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Biomedical subjects

J A Coller

Publications and source records attributed to J A Coller.

At least 19 recordsLinked to original sources
PubMed1992

Crohn's disease and carcinoma: increasing justification for surveillance?

Carcinoma of the colon that arises in patients with Crohn's disease is being reported with increasing frequency. To help clarify the nature of this association, records of 25 patients with Crohn's disease and colorectal carcinoma seen from 1957 through 1989 were reviewed. One patient had leiomyosarcoma of the rectum, and two patients had the onset of Crohn's disease after the diagnosis and treatment of colorectal carcinoma. Therefore, 22 patients were available for complete retrospective analysis. The median age at diagnosis of Crohn's disease was 37 years (range, 15-67 years), and the median age at diagnosis of carcinoma was 54.5 years (range, 32-76 years). The median duration of symptoms preceding the discovery of colorectal carcinoma was 18.5 years (range, 0-32 years). Carcinoma arose in colonic segments with known Crohn's disease in 77 percent of patients, and six patients (27 percent) had associated colonic mucosal dysplasia. One lesion was classified as Dukes A, nine lesions were Dukes B, five lesions were Dukes C, and seven lesions were Dukes D. Patients with an onset of Crohn's disease before the age of 40 years had primarily Dukes C or D lesions and consequently poor survival. Most patients presented with nonspecific signs and symptoms, with nothing to distinguish the activity of the Crohn's disease from the presence of colorectal neoplasm. Younger patients with long-standing Crohn's disease should be considered for colonic surveillance to permit earlier diagnosis and treatment of potential colorectal carcinoma.

Adolescent↗
PubMed1992

Anastomotic-vaginal fistula after colorectal surgery.

The most feared complication of anterior and low anterior resection is anastomotic dehiscence. Although most leakages remain clinically silent, some may lead to formation of a colovaginal fistula. At the Lahey Clinic Medical Center, the records of nine patients with colovaginal fistula as a complication of colorectal surgery were reviewed to determine clinical characteristics and optimal management. The mean age was 63.7 years (range, 47-72 years). The initial indications for surgery were carcinoma of the rectum (n = 4), diverticular disease (n = 3), and closure of the colostomy after Hartmann's procedure (n = 2). Hysterectomy had been performed earlier in seven patients (78 percent). The end-to-end anastomosis (EEA) stapling device was used in five patients, and four patients had a handsewn anastomosis. The fistula developed within 23 days after surgery and usually originated within 8 cm of the anal verge. Two patients underwent immediate diverting transverse colostomy. None of the seven patients who were initially managed medically had spontaneous closure of the fistula. High fistulas were successfully treated by colorectal resection in two patients, whereas low fistulas healed after transanal repair without colostomy in two patients. These results suggest that previous hysterectomy predisposes to development of a colovaginal fistula after colorectal surgery. Not all patients require fecal diversion. Colorectal resection for high fistulas and transanal repair for low fistulas appear to be viable options for treatment.

Aged↗
PubMed1979

Management of late complications of Teflon sling repair for rectal prolapse.

Recurrent rectal prolapse or postoperative rectal stricture occurred in four of 88 patients (4.5 per cent) who underwent Teflon sling repair at the Lahey Clinic during the past 15 years. Management of these and six other similar patients referred for treatment suggests that young men appear to be at a higher risk for recurrence. Strictures may be more likely to develop in patients with a long history of prolapse or problems with constipation. Teflon sling repair followed by recurrent prolapse or stricture formation should probably be treated by low anterior resection.

Adult↗
PubMed1979

Colorectal carcinoma: a decade of experience at the Lahey Clinic.

Carcinoma of the colon and rectum is the commonest visceral malignancy in this country today. Uncorrected five-year survival rates (1967-1971) for Dukes' A, B, and C lesions were 81 per cent, 62 per cent, and 33 per cent respectively, and are essentially the same as those observed in the previous five-year period (1962-1966). The actuarially corrected five-year survival rates for Dukes' A, B, and C lesions for the ten-year period (1962-1971) were 95 per cent, 90 per cent, and 55 per cent. Further improvement in these statistics depends on bringing the patient to operation with less advanced disease and possibly on supplementing resection with other modalities of therapy.

Colonic Neoplasms↗
PubMed1978

Perineal wound healing after proctectomy for inflammatory bowel disease.

One hundred fifty-one cases of patients who underwent proctectomy for inflammatory bowel disease at the Lahey Clinic were analyzed with respect to the factors that predispose to delay in perineal wound healing. Significantly poorer healing took place in patients with Crohn's colitis, in men with ulcerative colitis, and in patients with ulcerative colitis who underwent one-stage operations. Factors that were not statistically significant but that appeared to contribute to delay in healing were younger age of patients and presence of anal fistula. A comparison is made with the results of other series, and recommendations for treatment and prevention are presented.

Adolescent↗
PubMed1978

Colostomies--indications and contraindications: Lahey Clinic experience, 1963--1974.

Over a 12-year period, 276 temporary colostomies were performed on 271 patients. During this interval 118 colostomies were closed. The morbidity rate of colostomy construction was 21 per cent, and for closure it was 49.1 per cent. No definite factor could be indentified as contributing to this high rate of complications for colostomy construction. With respect to colostomy closure, predisposing factors that seemed to increase morbidity were shorter interval between creation and closure of the stoma and resection of colostomy (as opposed to closure without resection). Intra-abdominal drains were associated with a prohibitively high rate of wound infection, although subcutaneous drainage was not successful in reducing the incidence of infection significantly.

Adolescent↗
PubMed1978

Colonic hemorrhage.

We have briefly presented our concepts of the investigation and management of lower intestinal bleeding. Such bleeding was divided into massive and nonmassive colonic hemorrhage, and the differences in the investigative techniques were discussed for each of these circumstances. An algorithm of our diagnostic and management protocol for massive large bowel hemorrhage may be followed in a somewhat varied fashion in the investigation of those patients having nonmassive large bowel bleeding.

Barium Sulfate↗
PubMed1977

Ileostomy complications requiring revision: Lahey clinic experience, 1964-1973.

From 1964 to 1973, 50 patients who initially underwent ileostomy for inflammatory bowel disease at the Lahey Clinic required 84 revisions. The commonest reason for revision was stenosis. Fistula, prolapse, and retraction followed in order of frequency. Patients with Crohn's disease seemed to have a higher incidence of revision, but this was not statistically significant. Other reasons for revision were analyzed, and recommendations for treatment were discussed. Retrospective study revealed that 50% of ileostomy revisions were performed for probably preventable complications.

Adolescent↗
PubMed1976

Anastomotic recurrence after anterior resection for carcinoma: Lahey Clinic experience.

A retrospective study of 152 patients who underwent anterior resection for carcinoma of the rectum and rectosigmoid from 1963 to 1969 is presented. Eighteen anastomotic recurrences (two benign) were observed. Factors associated with high recurrence rates are discussed, and a scheme for identification of those patients in high-risk groups is presented. The value of this study lies in facilitating decisions involving operative and postoperative management of distal colonic lesions.

Adult↗
PubMed1976

Anterior resection for adenocarcinoma. Lahey Clinic experience from 1963 through 1969.

The results of anterior resection for adenocarcinoma of the rectum and rectosigmoid are reported with respect to survival rates and complications. Anastomotic recurrence is related to low lying, ulcerated, and less well differentiated tumors that have penetrated the bowel wall. The incidence of recurrent disease at the anastomosis increases with decreases in the margin of resection. Distal margins of at least 6 cm offer significant protection from recurrence. This study shows that anastomotic septic and fistulous complications are related to advanced age, diabetes, anemia, atherosclerotic disease, construction of the anastomosis below the peritoneal reflection, perforated bowel, obstructed bowel, and the use of drains. The determination of those factors that correlate with the development of anastomotic complications can be accomplished with pre- and intraoperative examinations. The role of these factors in operative decision-making and patient management is emphasized.

Adenocarcinoma↗
PubMed1976

Colonic polypoid disease: need for total colonoscopy.

Colonoscopic examination of the entire colon was performed on 146 patients for radiographically suspected benign polypoid disease. Of thirty-six patients who did not have a neoplastic lesion at the suspected site, seven (19 per cent) had unsuspected small benign polypoid adenomas elsewhere in the colon. Of the remaining 110 patients who had a neoplastic lesion at the radiographically suspected site, 17 lesions (15 per cent) were either adenocarcinomas or neoplastic polyps with invasive carcinoma. One hundred twenty-eight additional unsuspected neoplastic polyps were found in 62 of the 110 patients (56 per cent). Six of the additional neoplastic lesions were either adenocarcinomas or polyps with invasive carcinoma. Four of these malignant lesions were in patients who had a benign polyp at the radiographically suspected site. Suspected colonic polypoid disease should be evaluated colonoscopically despite radiographic evidence of benignity. Colonoscopic evaluation in colonic polypoid disease should include examination of the entire colon with pathologic documentation of all polypoid lesions encountered.

Colonic Neoplasms↗
PubMed1975

Symposium: Procidentia of the rectum: teflon sling repair of rectal prolapse, Lahey Clinic experience.

The Teflon-sling method of repair of rectal prolapse in the Lahey Clinic experience has proved to be one of no mortality and low morbidity, with a recurrence rate of 7.3 per cent over an average follow-up period of nearly four years. Bowel management and incontinence are problems inherent in the pathogenesis of the problem and, though improved, necessitate long-term patient re-education and physiotherapy. More than 85 per cent of the patients were satisfied with the results of the procedure.

Adult↗
PubMed1975

Recent thoughts on the development of colorectal cancer.

Considerable evidence demonstrates that a relationship may exist between adenomatous polyps and carcinoma. While the evidence may be circumstantial, it is not unimpressive. A recently completed 18 year follow-up of patients with benign polyps initially fulgurated demonstrates a statistically significant higher incidence of the development in colorectal carcinoma in these patients than in the unaffected population.

Blood Vessels↗
PubMed1975

Cathartics.

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Cathartics↗