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Biomedical subjects

B G Wolff

Publications and source records attributed to B G Wolff.

121 records · Page 7Linked to original sources
PubMed1984

Influence of sigmoid resection on progression of diverticular disease of the colon.

The surgeon is frequently confronted with the problem of how much colon to resect when operating on patients with colonic diverticulosis or diverticulitis. Two questions arise: will diverticulosis progress in the proximal colon if only the sigmoid is removed, and will diverticulitis recur in the more proximal diverticula? To evaluate these potential problems, the histories were reviewed of 61 patients who had elective sigmoid resection for diverticular disease and who had barium enema examinations before operation, early during the postoperative period, and at least five years later. Progression of diverticulosis was noted in only nine (14.7 per cent) patients on repeat barium-enema examination five to nine years after resection; the progression was noted to be minimal in all nine. Seven patients (11.4 per cent) had signs and symptoms of recurrent diverticulitis. Only three patients demonstrated progression of diverticulosis and recurrent diverticulitis. We see no benefit in resecting all of the diverticula-bearing colon after adequate sigmoid resection, as there is minimal progression in the diverticular process and the risk of recurrence is low.

Adult↗
PubMed1984

Colonoscopic decompression for acute pseudoobstruction of the colon (Ogilvie's syndrome). Report of 22 cases and review of the literature.

This report has described a series of 22 patients who underwent colonoscopic decompression for acute pseudoobstruction of the colon and summarizes those cases previously reported in the literature. Twenty of the 22 patients (91 percent) were successfully treated by decompression initially. Fifteen patients (68 percent) were cured with the initial procedure, and 4 patients (18 percent) experienced recurrence. Overall, in 17 patients (77 percent), the pseudoobstruction resolved completely with colonoscopic decompression. Three patients (14 percent) underwent operation because of cecal dilatation refractory to colonoscopic decompression, and in one patient (4.5 percent), the colonic dilatation resolved spontaneously after a failed colonoscopy. Complications resulted in the death of one patient (4.5 percent). Our data are similar to those in the literature and indicate that colonoscopic decompression is a safe and efficacious first line of treatment for acute pseudoobstruction of the colon.

Acute Disease↗
PubMed1983

Proliferative potential of cells from normal human colon epithelium, adenomas, and carcinomas of the large bowel.

The proliferative potential of nonmalignant and malignant cells obtained from the human large bowel was assessed with a soft agar culture colony-forming technique and by flow cytometry to analyze cell cycle kinetics. No colony formation occurred with samples of normal human adult colon mucosa. The absence of colony formation in all but 1 of 24 evaluable colorectal adenomas suggested that malignancy of tissue in vivo is generally necessary for colony formation to occur in soft agar cultures. A high proliferative index (S + G2/M), as assessed by flow cytometry, was significantly associated with higher soft agar culture counts in a series of 25 colorectal carcinomas.

Adenoma↗
PubMed1983

Comparison of the rigid sigmoidoscope and the flexible sigmoidoscope in conjunction with colon x-ray for detection of lesions of the colon and rectum.

A series of 1007 patients was randomly divided into two groups, one a group of 499 patients who underwent rigid sigmoidoscopy and the other a group of 508 patients who had flexible sigmoidoscopy. Contrast barium enema studies were subsequently performed in all patients. Eighteen per cent of the patients had a neoplasm. We concluded that, given the amount of colon surveyed by rigid and flexible sigmoidoscopy in conjunction with contrast barium enema, there was no difference in the rate of detection between the two endoscopic techniques.

Barium Sulfate↗
PubMed1983

The importance of disease-free margins in resections for Crohn's disease.

It has long been a fundamental principle of surgical therapy for Crohn's disease to remove all disease prior to doing an anastomosis. The authors recently noted with concern an article describing a series of patients demonstrating that residual involvement of anastomotic microscopic disease had no significant effect on the recurrence rate at the anastomosis. Examining their own series of 710 patients undergoing surgery for Crohn's disease, the authors found 42 patients with residual anastomotic disease. The criteria for involvement were more specific than that used in the above article and included microscopic mucosal disease. The recurrence rate within the follow-up period of eight years in patients with only microscopic involvement was 89.4 per cent. This was significantly higher than the institutional recurrence rate for Crohn's resections, previously reported, of 55 per cent at ten years. The authors feel that clear margins should be obtained in resections for Crohn's disease, if at all feasible.

Adolescent↗
PubMedDate not supplied

Twelve-year experience with the long intestinal tube.

A number of surgical methods, including use of the long intestinal tube, have been designed to decrease the incidence of recurrent small bowel obstruction. The aim of the present study was to review the indications, morbidity, and long-term results of the long intestinal tube at the Mayo Clinic. During the 12-year period 1981-1992, 47 patients had such tubes placed. The patients formed a complex surgical group: 46 patients had previously undergone at least one laparotomy (median 4, range 1-10); 41 patients had been hospitalized at least once for small bowel obstruction (median 3, range 1-15); and all 41 of these patients had undergone at least one previous laparotomy for obstruction (median 2, range 1-7). Eleven patients had a history of inflammatory bowel disease, and eight had a history of irradiation. In addition to dense adhesions in 46 patients, operative findings included large bowel tumors in six patients, intraperitoneal carcinomatosis in four, intraabdominal abscess in four, and small bowel stricture in three. Twenty patients required either a small bowel or large bowel resection, and three had a stoma fashioned. Only one case of morbidity (tube retraction) was related to tube placement. Among the 36 patients with complete follow-up, nine patients developed episodes of recurrent adhesional small bowel obstruction after a mean follow-up of 48 months, although only one required laparotomy. Of the remaining 11 patients it is known that two developed small bowel obstruction, one of whom required laparotomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Technique of per anal excision for carcinoma of the low rectum.

Per anal excision is suitable for rectal carcinoma that is less than 3 cm and has not invaded into the muscular layer of the rectum. The upper margin of the lesion should not be greater than 7 cm from the anal verge. The entire lesion is excised in its full thickness with a 1.5 cm to 2 cm normal margin, using electrocautery. It is important that the specimen is carefully examined by the pathologist for completeness of the excision and grade of the carcinoma. Abdominoperineal resection should be considered in good risk patients if adequate margins cannot be achieved and if the carcinoma is a high pathologic grade.

Anal Canal↗
PubMedDate not supplied

Lateral margins of resection in adenocarcinoma of the rectum.

Wide dissection of adenocarcinoma of the rectum is difficult because of the fixed structure of the anatomic pelvis. The role of lateral margins, excision of the mesorectum, and extended lymphadenectomy have recently received much attention in the literature in dealing surgically with more advanced rectal carcinomas. The basic question to be resolved in the future is whether additional radical surgery is of more benefit than adjuvant chemoradiation therapy in this setting.

Adenocarcinoma↗
PubMedDate not supplied

Bullets and their role in sepsis after colon wounds.

The objective of this study was to determine the relation between the presence of a bullet (gunshot) after injury to the colon and the incidence of sepsis in its track and the soft tissue where it is retained. A retrospective review was carried out of the charts of consecutive patients admitted for abdominal gunshot wounds with proved colon injury during laparotomy where the bullet was either retained in the soft tissue or exited the body. The review covered a period of 4 years beginning January 1, 1990. Three groups were identified for analysis: (1) patients from whom the bullet was surgically removed, with additional cleansing and debridement of the area (n = 21); (2) patients who did not undergo surgical removal of the bullet (n = 81); and (3) patients in whom the bullet exited spontaneously and in whom only débridement of the skin was carried out (n = 83). Similar risk factors were noted among the groups (age, ATI score, colostomy rate), except for a higher incidence of shock in group 3 (p = 0.003). The incidence of sepsis in soft tissue was least in group 1. It was five and seven times greater in groups 2 and 3, respectively. After an abdominal gunshot with colon injury, the missile should be removed if feasible and the local tissue débrided. If the bullet has exited spontaneously, its internal track must be débrided and lavaged extensively.

Adolescent↗
PubMedDate not supplied

Does the presence of a pre-ileostomy closure asymptomatic pouch-anastomotic sinus tract affect the success of ileal pouch-anal anastomosis?

Ileal pouch-anal anastomosis (IPAA) is the procedure of choice for patients with ulcerative colitis and familial adenomatous polyposis. This two-stage procedure with a temporary diverting ileostomy avoids the catastrophic consequences of anastomotic leakage. We set out to determine the incidence and effect of asymptomatic pouch sinuses detected prior to ileostomy closure on the outcome of IPAA. A total 1600 IPAAs performed at the Mayo Clinic were reviewed. Forty-one (2.6%) asymptomatic sinuses were treated expectantly. There were 22 males and 19 females who had a median age of 32 years (range 14 to 58 years). The median time to ileostomy closure was 5.9 months (range 4 to 11 months). Five patients required further surgery following closure of ileostomy. The pouch function in these five patients was similar to that in the remainder of the group. Patients with a persistent sinus at the time of ileostomy closure had the same function as the main cohort. This group had a median of five (range 2 to 12) stools during the day and two (range 0 to 4) at night. The total number of stools per 24 hours was seven (range 2 to 14). Frequent incontinence occurred in 9.7% and 7.3% during the day and at night, respectively. Only 2.4% (1/41) were disappointed with the results of the operation and 80.4% (33/41) found their quality of life improved. Functional outcomes were comparable to those achieved with uncomplicated IPAA. Radiologically detected asymptomatic sinuses can be treated expectantly with a low rate of pouch loss and subsequent surgery. This is not considered a serious setback inasmuch as long-term function and quality of life are comparable to that achieved with IPAA without sinus tracts.

Adenomatous Polyposis Coli↗
PubMedDate not supplied

Patients' perceptions of their participation in a clinical trial for postoperative Crohn's disease.

OBJECTIVE: To explore patients' perceptions of their participation in a randomized controlled trial. PATIENTS AND METHODS: A 27-item questionnaire was mailed to all patients who participated in a randomized controlled trial that determined the effectiveness of mesalamine in preventing the recurrence of Crohn's disease postoperatively. RESULTS: The response rate was 66% (99 of 149). Fifty-five per cent of the patients felt that they received better medical care than they otherwise would have and 53% liked taking the medication. Sixty-eight per cent of the patients did not feel that annual colonoscopy was too frequent and 81% felt that the time commitment did not significantly interfere with their job or other activities. Seventy-five per cent and 62% of the patients would have liked more information and education, respectively, about Crohn's disease incorporated into the trial. Although 91% of the patients would agree to participate in a future randomized controlled trial comparing medical therapies, only 44% would agree to participate in a future randomized controlled trial comparing medical with surgical therapies. CONCLUSIONS: The majority of patients were satisfied with their participation in the trial. A large proportion of the patients would participate again but would like more information and education incorporated into the trial. Furthermore, post-trial questionnaires may be helpful in the design of future trials.

Administration, Oral↗