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Biomedical subjects

D A Lieberman

Publications and source records attributed to D A Lieberman.

At least 19 recordsLinked to original sources
PubMed1992

Physician assistants in gastroenterology: should they perform endoscopy?

New technology and increased screening examinations continue to cause the demand for gastrointestinal endoscopic procedures to mushroom. Hospitals administered by the Department of Veterans Affairs, public health care facilities, and health maintenance organizations struggle to meet this demand because of limited resources for expansion of space or staff. For the past 3 yr, we have used a physician assistant in our endoscopy laboratory to assist with and perform endoscopic procedures. The benefits for our hospital include increased staff efficiency, improved housestaff education, and ability to perform an increased number of procedures with existing staff.

Endoscopy, Gastrointestinal↗
PubMed1992

Targeted colon cancer screening: a concept whose time has almost come.

Screening of large populations for colon malignancy has been advocated in several countries to detect cancers at earlier, curable stages and/or prevent cancer by detecting and removing premalignant polyps. Ideal screening would identify subjects with the highest risk of cancer and target sensitive screening tests at this population. Recent data suggesting that environmental factors and genetic alterations contribute to increased cell proliferation in colonic mucosa provide several avenues for identification of high-risk subjects. This review examines the current literature regarding colon cancer risk factors, focusing on new ways to identify individuals who may benefit from targeted screening.

Biomarkers, Tumor↗
PubMed1991

Screening for colon malignancy with colonoscopy.

Screening of asymptomatic individuals for colon malignancy has been advocated for the past 20 yr in the hopes of reducing colon cancer mortality. Although sigmoidoscopy is an important element of current screening recommendations, the sensitivity of this test in asymptomatic subjects has never been studied. The purpose of this study was to determine the prevalence and location of polyps and cancers in an asymptomatic population by performing full colonoscopy. We wished to assess the sensitivity of screening flexible sigmoidoscopy to 60 cm by determining how many patients with adenomas or cancer had "index" adenomatous polyps in the distal 60 cm. One hundred five healthy male outpatients, over 50 yr old, with negative examinations for occult blood in stools and no prior history of colon pathology, had full colonoscopy. Careful examination of the distal 60 cm was performed, followed by a full colon examination to the cecum. Forty-three patients (41%) had adenomatous polyps, and only 19 of these patients had an index adenomatous polyp in the distal 60 cm. Therefore, the sensitivity of sigmoidoscopy was 44%. The prevalence of adenomas increased with age. Patients were assigned to one of three groups based on the findings in the distal 60 cm. Group 1 (n = 65) had no polyps in the distal 60 cm, but 18 of these patients (28%) had adenomatous polyps in the proximal colon. Among 21 patients with only hyperplastic polyps in the distal 60 cm (group 2), six patients (29%) had proximal adenomas. In group 3, eight of 19 patients (42%) with adenomas in the distal 60 cm also had proximal adenomatous polyps. We conclude that adenomatous polyps are common in asymptomatic men who have negative tests for fecal occult blood. Sigmoidoscopy to 60 cm had a sensitivity of only 44% in this patient population, suggesting that this is an insensitive test for the detection of patients with adenomatous polyps.

Aged↗
PubMed1990

Colon cancer screening. The dilemma of positive screening tests.

Despite doubts about the benefits of colon cancer screening, sigmoidoscopy and fecal occult blood tests are now often performed by clinicians who must then deal with positive test results. The purpose of this literature review is to examine potential strategies for dealing with positive screening test results. If positive results are obtained, current data support the use of colonoscopy as the single most effective diagnostic strategy. Exceptions include situations that reduce the predictive value of the screening test. Several important areas of controversy are highlighted that need to be assessed in subsequent studies.

Colonic Neoplasms↗
PubMed1990

Improved scintigraphic assessment of severe cholestasis with the hepatic extraction fraction.

In previous studies, we found that biliary scintigraphy with technetium-99m-labeled iminodiacetic acid ([99mTc]IDA) provided excellent discrimination between intrahepatic and extrahepatic cholestasis, except in patients with profound cholestasis who had poor visualization of the biliary tree. In this study, we have used deconvolution analysis to determine the hepatic extraction fraction (HEF) of a hypothetical single circulatory pass of [99mTc]IDA. Our hypothesis was that extraction of radionuclide from the blood would be normal in patients with extrahepatic obstruction alone, but would be impaired in patients with intrahepatic disease (IHD). The purpose of this study was to compare the HEF in patients with profound cholestasis (bilirubin greater than or equal to 3.0 mg/dl) due to either IHD or common bile duct obstruction (CBDO). Normal subjects (N = 13) had an HEF of 100%. Patients with CBDO (N = 13) had slightly reduced HEF values (92.8 +/- 3.2%) despite profound hyperbilirubinemia (6.1 +/- 1.0 mg/dl). Patients with IHD (N = 23) had a markedly reduced HEF (43.1 +/- 4.1%) which was significantly lower than patients with CBDO and normal subjects (P less than 0.001). We conclude that the determination of the HEF during biliary scintigraphy is helpful in distinguishing between intrahepatic and extrahepatic disease in patients with hyperbilirubinemia (bilirubin greater than or equal to 3.0 mg/dl).

Bilirubin↗
PubMed1989

Nonverbal sensitivity of normal-hearing and hearing-impaired older adults.

The study compared the nonverbal decoding abilities of normal-hearing and hard-of-hearing older adults using the Profile of Nonverbal Sensitivity (PONS). The PONS test allowed the measurement of subjects' decoding accuracy for a variety of nonverbal cues presented under two auditory, three visual, and six audiovisual conditions. Nonverbal perceptual scores were lower for the hearing-impaired group under all presentation conditions. Perception of prosodic features of speech by hearing-impaired subjects was significantly related to low-frequency hearing sensitivity. Between-group differences in the decoding of visually transmitted nonverbal cues varied across visual presentation conditions. Results are compared to past deaf studies and related to processing strategies used by normal-hearing and hearing-impaired persons.

Aged↗
PubMed1988

24-hour esophageal pH monitoring before and after medical therapy for reflux esophagitis.

Medical treatment of gastroesophageal reflux disease often results in improvement of symptoms. The purpose of this study was to determine if improvement in symptoms and endoscopic appearance after treatment was associated with a reduction in reflux, as measured with 24-hr pH recordings. Twenty patients with severe chronic reflux esophagitis participated in an eight-week double-blind trial of medical therapy with metoclopramide and cimetidine versus placebo and cimetidine. Significant symptom score improvement was noted in 11 patients. Eleven patients also had improvement in the endoscopic appearance of the esophageal mucosa, and eight of these patients had significant symptom improvement. Initial 24-hr pH recordings were abnormal in all patients, evidenced by an esophageal pH less than 4 during 20% of the study period. Improvement in 24-hr results was noted in only five patients--three with clinical and endoscopic improvement, and two with no improvement. In conclusion, there was no relationship between clinical improvement and the results of 24-hr pH recordings. Successful symptom relief and endoscopic healing of esophagitis during medical treatment may occur despite persistent reflux of gastric contents.

Cimetidine↗
PubMed1988

Primary biliary cirrhosis: Tc-99m IDA planar and SPECT scanning.

The authors studied ten patients with primary biliary cirrhosis using planar and single photon emission computed tomography (SPECT); results were compared with those from 13 healthy subjects. Patients with primary biliary cirrhosis had six- to tenfold prolongation of mean halflife (t 1/2) hepatic excretion of technetium-99m iminodiacetic acid (IDA) compared with mean t 1/2 excretion in healthy subjects. All patients with primary biliary cirrhosis had diffuse, uniform hepatic isotope retention and normal major bile ducts on planar and SPECT scans. The gallbladder was seen within 60 minutes in nine of nine patients who had intact gallbladders. The mean gallbladder volume was normal, but gallbladder ejection fractions and ejection rates were reduced in patients with primary biliary cirrhosis compared with those of healthy subjects. In contrast with previous studies of patients with sclerosing cholangitis and common bile duct obstruction, patients with primary biliary cirrhosis had different findings on scintiscans. In the early evaluation of patients with cholestasis, Tc-99m IDA hepatobiliary scintigraphy may be useful in the selection of the most appropriate invasive diagnostic test to enable a definitive diagnosis.

Adult↗
PubMed1988

In the eye of the needle. A reappraisal of endoscopic sclerotherapy.

Endoscopic sclerotherapy is routinely used as treatment for bleeding esophageal varices. Recent controlled trials have evaluated the impact of sclerosis on short and long term survival after varices hemorrhage and compared sclerotherapy with shunt surgery. These studies are reviewed and the future of sclerotherapy discussed.

Esophageal and Gastric Varices↗
PubMed1988

Frequency of isolated proximal colonic polyps among patients referred for colonoscopy.

The American Cancer Society now advocates screening asymptomatic populations over the age of 40 to 50 years for colonic malignancy. It is possible, however, that fecal occult blood testing and sigmoidoscopy to 60 cm would fail to identify patients with adenomatous polyps located only in the proximal colon. The purpose of this study was to determine how many patients without polyps in the distal 60 cm of the colon would have more proximal lesions. Ninety-eight consecutive patients with positive fecal blood test results or suspicious barium enema results were studied, using the assumption that if they had been seen six months earlier, when asymptomatic, they would have been candidates for screening examination. Forty-one (42%) of 98 patients had adenomatous polyps or cancer, and 15 (37%) of these patients had isolated proximal lesions. The polyp detection rate from 0 to 60 cm was significantly less than the detection rate for a full colonoscopy (27% vs 42%). We conclude that isolated proximal colonic polyps may be common.

Adenocarcinoma↗
PubMed1988

Hepatocyte versus biliary disease: a distinction by deconvolutional analysis of technetium-99m IDA time-activity curves.

A combination of quantitative hepatobiliary imaging techniques was developed to study normal control subjects and patients with 3 categories of hepatobiliary disease: 1) alcoholic cirrhosis; 2) sclerosing cholangitis; and 3) isolated common bile duct obstruction. Scintigraphic images were supplemented by quantitative measurement of hepatic extraction fraction by deconvolutional analysis and liver excretion T 1/2 by a nonlinear least squares method. In diseases confined primarily to the biliary tract (isolated common bile duct obstruction and sclerosing cholangitis), the mean hepatic extraction fraction as measured by deconvolutional analysis was not different from that in normal controls. In severe alcoholic cirrhosis, considered primarily a hepatocyte disease, the hepatic extraction fraction was markedly reduced. The T 1/2 excretion, compared to normal subjects, was prolonged in all three liver disease categories. We conclude that these quantitative parameters were able to detect hepatobiliary disease and to separate severe hepatocyte disease from biliary tract disease.

Biliary Tract Diseases↗
PubMed1987

Metabolic bone disease in asymptomatic men after partial gastrectomy with Billroth II anastomosis.

We sought to determine whether gastric surgery might be associated with metabolic bone disease in a well-characterized population, and if so to explore its etiology. Sixteen asymptomatic middle-aged men who had had partial gastrectomy with Billroth II anastomosis but no other risk factors for metabolic bone disease were compared with unoperated healthy controls. Studies included a dietary survey, biochemical tests of bone and mineral metabolism, radiographs of the spine, determinations of bone mineral content, and bone histomorphometry. The gastric surgery subjects exhibited frequent vertebral fractures and an unusual constellation of bone abnormalities characterized by decreased bone mineral content and hyperosteoidosis without evidence of osteomalacia. Although serum immunoreactive parathyroid hormone and 25-hydroxyvitamin D levels were not different, 1,25-dihydroxyvitamin D levels were significantly higher (p = 0.037), and 24,25-dihydroxyvitamin D levels were significantly lower (p less than 0.0001) in subjects than in controls. Partial gastrectomy with Billroth II anastomosis may be associated with asymptomatic but clinically important metabolic bone disease. The pathophysiology is uncertain, but appears to involve alterations in vitamin D metabolism.

Bone Diseases, Metabolic↗
PubMed1987

Diagnosis of sclerosing cholangitis with technetium 99m-labeled iminodiacetic acid planar and single photon emission computed tomographic scintigraphy.

The purpose of this study was to determine whether 99mTc-iminodiacetic acid planar biliary scintigraphy combined with single photon emission computed tomography could detect sclerosing cholangitis and provide additional information regarding the extent and severity of disease. Thirteen patients with sclerosing cholangitis and 13 normal control subjects were studied. Scintigraphic results were also compared with previously reported studies of patients with isolated common bile duct obstruction and with primary biliary cirrhosis. The planar scintigraphy in patients with sclerosing cholangitis showed beading or bandlike constrictions of the biliary tract corresponding to lesions seen on cholangiography, and the image pattern was distinctly different from images obtained from patients with isolated common bile duct obstruction or primary biliary cirrhosis. The single photon emission computed tomography images of the liver in patients with sclerosing cholangitis demonstrated multiple focal areas of 99mTc-iminodiacetic acid retention, representing bile stasis in intrahepatic bile ducts. Compared to controls, the mean hepatic clearance half-time of 99mTc-iminodiacetic acid was markedly delayed in patients with sclerosing cholangitis (6-10 times normal). Individual patients with sclerosing cholangitis had wider variation in isotope clearance half-time from three regions of the liver than patients with isolated common bile duct obstruction, consistent with regional difference in disease severity and variable impairment of bile flow. In 4 patients with sclerosing cholangitis with incomplete filling of the right and left hepatic ducts at cholangiography, planar and single photon emission computed tomographic scintigraphy provided evidence of significant intrahepatic sclerosing cholangitis. In conclusion, combined 99mTc-iminodiacetic acid planar and single photon emission computed tomographic scintigraphy is a sensitive noninvasive test for the diagnosis of sclerosing cholangitis and reliably differentiates sclerosing cholangitis from isolated common bile duct obstruction or primary biliary cirrhosis. Measurement of isotope clearance half-time provides quantitative physiologic data that may be useful in the longitudinal follow-up of patients with sclerosing cholangitis.

Adult↗
PubMed1987

Medical therapy for chronic reflux esophagitis. Long-term follow-up.

The purpose of this investigation was to evaluate the long-term course of medically treated severe reflux esophagitis to determine if prolonged pharmacologic therapy was necessary to control symptoms. Twenty patients with chronic reflux esophagitis (mean duration, 13 years) achieved significant clinical improvement after acute intensive therapy with cimetidine and metoclopramide. During the 26-month follow-up period after remission, nine (45%) patients experienced a relapse of symptoms as drug dosages were tapered or discontinued, eight (40%) patients remained in remission, and three experienced a relapse of symptoms after a remission of longer than two years. Lower esophageal sphincter pressures were lower among patients who relapsed compared with patients with prolonged remission (4.9 vs 13.2 mm Hg). Drug requirements to maintain symptom control were antacids alone in five patients, bedtime H2-blocker in five, full-dose H2-blocker in four, and bedtime metoclopramide (10 mg) plus an H2-blocker in six. Moreover, the symptoms of three patients receiving full-dose H2-blocker therapy were controlled with antacids alone for two years, until relapse occurred. In conclusion, some patients with severe, long-standing reflux esophagitis will have a lasting response to short-term intensive medical therapy. Long-term intensive therapy may be unnecessary in many patients. Patients with lower sphincter pressures may have a higher likelihood of symptomatic relapse.

Barrett Esophagus↗
PubMed1987

Eosinophilic gastroenteritis presenting with biliary and duodenal obstruction.

Eosinophilic gastroenteritis is a rare disease associated with eosinophilic infiltration of the gastrointestinal tract which can result in gastroduodenal obstruction. Biliary obstruction due to duodenal disease is rare, and the simultaneous occurrence of obstruction of the duodenum and biliary tract has not been previously reported. We now present a patient with abrupt onset of both biliary tract and duodenal obstruction due to eosinophilic infiltration of the muscularis of the duodenum and stomach. The differential diagnosis and unique features of this disease are reviewed.

Cholestasis↗
PubMed1986

Intrahepatic versus extrahepatic cholestasis. Discrimination with biliary scintigraphy combined with ultrasound.

Biliary scintigraphy and ultrasound imaging were performed in 52 patients with suspected biliary tract pathology. Results were correlated with the findings of direct cholangiography. Several new innovations in scintigraphic technique were used. The combination of ultrasound imaging and scintigraphy correctly identified biliary tract obstruction in 17 of 19 patients, 12 of whom had dilated bile ducts on ultrasonography. Intrahepatic cholestasis was correctly diagnosed in 11 of 13 patients. Accurate discrimination between intrahepatic and extrahepatic cholestasis was achieved in 28 of 32 patients (88%) with the combined studies. Scintigraphy also provided a correct diagnosis of acute cholecystitis in all 9 patients with surgically confirmed disease. Eleven additional patients with gallbladder or pancreatic disease had normal bile ducts at scintigraphy, which was confirmed with cholangiography. When combined with ultrasound imaging, modern biliary scintigraphy can (a) provide excellent discrimination between intrahepatic and extrahepatic cholestasis and (b) help determine the need for subsequent invasive diagnostic studies in selected patients.

Adult↗
PubMed1986

Intrahepatic cholestasis due to Hodgkin's disease. An elusive diagnosis.

The case of a 53-year-old man with idiopathic cholestasis due to Hodgkin's disease illustrates the difficulty in making a definitive diagnosis and the limitations of noninvasive imaging studies. Hodgkin's disease should be considered in the differential diagnosis of profound intrahepatic cholestasis.

Cholestasis, Intrahepatic↗