Biomedical subjects

Gary R Zuckerman

Publications and source records attributed to Gary R Zuckerman.

3 recordsLinked to original sources

PubMed2006

Disseminated histoplasmosis in a liver transplant recipient.

A 61-yr-old liver transplant recipient presented with abdominal cramping and nonbloody diarrhea resulting in orthostasis. Multiple ulcerations throughout the colon were seen during endoscopy, and biopsies from the ulcer edges revealed histoplasmosis. Treatment with a course of itraconazole improved the diarrhea. The patient later presented with pericarditis and symptomatic pleural effusions, the latter of which was confirmed to be a result of disseminated histoplasmosis. Treatment with amphotericin B led to resolution. Histoplasmosis should be considered in liver transplant patients with diarrhea and large ulcers in the colon. The presence of disseminated histoplasmosis should be ruled out once colonic histoplasmosis has been diagnosed.

Amphotericin B↗

PubMed2003

Acute small bowel bleeding: a distinct entity with significantly different economic implications compared with GI bleeding from other locations.

BACKGROUND: Historically, acute lower intestinal bleeding has incorporated small bowel with colonic sources. This potentially obscures the unique characteristics of small bowel bleeding, which are eclipsed by the attributes of the much more common colonic bleeding. Separating acute lower intestinal bleeding into small bowel and colonic sources may delineate characteristics of each, thereby making it possible to determine whether clinical outcomes vary by anatomic level of bleeding. METHODS: A total of 29 consecutive patients (15 women, 14 men; age 68.6 +/-2.4 years) with acute small bowel bleeding were compared with two other groups, each with 29 consecutive patients, with either acute colonic bleeding or acute upper GI bleeding. Clinical presentation, outcomes, and resource utilization for small bowel bleeding were compared with similar parameters for acute colonic bleeding and upper GI bleeding. RESULTS: Although the clinical presentation did not always distinguish the 3 groups, resource utilization was significantly higher in the small bowel bleeding group. The latter group required a higher number of diagnostic procedures (p < 0.001) and blood transfusions (p < 0.001), remained in hospital longer (p < 0.05), and had a higher cost of hospitalization (p < 0.001) compared with the colonic bleeding and upper GI bleeding groups. The mortality rate for patients with small bowel bleeding was 10%. Although none of the patients with upper GI bleeding and only 14% of those with colonic bleeding required greater than 3 diagnostic procedures, 79% of patients with small bowel bleeding required 4 procedures for diagnostic localization (p < 0.0001). CONCLUSIONS: Small bowel bleeding ("mid-intestinal bleeding") is a distinct clinical entity with significantly worse outcomes compared with colonic bleeding and upper GI bleeding. The focus of the investigation should be directed to the small bowel, with enteroscopy or capsule endoscopy, when 3 investigative procedures fail to localize recurrent overt GI bleeding.

Acute Disease↗

PubMed2003

The colon single-stripe sign and its relationship to ischemic colitis.

OBJECTIVES: Endoscopic findings may assist in the clinical diagnosis of ischemic colitis but have not been systematically characterized. We noted that a single linear colonic ulcer could on occasion be found endoscopically after hypotension and proceeded to investigate its relationship to ischemic colitis. METHODS: Twenty-six patients (19 female and seven male, mean age 71 yr) with endoscopic evidence of a single linear ulcer running along the longitudinal axis of the colon (colon single-stripe sign (CSSS) were retrospectively studied. Colitis etiologies were determined in the CSSS patients and in 58 consecutive patients without a stripe forming a colitis comparison group; clinical course and outcome in CSSS patients subsequently were compared with those in 22 patients with circumferentially involved ischemic colitis. RESULTS: The CSSS was >/=5 cm in length in all instances and isolated to a segment of the left colon in 89%. Evidence of a preceding ischemic event was noted significantly more often in the CSSS (62%) patients than in the colitis comparison group (7%) (p < 0.0001). On blinded histopathological examination, 75% of CSSS cases had microscopic evidence of ischemic injury compared with 13% in the colitis comparison group (p < 0.0001). None of the CSSS patients required surgical intervention, whereas six (27%) patients from the circumferential ischemic colitis group underwent exploration (p < 0.05). Nine patients (41%) in the circumferential ischemic colitis group died, whereas there was one death in the CSSS group (4%) (p < 0.05). CONCLUSIONS: Ischemia can manifest endoscopically as the CSSS. This sign seems to characterize milder disease in the clinical spectrum of ischemic colitis.

Aged↗