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E V Loftus

Publications and source records attributed to E V Loftus.

43 records · Page 3Linked to original sources
PubMed1996

Risk of colorectal neoplasia in patients with primary sclerosing cholangitis.

BACKGROUND & AIMS: Studies implicating primary sclerosing cholangitis as a risk factor for colorectal neoplasia in patients with ulcerative colitis have been limited by small sample size and referral bias. The aim of this study was to determine the relative risk and cumulative incidence of colorectal neoplasia in a large sample of patients with sclerosing cholangitis. METHODS: A sample of patients with primary sclerosing cholangitis (n = 178), stratified by geographic area of residence, was identified and followed up to determine survival and development of colorectal neoplasia. The relative risk of colorectal cancer was determined using age- and sex-specific incidence rates of colorectal cancer in the U.S. general population as well as rates in patients with ulcerative colitis from central Sweden. RESULTS: The relative risk of colorectal cancer was elevated 10-fold (standardized morbidity ratio, 10.3; 95% confidence interval, 2.1-30) compared with the general population for exposure to both sclerosing cholangitis and colitis but not cholangitis alone (standardized morbidity ratio, 4.9; 95% confidence interval, 0.1-27). The observed number of cancers was similar to that expected on the basis of rates in Swedish patients with ulcerative colitis. CONCLUSIONS: If primary sclerosing cholangitis is an additional risk factor for neoplasia in ulcerative colitis, the clinical significance of the risk seems to be low.

Adenocarcinoma↗
PubMed1996

Primary sclerosing cholangitis is associated with nonsmoking: a case-control study.

BACKGROUND & AIMS: Cigarette smoking is thought to protect against the development of ulcerative colitis. The relationship between a related disease, primary sclerosing cholangitis, and smoking is unknown. The aim of this study was to determine if the relationship between smoking and sclerosing cholangitis is similar to that found between smoking and ulcerative colitis. METHODS: A stratified sample of 184 patients with primary sclerosing cholangitis and age- and sex-matched institutional control subjects were identified. Smoking information was obtained from a medical questionnaire completed at the time of visit. RESULTS: Eighty-one percent of the patients had associated inflammatory bowel disease. Only 4.9% of them were current smokers compared with 26.1% of the controls; 69.6% of the patients had never smoked vs. 46.7% of the controls. The estimated odds of having primary sclerosing cholangitis in current smokers compared with never-smokers was 0.13. The odds of having disease among former and current users of any tobacco relative to never-users was 0.41 regardless of the presence or absence of inflammatory bowel disease. CONCLUSIONS: The odds of having primary sclerosing cholangitis was significantly decreased among current smokers. Concomitant ulcerative colitis does not fully explain the association between nonsmoking and primary sclerosing cholangitis. Smoking may exert its protective effect in a systemic, rather than colonic, manner.

Adult↗
PubMed1996

Intraductal papillary-mucinous tumors of the pancreas: clinicopathologic features, outcome, and nomenclature. Members of the Pancreas Clinic, and Pancreatic Surgeons of Mayo Clinic.

BACKGROUND & AIMS: Intraductal papillary-mucinous tumor (IPMT) of the pancreatic ducts is increasingly recognized. This study investigated if clinical, imaging, or, histological features predicated outcome, formulated a treatment algorithm, and clarified relationships among IPMT, mucinous cystic neoplasms of the pancreas (MCN), and chronic pancreatitis. METHODS: The medical records, radiographs, and pathological specimens of 15 patients with IPMT (dilated main pancreatic duct or branch ducts with mucin overproduction) who were evaluated between October 1983 and January 1994 were reviewed. RESULTS: One patient had hepatic metastases. Fourteen underwent an operation (6 distal pancreatectomy, 4 total pancreatectomy, and 4 pancreaticoduodenectomy); all had dysplastic intraductal epithelium and chronic pancreatitis, whereas 3 had invasive adenocarcinoma. After a median of 25 months, 10 patients were alive; 3 of 4 with malignant and 2 of 11 with benign IPMT died (P < 0.05). Patients with or without carcinoma had similar clinical and radiographic features. A clinical diagnosis of chronic pancreatitis had been made in 9 patients with benign IMPT and in none with malignant IPMT (P < 0.05). CONCLUSIONS: IPMT is a dysplastic and likely precancerous lesion that is frequently diagnosed as chronic pancreatitis and is separate from MCN. Because it is not possible to distinguish noninvasive from invasive IPMT preoperatively, complete surgical excision of the dysplastic process is our treatment of choice whenever appropriate.

Aged↗
PubMed1995

Drug therapy for inflammatory bowel disease.

Ulcerative colitis and Crohn's disease continue to be frustrating to manage, but the treatment armamentarium has grown. Newer drugs and recent studies on all agents have resulted in a more defined approach based specifically on the patient's condition.

Humans↗
PubMed1994

Endoscopic treatment of major bleeding from advanced gastroduodenal malignant lesions.

OBJECTIVE: To summarize the results of endoscopic therapy for acute hemorrhage from gastroduodenal malignant lesions. DESIGN: The 3-year experience (1989 through 1991) of a specialized gastrointestinal (GI) bleeding team in the endoscopic treatment of acute upper GI bleeding from gastroduodenal malignant tumors was retrospectively reviewed. MATERIAL AND METHODS: Of 1,083 consecutive patients with acute major upper GI hemorrhage, 21 (1.9%) were found to have advanced tumors of the stomach and duodenum, 15 of whom received endoscopic therapy. In this study group of 15 patients, the tumors were gastric in 11 and duodenal in 4. Endoscopic treatment consisted of injection of epinephrine, heater probe coagulation, neodymium:yttrium-aluminum-garnet laser coagulation, or injection of sodium tetradecyl sulfate. RESULTS: Initial endoscopic hemostasis was achieved in 10 of the 15 patients (67%); however, bleeding recurred in 8 of 10 (80%), and all 5 in whom endoscopic hemostasis was not achieved continued to bleed. Mean transfusion requirements for the 30 days before and the 30 days after the first endoscopic treatment were 7.6 and 6.4 units of packed erythrocytes, respectively (P > 0.10). Five major procedure-related complications occurred, two of which were fatal. The median duration of survival after the first endoscopic treatment was 39 days (range, 1 to 1,414). CONCLUSION: In patients with major bleeding from advanced gastroduodenal malignant lesions, endoscopic therapy seems to provide limited benefit.

Acute Disease↗
PubMed1994

Cytomegalovirus as an exacerbating factor in ulcerative colitis.

Cytomegalovirus (CMV) colitis has been reported infrequently in patients with underlying inflammatory bowel disease, and usually in those who are taking long-term corticosteroid drugs and who are potentially immunosuppressed. We report a 39-year-old man with long-standing ulcerative colitis, taking only sulfasalazine, who developed a viral prodrome followed by bloody diarrhea. Severe colitis was noted on endoscopy. He worsened with intravenous steroid and antibiotic drugs. Flexible sigmoidoscopy with biopsy before a contemplated colectomy revealed a moderately active colitis with large cells containing intranuclear inclusions scattered throughout the biopsies, characteristic of CMV colitis. Serologic and immunologic studies suggested recent CMV infection. The patient improved with intravenous ganciclovir and a steroid taper, and colectomy was avoided. CMV colitis is a potentially treatable cause of fulminant colitis.

Adult↗