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Biomedical subjects

I S Grimm

Publications and source records attributed to I S Grimm.

6 recordsLinked to original sources
PubMed1994

Inflammatory bowel disease in older patients.

The onset of UC and CD may occur later in life. Although making the diagnosis of IBD in the elderly can be challenging, the clinical course, natural history, and response to treatment are similar for older and younger patients. In fact, both UC and CD tend to be less extensive in older patients, a feature that may contribute to the overall favorable prognosis for elderly patients with IBD. Overall mortality rates for both UC and CD appear to be similar to that of the general population except for those few patients that present with severe initial disease. Typical features of IBD in the elderly are summarized in Table 3. The differential diagnosis of IBD in the elderly includes infectious causes of enterocolitis, ischemic colitis, and diverticular disease as well as several other mimics of IBD. Awareness of the possibility of late-onset disease and the unique manifestations of disease in the elderly contributes to accurate diagnosis and timely treatment.

Aged↗
PubMed1992

Steatohepatitis and fatal hepatic failure after biliopancreatic diversion.

Steatohepatitis and hepatic failure are well known complications of jejunoileal bypass, an operation that has been abandoned as a treatment for severe obesity because of its potential for adverse metabolic consequences. Biliopancreatic diversion is a novel operation designed to avoid the harmful effects of jejunoileal bypass. Although it has not gained wide acceptance, this procedure is being advocated by some surgeons as a safe and effective treatment for severe obesity. Published reports indicate that liver histology generally remains stable or improves after biliopancreatic diversion. We present a patient who developed steatohepatitis and subsequently died in hepatic failure after this operation. Severe liver disease should be added to the list of complications that may follow biliopancreatic diversion.

Adult↗
PubMed1991

Successful shock-wave lithotripsy of bile duct stones using ultrasound guidance.

Eighteen patients with 41 gallstones in the common bile duct, common hepatic, cystic, and intrahepatic ducts underwent shock-wave lithotripsy using the electrohydraulic Sonolith 3000 lithotripter. Lithotripsy was performed using ultrasound guidance alone under intravenous analgesia/sedation. All patients previously had failed stone extraction via retrograde endoscopy, T-tube, or cholecystostomy. Lithotripsy was performed according to an FDA-approved protocol allowing a maximum of two 2500 shock-wave treatments at a 48 hr interval. Following the final lithotripsy or cholangiographic evidence of stone fragmentation, residual fragments were removed via endoscopic or percutaneous route within 24-72 hr. Ultrasound localization of gallstones was aided by continuous infusion of the common bile duct with saline solution. In 15 of the 18 patients, complete fragmentation of the stones was accomplished, two had minimal fragmentation, and one with an encysted stone had no fracturing. No serious complications were encountered. Overall nonsurgical stone-free success rate was 17 of 18 patients, indicating biliary duct stones can be successfully treated using an ultrasound-guided lithotripter and intravenous sedation alone.

Aged↗
PubMed1990

Inflammatory bowel disease in the elderly.

Ulcerative colitis and Crohn's disease both may occur in the elderly. In many populations, a second peak in the incidence of inflammatory bowel disease occurs near age 70. Clinical manifestations of inflammatory bowel disease in the elderly are generally similar to those seen in younger patients, although there is a tendency for both ulcerative colitis and Crohn's disease to involve more distal segments of the gut in older patients. Ischemic and infectious colitis, diverticulitis, and malignancy can all masquerade as inflammatory bowel disease in the elderly. Recent epidemiologic and clinical reports indicate that the outlook for older patients with inflammatory bowel disease is more favorable than previously suspected.

Adult↗