, intraarterial chemotherapy (implantable pumps, infusion plus embolization) or hepatic artery embolization? These decisions are not easily reached. Institutional enthusiasm is as much a reflection of local expertise and biases as are meaningful data. There are responders to all of these methods, but few long-term survivors. Side effects that limit life style and activity detract from some of the remaining days. Today patients share in the decision-making process. Their own biases are frequently in discord with the treating physician's. When this exists and data do not support one treatment method we acquiesce to the patient's wishes and use his or her experience to increase our data base. Intraarterial chemotherapy is making a strong impact, objective information not withstanding. Unless an implantable pump is covered by third party payments we prefer a "test trial" of several monthly intraarterial injections of chemotherapy to see if a positive effect occurs. Intravenous chemotherapy remains our therapeutic choice particularly if part of a trial. If there is no response and side effects are severe, we prefer to withdraw treatment.

Angiography↗
PubMed1982

Choledochoscopy.

Explore the source record for details and available documents.

Bile Duct Diseases↗
PubMed1982

A rationale for the endoscopic management of colonic polyps.

The incidence of invasive cancer in colonic polyps is related to the size of the lesion and the histologic type of the adenoma. It is greatest for villous adenomas and least for tubular adenomas. The malignant potential increases with the size of the polyp, and in lesions 3 cm and larger malignant disease is present in at least 12 per cent. In general, polyps with invasive malignant disease require colon resection, but for pedunculated adenomas, colonoscopic polypectomy is adequate treatment. Even when invasive cancer is close to the line of endoscopic resection but does not invade the stalk or does not display lymphatic or vascular invasion, a case may be made for conservative, endoscopic treatment alone because the occurrence of local or distal metastasis is very unusual.

Adenoma↗
PubMed1982

Percutaneous drainage of postoperative intraabdominal abscesses.

Twenty-two major intraabdominal abscesses in 19 postoperative patients were drained percutaneously using cross-sectional imaging techniques (computed tomography and sonography) for localization. Sixteen lesions were cured in 14 patients without reexploration. All patients were palliated by the percutaneous drainage procedure. All 22 abscess cavities were entered without complication or compromise of adjacent normal organs. Percutaneous abscess drainage is recommended as a safe, effective method of treating a major intraabdominal abscess in the postoperative patient.

Abdomen↗
PubMed1980

Results of partial mastectomy in 173 patients followed for from five to ten years.

A series of 173 selected patients was treated by partial mastectomy. Eighteen per cent of these also had axillary dissection and another 18 per cent were irradiated. The survival rate at five years was 76 per cent. In the earlier patients, despite adverse selection in terms of age and associated disease, 44 per cent survived for ten years. Twenty per cent of these patients required some form of additional treatment for the control of local or regional disease, but mastectomy was required in only 7.5 per cent. In the others, the cosmetic results were good. Although there is an increased risk of local or regional reappearance of the cancer that may require secondary treatment, partial mastectomy is a satisfactory method of treatment for selected patients with carcinoma of the breast who wish to have some of the breast tissue preserved. These patients should be warned of the increased risk of having to have a second operation for local recurrence, but they can be assured that, in terms of survival, the results seem comparable with those reported after total mastectomy. It is possible that the use of excisional biopsy and axillary sampling followed by external and interstitial radiation with iridium seeds may further increase our ability to save the breast.

Breast Neoplasms↗
PubMed1979

Changes in the pathogenesis and detection of intrahepatic abscess.

A comparison of two distinct 11 year time periods at our institution demonstrated a change not only in the cause of intrahepatic abscess but also in the procedures used to diagnose this condition. Significant improvement in the methods of detection of intrahepatic abscess permits earlier diagnosis and therapy and thus a significantly improved prognosis.

Adult↗
PubMed1976

Carcinoma of the ampulla of Vater: Review of 38 cases with emphasis on treatment and prognostic factors.

Thirty-eight cases of carcinoma of the ampulla of Vater are presented. The diagnosis has been confirmed at laparatomy in all patients. Three operations were done, a pancreaticoduodenal resection in 23 patients, a biliary-enteric bypass in 7 patients and a biliary-enteric bypass plus excision of tumor in 8 patients. The operative mortality was 8% following resection, 14% following bypass plus excision of the ampulla and 13% following biliary-enteric bypass. Five patients survived 5 or more years. The longest survivors have followed pancreaticoduodenal resections (131 and 216 months). The level of bilirubin or presence of pain did not correlate with prognosis. Prognosis was better in the absence of nodal metastases, and in the presence of papillary tumors.

Adult↗
PubMed1975

Acute areflexic paralysis. Association with hyperalimentation and hypophosphatemia.

Acute areflexic paralysis associated with diffuse sensory loss, cranial nerve paisies, and respiratory insufficiency occurred in two patients who developed hypophosphatemia during hyperalimentation. Prompt recovery followed replacement of serum phosphorus in both cases. An electromyogram performed on one patient revealed only decreased insertional activity. A muscle biopsy specimen from the same patient showed minor, nonspecific neurogenic changes.

Acute Disease↗