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Biomedical subjects

J J Mamel

Publications and source records attributed to J J Mamel.

At least 19 recordsLinked to original sources
PubMed2000

Esophageal cast: a manifestation of graft-versus-host disease.

Diffuse involvement of the gastrointestinal tract by graft-versus-host disease (GVHD) is a common complication of bone marrow transplantation. The esophageal involvement in this disease tends to be a vesiculobullous, ulcerative or desquamative process. To our knowledge, esophageal cast has not been described in the context of GVHD. However, it has been described as a result of trauma to the esophagus or in association with bullous disease of the skin. We present a case of esophageal cast in a patient with chronic GVHD following bone marrow transplant.

Biopsy↗
PubMed1999

Incidence of pancreatitis in patients undergoing sphincter of Oddi manometry (SOM).

OBJECTIVE: Sphincter of Oddi manometry (SOM) is a useful diagnostic procedure when evaluating patients with unexplained biliary pain or idiopathic recurrent pancreatitis. Acute pancreatitis is a recognized complication of SOM whose pathogenesis appears to be multifactoral. We conducted this study to determine the incidence of pancreatitis in patients after SOM and to identify any variables that may lead to an increased incidence of pancreatitis. METHODS: A retrospective review of 100 consecutive patients who underwent SOM between 1992 and 1996 at two university-affiliated hospitals was done. SOM was performed using a triple lumen catheter with each lumen perfused at a rate of 0.25 cc/min using an Arndorfer pneumohydraulic capillary perfusion system. The following data were recorded: age, gender, clinical type of sphincter of Oddi dysfunction, length of procedure, doses of medications used, duct cannulated, sphincter of Oddi pressure, whether endoscopic retrograde cholangiopancreatography (ERCP) with or without sphincterotomy was performed, and the number of patients developing pancreatitis. Statistical analysis was performed using a T test, chi2, and multiple regression analysis. RESULTS: The overall incidence of pancreatitis was 17%. Six patients with type II SO dysfunction and 11 patients with type III SO dysfunction developed pancreatitis. The incidence of pancreatitis was significantly lower in those patients who only had SOM, compared with those patients who had SOM and ERCP (9.3% vs 26.1%, p < 0.026). There was no significant correlation between age, gender, duration of procedure, dose of midazolam used, sphincter of Oddi pressure, or type of SO dysfunction with the development of SOM-induced pancreatitis. Multiple regression analysis showed that sphincterotomy added no additional risk, beyond that associated with ERCP, for the development of pancreatitis. CONCLUSIONS: The results of this study indicate that the incidence of pancreatitis was highest when SOM was followed by ERCP. A potential method of decreasing the incidence of pancreatitis after SOM is performing ERCP with or without sphincterotomy at another session, separated from the SOM by at least 24 h. Before this can be definitely recommended, the results of this study must be validated by others or by a prospective study.

Acute Disease↗
PubMed1997

Delayed tension pneumothorax after laparoscopy.

Laparoscopy is a safe and useful procedure in evaluating intraabdominal disease. Serious complications have been reported but are rare. Laparoscopy related pneumothorax is one such complication that may occur during the procedure or in the immediate period thereafter. This complication is typically neither hemodynamically significant nor tension in nature. We report the unique case of a 52-year-old woman who not only developed acute respiratory compromise from a tension pneumothorax but did so 3 h after the completion of a seemingly uneventful laparoscopic procedure. Prompt recognition of this potential complication may permit immediate and effective treatment of this life-threatening complication.

Female↗
PubMed1993

Clinical pharmacology of commonly used drugs in GI practice. Part II.

In Part I of this series of articles on clinical pharmacology of commonly used drugs in GI practice, drugs used in the GI laboratory, as adjuncts to endoscopic premedication, and as antibiotic prophylaxis for infective endocarditis and complications of endoscopy were presented. In Part II, drugs used in the management of peptic ulcer disease (antacids, H-2 receptor and proton pump antagonists), pancreatic enzymes, prokinetic agents, and drugs used with inflammatory bowel disease are described.

Humans↗
PubMed1992

Clinical pharmacology of commonly used drugs in GI practice. Part I.

Understanding the mechanism of action of pharmacologic agents allows the practitioner to rationally use them. This two-part review of clinical pharmacology attempts to address the chemical nature and action of drugs commonly used in gastrointestinal practice. Part I reviews agents used in the endoscopy laboratory for premedication and prophylaxis for infection. Part II will review the pharmacology of agents used in the daily practice of gastroenterology including antacids, H2 and proton pump blockers, cytoprotection agents, pancreatic enzymes, drugs for dissolution of gallstones, prokinetic agents, antiinflammatory agents for inflammatory bowel disease, and drugs for symptomatic treatment of functional bowel complaints.

Analgesics↗
PubMed1991

Use of endoscopy in peptic ulcer disease.

The diagnosis and treatment of acute bleeding caused by peptic ulcer disease has been greatly facilitated by fiberoptic endoscopy. The basic differentiation between malignant and benign gastric ulcer requires endoscopic confirmation with biopsy. The management of bleeding from peptic ulceration can be enhanced by endoscopic examination as can the prediction of risk for recurrent bleeding or need for surgical intervention. Various therapeutic maneuvers can be performed endoscopically, including monopolar and multipolar cautery, laser and heater probe therapy, and injection of vasoconstrictors to control bleeding. Endoscopic balloon dilation for the management of gastric outlet obstruction is often effective.

Acute Disease↗
PubMed1989

Percutaneous endoscopic gastrostomy.

The development of an endoscopic procedure for the placement of a gastrostomy feeding tube has revived interest in the use of this technique for nutritional support. The medical literature has reported a considerable amount of experience which attests to its ease of placement and low incidence of complications associated with placement. The "push" and "pull" techniques both have been used effectively to establish access to the stomach. Innovations by numerous practitioners have helped reduce some of the minor complications associated with percutaneous endoscopic gastrostomy (PEG) placement. Serious complications from pulmonary aspiration and stomal infection remain important management issues after gastrostomy placement and initiation of feeding. The adequacy of nutritional support should be the final measure of successful PEG placement.

Adolescent↗
PubMed1988

Cross-sectional study of nutrition knowledge and attitudes of medical students at three points in their medical training at 11 southeastern medical schools.

Eleven southeastern medical schools cooperated to evaluate nutrition knowledge and attitudes of medical students. This study complements previous reports of an examination of entering freshmen and seniors. Average knowledge scores for 165 students tested after basic sciences (preclinical) training in this study were 67 +/- 7% compared with 53 +/- 6% for freshmen and 69 +/- 8% for seniors. The upperclassmen's scores were higher than the freshmen's (p less than 0.001) and varied with the amount of required nutrition teaching. Only 13% of preclinical students perceived nutrition as important to their careers compared with 74% of entering and 59% of graduating students, suggesting that preclinical teaching reduces their sense of relevance of nutrition to medicine. These findings suggest that nutrition knowledge can be increased through preclinical coursework and that the knowledge level can be maintained through the clinical years. However, the positive attitude of freshmen toward nutrition is lost after preclinical training and is only partially regained after the clinical years.

Attitude of Health Personnel↗
PubMed1982

Antiinflammatory agents protect opossum esophagus during radiotherapy.

Eighteen opossums received 2250 rad 60Co to the entire esophagus and lower esophageal sphincter. Animals received treatment with 600 mg aspirin, 25 mg/kg hydrocortisone, or saline before irradiation and twice daily for 1 week after irradiation. At 10 days postirradiation, animals were evaluated for signs of acute esophagitis by esophagoscopy and barium esophagram. Each animal was then killed and the esophagus removed and evaluated histologically. Animals treated with either aspirin or hydrocortisone had significantly milder esophagitis than control irradiated animals.

Animals↗