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E Shemesh

Publications and source records attributed to E Shemesh.

At least 55 records · Page 3Linked to original sources
PubMed1987

Jejunogastric intussusception. A new diagnostic test.

Jejunogastric intussusception is a rare complication of gastrojejunal reconstruction of unknown cause. There are two types of jejunogastric intussusception: the acute type, presenting as a surgical emergency, and the chronic intermittent type, which is difficult to diagnose and is usually of mild symptomatology but which may progress to the acute type with the incarceration of the intussusceptum. With two case reports and a literature review, an endoscopic diagnostic maneuver is proposed, hinting at disordered motility with reversed peristalsis as a possible causative factor. Corrective surgical treatment to prevent recurrence and incarceration in chronic cases is advocated. Treatment should include dismantling of the efferent loop, which is the most frequent intussusceptum.

Aged↗
PubMed1987

Endoscopic retrograde cholangiography in the detection of small stones in the gallbladder.

Multiple small (2-5 mm in size) gallstones were demonstrated only by endoscopic retrograde cholangiopancreatography in eight patients who had recurrent upper abdominal pain and vomiting. Three patients had mild, rapidly resolving abnormalities of liver biochemistry and serum amylase. In the other five, both serum amylase and liver biochemistry were repeatedly normal. We conclude that endoscopic retrograde cholangiography may be useful in the detection of small gallstones in patients with symptoms suggestive of biliary tract disease, even in the presence of normal oral cholecystography, ultrasonography, serum amylase, and liver biochemistry.

Amylases↗
PubMed1987

Prolonged rectal bleeding associated with hemorrhoids: the diagnostic contribution of colonoscopy.

We studied 387 patients with prolonged rectal bleeding and hemorrhoids (grades 2 and 3) routinely examined by anoscopy, proctoscopy, single contrast barium enema, and hemoglobin measurements. Normal results were obtained in 86 patients above the age of 40. Total colonoscopy in these patients revealed one patient (1.2%) with cancer, 19 (22.1%) with colorectal polyps, and one (1.2%) with angiodysplasia. These findings indicate that in patients above age 40, a full investigation of the large bowel should be done in every case of prolonged rectal bleeding despite the presence of substantial hemorrhoids. Double contrast barium enema or colonoscopy must be used, rather than single contrast barium enema, which proved to be an inaccurate method of investigating prolonged rectal bleeding.

Barium Sulfate↗
PubMed1987

Radiologic and endoscopic appearance of intrabiliary rupture of hydatid liver disease.

Intrabiliary rupture of hydatid liver cyst was diagnosed in 6 patients presenting with obstructive jaundice. All patients underwent ultrasonography and endoscopic retrograde cholangiopancreatography prior to surgical drainage of the liver cyst. Hydatid debris were found in the common bile duct preoperatively in 3 patients, and postoperatively in an additional 3 patients. Accurate diagnosis was made in all patients based on combined duodenoscopic, cholangiographic and sonographic findings. It is concluded that the combination of ultrasonography and endoscopic retrograde cholangiopancreatography can accurately detect intrabiliary rupture of hydatid liver cyst and that both techniques should be performed early in the investigation of suspected ruptured hydatid liver cyst.

Adult↗
PubMed1986

Colorectal adenomatous polyps and carcinoma in Ashkenazi and non-Ashkenazi Jews in Israel.

In Israel, the incidence of colorectal cancer among European-American-born Jews is approximately 2.5 times that of African-Asian-born Jews. To determine the risk of all colorectal tumors for the two ethnic groups, 335 patients with colorectal adenomatous polyps and 295 with colorectal cancer, diagnosed between 1980-1984 at the Sheba Medical Center, were compared to the 35,094 persons attending the outpatient clinics at the same hospital, during September and October 1984. Ashkenazi patients (European-American-born) had a 2.5-fold risk (95% confidence interval 1.9-3.3) of colorectal polyps compared to non-Ashkenazi patients (African-Asian-born). The risk was similar for males (odds ratios [OR] = 2.3) and females (OR = 2.8). Ashkenazis also had a significantly enhanced risk of carcinoma: OR = 3.1; 95% confidence interval 2.2-4.3. The risk ratio was slightly higher for males (OR = 3.5) than females (OR = 2.7). Age-specific analyses demonstrated an elevated risk of both malignant and benign neoplasms among Ashkenazi patients at all ages at diagnosis. Among the polyp patients, the highest risk ratio was for patients between 30 and 49 years old, while among the cancer patients the risk was highest in the group of 60-69-year-olds. The distribution by size of polyps, number of polyps, as well as polyp subsite, was similar for Ashkenazi and non-Ashkenazi patients; however non-Ashkenazis tended to have slightly more right-sided colon cancer.

Adult↗
PubMed1986

A community-based program of colorectal screening in an asymptomatic population: evaluation of screening tests and compliance.

The incidence of colorectal cancer in Ashkenazi Jews is two to three times higher than in non-Ashkenazis. For a community colorectal screening program 1339 asymptomatic Ashkenazis over 40 yr old were asked to participate. Of these 1012 (75%) took Hemoccult II kits [fecal occult blood tests (FOBT)], and 614 (46%) personally returned them. Screenees were interviewed regarding family and personal medical history. Fourteen persons (2.3%) had positive tests, in whom colonoscopy revealed two with cancer (Dukes' B,C) and two with a greater than 2 cm polyp. The remaining 600 persons were invited for flexible sigmoidoscopy (FS) but only 287 (48%) appeared. The mean depth of insertion of the instrument was 50.3 cm (range 30-120), but was poorer for women. FS identified lesions in 28 (9.7%) persons: three had Dukes' A carcinomas and 25 had less than 2 cm adenomatous polyps. Significantly more women than men accepted FOBT, but among those completing FOBT, there was no difference by sex for use of FS. Middle-aged persons (50-69 yr) found screening more acceptable than young or older persons. Among screenees who agreed to undergo FS, a significantly larger fraction had a first relative with colon cancer, or a personal history of colon or female genital neoplasia, compared to those not agreeing to FS. There were no differences in screenees with relatives with noncolon cancer. Eighty-eight couples completed FOBT and were invited for FS. The decision whether or not to participate was made for both members in 81 (92%) couples. In conclusion, effective screening programs have to take into consideration compliance patterns of the target population.

Adult↗
PubMed1986

Common bile duct obstruction caused by hydatid daughter cysts--management by endoscopic retrograde sphincterotomy.

Four patients with cholestatic jaundice due to ruptured hydatid liver cyst into the biliary tract underwent endoscopic retrograde sphincterotomy with clearance of the bile ducts. Prompt relief of jaundice followed the produced and no complications occurred. After the procedure all patients received medical treatment (Mebendazole) for 3-4 months and were well at a mean follow-up of 8 months. We conclude that endoscopic retrograde sphincterotomy is a safe and effective treatment for cholestatic jaundice caused by hydatid daughter cysts obstructing the bile ducts. This method may serve as an alternative to surgery in selected, high risk, patients.

Adult↗
PubMed1985

The association of synchronous neoplasms with occluding colorectal cancer.

To find and eradicate synchronous neoplasms, colonoscopy was performed before and after resectional surgery in 50 patients with "occluding colorectal cancer," defined as encroachment of the lumen by tumor to a degree that prevented passage of a colonoscope. Synchronous, frequently multiple adenomas were found in 29 (58 percent) of these patients. Three patients (6 percent) had synchronous invasive cancer as well. None of these lesions was detected by intraoperative palpation, even though 46 percent of them measured more than 1.0 cm in diameter. Synchronous neoplasms were found significantly more often in patients with occluding cancer than in patients with non-occluding cancer, investigated concurrently at the same hospital. The former patients appear to be in double jeopardy with respect to synchronous neoplasms, these being more prevalent and less accessible than in patients with non-occluding tumors. Moreover, most of the synchronous lesions are undetectable by palpation. These findings bear out the importance of early postoperative, as well as preoperative, colonoscopy in all patients with occluding colorectal cancer.

Adenoma↗
PubMed1985

Colonoscopic findings in patients with hemorrhoids, rectal bleeding and normal rectoscopy.

Within a period of 18 months, 387 patients were referred to the Proctologic Service at the Chaim Sheba Medical Center because of recurrent rectal bleeding. Hemorrhoids were found in 194 of these patients and further investigation showed that 45 of the 194 patients (23.2%) had other coexisting colonic pathology (12 cancers, 28 polyps, 4 inflammatory bowel diseases and 1 angiodysplasia). Sixteen of 40 patients with diverticulosis and 13 of 30 patients with hemoglobin less than 11 g/dl had additional colonic pathology. Single-contrast barium enema, which was used in this survey for screening of the colon, proved to be inaccurate. In view of the issue of cost-effectiveness, this study suggests that patients with recurrent rectal bleeding and hemorrhoids (Grades II and III) who had normal rectoscopy should be further investigated by double-contrast barium enema if they are greater than 40 years of age. All patients with anemia, diverticulosis or abnormal findings in barium enema should undergo total colonoscopy.

Adult↗
PubMed1985

Management of bleeding esophageal varices by repeated endoscopic injection sclerotherapy--4 years' experience.

Endoscopic injection sclerotherapy (EIS) is successful in arresting bleeding from esophageal varices and has been used increasingly in recent years. Repeated EIS results in eradication of esophageal varices. Fifty patients were treated by emergency EIS and then by repeated elective injections; 177 EIS procedures were performed, with a mean follow-up period of 12.6 months. Most patients had nonalcoholic cirrhosis; 56% were in Child's Class C. Emergency EIS arrested variceal bleeding in 88% of patients, with a hospital mortality of 22%. In nine patients, bleeding persisted or recurred and was treated by repeated EIS or surgery. Complications occurred in five patients, all of whom recovered with conservative treatment. Patients in Child's Class C had a poor prognosis after EIS. Gastric varices were found frequently in patients classified as Child's C, but rarely in Child's Class A or B patients. Thus, the presence of gastric varices may be a marker for poor prognosis. Long-term observations demonstrate the effectiveness and safety of EIS in patients with bleeding esophageal varices.

Esophageal and Gastric Varices↗
PubMed1985

A prospective evaluation of the upper gastrointestinal tract and periampullary region in patients with Gardner syndrome.

Neoplasms of the upper gastrointestinal tract and periampullary region occur in patients with Gardner syndrome (GS), but their true incidence is not yet established. Fourteen patients with GS underwent esophagogastroduodenoscopy prior to colectomy and every 1-3 years thereafter. In 10 patients the pancreatobiliary system was also investigated: nine by endoscopic retrograde cholangiopancreatography and one at autopsy. All of the patients underwent ultrasound examination of liver, biliary tree, and pancreas. Adenomas in the upper gastrointestinal tract were found in all of the patients: Vater's papilla--12, duodenum--nine, and gastric antrum--seven. Only five patients had adenomas at the time of diagnosis of GS, and all the others developed adenomas within a mean of 2.5 years. One patient had hyperplastic polyps in the stomach fundus. Adenomas of the papilla of Vater demonstrated a higher degree of dysplasia compared to dysplasia in other locations of the gastrointestinal tract. Endoscopic retrograde cholangiopancreatography helped in detecting adenomas in distal common bile duct not visible at endoscopy. We conclude that adenomas at the upper gastrointestinal tract occur frequently in patients with GS and, therefore, periodic endoscopic systematic investigation of all patients with GS is mandatory.

Adenoma↗
PubMed1985

Endoscopic Gruntzig balloon dilation of benign strictures in the biliary system.

Five patients with benign strictures of the biliary tract were treated by Gruntzig balloon dilation during endoscopic retrograde cholangiopancreatography. All of the strictures were effectively dilated. One patient with a retained stone in the proximal biliary tree underwent surgery 3 weeks after the dilatation because of cholangitis. The other four patients were well at a mean follow-up of 6 months. There were no complications related to the procedure. We conclude that Gruntzig balloon dilation of benign bile duct strictures is safe and effective, and is a potential endoscopic retrograde cholangiopancreatography.

Aged↗
PubMed1985

Spectrum of extracolonic gastrointestinal tract involvement in Gardner's syndrome.

To define the prevalence of extracolonic gastrointestinal tract neoplasms in association with Gardner's syndrome, 17 patients with the syndrome underwent a systematic endoscopic and radiologic investigation. Adenomas were found at one or more sites in the upper gastrointestinal tract in all patients, most frequently at the papilla of Vater (64.7% of patients). Focal adenomatous changes in normal-appearing mucosa were seen in five patients, at the ampulla of Vater and in the duodenum in four, and in the gastric antrum in two patients. Adenomas were also seen in the duodenum (47%), stomach (29.4%) and small intestine (23.5%). Hyperplastic polyps were found in the gastric antrum, duodenum or small bowel in five patients. Adenomas of the papilla of Vater showed greater degrees of dysplasia than did adenomas of the stomach or small bowel, which might explain the more frequent occurrence of malignancy at the papilla of Vater in patients with Gardner's syndrome. A systematic investigation of the gastrointestinal tract is mandatory in all patients with Gardner's syndrome prior to surgery, and at periodic follow-up thereafter.

Adenoma↗
PubMed1984

Which electrode? A comparison of four endoscopic methods of electrocoagulation in experimental bleeding ulcers.

Several inexpensive endoscopic methods of electrocoagulation have been advocated for treatment of gastrointestinal haemorrhage. We compared four types of electrode: dry monopolar - Cameron Miller (M), liquid monopolar - Storz (L), bipolar - Bicap ACMI (B), and heater probe - Seattle (H). The electrical and thermal properties of these probes were studied using computerised monitoring of energy deposition and their efficacy and safety was tested in a randomised study in 140 experimental canine gastric ulcers. At optimal pulse settings 20J (M), 70J (L), 17J (B), 15J (H), effective haemostasis was achieved in all ulcers, the mean number of pulses being M5, L6, H6 and B11, the first three requiring significantly (p less than 0.01) less pulse than B. Relative safety of the electrodes was assessed by comparing the incidence of full thickness damage at histology: B24%, H20%, L58% and M69%; B and H proving significantly (p less than 0.01) safer than L and M. Sticking was assessed as H greater than B greater than M much greater than L. Insensitivity to extreme angulation and force of application was assessed as L greater than B greater than M (H is preset). Of the two safer electrodes the heater probe was more effective than the bipolar probe. Despite its greater tendency to stick than the other devices, the heater probe appeared the most promising of the endoscopic electrodes tested.

Animals↗