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Biomedical subjects

B M Schuman

Publications and source records attributed to B M Schuman.

At least 19 recordsLinked to original sources
PubMed1997

Achalasia in patients over 65.

Achalasia is a disease of undertermined etiology characterized by a defect in the innervation of esophageal smooth muscle causing aperistalsis of the esophageal body, increased lower esophageal sphnicter (LES) tone and inappropriate relaxation of the LES during swallowing. Several of the manometric and radiographic features of achalasia are also seen in individuals without the disease but they are reported much more frequently in older populations. We reviewed our cases of new onsst achalasia in patients over age 65 to see if their presentation and response to treatment might differ from that reported in younger patients. We found dysphagia to be the predominant symptom in our elderly patients just as it is in younger patients. Chest pain, on the other hand, was significantly less common. Additionally, our achalasia group had a high response rate to pneumatic dilatation, confirming an earlier study that showed greater efficacy in older patients than in younger patients.

Aged↗
PubMed1994

Long-term prognosis of well-differentiated adenocarcinoma in endoscopically removed colorectal adenomas.

Thirty-six malignant polyps were identified that met the following criteria: well-differentiated adenocarcinoma and complete excision endoscopically. Location, type, size, distance of the cancer to the cautery mark, and lymphovascular involvement were analyzed to determine if they affected findings at surgery or risk of recurrent cancer. There were 20 patients and 21 polyps in the nonsurgical group, and 15 patients and polyps in the surgical group. One patient from each group had residual cancer after endoscopic removal of the polyp. The only factor that had an adverse effect on outcome was the distance of the cancer to the cautery mark (< 1 mm). Although rectal location was associated with the residual cancer, poor prognosis could have been predicted by the inadequate margins. This long-term follow-up (65 months average) study supports previous observations that an adequate margin is the most important factor in predicting the prognosis of endoscopically resected colorectal adenomas containing well-differentiated adenocarcinomas.

Adenocarcinoma↗
PubMed1994

The influence of liver disease and portal hypertension on bleeding in Mallory-Weiss syndrome.

The records of 79 patients admitted to the hospital from January 1985 through December 1990 for acute esophageal hemorrhage were analyzed to determine the influence of liver disease and/or portal hypertension on the severity of bleeding from Mallory-Weiss syndrome. Forty-two patients had bled from Mallory-Weiss syndrome; 8 had liver disease and nonbleeding esophageal varices, 6 had liver disease without varices, and 28 had no evidence of liver disease. The severity of bleeding was determined by the transfusion requirement for each group. The number of units of blood needed for patients with liver disease was significantly increased (p < 0.005) over the number of units necessary for patients without liver disease. There was no statistically significant difference in the transfusion requirement between liver disease patients with and without varices (i.e., portal hypertension). The transfusion requirement was also unrelated to the Child classification of hepatic functional reserve. We conclude that the severity of bleeding from Mallory-Weiss syndrome is primarily related to the status of liver function and that portal hypertension does not make an additive contribution.

Adolescent↗
PubMed1993

Lymphocytic colitis. A definable clinical and histological diagnosis.

We reviewed colorectal biopsies and clinical records from 36 patients with chronic watery diarrhea who had been diagnosed as having microscopic colitis and compared their histologic features with the more detailed and precise criteria for lymphocytic colitis. Published pathologic criteria for lymphocytic colitis were applied to the biopsies and compared. Focal or diffuse nature of the lymphoid infiltrate were noted separately. The focal lymphoid infiltrate was related to lymphoid aggregates in the lamina propria of the mucosa. Eighteen cases had focal lymphoid cell infiltration, and 16 of them had associated diverticula, polyps, or both. Eighteen cases had diffuse lymphoid cell infiltration, and six of them had diverticula or polyps. Results indicate that focal cellular infiltration strongly predicts associated diverticula or polyps. The group with no diverticula or polyps most closely conformed to histologic criteria for lymphocytic colitis (Kruskal-Wallis P < 0.02). We conclude that lymphocytic colitis comprises a well-defined group of cases within the large and less-defined group of microscopic colitis.

Adult↗
PubMed1993

The limited role of total parenteral nutrition in the management of pancreatic pseudocyst.

Total parenteral nutrition (TPN) for the nonoperative treatment of acute pancreatic pseudocyst has been of hypothetical benefit. We reviewed pseudocyst hospital admissions in 40 patients treated with TPN who had serial imaging studies. The mean cyst size was 7.4 cm on presentation, decreasing to 5.6 cm after nonoperative treatment with TPN (mean 32.5 days). After a nonoperative period, 68 per cent of cysts regressed, completely in 14 per cent, partially in 54 per cent. Except for a patient with cyst-related obstructive jaundice, there were no complicated pseudocysts. Only 12 (28%) patients underwent cyst drainage. Fifteen patients (35%) sustained catheter-related complication, which included sepsis (26%), pneumothorax (9%), hydropneumothorax (2%), and septic right atrial thrombosis (2%), in the course of hospitalization. The majority of TPN-treated patients had a clinical and radiographic regression of their pseudocyst. However, the increased risk of catheter-related complications in this group suggests that this therapy should be limited to patients who are unable to sustain enteral nutrition.

Acute Disease↗
PubMed1991

The practice outcomes of a course in flexible sigmoidoscopy for primary care physicians.

A mail survey of 430 participants in a 2-day course on flexible sigmoidoscopy presented over the past 6 years was conducted to determine the extent to which flexible sigmoidoscopy was subsequently utilized in physician practice. Eighty percent of respondents performed the procedure in their practices on a regular basis. Two-thirds of the patients underwent sigmoidoscopy for screening. The course in flexible sigmoidoscopy appears to potentiate the motivation of primary care physicians to incorporate complete colorectal cancer screening in their practice.

Education, Medical, Continuing↗
PubMed1990

The Bouveret syndrome: an unusual cause of hematemesis.

Gallstones are usually silent. Less commonly, patients with cholelithiasis develop symptoms and/or complications; biliary fistula occurs in 3% to 5% of the cases. When a large stone is passed and occludes the duodenum, gastric outlet obstruction (the Bouveret syndrome) may result. In reported cases, the stones are usually larger than 2.5 cm. The usual presenting symptoms are those of bowel obstruction: abdominal pain, nausea, and vomiting. Less commonly, the patients experience melena and, rarely, hematemesis. We describe a patient who had the largest stone reported to cause hematemesis rather than bowel obstruction and to be diagnosed endoscopically. The 5 X 4 X 3 cm stone was extracted surgically. Endoscopic diagnosis and extraction of stones up to 3 cm in size has been reported, avoiding the need for surgery.

Aged↗
PubMed1990

The association of multiple colonic adenomatous polyps with cancer of the colon.

We reviewed our colonoscopy data for the past 10 yr for patients with five or more polyps to determine the association of multiple adenomatous polyps and colon cancer. During that period, 3,834 patients underwent colonoscopy. Fifty-two patients with five or more polyps at the initial colonoscopy were found. In 25 patients (group I) there were at least five synchronous adenomas, and in 27 patients (group II) a combination of adenomas and hyperplastic polyps totaling five or more. The number of polyps ranged from five to 30 (median, six). There was no significant difference in the location of polyps between groups I and II. Eight of 52 patients (15%) were found to have colon cancer at the initial colonoscopy. In group I, there were six cancers (24%), five of which were in the cecum. Two of 27 patients (7%) in group II had cancer, one of which was located in the cecum. Patients with five or more adenomas at the index colonoscopy are at high risk of having colon cancer that is particularly prone to arise from the right side of the colon.

Adenoma↗
PubMed1989

Inflammatory bowel disease in 64 black patients: analysis of course, complications, and surgery.

Sixty-four black patients with inflammatory bowel disease (IBD) were seen from 1960 to 1987 at the Medical College of Georgia, representing 22% of all patients with IBD: 38 of them had Crohn's disease (CD) and 26 had ulcerative colitis (UC). In those with CD, the small intestine alone was involved in 16% and ileocolitis was found in 58%; joint disease affected 11 patients (29%) and perianal disease 13 patients (34%). Twenty black patients (53%) underwent one disease-related surgical procedure, and 10 (50%) of those required two or more reoperations. Nine UC patients (35%) underwent surgery, and, except for three cases of sclerosing cholangitis (12%), black patients with UC showed no clinical findings different from white UC patients. In our American black patients, the course of IBD was similar to that of white patients, although in Crohn's disease the reoperation rate and the rate of joint involvement were higher in our black IBD patients; primary sclerosing cholangitis was also found in a larger percentage of black patients with UC than in our white patient population.

Adult↗
PubMed1989

Scanning electron microscopy of dysplastic Barrett's epithelium.

Twenty-six patients with Barrett's esophagus (BE) were followed prospectively by endoscopic examination and biopsy. Two biopsies were taken from each of 4 areas of BE. One was processed for light microscopy (LM) and one for scanning electron microscopy (SEM). Those in whom dysplastic BE was demonstrated by LM were reexamined at 6-mo intervals, and the others at yearly intervals. One patient had low grade dysplasia (LGD) by LM on entry, and in 2 others, LGD was recognized on the second examination. These changes have persisted in semiannual examinations over 3, 2, and 2 yr, respectively. SEM prints were examined without knowledge of LM findings, and features that might correlate with LGD by LM were sought. SEM findings were similar to those of Zwas et al. (Gastroenterology 90:1932, 1986) in that most glandular cells had surface features unlike either gastric or intestinal cells but unique to BE. In the patient with LGD on entry, there was an aggregate of very large cells covered by short microvilli with bald patches. In the other patients with LGD, there was more variation in size and shape of cells than in nondysplastic cases.

Adult↗
PubMed1988

Recovery from hepatic vein thrombosis (Budd-Chiari syndrome) complicating ulcerative colitis.

A 22-year-old female with active ulcerative colitis developed massive ascites, hypoalbuminemia, and hepatomegaly compatible with thrombosis of the hepatic veins. The diagnosis of Budd-Chiari syndrome was confirmed by ultrasonography, computed tomography, and by liver biopsy. A search of the literature disclosed only three previous reports of Budd-Chiari syndrome occurring in patients with ulcerative colitis. All patients have been young females with active colitis and no other known risk factor for the development of hepatic vein thrombosis. Our patient, unlike the previously reported patients who died, recovered sufficiently to be discharged from the hospital.

Adult↗
PubMed1988

Inflammatory bowel disease. Options in office management.

Current therapeutic options make office management of the patient with uncomplicated left-sided ulcerative colitis or mild to moderate Crohn's disease quite feasible for the primary care physician. On the horizon are additional drugs that will enhance the physician's ability to treat patients with inflammatory bowel disease effectively, with minimal risk of side effects or toxicity.

Adrenal Cortex Hormones↗
PubMed1988

Differentiating Crohn's colitis from ulcerative colitis. A rundown of likenesses and dissimilarities.

Crohn's colitis and ulcerative colitis are two distinct clinical entities with differing clinical, pathologic, endoscopic, and radiographic findings. Because of distinct differences in their response to surgical and, in some instances, medical management, clinical separation of these two unique disease states is important. Although at times diagnostic confusion may persist, thorough clinical evaluation, including the judicious use of mucosal biopsy, yields the correct diagnosis in the majority of patients.

Colitis, Ulcerative↗
PubMed1987

Gastric cancer in San Marinese and their first degree relatives in San Marino and the United States. Gastroscopic biopsy as an epidemiological tool.

The Republic of San Marino, a small, 23-square mile, independent country near the Adriatic Coast within Italy, has been noted to have a high incidence of gastric cancer in its 22,000 population (9% of all deaths from 1969-1983 with 33% of all cancer deaths attributed to gastric cancer). Gastroscopic biopsy studies on 284 first degree relatives of San Marinese gastric cancer patients in the Republic of San Marino and in Detroit, where 2,000-2,500 San Marinese reside, have allowed detection of six gastric malignancies. Intestinal metaplasia of gastric mucosa was found in 16 (52%) of 31 Detroit first degree relatives and 51 (36%) of 143 San Marino first degree relatives. Gastroscopy provides an important tool not only for the early detection of gastric cancer in populations of high risk (such as that of San Marino), but also for providing clues to the genetic and environmental factors in gastric neoplasia.

Aged↗