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Biomedical subjects

D J Glotzer

Publications and source records attributed to D J Glotzer.

At least 19 recordsLinked to original sources
PubMed1985

Aluminum hydroxide gel bezoar--CT diagnosis.

An obstructing aluminum hydroxide gel bezoar was first recognized on a retrograde gastrografin study through an ileostomy. In retrospect, a computed tomographic (CT) scan had demonstrated the bezoar as a high density intraluminal mass surrounded by somewhat less dense contrast material distending the bowel. A CT image of a phantom made of aluminum hydroxide gel surrounded by gastrografin was remarkably similar.

Aged↗
PubMed1982

The long-term outcome of restorative operation in Crohn's disease: influence of location, prognostic factors and surgical guidelines.

The course of all 113 patients with Crohn's disease whose initial procedure involved an anastomosis operated upon from 1942 to 1972 was followed through 1980. The calculated cumulative 30-year total mortality was 23.4%, 16.7% disease-related. The cumulative recurrence rate was 29% at five years, 52% at ten years, 64% at 15 years and 84% at 25 years, with no important differences between disease locations and types of operation. Sex, age, duration, granulomas, enteral or perirectal fistulas and length of the resection, the disease, and the proximal resection margin had no significant influence on the rates of development of recurrent disease or on functional outcome. By far the most common site of recurrence was the neo-terminal ileum, but in ileocolitis compared with ileitis, recurrence was 5.2 times more likely (p = 0.0001) to involve the adjacent or remote colon as well. Moreover, only 1/63 ileitis patients eventually required ileostomy, whereas 15/47 patients with ileocolitis or colitis ultimately required this procedure (p less than 0.001). The current status of the patients was excellent or good in 64% and unwell or dead related in 24%. Urolithiasis developed in 19%.

Colectomy↗
PubMed1981

Proctitis and colitis following diversion of the fecal stream.

Inflammation limited to excluded segments of the colon was observed in 10 patients without prior inflammatory bowel disease who had undergone colostomy or ileostomy for various indications. With the exception of 1 patient who complained of mucoid rectal discharge, the patients were asymptomatic when the lesion was discovered; 2 others subsequently developed mild symptoms. The proctoscopic findings were similar in appearance to those of mild ulcerative colitis. In 8 of 10 patients the inflammatory changes were confined to the distal few centimeters of the rectum, while in the remaining 2 patients the entire excluded segment was affected. Microscopic alterations were focal and included crypt abscesses, epithelial cell degeneration, acute and chronic inflammation in the lamina propria, and regenerative changes in the crypts. The inflammation persisted for as long as 8 yr in the 5 patients who did not have restoration of intestinal continuity, but subsided in the 5 patients whose colostomies were closed. The prior as subsequent clinical courses of these patients, together with the focal, nonspecific microscopic features, strongly suggest that the inflammation in these patients resulted from diversion of the fecal stream and was not a recognized form of specific or idiopathic colitis. Diversion-related colitis must not be confused with other forms of inflammation since this may result in improper therapy and/or delay in treatment of the condition for which the fecal diversion was performed.

Adult↗
PubMed1980

Colonic exclusion bypass principle: its use in the palliative treatment of malignant duodenocolic and gastrocolic fistulas.

Two patients with malignant upper gastrointestinal-to-colon fistulas had palliative operations utilizing the exclusion bypass principle. This principle entails isolating the affected portions of the colon from the remaining large intestine and anastomosing it to itself. Exclusion bypass reduces bacterial contamination of the upper tract (which is the important mechanism for the unrelenting diarrhea and malnutrition), eliminates prograde shunting, which can contribute to symptoms in malignant fistulas, and avoids the potential for closed-loop obstruction.

Adenocarcinoma↗
PubMed1980

Recurrence in Crohn's colitis: the numbers game.

There has been great controversy about the proper role of operation in the management of colonic Crohn's disease because of disagreement about the frequency of recurrence. Since, in our retrospective studies, the majority of patients with colonic Crohn's disease had a previous diagnosis of ulcerative colitis, accurate determination of the recurrence rate in colonic Crohn's disease requires review of all patients with colonic inflammatory bowel disease in order to define the population at risk. Using objective means for diagnosis and for the assessment of outcome, we have found that recurrent disease after ileostomy and colectomy occurred in a minority (approximately 16%) of the patients. Both Crohn's colitis and ulcerative colitis followed a generally favorable postoperative course after this procedure, since even those patients who developed recurrent disease usually were rehabilitated by one or more revisions of the ileostomy. We believe that needed operations should not be avoided solely because of a diagnosis of colonic Crohn's disease, since the high recurrence rates and poor prognoses reported in many studies are based on falsely low numbers of those at risk.

Colectomy↗
PubMed1980

Thromboembolism after insertion of the Mobin-Uddin caval filter.

The occurrence, in one patient, of a life-threatening pulmonary embolus 3 days following insertion of a Mobin-Uddin umbrella filter promoted a review of our experience with this device. Over the past 5 years, 41 patients had umbrella filters inserted at the Beth Israel Hospital. Five patients (12%) had proven or probable pulmonary embolization following filer placement. In four of the seven autopsied patients, thrombus was found on the cardiac side of the umbrella, and in one of these patients a fresh embolus was also found in the pulmonary artery. We conclude that the standard (nonheparin-impregnated) Mobin-Uddin umbrella device offers incomplete protection against pumonary embolization in patients who cannot concurrently receive anticoagulant drugs.

Adult↗
PubMed1980

Caudate lobe resection to reduce inferior vena caval hypertension prior to portacaval shunt.

Coexistent caval and portal hypertension was recognized on preoperative angiographic study of a patient with cirrhosis and variceal bleeding. This hemodynamic situation can preclude adequate reduction of portal hypertension by portasystemic shunt and can result in fatal postoperative bleeding. Resection of a very large caudate lobe effectively reduced caval pressure and allowed a direct solution to the problem by portacaval anastomosis, rather than by more complex shunts or by nonshunting procedures previously suggested as alternatives.

Esophageal and Gastric Varices↗
PubMed1976

Ulcerative colitus and Crohn's disease of the colon - a comparison of the long term postoperative courses.

Patients with colitis and ileocolitis of unknown etiology from two previously reported series have been combined and the follow-up studies have been extended to compare the long term postoperative courses of ulcerative colitis (UC) and Crohn's disease of the colon (CDC). The combined and updated series of 176 patients, 99% of whom could be traced, provided a mean postoperative follow-up period for UC of 14 years (5 to 31) and CDC of 13.1 years (5 to 36). There were highly significant associations between generally accepted clinical and distributional features of UC and CDC and microscopic findings generally regarded as reliable for each. However, because of spectrum of features was found in each entity, neither clinical and distributional nor microscopic features alone are sufficient for diagnosis in every case. There were no differences in gross or disease-related mortality in UC and CDC whatever the method of diagnosis. After anastomotic procedures in CDC a recurrence rate of 73% was found. After proctocolectomy the ileostomy revision rate (considering all types of those which required further excision of ileum) was higher in CDC than UC whether the diagnoses were based on microscopic, clinical, or combined criteria, but the differences reached statistical significance only in the comparison of "clinical UC", with "clinical CDC". Moreover, after the first 2 postoperative years, the risk of having an ileostomy revision in UC and CDC (combined criteria) per patient year follow-up was virtually identical and there were no cases of short bowel syndrome. Differences in the clinical courses of UC and CDC after colectomy and ileostomy are of degree and do not reflect the ultimate course or potential for rehabilitation. Decisions regarding surgical therapy should be made independent of the diagnosis of UC or CDC.

Colectomy↗