Tracking pharmacist interventions with a hand-held computer.
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Documentation↗
Biomedical subjects
J C Reilly
Publications and source records attributed to J C Reilly.
Safety and efficacy of dynamic graciloplasty for fecal incontinence: report of a prospective, multicenter trial. Dynamic Graciloplasty Therapy Study Group.
PURPOSE: Dynamic graciloplasty has been used for intractable fecal incontinence, and good results have been reported. The aim of this study was to assess prospectively the safety and efficacy of dynamic graciloplasty for intractable fecal incontinence in a prospective, multicenter trial. METHODS: A total of 123 adults were treated with dynamic graciloplasty at 20 institutions. Continence was assessed preoperatively and postoperatively by use of 14-day diaries. RESULTS: There was one treatment-related death. One hundred eighty-nine adverse events occurred in 91 patients (74 percent). Forty-nine patients (40 percent) required one or more operations to treat complications. One hundred seventy (90 percent) events were resolved. Sixty-three percent of patients without pre-existing stomas recorded a 50 percent or greater decrease in incontinent events 12 months after dynamic graciloplasty, and an additional 11 percent experienced lesser degrees of improvement. Twenty-six percent were not improved, worsened, or exited. In patients with pre-existing stomas, 33 percent achieved successful outcomes at 12 months. This number increased to 60 percent at 18 months. Seventy-eight percent of patients had increased enema retention time, and mean anal canal pressures improved significantly at 12 months. Significant changes in quality of life were also observed. CONCLUSIONS: Objective improvement can be demonstrated in the majority of patients with end-stage fecal incontinence treated with dynamic graciloplasty. Reduction in incontinence episodes can be correlated with improved quality of life. Adverse events are frequently encountered, but most resolve with treatment.
Adolescent↗
Bullous pemphigoid at colostomy site: report of a case.
PURPOSE: Pemphigoid is a well-recognized cutaneous lesion, occurring rarely in peristomal skin. We report the diagnosis and successful treatment of localized pemphigoid lesions adjacent to a colostomy. METHODS: We review the chart, immunofluorescence study, treatment, and follow-up of a patient with bullous lesions at a colostomy site. RESULT: Pemphigoid of the pericolostomy skin was diagnosed by immunofluorescence study and successfully treated with antibiotic. CONCLUSION: Diagnosis of bullous pemphigoid should be considered in the differential diagnosis of a bullous lesion adjacent to a colostomy site. Diagnosis is easily made, and treatment is simple and efficacious.
Aged↗
Life-threatening hemorrhage and exsanguination from Crohn's disease. Report of four cases.
PURPOSE AND METHODS: From 1979 through 1991, four patients of 631 admissions (0.6 percent) for Crohn's disease in Erie, Pennsylvania, presented with life-threatening gastrointestinal hemorrhage. These and 34 similar cases from the medical literature were reviewed to provide a composite of those at risk and elucidate appropriate diagnostic and therapeutic maneuvers. RESULTS: The study revealed a preponderance of young men (2:1 ratio) with an average age of 35 (range, 14-89) years, the majority of whom had known Crohn's disease (60 percent) for an average of 4.6 (range, 0-18) years. The site of bleeding resembled the general distribution for Crohn's disease, with small bowel disease predominating (66 percent involved the ileum). The five cases of exsanguination (13 percent of the total) were all men with known Crohn's disease (average, 5.8 years) involving the ileum alone or in part. Mesenteric arteriography was positive in 17 patients, providing precise preoperative localization resulting in no mortality in this group. Excluding those who presented with exsanguination, surgery was necessary to cease hemorrhage in 91 percent (30/33) of patients. Ileocolectomy was the most frequently performed procedure (53 percent). In follow-up, only one patient required further surgical resection for recurrent bleeding (3.5 percent), and two other patients (7 percent) required further therapy for nonhemorrhagic recurrence. CONCLUSION: Crohn's disease may be responsible for life-threatening gastrointestinal hemorrhage and even exsanguination. Many of the characteristics of these patients resemble the general Crohn's disease population. Surgical resection provides excellent palliation. A long-term benign course can be expected in this subgroup of Crohn's disease patients.
Adolescent↗
Polyomavirus in the urine: follow-up study.
This study was undertaken to determine the significance of polyomavirus nuclear inclusions in urine cytology specimens. Thirty-two such cases were identified and patient follow-up was instituted. We have determined that there is no detectable urologic damage in such patients. In a minority of cases inclusions were found in subsequent urines but they ultimately disappeared within 3 mo. In a minority of the patients (35 percent) there was evidence of diseases associated with immunosuppression or administration of immunosuppressive drugs.
Adult↗
Challenging the predictive accuracy of Goodsall's rule for anal fistulas.
To examine the predictive accuracy of Goodsall's rule, the records of 216 patients (155 men and 61 women) who underwent surgery for complete submuscular anal fistulas from 1982 to 1989 were retrospectively reviewed. In accordance with Goodsall's rule, 90 percent of 124 patients with an external opening posterior to the transverse anal line had anal fistulas tracking to the midline (87 percent men and 97 percent women). Only 49 percent of the 92 patients with an external opening anterior to the transverse anal line had anal fistulas that tracked in the radial fashion predicted by Goodsall (57 percent men and 31 percent women). Instead, 71 percent of these patients (62 percent men and 90 percent women) had anterior fistulas tracking to the midline. Overall, 81 percent (77 percent men and 93 percent women) of patients had complete submuscular anal fistulas that coursed to the midline (51 percent midline posterior and 30 percent midline anterior). In summary, Goodsall's rule is accurate only when applied to complete submuscular anal fistulas with posterior external anal openings. The rule is inaccurate in describing the course of complete submuscular anal fistulas with an anterior external opening. The men in this group had anal fistulas that defied Goodsall's rule in an unpredictable manner, whereas 90 percent of the women had fistulas tracking to a midline anterior origin.
Adolescent↗
Colonoscopy: its role in cancer of the colon and rectum.
In order to determine the feasibility, yield, and impact of routine total colonoscopy on the management of large-bowel cancer, 157 cancer patients underwent 175 colonoscopic procedures; 13.6 per cent of the cancers had been missed on double-contrast barium enema examination. Among 92 patients undergoing perioperative colonoscopy, the lesion was reached in 90 per cent and the cecum in 60 per cent; 7.6 per cent demonstrated synchronous cancers, all curable, and all missed on barium-enema examination. Seventy-eight patients underwent colonoscopy at an average of 3.7 years after treatment of the index cancer; 7.7 per cent demonstrated metachronous cancers, all curable, two-thirds of which were missed on barium-enema examination. Benign polyps were noted in 62 per cent of the patients studied; 77 per cent of those polyps, 1 cm or greater in size, were missed on barium-enema examination. Polyps were found proximal to the cancer in 60 per cent of the patients with polyps. Approximately 85 per cent of those with multiple cancers demonstrated benign polyps. Preoperative total colonoscopy with periodic postoperative colonoscopy at an interval of three to five years are essential in the reliable detection of synchronous cancers and for the detection of metachronous cancers at an earlier, more favorable stage.
Cecal Neoplasms↗
Crystalline bodies in cervical smears. Clinicocytologic correlation.
We examined 6,132 cervical smears, applying strict criteria separating hematoidin cockleburrs from crystalline bodies. We found only crystalline bodies in 37 cases. There was a significant increase in the incidence of crystalline bodies in women taking oral contraceptives and in pregnant women. The bodies were not associated with an increase in complications of pregnancy or of abnormal births. A review of the literature led us to the conclusion that in cervical smears two types of crystalline structures may be found. One of these is the hematoidin body, which is related to hemorrhage during pregnancy and is probably associated with an increase in complications of pregnancy or abnormal births; the other, crystalline bodies, is not. We also conclude that crystalline bodies are much more common than hematoidin bodies. We found an unexpectedly high association of crystalline bodies with low grade squamous intraepithelial lesion (CIN1) in cervical smears.
Adult↗