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Biomedical subjects

A M Markowitz

Publications and source records attributed to A M Markowitz.

14 recordsLinked to original sources

Hepatobiliary complications of polyarteritis nodosa.

Although polyarteritis nodosa (PAN) may result in thrombosis or aneurysm formation in any organ in the body, hepatobiliary complications are unusual. We reviewed seven cases that demonstrated the diagnostic difficulties and therapeutic options available in the management of hepatobiliary PAN. No consistent sign that indicated the severity of hepatobiliary PAN could be identified. In cases of thrombotic PAN, acalculus cholecystitis usually could be diagnosed preoperatively. Early tissue diagnosis and aggressive intervention are required for appropriate patient treatment. If the diagnosis is unclear, a preoperative muscle or skin biopsy specimen is often helpful in establishing a tissue diagnosis of PAN, even if no obvious pathologic condition is evident. Patients who undergo celiotomy for acalculus cholecystitis or peritoneal signs of an unclear origin should have tissue specimens (gallbladder wall, liver, or omentum) submitted for pathologic study. Angiography may be diagnostic preoperatively or when results of biopsies are equivocal. In addition, early angiography can define the extent of visceral involvement and permit control by embolization of hemorrhage secondary to aneurysm rupture. Awareness of the possibilities of thrombotic, ischemic, or bleeding complications from PAN allows more aggressive and rapid management of abdominal complaints, especially in patients who are receiving immunosuppressant therapy.

Adult

Elastofibroma dorsi: benign chest wall tumor.

Elastofibroma dorsi was diagnosed in seven patients at the Columbia-Presbyterian Medical Center between 1976 and 1986. The ages of the patients ranged from 6 to 79 years (mean 49.3 years). No sex predominance was seen. Five cases of unilateral subscapular tumor and two cases of bilateral masses were identified. Four patients had pain with arm motion, and the remaining patients were free of symptoms. A nonencapsulated soft tissue mass elevating the scapula was identified by computed tomography. Incisional biopsy was performed in all cases, followed by local excision of the tumor. On gross examination, these lesions were firm and rubbery. Histologic evaluation demonstrated a slightly hypercellular fibrous tissue that contained variable numbers of fragmented elastic fibers. All patients with symptomatic tumors had complete relief of their pain after the operation. No recurrences were observed. Clinically, elastofibroma may mimic sarcoma and fibromatosis (extraabdominal desmoid tumors). Whether elastofibroma is a true neoplasm or a reactive fibrous lesion that produces not only collagen, but also abnormal elastic fibers, has been the subject of controversy and remains undetermined.

Adolescent

Insulinoma: diagnosis, surgical management and long-term follow-up. Review of 41 cases.

The clinical features, diagnosis and surgical considerations in 41 patients with insulinoma treated at Columbia-Presbyterian Medical Center are presented along with a review of the literature. One hundred percent of patients surviving surgery for benign functional beta cell tumors were cured of hypoglycemia. A detailed long-term follow-up study in the majority of patients after surgical cure documented a statistically significant incidence of neuropsychiatric aberration, adult-onset diabetes mellitus and peptic ulcer disease. Patients who have undergone surgery for endogenous hyperinsulinism should be followed up carefully for the development of these disorders, and their overall prognosis should be considered cautiously.

Adenoma, Islet Cell

Factors influencing the complications of colostomy closure.

This retrospective review of 206 colostomy closures performed by different methods and at various intervals from the time of creation of the stoma suggests that attention to meticulous surgical technic is the most important factor in limiting the morbidity and mortality of this commonly performed procedure. Considerations of the location and type of colostomy, timing, method of closure, and patient population seem to be less importnat than suggested in previous reports.

Abdomen

Colitis proximal to obstructing colonic carcinoma.

Nonspecific colitis proximal to an obstructing colonic carcinoma has appeared in the surgical literature for over 20 years, but it remains an uncommon and difficult clinical problem. This report details the case histories of five patients with this entity who have been admitted to the surgical service of Presbyterian Hospital since 1967. The colitis described is clearly related to the obstructive lesion and does not represent chronic inflammatory colitis in association with a carcinoma. The patients may initially have symptoms secondary to the obstructing lesion or fulminant peritoneal signs secondary to the colitis. The roentgenographic appearance is typical and closely resembles that seen in colonic ischemia. The pathologic process varies from fibrosis and stricture formation to transmural necrosis and perforation.

Adult

Elastofibroma dorsi: CT demonstration.

Elastofibroma dorsi is a pseudotumorous connective tissue mass that characteristically arises between the chest wall and the inferior angle of the scapula. Its long axis is typically craniocaudal. Two patients are illustrated, each presenting with a fixed subscapular mass. Computed tomography showed each mass as elongated, incompletely marginated, and of soft tissue density deep to the inferior angle of a scapula. The latissimus dorsi and an underlying layer of fat were posterolaterally elevated inferior to the tip of the scapula. After incisional biopsy excluded sarcoma, each mass was locally excised.

Aged