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Biomedical subjects

I J Kodner

Publications and source records attributed to I J Kodner.

At least 73 records · Page 4Linked to original sources
PubMed1988

Endorectal sliding flap repair of complicated anterior anoperineal fistulas.

This report presents experience with a safe and effective form of treatment for anal fistulas that involve a significant portion of the sphincter mechanism. The technique includes removal of the involved crypt, closure of the internal opening with a sliding endorectal flap, and counter drainage of the fistula tract. This series includes eight patients treated over a five-year period with a follow-up of up to five years. This limited series had no complications and one case of early recurrence. Most of these patients had had previous failed attempts at correction of the fistula. The main advantage of this mode of treatment is preservation of the integrity of the sphincter muscle, thus avoiding the high risk of incontinence that is inherent especially with anteriorly located fistulas in females. It is proposed that, because it does not transect the sphincter anteriorly, this technique is safer than the placement of setons, as has been previously advised for management of anterior fistulas. The different treatment techniques for anal fistulas, including complications, recurrence rates, surgical techniques, and indications for types of management are reviewed.

Adult↗
PubMed1988

Axonal degeneration/necrosis: a possible ultrastructural marker for Crohn's disease.

Axonal degeneration/necrosis has previously been demonstrated in the small bowel autonomic nerve plexus of patients with Crohn's disease. It was suggested that this feature might be helpful in the differential diagnosis of Crohn's disease from other conditions, specifically ulcerative colitis. We performed a blind prospective study and examined tissue from 34 colonic specimens, in 15 patients, by electron microscopy. Cases of Crohn's disease (3 cases), ulcerative colitis (5 cases), and other controls [adenocarcinoma (4 cases), familial polyposis (1 case), peritonitis (1 case), and radiation colitis (1 case)] were evaluated for inflammation and axonal changes. It was found that only the cases of Crohn's disease showed extensive, seemingly independent, severe axonal changes that were unassociated with other markers of inflammation. This feature may be useful in the differential diagnosis between Crohn's disease and ulcerative colitis.

Adolescent↗
PubMed1987

Severe complication of rubber band ligation of internal hemorrhoids.

In light of recent reports describing severe and even fatal complications, the authors would like to report good results in two patients with massive edema and one with localized necrosis following rubber band ligation of internal hemorrhoids, which were recognized early and treated aggressively. The potential for severe complications emphasizes the need for determining other causes of rectal symptoms before ligation of hemorrhoids is undertaken.

Adult↗
PubMed1986

Clinical and operative experience with non-Caucasian patients with Crohn's disease.

Fifteen black patients with Crohn's disease were seen during a ten-year period (1975-1985). They represented 11 percent of our experience with Crohn's disease during that time. These patients had an earlier age of onset of Crohn's symptoms than our white patients, and correct diagnosis was delayed for an average of four years. All 15 patients required abdominal surgery, and seven (47 percent) suffered recurrences necessitating additional abdominal operations. The five-year actuarial estimate of probability of reoperation was 77 percent. Extraintestinal manifestations were present in all patients, and six (40 percent) had multiple manifestations. These disease manifestations are more severe than those noted in series that studied predominantly caucasian Crohn's populations, and suggest that Crohn's disease in the black patient is a distinctly aggressive form.

Adolescent↗
PubMed1986

Entrapped ovary syndrome.

Formulation of pelvic cysts afer proctectomy is an entity which is described in this paper with the cause supposed to be due to descent of the ovary from an intraperitoneal to an extraperitoneal position at the time of proctectomy. A simple surgical technique for fixing the ovary out of the pelvis to prevent this complication is described.

Adult↗
PubMed1986

Repair of anal stricture and mucosal ectropion by simple flap procedures.

A technique is described that has proven most effective in correction of postoperative anal stenosis. A modification of this technique also has proven effective in the treatment of symptomatic anal mucosal ectropion--a condition marked by pruritus and perianal soilage from mucosal weeping, usually associated with the Whitehead hemorrhoidectomy. The design of the flap allows primary closure of the donor site and tension-free flap inset with a robust flap blood supply.

Anal Canal↗
PubMed1986

Deficient cell-mediated cytotoxicity and hyporesponsiveness to interferon and mitogenic lectin activation by inflammatory bowel disease peripheral blood and intestinal mononuclear cells.

Intestinal mononuclear cells are poor mediators of spontaneous and antibody-dependent cellular cytotoxicity. In this study, we found that both interferon and mitogenic lectins were able to induce increased levels of cell-mediated cytotoxicity by intestinal mononuclear cells. Intestinal mononuclear cells from patients with inflammatory bowel disease exhibited hyporesponsiveness to cytotoxic activation by interferon or lectins compared with control intestinal mononuclear cells. Peripheral blood mononuclear cells from patients with Crohn's disease exhibited deficient spontaneous and antibody-dependent cytotoxicity that could be partially reversed by interferon or mitogenic lectins. These studies demonstrate that exogenous agents or endogenous factors can induce deficient intestinal and peripheral blood cytotoxic effector cells from inflammatory bowel disease patients to become active. In comparison with control cells, however, intestinal and peripheral blood mononuclear cells from inflammatory bowel disease patients are not only deficient in cytotoxic capabilities but also are hyporesponsive to interferon and lectin activation.

Antibody-Dependent Cell Cytotoxicity↗
PubMed1986

Altered patterns of secretion of monomeric IgA and IgA subclass 1 by intestinal mononuclear cells in inflammatory bowel disease.

Intestinal mononuclear cells (MNC) from patients with inflammatory bowel disease (IBD) demonstrated altered patterns of spontaneous secretion of immunoglobulin A (IgA). Control intestinal MNC had markedly high spontaneous secretion of IgA compared to IBD intestinal MNC. Control intestinal MNC secreted predominantly dimeric IgA (only 31% monomeric IgA), whereas IBD intestinal MNC secreted increased amounts (43%-53%) of monomeric IgA. Control intestinal MNC secreted 61% IgA subclass 1 (IgA1), whereas IBD intestinal MNC secreted 71%-74% IgA1. Intestinal MNC from involved portions of resected specimens secreted more of both monomeric IgA and IgA1 than MNC from uninvolved areas of the same bowel. Therefore, intestinal MNC from involved IBD intestinal specimens secrete less total IgA but high percentages of monomeric IgA and IgA1 compared to control intestinal MNC. This could be caused by increased homing of monomeric IgA- and IgA1-producing cells into involved intestine, or the in situ proliferation of monomeric IgA and IgA1 precursor cells resulting from immunoregulatory alterations. These observations may represent the normal mucosal IgA immune response to infectious agents or inducing factors of either a primary or a secondary nature.

Cell Movement↗
PubMed1985

Adenocarcinoma of the rectum. Results of radiotherapy and resection, endocavitary irradiation, local excision, and preoperative clinical staging.

The management of rectal cancer in 102 patients at the Jewish Hospital of St. Louis is reviewed. Therapy combining external irradiation, endocavitary irradiation, local excision, and excisional operation has been used in the treatment of adenocarcinoma of the rectum. Pretreatment evaluation for tumor fixation, ulceration, palpable presacral lymph nodes, distance of tumor from dentate line, size of tumor, and histologic grades was used to assign patients to treatment groups. Local recurrence is less than 2 percent, and two-year tumor-free survival is approximately 87 percent in patients receiving 2000 R or 4500 R preoperatively. Pathologic downstaging of tumors was noted more frequently with 4500 R preoperative irradiation. Endocavitary irradiation appears adequate to treat only favorable lesions. Only tumor fixation and histologic grade of the tumor notably affected survival. A logical plan for choosing the appropriate method of treatment using combined modalities is proposed.

Adenocarcinoma↗
PubMed1984

Loop ileostomy. Techniques and indications.

The records of 15 patients whose surgical treatment involved the construction of a loop ileostomy were reviewed. Indications for loop ileostomy include the necessity to protect multiple or complicated anastomoses, the protection of ileorectal anastomoses in patients with inflammatory disease, and the necessity of diverting the flow of intestinal contents in patients with fulminant inflammatory bowel disease. The technique of constructing and taking down a loop ileostomy is described.

Adult↗
PubMed1984

Internal intussusception of the rectum. Diagnosis and surgical management.

Internal intussusception of the rectum is described as a specific clinical entity. A review of the cases treated at the Colon and Rectal Surgery Service at Jewish Hospital is presented, along with the specific diagnostic procedures that have been developed and the surgical technique that allows relatively simple correction of the problem. It is believed that this entity presents commonly to the practitioner of colon and rectal surgery, and specific diagnoses and therapy will be an important addition to the armamentarium of the colon and rectal surgeon.

Adolescent↗
PubMed1984

Abdominal colectomy with ileorectal anastomosis.

From 1980 to 1983, 20 patients had abdominal colectomy with primary ileorectal anastomosis. Fourteen operations were elective and six were emergency. Elective indications included familial polyposis (five), inflammatory bowel disease (four), colon cancer associated with multiple polyps (four), and colon cancer associated with diverticulosis and a history of massive hemorrhage (one). Emergency operations were performed for obstructing sigmoid or rectosigmoid cancer (three), massive lower gastrointestinal hemorrhage (two), and right colon cancer associated with obstructing diverticulitis (one). All patients survived the operation; in three patients complications developed in the immediate postoperative period for a morbidity of 15%. Our experience suggests that abdominal colectomy with primary ileorectal anastomosis can be safely performed in carefully selected cases.

Adolescent↗