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Biomedical subjects

E R Feller

Publications and source records attributed to E R Feller.

At least 19 recordsLinked to original sources
PubMed2001

Gynecologic aspects of Crohn's disease.

Because Crohn's disease has a tendency to be transmural and to form fistulas, it may involve contiguous organs. Gynecologic involvement is frequent, diverse and often difficult to diagnose. Inflammation involving adjacent structures has been reported in as many as one third of patients. Enteric fistulas to the vagina, uterus, ovaries, perineum and vulva also have been reported. Diagnosis may not be obvious if pelvic involvement precedes active bowel disease, or if drainage is clear or mucoid. Abscesses, draining sinuses, edema and ulceration of the perineum or vulva are common, and are caused by direct extension from the involved bowel or by granulomas separated from the bowel by normal tissue. Lesions presenting with vulvar hypertrophy, a fluctuant mass or ulceration are easily misdiagnosed. Menstrual abnormalities are reported in more than one half of patients. Pelvic manifestations of Crohn's disease can be psychologically crippling. Patients or physicians may be hesitant to address serious psychosocial morbidity. To optimize management, physicians must be aware of the diverse manifestations, confusing presentations and psychologic morbidity of Crohn's disease.

Crohn Disease↗
PubMed1994

Massive gastrointestinal bleeding as the initial manifestation of pancreatic carcinoma.

Pancreatic carcinoma is a rare cause of GI bleeding. We have studied eight patients in whom major digestive hemorrhage was the first sign of a subsequently proven pancreatic malignancy. Bleeding was characteristically severe and unremitting, including hematochezia (four), melena (three), and hematemesis (one). In seven cases, direct tumor invasion into a contiguous portion of the GI tract was present. Tumor erosion occurred into the third portion of the duodenum (three) descending (two), stomach (one), and transverse colon (one). In one patient, a metastatic bleeding lesion was present in the sigmoid colon. The four patients who required urgent laparotomy for control of major hemorrhage died during the initial hospitalization. Conventional diagnostic evaluation by endoscopic and roentgenographic techniques was commonly unsuccessful. Our retrospective analysis suggested that a more aggressive approach, including early angiography in unrelenting and undiagnosed bleeding, might have aided diagnosis and averted laparotomy in a population with dismal prospects for a surgical solution. Clinicians should be aware that pancreatic malignancy may present with a varying spectrum of GI bleeding ranging from occult to potentially exsanguinating hematemesis, hematochezia, or melena.

Aged↗
PubMed1984

Endoscopic retrograde cholangiopancreatography in the diagnosis of unexplained pancreatitis.

Endoscopic retrograde cholangiopancreatography (ERCP) was performed on 73 patients with "idiopathic" pancreatitis to define its role after routine examination failed to yield an underlying cause. Twenty-three of 73 patients with unexplained pancreatitis had potentially curable disease diagnosed by ERCP. Nine patients had biliary calculi and five had stenosis of the ampulla of Vater. Three had nonampullary strictures of the main pancreatic duct. An additional five patients had the congenital anomaly of pancreas divisum. In all eight cases, pancreatic duct abnormalities were managed nonoperatively. The ERCP commonly shows underlying cause in unexplained pancreatitis. Major abnormalities of pancreatic ducts may frequently be followed up without surgery if treatable disease of the biliary tree or ampulla of Vater can be excluded. In mild, rapidly resolved pancreatitis, ERCP may have too low a yield to justify its routine use.

Adult↗
PubMed1980

Observations on management of choledochoduodenal fistula due to penetrating peptic ulcer.

Perforation into the biliary tract is a rare complication of benign peptic ulcer disease. This report describes our experience with 4 patients having this problem. The resulting choledochoduodenal fistula itself causes no unique symptoms in most cases. The diagnosis, hithertofore unsuspected, is most commonly made during barium examination of the upper gastrointestinal tract in patients with typical complaints of ulcer disease. Endoscopy and retrograde cholangiography may be useful to define the pathologic anatomy and to distinguish peptic ulcer disease from primary biliary tract disease or malignant ulcer. Medical management of the underlying ulcer disease with cimetidine and antacids usually suffices to relieve symptoms and to allow healing of the fistula. Surgery becomes necessary if biliary stenosis or cholangitis occurs, or if other aspects of the ulcer disease mandate operative treatment.

Aged↗
PubMed1978

Circulating immune complexes and complement activation in primary biliary cirrhosis.

We evaluated 20 patients with primary biliary cirrhosis and seven controls with extrahepatic biliary obstruction for presence of circulating immune complexes, having found serologic evidence of alternate complement-pathway activation in eight of the 20. Immune complexes were isolated by cryoprecipitation from serum and measured directly by the sensitive Raji-cell radioimmunoassay. Cryoproteins, found in high concentrations in 90 per cent of the patients with cirrhosis but undetectable in the controls, were composed of IgM (60 per cent), IgG-IgM (25 per cent) and IgA-IgM (5 per cent) and were capable of activating the complement system in vitro. Immune complexes detected by the Raji assay were found in 95 per cent of the patients with cirrhosis and circulated in exceedingly high concentrations (474 microgram per milliliter; range, 16.2 to 2192) but were absent in the controls. Furthermore, the alternate complement pathway was activated in eight cirrhotic patients. These complement-fixing immune complexes differ from immune complexes isolated from other types of liver diseases and may be important in the pathogenesis of primary biliary cirrhosis.

Adult↗
PubMed1978

Alpha-fetoprotein (AFP) in benign liver disease. Evidence that normal liver regeneration does not induce AFP synthesis.

One hundred sera samples, obtained during the early postoperative period from 11 patients after a partial hepatectomy, were assayed for alpha-fetoprotein (AFP). None were AFP-positive by radioimmunoassay, despite clinical and biochemical recovery associated with normal liver regeneration. AFP was elevated in 29% of patients with acute hepatitis, 34% of patients with chronic active hepatitis, and in 75% of patients with massive hepatic necrosis. The mechanism and significance of AFP elevations in some patients with acute and chronic hepatitis is uncertain but probably does not reflect normal liver regeneration.

Acute Disease↗
PubMed1977

Familial hemochromatosis. Physiologic studies in the precirrhotic stage of the disease.

We studied 12 members of a family with precirrhotic hemochromatosis to define the physiologic abnormalities in the asymptomatic phase of the disease. Six of 12 had increased iron stores; the mode of inheritance was consistent with an autosomal dominant trait. Serum ferritin levels were no more predictive of tissue iron levels than measurements of serum iron, transferrin saturation or chelatable iron excretion. In three affected family members intestinal iron content was normal. Liver proline hydroxylase activity and urinary hydroxyproline excretion did not correlate with tissue iron content, suggesting that, in addition to the possible role of tissue iron, hepatic fibrosis may involve other factors. "Borderline diabetes mellitus" was present in three affected family members, but extensive studies revealed that pituitary dysfunction is uncommon in early hemochromatosis. Increased levels of liver iron proved to be the most reliable marker for the disease.

Adolescent↗